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HomeMy WebLinkAboutBLD2004-00079 Stairs - BLD Permit / Conditions - 2/26/2004 Inspection Line (360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext.352 Mason County Bldg, 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 L RESIDENTIAL BUILDING PERMIT BLD2004-00079 OWNER: LAWRENCE SEYMOUR CONTRACTOR: LICENSE: EXP: RECEIVED: 1/26/2004 SITE ADDRESS. 171 E MOUNTAIN VIEW DR ALLYN ISSUED: 2/26/2004 PARCEL NUMBER: 122205100019 EXPIRES: 8/26/2004 LEGAL DESCRIPTION: LAKELAND VILLAGE 2 TR. 19 171 E MT VIEW DR PROJECT DESCRIPTION: DIRECTIONS TO SITE: STAIRS HWY 3 TO ALLYN, LEFT ONTO LAKELAND VILLAGE DR, LEFT ON MOUNTAIN VIEW DR, 6TH HOUSE ON LEFT. NAME ON PROPERTY. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: V-N Type of Use: SF Insp. Area: No. of Bathrooms: Occ. Group: R-3 Lot Size Deck: Type of Work: ALT Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building: Valuation: Building Height: 20 Occ. Status: Basement Stairs Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft Front: Ft. Shoreline. Ft. Water Body: SEPA?: Rear: Ft. Slope: Ft. Shoreline Desi Model: Width: Ft 9.: Side 1: Ft. Year: Serial No Side 2: Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Plan Check Fee KS 1/26/2004 $136.01 S12004 Building State Fee RLS 2/18/2004 $4.50 B12004 Building Permit Fee RLS 2/18/2004 $209.25 B12004 Total $349.76 BLD2004-00079 Please refer to the following pages for conditions of this permit 1 of 3 CASE NOTES FOR BLD2004-00079 CONDITIONS FOR B LD2004-00079 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. Th ar otential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-8 - 9 he person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) All app oved plans are quired to be on-site for inspection purposes. If an inspection is called for and plans are not available on site,then approval will not be granted. ion, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building De rt any further inspections being performed or approvals granted. X 3) accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located in such a position as to be plainly visible and legible from the street or road fronting the property. Mason County Building Department requires that this be completed prior to calling for any site inspectio;��-in ction fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or cont a t the address on site prior to requesting inspections. X 4) 1/1 uiding permits all have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to�req�u � al inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non oason County ordinances and building regulations. X 5) A changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Wprioron ction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached th a removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be ccollected by the Building Department prior to any further inspections being performed or approvals granted. X 6) A Xal r exceed all local ordinances and the 1997 Uniform Building Code requirements as adopted and amended by Mason County and th tateshington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupanc o Id r ult in permit revocation. X 7) changes to " ro building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County rdinance eg on, must be reviewed and approved by Mason County prior to construction. X BLD2004- 79 / Please refer to the following pages for conditions of this permit. 2 of 3 8) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the Unifo ( s amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspecto de prior to requesting additional inspections. X 9) 'pressuretrea oo nufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connector nd f ing. Install metal connectors approved for contact with the new types of pressure treated material. X This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress ins ction within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a pro ss inspection.Theo or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the abo cribed property an cture for review and inspection. is � ------- - 2G zoos, OWNER ORAGENT ---- — DATE: 2' BLD2004-00079 Please refer to the following pages for conditions of this permit. 3 of 3 1 1 S W a CONCRETE MECHANICAL MANUFACTURED HOME o ? Footings!Setbacks Date B y Ribbons 6 o Date By Gas Piping Date By 4 Foundation Walls Date B y Set-up Date By INSULATION Date By B G ! Slab Insulation Floors Final Date By Date By Date By FRAM NG IRIS FIRE DEPT Date D d By /�� cc� Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLIJOAIRD NAILING D.W.V. Date � i B y L Date By FINAL INSPECTION Water Line Date /2 i- B y Date By Date By 03 2 oq -a3 ZG o f-- z . - t Gc�t,W r.�z l 0 CD Rol -7 ELS 0 D. -a-/L - l2- -X3 -/L- 0 o Q � O a Q c o can 1 Q � Q � (n Q �y l 1 J O M J -v v Terry A. Nettles, P.E. h I Consulting Engineer structural & residential engineering 4 February 2002 Mr. Michael J. Byrne, Director Mason County Building Department P.O. Box 186 Shelton, WA 98584 RE: Residence of Lawrence Seymour, 171 St. Mountain View Dr. E Subject: Engineer's review of modified floor trusses On 29 January 2002, Mr. Seymour retained my services as a licensed structural engineer to examine the modifications that had been performed on three manufactured open-web trusses of his existing home. The trusses were fabricated using graded lumber top and bottom chords and webs and connected at all intersections using conventional gang-nail plates. Upon examining the three trusses and the modifications that had been performed by the Owner, I performed calculations for the design load conditions ;and determined that two of the three modified members would require additional reinforcements to make them fully capable of the loads to which they might be subjected in accordance with the provisions of the Uniform Building Code. The modifications required are detailed in the accompanying text and schematic drawings as Details 1 and 2. Once this work has been completed, it is my professional opinion that all of the modifications to the floor system as created by the Owner's attempts to create an interior stair access to the living space of the basement will be adequate to meet the full meaning and intent of all structural provisions required by the 1997 Edition of the Uniform Building Code and I recommend approval by your Department in response to building permits obtained by the Owner. A N , o Terry A. Iles, P.E. o� 1 3 E44 �(NAL Enclosure: three (3) pages calculations and details 7777 92nd Street NW Gig Harbor,WA 98332 VOICE (253)858-7777 FAX(253)858-7777 iI vOV I Terry A. Nettles, P.E. Project iC7MoU(L t`'C-2IDINGE Sheet i of Consulting_E Engineer_ngine_ --------- t4IIJu- '� fZ1=VtEU/ Job No. 22ai Co 7777 92nd Street NW Gig Harbor,WA 96332 VOICE&FAX(253)858-7777 Subject FIXO-, 1'i2Ux /VL0 I F Date 2 r r COt,I S71 TI Oht 7Q CUT 4, To A,, , ,v A, N FW To ?Fes, TKUxaF.-2 ��C-aii �Ly TZ� Sri r-ULI, Le�4G-1-H �( T =C�oNT W1"`<u, Tv tZG5'� WAU, 0 f HoUSC - 24' �I� - I �UP�bEM�IT l�t/� MoPi Fi ED TKU�� �� Wpat,, p�Et,o UJ i I _ 2 �Eaw I , A-VD WAu- P�ELot�1 No ck 16 E fAF,71At- f?L-,N-4 @ �Fc142 r I ►NG5 o f I Ns�Ec-�1 o-N TKU� �� RC6�U l Rom, �UP�t,EJ�1Ct�Pkt� '�EtN�2GCNt�T Inff T�+C- lti/C-txS;' TO Gt f fl K h'r TH-E C- o 1'A't.ICL Ta C A<KRy r(J L)- �4EIAJ 'rOp C+OR P ��,A � G l.Oc�T 10 �e2 L-E�4G)7 1 0 F NEW f'� T. -I�oN WA-U- � T(Z # 'ram F�i 2x 8 I iF�DE1Z I rs ?Or2- I Tl4'Y-1 70 THGt I N PdC?UAT1 Fi�IZ SIGN 1� � L E-AiuS A-LL E✓jCl S'T)r�1G 11.1- PL46ca �' UP PLEM CNr WITH ta�piece G CAI L, 12 ' ll vOv v I Terry A. Nettles, P.E. Project v/ M�(1� K�tS7�.} Sheet of 3 _ __ Consulting_Engineer �Z7 ��,prOp� Job No. ZZO 7777 92nd Street NW Gig Harbor WA 98332 VOICE&FAX(253)858-7777 Subject 2 Date Z OZ A. i �acK 7-0 Flr WITktr 4 r ,3801 lu��7 Gf�T� @ C�rtrJCa-t�lAtL ►� -P�-�cE 2x8 T� RFMA-rrJ REMA-lq �L4-� �IDC of TZUS,-� iglu, 4x� NSADE-k, -rIG14r (_)e t ►� -rr-� -Fizukxl-e�' 01 © , � f T sclP W:r To tWuAU, PtATe C� -Fa�iTfow7 0 "� & Toc -��►� L/1 o d AS, co Nc-c-n o►�1, CX�S7t NG W�� MUDS PtDDCD FAN D 8e-o W t4eW FO�-,i L OA-9 wAL4,-�;' Wnj P';eyat4D SN Terry A. Nettles, P.E. I Pr I Consulting Engineer structural & residential engineering 4 February 2002 Mr. Lawrence Seymour 171 St. Mountain View Dr. E. Allyn, WA 98524 INVOICE No. 22016: For site visit to residence located at the above address to inspect Owner performed modifications to the existing floor trusses and provide a report and details on the necessary additional reinforcements for meeting Building Code requirements for strength and durability. Provide report with details for use in submittal with permit application. 3 hours @ $90.00------------------------ $270.00 Total Amount Due and Payable---- $270.00 P A TAD�� Res ectfully Submitted, 4. 6aw Te . ettles P.E. RY 7777 92nd Street NW Gig Harbor,WA 98332 VOICE (253)858-7777 FAX (253) 858-7777 FLOOR PLAN 1. ROOM IDENTIFICATION: Each room and ILE C. Exposed top edge>36"above the floor, intended use must be clearly defined on the plans y the D. 1 or more walking surfaces within 36" applicant for plan review purposes. O PY horizontally of the plane of the glazing. 8. Glazing in railings s ee 2. EGRESS WINDOWS:UBC Section 310.4. All pmg See code for exceptions for Items 1 through 8. rooms and basements are required to have egress 9. Glazing in walls and fences used as the barrier for windows. The window shall have a minimum net clear indoor and outdoor swimming pools and spas when openable area of 5.7 square feet. The minimum net clear all of the following conditions are met: openable height dimension shall be 24". The minimum 9.1 The bottom edge of the glazing is less net clear openable width dimension shall be 20". The than 60 inches above the pool side of the window shall have a finished sill height not more than 44" glazing. above the floor. Window wells shall be provided when 9.2 The glazing is within Y of a swimming egress windows have a finished sill height below adjacent pool or spa's water edge. ground elevation. The well shall allow the window to be 10. Glazing in walls enclosing stairway landings or fully opened and provide a minimum accessible net clear within 5'of the bottom and top of stairways where the opening of 9 square feet,with a minimum dimension of bottom edge of the glass is less than 60"above:a 36". Window wells with a vertical depth of more than 44" walking surface. shall be equipped with a permanent ladder. Refer to UBC Section 2406.6 Glass Railings. Glazing in railings handout for additional information. shall be one of the following: • Single fully tempered glass. 3. SMOKE DETECTORS:UBC Section 310.9.1. A • Laminated fully tempered glass. detector shall be installed in each sleeping room and at a 0 Laminated heat-strengthened glass. --" point centrally located in the corridor or area giving For all types, the minimum nominal thickness shall access to each separate sleeping area. Where the ceiling he 114". height of the room open to the hallway serving the bedrooms exceeds that of the hallway by 24"or more, S. NATURAL LIGHT&VENTILATION:UBC Section$ smoke detectors shall be installed in the hallway and in 1203.2, 1203.3. Habitable rooms shall be provided with, the adjacent room. Each floor and basement shall have at natural light by means of exterior glazed openings with an least one detector. Required smoke detectors shall receive area not less than one tenth of the floor area of such their primary power from the building wiring and shall be rooms with a minimum of 10 square feet. Habitable , equipped with a battery backup. Detectors shall be rooms shall be provided with natural ventilation by means interconnected to provide audibility in all areas.When the of openable exterior openings with an area of not less than valuation of an addition,alteration or repair exceeds- one twentieth of the floor area of such rooms with a $1,000 and a permit is required,smoke detectors shall be minimum of 5 square feet. installed(Exception: Repairs to the exterior surfaces of a Group R occupancy are exempt from these 6. EXHAUST FANS:WSVIAQ Section 302.2.1. Exhaust requirements). fans are required in each kitchen,bathroom,water closet room,laundry facility,indoor swimming pool,spa and 4. SAFETY GLAZING:UBC Section 2406.4. All glass other rooms where excess water vapor or cooking odor is located in an area which the UBC considers hazardous produced. UBC Section 1203,UMC Section 504.6..The must be safety glazed: point of discharge of exhaust air shall be at least 3'from 1. Glazing in ingress and egress doors. any opening into the building or property line(this 2. Glazing in sliding door assemblies and panels in includes dryer exhausts and kitchen range hoods). See ; swinging doors(wardrobe doors excluded). energy section of this checklist for more specific ,. 3. Glazing in storm doors. requirements. 4. Glazing in all unframed swinging doors. 5. Tub/shower enclosures and any glazing in a wall 7. CLOTHES DRYERS:UMC Section 504.3. Clothes enclosure within 60"of standing surface. dryer exhaust ducts shall terminate outside the building, 6. Glazing in any opening adjacent to a door within and be equipped with a backdraft damper. Ducts shall not 24"where the bottom is less than 60"above the be connected with sheet metal screws or other fasteners walking surface. which will obstruct the flow. Duct length shall not,e.Yceed 7. Glazing that meets all of the following conditions• a total combined vertical and horizontal length of 14„_ , A. Exposed area of an individual pane>9 including 2 900 elbows. Two feet shall be deducted for square feet. each 900 elbow in excess of 2. Approved flexible duct B. Exposed bottom edge<18"above the connectors not more than 6'in length may be used, floor. provided they are not concealed within construction. I .. t=lle Name JC311 F.SKT Case No. File No. JC311F Borrower SEYMOUR,Lar /Jill Pro Address 171 E Mountain View Drive Ci Alin Coun Mason Lender/Client La Se more State WA Zip Code 98624 MVSZ � 32 �R �NS� 8' Deck $ Ayb� 58' r� e A e� Dining Bath 26' Family Room �.°r Room y Room Bedroom 0 3 3' re U Iasolo 26' • lasol0 Closet 12' Living Room i Porc Bath Be�lLpom Laundry Room Foyer Stairs Q3 5' 15.5' 32.5' 6' Porch 6' 6' 23' Lower Level 3c jwo.35' S<%dfr pc4t 12' Bath 2y�� 4RoomBedroom edo 1fuj (tJ1�1 26' Garage r3' 5' 26' lttilnies U14' Bedroom ne(�Workshop 28' 36-It w,.J 30' Living Area First Floor 1524 First Floor 170 58.0 X 26.0= 1508.0 Below Grade Area 8.0 X 2.0= 16.0 Lower Level 840 122 Total 1524.0 Lower Level Porches/Patios 35.0 X 12.0= 420.0 Deck 256 30.0 X 14.0= 420.0 Porch 36 24 Total 840.0 Side Porch 52 34 Garage/Carport Garage 668 108 s�rcn+rtaoo�.o� V h 7 ' c h 1 5T)q' 95"25 � , Ors 'ilkAj •���,�G£ ` N 3.�lort!(fu.2 x ,? j FL' lZ�A�Jt.(S r`�'AH�- r �� ��:! >s'�'�1��7 '.irj ' UvE►� <A�f'��(_ tlr o��` IPdovFK� , SAS tSFLL �S �.lpJrnlG �rJ�Jfi'f�1�', r � • EXISTING 2'X10' D.F. #2 EXISTING 2X4 DECKING ADD SIMPSON TP49 PT DECK JOIST (TYP). PLATE 2 3' O.C., ATTACHED TO LEDGER BOTH SIDES AND BEAM WITH SIMPSON TIES. ADD 6X6 BEAM P.T. D.F. STRUCTURAL GRADE. ADD 6X6 BEAM P.T. �� GR D.F. STRUCTURAL I N N m ADE Ex�f e�GLj EXISTING 6X12 1' MIN BEAM EXISTING 6X6 REAM EXISTING 2X6 PT BRACING SCREWED TO COLUMN AND BEAMS <TYP) SHORTEN COLUMNS NECESSARY TO ADD NEW BEAMS ADD NEW 4'X4' D.F. #2 PT KNEE BRACE 8 45 DEGREES (TYP) OR 6X6 TO MATCH BEAM BRACING AT COLUMNS TO BE EXISTING MAINTAINED TO EXISTING EXISTING 4'X6' FASTEN (2) J' DIA. LAG CONDITIONS, EXCEPT (2) P DIA. MIN THROUGH BOLTS IN EACH OR 6'X6' PT SCREWS FOR EACH COLUMN <TYP) WOOD BEAM AND BRACE BRACING AND COLUMN CONNECTION. CONNECTION. PENETRATE USE }' DIA. X 3' GALV. WOOD 1' MINIMUM IN EACH SCREWSWS IN EACH BRACING AND MEMBER, BEAM CONNECTION. PROJECT/ OWNER/ LOCATION- DECK REPAIR EXISTING SIMPSON COLUMN BASE LAWRENCE AND JILL SEYMOUR 171 E. MOUNTAIN VIEW DRIVE EXISTING CONCRETE PARCEL 12220-51-00019 SURFACE ALLYN, WASHINGTON ENGINEER- ENVIROTECH ENGINEERING PO BOX 984 I.vr)i, BELFAIR, WASHINGTON 98528 PHONE, (360) 275-9374 ^t "� FAX, (360) 275-4789 DRAWN BY, DATE # MCS 10/15/11 y aiius r DESIGNED BY, DATE, Michael Staten, P.E, 10/15/11 SHEET 1 SHEET I OF 2 ' EXISTING 2'X4' PT DF ROOF RAFTER E 2' O.C. WITH 2X H BLOCKING. OUST METAL SHEATHING TO BE ROOF COMPLETED EXISTING TURNBUCKLE EXISTING 2X4 DF PT SOLID RIM EXISTING 2X ROOF BEAM FOR HOUSE DECK BOARDS FLOOR JOISTS EXISTING 2X10 DECK ADD NEW 2X4 DF PT JOIST FLUSH WITH MEMBER HOUSE FLOOR ABOVE. FASTEN JOIST EXISTING EACH BOARD TO HOUSE EACH POST WITH (3) 16D NAILS. ADD 1/2' DIA. BOLT 2 32' O.C, CONNECTING DECK LEDGER TO HOUSE RIM EXISTING EXISTING 4X4 POST BEARING WALL 2 8' O,C, SUPPORTED BY (3) SIMPSON HANGERS. EXISTING 2'XIO' D.F. #2 PT DECK JOIST 2 2' O.C. EXISTING 4'X6' OR 6'X6' PT COLUMN GENERAL NOTES 1. THE OWNER AND CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL DIMENSIONS PRIOR TO STARTING CONSTRUCTION. ANY CHANGES TO STRUCTURE MUST BE APPROVED BY A LICENSED ENGINEER. PROJECT/ OWNER/ LOCATION, 2. EXCEPT WHERE NOTED BY AN ENGINEER, ALL BUILDING METHODS, MATERIALS, AND WORKMANSHIP SHALL BE IN ACCORDANCE WITH THE DECK REPAIR INTERNATIONAL BUILDING CODE (IBC) 2006 EDITION. 3. THE CONTRACTOR IS RESPONSIBLE FOR IMPLEMENTING SAFE WORK PRACTICES AND CONFORMING TO ALL SAFETY ORDINANCES. LAWRENCE AND JILL SEYMOUR 171 E. MOUNTAIN VIEW DRIVE DESIGN CRITERIA PARCEL 12220-51-00019 ALLYN, WASHINGTON 1. ROOF, 25 PSF LIVE LOAD (SNOW)i 3 PSF DEAD LOAD, ENGINEER, 2, DECKS, 60 PSF LIVE LOADi 10 PSF DEAD LOAD. ri.rvr 3. WIND, 85 MPHj EXPOSURE 'B' *� s,. ENVIROTECH ENGINEERING 4, SEISMIC, CATEGORY D2, ^` r% PO BOX 984 BELFAIR, WASHINGTON 98528 FLQOB PHONE, (360) 275-9374 FAX, (360) 275-4789 1. ALL WOOD IN CONTACT WITH CONCRETE SHALL BE PRESSURE TREATED, DRAWN BY, DATE, MCS 10/15/11 HOLD-DOWN AND TIES >` DESIGNED BY, DATE, 1, INSTALL ALL HOLD-DOWNS AND TIES PER MANUFACTURERS SPECIFICATIONS. Michael Staten, P.E, 10/15/11 2. ALL METAL CONNECTORS IN CONTACT WITH PRESSURE TREATED WOOD SHEET SHALL BE SIMPSON Z-MAX, TRIPLE ZINC COATED OR HOT DIPPED GALVANIZED FOR CORROSION PROTECTION, SHEET 2 OF 2 MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W.Cedar • P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner C;uLICO.!i f?F.. ;r c: Company Name Lr.. I ry�,,,! f;?�.1 r' i�TL Mailing Address Mailing Addres - City /4 t c' ,,</ State G_;sa Zip Code f-� ' City �'Stai�, Zip Code Phone > er Ph. , : ti n 5 S '/ r.. Phone `'der Ph. Lien/Title Holder r� r.at rt'IrSr �'ti` 1-(G.0 r r.A ,,iF.. Contractor Reg. # EScp- E mail address := / ` 4'i:�C�[iM:; '.'!>''A.1 • C'�ir f E Mail Address Drivers Lic.# DOB P'/'-E; ?; r Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic``�- �_ Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. 12 2 C' ' - Fire District Legal Description t,.w. ; ? c. ., ft F e-4-)4' ii,', _ 0 .F A."0,1 Site Address (Please include street name, street number and city) !7 ' F `r�1:.t }' iF "` Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building pt '��'' f Describe Work No.of Bedrooms— 3 No.of Bathrooms � Square Footage- 1 st Floor 2`I 2nd Floor � 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. CM/NER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the w*­proposed in the app4cation,I have obtained permission from them to apply for this permit and conduct the work proposed. :,,..- Date: X �.. Owner/Owner5 Ffepr¢sentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND T1,11IS POINT Accepted by:. {' .. Planning Pd Ck#" =: t. ;: ,:; .' !Date Bld Pd i Receipt No. DEPARTMENTAL REVIEW AP.PROVErt DENIED NOTES Building Department 0L� Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbin & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES