HomeMy WebLinkAboutBLD96-0191 Final Replace Cabin - BLD Permit / Conditions - 11/5/1996 Permit No,
MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
#1 O er KAJ c KOMYTA SALO S Phone# SSO - 4L7-7
ite Address_ 31 I AAJER LAKE L Fire District#
City TAo uU A St \/4A Zip
Directions to Job Site 14AVn-A LASE To HAVEK LAKE DZ. TH LM TO
�1T� ADD�ES_S.
Owner Mailing Address 3SI D TH1S A WA I N A&L L- ACE Sy M►NG TON
City a�[E=C)tq St V' A Zip 9 fs'31 Z
Lien/Title Holder
Address
City St Zip
#2 Contractor Name 3AME.S A. MILLED Contractor Reg# EAMESML0771). A.
Address Z.9 Stj 1 A vJ I.IEE Dz_ Expiration Date_/ v
City 3kLM E�?i N St W A . Zip 9 t331 O Phone# 3 73 -L3Z4
#3 If septic is located on i pro'ect site, include records.
Connect to Septic. , Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 cel o. ZZ _S _ 0 11 Lo
egal Description iM .<_ WA OF PLAT 01= - . OF PcATS
ZE b�t1 OF MA56K Cbui�l 1iVASNII�1GTOh1
#5 Building Square Footage: (existing/proposed)
1 st FI 4 8Q / /,(„6 2nd FI / 5 4S 3rd FI / Loft /
733 Basement / Deck / #bedrooms Z / Z_ #bathrooms Z / Z
Garage N A / Carport M A / (Circle:Attached or Detached?)
Other sq.ft. /
f
#6 Use of building CA.�S44 Describe work
Ke foyE Exo-rwis DLitt £ IXT NEW /.ABIN
#7 Type of Job: New LAZ It Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
-
#Bedrooms #Bathrooms Type of Heat
Purchase Price$
71
#9 Indicate by circling the applicable source iLfany water is on or adjacent to subject property:
River Pond Creek Stream Wetland Q!kDeMarsh Saltwater Seasonal Runoff Other �'
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
5 ATTAL.HM S HEE T
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Sty ATTAL.HEn SHE
PI umbing Fixtures ($3 each) Fgg Mechanical Fixtures ( 6 eaghl
No. Z Toilets _ CIRCLE FUEL TYPE: G<Electric
Bath Basins Heatpump, Other
_Bath Tubs No. Unk Fees
I Showers 3 _ Furn BTU
J—Hot Water Htr _ Heatpumps
_LLaundry Washer �_ _ Vent Systems
.3 Sinks �_ Spot Vent Fans c3�
_Floor Drains No. Boilers/Compressors
_Laundry Basins _ HP
Dishwasher _ No. Air Handling Units
_Disposal cfm#
_Urinals No. Fire Protection Systems
_Other _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $� No. Other
Gas Outlets
Wood, Gas ellet Stove
i
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ ��
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAI APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTM
X OWNER Ow a. n���kn.•.o�i X BY
DATE Z —Z 7— DATE
F��OFI'fGIAL 11SE dt�LY A�cepte��y bate.
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
ir
Environmental Health: ,
OWNER/BUILDER TO ASSUME ALL
2ESPONSIBILITY IF DRAINFIELD AREA '
[S ENCUMBERED.
Building Plan Review
Occupancy Group:_ Type of Const:_1[ 0
Fire Marshal:
Other:
FEES
Special Conditions:
Building Permit
Plan Check 8 °°
Plumbing Fee Z
Mechanical Fee 4 S-
Wood/Ga Iiet ZS
Radon Monitor
Violation Fee
Site Inspection
Building State Fee tf So
Other
Other
Building Valuation: 733 x v 7 - 30,796 TOTAL FEE
_ ;a
MASON COUNTY4p '�
b
DEPARTMENT OF HEALTH SE RVIC LLAUA i
.f JA
Environmental Health Wateroality SNO Aft.
8S 6S A 98584
W2 -
Ir 3' 27_ 670
L F41R 275V67 68
Aplication for Determination U L FRE -8�00
p 44 I
(36 -7 8
Instructions
................
.......... ...
. .......... ....
Y...
XX,:a I .....
............. . .....
. . . . ............. ........
..........
-P
PART 1: Applicant/Parcel Identification
Name of Applicant ZAi - ?-8-5EF—TA -7ALDS Date. Z-19 -9 Co
Mailing Address 3,f1Q TPI-5 A Wh� N W. Telephone b30 -4L7-1
2)1KEMEMN WA, . 96-317- -
Assessor's Parcel Number 7-L-z� -S-6�I I i.D
Type of Water System(Check One): Reason-forApplication(Check One):
E3 Public/ComnumityWater Systein(2ormore K Building permit
60-) C3 Land use application,K so..
In(iividual water source(one wnnection),if so.. 0 Division of land
Well #of Parcels?
❑ Spring/surface water SPH9 -
13 Other(explain) 13 Boundary line adjustment
13 Other(explain)_
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated for adequacy:
Public Water System
Name of Water System
Water Facility Inventory (WFI)Number:
0 The water purveyor has filed a letter granting blanket hookups to this water system.
13 1 am the manager of connections
system. The water has been approved for services. There are
presently tions= This connection. -TUs Twater system is able and
=g to-p-ro-vi'dewater to this(these)connections witho-uTte—xceeTm-g the limits of the water system or any limits
set by state and local regulation.
Signature of Water System Manager —Date
W-7 Ij--I1,VD.4T,4L4RCHITIDWATERAD3.JITP Update:October 20,1995
4`I►i j x
• ' ,- i ni ter Well
-Water well report(attach o applic vM t 1 17(D it.
4
f►
F capcy tel h�d�p ' ion gpm gpd
We acre} Lts a•e o ten l fo4ed by the well driller at the time the well is constructed. Test
esull nrdhe s are not d on the water well report. Results from these tests will be accepted.
he wde—well r r cane located by the applicant or if the water well report does not have a
f acity,test, el ity to ich provides stabilization o draw-down and recove data must
per eM lice#sed con r.
AA I recovery
a
,�,. atisfa baste logical (eaa t� ri.)
y
�� �. • ! Individual S rin /Su ace Water
��. OF permit(attach to application)
❑ of disinfection
r
r ❑ I have reason o believe that this water source can provide at least 800 gallons per day and/or provides water
at a rate of 2 gallons per minute based on the following observations.
AUTHOR OF STATEMENT DATE
RELATIONSHIP TO APPLICANT
In addition to providing the above statement,the applicant will need to arrange an on site inspection by the
health department prior to determination of adequacy.
Departmental use only. Do not write below thw line.
" 3, ee t epaa �lnl vacua v>l ( ` af, O Q�t��
SATISpA�TOIY DETpBNATIi01�i Applicant's::.:a ex sugpl�appears adequate to
meet fihe needy.of Yts zntended use rtn a� t Itili+!Tt7M. cl ... ads the. i fr bazO v :.: . sle
:>::.....:. .:.,:::::::::::.::::::: :::::::::::.. .. ::...................................
n�dqutxi wur x�iiFe� ante die furze, gar
f gutteelkn�lire
wildrll ltcl WDOJ wrier resource regutaiAzts
F
o UNSATISFACTORY DETER IINATION:' Applicant's water supply does not appear
adequate to meet the needs of its intended use for the following reason(s)
REVIEWER'S SIGNATURE DATE- �
H:WDATA'ARCHIVDPVATERAD3.WP Update:October20, 1995
Z) tr 7X;
> rn
*tr 1= 0 > M 777
77 -11
—4 2
>
m ri
7z
M S cl�
z -a
>
7r,
>
CA
x
co c
i� INS IT'D t., mm MSG ms
z
cn
=r Z
< < 3: -n
M fir.: M C
z 2 z
v A sm IM
ei z CA
z Y�
-0
10 OL
zz
00
all Z=
mw
it
if
'Al
I 3 1" :� r. -m
ry)
v... 4b &
IQ INN;
fr — —
swn 71 'Na T,
T m S r,
F4
CONCRETE MECHANICAL,.-' ' r c� MOBILE HOME
Footings-Setback date g-9 - f6 by c Ribbons
date / -Z - by 41121. Gas Piping date b
Foundation Walls date by Set Up
dates- 7- %' by t INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING,� s (— C-,-cc '^ Walls FIRE DEPT.
date -,- f, by r ✓ date 'a-5'- �� by date by
II PLUMBING Attic OTHER
Groundwork date mob`-S- Sy by I/ •--�
date by WALLBOARD NAILING
D.W.V. date - 13-7(. by L
date by FINAL INSPECTION
Water Line 4 s f G cbr r
date g-�f�py by date��S-l� by � � date by
C�rT ��0��'"` �...X, ! � �,rc�.aZ- �(� co`, �v-��� I..� sue•.� �r�-cs�i� s,
JA-
e- r�`aY, ✓, c e A -10 b e
tt
zz-O$"�� I-Fou<� C�aw•n/� ��. G�a..,ed3 to 2W v1n Se-4 be-a-L u,
t
i
3
t
a
r
(b 0 =r
f+—Ol 00 <
rm ml -0 z
O=n
< o;3 U)
Y
M CLO
�
$ -.h(l) c w 1-0 0 0 rr.<0 A
f+
Z— X=z
I X010
C6 a(t
0 < 07 YA M. Z
(D
M C7>rp,0:z
C.0 0—,Do.ay c�FF 0
+.at� z m>m i
z
lz rn 7 x=
0
�mom � � �—.�z;� �m�m� _-�---��m tst— x -s X � O
%b 0
0 7-- z 4Z
C/)
mn,
0 >to Oz 0__q
to cr 11 fl,e+ >
1 0 ==3 —
rrt
co 0 n 0<0 X 0
0 0 c X D
ca X
x<
S—Z
a =t ID 0 T z 0 0 X C C) p,
O.
0 T iii Ze-
wo :�<O —
I ev — rn X
m 10 0 C_ z X 10 QL
73 m OD
Jr
-ii r+—=r tp'C :r 71
P-P=N x —C" 0 m —
(t—C—e+e+z z mr-.Oz — 0 *
o
rt a =CrIO"I Cm".
e+=P+ --x*T r!7 4-) IV>
Z --4)zc>r-
:rOw
3E4 47) -(,a
^ <
—om
Ito
2 -7 114
0 —
7
CONCRETE MECHANICAL MOBILE HOME Y
Footings-Setback date by' Ribbons
date -/-Zq.94 by Gas Piping date b
Foundation Walls date by date by Set Up BG/SLAB Insulation INSULATION date by
date b Floors Final
FRAMING y date by date by
date by Walls FIRE DEPT.
PLUMBING date by date by
Groundwork
Attic OTHER
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
i,-Z9-44 sro metre c d g pvr g, P e L-Im
Ull
z
4z m
0 IT"
4D
rr
n r-
C6—
CL
>
"0
0
CD
0
V,S
t7l
0
X o
__m 0
> cl� < OD
11 —1-4
CL
7 co Cl)
03 =r Z
C&
0
VE
J;p
10
=
2D
ca
cr
< am 100-
4:p '7 00
4(t
< IV
M
iY Sj
0
0 10 0+0
C.7
w�
>97
S
rrt t r37 3
rrl Ti rn
iRS
4
"r
00
x " 0
CK3 z
�Z
m Q 0� cQ Q
-� Cl)
a D
W 1O Q
l J 0cn
Q
#1 r
i a
3
j �