HomeMy WebLinkAboutBLD07-007 (3) CITY OF PORT TOWNSEND
OVELOPMENT SERVICES DEPARTMENO einr.,7-04,City Hall,250 Madison Street,Suite 3 yPort Townsend,WA 98368 ' X01
Phone: 360-379-5095 Fax 360-344-4619 \:% i.w, c
,13,., j„_s::,file
RESIDENTIAL BUILDING PERMIT APPLICATION op`
NEW CONSTRUCTION, REMODELS, & ADDITIONS
Property Owner's Name(s) a,e it Ci 66 4 F i n n i e
Mailing Address % PO 8ax 48
City,State,Zip f'r
Phone 38
�-S L 1 2 - I Permit No. $Loo 1.y 10-7
Property Street Address y
' /3.3 /57/. -----)),9S' 41
Zoning District 1 / t ' Parcel# 9 ((fit 7)(
Legal Description: Addition /I_'77y C�y�:v c-'5 Block 1 Lot(s) -7 f-$ `ff,
General Contractor's Name C/• L5t9a%-»!�,
Mailing Address ; Y6 44---, .
Phone '3 9C--,)`.7-"?‘-/ Cell Phone 3) /-/5-37,
State License Number ..A„,- y Z City Business License Number 2//
Authorized Representative/Contact Person: C1 • es ti Phone: 37 cJ^ cu�cJG�
Estimated Value of construction$ �/.006
Financed By ._.,;.`, �
Date Work is to Begin /5-7 Date Work is to be Completed
Scope of Work:
Please check all items that apply for the type of building permit you are requesting:
New House /Addition
New Garage or Carport Repair/Remodel Garage
/ Repair/Remodel House Accessory Dwelling Unit
Manufactured Home Other(please describe):
Floor Area: the proposed structure is to be used for: 6? 63/0 d71/4-/c c ( 6X/3-7/•"r4 4 A P p)7'a NJ)
Finished Heated Space sq.ft: Z 2 `T 7 0 Garage sq. ft:
Unfinished Heated Space sq ft: Carport sq. ft:
Unfinished Basement sq ft: Porches sq.ft: / b' ' Gi..,
Semi-Finished Basement sq ft: Decks sq.ft:
Storage sq.ft: Other(please describe): 1 � a'i
P:1DSD\Forms\Building FormslApplication-Residential Building Permit.doc Page 1 of 2
410 40
CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION
NEW CONSTRUCTION,REMODELS,&ADDITIONS
Property Site Area/Coverage Information:
1. The total area of the property in square feet: / 0` 0 p v 97
2. The total area covered by existing and proposed structures in,square feet:
(total ground coverage from the outside of walls or supporting members) 2 0 Z-3
Percentage of lot coverage: (2±1) D °A.
Impervious Surfaces:
Please provide the square footage of the roof area of the proposed and existing structures,and the square footage of the total area
covered by porches,walkways,patios and driveways. Do not include decks allowing drainage to earth below.
A02_0710
Proposed Roofprmt sq.ft: 9" ( z ;AL- Existing House Roofprint sq.ft: '7 6I
Proposed Garage Roofprint sq.ft , Existing Garage Roofprint sq.ft: 1
,{-`
Proposed Porch/Walkway sq.ft: 9 0 �tExisting Porch/Walkway sq.ft:
Proposed Driveways sq.ft: Existing Driveways sq.ft: sD
Other(describe): Other(describe):
Total Proposed Impervious sq. ft: /0 Total Existing Impervious sq. ft: / 7 6 8"
Total Proposed+Existing sq. ft: O / `f 40 Percentage Impervious: * c�
(Impervious surface-lot sq. ft) G
*If total impervious surface is equal to or greater than 40%of the lot area,you must submit a written stormwater plan to address run
off.
Please check which plans you are submitting with this application (2 sets needed):
Site Plan 0JC. Interior&Exterior Wall Bracing(panel locations shown
on floor plan)
Drainage Plan(if 40%or more impervious) Typical Wall Framing Details(section from foundation
V4 "`' through roof)
s- Foundation Plan -' Elevations
Floor Plan 2003 WSEC*Compliance: Prescriptive_ Component
r Floor Framing Plan WSEC Construction Checklist(Washington State Energy Code)
Roof Framing Plan Other:
Installing Manufactured Home_Yes No Year: Make:
Was the manufactured home originally constructed within three(3)years of proposed placement? Yes No
2) Manufactured home must be placed on a permanent foundation with the space from the bottom of the home to the
ground enclosed by either load bearing concrete or decorative concrete or masonry blocks so that no more than one foot of the
perimeter foundation is visible above grade;and
3) Roof must be composed of composition,wood shake or shingle,coated metal,or a similar roof material;and
4) Title to the manufactured home must be eliminated as a condition of building permit approval.
P:\DSD\Forms\Building Forms\Application-Residential Building Permit.doc Page 2 of 2
•
CITY OF PORTWNSEND RESIDENTIAL I B I
ULD NG PERMIT APPLICATION
NEW CONSTRUCTION,REMODELS,&ADDITIONS
Special Conditions
Please check YES or NO as applicable YES NO
1. Is the property within 200 feet of a fresh or saltwater shoreline?
2. Is the property within the Port Townsend Historical District?
3. Is the property located within or adjacent to an environmentally sensitive area?
4. Will this proposal involve any sewer,water or other utility extensions that will,or could serve vacant
properties other than the project site?If yes,please attach information identifying the utility extensions and
sites.
5. Have any special conditions been placed on this property,or has the property been subject to any
conditions on any prior action of the City(if"Yes"to any of the following,attach copies of appropriate
documents):
Subdivision/Short Plat/Boundary Line Adjustment?
SEPA(environmental review)?
Variance?
Conditional Use Permit? i-
Street Vacation?
Planned Unit Development? �J
Restrictive Covenant?
Easement?
6. Are any properties within 800 feet of the site owned or controlled by the applicant,any relative or
business associate,or any partnership,corporation,or other entity affiliated with the applicant? (If
attach list.)
7. Have any of the properties listed in item#6 been developed within the last two years?(If yes,attach list.) ✓
8. Have you previously discussed this project with a City staff member? If yes,who and when?
Applicant Certification
The applicant hereby certifies to have knowledge of those sections of the International Residential Code and the Port
Townsend Municipal Code pertinent to the above project and that the applicant is responsible for constructing in conformance with
these codes;the applicant understands that the permit,if issued,expires in six months unless work is started;that the permit,after
construction has started,will expire after one year if an inspection is not made to show significant progress on the tructure;the
applicant agrees to abide by the ordinances,codes,regulations,restrictive covenants,deed or plat restrictions,and water and sewer
plans attached hereto;the applicant certifies that all information given above and on accompanying plans i complete and accurate to
the best of their knowledge; and the applicant understands that this information will be relied upon in granting permits and that if such
information is later found to be inaccurate any permits may be withdrawn.
P:\DSD\Forms\Building Forms\Application-Residential Building Permit.doc Page 3 of 3
• •
CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION
NEW CONSTRUCTION,REMODELS,&ADDITIONS
The undersigned hereby saves and holds the City of Port Townsend harmless from any and all causes of action,judgments,
claims,or demands,or from any liability of any nature arising from any noncompliance with any restrictive covenants,plat
restrictions,deed restrictions,or other restrictions which may have been established by parties other than the City of Port Townsend.
Complete Application
Port Townsend Municipal Code,Section 16.04.140,Vested Rights-Substantially Complete Building Permit Application:
applications for all land use and development permits required under ordinances of the city shall be considered under the zoning and
other land use control ordinances in effect on the date a fully complete building permit application,meeting the requirements&entified
in this section,is filed with the Development Services Department. Until a complete building permit application is filed,all
applications for land use and development permits shall be reviewed subject to any zoning or other land use control odinances which
become effective prior to the date of issuance of a final decision by the city on the application.
An application for a building permit shall be considered complete when an application meeting all of the requirements of
Section R105.3 of the International Residential Code,2003 Edition,is submitted which is consistent with all then applicable
ordinances and laws. In addition,to be considered complete,such an application must be accompanied by complete applications for a
subsidiary land use or development permits needed,such as a complete shoreline management permit application and/or complete
applications for other discretionary permits required under the ordinances of Port Townsend. An application for a partial permit under
Section R105.3.1 of the International Residential Code,2003 Edition,shall not be considered complete unless it meets all requirements
stated above and contains plans for the complete structural frame of the building and the architectural plans for the structure.
Signature of Applicant or Authorized Representative Date
For Official Use Only
Pe t No. Building Official Approval • Date Issued
Balance Due$ Date Validation Stamp below:
Owner/Representative Signature Date
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t • I
Residential Building Plans Checklist
o�QORr roil, City of Port Townsend
��04)
�� Development Services Department
ciz250 Madison Street, Suite 3
�� Port Townsend,WA 98368
43,4 zsty. (360)379-5095 Fax: (360)344-4619
Name F/A i !C Permit#
This checklist is for new dwellings,additions,remodels and garages. The purpose is to show what you intend to
build,where it will be located on your lot, and how it will be constructed.
In addition to this form,please submit:
• Residential Building Permit Application form
• Sensitive Areas Questionnaire
10),2001 Washington State Energy Code forms. Use either prescriptive forms, or component performance
forms with calculations.
, Washington State Energy Code Construction Checklist
• Two sets of plans. 18"x 24"plan sheet size is preferred. Plans must be to scale. t/4"= 1 ft. is preferred.
• If an architect has signed your plans,one set must have an original signature and wet stamp on each page.
• For structures that require engineering(including pole structures, sunrooms, dormers of a certain size,
Gjv "irregularly shaped"structures)provide two copies of calculations from a Washington Licensed Architect or
engineer. One set must have an original signature and wet stamp.
For New Residential Dwelling Construction also submit:
• Street/Utility Development Permit application, or Minor Improvement Permit application if water and sewer
are already stubbed to the property. For any utility extensions, provide engineered plans.
• Two additional copies of the site plan for Public Works (three sets if a septic system is proposed). Please
also include one reduced 8-1/2' x 11"size site plan.
NOTE: Electrical Permits are required by the State of Washington Department of Labor&Industries (L&I).
Contact L&I at(360) 417-2700 for more information.
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• 4
List the pggg number in the left column for each item that you have included on your plans. •
PAGE# SITE/PLOT PLAN
5 Legal description,parcel number,name, address and telephone number of property owner/applicant,
including cellular phone if available.
S Property lines and dimensions,including all interior lot lines.
S All building lines and exterior dimensions(including all dwelling and accessory structures).
5 Setbacks from property lines and buildings including structures on neighboring lots. (Indicate roof
overhang. Overhang may extend into setback area a maximum of two feet.)
Driveways,walkways,patios, decks and porches.
S On-site parking(Two 9'x 19' spaces required for new residential construction. These spaces may be
provided in a garage.)
NI A Trees: Diameter, species name, location and canopy of existing significant trees in relation to
proposed and existing structures,utility lines, and construction limit line.
"Significant trees"are those with a minimum diameter of 12 inches measured at 4-1/2 feet above
average grade. Identify all significant trees to be removed by placing an"x"on them, and circle those
trees that will remain. Significant trees removed in relation to and necessary for the construction of
buildings,parking and driveways in connection with the issuance of a building permit are exempt.
Exempt activity requires a written exemption issued by the Director of Building and Community
Development.
Street names, road easements and easements of record.
Existing and proposed utilities, service lines and pipe size.
N / Slope of land(grade and direction).
N A If there is 40%or more impervious surfaces on the lot, submit an impervious drainage system,
indicating square footages on drainage site plan and method of detention.
Waterfront property: indicate bank height,setback between building and top of bank or bluff, all
1' creeks,drainage corridors, etc. For new exterior construction, include all structures on either side
within 300 feet, and their setbacks.
p, Existing and/or proposed septic system, if applicable. Please provide an extra set of plans for the
County Health Department.
PAGE# FOUNDATION PLAN
?j Footings,piers, and foundation walls (including interior footing or pier locations).
Post and beam sizes and spans; detail beam/post and post/pier(or footing)positive connection.
Beam pockets or method of securing beam ends.
Floor joist size,material grade, layout and spans.
Foundation venting and calculations(1 square foot of vent/150 square feet of crawl space).
Crawl space access& dimensions.
le Plumbing sizes and locations of foundation penetration.
Vapor retarder on crawlspace ground(6 mil black polyethylene).
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PAGE# FLOOR PLAN
2 Room use, size and square footage by floor level.
All room dimensions.
1..;t Braced wall panel locations per UBC Section 2320.11.3 and Table 23-IV-C-1 (if multi-story include
length per story per Table 23-IV-C-1).
2 Smoke detector locations.
'41 Stairways: width,rise, run,handrails, guardrails,landings,etc.
Window, skylight and door locations and sizes,with egress and safety glazing, if applicable. (Include
brand/model and U factor on energy application.)
`._ Rafter and ceiling joist size,material grade, layout and spans. Roof framing plan required if rafters,
optional if trusses.
2 Attic access location and dimensions.
Plumbing fixtures.
Hot water tanks, furnaces, fireplaces, solid fuel appliances and combustion air ducts.
Location of whole house ventilation fan,controls and timer.
Location and cfm of all other exhaust fans(i.e. bathroom, kitchen and laundry).
Type of exhaust duct material,duct path and exterior termination point of appliance vents and
environmental exhaust ducts.
VI AC Type and location of all WSEC outside fresh air inlets. ` ^//NJD>S
-4/5 Fire blocking.
164 1-hr. construction between dwelling & garage on garage side(UBC Sec. 302.4, exception#3).
PAGE# WALL SECTION
IA- Footing size,reinforcement(include vertical rebar) depth below natural and final grade.
1 ( Foundation wall,height,width and reinforcement(rebar),hold-downs if applicable.
--- Anchor bolts,washers(2 x 2 x 3/16 square, steel) and pressure treated plates.
1.1 1 Thickness of floor slab.
Floor joist size and spacing,under floor clearance from crawl space grade for joists and beams.
Floor sheathing,type and size.
": Wall stud size, grade and spacing.
Framing to be used: standard, intermediate or advanced.
} ' Header, size, grade, spans and insulation(if applicable).
• A Wall sheathing and siding and material.
Type& location of weather-resistive barrier(UBC Section 1402).
Type and location of vapor retarder(WSEC 502.1.6).
Sheetrock: thickness,type and location.
-- c Insulation material and R-value in walls above and below grade, floor, ceiling and slab.
Rafters, ceiling joists,trusses, with blocking and positive connection of roof system to wall.
Ceiling height.
Roof sheathing,roofing material,roof pitch, attic ventilation(provide calculations).
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PAGE# EXTERIOR ELEVATIONS
Exterior views on front,rear and sides; show all windows and doors.
1. Decks, steps,handrails,guardrails,landings.
14A- Height of building per UBC Section 209. CX/
IIA, Chimneys: show required height above roof per UBC Section 3102.3.6. f5`?:
Final grade.
9J A Retaining walls, if applicable.
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•
WSEC Residential Construction Checklist
cony Tom City of Port Townsend
y� Development Services Department
250 Madison Street,Suite 3
file (360)
Townsend,WA 98368
3. (360)379-5095 Fax: (360)344-4619
Washington State Energy Code (WSEC)
2001 Residential Construction Checklist
Complete this form in addition to WSEC forms. Please answer the following questions:
TyPE OF PROJECT:
New construction, or addition over 750 square feet
Must meet whole house and spot ventilation requirements, and show full WSEC compliance as
a stand-alone project. A detached, habitable structure such as an Accessory Dwelling Unit
regardless of size must also meet these requirements.
❑ House addition under 750 square feet
Possible trade-offs are allowed with the existing building for WSEC compliance, such as
increasing ceiling insulation. See WSEC component performance forms.
NOTE: A house addition less than 500 sq.ft. does not require whole house ventilation.
Spot ventilation is still required.
TYPE OF HEATING—Please check all that apply:
Electric
❑ Wall Heater ❑ Baseboard ❑ Forced Air Furnace ❑ Radiant Floor(Boiler) ❑ Other
Non-Electric:
Propane::.:Radiant Floor/Baseboard(Boiler) ❑ LPG Stove ❑ LPG Furnace ❑ Other LPG.
❑ Heat Pump ❑ Oil Furnace ❑ Woodstove(can only be used as secondary heat source)
VAPOR RETARDERS:
Vapor retarders shall be installed toward the warm surface as represented below. Select one
option for floors, walls, and appropriate ceilings:
• Floors:
.'Plywood with exterior glue
❑ Poly plastic (greater than or equal to 4 millimeter thick)
❑ Backed batts
• Walls:
❑ Poly plastic (greater than or equal to 4 millimeter thick)
❑ Face-stapled, backed batts
f Low-perm paint
• Ceilings:
❑ Not required where ventilation space averages greater than or equal to 12 inches above
insulation
❑ Face-stapled, backed batts
❑ Poly plastic(greater than or equal to 4 millimeter thick)
' Low-perm paint
SEE BACK
P:\DSD\Department Fonns\Building Forms\Application-Residential Energy Code Checklia,doc
Page 1 of 1
111)
WASHINGTON STATE VENTILATION AND INDOOR AIR QUALITY(2000 Code):
Type of ventilation used throughout the house: ❑ HVAC Integrated Option ❑ Exhaust Option
Whole House Fan for"Exhaust Option":
• In what room is your whole house fan located? /it
• What size is the whole house exhaust fan? ❑ 50-75 CFM(1-2 bedroom house)
X80-120 CFM(3 bedroom house)
❑ 100-150 CFM(4 bedroom house)
❑ 120-180 CFM(5 bedroom house)
Note: the whole house fan shall be readily accessible and controlled by a 24-hour clock timer
with the capability of continuous operation, manual and automatic control. At the time of final
inspection, the automatic control timer shall be set to operate the whole house fan for at least 8
hours a day, and have a sone rating at 1.5 or less measured at 0.10 inches water gauge.
Spot Ventilation:
Source specific exhaust ventilation is required in each kitchen,bathroom, water closet, laundry
room, indoor swimming pool, spa and other rooms where excess water vapor or cooking odor is
produced. Bathrooms, laundries or similar rooms require fans with a minimum 50 cfm rating at
0.25 inches water gauge; kitchens shall have a fan with a minimum 100 cfm rating at 0.25 inches
water gauge.
Outdoor Air Inlets:
Outdoor air shall be distributed to each habitable room by means such as individual inlets,
separate duct systems, or a forced-air system. Habitable rooms include all bedrooms, living and
dining rooms but not kitchens, bathrooms or utility rooms. Where outdoor air supplies are
separated from exhaust points by doors, undercutting doors a minimum of%2 inch above the
surface of the finish floor covering, distribution ducts, installation or grilles, transoms or similar
means where permitted by the Uniform Building Code. When the system provides ventilation
through a dedicated opening, such as a window or through-wall vent,these openings must:
• Have controlled and secure openings
• Be sleeved or otherwise designed so as not to compromise the thermal properties of the wall or
window in which they are placed.
• Provide not less than 4 square inches of net free area of opening for each habitable space.
What type of fresh air inlet will be installed? (See figure below)
AI/Window Ports
❑ Wall Ports
P:\DSD\Department Focros\Building Forms\Application-Residential Energy Code Checkli3.doc
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Prescriptive Approach—Simple Form
For the Washington State Energy Code(2001 Edition)
Climate Zone 1
Site Information Building Department Use Only
Lot Permit#:
Address: Notes:
City:
State: Zip:
Contact:
Phone:
Phone 2
Fax:
Table 6-1
PRESCRIPTIVE REQUIREMENTS°':FOR GROUP R OCCUPANCY
CLIMATE ZONE 1
(Unlimited Glazing Option Only)
Glazing Glazing UFactor Doo? Wall Wall Wall Slab4
Option Area10 U- Ceiling2 Vaulted Above Into Ead° Floors On
%of Floor Vertical Overhead'r factor Ceiling3 Grade Below Below Grade
Grade Grade
' Unlimited
/-Th
Group R-3 0.40 R-38
0.58 0. R 30 R-21 R 21 R-10 R 30 R-10
Occupancy
C�
Only
See the code text for footnote references
Thisj
roect complies with the following:
:
P P
✓ The project is a single family residence or duplex.
✓ The project is wood frame OR all of the insulation is interior or exterior of the framing.
✓ All building components meet the requirements listed in Table 6-1,Option Ill.
✓ The project will meet all other provisions of the WSEC and VIAQ.
The prct will take advantage of the following exceptions to the prescriptive option:
U 602.6 Exception 1.One door,that is 24 ft.2 or less,that does not meet the standards is allowed.
Location of the door taking this exception
✓ 602.6 Exception 2. Doors with a LI-factor of 0.40 allowed without calculations, Option Ill only.
Location of the door(s)taking this exception
Copyright 200Z WSUCEEP02 056
Copied by permission from the Washington State University Cooperative Extension Energy Program
Prescriptive—Simple Form—Cimate Zone 1 531/2002
• • 2001 EDITION
TABLE 6-1
PRESCRIPTIVE REQUIREMENTS" FORAROUP R OCCUPANCY
CLIMATE ZONE�J
Glazing Giazint, U-Factor 9 wall Wall. WaltSlab°
Option Area Door Ceiling2 Vaulted AboveS int ext on
%of Floor Vertical Overhead" U-Factor Ceiling Grade Below Below FIGrade
Grade Grade
L 12% 0.35 0.58 0.20 R-38 R-30 (R15 R-15 R-10 R-30 R-10
II.* 15% 0.40 0.58 0.20 R-38 R-301 R-21 R-10 R-30 R-10
III. Unlimited 0.40 0.58 0.20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
Group R-3
Occupancy.
Only
* Reference Case
0. Nominal R-values are for wood frame assemblies only or assemblies built in accordance with Section 601.1.
1. Minimum requirements for each option listed. For example,if a proposed design has a glazing ratio to the conditioned floor
area of 13%,it shall comply with all of the requirements of the 15%glazing option(or higher). Proposed designs which cannot
meet the specific requirements of a listed option above may calculate compliance by Chapters 4 or 5 of this Code.
2. Requirement applies to all ceilings except single rafter or joist vaulted ceilings. 'Adv'denotes Advanced Framed Ceiling.
3. Requirement applicable only to single rafter or joist vaulted ceilings.
4. Below grade walls shall be insulated either on the exterior to a minimum level of R-10,or on the interior to the same level as
walls above grade. Exterior insulation installed on below grade walls shall be a water resistant material,manufactured for its
intended use,and installed according to the manufacturer's specifications. See Section 602.2.
5. Floors over crawl spaces or exposed to ambient air conditions.
6. Required slab perimeter insulation shall be a water resistant material,manufactured for its intended use,and installed
according to manufacturer's specifications. See Section 602.4.
7. Int denotes standard framing 16 inches on center with headers insulated with a minimum of R-5 insulation.
8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing.
9. Doors,including all fire doors,shall be assigned default U-factors from Table 10-6C.
10. Where a maximum glazing area is listed,the total glazing area(combined vertical plus overhead)as a percent of gross
conditioned floor area shall be less than or equal to that value. Overhead glazing with U-factor of U41.40 or less is not included
in glazing area limitations.
11. Overhead glazing shall have U-factors determined in accordance with NFRC 100 or as specified in Section 502.1.5.
12. Log and solid timber walls with a minimum average thickness of 3.5"are exempt from this insulation requirement.
Effective 7/01102 33
•
RESIDENTIAL CHECKLIST For 1-2Residences)
Family
NAME OF APPLICANT:
Date Received with all necessary paperwork: By:
BUILDING REVIEW BUILDING PERMIT#
/ Zoning= Impervious Surface%_
V Lot Coverage= OK w/zoning? Septic? If yes, contact County Env. Health
NIn a PUD? Yes/No .-- Parking—need dimensions on site plan
✓ Site Plan, all setbacks shown Address needed?
iv' Completed Plans Checklist _FAADU?Prepare Notice to Title
V Energy Code Checklist& Compliance Form ✓ If architect/engineer, plans wet stamp/signed
2 Sets of Plans Submitted? 1,1 Garage?
Attached Detached
/ Type of Heat ane- If a new detached garage or ADU, give copy
�/ of site plan to Francesca
/ Floor Plan: Number of bedrooms ,Z ‘z Typical framing details/section
✓ Number of bathrooms Z _
Foundation plan; if calcs, holddown symbol ✓ Floor framing plan; if calcs, shear wall
& verbiage must be shown on plans symbol&verbiage must be shown on plans
Floor framing plan try
iv Roof framing section plan
PLANNING REVIEW (if applicable) LAND USE PERMIT#
ROUTED TO: DATE:
Critical Area Map checked. If in CA, what is it mapped? Slope:
Within 200 ft of Shoreline Ordinary High In Flood Plain? Fill out FEMA forms if yes
Water Mark?
Lots of Record review(all 3 must be true): 9 or fewer lot(s), plat created pre-1937, AND
development requires water, sewer, or street to be extended; OR if a block is owned with one SFR&
wants to build another residence. CHECK for prior Public Works permit if it was already issued!
PUBLIC WORKS REVIEW MIP# ($53 due) or SDP# ($330 due)
ROUTED TO: DATE:
Submittal Checklist attached 8-1/2 x 11 Site Plan reviewed for all items
All trees in ROW identified Septic? Need County OK FIRST
Pre-app Conference? Date held: PRE#:
Impervious Checked
Any work in ROW beyond a driveway apron needs Engineered Plans. DO NOT ACCEPT PERMIT
WITHOUT THEM! Water, sewer, and/or streets being extended? Need 4 sets of engineered plans.
Any existing or proposed easements for shared utilities or driveway w/adjacent property owners?
We must have the licensed contractor's name and information for ANY right-of-way work.
P:\DSD\Forms\Building Forms\Checklist-Residential Building Plans-Front Counter Sep 06.doc Revised 9/27/06
• •
BUILDING PERMIT FEES CHECKLIST i3 Loo"--7- DO-7
Fees Based on Fair Market Valuation or Submitted Amount Valuation = , is j S 3 . 23 4 ►
FEES DUE AT SUBMITTAL
d 7c i o Plan Review Fee (2010)
MIPSSO (2164) .# {00
MIP Record Retention Fee$'3.(9992)di
SDP Fees:
Street$62.50 (2164)
Water$62.50 (1201)
Sewer$62.50 (1361)
Storm$62.50 (1401)
SDP Record Retention Fee$10 (9992)
PW Inspection Fee $70 (2140)
Other
Other
67 q )d TOTAL DUE AT SUBMITTAL
FEES DUE AT PERMIT ISSUANCE
Building Permit Fee (2000)
Propane Tank/Piping Inspection$47 (2000)
State Building Code Surcharge$4.50 (2005)
Plus $2/unit for multi-family
House Number$3 (2200)
$3 per unit if multi-family
Hamilton Heights Recreation Fee$200 (5030)
Hamilton Heights Transportation Fee$156 (2167)
Lynnesfield Off-site Transportation Fee$231 (2168)
Record Retention Fee$3 to $10 (9992)
Other
Other
TOTAL DUE AT PERMIT ISSUE
% ImpeMous
] Jotified Permit is Ready to be picked up (Who/Date/Initials):
calculation to Finance sent (Date): 2/6/LI k)i K—
P:\DSD\Forms\Building For s\Checklist-Residential Building Plans-Front Counter Sep 06.doc Revised 9/27/06