HomeMy WebLinkAboutBLD2007-00807 Final SFR - BLD Permit / Conditions - 2/6/2009 W �
o CONCRETE _ MECHANICAL MANUFACTURED HOME _
Footings!Setbacks Date 22'U Byow�� Ribbons 0
Gas Piping
0 Interior Date By interior-Date 7'2 G. 'DI!gy�/4�/{ Date By
0 0� Exterior Date BYfJJ �( Exterior-Date B -
up INSULATION 1, 0
Patr•t toad!Isolated Footings Rate By
BG r SLAB INSULATION _-___ m
Date By Data By FIRE DEPARTMENT M
Foundation Walls Floors Date By
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Date Z!-Cr-;7 BY/J>p�sData <p- g By_ DECKS
FRAMING Walls Date By
Date (,3O . r�$ By,3T Data - -Q By PROPANE TANKS
PLUMBING vault Date By
Date � By
S/J OTHER
Groundwork Attic
Date By Date "(.l ` By Type:
Date By
D.W.V DRYWALL Type:
Int Brace Wall
Date 1'�2' 0BY�✓f/l2 Date By W
Date2 > ay FINAL INSPECTION v
yWater tine,, ) Fire Seperation C
Date P� t3y fj Data By Date C)
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Type of Insp. Fail Date Date Done By Comments Co
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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 • Belfalr(360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
GwFw Aer►t C&Seg Tkay"s Company Name cGK C)IeyeloPet3
Mailing Address Mailin AddressNct�lt
City State Zip Code City t State Zip Code S6169
Phone 3500 -3 O-O!tf Other Ph. Phone 3460-$16 •0334 Other Ph. - ii
Lien/Title Holder Contractor Reg.#,5Mfi QZfi34i jN Exp.
E mail address Cosey"�'uat 't E Mail Address
Drivers Lic.# DOB 1 Drivers Lic.# DO
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect Water System Name of Water System Q 'r 5Ian u!A ifet6A s
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. jZ2Z9 - ZZ - Fire District
Legal Description SHK 2 t
Site Address (Please include street name, street number and city) {
Directions to site t OQht ��
AdLv
Will timber be cut and sold in parcel preparation?Yes No
Is property within 200'of Saltwater Lake River/Creek Pon
P p Y o
Wetland Seasonal Runoff Stream Slopes or Bluffs S15/o p-S
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE,X SEASONAL ❑
Use of Building 5FR Describe W rk CeAs+'cuci' OU" St on, Lot
No. of Bedroom No. of Bathroom Square Footage- 1st Roo 2nd Floor 110
3rd Floor Basement Deck— .—Covered Deck 154 Other Sq. ft.
Garage- 09. 1 Attached --&/ --Detached Carport Attached Detached
RED HOME INFORMATION - Make Model Year
Length Widt rial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purc Replacement Unit? Yes/No
Installer Name e i i
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit r tion.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection.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
MEANS AP ROG SS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date: 57 16 I'm 5g-
Owner/Own s presentative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date l
DEPARTMENTAL REVIEW APPROVED DENIED 4 NOTES
Building Department
Planning Department
Environmental Health Department D
Fire Marshal Z
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
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584 f
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # j' `/ `/Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existin #'ptic
Connect to Water System Name of Water SystemIWO
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. _Fire District
Legal Description
Site Address(Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluff 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No;
TYPE OF JOB - New ; Add Alt Repair Other PRIMARY RESIDENCE [] SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor , 2nd Floor
3rd Floor Basement Deck —Covered Deck Other Sq. ft.
Garage �`T' Attached i' Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model —Year
—
Length Width Serialo.
g No.. of Bedrooms—No.Len N I of Bathrooms
o
Type of Heat Purchase Price$ _ p acement Unit? Yes/No
Installer Name "'Cefficatl6n'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 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
MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date:
Owner/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
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
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
CONTRACTOR INFORMATION
APPLICANT INFORMATION c
ovm" ,doe t , �CaS�'�' ,d�LtG� Company Name %c, �c: eve\0pecs
Mailing Address Maili Address <UU �t c,ti lD e f c`�e
Cat State Zip Code City : " /1 0 i c 'l0` State W Zip Code
17
Phone ' -' ` "y9/ her Ph. Phone �' u `0 >4 Other Ph. 21 -0
Lien/Title Holder Contractor Reg. � 3yP1 Exp.
E mail address
c.,e t totiti a72z�r.�/fie , I, E E Mail Address �c0 >e.c c. e'.l �W�- , 0Q t
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to ew Sept'c Existingtic
ConneV Water System Name of Water System—
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit,Parcel No. IZ447 _ 7.Zr J Fire District
Legal Description ` \ �'\t=,t z "' L
Site Address(Please include sr�et name, street number and city)
Dar��(ctionstosite ✓Cal !, '��+1c� r�wy 'y rYt� �' Jcr�;t ~ .=«• j%�v +'eL,; Ic^r
('�.,c . TG+ v vl r r'5 I,v4 G V C L\ L -t -` - K- co")
Will timber be cut and sold in parcel preparation?Yes/ND.
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs>15%
I Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o
TYPE OF JOB - New I Add Alt Repair Other PRIYARY RES'DI�NCE SEASONAL ❑
!I Use of Building Describe VV rk
No. of Bedrooms No. of Bathroom 2- q Square Footage- 1 st Ft /Z`� 2nd Floor l 0
18
I Covered Deck h Other Sq. ft.
3rd Floor Basement Deck—
` Garage C Attached —Detached Carport Attached- , Detached
M UFA D HOME INFORMATION - Make Model Year
Length Width I No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Replacement Unit? Yes/ No
Installer Name Certifica ion
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
k� Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
f that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection.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
I MEANQ-QPjAPROG,F�ESS INSPECj N.INACTIVITY OF THIS PERMIT APPLICATION OF 1580DAYS IL INVALIDATE THE APPLICATION.
I X V c . >'` s=�.-----_.. Date:
`t Owner/Owners Representative/Contractor (indicate which one) _
` FOR OFFICIAL USE BEYOND THIS POINT Accepted by: V0 Date
DEPARTMENTAL REVIEW APP O D DENIED NOTES
i Building Department
Planning Department
Environmental Health Department
Fire Marshal t
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee /30 • �✓ Planning Review Fee
f Mechanical & Base fee 1 .^'P Other
f State Fee
Woo as Pellet Stove Fee
Violation Fee EN�F, Pre-Paid at Submittal
Valuation $ 0 5 2- 6• 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 INFORMATION CONTRACTOR INFORMATION
owrret :t t<'. Company Name
' Mailin Address .:TO �'.. 1 C\ti' 3"c t ( 4 G.
Mailing Address ;�
city �" ;��r rl State A. ► Zip Code = (n
City State Zip Code tY
a � / Contractor Reg.#�515�C� Other Ph. �=
Phone -Other Ph. '
(�Lp��!IN Exp. /�
Lien/Title Holder , E.Mail Address °= "� r��c)c� +` � �' 'lc f
E mail address r
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existi is
Connect to Water System Name of Water System "!
Well Z Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. / Z Z -" Fire District
Legal Description
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 within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye 0jN
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE IM SEASONAL ❑
Use of Building Describe Work E t"
No. of Bedrooms r-No. of Bathrooms-. Square Footage- 1st Floor2nd Floor
3rd Floor Basement Deck_ __—Covered Deck / Other Sq. ft.
Garage G I Attached 1.7 —Detached Carport Attached Detached
MANUFACTU..RED HOME INFORMATION - Make Model Year
Length Width ~w--Serial No.
�- No. of Bedrooms No. of Bathrooms
Type of Heat Pur-aiase°" Replacement Unit? Yes/No
Installer Name e i ica
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 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
MEAN APROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X V ,-I,,' Date -` t s: r_ -
�I Owner/Own rs Representative/Contractor (indicate which one)
1 FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Y �`t✓ Date 1
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
i
Building Department )1 U { '
Planning Department /i�7 eo
Environmental Health Department ` , °` ' J U
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee PlanningReview 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-�67t�•Belfair(360)275-4467•Elma(360)482-5269
n t e web www.co.mason.wa.us
APPLICANT INFOFWATION CONTRACTOR INFORMATI
pwM* Q1ft1&.%A-. &I -rhWMA.S Company Name " V"CAOD ,tS
Mailing Address' Mail' Addre stwo
City tate Zip Code City tate Zip Cod
Phony 40�v -O�l� Other Ph. Phon Other Ph.
Lien/Title Holder Contractor Reg. xp•
E mail address �y Mwba�, 4&1* Ae"c E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - C nett to New Se tic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel 22 2 ---7- Fire District
Legal Description
Site Address (Please include street name, street number and city) M
it
re tions to site
Is property within 200'of altwater Lake River/Creek Pond
Wetland Seasons Runoff-Stream-Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floor d Floor Basement Gara Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPCz_ Natural Gas_ Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace L
Bath Tubs Z Heatpumps --�
Showers Spot Vent Fan
Water Heater I _ Propane Tank
Clothes Washer 11 Gas Outlets
Kithen Sinks I Wood/Gas/PelletS
Dishwasher I Kitchen Exhaust Hood
Hosebibs _ . Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
O VVNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Ad:ruwAedgement 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
rties•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.
PR F CO UATION RK IS BY MEANS OF A PROGRESS INSPECTION. ,, /
X Date: f I rc.J d
Own Own epresentative/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 Ins ection
Mechanical&Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
TOTAL FEES
Violation Fee
PERMIT NO.
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
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR 11 FORK
6Mr i r° t� r e j 'bF,#;164 Company Nam 'e:e H��`��t `" V.
a� ILL:
Mailing Address MailingAddres,S
City y -,State Zip Code City ' ' f C l�''6t f t ate t" p Zip Code
H Phone r LD3 t�r Ph. � �.2-Olf/
Phone ( Other Ph �`�' �- � 4!
Lien/Title Holder Contractor Reg., Ex .
E mail address t-.6,X, y' . l(,W-i't(ks"C J,t"-)c` . t10 E Mail Address- �, e�=c. c tam `�' f, t
Drivers Lic.# DOB I Drivers Lic.# DOB
SEPTIC INFORMATION - C9priect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System 1416Yt "' '4 e r �7 �
PARCEL INFORMATION- 12 Digit Parcel N9. /2 ! 2 5— — ifs Fire District
Legal Description er.t? `-2 t Z
Site Address (Please include st{ t name, street pumper and city) /0 f z"` t44 vI
s to j D're tion site L ei} t-t r +4 tic ` ac F 4
y �t„(t, t is «� o Ct :; ` fCraF '0r'1 /1 {y�
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Season Runoff—Stream—Slopes or Bluffs 1 15%
TYPE OF JOB - New V Add Alt Repair ther Use of Building -
Location of Fixtures/Units- 1st Floor d Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPCz_ Natural Gas, Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink — Furnace
Bath Tubs Heatpumps
Showers —L Spot Vent Fan
Water Heater f Propane Tank t
Clothes Washer t Gas Outlets �—
Kithen Sinks t Wood/Gas/PelletStove----r—
Dishwasher t Kitchen Exhaust Hood
� Dryer Vent
Hosebibs
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
CNIINER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
P F CO UATION OFW?RK IS BY MEANS OF A PROGRESS INSPECTION.
y. . ._.-.— Date:
X Own VI Own epresentative/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 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
" IYiYi®IYI ' .
Mason County Planning Intake Checklist
Owners Name: Date:
Project: Reviewed By:
Commercial Development: YES 0 Comments:
PLANNER: GBM TSC CMM KJM PBC
S" a Plan:
North Arrow
5 �
Property Dimensions: X Z� � �� ��
ftreets and Driveways Shown. Road name: 3
ll Existing Structures shown with setbacks
ell Location, Septic and Drain-field Shown with setbacks
entify all surface water(streams, ponds, shoreline, wetlands, natural or historic drainage,
efined drainage ditches)
�fopography (slopes)
oposed Struct re Setbacks (DI r io S tback): �-
F: Sl: / S2: 1- S
Utility and Drainage Easemen=-*aLL'
if yes enter condition #5022)
�ther Easements XQw $�
w
Accessory Appurtenances: Propane / Heatpump
"ariance applied for: Yes / o parking spaces allotted? t�/ No
County Access Permit Needed azliecondition #0010) . J 0
State Access Permit Neede
d add condition
� n #0020
Standard Conditions to be added to all Building permits that planning reviews: #5019 and #0700
Site Access: Are there any Impediments (dogs/gates) that my restrict access to your site?
i
I Is the site clearly marked? How? ❑ Address
❑ Name
Critical Areas: ❑ Other: ��
-
Setbacks: Shoreline: Slope: -N` ZIP— w
Shoreline Designation: Comprehensive Plan: -Rural Zoning:
❑ Not Applicable ❑ Agricultural 1�kR 2.5 5 10 20
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3 S
❑ Conservancy ❑ Rural ❑ RI
❑ Natural ❑ RAC ❑ RNR
❑ Unknown ❑ RCC-Hamlet 7 ❑ RT
.......,III
'` Urban Growth Area , ❑ MPR
❑ Unknown O Unknown
Water Body (typrnknowat if unnamed): I3
SEPA: Yes/ No Flood Plain: YES/NOt!jow
Map#
Aquifer Recharge: YES/NO 6noDwnMap#
Tags/Cases:
RLC/SPI Case: 46-Year Dev. Moratorium: Y 0
Eagle Nest Tag: Y NO Other Y
Revised: 09-29-2006
IVIANUN CUUUN TY RESIDENTIAL PLANS SUBMITTAL.CHECKLIST
Owner's Aram eF Date: Reviewed By:
Documents:
Building Permit Application Completed
Planning Intake Checklist Completed,
Site plan includes:Allowable building ar f overhangs,decks
Fire Apparatus Access Road info req ' ? Yes No
Energy Code Application Form-O Electric wall hea ectric central ce O LPG Furnace
O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type )
O Other:Specify:
Mec ca 1 ' g Application-WATER HEATER FUEL TYPE
Enginee ' ? Ye (Need 2 sets of calculations)No _ qehnical report or assessment? Yes No
Snow load: Seismic Zone(circle o D2
Construction P 3 COMPLETE SETS STO /ioFoorftnaming
ableg �gr�zed Scale _ Views GYoss Section
on Plan l oof Framing Plan lan—Use of rooms noted(all floor levels)
Plan-all floor levels r resented? Lo crawl ace etc.
eP ft, sP
—Deck g��n� Judin
g covered.porch framing
Plan Details r , n �'� �it v
_�R framing details,truss lay-out maybe need truss r stick framevdY'`'U
�ranun -Does be 1 i t ex '� t' arrng- exceed U ' =ngi" r beg may be required) 1
Flo ftamin Floor'oists:�� � to � r beam
ow headers marked on plans: Typical header
v Fo�dation:footing size,reinforcement
�✓ ncrete Walls-Does Concrete Wall Height Ex '9(Engineering may berequired) /V
_�Idings at all exits? Less than 30"above grade. Y N
ted By Furnace-Location of Furnace
�Fi ce/Stove Information Shown-Fuel Type?_ Location(s): r
Sizes Marked on Plans
ra ced wall panels(sh on p engineering? (Plans may not be approved not
PP I Provided
)
-Sto . jEhgineeringmay be req: 602.10.1, 1 of a two-story D145%,D2—55%
CO S:
ENGINEERING REQUIRED:
Braced wall panels/braced wall lines are not marked on plans .10)
Arno does not equuired in Table R602.10.1
IRREGULAR BUILDINGS(Irregular 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.
j 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.
DESIGN CRITERIA:Wind 85 mph exp B(unless proven otherwise), Seismic Zone: Snow: psf
2003 IRC Plans submittal checklist siniplified/WORD
i
fi
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES _
Environmental Health - —'s" 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
Corrtpiete Bart 1. No determination can be made u 1 Part.1 i5 fuilu comi�lste�i:
2.` Comp#etg only"the portion 0f"Part"2 applyingid"ttt of vuater systerii utilized:
3. ubrr�it x". rr► letedx lic 0 n,wit# attadhmehtS to taro h It i o ai rnent for review.
PART 1: Applicant/Parcel Identification
pp 645--c4L Q�Date'
Name of Applicant '
Mailing Address 200 8106% 'TeK UA. 26114 O (ATelephone._340 IN-033u
O A. 913 66
Assessor's Parcel Number /222 4 -2 Z. - Y03G 2
Type of Water System Check One Reason for Application Check One):
Public/Community Water System (2 or more Building permit
connections)* o Land use application, if so..
❑ Individual water source(one connection), ❑ Division of land:
if so..
Well #of Parcels?
Spri surface wat r ❑ Boundary line adjustment
Other(explain ❑ Other(explain)---
**If you have more than lone resi e ❑ Replacement(please indicate name of water system
connected to this well, check the Public bo)L 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 t % L44k+-e—< .5V5*!ew, 2
Water Facility Inventory(WFI) Number:
(write"none"for two party) /✓or9C
❑ 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
Update:April 2006
-4ND � -
Individual Water Well
Water well report(attach to application) Depth --_—ft.
Well capacity test(attach to application) __------gpm __-----gpd
e well dfillero en pertorms well capaci y es s at the time the well is constructed. Results
from these tests are noted on the water well report. Results from these tests will be
accepted. if the water well report cannot be located by the applicant or if the water well report
does not have a capacity test,a well capacity test, which provides stabilization of draw-down
and recovery data must be performed by a licensed contractor.
Satisfactory bacteriological test(attach to application)
Individual S rin /Surface Water
WDOE permit (attach to application). ,
Method of.disinfection
❑ 1 have reason to believe ttiaf 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 this line.
PART 3: Heap Dep meet Evaluation (Staff Use Only)
SATISFACTORY DETERMINATION: Applicant's water supply appears adequate to
meet#h:r►
, eedsrQf its intendetl use.
This determination o .,riot address adequacy of the distribution system,guarantee
an adaauats supply of Inviter indefinitely into the future, or guarantee compliance
with all;epplica4/e VVDOE water resource regulations.
UNSATISFACTORY DETERMINATION:Applicant's water supply does not appear
adequate to meet the needs of its intended use for the following reason (s):
REVIEWER'S SIGNATUR DATE
0.1>
Update:April2006
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/VIAQ Compliance Application
Owner: Q.l r Telephone: i,wM Parcel#: ?ZZ _12, •Q03
62
Type of project (A New Residence ( )Addition ( ) Remodel
Total Sq. Ft. —1 1S Floor: 2 floor: [Heated Basement:
of heated area:: a *3 12G 6 11048
Heating System Type: O Electric wall heater >&lectric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other:Specify
Glazing Prescriptive Option see reverse side circle one: I II iV
Percentage: Compliance
Method O Component Performance , Chapter 5— Calculation worksheets required
% Check one:: O Systems analysis, Chapter 4
O Whole House Ventilation system O Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air Recovery Ventilation System (VIAQ 303.4.4)
System vents (VIAQ 303.4.1)
Check one
O Whole House Ventilation Integrated X Whole House Ventilation using an inline
with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3)
Window & Door Schedule (if needed, attach an additional sheet)
Total
Manufacturer Roomllocation U-Factor Size Quantity Square Feet
Windows:
Windows: Total Sq.ft.
Doors:
Doors: Total Sq. Ft
Total window and door area
Total window S door area /(divided by)total sq.ft of heated area = %of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELfi6'rv'(360) 427-9670 �BELFAIR(360)275-4467, Elma (360)482-5269 t
FAx: (360)427-7798 WEB SITE: www.cb.mason.wa.us
P.O. Box 186, SHELTON 98584
2004 Washington State Energy Code (WSEC)
2003 Ventilation and Indoor Air Quality Code (VIAQ)
effective July 1, 2004
Code Compliance Application Form
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code
--- - (WSECNiACf)applica-tlonloca e7-on th6 reverse-sde.
2. Complete the window and door schedule.dn the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location and fuel type of water heater, location of exhaust fans
(bathroom, laundry,'kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and
slabs,
4. Questions? Call Mason County Community Development at (360)427-9670 ext. 352. Additional
WSEC and VIAQ compliance information is available on the internet at:
http://www.energy.wsu.edu/code/
Prescriptive Requirements "for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Area%of Vaulted Above interior° exterior Slab"
Option FI oor vertical Overhead11 U Factors Ceiling Ceiling3 Grade below 4 Below Floors on
12
grade Grade Grade
I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
II* 15%* .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
IV Unlimited
Single
Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
(R-3)Only
*Reference Case/Call(360)427-9670 ext.352 for footnote information. Log&solid timber wall with a min.avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
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