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HomeMy WebLinkAboutBLD2013-00161 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT #: BLD13-00161 SITE ADDRESS: 94 COOK AVE Issue Date: 07/16/2013 PORT TOWNSEND, 98368 Final Date: 11/26/2013 APPLICANT: DANIEL PAU GOLDSTEIN PHONE: 360-379-9094 ELIZABETH R GOLDSTEIN 94 COOK AVENUE EXT PORT TOWNSEND WA 98368-9285 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001043011 Section: 4 Township: 30 N Range: 01 W PROJECT DESCRIPTION: SUNROOM AND DECK ADDITION THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 11/26/2013 \\tidemark\data\forms\F_BLDOccupancy.rpt 12/17/2013 BUILDING PERMIT APPLIC -ION B 01E1 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00161 Received Date: 5/23/2013 SITE ADDRESS: 94 COOK AVE PORT TOWNSEND, 98368 OWNER: DANIEL PAU GOLDSTEIN PHONE: 360-379-9094 ELIZABETH R GOLDSTEIN 94 COOK AVENUE EXT PORT TOWNSEND WA 98368-9285 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001043011 Section: 4 Township: 30 N Range: 01 W CONTRACTOR: SOLUTION BUILDING INC PHONE: 360-301-4191 PO BOX 761 PORT TOWNSEND WA 98368 Contractor's License SOLUTB191405 Expires 9/18/2013 REPRESENTATIVE: RICHARD BERG PHONE: 360-379-8090 TERRAPIN ARCHITECTURE PC (360) 379-8324 727 TAYLOR ST PROJECT DESCRIPTIOr SUNROOM AND DECK ADDITION TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 264 VALUATION 50,000.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: GARA CONST TYPE: DECKLE 176 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: " BEDROOMS: BATHROOMS: Exist: 3 Exist: 3 Prop: Prop: 0 Total: 3 Total: 3 Routing Date: 4703 Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $643.75 ZAL 05/23/13 142119 ` ,n Plan Check $418.44 ZAL 05/23/13 142119 AA�'�'ROVED State Building Code $4.50 ZAL 05/23/13 142119 JUL 1 6 Potable Water Application $66.00 ZAL 05/23/13 142119 2013 Total: $1,132.69 Jefferson County DCD \\+irlcmor4\rlo+o\forme\C RI Il A. PIA rn+ C,P71:117l11'2 BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00161 Received Date: 5/23/2013 SITE ADDRESS: 94 COOK AVE Issue Date 7/16/2013 PORT TOWNSEND, 98368 Expiration Date 7/16/2014 OWNER: DANIEL PAU GOLDSTEIN PHONE: 360-379-9094 ELIZABETH R GOLDSTEIN 94 COOK AVENUE EXT PORT TOWNSEND WA 98368-9285 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001043011 Section: 4 Township: 30 N Range: 01 W CONTRACTOR: SOLUTION BUILDING INC PHONE: 360-301-4191 PO BOX 761 PORT TOWNSEND WA 98368 Contractor's License SOLUTB191405 Expires 9/18/2013 PROJECT DESCRIPTION: SUNROOM AND DECK ADDITION TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 264 VALUATION 50,000.00 ADD'L: HEAT TYPE UH CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 176 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: 69000 Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $643.75 ZAL 05/23/13 142119 Exist: 3 Exist: 3 Plan Check $418.44 ZAL 05/23/13 142119 Prop: Prop: 0 State Building Code $4.50 ZAL 05/23/13 142119 Total: 3 Total: 3 Potable Water Application $66.00 ZAL 05/23/13 142119 Total: $1,132.69 Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE ATTATCHED Jt:fferson County Building ision Permit Nu er: BLD13-00161 Applicant: GOLDSTEIN BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks Erosion Control g/G/i:3 Foundation Footing ?/t !I3 Footing Drains 11/30`5 Foundation Stem Wall ,�,i`///3 Under Floor Framing s/36//3 Straps(hold downs) 8i6/r3 Ext. Shear Wall Nailing ,L /3 j7tfAs, / 1fA-v4 "Arc-✓/ Afias Rough-in Plumbing Framing toh4/ice Airseal ra—,B—f3 Insulation: Walls —(8-1 Insulation: Floors Insulation: Ceiling Wallboard Nailing Mechanical Systems FINAL INSPECTION - FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR CONDITIONS for Building Permit# :BLD13-00161 1.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 2.) The site plan as submitted with the Building Permit application on May 23, 2013 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated May 28, 2013 shall be resubmitted for review and approval by Jefferson County Department of Community Development. \\tidemark\riata\fnrmc\F RI n Permit Rhin rnt 7/1R/7f11 r . • • �4,,,i O,,,N JEFFERSON COUNTY 4, Al 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 4t 4. 621 Sheridan Street • Port Townsend •Washington 98368 1 C } 360/379-4450 • 360/379-4451 Fax _Zj� http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: --12f'CII\. t l2-z_. &D L PS-TEd Nt DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as'small,'"medium"or"large." The size determines whether a Stormwater Site Plan is required in conjunction :r;ii o .laid-aiuiic siurrnwater management permit application, building permit application, or other land use approval application that involves stormwater review. The hasic information will also be helpful for completing a Stormwater Site Plan,if required. PARCEL SIZE(I.E..SITEZI Size of parcel 2 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 4 o 7 i S 7 I sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative and non-veaetativel and/or the existing soil tonooraohy. Land disturbing activities include, but are not limited to clearing, grading, filling, -____ --`__ 2711 ____-- -==•=i-•te='.v th stabilization of structures and road construction. Pacific Northwest and which reasonably could have been exoected to naturally occur on the site. Examples include species such es r iniiniac fir western heeminrk western rAri reriar airier hip-leaf mania, and vino mania- shnthe siith as WilinW, etderbetty s4inum'llf:;•, an saiai:ne,uaceouj;wants such as swore tern.toam flower,ane fireweed. I LAND DISTURBING ACTIVITY.CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL 1 i �alcu a..e...e tots!area to be dear ed, g acted,filled, I Answer the following two questions refuted to G excavated. nrifor c nMod for p ed riovoiommnnt i rnnvers en of nati„e vegetatinn• i I project. Include in this calculation the area to be cleared for: ! I r , ;,,..c the nr,_,ir,l f i r,f i/F.ft 3:rlf res or mrire of Construction site for structures �'+CO sq/ft I native vegetation to lawn or landscaped areas? I fl Drainfield,septic tank,etc. sq/ft I Circle: Yes j i I Well,utilities,etc. sq/ft I Does the project convert 2%acres or more of 1 nr-t ve vegetation to pasture? I Driveway, parking,roads,etc. sq/ft I 1 N Circle: Yes o ! 1 Lawn, landscaping,etc. sq/tt I I Other compacted surtace,etc. Sq/tt I indicate 1 Otal VOItIFneS Of Proposed: I Total Land Disturbance �"� sq/tt I Cut t-Ill jcuiydj [over] • Ili Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 33(, sq/ftG�Structures(all roof area) 2 0 l C5. _sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios aq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking,roads,etc sq/ft Driveway, parking, roads,etc " (0 sq/ft Other .. sq/ft Other sq/ft r- Total New �IIN sq/ft Total Existing 1 55 sqlft TOTAL NEW+TOTAL EXISTING* 1?)d' sq/ft *This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v.REDEVELOPMENT Divide the total existinq impervious surface above by the size of the parcel and convert to a percentage: 4-GC% Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the atta• ed Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is conside :. new dove o• en.and the attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to •:termine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stonnwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE i y siuilifla the Siurthwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 5 Z3(13 (I•�AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) [ ] Impervious Surface coverage percentage: Resource Lands& Public: I Rural Residential: 25% Rural Indial: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage: 60%in Rural In ial Lands only [ ] Total Building (s) Size: RVC:20,000 SF CC: 5,000 SF NC: 7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None spfied [ Setbacks: Front: '7co Left Side: 4� Right Side: ' Rear: tJ Shoreline Setback: LSHA Setback: [ t Road Classification: Road Approach: Ex1SrI NOT REQD RAP SEPA Required: YES XEMPT [ Flood Certificate: [L4 Existing Case(s) & Condition(s): Violations: Yes No [ t Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [i/f Lots/Require Declaration of Restrictive Covenant YES9 submitted: YES NO [ UGA No Protest Agreement YES I Oibmitted: YES NO [ c Site Visit conducted YES [ /,]/ Require Final Zoning Approval ES [ ADMIN: Setbacks entered in Permit Plan case /AYES New Parcel Tags entered in Permit Plan YES Special Reports Scanned 1VYES No parcel tags found for parcel Cases Associated with APN 001043011 Cases Name Review Type Status Planner BLD13-00161 GOLDSTEIN P Application Received: 5/23/2013 Permit Issued/Case closed: Case Finaled: SUNROOM AND DECK AUDITION BLD92-00189 BOLLING F Application Received: 3/27/1992 Permit Issued/Case closed: 4/1/1992 Case Finaled: 6/22/1992 MOBILE HOME INSTALLATION BLD92-00615 BOLLING F Application Received: 9/17/1992 Permit Issued/Case closed: 9/24/1992 Case Finaled: 6/22/1992 single family residence BLD99-00324 GOLDSTEIN F Application Received: 6/4/1999 Permit Issued/Case closed: 6/4/1999 Case Finaled: 6/11/1999 propane tank , pipe and water heater installation SEP92-00094 BOLLING F Application Received: 3/24/1992 Permit Issued/Case closed: 3/24/1992 Case Finaled: 6/22/1992 SOM92-00094 GOLDSTEIN F Application Received: 6/22/1992 Permit Issued/Case closed: Case Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 5/28/2013 Page 2 of 2 - •Up Front Parcel Review. Parcel 001043011 Printed: May 28, 2013 DANIEL PAU GOLDSTEIN Site Address: ELIZABETH R GOLDSTEIN 94 COOK AVE 94 COOK AVENUE EXT PORT TOWNSEND, WA 983E PORT TOWNSEND WA, 98368 Parcel Number: 001043011 S-T-R: 4-30N-01W Total Acreage 2 Legal Description S4 T30 RI W NW NE NW SW(LESS TAX 54) ENLG BY Land Use: 1100 TAX 53 - BND TGTH THRU BLA#87719 Flood District: Fire District: 1 Planning Area: 2 Flood Map(FIRM) Panel No: School District 50 Zoning: Zo COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ LI Plot plan states "property line" [ Assessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ Legal Access to Property YES NO [frr Parcel Tags or Scanned Documents YES NO [ ESA's: Special Reports Nearby YES NO [ Designated Ag YES NO [ Shoreline Designation: YES 0 [ V Shoreline Slope Stability: YES 40 Stream Type:YES NO Fish & Wildlife:YEs NO Wetlands: YES NO Rare Plants:YES NO Seismic: YES NO Landslide: YES NO Flood: YES NO Erosion: YES NO Aquifer Recharge Are.4 0 <_� -- SIPZ: none At Ris High Risk Coastal CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: YesNo [(zy Forest Lands: YES 0 Adjoining Forest Lands: Commercial/ Rural/ Inholding [ I]- Mineral Lands: YES 0 [ v]- Agricultural Lands: � 0 [ frr Archaeology: YES [ ✓( Stormwater: New Impervious Surface Land Disturbing Activity 4 0 ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ V] Notice Provisions/Disclosure:Airport YES NO MRL YES NO Forest Lands YES NO [V Landscaping Required: Yes No Parking Spaces Requ' ed(0 2 Other I (.1" Building Height: . UBC Standard a SON ,�4��' COl,. JEFFER T COUNTY 2. 13 — /(o \, � DEPARTME OF COMMUNITY DEVELOPMENT 1 0 621 Sheridan Street • Port Townsend •Washington 98368 \t„..., Ptt;t. 360/379-4450 • 360/379-4451 Fax ,4rINOA• www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): yENI i.iN roc,N1 -A DD 1 iicNI b 1 - Tax Parcel Number: 0 0 1 r`/"3 C / ( Property Size: IC 7) -3 I / (acr square feefi Site Address and/or Directions to Property: `"1`!- CCc,e_ AUK NLIE [Yr: P i r grtuNstivos l,.i 74- "if%3 Property Owner(s)of Record: >A N $ L I y GcL_D S TE I N Telephone: (3 G. L ; 1`) - `1 C `)-4 Fax: email: .. Mailing Address: Applicant/Agent(if different from owner): T.Eef,4 P i N A KC I-1 1 TC1 I("pc Telephone: 3¢c) 3 )`I - C 9 r Fax: email: Mailing Address: 72 7 `1'AYLC+-F `>j'- Pi/' T T 6,'t`15L H Di t, A g 3(14F, What kind of Permit?(Check each box that applies Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C)** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat'"' ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: ( . (tat DESIGNATION OF AGENT I hereby designate U/l % t t act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ���"`�<< `\� L7 /� �- Date: 'i /Z S/i` By signing this application forrul,life owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that h or she wants pro•no J� )3T l Signature: �U-P 1 hp_ L i1 V� c -t Date: L: Q /) The action or actions-4plicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfefable,responsiib'ility for adheri• and g it SA. The Applicant has read this disclaim r and s' ns and dates it below. Signature: � � C •, � `�_ Date: J �c�- �/J G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc �' ' : BUILDER STATEMENT , The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 1U-h'a-,1 1-3v t d,‘"-ct c... ( ) 385 6/2/ ( ) 38c 6ILO MAILING ADDRESS: 'PO B ok -7 6 J P. 1. w it\9 83 4 g EMAIL: rob 501 V)-I �@ O a 1`/AA1-)uc-t1E5L CONTRACTOR'S LICENSE WAINS NUMBER: So L-U"r-131 1 \ Li( O S NUMBER ARCHITECT/ENGINEER: rv-� 1 _!, C Ar1 _ r� -f� PHONE ( ) 3-7 7- gQg0 FAX:( ) MAILING ADDRESS: '27 1- 'or s-i- TP.T. A9,836g EMAIL rIct rolEtcroy,�,—ar-cl-7. Co-v, Project Type: Frame Type: 1 Bathrooms: Shoreline: Type of Sewage Disposal: 1 New Wood Existing: 3 t'/,a i Sewer Iiir Addition ❑ Steel Proposed: .Y Bank :1 Community System ❑ Alteration/Remodel 0 Concrete Total: 'i Height: X Individual System ❑ Repair ❑ Masonry SEP Permit# 5E17'72 .Cc// Bedrooms: Supply: 0 Demolition ❑ Other: Water Su 1 Existing: "3 Setback: 1 Private well 0 Two Party Type of Heat: Proposed: " Ii Public Total: 3 Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i Woodstove i Fireplace Insert I Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated 152 H Bid App Review: (7p ear 2� 3 Floor Heated ` Consistency Review: fP i Other Heated Base fee: / ' z (o7J• 7S Mezzanine Additional Section: Heated Basement Plan Check fee: g'/iooff_r.r If Unheated Basement State Surcharge fee: if. 50 Other Unheated f Pot Water Review fee: O Garage/Carport SUBTOTAL /y7 69 911/Rd Approach fee: Decks i 77 S4.rr. q 9ro•qv .9244 Other , 9 S 3 TOTAL: $ ,y 6 o- Receipt Number: /L/a// 9 Cash/Check Number: 0/7D 3 3 ESTIMAT ST(REQUI ED) Date: J 3 l .Fair m et value of all labor and materials fou dation to finish 50 o00,`—`' Initials: • G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.doc � m 0 � - v r- -I b m m r r n —I 7o m cn -v N r � Z C� l„ -o �O p cn Z � > 6 COOK AVE ROx -f OO . xx6 O D ^; Z � 7o _ �' O O n DO rn0 D =1 m � -p Cr) O --I -- O &� in -I -1 Y. n n (.-I m AD - CocnX v n > � =1 -1n N m -v 0 C) w -0 Z ZO , z w . c.) 0 �0 4, 13 c� < rZCm < Or0ZZO m N 7Do p �� Om [� T'v, i•?iv v � OrO C -nI cn O 0 3 0 � m o m < m C) C) < n -I O 7C R. 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