HomeMy WebLinkAboutMIS99-0078 Install Gas Tanks - COM Permit / Conditions - 2/24/1999 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
tV1 1 M7;C E: IL. 1.. A 1V F 471L.1;� P F " M 1 _I I"OR INSPECTIONS CALL 427 .9670
M1899 0078 PA.RG'EL 1221321 190330 Pl , s ; D I V : BLK ; LOT
JOR ADD#1E^Sr 1081 E PICKURING 111) SHi-1 ON
APPLICANT ; R I CHARD K IM 42.6-•1901
OWNER- R ICIIARD K IM 426- 1901
LEGAL s T1 33 4E OOVT I.OT 1 11 2 Of S? 1755 W SURV1•T 5142 E 1481 iPICKENIH Bfi D BMIE N
XpmikTIO
PROJECT DESCRIPTION : Olt)
INSTAL.!_ TANKS ijuL, 0u '� p\ B f 1
. DATE ^-
PROJECT LOC:ATIONa
PROJECT NOTE :
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TYPE AMOUNT BY DATF RECEIPT
PLC:K 84 .00 KW 02/ 18/99 49469
PRIVIT 84 ,00 KS 02/24/99 49542
VIO 84 .00 KS 021 4199 49542.
V10 42W KS 02/24/99 49542
TOTAL : 340 .`;0 OWN
4F Rr AC;E.N'T DATE: `
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WJ111, rev: #4111192 COMPt I ANC IF TO A I'TACHED CONDITIONS IS
REQUIRED
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
A
F-1 E= rt M i T ►C:: c') N E7 1 "li" t C7 N;�>
Case No . s MIS99-•0076
For : RICHARD KIM
Page . 1
1 ) Approved per, dimensions: anti setback-; ott �,tihmltted
sits:--plan ,
All approved p 1 ar► arr satin i reci i o be eRn Ga i to for ! n peat ion purposes .. It Inspection
is called for and plans are not an site, Approval WILL NOT be granted . In addition, a
Res. I nspeot l on foe ! n the mmotint of $42 00 per- hour, (m In imum i hour ) w i 11 he ohauged and
must: be collected by this department prior to any further inspections being performed or
apprava 1 gr-anted ,
X__
3 ) PURSUAN'T TO 1994 UN I FORM 6U I L D!NG C0(;F , ALL S I fF: MUS 1` SE MA ItKFD WITH APPROVFC) NOMBFfiS
OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM T14E
STREET OR ROAD FRONT I NS TUIF PROPf RT Y MASON COUNTY 11111 i_D I NG hE PARTME::N1 REOU I RE: T 14A f
THIS BE COMPLETED PRIOR 'TO CALLING FOR ANY SITE INSPECTIONS . A RF I NSPF.CT ! ON FEE , BASE1.7
CAN RATES IN TABL F 3A OF 'T IIF 1994 UN I-FORM 611 1 1 D I NC C ODF W 1 1 E CIF AS SF SSE D If
OWNER/CoNTRACTOR FAILS 70 POST AODRESS ON SITE PRIOR TO REQUESTING INSPECTIONS .
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date FRAMING by date by date by
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. - WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
MASON COUNTY
' Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
x
4 ) Tank removal petuot is approve(.j pend i nu approval and monitoring by DOE or, other
approved ageraely . Conformance to all app i I cab I ea WA State I aws t re qu i at i cans for tank
removrai s is emanditory and an ilndergotind Storage 'rank Site Asset smeat Report must be
;s+.abtnitted to the Masan County Building Department rot-, files records prior to fina.1
I nspeot I on ..
X
x
5 ) At t CONS rRi1C T I ON MUS t MEET OR E:XC FE D A!_t. t.00AL. CODES AND t)BC;
REQtt I RE� M N'T<,
x.....__ _.._..w...._.._._.._ _... ..._ _
6) changes to taE pFoved but Wing plants thdt effect comp ! itanoe to !:tree 1991 Wfa :.hincrton ";trate
Energy Code, 1991 Ventilation and Indoor Air Quality
Code , the Uniform But Wing Code and/or Mpgn Count v Regu I at i oris must be approved by
Mason County prior to construct i onX
7) CONSTRUCTION PROC H(5c 8 TO BE. F I FLD CORRECTFF) AS IIFC)t)I REF) PUP MA:30N C'OUN rV Fill I t to I N(i
DE PAnTMENT AND UNIFORM BUILDING CODE
8 ) At l upland areas disturbed or� new I y c;,,eat ed by nonst r not I on as t i v I t I es. Sha I I be seeded,
vegetated or given soeue other equivalent types of protection against erosion .
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PERMIT NO. MIS W�
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION a�b
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton(360)4ZZC670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMAMN , CONTRACTOR INFORMATION
Owner 'k,"7I . Contractor Name tAEL-A
Mailing Address,,/)x/ c pe4pqg Fe7oop Mailing Address i10 F otxo.j
city �rnnl Sta eWA Zi Code City Oky w.,�;,, State wh Zip Code '105ot
Phone(;?- 3 ) & - oacf'/ Other Ph.( <3 )�D^�i5/ Ph. 3bn 35d. 9035 Other Ph. 3bo :� N1�7
Lien/Title Holder Contractor Reg. # ► F-6 c,u # 0411 tits
Address lExpiration 'g l 05
PARCEL INFORMATION-12 digit Tax Parcel No. 7 2 4. m / i / �!0 3 3 c Fire District
Legal Description 5
Site Address(include street name and cityllxl
Directions to site:
Will timber be cut and sold in parcel preparation? (Yes/No) VO
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe proposed construction z%3ST-Ak� Tw S v-
SHORELINE PROJECTS New Replacement Repair Expansion
Bulkhead Material (concrete, rock, wood, etc.) Length Height
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-]certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the
ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued
will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall
first obtaining approval. be made without first obtaining approval.
X Date Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Dat "" �ubmittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department
Occ Gro Type of Const. V 10 6chd
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal OW
Valuation $
FEES
Building Permit Fee �CC.� Site Inspection
Plan Review Fee Other
UFC Plan Review Fee Others 2
Violation Fee ®_ Z Pre-Paid at Submittal ( )
TTAL FEES
O
�/iuKs
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name PARCEL NUMBER 11 9033N Date
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography v� E
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System S
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property line4 1f-adjacent property line
Ihi �S.tbTErr 3�°
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adjacent rdCylrie4 I �rilvFwa� I <—adjacent property line
t IDS' No SCALE
SAMPLE SITE PLAN E �Opb
adja t property line—) 3La, f
_ -adjacent property line
D 30' F;tLi rtvE gel
-SE.4SGu A1_ ' ^� L _nPT7L J.
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C Me.EK \ I (� I NOM tr i Graa6N
I j Prio Posen sm Pt:c
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adjacent property lined ; c \i <—adjacent ro ert'line
TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE
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Signature Date
FEB-17-99 WED 10:36 AM SWRO FAX NO, 3604076305 P, 02/03
UNDERG JUND STORAGETANK '., ,oa,ct, >a�rcx.l,;:;.!`:.,;
30 DAY NOTICE
logy.
Orrw•sidivd f� >hd torn aRvvs as
See back of form for instmcdons your►wrr.ry permit for ow%nia creed b oi,*W.
Please ✓ the appropriate box: C3 Intent L) Intent 4Both '9' FER 1(, ::.7
to Install94
to ose
Site Information Owner Information
Pie trtlomtrtion wAl t»rv0lmvd w this wldrr.$)
Site ID Number UST Owner/Operator —
(Aveliw:ie from Ecology If Ow tanxt uv rsqutwvd)
Slte/8uslness Name Mailing Address
-
Site AddressSl �'t t�k-� �+�llh R-�•
°.drat P_o.Box
City/state Glr�L--MQ_ �'A _ Clty/State SI LTO.J �7A
Zip Code C�7a5 _ Telephone(�) Zip Code Telephone{2=a E12 D��I
Tank Installation Company of known), Fill out this sedlon ONLY if tanks are bairig Insta)led,
Service Company 6t _ Contact Name WuV-E-; t_F�►yMJ / 1�04 � w.�s w�.+�
Address 12-C) E. Q`t+Jk000
strw P.O.Box
Ok w� 't v� WA 9 e,50I Telephone 3( 40) VS Z- 9 63�
Cityo Zip can'
rent.Closure Cb miiany . ill alit 4tils s.cpot3 b?&j'.-bkhk'* being aks*d. '
Tank Perrina " t>r`�owh3.
4.
ServiceC'ori ri ;s.:: :CoitladNarita
i':r....:.;.
Address' •' :.,.... ,; .. ..:;:.:r:. ....�:,.:::,.
city.. ,•sm..':.; .:•:,';''�..� ...z�;rod. ,
;s<• Tank Installation
•���io:ti•'��::��:.,;'- ?�..°.r..;::.s•:.• <;�•.: Information
'Fii.oitttt7E�`.spctl: `??SN��'if;�ar ;�irebai� ci• Fill out Ns section ONLY It
' ;lks,.....�.9::..,..;:�'...:.4 ::" .:<�;�,,,.,;
,;, " ;,•
:tanks are being installed.
ki 1'tfN'r>
�t6dl�C��!.#�i����F�f�s;ii
Cfcours Tank 7; iill t�o�ti; CJsbs''>rink...,.; 'aha:'7t k'"' `7a�ik:yVas": Appro><.
�' t ": T■nk ID inat#11 Dab
T■nk ID.: > atr. Stdrrrd'%'':';i:';'1■si;Vs�d'' ':: es« r r::`
4�padty<, 1 rid.;
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To reooive this downwrit in an skamativo format,contact tier•TO .a GL EMUP PROGRAM at 1.8D0426-7716(VOICE)OA(360)407-G006(MD).
ECY 020-95(Rev.4M)