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Home My WebLink AboutCOM2010-00056 Final Change in Tenant - COM Application - 4/21/2017 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 + Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352 � Shelton,WA 98584 w i� COMMERCIAL BUILDING PERMIT COM2010-00056 OWNER: MCDONALD RECEIVED: 6/23/2010 CONTRACTOR: LICENSE: EXP: ISSUED: 1/25/2011 SITE ADDRESS: 22721 NE STATE ROUTE 3 BELFAIR EXPIRES: 7/25/2011 PARCEL NUMBER: 123325000063 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TRS A& B OF S 360, OF TR 26 PROJECT DESCRIPTION: DIRECTIONS TO SITE: CHANGE IN TENANT- BELFAIR TIRE General Information Construction &Occupancy Information Type of Use: Insp.Area: No. of Units: Type of Constr.: No. of Bathrooms: Occ. Group: Type Work: TRA Fire Dist.: 2 No. of Stories: Exit Design.Load: Valuation: Building Height: Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: Model: Width: Building: Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline&Planning Information Front: Ft. Shoreline: Ft. Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Side 1: Ft. SEPA?: Comp. Plan Desig.: Side 2: Ft. Fire Protection System Information Auto Fire Alarm System?: Emergency Key Box?: Standpipe?: Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2010-00056 Please refer to the following pages for conditions of this permit. 1 of 5 Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Tenant Review Fee TW A194/9n1n �1d1 nn C1gn1nnn EH Plan Review f 1:W 7/R/9n1n -t1n2 nn C1gn11nn IFC Plan Check Fee I AW 7/Q/?nln Ran rn C1gn1inn Planning Dept. Permit AHR 11/1Q/7n1 AR5 nn C1gn1inn Additional Plan Check I AIN 19/1/gn1n R7i nn C1,?n11nn Building Permit Fee r,Mnn 1/'A/,?n11 41d1 nn C19n11nn Building State Fee l MM 1/11/9n11 ed 5n S17n11nn Total $598.00 CASE NOTES FOR COM2010-00056 CONDITIONS FOR COM2010-00056 1) In stall a know box on the front of the building per section 506 of the 2006 International fire code. Please contact the local fire district for more information and insgpctions. X Maximum tire storage height is 6 feet, per the owner of the building (Jack Johnson)there will be no storage of any hazardous materials, oil, gas, anti-freeze, solvents etc. Also there will be no hot work done on site as definded in chapter 26 of the 2006 International fire code, welding, grinding, cutting etc.of an X Install 3A40BC fire extinguisher, one on each level with a maximum travel distance of 75 feet in any direction and mounted no more than 48 inches above the floor to the unit. X The building and the site are subject to inspections and corrections as deemed necessary by the Mason County Fire Marshal to insure the minimum fire and life safety r ements are met as adopted by Mason County. X 2) Contractor reg ration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982. Thep signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 3) All approved plans ar quired to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charge d collected by the Mason County Building Department prior to any further inspections being performed or approvals granted. X COM2010-00056 2 of 5 i 4) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. . X. 7 5) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND THE INTERNATIONAL CODE REQUIREMENTS AND OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF USE OR OCCUPANCY WOULD RESULT IN PERMIT REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x 6) Changes to approved building plans that affect compliance to the current Washington State Energy Code (WSEC), ventilation requirements), Building/Plumbing/Me hanical Codes and/or Mason County Regulations shall be approved prior to construction. X v 7) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Bui�pector shall be made prior to requesting additional inspections. X 8) All property lines shall be clearly identified at the time of foundation inspection. X 9) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason my ordinances and building regulations. X 10) All permi expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder hA evented action from being taken. No more than one extension may be granted. X � 11) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982. The person-signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 12) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 13) Prior to final approval, all upland areas disturbed or newly created by Qoaeoiction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 14) Parking shall be sufficient for 4 standard parking stalls (9 feet by 20 feet) and 1 handicap parking stalls (12.5 feet by 20 feet)with sufficient maneuvering aisles. Handicap stalls shall be of a smooth surface at level or ramped to entry, located closest to the building entry shall be signed with the International Symbol of Access. Screening from adjacent residential properties is required. 15) The applicant/business operator may store products in 24 ft deep by 30 ft wide canopy and fenced structure adjacent to State Route 3 but shall not store products, materials, and waste items outside of the building on the north side adjacent to Sweetwater Creek (not allowed in the buffer of this stream). X COM2010-00056 3 of 5 16) Approved per sions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X ^17) The applicant or owner sh ide landscaping shrubs and trees in the northeast area along State Route 3 frontage to separate this land use from road. This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended fora period of 180 days at any time after work is 'commenced. Evidence of continuation of work is a progress inspection 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 progress inspection.The owner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property an tructure for review and inspection. OWN ER OR AGENT: DATE: �-s COM2010-00056 4 of 5 0 ; CONCRETE MECHANICAL MANUFACTURED HOME n Dale By _ O CZ) Footings I Setbacks Gas Piping Ribbons 0 o Inters Date By Interior-Date By Data By D r rn Extenor Date By Exterior-Date Bt. up Point Load/Isolated Footings INSULATION Date By BG I SLAB INSULATION -- Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date. By Data By DECKS FRAMING Walls Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Late By Date By Type Date By D.W.V DRYWALL Type- n InL Brace Wall 0 Date By Date B Date By E y FINAL INSPECTINJI ION Water Line Fire Seperation C Date By Date By Date �, �� / B C Pass or Request Inspect. o Type of In'sp. Fail Date Date Done By Comments 0 Note: Setbacks are historical,- no further encroachemt allowed i o ee / I - ,*, C~ee Exist.FH 1200 gpm / �j "Building 2 h _ � � * C 14K,. ,1 10 j 1120.sf � � y � 5. /� I 12.232-50-00063 Mx tF .,, a.,;�• t xist.pnvement / r---1-1, /1 1 ��G� / CV/ i I 1 � � - Exist.ro approach d " 1 , a \hoot / Exist.drainfield I �z° •' / Site f Proposed x`enant Improvement 1 it 12232-50-00064 I / - Building 1 kX I� 568 sf sf I / Exist.septic tank IL �rc 4&-p From: Debbera Coker To: Allan Borden Date: 10/25/2010 3:04 PM Subject: Tire shop in Belf air I have sent over, via inter-office mail, a site plan prepared by Jack Johnson showing the proposed location for the metal carport for the tire store in Belf air. The tenant is concerned about the cost and I have told him that we cannot give him all $ amounts until A Borden has an opportunity to review. Please call me to let me know if he will need additional permits (DDR??) for the project. We will add the structure to COM2010-00056, unless you object. Debbera Coker Mason County Building Department Building Inspector IV/Code Enforcement Phone: (360)427-9670 ext 510 FAX: (360) 427-7798 e-Mail: DLC@co.mason.wa.us PO Box 186 426 West Cedar Street Shelton, WA 98584 Ce ll got i Note: Setbacks are historical; no further encroachemt al 40 ft± / eek / Exist.FH 12400 gpm 1 / Building 2 6 j 12232-50 00063 Z Exist.pavemenfi o Exist.ro nppronch / � I / / �y / i I i ti \ �aCj { r �otc Exist.drainfield i k�o • / 5 / Site f Pro osed /-tenant Improvement l / 12232-50-00064 APPROVED / - Building 1 M ON COUNTY DCD PLANNING 568 sf sf for ITE PLAN REQUIRED TO BE ON SITE CHA GE SUBJECTTOAPPRO YAL i > y Date Z y_i pa hz / Exist.septic tank RPM IN x Iti n7 1 West Coast Metal Buildings,Inc. �C SIE-11 tRBf FOR TJ%jSHW Opp 5073 Salem-Dallas Hwy NW Salem,OR 97304 CUSTOMER 21 _ Phone: 503-566-7788 ORDER 'rR MF Toll Free: 866404-7788 OtJW F x: 503-566-8833 "��FINSTALLAR ON CCB# 161581 S 4 DEALER FAX PHONE K&AN-3 7(DATE CUSTOMER NAME t/ c_.+- \\--%nnCj1A COUNTY,ZVG-� ADDRESS 2 !- 2 �TO� � 3 Y , 1�l a z y Street City l Stated Zip PHONE: WORK(.%0, Z?5`31473 HOME )'?��'�1��CELL ( ) WIDTH x LENGTH: 1 a k 14ga Price: All Orders C.O.D. LEG HEIGHT: t A-FRAME )ROUND) price $ ?7 VERTICAL: � ROOF ALL CERTIFIED: YES NO Total $sj- en�T ` I Down Payment d - Before taxes $ Balance Due at installation $ ROOF COLOR: TRIM COLOR: ELECTRICITY ❑YES ❑NO ❑CONCRETE AGROUND ❑WOOD LEVEL: IRLYES ❑NO Things You uld Know Please inform installers of any underground cables,gas lines,or underground utility lines.WE WILL NOT BE RESPONSIBLE FOR ANY DAMAGES. We are not responsible for permits or restrictions. •Land MUST be level or carport will be installed"AS IS"and any warranty will be null and void. •Down payments are required on all orders,payable to the dealer.Deposits are valid for 90 days. •WCMB will absolutely not be responsible for any refunds of the customer's deposit collected by the dealer. •A 50%fee will be assessed on cancellation of special orders. •If price discrepancy is over$50.00,WCMB has the right to cancel order. •WCMB is not liable for any damages as a result of inclement weather. •If you are not completely satisfied you must contact your dealer or WCMB within 10 days of installation. •Any preparation of the site by installers will be charged at$50.00 per hour(one hour minimum). •Installers will assess additional charges for building over any existing structure or object. •Certification price varies according to width and length of the building.Call WCMB for pricing. •Customer will pay 50%of the total to WCMB prior to any special order construction. •All repairs are done as a"Goodwill Gesture",there is no implied warranty or guarantee. •A service fee will be assessed upon WCMB returning to your site to add to your building. •Mobile Home Anchors will not be installed into excessively rocky ground.If anchors are still desired,the customer must assume responsibility for installation. INITIAL •Customer Service will contact you for installation of your building 1 to 2 days BEFORE DELIVERY. THREE(3)DIFFERENT GRADES OF BUILDINGS •GOOD-Our 14 gauge carport carries a 10 yyear limited warranty that covers rust through of framing and roofing material assuming normal care and maintenance are performed. •BETTER-Our 12 gauge carport carries a 20 year limited warranty that covers rust through of framing and roofing material assuming �pormal care and maintenance are performed. (v�EST-Our 12 gauge certified carport,the strongest unit available,carries the same 20 year limited warranty as our standard 12 gauge and AINMAL also comes with engineered stamped certification which guarantees that it will withstand specified wind and snow loads.Needed for permit. CCB# 161581 Wa#WESTCCM966MR We Accept ..-)Vustomer Signature ® visa Dealer Signature M V Cash or Personal Check CUSTOMER ORDER FORM(10/09) $25.00 Service Charge For All Returned Checks Case Activity Listing 11/19/2010 3:56:40PM 11 Case #: COM2010-00056 014 Assigned Done Activity Description Date I Date 2 Date 3 Hold Disp To By Updated Updated By COMA010 Application Received 6/23/2010 6/23/20110 None DONE TW 6/23/2010 TW COMB200 Environmental Health Review 7/8/2010 None DONE CEW 7/8/2010 CEW COMB009 Fire Marshal Review 6/23/2010 7/12/2010 None DONE LAW LAW 7/12/2010 LAW COMB110 Building Plan Review 6/23/2010 7/12/2010 None DONE DLC LAW 7/12/2010 LAW COMB 130 Planning Review 6/23/2010 7/23/2010 None DONE AHB AHB 7/23/2010 AHB Review included use activities outside of the building. AHB COMAI00 Approved for Issuance 7/28/2010 None DONE GMM 7/28/2010 GMM CALLED AND TALKED WITH VICKIE AT BELFAIR TIRE,LET HER KNOW THAT THE PERMIT IS READY TO BE PICKED UP,ALSO GAVE HER THE REMAINING AMOUNT DUE. COMA910 Meeting 10/25/2010 None DONE DLC 10/25/2010 DLC Tenant has been told by the fire district that the tire inventory needs to be contained in another area because of the hazard level. Based upon meeting with LAW and AHB the tenant proposes to install a manufactured carport structure. He was investigating the cost and liklihood of approval before submitting and committing to the investment. Because of location on the property a site plan was delivered to AHB to review and identify issues. When determined DC will call the tenant. � l ha7V 2 � 1 Pa 1 of 1 CaseActivity..rpt Provide a sign on or adjacent to the door L stating: "THIS DOOR MUST REMAIN O UNLOCKED DURING BUSINESS HOURS.' 7 The sign shall have letters not lees than 1" high,with a contrasting background. UBC 1007.2. JZ - am 1 Q, ? N H J B dr 0 IN P CT " t ,Fly- IV 6 "L O �c r i0R RF Rn.�.. p i ` xS N n N o , t � r SExit doors shall be openable from the insideSeparate permit without the use of a key or any specialknowledge or effort. The unlatching of any required for Signageleaf shall not require more than one operation. Provide lever o erated hardware. UBC 97 100 . .8Ifa� tHIrkK V V t bL-,rC?PSt Q. S"�=' '� Z�400 sq, �t MASON BUILDING INSPECTOR v1nccMbAaar-tLW\ 1L o,6 CH S SUBJECT TO A PROV L DATE a _ Xt ` U"` _ J,r_�"\ Direction: Scale: Approval:for once use Building Permit nurnbe CJ�^'� ts'�`f Building: Owner/Applicant: Date of Planning: application: Env.Health: Parcel Number:,�23 3 Z� 5 d ' ticx�54! ram N rownt SAM cedes nm t E nro FAIM 9 pacific Fl In 2a NW,WA�2l �� tenter May 14,2004 To whom it may concern, The PNWSC has allowed and provided to the Hood Canal Watershed Project Center and their Washington Service Corp's AmeriCorps program the use of the described building to articulate and cast a 30 foot grey whale skeleton. There is no monetary reimbursement and all costs associated with their project are donated from within the community. Parking is provided and accommodated at the Mary E.Theler south parking lot adjacent to said property and restroom facilities are also provide by the Mary E.Theler Center which are ADA accessible. This property is scheduled for demolition in the near future and there is no interest from the PNWSC to rent it in the future. This is strictly a community support project. Respect submitted, Neil W.Werner President Pacific Northwest Salmon Center RE CE;VEn MAY ) 426 �A ACCESSIBILITY DESIGN FOR ALL . 0 PARKING SPACE e PAVED WALKWAY TO To minimize travel distance, accessible parking It Is Important that the curb ramp which connects BELHOW INTERNA ONAL BUILDING CNTR.NCC must be located in those parking spaces nearest parking space to a walkway be aligned with,and SYMBOL the accessible entrance.The wider space Is essen• be a continuation of,the access aisle,to prevent tial for a person to transfer Independently from a Its obstruction by vehicles. wheelchair to an automobile,or to operate a van lift. Section 1107.3 of the regulations states that every Because these functions are very difficult to perform barrier•free parking space Is required to have a sign E on slopes,the surface may not slope in any direc• 'centered between 3 and 5 feet(915 mm and 1525 tlon more than 1:48. mm)above the parking surface....'Literally Interpret- The accessible parking space must have direct ed,this language can be understood to limit the sign E access to the walkway, to avoid the hazard of placement to a location centered at 4 feet above the entering the vehicular roadway.Where there Is a surface. The Intent, however, is that the sign be grade separation between the parking space and the mounted with the center from 3 feet to 5 feet up;II E walk, a curb ramp or cut must be provided. Out maybe at3 feet or at 5 feel,according to conditions, ramps must not project Into the parking space or the or anywhere between. access aisle.it is very important to place the signage as specified, so that parking space can be found RESER��D E easily. It is recommended that a large Symbol of Ir sY TC 9 Y SIGN WITH INTERNATIONAL E Access(white on a blue background)also be painted PARKING SYMBOL of ACCESS b—CrYWO TO b'AC i L on the parking surface,further to discourage use of ) ABOVE GRACE the space without the required state permit.However, R each space Is required to be Identified by a •INTERNATIONAL SYMBOL or permanent posted sign at the head of the stall.A ACCESS PAINTED ON PAVING new requirement in the 1992 regulations,and In the rIRU19 '1 COSOVO OLrH NT r Americans with Disabilities Act of 1990,is for-van MORC THAN IIAb accessible' parking spaces (8 feet wide with an 8- foot-wide access aisle adjacent),and a sign with the L .WALKWAY STRIPES PAINTED t words,*van accessible,'mounted below the standard ON SURFACE TO DISCOURAGE t at PARKING VIOLATION �16 1••I min1•°I min. sign, This is required for all parking excep °^ '►°°' s r..I min. I ' residential_occupancies,and is recommended there. also. I The adjacent drawing indicates some alternative ar• rangemenis for adapting standard parking spaces.It a areasonable pedestrian use simultaneously the extra width th a xtra spcewalkway.It also Is possible to share rL q b e the extra space with the adjacent parking space,thus iLLPII� � o giving the person who is using a wheelchair the o option of entering the automobile from either side. ONE TWo THREE FOUR ACCESSIBLE A SI Where a fire lane is required between accessible cccssleL ACCESSIBLE SPACES sr.crs SPACES parking space(s) and the accessible building en• SPACE trance(s).a designated pedestrian walkway must be I I I STANDARD 8'-0• b Acc 5I provided. WITH ACCESS AISLES AS SHOWN MASON COUNTY com CHANGE IN TENANT APPLICATION Complete the Change in Tenant Application and return with a floor plan,site plan,septic pumper's report,septic records and fee to the Mason County Permit Center,P.O.Box 186,Shelton,WA 98584. Evaluation of the Change in Tenant Application will involve staff members from the Building,Fire Marshal,Environmental Health,Planning and Public Works offices who will identify compliance requirements. This application is intended for tenant change only. If construction or remodeling is proposed or required a building permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued,schedule an inspection by calling(360)427.7262.Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a conspicuous place on the remises. r :fYf? pPRT.YJtB'.f�. l :wti } ti Date: p Assessor's Parcel Number: o C oa Legal Description: - Building Site Address: Method of sewage disposal: A114 O Septic O Sewer—name of district: Water source: O Individual Well O Community Well 17 Public System,name of system. Name of Applicant: L Mailing address: S 2FAL,—eCrdt/-4 City: St te: u,4 A Zip: f'Z Day phone: Contact Person: eiL /irl Qti Message phone: Proposed business name: d,� Proposed use: Number of employees: g Previous business name: A.51c.- Describe previous use: Check one: etached single level/single tenant O Single level/multi tenant j O Multi level/single tenant O Multi level/multi tenant _ Age of structure: Is structure currently If not occupied,how long has it been vacant? r occupied? Yes ® Yr. / Mo. Square footage: I Basement; I First: en Mezzanine: Second: Third: Is the structure heated? I Heating type:Circle one: Circle one: Yes Electric Liquid Propane atural G Oil Type of heat:Circle ondC_Eurn`ac Heat Pump Electric baseboard or wall mount Radiant Will there be any changes to the following?Circle yes orno,If applicable: Floor lay-out: Yes CM> Lighting: Yes 9W Heating:Yes Q Exterior Finishes: Yes t&Z'— Interior Finishes: Yes 4a Parkin :Yes C6 Number of restrooms provided: 6 1 Number of fixtures in each Is structure handicap accessible?Circle on No _ Is the structure equipped with afire sprinkler system? Yes Fire alarm system? Yes Monitoring Station Name: Phone number: s' RL1�.�ltT�Q•�I,YUJt,4.: Q. ��. .Af�1l�I�b�iTi�uT, ,q? :;;. , 1.VRe ( ): o to scale Use of rooms • nsl sLocation of all exits and windows(include dimensions) lumbm and mechanical fixtures Interior doors with swing radius 2. Site Plan(5 sets): Note scale used • Property lines,easements,&right of ways Location of all existing structures&dimensicRE C E I V E Distance,In feet,from property line&structures • Landscape buffer yards • On-site sewage tanks and drain fields,&reserve Well location MAY 14 200 • Location of fire hydrants&vehicle access roads • Parking areas number&arrangement) _ _ 3. Septic records,pumper's report or O&M report. 426 W_CEDAR 6T. 4. Fees will be collected at time of submittal {�Accepted by Date Submittal Amount$ Receipt number Department Review Initials Date Comments Building Envirournental Health t/ v 44, htWat For �. Fire Marshal Planning Public Works Occupancy Change? (circle one) Yes No Type of construction Occupancy classification change from to Occupant load calculated: persons Existing occupant load design persons. Land Use Designation: Occupancy Classification: MASON COUNTY CHANGE IN TENANT APPLICATION Complete the Change in Tenant Application and return with a floor plan, site plan, septic pumper's report,septic records and fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. Evaluation of the Change in Tenant Application will involve staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices who will identify compliance requirements. This application is intended for tenant change only. If construction or remodeling is proposed or required a building permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule an inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a conspicuous place on the premises. PROPERTY INFORMATION Date: Assessor's Parcel Number: 1.2212,2_ O—ppD6, Legal Description: o T a Zr- Building Site Address: a7 t ' Method of sewage disposal: O Septic O Sewer—name of district: Water source: O Individual Well O Community Well O Public System, name of system: PEOPLE INVOLVED IN THE PROJECT Name of Applicant: � `—_-- �--"---�--- Mailing address: City: State: Zip: Day phone: Contact Person: Message phone: PROJECT INFORMATION ` Proposed business name: Proposed use: Number of employees: Previous business name: Jp�J��, s —s `w reed Describe previous use: �o„s�s'�e o., � Q r�� — ��4 C— STRUCTURE DETAILS Check one: C6-Detached single level/single tenant O Single level/multi tenant O Multi level/single tenant O Multi level/multi tenant Age of structure: Is structure currently If not occupied, how long has it been vacant? occupied? Yes No Yr. Mo. Square footage: Basement: I First: ) 0 Mezzanine:SG g5j Second: Third: Is the structure,heated? Heating type: Circle one: Circle one: Yes No Electric Liquid Propane cvtural Gas Oil Type of heat: Circle one: Furnace Heat Pum Electric baseboard or wa m adiant Will there be any changes to the following? Circle yes or no,if applicable: Floor lay-out: Yes Lighting: Yes Heating:Yes MID Exterior Finishes: Yes o Interior Finishes: Yes E Parking: Yes o Number of restrooms provi ed: I I Number of fixtures in each Is structure handicap accessible? Circle one Yes No Is the structure equipped with a fire sprinkler system? Yes Fire alarm system? Yes N Monitoring Station Name: Phone number: APPLICATION,WILL NOT BE ACCEPTED WITHOUT: 1. Floor Plan(5 sets): • Draw the floor plan to scale 0 Use of rooms • Room Dimensions • Location of all exits and windows(include dimensions) • Location of plumbing and mechanical fixtures • Interior doors with swing radius 2. Site Plan(5 sets): Note scale used • Property lines, easements, &right of ways • Location of all existing structures&dimensions • Distance, in feet, from property line&structures . Landscape buffer yards • On-site sewage tanks and drain fields, &reserve • Well location • Location of fire hydrants&vehicle access roads I e Parking areas number&arrangement) 3. Septic records,pumper's report or O&M report. 4. Fees will be collected at time of submittal Official Use Only Accepted by Date Sllbmittai Airiouflt Reccipt number De aitment Review initials Date Comments Building 7 1Z_ 0 Environmental Health Fire Marshal Planning Public Works Occupancy Change? (circle one) Yes No Type of construction Occupancy classification change from to Occupant load calculated: persons Existing occupant load design persons. Land Use Designation: Occupancy Classification: