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COM2005-00059 Pole Bldg Final - COM Permit / Conditions - 8/12/2005
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.(-�J ► ► � PLEASE PRESS HARD BUILDING PERMIT APPLICATION mot 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 INFORMATIONCONTRACTOR I FORMATION Owner Company Name s Mailin ddress Mailin Addre s - City tate Zip Code - D City State_1.0r, Zip Code Phone - Other Ph.366 _&57- �� Phone. e6_ .3f�2- _Soa S Other Ph. Lien/Title Holder S Contractor Reg.# Exp. E mail address D o E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTE4 INFORMATION - Connect to New Septic Existing Septic ,/(/ o Connect to Water System (Z Name of Water System Well--Water Syste me PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) .2-5 0 Directions to site A2 e Will timber be cut and sold in parcel preparation?Yes lev Is property within 200'of Saltwater ,Lake W O River/Creek Nei Pond /) e9 Wetland /1 n Seasonal Runoff_&�2 Stream Slopes or Bluffs > 15% -) n Is this permit submittal th result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe Work 5 c No.of Bedroo s o.of Bathrooms�,QSquare Footage- 1 st Floor2nd Floor 3rd Floor Basement 4_ Deck Covered Deck_ 16ther Sq.ft. Garages Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width S ' No. No.of Bedrooms No.of Bathrooms Type of Hea Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. OVIINER/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 an grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINU I F W K IS BY MEAN FA PROGRESS INSPECTION. s / Date: S o� Own r/ ners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department no 1/10 Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Buildinq Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical &Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. --( �1`-1 i BUILDING PERMIT APPLICATION r �c5 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 INFOf�■.ATIO CONTRACTOR FORMATION 4 Ate" Owner F ; 1/ :-- ' A4L Company Name ' jl+ I Mailin ddress Mailing Addre s - d City fate Zip Code G' City State W e, Zip Code f / � _ i Phone Other Ph. +twt% -;�S 7- ' Sr Phone '.'tee- 3C 2- Gc9b Other Ph. Lien/Title Holder -` fi Contractor Reg.# Exp. E mail address �> c= E Mail Address l Drivers Lic.# DOB Drivers Lic.# DOB j SEPTIC/WATER SYSTE INFORMATION - Connect to New Se ic. -''`? existing Septic Connect to Water System L1 Name of Water System --' Well _Water System . � I'd a ystem-M.- PARCEL INFORMATION- 12 Digit Parcel No. Fire District ' I Legal Description Site Address (Please include street name, street number and city) Z` Ocro E. Directions to site +� ' ' , .9 4 Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater k_Lake e° River/Creek A-� Pond dr r Wetland AL Seasonal Runoff_& , Stream Slopes or Bluffs > 15% ;j Is this- milt submittal 2aresult of a Stop Work Notice,Correction Notice or other enforcement action?YeaMo TYPE OF JOB evv Add Alt Repair Other RIMARY RESIDENCE SEASONAL Use of Building 5 - ► Describe Work ' No.of Bedroo s� `Y o,of Bathrooms 21 Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck _Other Sq.ft. _ Garage- Attached Detached ;-'� Carport =' Attached Detached MANUFACTURED HOME INFO ATION - Make Model Year Length Width S No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No i Installer Name Certification No. CNVNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Adexxviedgement 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 pa *#permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application:t obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents the information provided is accurate ar4grants employees of Mason County access to the above described property and structure for review and PROOF OF CONTIN F WORK IS BY MEAN F A PROGRESS INSPECTION. _ / Date: —Zk Owner/ ners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ' Planning Department Environmental Health Departmen Public Works Department Fire Marshal { FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Plannin Review Fee Mechanical&Base fee Other I Wood/Gas/Pellet Stove Fee State Fee i Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES { MASON COUNTY PERMIT NO. 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 APPLICANT INFORLMATIO.N CONTRACTOR INFORMATION f f t t ? a Owner1'{ ' .'1 r //` Company Name Mailing Address Mailing Address .+r &r. t r { f 4 City 1 � c Qrate Zip Code ` - ' �' City p State = r . Zip Code ' Phone � z Phone �� Other Ph, t .1 �- $�.:/ r 5�:- � Other Ph. Lien/Title Holder Contractor Reg.# Exp. P Email addrgs e,r C c: i.' E Mail Address Drivers..Llc.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic_ Connect to Water System } .' Name of Water System Well �Water System Narfie'btWater System PARCEL INFORMATION- 12 Digit Parcel No. 10 7 Fire District '' Legal Description Site Address (Please include street name, street number and city) f t. t `7 ' Directions to site Will timber be cut and sold in parcel preparation?Yes/ 10 Is property within 200'of Saltwater;/,' Lake ' River/Creek Pond Wetland A= Seasonal Runoff : Stream Slopes or Bluffs > 15% A J . Is this=K submittal t result of a Stop Work Notice,Correction Notice or other enforcement action?YeeMo TYPE OF JOB - New Add Alt Repair Other F RIMARY RESIDENCE M SEASONAL ❑ Use of Building#~ 1. Describe Work _ + ` r a ' r No.of Bedrooms o.of Bathrooms , Square Footage- 1 st Floo 2nd Floor 3rd Floors Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year y Length Width S ' No. No.of Bedrooms No.of Bathrooms Type of Hea Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. OWNER/BULDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Advtowledgement 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,y perm>ission 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*the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF O NTI F CON 1PF W9RK IS BY MEANS OF A PROGRESS INSPECTION. L ✓,, :" Date: ; Owner/Owners Representative/Contractor indicate which ne FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED L NOTES Building Department I 4N ._. /'` j / Planning Department Environmental Health Department o Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee 3 Plumbing& Base Fee Planninq Review Fee Mechanical& Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. C40" 3.<2)CU'9: BUILDING PERMIT APPLICATION cc)os-`�'l 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 INFOBfAATION CONTRACTOR I FORMATION Owner Company Name Mailin ddress Mailing Addre s � d�C City tate Zip Code - D City State fir, Zip Code Phone Other Ph.34�b -d 57-�� Phone"=3t-2- Soa 5 Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail addr'less fl to E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTE4 INFORMATION - Connect to New Septic 1169 Fxisting Septic Connect tp Water System ., Name of Water System------- ~ Well Water Syste PARCEL INFORMATION- 12 Digit Parcel No. ~ Fire District Legal Description Site Address (Please include street name, street number and city) O - i Directions to site j Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater . /0 Lake WO River/Creek A,142 Pond ,A) ,0 Wetland Al 41 Seasonal Runoff_& Stream Slopes or Bluffs > 15% Aj n Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yewft TYPE OF J Alt Repair Other PRIMARY RESID NCE SEASONAL Use of Biail Describe Work No.of Bedroo i athrooms— jQ=Square Footage- 1 st Floc 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached —Carport Attached Detached MANUFACTURED HOME INFO ATION - Make Model Year Length Width S No. No.of Bedrooms - No.of Bathrooms Type of Hea Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. CVVNM/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.AclaxWedgement 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 pa ' permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,419kve obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents ftAthe information provided is accurate an grants employees of Mason County access to the above described property and sthxture for review and ion. OF CONTIN I F W K IS BY IVIEANSPFA PROGRESS INSPECTION. / Date: S---/� Own r/ Hers Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THI POINT Accepted by: Date DEPARTMENTAL REVIEW POE DENIED NOTES Building Department G Planning Department Environmental Health Department Public Works Department Fire Marshal p -� FEES Building Permit Fee Site Inspection r Plan Review Fee EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ,a Valuation$ TOTAL FEES MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST Owner's Name: l/V k _S ; ILIF Date: , b/>05 Reviewed By: 1— Documents: Building Permit Application Completed I�'Planning Intake Checklist Completed, plan includes:Allowable building area,;eof overhangs,decks,etc. ,���",e,�paratus Access Road info required. Yes�o Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type ) O Other: Specify: —Menical/Pl • g Application-WATER HEATER FUEL TYPE Tngineering? Yes No Snow loa/d_used: Seismic Design Category: D1 or D2 Geotechmcal report or assessment? Yes �No Construction Plans: I.- 3 COMPLETE SETS V Plans Legible Recognized Scale 'Elevation Views Cross Section _Foundation Plan _Roof Framing Plan _Floor Plan-Use of Rooms Noted a --'Floor Framing Plan-all floor levels represented? Loft,crawlspace,etc. Deck Framing Plan,including covered porch;oof framing plan Plan Details: Zi1l _Roof framing details,truss lay-ottuit 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 9'?(Engineering may be required) Landings at all exit levels? <30"above grade? Y / N Heated By Furnace-Location of Furnace _Fireplace/Stove Information Shown-Fuel Type? _Window Sizes Marked on Plans 2-Story Garage? (Engineering may be required)R602.10.1, V story of a two story: D1—45%,D2—55% —Braced wall panels(shear walls)marked on plans or lateral engineering?(Plans may not be approved if not provided) COMMENTS i r' G� IRREGULAR BUILDINGS(Unusual Shape)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 includes masonry or concrete construction(exc: fireplaces,chimneys,and.veneer). 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