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HomeMy WebLinkAboutBLD2008-00824 Cancelled SFR and Water Adequacy - BLD Permit / Conditions - 6/6/2008 Inspection Line(360)127-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext. 352 Mason County Bldg. III 426 W. Cedar P.O. Box 186' 1 Shelton,WA 98584 RESIDENTIAL BUILDING PERMIT BLD2008-00824 OWNER: DAN RODIUS RECEIVED: 7/3/2008 CONTRACTOR: PACIFIC BUILDING 360-280-0256 LICENSE: PACIFB'0131_4 EXP: 12/13/2009 ISSUED: 10/7/2008 SITE ADDRESS: 530 E DARTMOOR DR EXPIRES: 4/7/2009 PARCEL NUMBER: 321275300136 LEGAL DESCRIPTION: LAKE LIMERICK 4 TRACT 136 PROJECT DESCRIPTION: DIRECTIONS TO SITE: New SFR Lake Limerick 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: R3/U Lot Size: Deck: 96 Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 c. L Building:2,370 Garage-Attached 483 Valuation: Building Height: O St u Prima Basement: cov deck 36 Manufactured Home Information Setback Inform tin Shoreline&Planning Information Make: Length: Ft. Front: W $0.0 Ft. h Water Body: Cranberry Creek eli e: 10 SEPA?: NO Model: Width Ft. Rear: E 105.0 Ft. lop Ft. Shoreline Desig.: Conservancy Side 1: N 6.0 Year: Serial Side 2: 6. Ft. Comp. Plan Desig.: Rural Plumbing Fix res ec anic I Fixt s,/ FEES Type Qty. pasOutlets Qty. Type By Date Amount Receipt Dishwasher 1 ood 1 Plan Check Fee KKK 7/3/2008 $999.02 S22008000 Hosebibs 3 100K 1 Plan Check Fee KKK 7/3/2008 $999.02 S12008000 Kitchen Sink 1 3 EH Plan Review KKK 7/3/2008 $40.00 S220b8000 Lavatories 4 Tank 1 Water Adequacy Plan Review KKK 7/3/2008 $40.00 S22008000 Water Closets (Toilets) 3 Ventilation Fan 1 Planning Review Fee KKK 7/3/2008 $190.00 S22bb8bbb Water Heaters 1 Heat Pump 1 Address Fee CMH 7/15/2008 $162.00 S22bb8bbb Building State Fee MAL 7/16/2008 $4.50 522008000 Bath Tubs Propane Stove 1 Building Permit Fee MAL 7/16/2008 $1,536.95 S22008000 Clothes Washer 1 Dryer Vent 1 Mechanical Base Fee MAL 7/16/2008 $26.60 S22o08000 Mechanical Fee MAL 7/16/2008 $205.00 S22008000 Plumbing Base Fee MAL 7/16/2008 $23.10 S22008000 Plumbing Fee MAL 7/16/2008 $120.01 S22008000 EH Plan Review CEW 9/4/2008 $60.00 S22008000 Total $4,406.20 BLD2008-00824 Please referto the following pages for conditions of this permit. 1 of 5 I/-fir®I�YI IIYI�II�Y�YIYIIYIIi ���s/�Ii OIWYI�i��lll��" CO v N O O co ono XW� CA 0 m xm m �v m a) ° � v ° M °1 = x ,.. omi n�i � < � cn N < c to CD p 0 cn 7 >•� n fl I n C o o (a 0) CL cn m m m m M:3 CL M �, 0 rtN � 3 = � N m fD ' o mr' Lcn s � C � md a) � cnd 0m o oaoL m � ? j -D �m 0 CL mm3c 3 m r: m cn T. � m cn ni cr � dv 3mo°i m O0 3 fl � � n3i mcmn � < a � fD O a: O m O N G C ZU1 S U (--'D' a 0 0 P• m rt m m � .'* O o y �' m 3 °c U0 O� � Cr CL > > -0 rt d O 0 (DD X ~`O N s o 0 N m � O N 0 0 3 mar0n (nM P. - Nm M � v Oa = CL CL .� 0) � m 0 CD mo (D a — (a xcn cn � 3 �lu CL ' S' m m ^� m . _CD 0cr s X m ' °' m a' 3 s = m a ? c .m°. m x (a CD cn o m N O 0 ° 0 N 0-0 CD 0+ CO N N m N C- N m ? �. < � 0 3 v, 3 c o d < CL 3 cn m 'D .+ m m y m v CD ' m o ° O M O N '+CD � d 3 ('� cc (Do m s 3 �c — _ o w � cn -" 0 m < - 3 m m tu - cn sQ � a N O 0 ;� 0 m"O ,0. r_► (D :� m. 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S m m 7 p� O- M � '0 O -Ow C N O n •< C n m 3 -+ m O m CD N vcl. n O fppl � 0. 3 N d CD CD aKi 0 w m 0 c c3i :3m ca80, 7 S N O `< 0 o 3 � c O n O n c O C 0 =r a)O o �' X CD r: c :30 p ff ca � > > m � o Q m ° ` s5. a m cD o. wpm C n as NQ JCL 0co o X 5' m m I 2/6/2009 Conditions Associated With 9:12:20AM Case#: BLD2008-00824 Permit Condition Status Updated item# Code Title Status Changed By Tag Date By 1) 5004 WSEC RESIDENTIAL HEATING EQUIP. NOT MET 7/16/2008 MAL Installation of heating equipment in single family residences shall meet the requirements of the current Washington State Energy Code. The furnace to be installed shall not exceed 150%of the heating and cooling design load. Heating and design load calculations for the purpose of sizing HVAC systems are required and shall be calculated in accordance with accepted engineering practice,including infiltration and ventilation. Design calculations shall be available for inspection during the framing inspection. Warm-air furnaces shall have a minimum efficiency of 78%AFUE or higher or 80%combustion efficiency. All ducts shall be securely fastened and sealed with welds,gaskets,mastics(adhesives), mastic-plus-embedded-fabric systems or tapes installed in accordance with manufacturers installation instructions. Duct tape is NOT permitted as a sealant on any ducts. Ducts in unheated spaces shall be insulated t X 2) 5100 Tips for Propane Tank Placement NOT MET 7/16/2008 MAL The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however,propane tanks are subject to Planning Department regulations. Such regulations primarily consist of - setbacks from shorelines and features considered to be critical areas(streams,wetlands,slopes,etc.) If you think such features exist on or nearby your the Planning Department so that exact setback requirements can be determined.X pr ct 3) 1700 Stormwater Management Worksheet NOT MET 7/16/2008 MAL 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/drainfreld 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 consult with the septic design professional involved with the project. By calling for a final inspection oft uilding permit the owner/agent/contractor is acknowledging that all components of the stormwate mana em have been installed as approved on the stormwater site plan.X 4) 5020 Slope Setback NOT MET 7/16/2008 MAL Placement of structure must comply with standards set forth per the international codes regarding descending an r asc es. X 5) 1012 SITE PLAN REQUIRED ON SITE NOT MET 7/16/2008 MAL 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 Department prior t tions being performed or approvals granted. X 6) 200 SIT AN NOT MET 7/3/2008 KKK AP r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest pr ection o cture. X Page 1 of 5 CaseConditions..rpt 2/6/2009 Conditions Associated With 9:12:20AM Case#: BLD2008-00824 I , 1� Permit Condition Status p to item# Code Title Status Changed By Tag Date By 7) 1500 ROOF WIND LOADS NOT MET 7/16/2008 MAL Per 2003 IRC-SECTION 1609- WIND LOADS- 1609.1 Applications. Buildings,structures and parts thereof shall be designed to withstand the minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609 BASIC WIND SPEED the wind speed for Mason County is 85 MPH. —z- 8) 1510 ROOF COVERINGS REQUIREMENTS NOT MET 7/16/2008 MAL Per IRC-SECTION R905 -REQUIREMENTS FOR ROOF COVERINGS-R905.1 Roof covering application. Roof coverings shall be applied in accordance with the applicable provisions of this section and the on instructions. X 9) 6000 RETAINING WALLS NOT MET 7/16/2008 MAL Retaining walls needed to support a surcharge such as structures,roads,or to support slopes,shall require a se ermit and approval prior to construction of the retaining wall. 10) 700 RCW 7 NOT MET 7/3/2008 KKK Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries,Contractor Compliance Division.There are potential risks and monetary liabilities to the _ homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982.The person signing this pondWon is either the homeowner,agent for the owner or a registered contractor according to WA state law. 11) 5510 Property Lines NOT MET 7/16/2008 MAL All 7mshall be clearly identified at the time of foundation inspection. X 12) 5090 PROP TANK NOT MET 7/16/2008 MAL All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must meet the installation requirements and minimum setbacks as listed in my Fire Marshal's Standards for the Installation of Propane Tanks. X 13) 5700 PRESSURE TREATED LUMBER NOT MET 7/16/2008 MAL Pressure treated wood manufactured after January 1,2004 may contain high concentrations of copper which could quickly corrode metal fasteners,connectors,an stall metal connectors approved for contact with the new types of pressure treated material.X 14) 1001 PLANS REQUIRED ON SITE N E 7/16/2008 MAL 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 Department prior to any furt s eing performed or approvals granted. X 15) 1003 PLAN REVIEW CORRECTIONS NOT MET 7/16/2008 MAL 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. Fa' or removal of approved documents will result in failure of required building inspections. X Page 2 of 5 CaseConditions..rpt 2/6/2009 Conditions Associated With 9:12:20AM Case#: BLD2008-00824 i� Permit Condition Status Updated item# Code Title Status Changed By Tag Date By 16) 5610 PERMIT EXPIRATION NOT MET 7/16/2008 MAL 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 for a period not exceeding 180 days,upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have prevented a i en. No more than one extension may be granted. 17) 34 No Degradation of Water Quality NOT MET 9/16/2008 RDH Wabe degraded to the detriment of the aquatic environment as a result of this project. X 18) 5019 MCPW Development Requirements NOT MET 7/16/2008 MAL 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 located within 25'of a Mason County road right of way,it is suggested to contact that office to revi d work which may affect your project. X 19) 1000 HABITAT MITIGATION NOT MET 9/16/2008 RDH Development is subject to all the conditions and recommendations of the Habitat Management Plan prepared by June 2008. All recommendations in the HMP are REQUIRED. X 20) 5095 FUEL PRANG NOT MET 7/16/2008 MAL Fuel piping shall be inspected after the installation of fuel piping is complete,and before the attachment of fixtures,appliances,or shut-off valves. At the time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall not be used until the fina s been performed and approved by a Mason County building inspector. X 21) 4998 FIRE WMA RATUS ACCESS ROADS NOT MET 7/3/2008 KKK The international code requires a fire apparatus access road for every facility,building,or portion of a building that is more than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained p ]c X 22) 5600 FINAL INSPECTION REQUIRED NOT MET 7/16/2008 MAL All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration.The failure to request a 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 Co d building regulations. X 23) 1011 F I L NOT MET 7/16/2008 MAL THE N SYSTEM SHALL BE PLACED ON UNDISTURBED,NATIVE SOIL. X Page 3 of 5 CaseConditions..rpt 2/6/2009 lipConditions Associated With 9:12:20AM Case #: BLD2008-00824 , Permit Condition Status Updated item# Code Title Status Changed By Tag Date By 24) 5045 FIELD CORRECT NOT MET 7/16/2008 MAL 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 international codes as amended and adopted by Mason County. Any corrections,changes or alterations required by a Mason County Building Inspector shall be made pri q itional inspections. X 25) 60 Erosion Protection NOT MET 9/16/2008 RDH Prior to final approval,all upland areas disturbed or newly created by construction activities shall be seeded, ve at an equivalent type of erosion protection(silt fencing or straw matting). X 26) 5002 ENGINEERING OR ARCHITECTURE NOT MET 7/16/2008 MAL 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 documents are removed, approval will not be granted. In addition,a re-inspection fee(refer to current fee schedule,minimum 1 hour) will be a and shall be collected by the Building Department prior to any further inspections being pe o d r vals granted. X 27) 5030 CHANGES TO APPROVED PLANS NOT MET 7/16/2008 MAL All changes to"approved"building plans that effect compliance with the international codes as amended and adopted,or any other Mason County ordinance or regulation,must be reviewed and approved by Mason C n nstruction. X 28) 5003 ALL CONSTRUCTION NOT MET 7/16/2008 MAL All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and pe ation. Any non-approved change of use or occupancy would result in permit revocation. X 29) 1002 ADD OAD SIGNING NOT MET 7/16/2008 MAL Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in acco ce on County Title 14.28. X 30) 1000 SETBACK FROM STREAM NOT MET 9/16/2008 RDH The Variance(VAR2008-00010)has been approved for a structure setback of at least 105 feet from the Ordin ► Mark of Cranberry Creek. X 31) 6550 LANDI S AND STAIRS NOT MET 9/17/2008 CMH Landings and stairs must meet the same setback conditions as any permitted structure;and,must be shown on your site plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setb�listed. X Page 4 of 5 CaseConditions-rpt 2/6/2009 Conditions Associated With 9:12:20AM Case #: BLD2008-00824 i , Permit Condition Status Updated item# Code Title Status Changed By Tag Date By 32) 6500 ACCESSORY STRUCTURE NOT MET 9/17/2008 CMH By definition,propane tanks and heatpumps are structures,which must meet setback conditions. Please check yo Plan"to ensure these structures meet the setback conditions listed. X 33) 1000 SEPTIC SYSTEM NOT MET 2/4/2009 CEW FOUNDAITON MUST BE 30'FROM DRAINFIELD. x � � Page 5 of 5 CaseConditions..rpt CONCRETE MECHANICAL MANUFACTURED HOME Footings f Setbacks Date 'Gas Piping lay Ribbons lnteriorDate By Interior-Date By Date I3y1 Exterior Date By Exterior-Date B Set-LIP Point Load I Isolated Footings BG I SLLAB I INSU SULATION Date gy 'ems /S Date BY Date By FIRE DEPARTMENT Foundation Walla Floors Date By Date By Date' By DECKS NA FRAMING Walls Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Type Data By Date By Date By D.W.1f DRYWALL Type: —� Int Brace Wall date By Dace 6y Date By-0 FINAL INSPECTION 2 Water Line Fire Seperation 8 Date By Data By Date By m I Pass or Request Inspect. Type of Insp. Fail Date Date Done By Comments CD . .� ( 1-2ct-/3 7-30' 6--) 1 8 N O 0 MOW` w �2 .0i _-V V�� CONCRETE MECHANICAL MANUFACTURED HOME M Date By Ribbons J Setbacks Gas Piping Ribbons E O interior Date By interior-Date BY Date By Cl) o B INSULATION _ + 00 Cxtefw Date y Exterior-Date B -41 Point Load 1 Isolated FootingsDate By Z BG f SLAB INSULATION --- -�— Date By Data By FIRE DEPARTMENT Foundation Walls Floors Gur•sPs gcd.4 MIOF4 LJW Date By Date By G,AtL/ Data By DECKS FRA Mi ING Walls Date By Date I P°L By Wit Data 2. `t ey PROPANE TANKS PLUMBING Vault Data By Date By OTHER rData ndwork Attic Date By Type. BY __._._ -. Dates By RYWALL type V InL Brace Wail Date By W Date ale"I Ofj BY�/�12 Date By r v FINAL INSPECTION CD Water Line Fire Seperation Date 2f L1 By LPL Dates By Dates By Q Pass or Request Inspect. c 0 Type of insp. Fail Date Date Done By Comments co s � �-� (D�1 ti v� L-�IL Cc7XAM m OL8 m :71.-F c L u c r_AA I peas, � ��''`� ► 3�' ,� ENDS o uNEJ -t � oEn 5 , Gk 2 Z % ZZV c &will W4�( Pow Z3p9 dY L-011 r l I I Z!I 04 l II'Z-31 LVIJ 1-0k �SI^���UIi CND rj,tri r. IInS�.lv��� o L 01 1,,O) , 0 fo 4 Permit# MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be corrected to gain compliance sT =cT� / 1 You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Cell for re-inspection when corrections are made before continuing ❑ Please contact our office ❑ Make corrections, items will be checked on next inspection regarding possible structural ❑Q*F4O 4�2 T S/'Z7:;C V Cr— damage incurred by recent y "natural/man made" This is not a complete inspection �i'l� T disasters.This is NOT a Date /Z—Lam/ Department ����� � RRECT/ON NOTICE. Inspector NO* w� N*�T `IMI� *4 ' ' THIqx T" _ * l � Permit# MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location �6)y e a 1-1 r"`eV(�- This structure has•been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be Corr cted to gain compliance r.� lc 4-li IC4.1 v.— <.e,-, 1 e,f 1,j, S �s pew vi a e of I I a,I e ' 4 1t -'0 ✓, I I A T T All 31At> r++, hs %I AK � I 11 �i+., IZ rl,4 Gn, I430c— c,rvw a I All fA4jk /III ,tnt„Yrat�tr c,nn Grr i.11 (^-fv cy.37 �x S �' C1'r n h r�✓til �>'' Q✓✓` �U�^'�'Z.c� A ►fi &W e7a v.'l otr PO/a. -zpr,.q <x' at C d k v,7,4A 7 ct't''�rL- ��(s.�� �i•s� i'n�..�.ti �'!�. f :.ra.mot-�.� -7'c! � H M\ J .�! �n7 G.i l's. � � ,mil G.'r �,'r t✓�. 7v5..�S �r3 You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK Call for re-inspection when corrections are made before continuing ❑ please contact our office ❑ Make corrections, items will be checked on next inspection regarding possible structural ❑ OK to damage incurred by recent "natural/man made" ❑This is not a complete inspection disasters.This is NOT a Date 11�IbGt Department 1I1- CORRECTION NOTICE. Inspector N O* 0I ,�T , �-�l�,�� ' THIqx T. , -* qff FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION ?) 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 CAL Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLIC�KT INFO 121us ON CONTRACTOR I OR�VI TIOOwner J—X-x Company Name Mailin Address_ Mailin t res City State��Zip Code City State�°' _ Zip Code Phone 6-U2? 0 1 e r P 2 "O Phone D-U7I 6T Othe Ph. —ALien/Title I-Inlriar V1 SBA 1 U Contractor Reg. xp. E mail address — E Mail Addres Drivers Lic.# ff DOB fl Drivers Lic.# U OB SEPTIC /WATER SYSTE*INFORMAT N - Connect to N w Septic Existin Septic Connect to Water System 41 Name of Water System Well Sewer System Name of Sewer System PARCEL INFORM TION - 1 Digit Parcel No.,—e I Fire District Legal Description y Site Address (Please include street name, street number and city) a f V Dire tions to site Ki •r f 1 ♦ �m 'c Will timber be cut and sold in IYarcel preparation?Yes/Q o ` Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 150% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes o TYPE OF JOB - New Add Alt Repair Other PRIMARY SIDENCE SEASONAL ❑ Use of Building e-� Describe Work JU61 nia 2 R b No. of Bedrooms_ No. of Bathrooms—a—Square Footage- 1sttfloor _ . 2nd Floor /077 3rd Floor Basement Deck Covered Deck 36f Other Sq. ft. �- Garage Attached �Detached Carport Attached Detached M Uth CTUR HOME INF ATION - M�a Model Year Len idt S I No. of Bedr ms No.VN athro s Type of Hea Purchase Replaceme ? Yes/ 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 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 informaticn provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY P%( I Tlo"i ACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: �� 6 wner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department t__ Environmental Health Department l L " (Y)3 Fire Marshal FEES Building Permit Fee Site Inspection 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 lluation $ TOTAL FEES l� o MASON COUNTY PERMIT NO. -�J 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 APPLIC T INFO CONTRACTOR IOR TIO Owner c�I Company Name _� tLit Mailin Add s / C Mailing�ddres city of j—State "-k* 7ip Code City - State �_ Zip Code w � Phone 4 O er Ph - "b Phone Othe Ph. 0 Lien/Titles Holder- t�'1 des I V Contractor Reg. /X%xp. E mail address E Mail Addres Drivers Lic.# C> 0 DOB V Drivers Lic.# KOVLTU OB SEPTIC /WATER SYST 11NFoRMATI N - Connect to N w Se tic ExistingSeptic Connect to Water System fF Name of Water System � Well Sewer System Name of Sewer System PARCEL INFORM TION - 1� Digit Parcel No. ► Fire District Legal Description I. y Site Address (Please include street name, street number and city) ca r 0N_ f'1r Directions to site 'r 41 f i 1 m Gre ri Will timber be cut and sold in Parcel preparation?Yes/ o Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 15% Is this permit submittal the reQ estop Work Notice,Correction Notice or other enforcement action?Yes o TYPE OF JOB_ NeW A d Alt Repair Other PPdMA�RY SIDENCE X SEASONAL ❑ Use of Building• t , er- —Describe Work No. of Bedrooms__ 7 o. of Bath room s—S are Footage- 1st,. II 2nd Floor. 3rd Floor Basement Deck overed Deck. Other Sq. ft. Garage.. Attached �Detached Carport—.,Attached Detached 4P M U CTUR HOME INF ATION - Ma Model Year Len th dt Se I No. . of Bedr ms ` No. f Bathro s Type of Hea Purchase � Replaceme ? Yes/ N Installer Name Certification. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop(w "k ord r'or.permit revocation. ' Acknowledgement of such is by signature below. I declare that I am the owner, owners legaf rep seMt tiv gr 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#haul v obtained the permission from all { the necessary parties. If permission is required from any easement holder or any other party in intere r arding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and cond t the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employ%�v Mason County access to the above describedvproperty and structure for review and inspection. This permit/application becomes nurd if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.P OF CONTINUATION OF WORK IS BY P I TIOALINACTIVITYOF THIS PERMIT APPLICATION OF180DAYSWILL INVALIDATE THEAPPLICATION. X Date: -� � caner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPRO D DENIED NOTES Building Department Planning Department rr��? Environmental Health Department " W� Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Planning Plumbing & Base Fee Review Fee Mechanical & Base fee Zlo�— a= Other Wood/Gas/ Pellet Stove Fee State Fee i Violation Fee Pre-Paid at Submittal TOTAL FEES Valuation $ 4 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD 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 I On the web www.co.mason.wa.us APPLICAIT INFO MATION CONTRACTOR I OR�1AT�IO Owner J—X-x 1 S Company Name Marlin Add s C Mailin dres City Statel19 Zip Code City State L _ Zip Code Phone 0-U2 — Other P 2 "0 Phone - 7I Othe Ph. "0 Lien/Title Holder VN ;2 Bd I U Contractor Reg. xp. E mail address — E Mail Address Drivers Lic.# t5, DOB �/ Drivers Lic.# U OB SEPTIC /WATER SYSTEM*INFORMAT N - Connect to N w Se tic Existin Septic lam,— � . Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 1? Digit Parcel No 2- I Fire District Legal Description • Y Site Address(Please include street name, street number and city) a {' V Dire tions to site r' fL. + - m ' oifik± h Will timber be cut and sold in arcel preparation?Yes/ o ` Is property within 200'of Saltwater Lake River/Creek7. Pond Wetlan d Seasonal Runoff Stream Slopes or Bluffs 159% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes TYPE OF JOB - New Add Alt Repair Other -GIB SIDENCE SEASONAL ❑ Use of Building ?-� �•--Describe Work�,l� �'►�� 77�V No. of Bedrooms No. of Bathrooms—�S are Footage- Istt IIPc r 7%2— 2nd Floor 3rd Floor— --Basement Deck hovered Deck�Q—Other Sq. ft. Garage�� Attached —Detached Carport Attached Detached M U CTUR HOME INF ATION - Ma Model Year Len th dt S ' I No. of Bedr ms No. f Bathr s Type of Hea Purchase Replaceme ? Yes/ N 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. 1 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.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY PR- I TIOI�NACTIVITYOFTHISPERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION. X Date Gl6, O� caner/Owners 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 Department � Uy Lg Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee I U U Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other L4 a 40 L d/Gas/Pellet Stove Fee State Fee tion Fee Pre-Paid at Submittal ation $ TOTAL FEES MASON COUNTY PERMIT NO. ILL • BUILDING PERMIT APPLICATION . 426 W. Cedar P.O. Box 186, Shelton, WA 9858 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLIC�NFORMATION CONTRACTOR I ORTIO jOwner g tj Company Name C ►"F Mailin Addr s / �' /� ' Mailin dre City �� _State kjZip Code f/ = City State Zip Code Phone .ta•t 1 " ° = Ot�ier Ph - `0 � Phone 0-L122: 4 Oth r Phi. 'G2. Lien/Title Holder '" !��� 1 Contractor Reg. 1 Exp. E mail address E Mail Addres Drivers Lic.# lL> "� DOB / Drivers Lic.# DOB SEPTIC /WATER SYSTEA INFORMATION - Connect to N w Se tic Existin Septic Connect to Water System 1, _Name of Water System Well Sewer System Name of Sewer System PARCEL INFORM TION - 12 Digit Parcel No t Fire District Legal Description + I ,. Site Address (Please include street name, street number and city) • " Directions to site Kt >ri c r Y' Will timber be cut and sold in Orcel preparation?Yes/ o Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasol to ff Stream Slopes or Bluffs 15% ' Is this permit submittal`the `esult of a Stop Work Notice,Correction Notice or other enforcement action?Ye No TYPE OF JO .- New X Add Alt Repair Other IMARY ESI ENCE tZ SEASONAL ❑ Use of Building '/J �' yes• describe Work— '+� No. of Bedrooms__-7 No. of Bathrooms—Square Footage- 1 s Fop 2nd Floor 3rd Floor Basement Decker overed Deck Other Sq. ft. Garage Attached —Detached Carport Attached Detached M NURACTUR HOME INFORMATION - Mike �` Model Year Lertti Widt Serial No o. of Bed oms�''-No. of Bathm Type of He � Purchase $ Replaceme nit? Yes/ N �� 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.thatl,h,ave obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest'r6garding 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 informaticn provided is accurate and grants employees oVMason County access to the above described property and structure for review and inspection. This permit/application becomes null $..vdid if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY Pk0GRF6q1 TIOI-LNACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: _ ' nwner/Owners Representative/Contractor (indicate which one) C1 FOR OFFICIAL USE BEYOND THIS POINT Accepted by' L&I �. Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department PlanningDepartment f f Environmental Health Department � �� - Fire Marshal FEES Building Permit Fee Site Inspection 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 Valuation $ TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO. PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360) 427-9670• elf (360) 275-4467•Elma(360) 482-5269 on the web www.co.mason.wa.us APPLI T INFO Ip�S CONTRACTOR IN MAT N Owner Company Name ' t I S Mailing ddr MailingAdd ss City tate Zip Code City toe Zip Code Phone - _ ther Ph -O Phone - 7- 40 O her Ph. Lien/Title Holder Contractor Reg.4 FhAOI!LLLExp. E mail address E Mail Address Drivers Lic.# Drivers Lic.# '"MUM 33&f DOB 1'9"-67 SEPTIC INFORMATION - Connect to New Septic Existing Septi Connect to Sewer System Name of Sewer System PARCEL INFOR ATIO 12 Digit Par el No. — Fire District Legal Description iV� LC- IG Site Address (Please includp street name street num er and city) Direc 'ons site aKt 9' C 1 w to Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 1 % TYPE OF JOB - New-K Add Alt Repair Other Use of Building ftelull Location of Fixtures/Units- 1 st Floor � 2nd Floor_ Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG,_ Natural Gas_ Heat Pump_ Toilets AILType of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs -- Heatpumps Showers Spot Vent Fan Water Heater �— Propane Tank Z Clothes Washer —� Gas Outlets 3 Kithen Sinks 1 Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs 4= Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OVVNER/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 prowde employees of Mason County access to the above described property and structure for review and inspection. PR OF CO Tt K IS BY MEANS OF A PROGRESS INSPECTION. tj X Date: Q 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-Type Constr.- Planning Constr.— Planning Department Environmental Health Department FEES Plumbing& Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES Look Up a Contractor,Electrician,Plumber or Elevator Professional License Detail Page 1 of 3 Information in Spanish I Topic Index I Contact Info Home Safety Claims$Insurance Workplace Rights Trades&Licensing ................................................................... ...................................................... Find a Law(RCW)or Rule(WAC) :Get a form or publication :.................................................................. .....--.................................... ......: Return to List > Start a New Search > Printer friendly Genera USpecialty Contractor A business registered as a construction contractor with I-Ed to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Verify Workers' Comp Premium Status Check for Dept. of Revenue Account Name PACIFIC BUILDING UBI No. 601388025 Phone No. (360) 426-7418 Status ACTIVE Address 2501 SAINT ANDREWS License No. PAC IFB*013L4 DR N License Type ;. CONSTRUCTION Suite/Apt. CONTRACTOR City SHELTON Effective Date 6/24/1999 State WA Expiration Date 12/13/2009 Zip 98584 Suspend Date County MASON Previous License DANROCH088KJ Business Type INDIVIDUAL Next License Parent Associated Company License Specialty 1 10 GENERAL Specialty 2 UNUSED Business Owner Information >f Hide All Name Role Effective Date Expiration Date RODIUS, DAN OWNER 01/01/1980 Bond Information https://fortress.wa.gov/lni/bbip/Detail.aspx?License=PACIFB*013L4 9/17/2008 ru Proposed Mitigation Area Approximately 2500Ft2 (Native vegetation Enhancement) o I I I I GR y APPROVED o W Wo MASON COUN d Y aCD PLANNI NG o x Uj SITE PLAN REQUIRED TO BE ON SITE o o xUj RANGES SUBJECT TO APPROVAL ' By W U z;Q p Ll: s -. to Z i 1110 J W', CD' Q U-;.W W; > 0 g Z? �. x 0 0 t5 a proposed Impact Area zQ c �PgQc � r�rl►rFt"d� Approximately 2165 Ff m p Ln 0 a -� zW tar oc�N �---- Gwo� LLI W turi 3z3ti� HCA Buffer 0 z;�- • af,Uo1--u- �. w:7' -[tea-ram aaa ;e- r MASON COUNTY DEPARTMENT OF HEALTH SERVICES July 16, 2008 PO BOX 1666 Shelton WA98584 Shelton (360)427-9670 Fax (360)427-8442 DAN RODIUS Elma (360)482-5269 181 PEEBLES CT SHELTON WA 98584 Belfair (360)275-4467 Case No.: BLD2008-00824 Parcel No.:321275300136 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Application for Water Adequacy Please see comments at the end of this letter. Please call me at(360)427-9670, ext. 554 if you have any questions. Sincerely, Trish Woolett tw@co.mason.wa.us Environmental Health Mason County Health Services Comments: SYSTEM INSTALLED 1996. NEED INSPECTION OF SEPTIC SYSTEM TO VERIFY IT IS IN GOOD WORKING ORDER. I 7/16/2008 1 of 1 BLD2008-00824 I i E I f f' MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health - Personal Health PO BOX 1666 SHELTON, WA 98584 LOCAL (360)427-9670 BELFAIR (360)275-4467 Application for Determination of Adequacy FAX(360)427-7798 Instructions t Complete Part 1. No determination>can I be made-until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water systerri utilized. 3.: Submit completed application, with:attachments to the health department for review. PART 1: Applicant/Parcel Identification Name of A licant ;OS Date G"U� PP ��� Mailing Address )V ?t e_6YeS C- -. Telephone AZ— 2-'K0•-02" Assessor's Parcel Number 3 `�?-�� l Type of Water System Check One): Reason for Application Check One): Public/Community Water System (2 or more Building permit connections)— ❑ Land use application, if so.. ❑ Individual water source(one connection), ❑ Division of land: if so.. ❑ Well #of Parcels? SPL - ❑ Spring/surface water ❑ Boundary line adjustment ❑ Other(explain) ❑ Other(explain) **If you have more than one residence ❑ Replacement(please indicate name of water system connected to this well,check the Public box. below if applicable-no signature required) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water System , Name of Water System Water Facility Inventory(WFI) Number: (write"none"for two party) ❑ I am the manager of this water system. The water system has been approved for services. There are presently connection(s) in use. This will be the connection. ❑ I am the manager of this system.This connection will be to upgrade or change the use of an existing connection on this system(ie: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this(these)connection(s)without exceeding the limits of the water system or any limits set by state and local,regulation. Signature of Water System Manager Date I.IEH FORAMWATERAD4.DOC Update:April 2006 MASON COUNTY DEPARTM4g NTH SERVICES JL. Personal Health Environmental Health pO R_nX 1666 SHELTON, WA 98584 LOCAL(360)427-9670 MA �� COUNTY BELFAIR(360)275-4467 &4468 Application for Determination of Adequacy Instructions 1. Complete PatC 1. No determination can be made until Part 1 is fully mom lep ted- 2 Complete only the porti a health ent for review; on of Part 2 app]ying to the type owater system utilized. 3;j Submit com leted a lication,with ttachments to the ailm PART I: Applicant/Parcel Identification Date Name of Applicant Telephone Mailing Address , Assessor's Parcel Number Type o Water System Check One): Reason One): orA lication Clieck ❑ Building permit ❑ Public/Community Water System (2 or more ❑ Land use application, if so.. connections) ❑ Individual water source(one connection), if so.. ❑ Division of land ❑ Well #of Parcels? SPH9 - ❑ Spring/surface water ❑ Boundary line adjustment ❑ Other(explain) ❑ Other(explain) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated for adequacy: Public Water System Narne of Water System A < `,p Water Facility Inventory (WFI)Number: i s -r ❑ The water purveyor has filed a letter granting blanket hookups to this water system. 10 services. There are I am es the manager of this water system. The water Th s will be thee t has been apopnnection.ved for /water system is able and presently t O connections m the limits of the water system or any willing to prove a water to this(these)connections without exceeding limits set by state and local regulation. Date � 2Z Signature of Water System Manager H..1WDATAWRCHIVEIWATERAD3.WP Update:March 22,1999 w - 7 Name EL LA �� Parcel# J�1 G22 0��l B '` Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet(pagi 2 Of Based Upon the information you have provided a Storinwater 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: htti)//www.co.mason.wa—us/Code/Commissioners/index.htin 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" -BEL- THE ST IiMWATER A) V 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. I 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 i 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 cknowledge that the ' n provided is accurate and employees of Mason County are granted access to the above- described p for w ec may be required. Owner/Agent/Contractor(circle one)Date: Page 2 of 2 I r Named A/J 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'. '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. 2Common 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. ME 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 - -- 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 = u .. _;. .............................................. .. ........................ If the Total Impervious Surface Area is LESS THAN 2000 Square 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. 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: 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