HomeMy WebLinkAboutBLD92-1543 SFR - BLD Permit / Conditions - 1/26/1993 MASON COUNTY • T
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Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICALO<c MOBILE HOME
Footings-Setback date 3 ,z,S- by < Ribbons
dates- by AGas Piping date b
Foundation Walls date by Set Up
date by INSULATION 1 date by
BG/SLAB Insulation Floors hN Final
date by date by date by
FRAMIN Walls FIRE DEPT.
date - 3 by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD N41LING, 1 C 1 Q z
date 3-,.Z 5 3 byI date ftLAU(-) y O[ Ioc
Water Line FINAL INSPECTION
date by date _2 y z by C ; date by
X Cr4/I,EZ) A f
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
( ase No � : BID92—P,43
For ; STACY VI(A[ AN
PAqp t 1
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Tot.Al number of bedroomt; o:atmol- t,- c
disposal tic) st:.em J �: upgraded
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback dated by Ribbons
date by Gas Piping date b
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 Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
BUILDER/HOMEOWNER AGREEMENT LTSGC
Super Good Cents
HOMEOWNER: Stacy & Julie McKean PHONE: 275-0605
SITE ADDRESS : NE 801 Old Belfair Hwy. Belfair ACCT•
MAILING ADDRESS: PO.Box 376 Grapeview, Wa. 98546
BUILDER: Homeowner PHONE
MAILING ADDRESS :
I understand that in order for the electrically heated home located at
the above address to be certified and in addition qualify for "LONG
TERM SUPER GOOD CENTS" . Home must be constructed in compliance with the
Washington State. Energy Code, attached Wattsun heat loss and Long Term
Super Good Cents addendum/specifications .
I understand that inspection by District staff is required at each of
the following stages :
Prior to pouring of concrete slab if required.
Prior to installing exterior insulation and damp proofing the
below grade basement walls if required.
X Prior to installing insulation (structure is framed, roof is on
roughed-in plumbing, heating, wiring, telephone and TV cable are
installed, and all penetrations are sealed) .
x Following installation of insulation and vapor retarder but
prior to covering.
X Final inspection - all components installed.
_X Other a� needed
NOTE: Final inspection by the appropriate Building Department must be
completed prior to the District' s final inspection for Super Good Cents .
It is understood that the Super Good Cents Department is to be notified
at 426-0777 or 426-8255 Ext.� 777 , not less than 48 hours prior to
required inspections .
I understand the "Long Term" Super Good Cents certification by Mason
County Public utility District No. 3. only verifies compliance with the
Long Term Super Good Cents program standards and only in respect to
energy efficiency. Neither the District nor any employees make any
warranty, expressed or implied, in regard to the general workmanship and
structural integrity of the residence or the future electrical
consumption.
I, the undersigned, understand that if the home is built according to
this agreement, the attached specifications , detailed checklists, and
addendum, and is certified by the District representative that I will
be eligible to receive Long Term SGC incentive payment(s) in the amount
shown on the attached worksheet.
Initial
WATTSUN 5.3 LONG TERM SUPER GOOD CENTS/1991 MCS COMPLIANCE REPORT 12/02/92:
FILE: A:MCKEAN.WS HOUSE I D: L•i"t_;
�s ::::�:_=ss—"_..-_-.._:css::=:='_=r.=:-�=•_ss�=:=�.:;__»:_.=ems�:c s:.;•__��=^.sue.=•�.-:=sss=a:::._..._._-.._--..... .._s��=__�xs......_.......
Site: NE '3G1 OLD BELFA I R HWY . Analyst: KELLY BUECHEL
BELFA I n, WA Jurisdiction! MASON COUNTY ,
Utility: MASON COUNTY PUD #3
Homeowner: STACY/JUL I E MCKEAN House Type: Single Family
Floor Area : 2659 ft2
BuiI der: JULIE MCKEAN Weather Data : olxmpia, WA
P.D. BOX 376 Climate Zone: 1
( 06 )2 75-0605
The PROPOSED design QUALIFIES for SGC( 91 MCS ) Tier 1.
REFERENCE PROPOSED
COMPONENT FIERF OFihAN1_'E 492 489 Btu/hr--F
ENERGY BUDGET 3.53 3.66 kWh/-rt2-yr
i
REFERENCE DESIGN
Reference
Component Desc:r f fat i on VaIu, X Area = UA
------------------------------------------------------------------------------------
Floor R30 vented joist U-0.02 9 1683 48.8
Glazing @15% 0.35 U-value U-0.350 398.9 139.61
Doors Metal R5 base ease t_I-0.:19�r 40.0 7.c_5
AG Wall R21+R5 ADV U-0.041 . 2410 98.
Ceiling, Attic: R49 blown Attic: ADV U-0.020 1.428 23.6
Ceiling, Vault R36 Batt vault vented U-0.027 280 7.6
Infiltration ::standard air sealing ACH-0.350 25:114f t :. 160.9
-----------------------------
Referei-,c:e UA 492
-.-_...-----------_._---.---_--_--------••--•---•----_-•-- -------------------------------------------
PROPOSED DESIGN COMPONENTS
Component Description Value x Area = UA
._-..-.._- ---_._.....-_._..._.__..----_-.-..._..._._---..-_--._-_--_.---_---._----__----_-___.--._.-__...__--.._._.___ _........
Floor R30 vented Joist 16oc U-0.029 1418 41.1
R30 vented Joist 16oc l_f-0.029 213 6.2
i=i:30 vented Joist 16oc U-0.029 52 1.5
Glazing @ 18% "*ALPINE ::H W/LOWS/AR U-0.350 158.0 53.7:;
x"ALPINE VINYL LOWE/AR __ U-0.320 1.46.0 45.-'*
-----------------------------------------------------------------------------------
Items in parentheses not Included in COMPONENT PERFORMANCE totals.
�-:-: Denotes non-standard values - check calculation of thermal value .
>r Denote:_ adjusted UA to reflect 7--1/2 mph wind speed.
Pace 1
-•C�__^"..:�'h�:.���"_._._.__._...—..."..:�:�W�:--_::s::':..���_...._..._._....'_-.::w—...'�:� �:�."._.'�S'2._5.�.•_-..-.-':S�d�tL'�..._.._....__.s��:=l:��::�.:�.'C SIC�:'�:«::::':.::._
WATTSUN 5.3 LONG TERM SUPER GOOD CENTS/1991 MCS COMPLIANCE REPORT 12/02/92
FILE: A:MCKEAN.W2 HOUSE ID: L..T()
"ALPINE PATIO LOWS:/AR U-0.400 33.0 12.•_:i::r:
Doors Metal 1-3/4" urethane flush U-0.140 40.0 5.,.'v-
AG Wall :*:s Q21 + R3.1 I NT Lap Wood U-O-.043 2252 _ 96 8
AxR21 BUFFER/RIM U-0.053 220 11.7
ceiling R38 blown Attic STD baffled U-u.0 31 1428 44.3
R30 Batt Vault vented 2x12 24oc U-0.031 280 9.2
Infiltration Standard Air Sealing ACH-0.::350 25114ftS 160.9
-----------------------------
Proposed UA 489
S true: Mass Light Frame, Shee track: walls M- 3.000 2659 - 7977
---------------------------------------------------------------------------------------------------
HEAT I NG/COOL I NG/VENT I LA"i I NG SYSTEMS
PROPOSED
Heating System Type: Electric: Zoned
System Efficiency: 100 %Modified Efficiency: 100 %
y
Design ACH: 0.60
Heating Load( at 53F dt ): 32013 Btu/hr .�
System Size: 9.4 kW
Maximum S i me @1!50%: 14.1. kW o
Average Annual Heat: 14111 kWh
Annual Cost: $ 631-5
Ventilation System: Non-Heat Recovery: OTHER
Gaoling System: NONE
SEER: 0.0 ( 1 Jt-Ir. acted ) �)
Cooling Li iad( a t !::iF dt ): 2602 rf Btu/h*r
Recommended Size 0125%: 3-0 tans
Annual cool re<'jt..1 i re;r,ent: kWh/yr
Solar Access: C��T Part i al Iy'`Shaded
t,•ti
GLAZING ORIENTATION
PROPOSED PROPOSED 3 i oo y 229 : 13•SyK
South 84.2ft2 North . 84.2ft2
Southeast : Northwest :
East 84-2 We s t . 1=4 .2
Northeast :Southwest
t
Economic and energy consumption estimates are designed for compara't I of:-,
purposes only . Actual t. for heoting will v8ry depending on weather*
conditions, occupant, lifestyle and other factors.
-------- ----- c-..__._ ^ - - _.. . . -
I further understand that it is my responsibility to be aware and adhere
to the Long Term Super Good Cents specifications . Only upon verified
completion by the on-site inspections listed in this agreement of all
the attached criteria by the Mason County Public Utility District No . 3
Long Term Super Good Cents representative, will the house be certified
as a Super Good Cents home.
Signed:
04
Hom w er Julie McKean Builder
/,�2- 63 9;�,
Date Date
Fecerai !D# or Sccia! Security # Federal 1D# or social Security
(�k/ll � pz_ ,�ek� -
t lity Representative
Kelly M. D . Buechel
Utility Representative (print)
December 2, 1992
Date
NOTE: The Internal Revenue Service has ruled that incentives
received from conservation programs are considered income and are,
therefore, subject to federal income tax. A 1099 form will be
mailed to the individual receiving the incentive payment prior to
January 31, of the year following receipt of the incentive.
As an alternative, Homeowner incentives may be applied as a
non-refundable credit on your utility account. Under IRS ruling
91-36 , conservation incentives applied as non-refundable credits
are not oart of a customer' s gross income and a 1099 Form need
not be issued.
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
RESIDENTIAL REQUIREMENTS (NEW CONSTRUCTION, ADDITIONS, & REMODELS)
THE PROCESSING OF YOUR APPLICATION CAN BE EXPEDITED IF YOU PROVIDE
COMPLETE AND DETAILED INFORMATION.
YOU ARE ENCOURAGED TO COMPLY TO THE 1991 WSEC BY UTILIZING THE
APPROPRIATE PRESCRIPTIVE PATH FOR YOUR PROJECT. TINS WILL ALSO HELP
EXPEDITE MATTERS.
TIIE FOLLOWING INFORMATION MUST BE PROVIDED:
1) A complete window schedule must be submitted with your WSEC compliance information, even
if a window schedule is included on your building plans. Note that sliding glass doors (patio),
french doors, and any door with 50% or more glass in it is considered a window with the area
(sq.ft.) being the entire units rough opening dimensions. Any windows in doors (less than 50%
of area) must be taken out of the door area and put into the window area on the schedule.
This window schedule must minimally show the dimensions of the rough openings of each
window, the model (casement, horizontal slider, single hung, awning, picture, etc...), and the
units tested U-value.
2) If you are complying to the WSEC by prescriptive path and are using the area weighted
averaging method you must include your calculations (worksheet).
3) Indicate type of hot water heater, location of exhaust fans (bathrooms, laundry, kitchen), the
location of your whole house fan, and all insulation levels (walls, floors, ceilings, and slab)
on your building plans.
4) Indicate how you will comply with the requirement for introducing fresh air to each habitable
room on your building plans (window frame vents, through the wall ports, or an integrated
system with your furnace).
5) If your home is 2,000 square feet or less, and using electric resistance heating (excluding heat
pumps) be sure to put your Social Security Number or Federal ID# on this form so that you can
receive the $900.00 "Payment to Owner at Time of Construction" rebate from your service
utility.
Using electric heating or a heat pump in your home???? You may want to talk to your service utility
regarding Long Term Super Good Cents incentives. Call PUD#3 at 426-0777 or PUD#1 at 877-5249.
If you need assistance in showing compliance to the WSEC please ask for the brochure "What You Need
to Know to Meet the Energy Code"; call the State Energy Office at 1-800-235-8248; or call and make
an appointment with Dan Fitchitt of the Mason County Building Department at 427-9670.
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
COMPLIANCE INFORMATION
TYPE OF PROJECT: ( ) NEW RESIDENCE ( ) ADDITION ( ) REMODEL
AREA (SQ.FT.) 1ST FLOOR 2ND FLOOR BASEMENT
TOTAL SQUARE FOOTAGE OF CONDITIONED AREA
COMPLIANCE METHOD:
() PRESCRIPTIVE PATH -- circle option -- I II III IV V VI VII VIII
Glazing percentage (total glazing area divided by total conditioned area)
( ) COMPONENT PERFORMANCE -- Chapter 5 -- attach documentation and worksheets
( ) SYSTEMS ANALYSIS -- WATTSUN 5.2 -- attach documentation and worksheets
HEATING SYSTEM:
ELECTRIC RESISTANCE
( ) Electric Central Furnace ( ) Electric Wall Heaters ( ) Baseboard Units
( ) Radiant Panels () Other
( ) 2,000 sq.ft. or less -- Name
SS or FED.ID#
OTHER FUELS
( ) Heat Pump ( ) Gas Furnace () Oil Furnace () Other
( ) Boiler System (indicate type)
Make Model
Size AFUE HSPF
VENTILATION SYSTEM:
( ) Spot and Whole House ( ) Central Ducted System () Integrated with Furnace
( ) Heat Recovery System (air to air heat exchanger -- heat recovery heat pump)
GENERAL NOTES:
Your building plans should indicate certain compliance measures: framing to be used (standard,
intermediate, advanced); type of vapor barriers being used; location of furnaces, hot water tanks and
other equipment; location of solid fuel burning appliances, fireplaces and their combustion air duct runs;
and termination points of exhaust ventilation fans.
� . 1.cu ia� Vl• l 1:,1�1'll 1 ,
WINDOW SCHEDULE
WINDOWS
Brand Model U-Value Quant. Size Area (Sq. Ft)
Ji
TOTAL WINDOW AREA
SKYLIGHTS
Brand Model U-Value Quant . Size Area (Sq.Ft)
TOTAL SKYLIGHT AREA
DOORS
Brand Model U-Value Quant . Size Area (Sq. Ft)
TOTAL DOOR AREA
I r
r 1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
PRESCRIPTIVE PATHS
OTHER FUELS (GAS, OIL, HEAT PUMP)
HVAC$ Glazing wall wag Ine wall ext' Slab$
Equip. %Floor Glazing Doors Vaulted Above Below Below on
Option Eft. Area U-Value U-Value Ceiling, Ceiling' Grade Grade Grade Floor Grade
I. Mod. 10% 0.70 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
if. KW. 12% 0.65 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
III. High 21% 0.75 0.40 R-30 R-30 R-19 R-19 R-10 R-19 R-t 0
N, sN �.. .x '!G1 < ,,:. -�St.'. Referencecase
V. Low 21% 0.60 0.40 R-30 R 30 R-19 R-19 R-10 R-19 R-10
VI.y Mod. 25% 0.50 0.40 R-38 R-30 R-19 R-19 R-10 R-25 R-10
V11.7 Mod. 30% 0.45 0.40 R-30 R-30 R-19 R-19 R-10 R-25 R-10
1 Miwnum requwomernsa for each option fisted. For sxw pio,ifa proposed design lea Floors over Floo over crawl spaces or exposed to ambiort air condtions.
a glaring ratio to he condAioned Vloor area ofIM t shall oomply with all of the
requiamerts d Me 21%glazing option(or higher). Proposed designs which cannot 6 Required stab porimneter inoulation shall be a wales ro start material,manufactured
meet the speafic requwwnants or a listed option above,may cakulato conpiance for its intended use,and installed according to manufadurses specfi-wions. See
by Chapters 4 or 6 of this code. section 602.4.
2 Requirsrtwrb applies to all owlings except single rafter or joist vaulted ceilings. 7 These options sha11 be applicable to buildings less than three stones.
'Add denotes Advarwed Framed Ceiling.
3 Requwartnent applicable only to single ratter or joist vaulted cein 8 This wall insulation requirement denoloo R-19 wall cavity insulation plus R-5 foam
gs. sheathing.
4 Below grade wale shall be ixulaled edhor on the exterior to a minimum level of R• 9 Minimum HVAC Equiprrert effKienxy requirement. town dendea an AFUE of 0.74,
10.a on tie interior to the same level so walls above grade. Exterior insulation 'Mod derwles an AFUE d 478. 'High'dendw an AFUE d 0.8a:
ietall.d on below grade web shall be a wwo reewtam melonal,manufactured for
Is inlonded use,and installed a000rding to the mrmtadurmis spocficudions. See
sodicxt 6022
ELECTRIC RESISTANCE HEAT
Glazing wail wag intt wall exC Slab$
%Floor Glazing Doors Vaulted Above Below Below on
Option Area U-Value U-Value Ceiling= Ceiling' Grade Grade Grade Floor Grade
I. 10% 0.46 0.40 R-38 R-30 R-21 R-21 R-10 R-30 R-10
If. 12% 0.43 0.20 R-38 R-30 R-19 R-19 R-10 R-30 R-10
Ill. 12% 0.40 0.40 R-38 R-30 R-21 R-21 R-10 R-30 R-10
:7
>. . .,,..... ..�<„. ,...,..,.. ................:..««. .. ,> .,.z>x.<...E31�.<..,� •;R`I�»;ant«1�i-3r�::�:�:x:�.1..a� Referents case
V. 18% 0.39 0.20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
V1. 21% 0.36 0.20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
V1I.' 25% 0.35 0.20 R-38 R-30 R-19+R-5' R-21 R-10 R-30 R-10
Vill.? 30% 0.32 0.20 R-38 R-30 R-19+R-5' R-21 R-10 R-30 R-10
1 Mffwmmrn requwerrwts for each option listed. For example,f a proposed design has 5 Floors over crawl sosoes or exposed to arrnbiont airoond6ons.
■glazing ratio to the conditored Vloor area of1M t shall oo"*with all of the
rsquwomerts of he 21%glenn9 option(or fighter). Proposed designs which cannot 8 Required slab psrknoter i oulation shall be a water resistant matsfim4 manufactured
meet the somata rmgtrwornerts of a)*ad option above,ley calculate conpiarwe for its irtordod use an, d nst"Od a000rding to m am4srfurses spocficationa. Soo
by Chapters 4 or 6 of he oode. section 602.4.
2 RoquWanniwts applies to apt coilings except single rafter or joist vaulted c dings. 7 Those options shall be
'Add doe too Advanood Frvred Gating. apPtK+bh to buildings has than terse stories.
6 Thia want iroula on mgtrwornwt denotes R.19 waH c"insulation plus R•6 foam
3 Roquirerrent applicable only to single rafter or pat vaulted coifings. shoathw+q.
4 Below grade walls shell be insulated other on the extaor to a minimum level of R-
10,or on the irterwr to the same level as walls above grade. Exterior insulation
instalhd on below grade wab shall be a www resiwwt material,manufactured for
Is intended use,and installed according to the menufacturees spoclicalions. Sea
section 602-Z
I L.1\1vll 1 ") rr.LJA-A 111)iN
yci a 15 43
#1 Owner Phone#
Site Address
City St Zip
Directions to Job Site '?
{
Owner Mailing Address
Cit St_ (>1�, si4
Lien/Title Holder E'5 ,)
Addres V-A
City St \A=.�. Zip 9tO- 5)541
#2 Contractor Name L�1 X '.y I ' R�i-a� �� np r1Contractor Reg# 1 J J__
Address__' .1 r,�� Expiration date
City St Zip Phone_;27.�; UCGO
#3 If septic is located on project site, include record
Connect to Septic?_ Public Water Supply
(If residential, proof of potable water may 1r
#4 Parcel No. ?..3 Z-Q -113 - DD
Legal Description P" ; OP AhA) '1 _
P
#5 Building Square Footage: (existing/proposed) Gw-
Ist Fl_ 2nd F1 ' / 3rd Fl / Loft /
Basement / Deck ' / #bedrooms_ ##bathrooms_L_
Garage /4g0 Carport / (Circle: Attached or Detached?)
Other sq f t /
#6 Use of building 451 pn'y t-- Describe work
#7 Type of Job: New ;—Add Alt Repair Demolition
Wcodstove Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river 1/ pond wetland seasonal runoff
other
Lot J=ensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Scale:
Name of Fronting Street
Date:
APPLICANT TO DRAW SITE PLAN BELO
� wo w
s.
r a
`APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
' I
I
fit ty
c
No. 1 Toilets u ���
- - Vent Syste_*i1s X 3 . 00
Bath Basins -P Vent Fans X 3 . 00
Bath Tubs oers C
Showers � No Bil / omPressors
1 Hot Water Htr �_ 0-3 HP - -O
Laundry Washer
f 3 -10 HP ---��
��Sinks
__�.
15-3 HP
30-50 HP --�0
Floor Drains
Laundry Basins 50 + gp
No. Aix Air Handling Unit
Dishwasher <- 10000 cfm.
Disposal > 10000 cfm.
—Urinals 7 • SL
Other
Other
Evap Coolers
Permit Basic Fee Hoods
— � Fire Suppression
TOTAL PLUMBING $
Domes. Incin.
COmml. Incin.
Mechanical Fixtures Reloc/Repair 6 . 0�
No. Peel Types Gas Outlets X 2 .00
Woods t ove �pa_rL-Q
Fern < 100K BTU _ 6 . 00 Furn >- 100K BTU 6 . 00 Other
Furn - Floor 6 . 00 Permit Basic Fee
mp
Heat Pus -3S01
--��- TOTAL MECHANICAL
ttr •`
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF WORK
CON OR COONSTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AN EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 AND AN AWARE IN THE STATE OF WASHING70N AND
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH I AM AWARE OF THE
ORDINANCE REQUIREMENTS REGULATING THE FORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST DEPARTMENT. OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT.
XOazL w� Aj XBY � -
DATE
DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584
427-9670/1-800-562 -5628
FOR OFFICIAL USE ONLY: Accepted by- � Date: �^' -1k
Approved Cond Hold
Approval
Planning:
i
Environmental Health: 1� M�
Building Plan Review:
Occupancy Group:
Fire Marshall:
Other:
FEES
(ISpecial Conditions: (( llSite Inspection ( ((
0 11 IlBuilding Permit
Il (56;t4- - 3 Z-b II II �1
II 11 11violation Fee I ((
11 11 II 'I
II 11 llViolation Investigation Fee 1 II
II 11 H 'I
11 11 II Plan Check
11
Il 11 11 Plumbing Fee I it
ii
11 H 'I
II 11 11Mechanical Fee i II
II 11 1 I
11 IlWoodstove Fee i II
11 1
11 IlBuilding State Fee I II
I I I
L1Building Valuation: /Z� , 5Sso 11 II TOTAL I ��5 0011