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COACRETE " MECHANICAL MOBILE HOME —T '
Footings-Setback date b Ribbons
date //-30'%3 by Gas Piping ..may.....-_ date b
Foundation Is G T. date b Set Up
date 2 L /` by INSULATION date by
BG/St-Apfnsulalion `
—/'I— by d��Tr" Floors Final
date
FRAMING date by date by
Walls FIRE DEPT.
date by date by data by
PLUMBING -
Groundwork 7sW V ..�C•oy �^�
Attic OTHER
date G--/y'9I T/ b w�J`/ date by
$_rt- q VALLBOARDNAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
F•� ///OTE ASS
/ � �L�in /3•�s � .Poo,-c a�Ly �,r�ss �- ir- g��.�e��
• - �s 4
OF
- l99
1-16 -F7 �Du [T�syCUi� .dAlf
I Permit No.B.0 -ooZ/J
MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner 1��} C1 r_ Phone#
[\r I Ll IP.V�,VI.oP J
Site Address -
City State Zip q $S
Directions to Job Site r 1` V
Owner Mailing Address
City r State Zip
Lien/Title Holder
Address
City State Zip
#2 Contractor Name
Contractor Reg #
Address Expiration Date
City State Zip phone
#3 If septic is located on project site, include records.
Connect to Septic? Public water Supply well a`
(If residential, proof of potable water may be required. )
#4 Parcel No. y-zo ( RX'!' - 000-!Q
Legal Description V A 6 Klzj Sig
#5 Building Square Footage: (existing/proposed)
1st F1 Sly 2nd Fl 39Y / 3rd Fl / Loft /
Basement / Deck / #Bedrooms / #Bathr oms /
Garage / Carport / ,(Circle: Attached or Detached?)
Other sq ft /
C.bway, 40 R-3 -/-
#�Use of building Describe work e_
6l�2F� A- 3 n,44 , } n
00%V" New J
7 Type of Job: New—X— Add Alt Repair Demolition
Woodstove Re-roof Bulkhead Other
#8 Mobile Home Information
Model Year Make Model
Length Width Serial No.
#Bedrooms #Batt�h//rooms Type of Heat
#9 An water on or ad'aceat' to r per y�()�;Y j pro ert Sa twater Lake River
Pond Wetland Seasonal runoff Other
Shoal fOIT'ntui
Lot Dimensions 'Flood Zones.
Existing,Structures ':. Fences . :.
Stzucture. Setbacks ..Water Lines Driveways - ,
Drainage Plan - 'Shorelines ' ._ ;
Septic System Topography
Proposed Wells
Name of Flanking
Street
Basements
Name of Fronting oi .Street - _. _. .:. Scale:.--------------
.
.. ,Dater' ....
APPLICANT TO DRAW SITE PLAN BELOW.
i
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Il
.. .. . . _ L�U`� •mod
wk
Plumbing F r*„res ($2.00 each) Fee: No. Boilers/Compre sor
NO.---Toilets Fees:
0-3 HP 6.00
_Bath Basins 3-15 HP
_Bath Tubs 6.00
_Showers 15-30 HP 6.00
30-50 :HP 6.00
_Hot Water Htr 50 + HP
_Laundry Washer 6.00
_Sinks No. Air Handling Unit
_Floor Drains _<a 10, 000 cfm.
50
_Laundry Basins --
_� 10, 000 cfm. 7 50
_Dishwasher
_Disposal Other
_Urinals _Evap Coolers
_Other _Hoods
Permit Basic Fee 3.00 _Fire Suppressio_Domes. Incin.
TOTAL PLUMBING $ _Comml. Incin.
_Reloc/Repair .00
Mechan; a1 v�rr ,r
No. Fuel Types
_Gas Outlets x 2 ,00
_Woodstove
_Porn < 1001C BTU 6.00 .separate
_Porn >- 100IC BTU 6.00 _Other.
,_Fern - Floor 6.00 Permit Basic Fee 10.00
—Heat Pumps 6.00 TOTAL MECHANICAL $
Vent System x 3.00 00
_Vent Fans x 3.00
NOTICE: THIS PERMIT BECOMES NQLL AND: ':VOID IF 1POR$` OR COASTAIICTION
ADTEORIZED IS NOT CaS=qC3M WITHIN 180 DAYSR OR IP CONSTRUCTIOa OIL No
SUSPENDED OR ABANDONED FOR M.A PERIOD OF 180 DAYS AT ANY TID18. 9PO .IS
:.IS
COMMENCED.
OWNERS AFFIDAVIT CONTRACTORS A DAVIT
I certify that I am exempt from the requirements of the I certify I am a currently regi eyed co or in
contractors registration law RC"'
18.27 , and am the State of ashington and I a are of the
aware of the Mason County Ordinance requirements for ordinance require is regulati a work for which
which this permit is issued and that ail work done w_i_ll the permit is issued d walkdone will be in
be in conformance therewith. No changes I conformance therewi charges shall be made
made without first obtaining approval from the Building without first ob ing appro from the Building
Department. Department.
X OWNERS C B�
DATE: 01 '6ATE
Return permit to: Department of General Services 429 W. cedar Street/P.O. Box 186
Shelton, WA 98584 427-9670/1-800-562-5638
FOR OFFICIAL USE ONLY: Accepted by:_/.(J/� Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Planning:
111�IU
Environmental Health:
Building Plan Review:
Occupancy Group: _ r3
Fire Marshall:
Other:
FEES
gQ6 1, NtwI Special Conditions: 021
Site s In ection
Building Permit cc
I1C,r1 violation Fee
4
Violation Investigation Fee
6 i
I _
lv Plan Check
Plumbing Fee
Mechanical Fee � �� 06
Woodstove Fee
i
Building State Fee 1
Building Valuation:
TOTAL
1
Date Checklist Prepared-4 93
MASON COUNTY BUILDING DEPARTMENT y
PLAN REVIEWER AND INSPECTOR CHECKLIST
1991 WSEC AND V&IAQ CODE COMPLIANCE
Permit Number q3- 8 Address AsllvcL _�ocd Sq. Ft. �04100
Name on Permit CJ'k yGN(5E)' `1Z�;a n Contractor/Phone # O
Compliance Method: ( ) Prescriptive (Option) ( ) Component ( ) Systems Analysis
G1,14-Se a-F lase US24d
New 896e
Date FOUNDATION
Insp. Rev. qQ. a
( ) ( ) Stab: R-_Q 4'S der (V�"17��� /Uvt - n a Slab e! twreRer
(Eel. ounda on down cost ine/s bonom;or interior 24"top of slab& orizomal. Radunt uo entire)
( ) ( ) Below grade exterior wall insulation: R-
( ) ( ) Crawlspace ventilation: (I sq.IIL j EA/150 sq.ft.floor area-cross vented)
FRAMING
41tandard ( ) Intermediate . .. ( ) Advanced \
( ) ( )) Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox. '�� f8A o,,1arYn.4 1.
( ) ( J/Standard air seal: (Bottom plate/subBear,rimjoist/mudsill,window/door frames,penetrations condition to oon-condi ion.) JJJ
( ) ( -am Attic ventilation (I sq.e.dFA/15o sq.ft.Ailing area)
( ) ( 'Jyy Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cfm®.25 WG. Vented out with dam .)
Flesh air ventilation: Available to all habitable rooms. Installed and operational. (integrated forced air,windows, all ports.)(� Mort, Q.^f •"RS IN/ a".1 G/+ in 0et
O ( Whole house exhaust fan:gG Cfm (Imermnlem system manual&auto controls/sons less than or=to 1.5 at.1
INSULATION
( ) ( Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extend 12"abow loose fill ar 6"
e bait insulation)
Mechanical ventilation ducts R-4(Exhaust in unconditioned space&supply in conditioned space.) �
Wall insulation(above grade) R-�(Bats fa«:,.pied) All -S-ktn da rd TTCI C7/-//
( ) ( ) Wall insulation(below grade-interior) R- (Batts face stapled)
( ) ( -) �_Vapor retarders on Walls (Faced bait,or 4 mil poly or perm paint.-circle one)
( ) ( �) R 1m.J0iSt(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.)
( ) ( O Vaulted ceiling insulation R- (Vapor retarder& I"air space) .
FINAL
Floor insulation R-19 (Substantial contact w/surface,supports less than or=to 24"OC,not blocking vt W)
( ) ( Ventilation system is operational (spot,whole house,fresh air to all habitable rooms. If integrated system•certific aim by installer is
/re ired.)
AC ducts in unconditioned areas R-8 (Joints sealed;mechanically fastened with a minimum of 3 fasteters.)
( ) ( pe insulation R-3 (Ha and cold lines in unconditioned arm-service or recha see Table 5-12).
( ) ( HW healers: (NAECA label,separate power or gap shut-off,on R-10 pad if electric' unconditioned or on concrete.
( ) (Heating system type: ntm
( ) ( --)-'_Radon monitor on site with instructions.No. - supplied by MCBD
( ) ( Thermostat: (Heat range 55-75;AC 70.85;bah 55.85. Backup heat controls Qockoul)prevent simultaneous operation of primary system),
( ) ( �)/Solid fuel appls.: (Glass/metal tight-fitting doors;dir.comb.au source,or 4"die.dampened•indir.source far existing m1.)
�J( ) ( Ground cover( (6 mil black polyethylene or approved equal lapped 12"at joints,extending to foundation wall.)
( ) ( penetrations(All exterior wall and ceiling penetrations sealed to drywall-plumbing,exposed beanv,wall receptacles, ro,recessed lights.)
O ( eiling Insulation R-3al (Insulate&weathentrip access•baffle to prevent spillover-no cardboard)
( ) ( ) Vapor retarder paint if a vapor retarder was not installed when insulation was installed.
rni�u1� - �lUn. - 1��C Wi idowl = , S� (� Ve4tV�s
✓'l,�a/!� - AlJM - X0 L,.1%daW5 — •Y.z L) Vc,IL,c,3
cS ndow4 = . C90 or uQ-Her tOc)7
GLAZING dr\-� w`}TrEuro
Plan Reviewer-Fill out this glazing section or attach a window schedule to this checklist. IMpector- Verify window
information during field inspections. Include skylights, glass doors and all other glazing on this form. Use rough opening
area for calculations.
Size Date
Quantity Area S . Ft. U-Value Manufacturer Rev. Ins .
3 0
ore.. � Ca crt�/ems
5 D 3 kO / o/d J
` /- !2 2 /V1�1 wd-
/y I r
O " o S �. �O� tfer ✓
,LIZ
5 b 0 ! !Y 4/2
r a Ex zt >? q SZ
>S 3 c 0 !t =/ .2q y2
,tale o d > I >
1;Y
L)
04
i S W� Total glazing area:
,� � Total conditioned area: c�c7yh�
:j
Percentage glazing: O O / erifted•
DOORS
Plan R vt w r-List opaque doors by type (solid core, insulated,etc.)quantity,U-value,and manufacturer. jmpector-
Verify door information during field inspection.
Type/Quantity Date
U-Value Manufacturer Rev. Insp.
3 3 'R V CR eac ire - Ae><u!
Signature of Building Inspector: Date of Final Inspection:
r MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O.Box 186 SheBon,Washington 98584
(360)427-9670
BUILDING PARKS&RECREATION FAIRICONVENTION CENTER ADMINISTRATION
TO: O r/p1I
uJ /O�Q t�7� 0C,1 f
IP D/l, 6&&j?s5sl -
RE: Permit Number#OW93�6a,3 /
Parcel No. and or Legal Description: ' OO(/
As per your recent request, " this office has granted a 180 day
extension to the above' permit . In order to keep the permit valid
beyond the extension date of / -9 , you must call for a
progress inspection prior to — — In the event that you
do not call for the required inspection, this office will mark the
permit null and void by expiration. once the permit has been noted
as expired, it will be necessary to renew the permit by paying the
applicable permit renewal fees and/or applying for and completing
the permit process again prior to further construction.
Sincerely,
Mason County Building Department
CC : Property File
pn.
L. I 1 L w A 1 AIE NEJ',-i. ,y D CC I AC FEPC
C) 3i 92
i I IN5' Cl F �)El', GE WS H( CLEVEF%IGEP
.I..... �-"I NM IT TR C
..........
S ')na YE
J. e,.; .1 -,t g FOSIER AND WILLIAMS PISSUL.
L"It
,C J
Uti I J.t V,. p. L.I. 0. #
Type y
D .11"IN CLEVII-EINE it.1%. o u s�e -, S i r)4..l 1 e F:a ifl i .1.
(Do y r ea, D
Ii U. 'Ic!e 1 W t h(-,-,r .0 a L,a" 0 1 Imp J.8., W Pi
C'I i rint a t e Zone,., t
y
/s4
...... ..................................... .......................... .........
..................................... ..........--.—....... -----------
4NJI'MF:'LIES* wit'n 191? 1. VIA SL<:*,ttrj Enc.=rciv Cinde.,
5 tLA/I-,5 Cil -11 F
COMPONIEN-1 PERR FMi'.)NC',E
1 -NEREcy' BUDGE.- I 7•4 kWh/
R.EFERE-NCE IDESIGN
va 1.Lie X ArF...'p. ,-%
C ci m 1::)o r i e n t
............. .................... .......... ..............
Ij -c -o
C.1 Z
X,
A'S Via J. I LI 0.. Q62. -4 t.$
7. C...7 ling, Attic U -CI.
cei ling, Val-�It J-0, 0--,4 L' 4 1
I n+ i t r at- i o n ACH O. MO 1 6:-..B 4 C)4
............ ...................................
R e f F.,r n c e LVI. it CY
..................... ............. ..................... ........ ...... ............
1) LE'DIGNi COMPONEW S
ccmflnone�ftt C)rl
v
............ ..........I...... .......... ....................
4 flz IC5� I
Lill Gr�,.rje-. RO Uni rnu- ated '
ei;z i ng VVIIJ. lrllar d Alum. F X(J., C.L../(--**L. -0.. 5",C7 27.. 4
CL/CL. U- 0 4H 7
P f3a h t r e �tore
a Half LJA Door U- 1. :1.Z[
a SIC h t- e C.) rD
................. .......... . .....NCO fib/'
- --- 10- --------� q3 5
...........
Ln(.. �udecd i, ,� .nj,jr:0I ENIf F!DIRFE-IR! ANCE:_ hj,�-
I D cialcuIaL ion of therma l dc lau
ncAes, nc)n--st�u) I l" d
WMITSUN 5. 3 IV91 WA STAYE ENERGY CODE COMPLIANCE REPOR ! 10/22/92
FILE: CI\WATTSUN5\CLEVENSE. WS HOUSE IDs CLEVENGER
AG Wall R19 STD TI-11 U-- 6 3 1952 126. 9
Skylights * BPIF teal Alum. CL/AR U-0. 540 B. 0 4. --,
Ceiling R38 blown Attic ETD baffled U-0. 031 96 ) 29. 8
R30 batt Vault vented 2xl2 24oc U-0. 033 122 4. 0
ltration Standard Air Sealing ACH.....0. 350 163BTft3
---------------- --------------
Proposed UA 30.J
Struc Mass Light Frame, Sheetrock walls M- 3. 000 2043 6101
............ ..........1.1-11-1--....-I----------------------------------------------------------
HEATING/COOLING/VENTILATING SYSTEMS
PROPOSED
Heating System Type, Gas Furnace
Makeg Generic
Model ; Generic/
System Efficiency- 80 %
Modified Efficiency: 75 %
Design ACH4 0. 60
Heating Load (at 53F dt ) : 29269 Btu/hr
System Size,, 29. 3 kBtu/hr
Mamimum Size @150%. 43. 9 kBtu/hr
Average Annual Heat., 64 MBtu
Annual Cost; $ 360
Ventilation System; integrated Spot
& Whole House
Cooling Syste=
BEER.- 0. 0 (Unductea)
Cooling Load (at 5F dt) :: 19042 Btu/hr
Recommended Size @125%- 2. 2 tons
Annual cool requiremenn *** kWh/yr
Oolar Access; Partially Shaded
-----------------------------------------------------------------------------------
PROPOSED DUCT SYSTEM
Location Avg Rvalue Surface Area
-- ------------------------------------------- ------
SUPPLY All in heated space
RETURN All in heated space
------------------------------------------------------------------- -----------
.................... Page 2
1'!--3L.1!N 5. -!i 1991 WA STATE ENERGY COUE COMOLIANCE REPOR-1 10Y 220
FILE: MAWATTSUNMELEVENGEMS; HOUSE ID: CLEVENGER
--------------------------------------------------------------------------------
GLAZING ORIENTATION
PROPOSED PROPOSED
South 50. 7ft2 North F 50. 7ft2
Southeast Northwest
East 50. 7 West a 50. 7
Northeast �; I southwest .
---------------------------------------------------------------------
Economic and energy consumption estimates are designed for comprradivt�.
purposes only. Actual cost For heating will vary depending on wealher
conditions, occupant lifestyle and other factors.
Project:
WINDOW SCHEDULE
WINDOWS
_M!2pr=L "/( ) U-VALUr= WANT. SIZE A A (SQ. FT.)
5 � �
. 5a
't ! I
TOTAL WINDOW AREA
SKYLIGHTS
_ g MODELPA ) U-vA u QUANT. sl E A A ($a FT.)
. s
TOTAL SKYLIGHT AREA
DOORS
MOPFEL •/( ) LI-VALUE QUANT. SIM A RgA (SQ. FT.)
TOTAL DOOR AREA
('^ValviS
IJM - Xc9 W,kdowS Y2 U-Vulvc3
�1 6
0
GLAZING d� f..)f}77Su1� tJ✓�
t
Verify window
Plan R viewer-Fill out this glazing section or attach a window schedule
and all other glazing on Ithmis form. use se rough opening
information during field inspections. Include skylights, g
area for calculations. Date
Size uantit Area S . Ft. U-Value Manufacturer Rev. Ins .
/ci ea ch'1/cam /
f 3 O u-
5� D 3 XO
%2 �l l I�l �ea cl'1'Iree.
1`/l i l orcl-
O /Li o S
0 o ko I yz
IY ,y2
b p !
9 r�Kj a � E A » 4 92.
,y2 �
A.cS 3 0 !1 7
�
S �
Y
I'SUI� a- Total glazing area:
S tSl Total conditioned area: nC� y�
l�
3 S Percentage glazing: 60 0 erifie
DOORS
Plan Reviewer-List opaque doors by type(solid core, insulated,etc.)quantity,U-value,and manufacturer. IMPtdK
ERE
ition Date
lue Manufacturer Rev. Insp.
eac �vz - ✓1I e>zu l
Date of Final Ins tion:
Signature of Building Inspector:
Date Checklist Prepared
MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
1991 WSEC AND V&IAQ CODE COMPLIANCE
Permit Number G_3-=�' Address W 7(?/O sl el9oll MG �a
Name on Permit oe d —Sq. Ft. �C�4
YEN�Eh� �lZr Contractor/Phone # S 7- �Compliance Method: O
Prescriptive (Option) Component e a� 0,Te !/Sz ,,K Sys ems AnalysisNet IC1i4;on S96,a
Date FOUNDATION
Insp. Rev.
( ) ( ) Slab: R-__o_ r unJalion down')b'fro�stlineT(eGbouom tar inlerim 24"top of ab& o�2ontel.R��ael u dtt eehre)e
1
{ ) Below grade exterior wall insulation: R-
( ) ( ) Crawlspace ventilation:
(I sq.ft.f9EVI50 sq.it.Moor area-cross vented)
FRAMING
( ) (- ( 7 standard ( ) Intermediate
( ) ( ) Advanced �
Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.y f 16 1
( ) ( Standard air seal: (Bottom plate/subBoa,rimjoisumuJsill,window/door frame,penevatiom condition to aoo-cu ilioo.)
Attic ventilation (I sq.ft.bEW150 sq.ft.ailing area)
Spot exhaust fans: (4'exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cfm @.25 WG. Vented out with da
Fresh air ventilation: Available to all habitable roouu. Installed and operational. (Integrated forced air,windo�ws, all ports.)
Whole house exhaust fan:c"�'"cfm (Irn't'eim'ilent�em manu I$ co c ds�hone less then orC to 15 s.11
m�
/ INSULATION
Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven bait insulation) driven moisture,extend 12'■ ve loox fill or 6"
( ) ( -I Mechanical ventilation ducts R-4(Exhaust in unconditioned space&supply in conditioned space.)
Wall insulation(above grade) R. "j 4
(Batts face stapled) Al1 —�,.tda rd
( ) ( ) Wall insulation (below grade- interior) R- /
( ) (Batts face stapled) �?/-//
( ``''Vapor retarders on WallS (Faced bait,or 4 mil poly or perm Paint.-circle one)
( ) ( -jim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil
poly.)( ) ( Vaulted ceiling insulation R- IVD (Vapor retarder R 1'au space)
(DV'4-Crc"JI FINAL
/Floor insulation R-1— (Substantial contact w/surface,supports less than or=to 24'OC no(blocking ve ts.)
( ) ( - Ventilation System is Operational (spot,whole house,fresh air to all habitable rooms. If integrated system,cettiFi ion by installer is
/rree�luired.)
(( ) ( - �tf SAC ducts in unconditioned areas R-8 (Joints sealed;mechanically fattened with a minimum of 7 fanenem)
) ( pe insulaion R-3 (Hot and cold lines in unconditioned areas-service"recite.see Table 5-12).
( ) ( IfW heaters: (NAECA label,separate power or gay shut-off,on R-10 pad if electric' unconditioned er on rnmxeta)
heating system type: .
( ) ( -) Radon monitor on site with instructions.No.
( ) - Supplied by MCBD
( Thermostat: (neat range 55.75;AC 70-85;bah 55.85. Backup heat controls ockout( ) (I )prevent simultaneous operationofprimary system)`( ) Solid fuel apply.: (class/metal tight-fitting doors;dir.comb.air source,or 4"din.dampened,indir.source for existing L)
( ) (Ground cover: (6 mil black polyethylene"approved equal lapped 12"ai jointa,extending to foundation wall.)
Penetrations(All exterior wall and ceiling penetrations sealed to drywall-plumbing,exposed beans,wall receptacles,fa ,recessed lights.)
(veiling Insulation R-38( ) (Insulate o weatherstrip access,home to prevent spillover-no cardboard)
( ) Vapor retarder paint if a vapor retarder was not installed when insulation was installed.
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4FA!_TH SERVICES
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