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HomeMy WebLinkAboutBLD2004-01862 - BLD Application - 12/5/2004MASON COUNTY BUILDING PERMIT APPLICATION 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 PERMIT NOig LDZoob-%'— o)86Z APPLICANT INFORMATION Owner Mailing Address City State Zip Code Phone ( Lien / Title Holder Email Address Other Ph. ( ) CONTRACTOR INFORMATION Contractor Name Mailing Address City State Zip Code Phone ( ) •Other Ph. ( ) Contractor Reg. # Exp. . / Email Address SEPTIC / WATER SYSTEM INFORMATION - Connect to New Septic Connect to Sewer System Name of Sewer System Well Water System / Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. / / • Legal Description J Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater Lake River / Creek Wetland Seasonal Runoff Stream ,elopes or Bluffs Existing Septic Fire District Pond PERMANENT RESIDENCEAT SEASONAL RESIDENCE El TYPE OF JOB - New v Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action? (Yes/No) Describe Work ' No. of Bedrooms `"; No. of Bathrooms SQUARE FOOTAGE - 1st Floor i 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage I Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION,- Make Length Width Serial No. Type of Heat Purchase Price $ Installer Name Model Model Year No. of Bedrooms No. of Bathrooms Replacement Unit? (Yes/No) Certification No. 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT - I certify that I am exempt from the require- ment of the Contractor Registration Law RCW 18.27 and am aware of the ordinance requirements for which this permit is issued and that all work will be done in conformance therewith. No changes shall be made without first obtaining approval. X Date CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- tered as a contractor in the State of Washington and that I am aware of the ordinance requirements regulating the work for which this permit is issued and all work shall be done in conformance there- with. No changes shall be made without first obtaining approval. X Date ! FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Date Bld Pd. DEPARTMENTAL REVIEW APPROVED DENIED Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ Building Permit Fee Plan Review Fee Plumbing & Base Fee Mechanical & Base Fee Wood / Gas / Pellet Stove Fee Violation Fee / ,_ grz t 1(O. j FEES Site Inspection EH Review Fee Planning Review Fee Other State Fee Pre -Paid at Submittal TOTAL FEES C k# Reciept No. CONDITION CODES 475 oc) MASON COUNTY BUILDING PERMIT APPLICATION PERMIT NO. 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 APPLICANT INFORMATIO j Owner r i w1 l� s4- I L i 1\ f L. Y' ! �.An'1111./( Mailinddress 1 Lj_ar"L ;) n'11)1 `(�! 1. NI ? - City State VV n Zip Code )(61 Phone ( ) 71) ,)Other Ph. ( ) Lien / Title Holder Email Address CONTRACTOR INFORMATION Contractor Name 1 041Y Mailing Address . City (' i i.1111.:)//4.,_ State IA f_aZip Code (/i',-'_ ;? Phone ( • ) Y. f Other Ph. ( ) Contractor Reg. # ,; ;, ;, r t 4.',% Exp. I / • ; / 1 Email Address [\)1 ;ti} SEPTIC / WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION - 12 digit Tax.Farcel No. ' /1 .,-5-14) LOU-- Fire District r - Legal Description .� ' l - ,? i.' /',� , V '''VV `;'{ . , d. t .+ D Site Address C; t (Ple se include street name, street nu �ber and city) .,7_1-1 / ./I Direction to site L _ i' VudI€1( )7'-',v1/1 i t IAlt;{ , c di r Will timber be cut and sold in parcel pr aration? (Yes*yo)1' ) Is property located within 200' of saltwater t�al�g ,� River / Creek Pond Wetland Seasonal Runoff Stream \ i'�J7�St5pes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New V/ Add Alt Repair Other Use of Building 4'± -,,F -12 -- Is --- Is this permit subrpittal the result of a Stop Work Notice, Correction Notice or other enforcement action? (Yes/No) Describe Work Al . ti: 1 I i1 No. of Bedrooms t- No. of Bathrooms 1.- 1170 2nd Floor 3rd Floor Loft Garage 1-$9 Attached MANUFACTURED HOME INFOR Length Width S Type of Heat Installer Name Basement Detached TI9N -Maly I o f,' I rdh s6 P/tic SQUARE FOOTAGE - 1st Floor Deck Other Carport Attached If I,t sq. ft. Detached Model Model Year No. of Bedrooms No. of Bathrooms Replacement Unit? (Yes/No) Certification No. 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT - I certify that I am exempt from the require- ment of the Contractor Registration Law RCW 18.27 and am aware of the ordinance requirements for which this permit is issued and that all work will be done in conformance therewith. No changes shall be made without first obtaining approval. X Accepted by Date Date CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- tered as a contractor in the State of Washington and that I am aware of the ordinance requirements regulating the work for which this permit is issued and all work shall be done in conformance there- with. No changes shall be,made without first obtaining approval. X ��1'1-7 11 Date i2 -:`JI FOR OFFICIAL USE BEYOND THIS POINT Planning Pd `Ck# Bld Pd. Reciept No. DEPARTMENTAL REVIEW APPROVED Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ 1(9119 Building Permit Fee Plan Review Fee Plumbing & Base Fee Mechanical & Base Fee Wood / Gas / Pellet Stove Fee Violation Fee tQ DENIED CONDITION CODES FEES Site Inspection EH Review Fee Planning Review Fee Other State Fee Pre -Paid at Submittal TOTAL FEES 0-9 ( MASON COUNTY BUILDING PERMIT APPLICATION PERMIT NO. 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 APPLICANT INFORMATION Owner I' - ! Mailing Address y '-1 ' 11,t ' +, City ;1`�' rState Zip Code Phone ( ) ;3 i Other Ph. ( ) Lien / Title Holder Email Address CONTRACTOR INFORMATION Contractor Name / 0't Mailing Address City Phone ( ) Contractor Reg. # Email Address State , Zip Code /i0ther Ph. ( ) . _ Exp. / / SEPTIC / WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System ✓ Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. Legal Description , ,t.� Site Address (Please include street name, street number and city) Directions to site 1( ! A. ' ' I r°. } t ' + 1:4 pi Will timber be cut and sold in parcel preparation? (Yes/No.)" Is property located within 200' of saltwater Irak River / Creek Wetland Seasonal Runoff Stream;',. : •.ti' topes or Bluffs PERMANENT RESIDENCES SEASONAL RESIDENCE ❑ TYPE OF JOB - New v" Add Alt Repair Other Use of Building ' ice~ Is this permit subrpittal the result of a Stop Work Notice, Correction Notice or other enforcement action? (Yes/No) Describe Work I ;.- ' . ; f No. of Bedrooms LI No. of Bathrooms SQUARE FOOTAGE - 1st Floor I' 1, .. 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage- `+� ` i Attached Detached Carport Attached Detached 1 I i y Vit' i Fire District Pond !J t `. 'i t 1'g i'4 MANUFACTURED HOME INFORNKI©N,- Make , Length Width Serial Not' Type of Heat ; PUrehase Pric'aj$ --- Installer Name Model Model Year No. of Bedrooms No. of Bathrooms Replacement Unit? (Yes/No) Certification No. 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT - I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there - shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval. X Date X FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Date Bld Pd. Ck# Reciept No. Date DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ Building Permit Fee Plan Review Fee Plumbing & Base Fee Mechanical & Base Fee Wood / Gas / Pellet Stove Fee Violation Fee FEES Site Inspection EH Review Fee Planning Review Fee Other State Fee Pre -Paid at Submittal TOTAL FEES it FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD PERMIT NO.: (.A1 -4269) -- MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 Shelton (360)427-9670 Belfair (360)275-4467 Elma (360)482-5269 Seattle (206)464-6968 APPLI ANT FO ATION Owne Mailin City Phone( ) Lien/Title Holder Address il' 1 Muir /!I State Mt Zip Code 0.Q -other Ph.( ) CONTRACTOR I Contractor Name Mailing Address City�L Ph.( ' ) X72 Contractor Reg. # Expiration I 1 State (Other Ph.( Pal . Y. 214'. / SEPTIC INFORMATION -Connect to New Septic ✓ Existing Septic Sewer System PARCEL INFOR Legal Description Site Address(Ple Directions tot site ,.51` JO 12 di it x Parc e nclude.sfreet na r� I- V 1�Y1 J A 110- 2 -) y1c-2-) Zip Code4rel (Z Connect to Sewer System Name of L k5 -A/PC-1 (l )11-4:.7 num •er and cit ) it -ill 01A. --t1 VOA(Xl flt .S✓� � '/— l Y�� L T . Fire District Is your property within 200' of the following: Body of Water (Nam Lake River/Creek Pond Wetland Sea Bluffs TYPE OF JOB New 1/1 Add AlIt Repair 2nd Floor of Fixtures/Units 1st Floor Stream Other Use of Building Basement Garage Saltwater Slopes or Closet i PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric✓ Type of Fixture No-7lof Fixtures Fees LPG Natural Gas Heatpump Toilets i / y C'( Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs /. /'/& t Heatpumps Showers Vent Fans 'i ; / )5 -- Water 5`Water Heater 1 7 C(' Propane Tank Laundry Wsher 1 2 it Gas Outlets Sinks }1/ if Wood/Gas/Pellet Stove Dishwasher 1 "7t.(= Direct Vent? Other Other Other Other Base Fee .)c- TOTAL )t. TOTAL PLUMBING `/ C.(1 TOTAL MECHANICAL Base Fee A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 -I certify that 1 am exempt from the requirements of the Contractor Registration Law RCW 18.27 and am aware of the ordinance requirements for which this permit is issued and that all work will be done in conformance therewith. No changes shall be made without first obtaining approval. x Accepted by Building Department Occ Group _ Type Constr. Planning Department Other Other Permit Fee Plan Review Fee Plumbing & Base Fee Mechanical & Base Fee Wood/Gas/Pellet Stove Fee IViolation Fee Date CONTRACTOR'S AFFIDAVIT -I certify that I am currently registered as a contractor in the State of Washington and that I am aware of the ordinance requirements regulating the work for which this permit is issued and all work shall be done in conformance therewith. No changes shall be made without first o4te• ing approval. x� FOR OFFICIAL USE BEYOND THIS POINT Date Submittal Amount Due Site Inspection IUFC Plan Review Fee Other Other Pre -Paid at Submittal TOTAL FEES Date 1j� 2' Receipt No. 10,A Gc .z (}t>$,L Name /Za''"i �1/� r �c+ MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT FEE CALCULATION WORKSHEET Residence /Addition /Basement Garage /Storage Building Basement (semi -finished /unfinished) Deck Carport /Covered Deck Other VALUATION DETERMINATION $66.35 $23.95 $32.64 $ $11.60 $ $16.50 1 $ Is $ Total Valuation J $ Estimated Plan Review Fee, due when the permit is submitted: $ Planning Dept. Review Fee ($155/$255), due when permit is submitted: $ TOTAL DUE WHEN PERMIT IS SUBMITTED: $ /2 s'9/ r�C, _3Js. yy 3G' -y./.L/3 3 7.4/ The estimated plan review fee is based upon information provided at the time of application and is subject to change. Planning Department fee is a flat fee which is due when permit is submitted. Building, mechanical, and plumbing permit fees will be calculated during plan review. Environmental Health, and other fees will be collected when the permit is issued. Building Permit Fee (see table attached to Building Permit Fee list U.B.C., table 1-A) Estimated Mechanical Fees (u.M.c. , Table 1-A) Estimated Plumbing Fees (u.P.c. ,Table 1-1) Estimated Environmental Health Fees: $35.00/$75.00 Estimated Fire Marshal Fees (Commercial projects -50% plan review) State Fee Address Fee Estimated Fees due when permit is approved: Total Cost: •S 4.50 I:\BUILDING\ESTIMATED FEES — revised 8-25-2004 } ) c'C-.� Prepared by: /C 7/ :MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST Owner's Name: /( <? "1C /; e ! Date: /) it - 611( Reviewed By: Documents: Building Permit Application Completed A. Planning Intake Checklist Completed, Site plan includes: Allowable building area, roof ov hangs, decks, etc. Fire Apparatus Access Road info required? Yes / or _ Energy Code Application Form - HEAT FUEL E _ Mechanical/Plumbing Application - WATER HEATER FUEL TYPE _ Engineering Included & info transferred onto building plans: Design criteria: Code reference: , snow load Seismic Zone (circle one): D1 or D2 ; Calculation incl (circle): Vertical Yes / No , Lateral Yes / No Construction Plans: ` 3 COMPLETE SETS _ Plans Legible _ Recognized Scale _ Elevation Views _ Cross Section _ Foundation Plan Roof Framing Plan _ Floor Plan - Use of Rooms Noted Deck Framing Plan, incl cov. porch framing _ Floor Framing Plan - all floor levels including loft, crawlspace, etc. Plan Details: _ Roof framing details, truss lay -out may be needed _ Wall Framing - Does bearing -wall height exceed 10'? (Engineering may be required) _ Floor framing: Floor joists: , Floor beams: _ Window headers. Typical header: _ Foundation: footing size, reinforcement _ Concrete Walls - Does Concrete Wall Height Exceed 8'? (Engineering may be required, see details) Non -Conventional Framing - Foam Core, Logs, etc.? (Engineering is required) _ Point loads trace to footings below? _ Slab insulation shown _ Landings at all exits? _ Heated By Furnace - Location of Furnace _ Fireplace/Stove Information Shown - Fuel Type? Window Sizes Marked on Plans Braced Wall Panels (BWP) [also referred to as shear walls] Reference 2003 IRC Section 602.10: Braced Wall Panels (BWP) Marked on Plans? YES (continue below) NO (lateral analysis included?) 4' Exterior BWP's located at corner, OR check option below: 4' panel within 8'of comer with 1800# holdown , or 2' comer panel and 4' BWP located within 8' or comer R602.10.5 (see detail), or 2'8" Alternate BWP (ABP) _ 4' Interior Braced Wall Panel (IBWP), within 8' of comer, not to exceed 25' o.c. EXCEPTION: spacing may be 35' o.c. in order to accommodate one single room not exceeding 900 SF, length of wall shall be required length multiplied adj. Factor from Table R602.10.11 (25' - 30' use factor of 1.2, 30+' to 35' use factor of 1.4) Continuous footing required under 2 -story structures in D2 or see exception in 602.10.9. IRREGULAR BUILDINGS R301.2.2.2.2 Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur: 1) Exterior braced wall line or BWP cantilevered or offset by more than 4' 2) Roof or floor is not laterally supported on all edges 2A) Portion of roof or floor extend more than 6 ft. beyond the braced wall line. 3) End of BWP extends more than 1 ft. over an opening more than 8 ft in width below. 4) Opening in a floor or roof exceed the lesser of 12 ft. or 50% of the least floor or roof dimension. 5) Portions of floor level are offset vertically 6) Shear wall lines do not occur in two perpendicular directions. 7) When a story above grade is includes masonry or concrete construction (exc: fireplaces, chimneys, and veneer). When this applies the entire story shall be designed. In accordance with accepted engineering practice. COMMENTS: Mason County Permit Assistance Center y Planning Intake Checklist Owners Name: �, vi S fir /rl Date: % - cf�! Project: ,Sb - i? Reviewed By: Commercial Development: Y. . (fTO Comments: Planner: GBM RAM TSC Site Plan: f North Arrow ' Property Dimensions: ✓ 2 ZX 3t6 i Streets and Driveways Shown. Road name: 4,e. J I '&1 All Existing Structures shown with setbacks Well Location, Septic and Drain -field Shown with setbacks ' Identify all surface water (streams, ponds, shoreline, wetlands, etc.) ,'G Topography (slopes) AProposed Structure Setbacks (Direction/Setback): F: ;,fit / C R: S / S1: C.,i / D S2: E / .?-t A Utility and Drainage Easements: Yes T9- (if yes enter condition #5022) • Other Easements n;..�f • Accessory Appurtenances ❑ County Access Permit Needed (add condition #0010) u State Access Permit Needed (add condition #0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and #0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: ❑ Not Applicable ❑ Agricultural Urban ❑ In -holding ❑ Rural ❑ LTCFL ❑ Conservancy ❑ Rural O Natural 0 RAC O Unknown ❑ RCC -Hamlet Urban Growth Area 0 Unknown Water Body (type of water if unnamed): SEPA: Yep' No Unknown Flood Plain: YES 0 Unknow�yr .Map# Aquifer Recharge: YES NQS"Unknown Map# Tags/Cases: RLC/SPI Case: Eagle Nest Tag: YES NO Rural Zoning: ❑ RR 2.5 5 10 20 ❑ RMF ❑ RC 1 2 3 ❑ RI ❑ RNR ❑ RT ❑ MPR ❑ Unknown 6 -Year Dev. Moratorium: YES NO Other YES NO/ Addressing: Check box if needed -' ❑ Reviewed by: Revised: 1 1-05-04 I:\PLANNING\CHARELL & RENEE\PLANNING INTAKE