HomeMy WebLinkAboutBLD2011-00359 Final Replace MFG Home - BLD Permit / Conditions - 7/26/2011 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2011-00359
OWNER: ROSALIE SIMINGTON RECEIVED: 5/6/2011
CONTRACTOR: LICENSE: EXP: ISSUED: 6/3/2011
SITE ADDRESS: 121 E ERRIGAL PL SHELTON EXPIRES: 12/3/2011
PARCEL NUMBE
LEGAL DESCRIPTION: LAKE LIMERICK 4 LOT: 148
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
REPLACE EXISTING MANUFACTURED HOME WITH NEW HWY 3 TO MASON LAKE RD RIGHT ON DARTMOOR TO ERRIGAL
MANUFACTURED HOME
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 2 Type of Constr.: VB
Type of Use: MH Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:
Valuation: Building Height: 17 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make:CLAYTON Length: 52 Ft. Front: S 60.0 Ft. Shoreline: Ft. Water Body: CANBERRY CREEK
Rear: N 130.0 Ft. Slope: Ft. SEPA?: No
Model:FIRESIDE I Width: 27 Ft. Side 1: E 8.0 Ft. Shoreline Desig.: Conservancy
Year:2011 Serial No.: Side 2: W 8.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Mobile Home Submittal Fee GMM 5/6/2011 $264.25 S12011000i
EH Plan Review GMM 5/6/2011 $103.00 S12011000i
Planning Review Fee GMM 5/6/2011 $205.00 S12011000i
Mobile Home Issuance Fee LDK 5/26/2011 $264.25 S12011000i
Total $836.50
BLD2011-00359 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2011-00359
CONDITIONS FOR
BLD2011-00359
1) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at
(360)427-9670, ext. 450. The building permit will not be"finaled" until the permit holder can show proof that the access permit from Public Works has
bees d" and approved.
2) 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
1-8 - 4 . T e p rson signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
3) Ownei g nt is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
4) Prior to f al approval, all upland areas disturbed or newl created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
5) Ap a per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
6) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR WAY.
X
7) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
the a tructures meet the setback conditions listed.
X
8) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Appr d Site Plan" to ensure these structures are shown and meet the setback conditions listed.
X
9) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Managem A , its rules, and the Mason
County Shoreline Master Program. Cranberry Creek is regulated as a Conservancy shoreline environment. X
BLD2011-00359 Please refer to the following pages for conditions of this permit. VPage 2 of 6
10) The Mason County Resource Ordinance regulates the area within 200'of Cranberry Creek as a Fish & Wildlife Habitat Conservation Area. The
area between the ordinary high water mark(OHWM) and 15'waterward of the residence is considered to be a buffer to the creek. The 15'area
waterward of the residence may be used for lawns, patios, or landscaping. From that point toward the creek, is considered to be a required
vegeteted buffer and is regulated by the Resource Ordinance. Enhancement of this beffer with native vegetation is encouraged. Existing and
main a landscaping may continue. Within this chapter are those activities allowed within the buffer both with and without permits.
X
X
11) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. o f ndation drains within 30ft, down gradient of drainfield/reserve area.
X
12) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal of a roved documents will result in failure of required building inspections.
X
13) All approved plans are required 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. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
X rty pr�r tom rther inspections being performed or approvals granted.
14) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
15) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Buil partment prior to any further inspections being performed or approvals granted.
X
16) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State
Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present
to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified
installer responsible for each major part of the installation. RCW43-63B.090
An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily
located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each
installer performe o in ailed. certification number and signature of the certified installer responsible for each major part of the installation.
WAC365-210 X
BLD2011-00359 Please refer to the following pages for conditions of this permit. Page 3 of 6
17) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American
National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you
can con he Offfice of Manufacturing Housing (360) 725-2800.
X
18) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. 'NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic
system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contra����Ihat all components of the stormwater management system have been
installed as approved on the stormwater site plan. X
19) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
20) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved
access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such r Qs onnect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
IF
21) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
I
ermit o tion.
X
22) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all
responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the
inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason
County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been
discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy (Final
Inspection)will be granted for the residence.
OWN ER/CONTRACTOR(indicate which) Signature X
23) Applicant has indicated this is a replacement unit. Prior to Mason County al t �occupnacy of the new proposed unit, the existing unit which is
on-site and is being replaced MUST be removed from the parcel. X
24) This permit is for the acement and installation of the manufactured home only and does not imply approval or review for any other items indidcated on
the plot plan. X
BLD2011-00359 Please refer to the following pages for conditions of this permit. Page 4 of 6
25) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be locate thin 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.
X
26) Placeme t f structure must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
X
27) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinan r regulation, must be reviewed and approved by Mason County prior to construction.
X
28) 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 Building
Inspector sh I be de prior to requesting additional inspections.
X
29) Owner/applicant must obtain a seperate permit for the placement of any size propane tank serving a fixed appliance within a dwelling structure or unit
prior to the placement of the tank. X
30) All property lines shall be clearly identified at the time of foundation inspection. X__?_
31) 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 County ordinances and building regulations.
X
32) All permits 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�7 _
e revented action from being taken. No more than one extension may be granted.
X
It
33) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connect , and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X
34) Retaining walls needed to support a surch e u a tructures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
BLD2011-00359 Please refer to the following pages for conditions of this permit. Page 5 of 6
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 commence vidence 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 continua.on o 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 M son o access to the above described property and structure for review and inspection.
OWNER OR AGENT: DATE:
BLD2011-00359 Please refer to the following pages for conditions of this permit. Page 6 of 6
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ADDRESS:
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See Mason County
Manufactured Home Checklist (attached)
Review pages 9-12 for general
requirements and a manufactured home inspection checklist.
All decks, stairs and guards must meet minimum code requirements.
Useful details and information are attached to the checklist.
See also item numbers 1 , 30, 31 ,32,33,34, 35, 36, 44, 49, 53, 55, 56, 69, 96, and 110.
For information about skirting vents and crawl space access
requirements see item #51 and #60.
Site address must be posted see item #78.
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' '• � rl .,!assage Doors •32"LCD HDTV with Built in DVD Player
"fsjnded Drywall Corners •Stacked-Stone Fireplace Surround with TV Alcove
!DunN►orpe Shaker Beech Cabinetry "Fiberglass Oval Tub/Shower in Owner's Suite irrts
.Stainless Steel Kitchen Sink -Dual China Sinks Master Bathroom ♦,.� ,�
t +Cefamic Splash •Towel Bars and Tissue Holders
*Ceiling Lights(Double Bulb) -Main Water Shut-Off Valve
'Blushed Nickel Faucet Thru-out •9-Lite Rear Door
*Wall Oven&Microwave 'Recessed Front Entry
-Pot and Pan Drawers •2x8 Floor Joist
vElectric Glass Cook Top -Storage Bench in Utility Room
Side-by-Side Refrigerator 20cf -Painted Dining Room Feature Wall
PPot Scrubber Dishwasher •llaulcr Ceiling Fan with Light in Living Room
x:'..:'�Jtecessed Kitchen Lighting 116"Eave Front Door Sidewall
k'r •Curved Shower Rods -TV Jack(1), Phone Jacks (3)
''_'.vCFL Bulbs in all Light Fixtures *Hose Bib(1) & Exterior GFI(1)
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2,Paltol Passage Doors •32"LCD HDTV with Built in DVD Player
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:+ Dunthorpe Shaker Beech Cabinetry *Fiberglass Oval Tub/Shower in Owner's Suite nits
-Stainless Steel Kitchen Sink -Dual China Sinks Master Bathroom
-Ceramic Splash 'Towel Bars and Tissue Holders
' •Ceiling Lights(Double Bulb) *Main Water Shut-Off Valve
'Blushed Nickel Faucet Thru-out •9-Lite Rear Door
a *Wall Oven&Microwave 'Recessed Front Entry
.r. *Pot and Pan Drawers •2x8 Floor Joist
-Electric Glass Cook Top *Storage Bench in Utility Room
- -Side-by-Side Refrigerator 20cf *Painted Dining Room Feature Wall
!' PPot Scrubber Dishwasher •lluulty Ceiling Fan with Light in Living Room
Recessed Kitchen Lighting 116"Eave Front Door Sidewall 1
'Curved Shower Rods -TV Jack(1), Phone Jacks (3)
+CFL Bulbs in all Light Fixtures •Hose Bib(1)& Exterior GFI(1) a
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Name—> ,r l) nqAvo Parcel#32-1 2-1 G-s 001% BLD#
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Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface'.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings Z X =
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I
further ackno*ledge that the information provided is accurate and employees of Mason County are granted access to the above-
desc ' d prope fo eview and inspection as may be required.
V —51,-,W� Owner/Agent/Contractor(circle one)Date: `( 'l
If the Total Imperviou Surface Area is GREATER THAN 2000 Square Feet, please read, acknowledge and sign
the information provi ed on page 2 of 2.
Page I of 2
Nam � Parcel# BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
http//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850, Shelton WA 98584
Physical:415 N 6th St, Shelton WA 98584
If this development has,or will have,a septic/d ra infield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel. You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT.352
Mail:P 0 Box 1666,Shelton WA 98584
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
PERMIT NO
MASON COUNTY
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
APPLIC,gNT INF •RMAT ON CONTRACTOR INFORMATIO .
Owner ��- Z pyl r✓i_ L Company Name OC J� %X_�MS IA,)(- -
Mail' ddress C Mailir}gy Address �
City Stat Zip Code City� Z 4u 'State - Zip Code -31
Phon Oth r•Ph. Phon � Q Other Ph. _P56 Q
Lien/Title older 440 i Contractor Reg. #S tt vt Exp -/
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.#6644 Wtj:. DOB
SEPTIC/WATER SYSTEM I ORMATION - Connect to e S ptic Existing Septic Z,
Connect to Water System / Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No Fire District
Legal Description ��-- I "j
Site Address(Ple sp include stre t namp street number.and c ) A--
Directions to site LJ' 16 �Sd is _ lJ Cl r
Will timber be cut and sold in parcel preparation?Yes N
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal th result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New V Add Alt Repair Other ,er PRIMARY A SID NCE SEASONAL ❑
Use of Building Sr Describe Work
No. of Bedrooms No. of Bathrooms Z- Square Footage 11 st Floor '2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORM l!O - Make ' QL )�_ Model • YeaoYff
Length..�2 idth �_Serial No. ►- No. of Bedrooms o of Bathrooms 2—
Type of Heat urchas� Price$ �� 7�L Replacement Unit?�e211
Installer Name l� Certification No.
OWNER/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 worts as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the worts proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
P,15100F,OF CONTIN TlON OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
%lac- Date: '
Owner/Owners Re r sentative/ ontractor indicate which one
FOR OFFICIAL USE 6EYOND THI POINT Accepted by: Date `
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department y ZG 11 1.4/J
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation S TOTAL FEES