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HomeMy WebLinkAboutBLD2011-00475 Cancelled Garage, Addition, Remodel - BLD Permit / Conditions - 2/19/2021 1 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 BLD2011-00475 OWNER: COREY URBAND RECEIVED: 6/10/2011 CONTRACTOR: LICENSE: EXP: ISSUED: 7/19/2011 ` SITE ADDRESS: 51 E HITTHE RD BELFAIR EXPIRES: 1/19/2012 PARCEL NUMBER: 122077590201 LEGAL DESCRIPTION: TR 20-A OF SURV 5/94-96 LOT: 1 OF SP#2435 PROJECT DESCRIPTION: DIRECTIONS TO SITE: 644 SF Garage& 1012 SF Dwelling ADDITION AND REMODEL CORNER OF HITTHE RD AND AND RASOR RD � vP A e-Jt7►/o�0 T_ z-Lf 4P,fOX1.5 General Information Construction&Occupancy Informatiop Square Footage Information No. of Bedrooms: 3 Type of Constr.: V Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No.of Stories: 2 cc. d: Building:1,012 Garage-Attached 644 Valuation: $ 144,005.44 J . Building Height: O t Basement: Manufactured Home Information Setba I t n Shoreline&Planning Information Water Body: Make: Length: Ft. Fro E 0. t. oreline: Ft. Rjj r: 40. t. Slope: Ft. SEPA?: No Model: Width: Ft. .d 10) Shoreline Desig.: Not Applicable Year: Serial No.: S 4 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Water Closets (Toilets) 2 Ventilation Fan 3 EH Plan Review GMM 6/10/2011 $103.00 S12011000( Lavatories 3 Pellet Stove 2 Plan Check Fee GMM 6/10/2011 $809.74 S1 201 1 0 001 Bath Tubs 2 Dryer Vent 1 Planning Review Fee GMM 6/10/2011 $205.00 S120110001 Water Heaters 1 Building State Fee TW '7/18/2011 $4.50 S12011000( Clothes Washer 1 Building Permit Fee TW 7/18/2011 $1,245.75 S1 201 1 0001 Hosebibs 1 Mechanical Permit Fee TW 7/18/2011 $182.00 S120110001 Mechanical Base Fee TW 7/18/2011 $28.50 S120110001 Plumbing Permit Fee TW 7/18/2011 $84.50 S12011000( Plumbing Base Fee TW 7/18/2011 $24.70 S12011000i Total $2,687.69 BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 1 of 6 r CASE NOTES FOR BLD2011-00475 CONDITIONS FOR BLD2011-00475 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There otential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800- - 82. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) Owner/A f' responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 3) Approv r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 4) All construction and demolition debris must be removed from the site after project completion. Pro posal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X 5) Temporary erosion control measures must be implemented to prevent water quality degradation of ad' t waters or properties. Silt fencing or straw/ jute matting must be installed and maintained until upland vegetation has become established. X 6) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these str ctures meet the setback conditions listed. X 7) Landi and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Appro ite Plan" to ensure these structures are shown and meet the setback conditions listed. X BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 2 of 6 -r► 8) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Uesign, 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 cons with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is n wledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 9) 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 Departm t or to any further inspections being performed or approvals granted. X 10) 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. Zhe 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 it proved documents will result in failure of required building inspections. X 11) 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 Building De ent prior to any further inspections being performed or approvals granted. X 12) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air leakage results if a blower door test was conducted. Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA) when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing. Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate" and are available in %or'/z sheets. The Mason County Permit Center will also have some available. X L4- BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 3 of 6 13`7 A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or installed round swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps). Refere c EC 505. X 14) Washington State Energy Code Compliance has been approved as follows: Heat Type: Electric or other than electric, Compliance Method: Component Perfomance (see below), Window(Max U-Factor):0.30, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.40 or less, Wall insulation R-21, except upper floor knee walls R-25, Floor insulation R-38, Ceiling Insulation R-38 standard, and Vault Insulation R-30. In addition the following credit from Table 9-1 HAS BEEN completed: Component performance for compliance to Table 9-1, option 3B (15% increased efficiency): Target 137.4/Prop 137.2: X 15) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85 MPH. X 16) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacture ' ' stallation instructions. X 17) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If o nts are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged an Me e collected by the Building Department prior to any further inspections being performed or approvals granted. X 18) All construction mu meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington cupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. X 19) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency(ORCAA). It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been identified a moved from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or operator h ob fined written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 www.orcaa.org X BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 4 of 6 20) 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 Mas County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be loca d ' hin 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 21) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance o {e lation, must be reviewed and approved by Mason County prior to construction. X 22) 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 internaliDnal codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector sh ade prior to requesting additional inspections. X 23) Epoxy grout required and specified on the approved building plans shall require a special inspection. The special inspector shall be the engineer of record or their authorized representative, a WABO Certified special inspector, or certified testing laboratory. In addition a Mason County Building Inspector may perform the inspection provided holes are prepared in accordance to manufacturer specifications that are available on-site during inspection. Special in ctors shall inspect the installation of grouted construction anchors as stated in the manufacturers specifications. An inspection report shall be prepay submitted to the Mason County Building Department prior to the framing inspection of the project. X BRA 24) All property lines shall be clearly identified at the time of foundation inspection. X 25) All buildinla permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to requ t 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 y ordinances and building regulations. X 26) 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 f riod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder h vented action from being taken. No more than one extension may be granted. X 27) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT PROPERTIES NOfPVREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM OR ROAD WAY. X (W BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 5 of 6 This permit becomes null and void if work or c ruction 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 commenced. E ence o o inuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation ork is y eans of a progr nspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Maso unty c ss a abo d ribed property and structure for re 'ew an inspection. OWNER OR AGENT: C DATE: 7 BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 6 of 6 w r o CONCRETE MECHANICAL MANUFACTURED HOME o Date By M_ 00 Footings 1 Setbacks Gas Piping Ribbons o Interior Date By Interior-Date By paw By Exterior Date g�/6— BY Exterior-Date BSet-up --_....- Point Load I Isolated Footings INSULATION Date By O BG i SLAB INSULATION - - X Date By Data By FIRE DEPARTMENT M Foundation Walls Floors Date By Date By Data By DECKS FRAMING Walls Date By Date By Data By PROPANETANKS PLUMBING vaun Data ay, . Date 13Y OTHER Groundwork Attic Date By Date By Type:. Dates By mw.rr DRYWALL Type- Int.Brace Wail Date By W Date By co Date sy FINAL INSPECTION 0 v N Water Line Fire Seperation N m CDDate By Date By Date ByCD N j g Pass or Request Inspect. c g Type of Insp. Fail Date Date Done By Comments Sh� d /(O /1 y o- .rrv,,.•r r 0 N 3 v co cu 0 (8/12/2*11) Kathy Soine- Inspection request for: BLD2011-00475 Page 1 " i - , + From: <wolfman0918@yahoo.com> To: <ks@co.mason.wa.us> G� CC: <pib@co.mason.wa.us > Date: 8/11/2011 8:49 PM Subject: Inspection request for: BLD2011-00475 Date inspection Requested: 8/15/2011 Name on Permit: Corey Urband Site Address: 51 E. Hitthe Rd, Belfair, 98528 (/ Permit Number: BLD2011-00475 b c Requestors Name: Corey Urband Phone Number: 360-621-9020 Inspection Type: Footing Comment\Other Type: Anytime after 12pm please! This will be a partial footing inspection as per structural engineerVs addendum. Please call if there are any questions. Thank you! MASON COUNTY 360427-9670 Shelton ext.352 Belfair ext.352 COMMUNITY SERVICES 360-275-4467 360 482 5269 Elma ext.352 Inspection Hotline 360-427-7262 Building, Planning,Environmental Health,Community Health (D 615 W.Alder St.Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us CORRECTION/INSPECTION REPORT PERMIT/CASE NUMBER: ADDRESS/LOCATION: -57 Ls- FI INGS: �u to 4 C-! �s?��Z w/► -S ��- y t-c�V�rLtAJ 02 f7 v X y nj*—tc_ AtT O. C, 3 �► L a c�n�L� �-�- L�X�-� � -S - G 'o. C, Y Items listed above must be corrected to gain compliance. ❑ THIS IS NOT A COMPLETE INSPECTION ❑ This structure has been inspected by Mason County Building Department and the items listed above are in VIOLATION of Mason County laws and/or ordinances. ❑ Call for re-inspection when corrections are made before proceeding with any further work. Make corrections, items will be checked on the next inspection. ❑ OK to Date: 3 Z 1 7W ❑ Please contact our office regarding possible Departme structural damage incurred by recent "natural/man made"disasters.This is NOT a Inspector: CORRECTION NOTICE. DJ NOT REMOVE THIS TAG MCC14.12 Cc�y UR3A49 NOT TO SCAB 0 0 ) ram_ °a �(1 \ R©O KITCHEN � rq GREAT ROOM ��•-k�?�-!�t so:crco o �� - I >� FIG�tVQATIDfJ T b/Sho § BATHRO STIR za-xe•e-co Si BEDROOM \",' " �\ BEDROOM Roof< 5�ecL-Y ; r O � DLi 2-CAR GARAGE ---------------- --I j I I I i I I I f I I I I I I I I 1 I I I favrsa-o'ro I N t7TAjG ZoRT) , � .► ► f 2vb1 - 00475 COai�Y URaAI-7 RIOT To LOFT z�x�o WALK-'IN cwsr.1 SW I-rGl4 PI.RC-ES MASTER $ WALK-IN BATHROOM CLOSET w cog tr� ONUS ROOM 0-o SD t7 r AS S wkt� A-UDED STER BEDROOM %N wRzoM �S b ECG Qess`- s� lams 08-12-'11 14: 03 FROM-NL OLSON & ASSOC. 360-876-1487 T-325 P0002/0003 F-573 �("I N L.Olson&Associates,Inc. Engineering, Planning and Land Surveying. August 12, 2011 Corey Urband S� PO Box 742 Belfair, WA 98528 RE: Foundation for Addition at 51 E Hitthe Road Permit#BLD2011-00475 Dear Mr.Urband, 1 prepared the engineering for the addition to your residence at 51 E Hitthe Road. To facilitate construction,I have been asked if it is possible to pour the footing in two separate pours. The proposal is to pour the footings along the sides of the addition, including the end galls adjacent to the garage. Then the footing under the garage door would be placed simultaneously with the garage slab. This proposal is acceptable to me, Attached is a sketch of the footing wall adjacent to the garage. The first part of the footing pour should extend 12"into the garage door opening. The footing rebar should extend 24"past the end of the first footing pour. This will allow the garage slab to cover the cold joint and reduce the possibility of rebar coirosion in the future. 1 am faxing a copy of this letter to Mason County in support of your building permit. Please feel free to contact me with any questions, Sincerely, 04 � o� H �O Matthew Zawlocki, PE c wnsri Cc: Mason County ?o Sao 0916 Enclosure: Footing Sketch SS;6,.G S 2453 BETHEL AVENUE, P.O. BOX 637, PORT ORCHARD, WASHINGTON 98366 (360) 876-2284 FAX (360) 87&1487 08-12-` 11 14:04 FROM-NL OLSON & ASSOC. 360-876-1487 T-325 P0003/0003 F-573 N.L. OLSON &ASSOCIATES, INC. JOB v (A')Gr-. 2453 Bethel Rd. SE SHEET NO of P.O. Box 637 CALCULATED BY_ DATE=r ILL 1� Port Orchard, Washington 98366 (360) 876-2284 • FAX (360) 876-1487 CHECKED BY DATE SCALE � R' . 7. 7 I I j .....i. ...I i 1 I I ....I... I.G I ,� I ......I- •-••I• • •; _- �__�--._.j........1 t •i-....-•!-•--..kf._.__I — i - ' I • I � I I !. . I j ..� .._..�. � is � ..._.j..... I i I j � I i I I ,• i I i I I I i I i I � ! I i l I I � 1—• I I I 1 --..i. i . i. I !._.. �.. VA I._...J.........! I ! . .i. .. .1... ;. .. ..(_.......L... ! . .�... '• .. I I j j.... _ . . i. .( i• I_ •i .• I i i i i I ...;.. j I ........... i I i I i � i i_ ...� i I I I .i _..i.. ..I i 1• I I I- �" I .I I I I I — I j ) ( I i I I I I I. i.. ._.,_.... .. .j i._._� �.. I i I ~• I I 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 1� RESIDENTIAL BUILDING PERMIT BLD2011-00475 OWNER: COREY URBAND RECEIVED: 6/10/2011 CONTRACTOR: LICENSE: EXP: ISSUED: 7/19/2011 SITE ADDRESS: 51 E HITTHE RD BELFAIR EXPIRES: 1/19/2012 PARCEL NUMBER: 122077590201 LEGAL DESCRIPTION: TR 20-A OF SURV 5/94-96 LOT: 1 OF SP#2435 PROJECT DESCRIPTION: DIRECTIONS TO SITE: 644 SF Garage & 1012 SF Dwelling ADDITION AND REMODEL CORNER OF HITTHE RD AND AND RASOR RD General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R31_1 Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:1,012 Garage-Attached 644 Valuation: $ 144,005.44 Building Height: Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: E 100.0 Ft. Shoreline: Ft. Water Body: Rear: W 40.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 142.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: S 40.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type City. Type By Date Amount Receipt Water Closets (Toilets) 2 Ventilation Fan 3 EH Plan Review GMM 6/10/2011 $103.00 S1 201 1 0 001 Lavatories 3 Pellet Stove 2 Plan Check Fee GMM 6/10/2011 $809.74 S12011000i Bath Tubs 2 Dryer Vent 1 Planning Review Fee GMM 6/10/2011 $205.00 S12011000i Water Heaters 1 Building State Fee TW 7/18/2011 $4.50 S12011000i Clothes Washer 1 Building Permit Fee TW 7/18/2011 $1,245.75 S12011000, Hosebibs 1 Mechanical Permit Fee TW 7/18/2011 $182.00 S12011000i Mechanical Base Fee TW 7/18/2011 $28.50 S120110001 Plumbing Permit Fee TW 7/18/2011 $84.50 S12011000, Plumbing Base Fee TW 7/18/2011 $24.70 S 120110001 Total $2,687.69 BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 1 of 6 CASE NOTES FOR BLD2011-00475 CONDITIONS FOR BLD2011-00475 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There otential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800 - 82. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) Owner/A t' responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 3) Approv r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 4) All construction and demolition debris must be removed from the site after project completion. Pronap"isposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X 5) Temporary erosion control measures must be implemented to prevent water quality degradation of ad t waters or properties. Silt fencing or straw/ jute matting must be installed and maintained until upland vegetation has become established. X 6) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan" to ensure these sjtfyctures meet the setback conditions listed. X 7) Landi and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Appro it e Plan"to ensure these structures are shown and meet the setback conditions listed. X BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 2 of 6 8) 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 cons with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor isQnpwledging that all components of the stormwater management system have been inspection of the building permit the owner/agent/contractor is installed as approved on the stormwater site plan. X 9) 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 Departm t or to any further inspections being performed or approvals granted. X 10) 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 removalkr proved documents will result in failure of required building inspections. X 11) 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 Building De ent prior to any further inspections being performed or approvals granted. X 12) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air leakage results if a blower door test was conducted. Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA) when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing. Compliance certificates are available online at the WSU Energy program website titled, " WSEC 2009 Certificate" and are available in '/4 or'/z sheets. The Mason County Permit Center will also have some available. X -4 BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 3 of 6 13) A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or installed round swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps). Refere c EC 505. X 14) Washington State Energy Code Compliance has been approved as follows: Heat Type: Electric or other than electric, Compliance Method: Component Perfomance (see below), Window(Max U-Factor):0.30, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.40 or less, Wall insulation R-21, except upper floor knee walls R-25, Floor insulation R-38, Ceiling Insulation R-38 standard, and Vault Insulation R-30. In addition the following credit from Table 9-1 HAS BEEN completed: Component performance for compliance to Table 9-1, option 3B (15% increased efficiency): Target 137.4/Prop 137.2: X (S� 15) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85 MPH. X 16) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacture ' stallation instructions. X 17) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If nts are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged an Me e collected by the Building Department prior to any further inspections being performed or approvals granted. X 18) All construction mu meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington cupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. X 19) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency(ORCAA). It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been identified a moved from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or operator h ob ined written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 www.orcaa.org X BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 4 of 6 20) 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 locat d hin 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 21) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance o elation, must be reviewed and approved by Mason County prior to construction. X ) J 22) 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 intern nal codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector sh ade prior to requesting additional inspections. X 23) Epoxy grout required and specified on the approved building plans shall require a special inspection. The special inspector shall be the engineer of record or their authorized representative, a WABO Certified special inspector, or certified testing laboratory. In addition a Mason County Building Inspector may perform the inspection provided holes are prepared in accordance to manufacturer specifications that are available on-site during inspection. Special in ctors shall inspect the installation of grouted construction anchors as stated in the manufacturers specifications. An inspection report shall be prepay am submitted to the Mason County Building Department prior to the framing inspection of the project. X Qc 24) All property lines shall be clearly identified at the time of foundation inspection. X 25) All buildin permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to requ t 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 y ordinances and building regulations. X 26) 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 f eod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder hvented action from being taken. No more than one extension may be granted. X 27) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT PROPERTIES NO REASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM OR ROAD WAY. X BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 5 of 6 This permit becomes null and void if work or c ruction 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 commenced. E encAo tion of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation ork iof a progr nspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Maso C untya abo d ribed property and structure for re 'ew an inspection. OWNER OR AGENT: DATE: BLD2011-00475 Please refer to the following pages for conditions of this permit. Page 6 of 6 51 r N ITTA : RuND , 3f-- rF I K # 2011 - 004*75 co Y v a t NoT -To SCht-V, LOFT S'Fr6-T I Nl�ST�K 3�TF4 %� Wes 1 - 1N CWS11 Z SW ITr_4 9L-ACSS MASTER S J WALK-IN BATHROOM CLOSET ter/ . 1 ONUS ROOM c0�5p S'ra8'd!Iz•r,er Gl`J SY STER WPA.A- !►cD TO cgwrE BEDROOM 'ap�.tUS F2oOM b a CL-ose s &-DDo .� C �e,<xS`s NOT TO Sckc r � } �) p :n KITCHEN "a ( GREAT ROOM a ma FICaVQATIOn1 T b/Sho � ; Rbk; Dlp IWC DU Nli SATHRO �< CS+ZIC l� ad+rroo S� m I I 1 BEDROOM BEDROOM FLQotZ �a1ls �•Jo.at O r-L.S ' 2-CAR GARAGE h 4 r--------------- - I I I I I I I i I I I i I I I 1 I � Nam41 Q y Parcel# BLD# 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 2. '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. ZCommon 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 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 = development is greater than 2000 square feet a X Small Parcel Stormwater Site Plan is Required Total Impervious Surface Area(sum of all areas 100g If the Total Impervious Surface Area is LESS THAN guare 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. AcknowI d ment of s h is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further ac wled th the information provided is accurate and employees of Mason County are granted access to the above- describ ope and' s ction as may be required. X Owner/Agent/Contractor(circle one)Date: If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 Name 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: hM//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/drainfield 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 2009 WSEC Component Performance Worksheet (Climate Zone 1) Name: Urband Sq. Ft 1006 Permit Number: BLD2011-00475 Parcel Number: 12207-75-90201 Target from Table 5-1 U-factor Area Target UA Glazing 15% U-0.30 150.9 45.27 Vert Glazing U-.50 16 8 Doors U-.20 21 4.2 Attic R-49 standard U-.027 531 14.337 Vault R-38 U-.034 288 9.792 Wall - Electric R-21 intermediate U-.056 909 50.904 Floor R-30 U-.029 1006 29.174 Slab R-10 fully insulated F-0.36 0 Below Grade- Interior Insulation 2' depth R-21 U-.042 0 3.5' depth R-21 U-.041 0 T depth R-21 U-.037 0 161.677 Add 15% efficiency Table 9-1, option 3b Total Targeti 137.42545 PROPOSED Actual R Actual U/F Area Proposed UA Factor factor Glazing 0.3 50 15 Vert Glazing 0.5 16 8 Doors 0.4 21 8.4 Attic R-38 0.031 531 16.461 Vault R-30 0.034 288 9.792 Wall R-21 0.056 670 37.52 Floor R-38 0.025 1006 25.15 Wall upstairs— R-25 0.047 360 16.92 Below Grade - Interior Insulation 2' depth 0 3.5' depth 0 7' depth 0 Below Grade Exterior Insulation 2' depth 0 3.5' depth 0 7' depth 0 Total Targeti 137.243 .;E.LE PLANS r,UST EE ON THE JOB SITE APPROVED` PLANNING:ASON COUNTY DCD PLANNIN MEASURED SITE PLAN REQUIRED TO BE ON SITE ALL SETBACKS ARE CHANG S SUBJECTTO APPROVAL FROM THE FURTHEST By Date �Ol( PROJECTION OF THE BUILDING 1 � to I z �} r4 E r RECEIVED Z JUN 10 2011 Z " J 426 W. CEDAR ST. MASON COUNTY PERMIT NB C)20) f— BUILDING PERMIT APPLICATION C� 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 d APPLICANT INFORMATION CONTRACTOR INFORMATION Cs Owner MC i—i 6. Company Name l Mailing Address P 0 - -�,' o x 142- Mailing Address City"P,t I State N-,JP, Zip Code-Mc-0) City State Zip Code Phone(Lc') G21 - gnu Other Ph.(�L 25 96bb Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address 20c*vi MAP 0505 1 VAN u o 'C,CrA E Mail Address Drivers Lic.# 0?1WQ1C(ITH tx' _ DOB `o Z Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic �S Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No- 122Cy1 25; 92201 Fire District �— Legal Description Site Address(Please include street name, street number and city) 61 E H 111ltt tE'D tT3Eti=r11t?.,\,1A Directions to site 2oM S,2 3= w co S2 t� t't 'Al -1-0 ?• A \jj c >Z >,E:r, oN kl-�Fe&Wec 1 ml\,c' VP 1t 4 iLWUCJ Ib f�Pc`�0�2 Z D . U!j -KIP Will timber be cut and sold in parcel preparation! Yes/ c Is property within 200' of Saltwater I_Lake ►J River/Creek _Pond 1,30 Wetland }Seasonal Runoff jStream 0(-� Slopes or Bluffs ] 15% Nip Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE E] SEASONAL ❑ Use of Building RIE5UVi=NCi Describe Work ADD 2 3E ran 2 CAk W f2EL4cA-rf EylS-jwc, 3eC,/y,21 No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor -- - Basement ' -- Deck Covered Deck Other Sq.ft. Garage � ' 5 i- Attached >` Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Tkt Model -ti A- Year k Length Width — Serial No. No. of Bedrooms No. of Bathrooms — Type of Heat '" Purchase Price$ = Replacement Unit? Yes/No Installer Name 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 work 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 er or any other party in interest regarding this application or the work proposed in the application,I have obtained permission them to r this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is rate a g s employes&of Mason County access to the above described property and structure for review and inspection. PROOF O CONTIN O K BY MEANS OF A PROGRESS INSPECTI7/;A X Date• Own Owners Representative/Contractor indicate which one FOR OFRiCIAL USE BEYOND THIS POINT Accepted b : — Date Lod 0-1 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department — �3 2- 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 Plan�nincl view Fee Mechanical& Base fee Ot Wood/Gas/Pellet Stove Fee State Ope Violation Fee O>W-- 7 / t Pre-Paid at Submittal �� 7 Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360)427-967t0B -4467• Elma (360) 482-5269 nheO web www.co.mason.wa.us - APPLICANT INFORMATION CONTRACTOR INFORMATION Owner CG'+<i:y Ca Company Name \ r Mailing Address L 1�1 �o;c "74z— Mailing Address City -f!s�- State : iA Zip Code . `9 Z� City State Zip Code Phone4j�oZ(r?1 W Other Ph.�3En) z t5 `)t`ka Phone Other Ph. Lien/Title Holder Contractor Reg.49 Exp. E mail address U.:CLEKAhJ 10 NY- o 0o E Mail Address Drivers Lic.# DOB 72, Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic _ Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) 51 1:-: - 1A IT-r rim IRD, Directions to site E ecA 5 R 3' \)+ rN S 104, 1 ; M rs TU ;Zwov kD �;� 2w R . i•'; r� t,t-S +P rc�u£iz,l;Cis 1ZASc3R i�i) cN ;W�,CKL . •v 'LOC` t�5 ie+ u iTirli Is property within 200'of Saltwater 1-10 Lake NO River/Cr Pond N eek tJ� Wetland No, Seasonal Runoff L Q Stream I D Slopes or Bluffs > 15% t-I D TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric4 LPC;_ Natural Gam Heat Pump_ Toilets A —"IcATF- I = Z Type of Unit No. of Units Fees Bathroom Sink I = -3 Furnace Bath Tubs - L Heatpumps Showers Spot Vent Fan \1. ADD 3 Water Heater '�'rZc�ocATC l Propane Tank — Clothes Washers Gas Outlets Kithen Sinks Wood/Gas/PelletStove k Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent V ut-c,cATt i Other Other Base Fee Base Fee I TOTAL PLUMBING TOTAL MECHANICAL OVMVER/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 work 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 work 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—TVDe Constr. Plannin Department Environmental Health Department FEES Plumbinq & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee ITOTAL FEES