HomeMy WebLinkAboutBLD2007-00286 JILDING PERMIT APPLICATIN MRLA07N002296
Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00286 Received Date: 6/5/2007
SITE ADDRESS: 311 VICTORIA LOOP
PORT TOWNSEND, 98368
OWNER: KATHRYNE KENT PHONE: 360-643-3008
311 VICTORIA LOOP
PORT TOWNSEND WA 983689471
CAPE GEORGE COLONY DIV 1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 937800119 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: STEVE COOPER CONSTRUCTION INC PHONE: (360) 385-2066
120 S RHODODENDRON DR
PORT TOWNSEND WA 98368
Contractor's License STEVECC120P1 Expires 9/29/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW SFR W/ATTACHED GAR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,636
VALUATION 280,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: 324 SETBACK:
DECK: 84 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: CAPE GEO
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 3
Total: 2 Total: 3
Routing Date: C /5/O 1
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,001.75 CJZ 06/05/07 91157 APPROVED
Plan Check $1,301.14 CJZ 06/05/07 91157
State Building Code $4.50 CJZ 06/05/07 91157 DEC 3 2007
Potable Water Application $58.00 CJZ 06/05/07 91157
Jefferson County Planning
Total: $3,365.39 R� Building Department
LOG ITEM
110
Jefferson County Building Dives on Permit Numb BLD07-00286
Applicant: KENT
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that 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 Gf,13-O (�
Erosion Control
Foundation Footing
, �
Foundation Stem Wall e_4,...t2E,
Underground Plumbing jd --3-0 ^4
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing
it/13/0t SAA-toz.e /HFraaD
Rough-in Plumbing - _v�
Framing
Airseal
Insulation: Walls
Insulation: Floors
Insulation: Ceiling �,r l .Fj 'R
Int. Shear Wall Nailing 1,� ,'"r l �v
Wallboard Nailing
Gas Line: Interior ,L a
Gas Line: Exterior 6
Propane Tank 3-02t 0`(
Heat/Chimney Clearance 3_014(.Oct pio
Drywell/Alt Drainage
Address Posted
LOG ITEM
FINAL INSPECTION 3,,2/ �/ C
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD07-00286
1.) PRIOR TO OCCUPANCY& BUILDING FINAL INSPECTION FINAL APPROVAL OF
SEPTIC SEP06-166 IS REQUIRED.
2.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS.
3.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY
PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE.
4.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC
TANK, RESERVE & DRAINFIELD.
5.) The application was reviewed by the Jefferson County Department of Community
Development staff on July 6, 2007 for the potential presence of Environmentally Sensitive
Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an
initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
natural/suburban shoreline designation; seismic; landslide hazard area 1 & 3; SUSC
aquifer recharge area; coastal SIPZ.
6.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
7.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
8.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
9.) Marine shorelines and islands are susceptible to a condition that is known as seawater
intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in
an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater
suitable for public consumption without significant additional treatment and cost.
Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of
the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater
withdrawals (primarily through wells). The Washington Department of Ecology is the
agency with statutory authority to regulate groundwater withdrawal for individual wells in
Jefferson County. New development, redevelopment, and land use activities on islands
and in close proximity to marine shorelines in particular should be developed in such a
manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to
the maximum extent possible by infiltrating stormwater runoff so that it recharges the
aquifer.
10.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according
to the County GIS map. There are voluntary and mandatory measures identified in the
Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23,
2002) that apply to well drilling proposals and building permit applications on existing lots
of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine
shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources
within 1000 feet.
11.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
12.) A Geotechnical Report dated March 31, 2006 with addendums dated August 4, 2006 and
October 29, 2007, prepared by Stratum Group were submitted in conjunction with this
application. The report addressed the stability of the geologic hazard area. A setback of
65-feet shall be measured perpendicularly from the top or toe of the geologic hazard to the - %---
proposed single family residence. # 13
P, of �(
13.) PRIOR TO FINAL BUILDING OC•ANCY, PROPONENT SHALL SUBMIT A•ITTEN
06:\ LETTER FROM THE GEOLOGIST (STRATUM GROUP) WHO PREPARED THE
jGEOTECHNICAL REPORT DATED MARCH 31, 2006 STATING THAT THE
�( ( STRUCTURE AND/OR FACILITIES HAVE BEEN CONSTRUCTED IN CONFORMANCE 5 1
'`<�\ WITH THE REQUIREMENTS OF THE "GEOTECHNICAL REPORT." THE LETTER a'
SHALL BE STAMPED BY THE LICENSED GEOLOGIST/ENGINEER AND ORIGINAL v n
SUBMITTED TO THE DEPARTMENT.
14.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
15.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
16.) All construction activities shall not encroach upon the landslide hazard area buffer. This
includes the storage or preparation of materials.
17.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
18.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
19.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
20.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
21.) The applicant is proposing to create or add 1960 square feet of impervious surface and
2910 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your
proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution
Prevention) of the Department of Ecology Stormwater Management Manual for Western
Washington 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.
22.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through #12 of the Department of Ecology's Stormwater Management
Manual for Western Washington 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.
23.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i).
24.) The revised site plan dated November 30, 2007 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 November 30, 2007 shall be resubmitted for review and approval by
Jefferson County Department of Community Development.
25.) This approval is for a single family residence with attached garage only. Any future
permits on this site are subject to review for consistency with applicable codes and
ordinances and does not preclude review and conditions which may be placed on future
permits.
26.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
27.) A Restrictive Covenant was recorded on August 4, 2006 under AFN 514071 due to the
1997 slide event that occured on the parcel leaving the septic tank hanging over the bank. LU ITE
Due to this parcel being on a feeder bluff, wave action is expected to continue to erode the t
bank and future failers are likely to occur. The county is hereby held harmless.
28.) Outdoor residential storage shall baintained in an orderly manner and shall Ote no
fire, safety, health or sanitary hazard.
29.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened
from view of neighboring dwellings and rights-of-way. Such screening shall meet all
applicable performance and development standards specific to the district in which the
storage is kept, and shall be in keeping with the character of the area. Screening shall
meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an autormobile wrecking
yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
30.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
31.) Minimum setback from Victoria Loop Road right-of-way shall be 20 feet. Minimum side
yard setbacks shall be 5 feet. Minimum setback parallel to the top of bank shall be 65 feet
per the geotechnical report.
32.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
33.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
34.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
35.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
36.) The building height is not to exceed 35 feet.
37.) An address of 311 Victoria Loop Road, Port Townsend has been assigned to the parcel.
Victoria Loop Road is private (P172).
38.) The lot was created through the Cape George Division 1 Subdivision on July 18, 1961
under AFN 168940.
39.) The lot is served by the Cape George Colony water system (ID#11050)
40.) A septic permit (SEP76-0016)was finaled on December 12, 1976 and is now filed with
SEP06-0166 that was approved on August 4, 2006. A building permit(BLD06-0558) to
demolish an exsting house and leaving cement foundation was finaled on October 15,
2007. A complaint(COM06-0017) for allegedly living in bassement of condemned home
was finaled on August 15, 2006.
41.) THE OLD SEPTIC TANK THAT IS PARTIALLY EXPOSED ON THE TOP OF THE BLUFF
SHOULD BE LEFT IN PLACE. THE TANK IS LOCATED WITHIN A VERY HAZARDOUS
LOCATION. THE USE OF EQUIPMENT AND ACTIVITIES ASSOCIATED WITH
ATTEMPTING TO REMOVE A LARGE HEAVY STRUCTURE AT THIS SITE WOULD BE
VERY DANGEROUS TO ANY WORKERS. THE TANK IS NOT CAUSING ANY
PROBLEMS WITH SLOPE STABILITY AND WILL NOT CAUSE ANY FURTHER
PROBLEMS WHEN IT ULTIMATELY FALLS FROM THE TOP OF THE BLUFF.
42.) NATIVE VEGETATION, PARTICULARLY TREES AND LOW NATIVE BRUSH ON THE
SLOPE SHOULD BE DISTURBED AS LITTLE AS POSSIBLE. NO TRAILS OR
GRADING SHOULD BE PERFORMED ON THE BLUFF FACE.
43.) WASTE AND OTHER DELETERIOUS MATERIAL SHOULD NOT BE PLACED ON OR
OVER THE SLOPE. SUCH MATERIAL SMOTHERS VEGETATION, RETAINS WATER
AND ACTS TO DESTABILIZE THE SLOPE.
44.) STORMWATER FROM ROOF RUNOFF AND DRIVEWAY RUNOFF SHOULD BE N'"z.
DISPERSED AS MUCH AS POSSIBLE THROUGH ALLOWING SHEET RUNOFF AND ITEM'
LATERAL DISPERSION SPREADERS SUCH THAT STORMWATER IS NOT 13
CONCENTRATED ANYWHERE ON THE PROPERTY AND ONTO THE BLUFF FACE. 3---
45.) STRATUM GROUP (GEOTECH) •OMMENDATIONS REGARDING OCCU•JCY
• OF THE HOME:
A) IF RAINFALL EXCEEDS 6 INCHES OVER A PERIOD OF 30 DAYS, THE HOME
SHOULD NOT BE OCCUPIED.
B) IF SNOW ACCUMULATIONS OF 6 INCHES OR GREATER TAKE PLACE THE
HOME SHOULD NO LONGER BE OCCUPIED.
C) INSPECTIONS OF THE BLUFF SLOPE BY ANOTHER LICENSED GEOLOGIST
FAMILIAR WITH THE SITE OR STRATUM GROUP SHOULD TAKE PLACE AT A
MINIMUM OF ONCE PER MONTH STARTING IN NOVEMBER. IF DURING
INSPECTION OF THE BLUFF, THERE IS ANY INDICATION OF RENEWED
ROTATIONAL MOVEMENT ON THE LOWER PORTION OF THE BLUFF, THE HOME
SHOULD NO LONGER BE OCCUPIED.
D) IF ANY FAILURES TAKE PLACE ON THE BENCH AREA LOCATED
APPROXIMATELY 15 FEET BELOW THE HOME SITE OR IF ANY FAILURES TAKE
PLACE ON THE STEEP UPPER SLOPE IMMEDIATELY BELOW THE UPLAND OF THE
PROPERTY, THE HOME SHOULD BE VACATED UNTIL A GEOLOGIST INSPECTS
THE SLOPE.
46 ) BURIAL OR REMOVAL OR THE EXISTING OLD FOUNDTION ON THE NORTH
PORTION OF THE LOT WILL NOT CAUSE ANY SLOPE PROBLEMS FOR THE SLOPE.
LEAVING THE EXISTING FORMER BASEMENT FOUNDATION AND CONCRETE
GARAGE SLAB WILL BE ACCEPTABLE AND WILL NOT CAUSE SLOPE PROBLEMS.
47.) STORMWATER RUNOFF FROM THE DRIVEWAY WILL BE ALLOWED TO SHEET
FLOW OFF THE DRIVEWAY AND THAT FOOTING DRAINS AND DOWNSPOUTS
WILL DIRECT WATER INTO A DISPERSION/INFILTRATION TRENCH LOCATED ON
THE SOUTHERN PORTION OF THE SOUTHWEST SIDE OF THE PROPERTY. DUE
TO THE RELATIVELY COURSE GRAINED NATURE OF THE SOILS AT THE SITE,
DISPERSION AND INFILTRATION OF WATER AT THIS LOCATION WILL NOT CAUSE
NEGATIVE IMPACTS TO THE BLUFF SLOPE OR OTHER PROPERTIES.
LOG 'ITEM
,4 t 3
ii,efr4°11
�c JEFFERSONO)UNTY •
rz DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368 •
360/379-4450 • 360/379-4451 Fax
iqS, NG�Ci www.co.jefferson.wa.us/commdevelopment
JUN -al(
to
Permit Application MLA: - (to
Project Description(include separate sheets as necessa ): ---
new S t^^9 le_ -P kte ,c. (•( reS L c�
Tax Parcel q
7 Property 4
Number: r�
Size: d`� G'r� � (acres/square feet)
Site Address and/or Directions to Property:
3[ 1 ki i 0 L►>l c L0p�D Property Owner(s)of Record: 4t,f
Telephone: 3(4,0 G 4 , )O` v ax: — 0 email: �C�(.ike I,u: ' (
t�t�a t raim
Mailing Address: ?).) . IJ t.0 T L-11C [�t,rL4- Ttu:lti .; -CL33(,)R
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
What kind of Permit? (Check each box that applies
[1113uilding 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ C:onditional Use[C(a), C(d),or Cj**
FfSingle Family ❑ Garage Attached/Detached D Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
0 Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication * 0 Jefferson County Shoreline Master Program Amendment
0 Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request
*May require a Pre—Application Conference _ **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
6 v PC? ICY �->,, - '— aVa-hc
DESIGNATI OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Knt.....( \(ê,v LT- /cl`✓7
Date: ' t
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's 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 app�ic�tion th t he or she wants p for notice.
Signature: ✓✓�L f• Date: 5 1/S I t9
The action or actions Applicant 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-transfer b res nsibility for adhering to and complying with the EA'The Applicant has read this disclaimer and signs and dates it below.
Signature: ,C. -14,Z, , — S Date: )I sip
at 1
G:\PermitCenter\###FORMS###\ORD FORMS\Master Permit Application 12-19-2006.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 olthe General Contractor for the proposed project.
Signature: I,U.i/ 6p4 Date: 5//407
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
-f e v-e,v\ COO p - c)3 ASS 2Oc cc ( )
MAILING ADDRESS: C Q koct0 1 m..5„Dr. EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: U U \,.{ 40 U PHONE (3(co ) , FAX: ( )
MAILING ADDRESS: e..( I 10t.Li (0i-$ l - '3 i R EMAIL Ho y ,6 o g 0 6 iv.o.,,,coyvk
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
6-"-New n—Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: 2 Y2_ Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete • Total: Height: , ..Pr-Individual System
❑ Repair CI Masonry SEP Permit# o(a-bb I Col,
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: 2- r �Public
Total: (Q 5 Nar ,a of Systm:
('ape-C7CoIle-
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 1 Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove 1 Woodstove I Fireplace Insert I Hot Water Tank i Pellet Stove 1 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 UseOnly • Amount Revision
Main Floor Heated EH Bld App Review:
1 i3tic, -1o4.?4g,
2na Floor Heated Consistency Review: ( 5 3
Other Heated _ Base fee: �,04( . 15
Mezzanine Additional Section: _ ----
Heated Basement — Plan Check fee: t 30
t .1
Unheated Basement State Surcharge fee: 4k ,p
Other Unheated Pot Water Review fee: 1- 00
Garage/Carport a SUBTOTAL 7
324 rl,434. 4 3, ( .39
Decks 911/Rd Approach fee: E)(CiAN n ,
Other Covered ?arc./.-. $4'1 i 6nqCg -' TOTAL: $
Receipt Number_ 51
l r (t• l Cash/check Number /_ 2� �.A
ESTIMATED COSTIREQUIRED) pate: 69 1 Gaf 07 ,�
•Fair market v0ie of all labor and materials foun ation to finish A _ r r i- f
''',,,,_:!__.1 c7t�� V v v Initials: ��U iV � '�'v? '.6:,/ 03V7" -
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