HomeMy WebLinkAboutBLD92-1213 Mobile Home - BLD Permit / Conditions - 11/4/1992 MASON COUNTY
- Mason Counly Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-S.:tback date by Ribbons
date by Gas Piping date by
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
y P,O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date _3 by .
BG/SLAB Insulation Floors Final
date by date by date by 4-
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic [�
date b
1,date b y
D.W.V. WALLBOARD NAILING
date by date by Si�,� D�i,Eo>c�s� Z;rSr�O
Water Line FINAL INSPECTION
date by date by date by
V1Zi ./.t/G
MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
N::: N..._ N:::3 ::C:: Mw# 1;_;i 1:> E.:.. F M : ': 1"` FOR INSPECTIONS CALL 427-9670
BL092-1213 PARCEL : 123174100090 PLAT : DIV: BLK : LOT :
JOB ADDRESS : . . . . . . . . . . . . . . .
OWNER : LYDIA WOOD 275-6218
CONTRACTOR :
LEGAL : TN 9 OF NE SE FS 05126 1[ 163
I
CLASS OF WORK NEW BEDR : 2 . BATH : 2 TYPE AMOUNT BY DATE RECEIPT TYPE AMOUNT BY DATE RECEIPT
TYPE OF USE . . . . : MH STORIES . . . . . . . : 1
OCCUP . GROUP . . . : ? BLDG . HEIGHT . . : 0 t L MHOF Z 85.25 TW 11/14/92 31644
TYPE OF CONST . . : ? FIREPLACES . . . . : 0 STFE = 4.50 TW 11/14/92 3 164 4
OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . : 0
DWELL . UNITS . . . . : 0 PARKING SPACES : 0
INSPECTION AREA : 1 SHORELINE?. . . . : N TOTAL: 89.15 VALULAIION: 24864
' SETBACKS-------------- TOILETS . . . . . . . . . . : 0 FUEL TYPES---------- BOILERS/COMP---- MOBILE HOME--
FRONT . . . E 5ft BATH BASINS . . . . . . : 0 : ? 0-3 HP . : 0
REAR . . . .W 5ft BATH TUBS . . . . . . . . : 0 3-15 HP . : 0 MODEL : CASTLEWOOD
SIDE ( 1 ) . N 100ft SHOWERS . . . . . . . . . . : 0 FURN ( 100K BTU : 0 15-30 HP . : 0 —MAKE------
SIDE ( 2) . S 100ft WATER HEATERS . . . . : 0 FURN )=100K BTU : 0 30-50 HP . : 0 115-2FKM
SHRLINE . ? Oft CLOTHES WASHERS . . : 0 FURN — FLOOR . . . : 0 50+ HP . : 0 —YEAR------
AREA ---------------- KITCHEN SINKS . . . . : 0 HEAT PUMP . . . . . . : 0 93
LOT SIZE . . : ? FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 48
BUILDING . . . : 1144sf DRINKING FOUNT . . . : 0 VENT FANS . . . . . . : 0 HOODS . . . . . . . : 0 WIDTH . : 28
BASEMENT . . . : 0sf LAUNDRY TRAYS . . . . : 0 DOMES . INCIN : O —SERIAL#----
DECKS . . . . . . : 0sf DISHWASHERS . . . . . . : 0 AIR HANDLING UNITS-- COMML . INCIN : O FACTO
GAR/CARP : ? Osf GARB DISPOSALS . . . : 0 (= 10000 cfm. : 0 RELOC /REPAIR : 0
AT/DT . : ? URINALS . . . . . . . . . . : 0 > 10000 cfm. : 0 OTHER UNITS . : 0
MISC PLM FIXTURES : 0 GAS OUTLETS . : 0
PROJECT 0ESCRIPTI0N:M0BILE HOME
PROJECT LOCATION:APPROXIMATELY 2 NILES ON OLD BELFAIR HWY FROM BELFAIR, NORTHWEST DIRECTION
THIS PERMIT BECOMES MULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 181 DAYS, OR If CONSTRUCTION OR WORK IS SUSPENDED FOR A PERIOD
OF 181 DAYS AT ANY TIME AFTER WORK I COMMENCED. EVIDENCE OF CONTINUATION OF WORK IS A PROGRESS INSPECTION WITHIN THE 181 DAY PERIOD. FINAL INSPECTION MUST BE
APPROVED BEFORE B U I L 0 1 N 6 CAN BE
/z
OWNER OR AGENT: DATE: �l' 5z
BLD PRNT, rev 13/31/91
�7S - 12( �
Washing-ton State Energy Code 1 Ventilation and Indoor Air Quality Code
SET-UP INSPECTION CHECKLIST FOR MODULAR HOUSr\G
Note: 40
------------
This checklist is not comprehensive: other code requirements may apply. This checklist can be
used by local by building departments for modular homes built to the 1991 Washington State Energy Code ( VSEC) and inspected in the factory by the Washington State Department of Labor
and Industries (L&I).
Ground Cover: 6 mil, black
?W_,Ventilation: Ventilation in crawlspace must be a minimum of onesquare
ventilation area (without louvers)pe uuare feet foot
f free
crawlspace area, or a passive radon vent p pe must be installed. Note: UBC
regulations may require more ventilation.
Pipe Insulation: Cold and hot pipes insulated to R-3 in unconditioned areas.
Floor Insulation:No damaged or missing insulation; if floor insulation is done on-site,
R-value installed is consistent with NLEA form.
Ducts: Where appropriate,crossover ducts are properly joined, sealed, and supported.
Duct insulation is in place and in good condition. If duct insulation is
installed on site, insulation value shall be R-8, or according to NLEA form.
Marriage Line: Sections are properly aligned, and sealed or gasketed with appropriate
materials (a non-porous material, such as a foam sill seal) to limit
infiltration.
_Attic: Check for bate moved and not replaced during set-up. Loose fill insulation is of
uniform depth. Baffles displaced during set-up or transit are properly reinstalled.
Doors: Check doors to ensure that they close and latch properly.
Notice to Local Enforcement-Agency Form (NLEA): 'rhe NLEA has been reviewed and
the items listed have been inspected-
IZ I7,91
Washington State Energy Code - Ventilation and Indoor Air Quality Code
MODULAR HOUSING SET-UP Pi iSPECTIQN PROCEDURES
Background
r
The Washington State Department of Labor and Industries (L&I) performs Washington State
energy Code (WSEC) plan reviews and inspections in the factory for modular homes subject to
the Uniform Building Code (UBC). Although many of the WSEC and Ventilation & Indoor Air
Quality Code (VIAQ) requirements are inspected by L&I, some items can only be inspected on
site, and therefore, may fall within the jurisdiction of the local building official.
The Notice To Local Enforcement Agency (NLEA)
Attached to each modular home inspected by L&I is the NLEA, which provides the local
enforcement agency with information pertinent to the site inspection. Often, a modular home is
shipped to the site before some items normally inspected by L&I are completed_ In these cases,
the L&I inspector fills out the NLEA form and lists items not inspected at the factory. For
instance, when a manufacturer ships a modular home before floor insulation is installed, the
NLEA form will indicate the R-value of the required floor insulation. The Iocal building
officials' careful review of the NLEA form is an extremely important part of the modular
housing set-up inspection.
Damage Incurred During Transit
Sometimes a modular home may be damaged during transit. Although L&I is the building code
authority for the home until it arrives at the building site, often no L&I inspector will see the
home after it is delivered. If the local inspector discovers any damage incurred in transit, L&I
should be notified as soon as possible. (Contact Dan Sevcik at 206-664-0548.)
Authority of the Local Building Official
The local inspector has the authority and responsibility to inspect any work done by the set-up
crew. Some of the work to be inspected will be listed on the NLEA form Frequently, however,
the set up crew may damage or alter work previously inspected by L&I. The local authority does
not have the authority to inspect work already approved by L&I,except those specific items
altered by the set-up crew. For example, if attic insulation is moved out of place by the set-up
crew, the building inspector may require that the insulation be properly replaced, but may not
require that the attic be insulated with bate of a higher R-value than approved by L&I.
The WSEC Set-up Inspection Checklist
RCW 19.27A.035 requires that utilities provide an "owner at the time of construction payment"
for WSEC homes (only electric resistance heated homes 2000 square feet and under qualify for
the payment). Some utilities may ask for verification of a local jurisdiction set-up inspection
prior to making a payment for modular homes. On the reverse side of this page is a sample of a
WSEC Set-up Inspection Checklist for Modular Housing that may be accepted as adequate
verification by the local utility.
... .. r ey E{. erK t:.'., r!:4v���'}r•�i��4 fr� •����,1 _, ..a . . �� ,
..,,1 r -.. Iva K,1! '•7t eRj�ln.'T''r!',
IA Grtrti SL cA, lr�GTON f; �, /ar •4tae '7T F!'e?
In thle contract the words IyIE,and MI rorar to tM Buyer antl Go-Buysr signing this c0 words Y and YOUR�rofer to the Dealer.
Sub set to the terms an_b co "ona on both sldN oft is agreement you
agree to.11 and t our"to purcrak"tM f o� Asscrlbed unit.
BUYER(S) PHONE - GATE
55 - - -- .r•e- ALfSPERY90N
DELIVERY AFORE SS -
MAKE a MOUE L yH .;YEAH,.. BD ROOMS f- SIZE HITCH SIZE : � STOCK NUMR6H
�✓S t-A l ____ - j-. W L W.
$EFIAL,NUMBER T., ( )LUH PROPOSED DELIVERY PATE Kf Y.NUMBER$
F3 NEW . L1 USED
LOCATION R-VALUE THICKNESS TYPE OF INSULATION ._BASE PRICE OF UNIT $
LUyu' OP71ONAL EQUIPMENT
--- — —
EXTERIOR
i FLOORS SUB-TOTAL
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND
I 1 CLO ED IN COMPLIANCE WITH THE FEDERAL TRADE COMMISSION RULE SALE5 TAX
16CPf SECTION 460 16,
OPTIONAL EQUIPMENT LABOR AND ACCESSORIES NON TAXABLE'ITEMS
VARIOUS FEES AND INSURANCE
-- --
'22-
1. CASH PU HASE PRICE $
TRADE-IN ALLOWANCE $
- LESS BAL DUE ON ABOVE -$
NETALLOWANCE-. $
.CASH DOWN PAYMENT $,
---- CASHASAGREED
SEE"REMARKS"
2. LESS TOTAL CREDITS S Al
---- ---- SUB-7 TA
SALES TAX If Not Included Above
3. Unpaid Balance of Cash Sale Price ° ^
I -- Remarks:
I
_Pl
inn LTtd_uclus Cln _ -
`l
i I�by t ck.20 feet of
'cslyer and wP 4r Linn t,BbOVu QfOt"'Sd conneetkm IS k1 -- ;
+•,.�d. Cl,�ro;s^.^T t, r,�s�_ •�t�f�_�L���•tli al_.h_�!._i�� _ ,
ard of o";nhig any required
Tim and am not Includgo In pj!KnNM POC-3 of
BALANCE CARRIED TO OPTIONAL EQUIPMENT $ 1.tpA•►t:-
NOTE:WARRANTY AND EXCLUSIONS AND LIMITATIONS OF DAMAGES ON THE REVERSE SIDE "' x'I`
DESCRIPTION OF TRADE IN -EAR -SIZE
MAKE - _ MODEL BEDROOMS -
_.•.r. - VAA!npK'9'?iV•A•t/1::ryYFe!"^^^'+. .- ..
TITLE NQ SFR/At NO - COL!tR
I AMOUN T OWING TO WHOM
ANY DEBT 1 OWE ON THE TRADE-11V IS TO BE PAID BY L1 YOU I
THIS AGREEt M CONTAINS YHE MIRE UNDO TANOMa BEMEEN YOU AND ME AND NO OTHER REPRESENTATION OR IWUCEMENT,VERBAL OR WRRTEH,HAS BEEN MADE W14"IS NOT CONTAINED IN THIS CONTRACT.
You and I certify that the additional terms and conditions printed on the other side of this contract are agreed to as a part of this agreement, the same as if
printed above the signatures. I am purchasing the above described trailer,manufactured home or vehicle;the optional equipment and accessories,the insur-
ance as described has been voluntary;that my trade-in is free from all claims whatsoever,except as noted.
.. ._... 6 cc��(( RECEIPT Of QQ�Y�TTHIl��QQl!��QQ��gg
' W VERUN RS _ _ T►L€�CR O MSAGREEMENTHUNT MUBtLE Hc:h1ES, tIVC SIGNEDX DEALERNot Vai'd Ohle:s S;nnnd and er ed by a�Cw er)f the CompanyS(yCIAL S=EU Y NOSIGNEDX -•� BUYER
Ryan v d , . sot, Ecuanr o '--Cf
-) Jenlune usinass Forms does not g,ve.legal advice now represent any paNcular legal
I A PLAIN LANGUAGE PURCHASE AGREEMENT effect as res,aang from the use of tlh;s total If the user does not understand any terms.
FORM 500.3WEL
DUPLICAtE n,the„legal effect.seek compemn,IPgal,:nunse,
[MA
0 0BATH 12 I ROOMLAUNDRY 1 - KITCHEN BEDROOM uR[N 1 IuAN
26._0., -Ali\_I _ MORNINGCROOM�Vl i II IIL
13'-0'• BEDROOM 12 I LIVING ROOM t I I 1 1
PORCH
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-i0.7"
- -- Plan 115 - 4828 - 2FKM Approx. 1144 Sq. Ft.
I 1 I I I
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I I 1 I Z D I I 1 I I I 1
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LAUNDRY I 1 I I I 1 I
13'-0" I MASTER BEDROOM I ;� BATH I I fAMIIY ROOM I I LMNG ROOM
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I I I I 1 I 1 I I I 1
I I I I I I 1 I 1 1 I
I 1
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1 I I 1 1 1 I 1 I I 1
® \�/ • 0. I ( I 1 OFT BUFFET
o I I 1 I I I j
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13'-0" 1 I 1 I 1
MASTER BATH BEDROOM/2 BEDROOM 1J KITCHEN 1 MORNING ROOM
I I I 1 1
G I 1 1 I I I
I I PORCH
I t 1
4�-9'-I1- 11'-1•�12•_0" 13'-7" •1- 12- L B•-0'•--•1
Plan 116 - 7028 - 3FLR Approx. 1960 Sq. Ft.
42,_0"
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1 'L.RY
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KRiHEN ; BATH BEDROOM 13
I
t I 1 1 1 1 FUR
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26'-0" I 1
1
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Plan 117 - 4628 - 313C Approx. 1092 Sq. Ft.
HUNT MOBILE HOMES
P.O. BOX 789, HWY 16
GORST, WASHINGTON 98337
206-373-5001
CUSTOMER'S ORDER NO. DATE
NAME /` 19 _
✓ C �'� < A u N
ADDRESS
SOLD BY CASH C.O.D. CHARGE ON ACCT. AIDSE,RETD. PAID OUT
1
DESCRIPTION
V
/ / 1
14
TAX
TOTAL
ALL CLAIMS AND RETURNED GOODS MUST BE ACCr BY THIS 8/1t�/o
01213 REC'D BYU��
FIONEEB BUSINESS FORM..TACOMA.WASH. 3E0916 2
Cf P SEPTIC PUMPING INVOICE NO,
P. O. Box 985 5 617
Selfair, WA 98528
SOL SHIPPED TO
STIR E N ST-PEET
CITY STA ZIP/ CIT ST _ ZIP
CUSTOMER' RDER SA SMAN TERMS S F.O.B. DA
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'L 706/
01706
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B=DE";G PERMIT APPLICATION
PLEASE PRINT
j #1 owner LYN ►9 W()0 phone#
Site Address NSF . lgbl oLi) 3eLF i2 1Aw
City Z-C L Fri t 2 St L>J Zip $;
Directions to Job Site MO--es
�3� i_�N �2 1��w�, F 2a vti� � e L F►4 � 2 ►� C� i'--i�� w�s� D i 2 ec.�o�i
Owner Mailing Address tom . 1O1 b 1 0 L 0 3e L i=N t2 Wes;v
City , . i t; t - St
Lien/Title Holder
Address
City St Zip
#2 Contractor Name Contractor Regx
Address Expiration date
City -St—zip Phone
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water may be required)
#4 Parcel No. ! - - I 1 �2 3 l 7 Lit O C)dGj�
Legal Description TQ I'� q C F
#5 Building Square Footage: (existing/proposed)
1st FI /44 2nd Fl ^ / 3rd FI ti' I / Loft N /
Basement N Deck / #bedrooms
Garage N ��/ Carport /� / / --�— #bathrooms >=
(Circle: Attached or Detached?)
Other sq ft /
#b Use of building \ �S t ('l 4j N r Describe work 'S 2'T YrU(3 1 2
IA-O vv\-e i r--QC ti
#7 Type of Job: New Add Alt Repair Demolition
Woodstove Re-Roof Bulkhead Other Aviv 1
#8 MOBILE HOME 2 FORMAT70N
Model Year I c`i Make C ASrIt we, 0 Model
Lengt Width_ Serial No. ` �i"' .( J'9
#Bedrooms OL #Bathrooms -- Type of Heat For efN- -�
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
nr'I$a,- t Ls
a_ ==' -q _ tz r-S Jt ?aC ) �oc�
NC . " _ecs --
'� Vent Syst�ts { 3 . 00
Sat h 3as_ns Vent _=ins X 3 . 00
_Sat: s No. Boilers/Compressors
Showers 0 6 . 00
Hot Water Htr 3-15 HP
--- 6 . 0 0
".,aund_^,, washer 15-30 3P 5 . 00
Sinks
30-50 HP 5 . 00
Floor Drains 0 + Hp 5 • 00
Laundry Basins
NO. Saadliag Uai t
Dishwasher <= 1 000 cfm. 7 . 50
Disposal 1000 cfm. 7 . 50
IIr-4 als Other
Otherp Coolers _
Hoods
Permit Basic Fee 3 . 00 Fire Suppression _
TOTAL PLUMBING $ Domes . Incin.
Comml . Incin.
Reloc/Repair 6 . 00
Mechanical FiYtsreg Gas Outlets X 2 .00
No . Fuel Types Woodstove seoarate
Fuca < 100K BTU 6 . 00 Other
Furs >- 100K BTU 6 . 00
Furs - Floor 5 . 00 permit Basic Fee 10 . 00
Heat Pu=s 5. 00 TOTAL MEC WICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AOTHORZ= IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT AW=4E AFTER WORK
IS COMMENCED
OWNERS ABFInAVrr COPTI2AL."ORS AFFatAVIT
I CERTIFY THAT I AM EX19Vr FROI THE REOUIREPIEM Of THE .I CERTIFY THAT I AN A QJRRDITLY REGISTERED CONTRACTOR
CONTRACTORSAR
REGISTRATION LAY RCW 1E.2T AND AN AUE IN THE STATE Of WASHINGTOR AND I AN AWARE Of THE
Of THE MASON COUNTY ORDINANCE RMIREMENTS FOR WHICH ORDINANCE REWIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AMC ALL WORK DONE WILL BE IN
CONF RMNCE THEREWITH. MO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE WIDE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING YITHQIT fiR37 OBTAINING APPROVAL FROM THE BUILDING
DEPAlITMEN;� aC� OEPARTNENT.
a By
DATE
Ic Owner _r
Return permit to: Department of General Sez-7ices
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
POR OFFIC=-AL USE ONLY: Accepted by: Date:
.Show• folloaring on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
St^scture Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed I=rovements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
PLICANT TO DRAW SITE PLAN BELO
i
i
PLICANT To DRAW TopOGgApgy PROFILE BELOW
DER ARTN ENT L REVEW
FOR OFFICE ME aNLY
Aoprovw COM Hold
Approvsl
Eaviroam tal Health: Apn'""`� A�5., .. 6
r
Building Plan Review:
Occupancy Group :
Fire Marshall :
Other:
r= FEES
(lspec II Ilsite Inspection I II
II II I
II II IIBuil�g Permit 2`l I II
II
I' rFN9RA II (IViolation Fee I II
II li I
S o II Violation Investigation Fee I II
II II II Plan check I II
II II If ;I
II II Plumbing Fee I II
II II I! II
II II IlMechanical Fee I II
II it Ilwoodstove Fee I II
II IlBuilding State-Fee I
IlBuilding Valuation: II II To l rj II
40 PLOT PLAN
ADDRESS lilt-e , f-Al PERMIT NO. o 0
= o
n >
a o
0
LEGAL
DESCRIPTION /� LOT BLK ADDITION u
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Yc neft
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I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
S) OF OWNER(S) OF SITE Q STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
CT AS NOTED
CON ctatNTIN
PLOT PLAN
ADDRESS ,V lQO'� .' {�1.1Awu PERMIT NO. o
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION A•'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER. GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"-20'
I
Par,
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I/We oudty that the propoW aonstnictan im"'oontonn so the d1monalav and um shown abovo and that ne ehan"s will be made wlMout
Qtat obtalnlns approval.
groper �UJ(IQI4 �ia wood,
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cow"111111111111 OF ofu u iN ► N
00 NOT"Irl flLOW THIS L/NI
APPROVED
DISTRICT AS NOTED DATE
ONCLTON •RINTINO