HomeMy WebLinkAboutPermit File 2006 29th Place O t Y OF CITY OF ANACORTES
wA3HINGTON
eBUILDING DEPARTMENT
9C
CERTIFICATE OF OCCUPANCY
This is to certify that the(Description of Building or Structure):
Single Family Residence
IILocated At: 2006 29th Place
STREET B NUMBER
Owner: R&M LLP
Constructed By: Owner
OWNER,OR CONTRACTOR
Bldg. Permit#:
SLD 200`i�f1187
k':, Date Issued: Hay 20, 2005
r Occ. Group: R3 Use Zone: R2
Has Been Inspected And Occupancy Is Hereby Authorized.
i ,
pecember 05
1'": This 13th Day of 20
z. .ti C
t, 'pT oRIiINR OFFICIAL
- SEE REVERSE SIDE FOR SPECIAL REQUIREMENTS. GG
y
i::;
:::! !:::
CERTIFICATE OF OCCUPANCY
This is to certify that the(Description of Building or Structure):
f" Residence
; Sin81e 'r`aat ly
1:"''
Located At: 2006 29th Place '�
STREET&NUMBER
Owner: R&M LLP
t
Constructed By: Owner
OWNER OR CONTRACTOR
Bldg. Permit#: BLD-2001-®187
Date Issued: May 20, 2005 ,'
` Occ. Group: R3 Use Zone: El
4i'
Has Been Inspected And Occupancy Is Hereby Authorized.
This 13th Day of December 20 05
Q mAis liai OFFICIAL
SEE REVERSE SIDE FOR SPECIAL REQUIREMENTS.
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CITY OF ANACORTES "AS-BUILT" pf Sewer
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NTRACTOR: e; /2 C (/J r `i h? COL,
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PLAT/DIVISION: ;r ! a,; C C'f-.e L.,'v '= r,✓ BLOCK A
LOT ADDRESS: %{n �' 7 K i u/
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DATE: � ,�
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PERMIT# JL O )0b U -Q J iSCALE
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05140004-1 0004 05/20/2005 002 4
C Y O r. Cityof PerPermit Fee_ 0061 $9,'971 .73
G Anacortes Permit#: BLD-2005-0187
904 6th Street Issue date: 05/20/2005
P.O.Box 547 Expire date: 05/20/2006
`r' t/s' Anacortes, WA 98221-0547
Job Address: 2006 29TH PL Permit Type: Single Family Residence Permit
ANACORTES WA 98221-3870 Project:
APN:
Remarks: Construct new single family residence per approved plans as noted
Owner: R&M LLP Contractor: H R CHRISTENSON CONSTR LLC
Address: 4620 HICKORY DR Address: 4620 HICKORY DR
ANACORTES WA 98221-8729 ANACORTES WA 98221-8729
Phone: (360)661-3594 Phone: (360)661-3594
' License#: HRCHRCL990BE
General Information: Fees:
Lot Area 10049 Plan Review Deposit 100.00
1st Floor Square Footage 2895 Building Permit Fee 890.50
Lot Coverage 37 Plan Review Fee 478.83
Garage Square Footage 676 Mechanical Permit Fees 121.90
#of Stories 1 Plumbing Permit Fee 139.00
Building Height 17 State Building Code Fee 4.50
Building Valuation 282246 Sewer Inspection Fee 50.00
# Forced Air Furnace<=1,000 1 Storm Drain GFC-Residential 1,126.00
#of Backflow Devices 1 Sewer GFC-Residential 5,646.00
#of Bathtubs 2 Park Impact Fee 615.00
#of Clothes Dryers 1 Traffic Impact Fee 900.00
#of Clothes Washers 1 Total Calculated: 10,071.73
#of Dishwashers 1 Deposits/Receipts: 100.00
#of Gas Fireplace 1 I
#of Gas Piping 4 Total Due: 9,971.73
#of Gas Water Heaters 1 I
#of Hose Bibbs 3
#of Kitchen Sinks 1
#of Lavatories 4
#of Other Mechanical Units 1
#of Showers 1
#of Ventilation Fans 5
#of Water Closets 3
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL
PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR
NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER
STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
eC.....s......,
RE OF OWNER OR AUTHORIZED AGENT ISSUED BY
1
0511504-1 0011 04/25/2005 002 4
Permit Fees 005986 $87.83
GZT Q�., City of Anacortes Permit#: BLD-2005-0293
904 6th Street Issue date: 04/25/2005
P.O.Box 547 Anacortes, WA 98221-0547 Expire date: 04/25/2006
Job Address: 2006 29TH PL Permit Type: Foundation Permit
ANACORTES WA 98221-3870 Project:
APN:
Remarks: New single family residence-foundation only.
Owner: R&M LLP Contractor: HR CHRISTENSON
Address: 4620 HICKORY DR Address: 4620 HICKORY DR
ANACORTES WA 98221-8729 ANACORTES WA 98221-8729
Phone: (360)661-3594 Phone: (360)661-3594
License#: HRCHRCL990BE
General Information: Fees:
Building Valuation 5000 Building Permit Fee 50.50
Plan Review Fee 32.83
State Building Code Fee 4.50
Total Calculated: 87.83
Deposits/Receipts: 0.00
Total Due: 87.83
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL
PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR F
NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER
STATE OR LOC L LAW REGU NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
1
I ❑ F OWNER OR AUTHORIZED ISSUED B Y
•
CITY OF ANACORTES BUIDLING DEPARTMENT RESIDENTIAL
CHECKLIST
(This form is to be completed plot to issuing the building permit)
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Site Address: 4)-00 a at IL l_ I Data u T " r
Contact Person: ^"^- Phone No.:G
Assessors No.: Lot: 7'1•7 Block . - Addition: QU-4u-.r
(Building Department Checklist for Completeness)
•
OS NA OK NA
❑ - Fire Department Access 0 Fire Hydrant Located within 250 feet
O Fire Flow Required ❑ Shoreline or Wetlands
O Site Plan ❑ Covenant Approval
• 0 Variance Required ❑ Regulated Slopes "
❑ Plat Facts and Findings Compliance ❑ Survey in File
❑ Fill on Site
Received and Reviewed by: . Date: k`1 `v <.
(Engineering Department Checklist for Completeness)
OK NA OK NA
❑ Water Extension/Meter . 0 Sewer Extension/Connnection
O Street Improvements/Sidewalks Z ❑ Site Drainage Plan
❑a Ars Covenant Not to Oppose Future LID" ❑ Latecomers Agreement
0 ❑ Street Drainage ❑ Driveway location,slope,culvert
❑ ❑ Storm Drain Extension
Received and Reyieweq by: Data "(-6 v D )
rIPURTHER COMMENTS1
Zoning:lR.-2,
Lot Size: Uj O' 7 S
Coverage Allowed: 3 7 a/b — bc-w;'R^ �t `"
II �c-08=04-2 0005 07/25/200`5 002 4
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`�' Site Address: (`'//�;.i7�'d�,,P j� #) �OQCO
a C1 Parcel No.:
IV
\ Lot: 40-.Qb Block: Div: Addition:
te\\ .2. .. . 'Y..i.. - :e lORNAic. 'al'wn -. . , ..
�A" Name Name Name
V. KtM N2 ent snalasaLl ('At.1,6L1 I ri
Mailing Address Mailing Address Mailing Address
sst' 421.0 litCAt t52y tW.w
`a 4W2p Iltuc�Ry O2tvE
City: State: Zip: City: State: Zits: City: State: Zip:
AtsAc,02-ces. wp, G82.'Lt AtJACoo-1ES, W16r 961lt.
Contractor Lie.No.:WP_C.MM2C. .,R9 Tp t3E
Phone No.: Le to t- 359 4- Phone No.: Phone No.:(ate 1-3-St4Exp Date:
Contact Person: At. TAy; nFL Phone No.: S5C o-too;tp
d- ' - n W.:.x:R7Xt '.' a " � At a : ;r: ': - .yvc � �ri �''n AK :t: i
(Check One)
Single Family: "Multi-Family: Apartment: Condominimum: Senior Housing: Retail: Office:_Restaurant:_
Manufacturing: Storage: Bank: Assembly:_Accessory: Automotive Repair: Other(Specify)
DESCRIPTION OF WORK: GOt.I ST taucT SI rd&t FADAt t.-y CLestc -pjcE (f ZPa4 o4r)
sa:t, s�»�:lsrr;�; :.:r,:�•,..:n.s: ,ew`� sv �'"4�it - ss. ...,
t yn >#}�, .5<;``f x..v 4 +a$jd. p.,-,A it . +F::.s,<i`Sl+. 'sv C.,+k.`.'.vZ.:' _ry `ay: l �.i
t'4`:i.°.C.cB•;i?.`'Zxri'a.'�'�:`2.v�.".S�°>...>`:Ri.,.'F.�?q?:., q,.tir`� ¢v�¢]�.�i4y('A �,{y����y S '�!'�'�ryg�,4: `P Rry 'Ka.' ��}$, 1`i.. l t�,"'
i .... .H. Sv4!M.�` tY 'AiX.-' � �` +.6:!0 h .S.e„S b �e�a.,�,.,.v. `l�:�ay"r�i:t � �}yi�n' 'Y '.R�'..".t�>'„,'�d
Street Setback: _2 of ft. 2"d Floor: sf. (Circle Y or N)
1"Side Setback: 1.5' ft. 3'd Floor: sf. Shoreline/Wetlands Y N
2"d Side Setback: 1.5' ft. Basement: sf. Water on/Adj.To Property Y N
Rear Setback: to' ft. Occ.Group: Soils Report Y N
Use Zone: Carport Area: sf. Sensitive Area Y N
Type of Construction: l Garage Area: -I L3 sf. Latecomers Agreement Y N
Lot Area: la,044 sf. No.of Stories: I /5;9-ble Fire Hydrant(250 Feet) Y N
No.of Dwellings: I Building Height: t ( 1' Variance . Y N
Lot Coverage: 37°/e Deck Area: sf. Covenant Y N
18`Floor 2-0ga sf. a(o(o,rim.el Flood Zone X A AE VE
n i r�p�P1-I
Project Valuation(Labor and Material Cost): <YOOC (p
THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING CODE,AND SHALL EXPIRE BY LIMITATION
AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY AFFIXING MY SIGNATURE I HEREBY CERTIFY THAT I '
AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS \
AND ORDINANCES GOVERNIN IS TYPE OF WORK LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTIONS. n\n
SIGNATURE: -_ DATE: i%%i(3G J UVV
Itit,(%2: % J/!ce/ /sue 42 o5 n
gyp- 2oo3"10/8>7
(1') (--)
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,
-9 (I a dc7 9' oe,Site Address: CO - — Parcel No.: ,1, .‘d-2 R. [.-_'.
Lot(s): Ma- 2C) Block: Addition:
Contact Person: AL TP:i Lott Phone: BSC°- tc1c1t4,
-:t:1: 11:KaaiRtAg.?.../Matc`kilifFt/-": 0;1:1‘12::5::P:::!-RINVigi;i:Cilil;i1,21P104trUfig}r7WWWW,5114.3,-*,;:1;1;frS4Iti
Name: Rs1P.M Name: Ye- CACAss-11,644sota C oNtst L-A...C.,
Mailing Address: 14PW 41tctoe•-f DalVe Mailing Address: 4(021? IA lett)IN IX-WC
City: AKA°,OTESState: WA Zip: qessa.1 City: Da....115,C0Prt-S State: 6.3p. Zip: Ciea.2.1
Phone No.: (plot- .
_Ill 4 Phone No.: Lela I- '2a:i 4
f.''..AbIky:TAF.,`Z,11.:V,,11-1:opisr‘r:cP is:W l`;',ti“:1:4.;T:,,IZ,M-4,:,$:3Y1,:;11:61;cZ,kt:',Y:A,E.:-:i. Weill.: 1 0All'Ibtt.s;;':i ',:fri4cM4..Zo;zf.r.treg
No.: Type of Fixture No.: Type of Fixture
5 Water Closet 1.5 GPF
I Air Cond.Unit HP
Bathtub t-
Refrigeration Unit HP
2._
Shower 2.5 GPM Boiler BTU/HP
[1:)
( Dishwasher 2.5 GPM I Forced Air System BTU -78.1 ics
4
Lavatory 2.5 GPM -81- Floor Furnace
I Kitchen Sink 2.5 GPM
.8- Wall Heater
Clothes Washer I Clothes Dryer
[
Urinal 1.0 GPM.0-
Ventilation Fan 4
1
- Drinking Fountain Range Hood
IS-
-0- Floor Sink or Drain
-G- Pre-Manf.Stove or Fireplace
I Water Piping
I Gas Fireplace
3 Hose Bibs Gas Water Heater
I ,
i Back Flow Prevention Device I Gas Piping
Other(Describe) Other (Describe)
kN[N
HMS APPLICATION IS RECIVED BY THE BUILDING DEPARTMENT UNDER THE PROVISIONS OF THE UNIFORM PLUMBING AND MECHANICAL CODES AND SHALL EXPIRE BY
LIMITATION AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY AFFIXING MY SIGNATURE I HEREBY CERTIFY THAT I \...,
AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS AND ..3
ORDINANCE COVERING T TYPE OF WORK WILL BE COMPLETED WITH,WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTION I
SIGNATURE: DATE C )
3/ 05
L1/GG/V4 Elul' 11 :J1 VAS JOVGVOLUJO CACUU11YC IQJUVL
- ( )
•
; '- Residential Energy Code
(Simple Form)
•
2003 Washington State Ventilation&Indoor Air Quality Code
2003 Washington State Energy Code
This worksheet Is intended to assist you In deciding which methods of construction will be used to meet the requirements of the
• WA ST VIAQ and WSEC Codes. After completing this form,please add all relevant information to your construction plans.
PART 1 •
Whole-House Ventilation:select one of the following methods.
_,. Fresh air will be dreulated by the central forced air furnace along with a whole house exhaust fan. A single whole-
. . house exhaust fan,which usually does double duty as a room spot fan,is required and must be controlled by a timer
set to operate tan a minimum of 8 hours per day. The CFM capacity of the fat must be measured at 0.25 w.g.and
have a maximum sone(noise)rating of 1.5. Fresh air intake ports or ducts are required with this option. (WA VIAQ
303.4.1)
The minimum size of the fan is based on the number of bedrooms and the size of the house. For houses up to 3,000
square feet the following sizes are acceptable:
_1 or 2 bedreams-75 CFM •
3 bedrooms-90 CFM
• _4 bedrooms-105CFM
• For other options contact the Planning 8 Permit Center.
A.B. Fresh air will be circulated by the central forced air furnace system. The furnace must have a fresh air intake duct and
• the blower must be activated by a timer to circulate air daily. An exhaust fan is not required with this system. (WA
VIAQ 303.4.2)
C. Fresh air will be supplied by wall or window vent ports in each bedroom,kitchen,living room and other.habitable moms
along with a whole-house exhaust fan as described in Option A. (WA VIAQ 303.4.1)
_D. A heat-recovery ventilation system.(WA VIAQ 303.4.4)
PART 2
•
insulation and Windows:select one of the following methods. (WSEC Table 6-1)
• Glazing% Li-factor Ceiling Vaulted Walls Floor Slag
•_1. (2x4 construction) up to 12% 0.35 R-38 R-30 R-15 Ft-3O R-10
L2. (2x8 construction) unlimited 0.40 R-38 R-30 R-21 R-3O R-.10
If you intend to use 2x4 construction,compute the window glazing percentage of heated floor area to
verify that the project falls below the 12%maximum allowed glazing:
Total area of windows,skylights and patio doors: sq.ft•
Total heated area: sq.ft. t'
.Total window area divided by total heated area=glazing % p,
,
Updated:August 24,2004 Page 1 or 2 • L - '�'��„`
Residential Energy Code
'`°" (Simple Form)
2003 Washington State Ventilation &Indoor Air Quality Code
2003 Washington State Energy Code
This worksheet is intended to assist you in deciding which methods of construction will be used to meet the requirements of the
WA ST VIAQ and WSEC Codes. After completing this form, please add all relevant information to your construction plans.
PART 1
Whole-House Ventilation: select one of the following methods.
A. Fresh air will be circulated by the central forced air furnace along with a whole house exhaust fan. A single whole-
house exhaust fan,which usually does double duty as a room spot fan, is required and must be controlled by a timer
set to operate fan a minimum of 8 hours per day. The CFM capacity of the fan must be measured at 0.25 w.g.and
have a maximum sone(noise)rating of 1.5. Fresh air intake ports or ducts are required with this option. (WA VIAQ
303.4.1)
The minimum size of the fan is based on the number of bedrooms and the size of the house. For houses up to 3,000
square feet,the following sizes are acceptable:
1 or 2 bedrooms—75 CFM
3 bedroohu—90 CFM
4 bedrooms—105 CFM
For other options contact the Planning&Permit Center.
_B. Fresh air will be circulated by the central forced air furnace system. The furnace must have a fresh air intake duct and
the blower must be activated by a timer to circulate air daily. An exhaust fan is not required with this system. (WA
VIAQ 303.4.2)
_C. Fresh air will be supplied by wall or window vent ports in each bedroom,kitchen,living room and other habitable rooms
along with a whole-house exhaust fan as described in Option A. (WA VIAQ 303.4.1)
D. A heat-recovery ventilation system.(WA VIAQ 303.4.4)
PART 2
Insulation and Windows:select one of the following methods. (WSEC Table 6-1)
Glazing% U-factor Ceiling Vaulted Walls Floor Slab
_1. (2x4 construction) up to 12% 0.35 R-38 R-30 R-15 R-30 R-10
2. (2x6 construction) unlimited 0.40 R-38 R-30 R-21 R-30 R-10
If you intend to use 2x4 construction,compute the window glazing percentage of heated floor area to
verify that the project falls below the 12%maximum allowed glazing:
Total area of windows,skylights and patio doors: sq.ft.
Total heated area: sq.ft.
Total window area divided by total heated area=glazing
Updated: August 24,2004 Page 1 of 2
d \ /
INSTALLER"S CHECKLIST
6 mil black polyethylene covers the crawlspace area.
R-10 insulation is installed at slab perimeters or beneath full slab if radiant heat is to be installed.
Windows of correct U-value are installed. Window vent ports,if they will be used on this job, are installed.
Openings around ducts,wires and pipes are sealed with caulk or insulation.
Waterlines in unheated areas are insulated.
Heat ducts are insulated to R-8 and exhaust ducts are insulated to R-4.
Whole house fan, if required,with a sone rating of 1.5 or less is installed,with timer or dehumidistat.
Windows and doorframes are sealed to prevent air infiltration.
Exterior doors are weather-stripped.
Baffles to maintain vent openings in ceiling are properly installed.
Correct insulation R-value is installed in the floor,walls and ceiling.
Insulation is installed behind partitions and in corners;fitted around wiring and pipes.
Insulation is installed behind bathtubs and showers.
Openings around interior plumbing pipes in exterior walls are sealed.
Furnace is the correct size.
Interior doors are undercut to allow air movement.
Exhaust fans terminate outside the building.
Showers and lavatories have 3 gpm flow limiters.
li
Updated: August 25,2004 Page 2 of 2
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NO: Type of Fixture NO: Type of Equipment
Water Closet 1.5 GPF Air Cond.Unit HP
Bathtub Refrigeration Unit HP
Shower 2.5 GPM Boiler BTU/HP I
Dishwasher 2.5 GPM Forced Air System BTU
Lavatory 2.5 GPM Floor Furnace
Kitchen Sink 2.5 GPM Wall Heater '
Clothes Washer Clothes Dryer
Urinal 1.0 GPM Ventilation Fan
Drinking Fountain Range Hood
Floor Sink or Drain Air Handling Unit CFM 1
Slop Sink Pre-Mae Stove or Fireplace
Water Piping Gas Fireplace
Hose Bibs Gas Water Heater 1
Back Flow Prevention Device Gas Piping
Other(Describe) Other(Describe)
GAS: ELEC: OTHER:
THIS VED BY THE BUILDING DEPARTMENT UNDER THE PROVISIONS OF THE UNIFORM PLUMBING AND MECHANICAL i
CODES AND SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS
APPLICATION. BY AFFIXING MY SIGNATURE I HEREBY CERTIFY THAT I AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS
APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS AND ORDINANCE GOVERNING THIS TYPE OF
WORK WILL BE COMPLETED WITH,WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTION.
SIGNATURE: DATE:
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Site Address: Parcel No.:
Lot: Block: Div: Addition:
�•. _su'kx � Sa.• ..,r'ye v'-:i ',i.,�
....:. .:�.::. ,�Yc'NER:, .;.; , :.:; '�IENDE �� ( -.;{i;a..:...,.,. Ol`l�n.: Olti .y�:: .. . ,.
Name Name Name
Mailing Address Mailing Address Mailing Address
City: State: Zip: City: State: Zip: City: State: Zip:
Contractor Lie.No.:
Phone No.: Phone No.: Phone No.: Exp Date:
Contact Person: Phone No.:
(Check One)
Single Family: Multi-Family:_ Apartment: Condominimum:_Senior Housing: Retail: Office: Restaurant:
Manufacturing: Storage:_Bank:_Assembly:_Accessory: Automotive Repair: Other(Specify)
DESCRIPTION OF WORK:
. �a.,�,.°y2.Y6tisJs,"i^.:t'._��,°'"3�. ..::#:i`:�,:^i:v;' t+�: �. ,..v,.r :;�7>frs.,7,7:: :isroi^ k?:y.., :t,; i!��S ,+ e!v .
v,."�.,�§., rt: yw;< ,n ''F<�4$w'����'^ �][��u ' „:- is.: sP y�.�... . - - i:i;, ,
� �,...,_' �...�....
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Street Setback: ft. 2"4Floor: sf (Circle Y or 1V)
ls`Side Setback: ft. 3rd Floor: sf. Shoreline/Wetlands Y N
2"d Side Setback: ft. Basement: sf. Water on/Adj.To Property Y N 1
Rear Setback: ft. Occ.Group: Soils Report Y N
Use Zone: Carport Area: sE Sensitive Area Y N
Type of Construction: Garage Area: sf. Latecomers Agreement Y N
Lot Area: sf. No.of Stories: Fire Hydrant(250 Feet) Y N
No.of Dwellings: Building Height: Variance Y N
Lot Coverage: Deck Area: sf Covenant Y N
1s`Floor sf. Flood Zone X A AE VE
Project Valuation(Labor and Material Cost):
THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING CODE,AND SHALL EXPIRE BY LIMITATION
AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY AFFIXING MY SIGNATURE I HEREBY CERTIFY THAT I
AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTIONS.
SIGNATURE: DATE:
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