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BLD2008-00987 Final Replacement SFR - BLD Permit / Conditions - 2/13/2009
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O - O O 0- a`< o r. � vo - 3 o a � 0 (n a`` O (D (D C VI 0 W co cn O 6 -D N '0 7 0 p ' Q p (D D (O 0 7 a- N' (n' (n W (D y �. En v (D � y o 3 CD m0 (D -O a �. (D o O (D 7 ? W ; p m CD o_ O 0 Cl0 A W _ (WD 3 6. Lo O cQ 0 j CD O N -0 n d _ "O (n > >. (D _0 ;v (0 C N fl. -a `z (D O '" p O O W 0 0 `G �., `� -0 CDO :3 0• N (D (D c= oo a O o- N O 6 0 -' o- m � CD � 3 m n•M W D (D a (n (n 3 0 .< X d (D (CD O (D :3 -0 m O 0 W a) 7 o (n ooa) =r o `` 0 v OCD 0 00 O 0 (� � O to o a 0 :3 c � CD (D (CD -^ 3 CJi O p 7 7 � 'p -I (D (D (DN (SD W C (D C o v CD D 3 N $ � o m 0 X* � m o En- co o CONCRETE MECHA ICAL J MANUFACTURED HOME N Date CD o m mks �J Ribbons�iT Gas Piping Z oInterior Date By Interior-Date By Date By L. Extww Date Byl��Iqd Exterior-Date/ - 8 St.up rn -n Point Load I Isolated Footings INSULATION Date By -n BG I SLAB INSULATION - Qo Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date B Data Z_ c By DECKS F RAM I NG Wails Date By y Date J B Data B PROPANE TANKS PLUMBING vault Date _ p� ._-_....- a. - Date By OTHER Groundwork Attic Date By Date 2 l o B Type- Date By D.w.v DRYWALL Type. InL Brace Wall Date By W Date _ ByJ�f Date By FINAL INSPECTION 0 v Water Lin"¢�,� Fire Separation N Date CG By Date By Date '-7 B6Wp m 00 Pass or Request Inspect. c Type of In Fail Date Date Done By Comments w CD �o" — 0 �, 0 gr/ N uti� P� 0 h !! MASON COUNTY PERMIT NO ow " AUG � 2008 BUILDING PERMIT APPLICATION �Q_5 IAp ix` i;f/_ UNT 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-52692 /d On the web www.co.mason.wa.us APPLICA TINFClRMT�QN CONTRACTOR INFORMATION Owner //P _ Company Namelr�nRke Mailing Addre s ! E Lcse Mailing Address ' City F; State W,4 City State bp Code �� —tip Code!�4' Phone 90141 Other Ph. PhoneC2sz) Other PhC2r3)34s-SbIL act Lien/Title Holders Q 7 l Contractor Reg. #ST,4�itrc�9s3P,o Exp. la E mail address u u E Mail Address S Drivers Lic.# L LrG DOB ZZ2/-70 Drivers Lic.#5.;!,�7 EL 5��9yDF DOB 16LCZ SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic X' Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Di 't Parcel No �T Fire District Legal Description I n-6 S Site Address(Please include street name, street number and city) 12 E r Directions to site S'P-e .4 &r her s�Pp 415' 74 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?Yes/No TYPE OF JOB - New V Add Alt Repair Ot r�-��� PRIMARY ESID NCE ® SEASONAL ❑ Use of Building _ Describe Work �fi4/fllC - HC�� No. of Bedrooms No. of Bathrooms_2 Square Footage - 1 st Floor 2, 2nd Floor 3rd Floor Basement Deck Covered -2/ -;z NRO_ �K — Sq. ft. Garage S'SS 0 ttache Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No 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 [PR it and to do the as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is red fr asem nt holder or any other party in interest regarding this application or the work proposed in the application,I have obtained issi fro em to for this pe�andason'County ust the work proposed. The owner or agent on owners behalf,represents that the infomtation is e g employe access to the above described o rty and structure for review and inspection. F C OF NS OF A PROGRESS INSPECTION. Date• 4/ - er/Owners Re presentat' /Contract indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted b : DatOB-LU-oe) DEPARTMENTAL REVIEW A ROVED DENIED NOTES Building Department Planning Department C. Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee 3 EH Review Fee Plumbing & Base Fee 0.3 . / Planning Review Fee Mechanical & Base fee • Z U Other IV ood/Gas/ Pellet Stove FeeC� - G'iJ State Feeolation Fee /-O Pre-Paid at Submittal aluation $ TOTAL FEES 2008/AUG/05/TUE 08:30 AM SUNSET AIR INC. FAX No. 360 456 4990 P. 002 MASON COUNTY PERMIT NO. PLUM BINGIMECNAPNICAL PERMIT APPLICATION 426 W.Cedar• .O.Box 186,Shelton,WA 98564 Shelton(360)427-t67&•Repair(360)27-5- 7•Elma(3W)482-5269 e w www.00.meson.wa.us APPLICANT INFORMATI["' CONTRACTOR I AT1p Owner Company Na,��/per � me Malin g p Maili A dress City State. Zip Code City State-LzzL—Zlp Code Phone- �� � '�-;t�.�;_ru Ph 2 -1 Phon )3 4s-Sosa Other P s y5 �xf ia/ Lien/Title M00-r Contractor Reg.#,51 II . vA 3°"� Exp. d- - E mail address E Mail Address Drivers Lic.# L- - — Drivers Lic.e S iz3,7WOioos SEPTIC INFORMATION-Connect to ew Septic Existing Septic_Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 Di 't Parcel No Fire District Legal Description Site Address(Please include street liame,street))umber and city) Sa Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs ? 15% TYPE OF JOB-New Add Alt Repair Other Use of Building Location of Fixtures/Units-let Floor f 2nd Floor Basement Garage Closet PLUMMG FIXTURES(Show NuMDOf Of e MECHANICAL UNITS Tvoe of Facture No. of Fixtures Fees Fuel Type:Electdc. LPG_Natural Gas_Heat Pump_ Toilets 7voa of unit its EM Bathroom Sink Fumace . Bath Tubs Heatpumps Showers Spot Vern Fan Water Heater Propane Yank Clothes Washer Edcchoe O L Di hen Sinks ��Dishwasher n et Hood 7 Hosebibs fir. Dryer Vent / Other Other Base Fee Base Fee TOTAL PLUMBING I TOTAL MECHANICAL GINNER/BULpFT;Aciowmad9e8 submia Wan d inaoowde infomnson mit r revA in a slop work order or permlt revocation.AdwaNiodgement d such is by atgnstue below.1 declare that 1 am the owner,omwors legal rapraeenl Wa,or Me conrador.I further declare that I am entitled to revive this pann4 and to do w proposed in the ap ksillon.I dedsre that I have obtained the potmMon tiom 0 the necessary parties.tl petmisaion is required me holder or any other parry eat regerang ft ap lion or Uta work proposed in the applWkw,I have obtained poem n to for this per rm and uQ the work proposed. The owner or agent on owners behalf,repreeenta tW the iMom)Mon P 9 NOF W empl� S Oy ti1FJWSOFA PROGRESS ttIBPEC710Nson Cow*amw in the above d atructare for review and inspection X Date: 4V oA Owner/Owners Representative/Comradar (indicate which one) FOR OFFICIAL USE HEVONO THIS POINT Accepted b : Planning Pd Cke Date -C)IES Bid Pol Receipt No. DEPARTMEkTAL REVIEW APPROVED DENIED NOTES Building Department r Planning Department Environmental Health Department FEE Plumbing 8 Base Fee Site Inspection IdeChanioal&Sue tee UFC Plan Review Fee Food/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES a� I 'd ases-226-ES2 sswoH wo1snD amooique-4S wbe1 :8 9002 SO 2md 2008/AUG/05/TUE 08:30 AM SUNSET AIR INC. FAX No. 360 456 4990 P. 002 MASON COUNTY PERMIT NO. OASON C,C)U NT LUMBIN 4"26 ECN I CA1L8 PERMIT APPLICATION Shelton(380)427$7&e Beawlr w(35 Elmo(360)482-52H862oaw wa.us APPLICANT INFORMATIONJ CONTRACTORI R AT10 Owner /�� �Wm Company Name Ilnca7l Mailin dress_ pn Ya /2 a o 41 A Maili dress �04 � G .�...�..._ City State Zip Code City State�—Zip t,oda l�`t2�1 Phone - her Ph 2 -r Phon s3)3 4s 5os c Other Ptt r `/5 Lion/ trotder Contractor Reg.#, _"47 I°"�Exp. d - E mail address E Mail Address Drivers Lie.N L B — D rivers Lic.0S S 3 OOB SEPTIC INFORMATION-Connect to ew Septic Existing Septic_Connect to Sewer System Name of Sower System PARCEL INFORMATION•12 Digit Parcel No Fire District Legal Description 3 Site Address(Please include street pa e.street umberand city) ra Directions to site Z-a Is property within 200'of Saltwater Lake River/Creek Pond edand Seasonal Runoff Stream Slopes or Bluffs ? 15% TYPE OF JOB-New Add Alt Repair Other Use of Building Location of Fixtures/Units-1st FlooL_j__ 2nd Floor Basement Garage—Closet— PLUMMO 7(TURES(Show Number 01 each) MECHANICAL.UNITS Tune of Fixture No. of Fixtures Fees Fuel Type:Elecirlc LPG_Nadural Gas_Heat Pump_ Toilets Tyne Unit No.gj Units EM r Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater j -- Propane Tank Clothes Washer �— Exhdoen :8,'t OL Kthen Sinks eI�sove Dishwasher Flood Hosebibs Dryer Vent Other I Other Base Fees Base Fee TOTAL PLUMBING TOTAL MECHANICAL l /BULDE t Admowledges submission of inaoeumo information may result in a stop work wil r or permit revocation.Acknowledgement d such is by elpneture below 1 dadare that 1 am @me owner,owners legal repreaenteive,or .the contractor:I further decors that I am erttled to Ktelve this patmM end m do p mposed in IM aWia den.I dachas 4nat I have obtained the pem*Aon bvm all the necessary parties.Y permission is required rno holder or any other party est resardiM thisap Lion or the work proposed in the appkNion,I have oaarned n to t«leis permit and not the work proposed. The owner or agent on cmam behal.mprssants that M inlomm gon g emdaye aeon County access to the above described pro arty nd structure for review and inspraaiom M P N OF a UY EMS OF A PROGRESS"5PECT10N. X Oats: Owner/Owners Represen*lve/Contractor (indicate which one) FOR OFFICIAL USE BIEVONO THIS POINT Accepted Planning Pd Ckrt Date -C_ Bld Pd Receipt No. DEPARTME AL REVIEW APPROVED DENIED NOTES Budding Department u r Planning Department Environmental Health Department FEE Plumbing 8 Base Fee Site Inspection jAeC.hanicat Base lea UFO Plan Review Fee Food/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES 1 I •d ZeZS-ZZ6-ESZ sewoH wo1sn0 amooique2s wwatre e002 SO gnu 2008/AUG/05/TUE 08:30 AM SUNSET AIR INC. FAX No. 360 456 4990 P. 002 r '�5 6 � .. MASON COUNTY PERMIT NO. MASON' (, OUNT PLUMBIN 4WMECNAdar*pN1 CAox�L8PERMI PERMIT 98584 Shelton(360)427-V7&• vnIt 1360)275-446T•Elms(3W)482-5269 e w ww.00.rneson.wa.us APPLICANT INFORMATIC% gg� CONTRACTOR'" "? Owner ,�1/P� -, G Company Name ,, P��.s — Mailin a bet p() C3ou I 141 Maiii A dress r City State Zip Code City State Vp Code�`�?`L Phone - Other Ph 2 /-��9 Phan 3 ti�-Soso Other Ph(zr LIMI Title twtder Contractor Reg. Email address o E Mail Address 5�� /s a aaA�� Drivers Lie.#4 L 1 Drivers Lie.if S GOB 3- -16/ EPT1C INFORMATION-Connect to ew Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 IN it Parcel No Fire District Legal Description Site Address(Please include street lame,streel umber and city) ra Directions to site L-M ' /Ig I Is property within 200'of Saltwater Lake —River/Creek —Pond edand Seasonal Runoff Stream Slopes or Bluffs ? 15% TYPE OF JOB-New Add Alt Repair Other Usa of Building Location of Fixtures/Units-1st Floor 2nd Floor Basement Garage Closet PLUMMO FIXTURES(Show NuMDef Of each) MECHANICAL_UNITS T_we of Fixture Ng.of Fixtures Fees Fuel Type:Elecb1c.�Lt.PG_Natunal Gas_Heat Pump_ Toilets 7vne of Unit EM Bathroom 5ink Fumace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Pr opane Tank Clothes Washer _�— eDthen sinks et stovDish+nresher Flood 7 Hosebibs .. Dryer Venl l Other Other Base Fee_. Base Fee TOTAL PLUMBING TOTAL MECHANICAL O WNERIBULDEA Advtowledpes 4ub;nissicn of inaoctume intom+raon may retwtl n a seep work ceder or permit revocation.Adcrowledgement d such is by a�nattee below.l dadare That 1 am the owner,owne+m Iagal representative,or the contractor.I furthar declare that I am arMed to receive this pertnk and to doproposed in the aWwalon.I dadara that 1 have obtained the permWon from all the necessary lowtim.N permMion Is V @ON huller or any ether party eat MWAk g this ap'ication or the watrk proposed h the oWicokw%I havet�� r"pem'fit and nottheworkproposed. The owneroragentonownersbehalf,reprmtlerttsttatteinfamudon employees aeon Cow*access in the above described mucture for review and insper3ion. FS my MEANS OFA PROGRESS OWECTION. ,,(Date: Owner/Owners RepreserrWiva/Connraetcr (Indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted Planning Pd Cka Date a-tC-bgBld Pd Receipt No. DEPARTME AL REVIEW APPROVED DENIED NOTES Building Department r Planning Department Environmental Health Department FEE Plumbing 8 Base Fee Site Ins action tdochanigal&BaGe fee UFC Plant Review Fate Wood/Gas/Pellel Stove Fee Other Violation Fee TOTAL FEES I 'd zBZS-ZZ6-ESZ sawoH wolsnD as(oojquszs Wli9T :8 8002 SO 9ny 2008/AUG/05/TUE 08:30 AM SUNSET AIR INC. FAX No. 360 456 4990 P. 002 ED f t,ll ZOOS MASON COUNTY PERMIT NO. ,rA s ;OUNTPLUMBINWMECHAPNICAL PERMIT APPLICATION 426 W.Cedar• .O.Box 186,Shelton,WA 98584 Shelton(360)427-g7�•BeHalr(360)275-4467•Elmer(360)482-S269 e vrww.00.mason.wa.us APPLICANT INFORMATIPIJ CONTRACTOR IIAA / , ILOO P( crs---r `nor� Owner Company Name � � � � . Mailin artrtresa pto-Bag ]1 �(� Mail' ��Oi A dress �rF City State Zip Code City State 14ZI: Zlp Code=4t2q Phone uj�Q 1 7� Other Ph 2 -1 Phon Other Phr `i5 e /ol tiiett/rtle Molder Contractor Reg.#f ",P Exp. E mail address E Mail Address 5i'nre/4 �,�fy�h�rP s/n vll Drivers Lic.A L B Dtfvers Lic.M.5 S5gZjUL,. OOB 3— —J Ej EPTIC INFORMATION-Connect to ew Septic Existing Septic_Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 Di it Parcel No Fire District Legal Description Site Address(Please include street ems,street number and city) ro � Directionstosite ��j n1 512 4' 2� 36 ��Z,/I Is property within 200'of Saltwater Lake River/Creek Pond Welland Seasonal Runoff Stream Slopes or Bluffs ? 15% TYPE OF JOB-New Add Alt Repair Other use of Building Location of Fxtures/Units-1st Floor / 2nd Floor Basement Garage Closet PLUMMIG FIXTURES(Show Numberoe MECHANICAL UNITS Tvne of Fixture No.of Fixtures Fees Fuel Type:Elecsric X LPG_Natural Gas_Heat Pump_ Toilets Tvne of until No.of Unit Fags Bathroom Sink Fumace Bath Tubs / Heatpumps Showers Spat Vent Fan Water Heater / Propane Tank Clothes Washer Gas O-Ldiets L115 KMen Sinks W et Stove r Dishwasher lKitchen-Shaust Hood Hosebibs Dryer Vent __ ! Other Other Base Fee Base Fee s_ TOTAL PLUMBING TOTAL MECHANICAL CWJNER/BUIDEFt AdnowWps aubmiasion d inaoouate infonnaliort may respA in a stop work order or permit► vomtion.Adohowledgemerht d swh Is by ebrwo"below.I declare that 1 am fits owner,ownecm legal representative,or the contrador.I further declare that I am er*Ued to t eaNve tits pemn4 and to do proposed in the applladw.I dedere that 1 have obtained the permission bvm 9A the necessary parties.If pembelon Is required me holder or any other paAy eat reganks this ion or the work propoind h the mptic oien,t have obtained perm n to for this pem*and uotthe work proposed. The owner or acenf on owners behalf,represents 1hd the information 9 empioysea aeon County access to the above deaciftcl pro omy not oil ture for review and inspection. P Nor W 8 air MZANS OF A PROGRESS 94PECTION. X Daie: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS DINT Aocepted b . Planning Pd Ck# Pd Receipt No. DEPARTME AL REVIEW APPROVED DENIED NOTES Building Department Groupr Plannin Department / :y._ � Environmental Health Department FEE Plumbing&Base Fee Site Inspection jAsChanical&Base fee UFO Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES T 'd zBZS-2Z6-ES2 sawoH wolsnD a>,00iqueas Nd81 :8 8002 SO gnu REVISED DATE TX Ai ' f 1a AFIlG/r/4 t 1!U FOL r (I •,yry, I;. �t=i' i htS ilkL Mf]$31.f. ki ' -.� � ` I 00, f:t F,. .. , i>t.;ttrk.; •fas, �; � ice. ... ;• 1! ,.• ' Trl-t- `>:Y, to S,• 1 f , �t.�sf j jt 1 1 r^�•+ E 3w,sb , arrwor� ` i jR<yic4;nti APPROVED MASOP-i COUNTY DCD PLAN NfNG 'iTE PLAN REQUIRED TO BE ON SITE '(-ES SUBJECT TO APPROVAL ry ___—Date , Lf VTy z 'd wo�snD aiooaque�S WdB �£ 00Z T i ed{ n M PH�£ w w ddEMHDHxv.LS I06N V8 c£n)--4 l 1 N n❑S N❑S d W U wm ay eawoH La and aa�quWS SOOZP'aa9 uaV ® eawaH uw,ana awop„ais epu Iwa Rued aw•N+aa a,!n a auap aaaa, eme,vazuwwa"n utoa'axoaqu nS-... 006£-I SZ) i+I as u,'aww�wmaro ay�ou,ws n uw.uoa wa wA.aLm waw.o<n wrv!awo we nwn+•Ruaa w!a a w aova..e R IL£86vM'dnlle6nd t,ZS86 `•d/1 'N),-l-]d A— ,.,a�a�amw%Aw,j mn• �•a��aa,aa��a,aaa�aaa„ •M•N•and,(a[IRA IOZ d a d❑❑� /`13I A 3 d d d 9 '3 6 T Z 9 °1'p B°wn u,a,ueu weaow,ewu wa rh,�am.e,uaa m a wtiaw,<,amoaa vv uoH wmwq aampuws m (d) SdN3Q?Jd8 3H1 s�woxwo;sn� 3I�3s Hdd �❑lnd�J d N d S d �1 I S S o s a Iv a}�OO.IC�U�� —T �T a 4 0 o s S (/J ,68'6Zff 3 „£I,LZ.O N ---- _ f ,kVM3AI8(1 / ^\ LO / I C ua ¢ I \\\ I JQ dC7 IWIQI I 1 3 I w I I �pq w I 1ryI \ woo¢ w lA I \ f�wJ I :� —T— I \ `\ C7 E w fy I I LIJ \\ \ 1 z¢O I — — I I V �Za \ W I I I LD ( Q� I LLl \ \ —\ _— V�fj IZIwI I o LQL Q ❑ 1iI -,O S I \ \\W 3\\a P \\\ \\ ` \\ IIjI ¢ I I rNm 1r�1 n W LU � CL > >Z ~'Z O o z CL QUJ 0am WDo � 0 0 ---�-------- wL J Lu p_p2 LO P ----- ---- W O JU .0 d nC^)Q W > \\ \ I I \ d I I I 68"6L£3 „ZI,9rW N Q Q Ew c o as � o 0 4 3 � LJ cu g8 H LO O CC) �y�CD >I I IAT CD CL Q Q c 3 F-1 m (� O CU Licu z - ClJ o ID Q z E— O - J z 3 � o � U z > S w Lwwm Q q Q � Q ry LD L J W J z LJ J e U LJ Q ' LL J u o Lei (U J Q O 3 Q � �DQ d � J o f S Look Up a Contractor, Electrician, Plumber or Elevator Professional License Detail Page 1 of 2 Information in Spanish I Topic Index I Contact Info Home Safety Claims ft Insurance Workplace Rights Trades Et Licensing Find a Law(RCW)or Rule(WAC) Get a form or publication Return to List > Start a New Search > Printer friendly General/Specialty Contractor A business registered as a construction contractor with LEtl 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 STANBROOKE CUSTOM UBI No. 602235377 HOMES INC Phone No. (253) 345-5050 Status ACTIVE Address 4809 PACIFIC HWY E License No. STANBCH983PP Suite/Apt. License Type CONSTRUCTION CONTRACTOR City FIFE Effective Date 10/17/2002 State WA Expiration Date 10/17/2008 Zip 98424 Suspend Date County PIERCE Previous License Business Type CORPORATION Next License Parent Associated Company License Specialty 1 A., GENERAL Specialty 2 A) UNUSED Business Owner Information Hide All Name Role Effective Date Expiration Date CROSS, THOMAS A PRESIDENT 08/01/2004 SUHRSTEDT, JERRY PRESIDENT 06/25/2004 09/04/2007 SANDERS, MAURICE 1PRESIDENT 10/17/2002 06/25/2004 https://fortress.wa.gov/lni/bbip/Detail.aspx?License=STANBCH983PP 8/27/2008 Aug 04 08 03tDOp Stanbrooke 253 841 3001 p.1 S t b r oke C1 OM HOMES 4 PO 1fc HVVY E Fife WA 95424 (25 ) 3d5-5050 Direct Line (2 )345-5a43 ❑ Urgent FAX To: P From: Fax: L> — popes: Phone: ' 2 ,C1 O date: Re: CC: Po R *'ow Please Comment a3-lpI ase Reply © Please Rocycte J�f I 4r- -, A, 74 �� f I stanbri oa oke CUSTOM HOMES 4809 Pacific HWY E Fife WA 98424 (253)345-5050 Direct Line (253)345-5043 ❑ urgent FAX To: From: , Company: G Sidnr� Pages: Phone• fr��0) ��� � Date: Re: CC: For Retiew Please Comment Please Reply ❑ Please Recycle r a �,4 n fi'e e I -d ZBZS-zZ6-ESz sawoH wo4sno a}Ioouque4S WdeS =E BOOZ Ti 2nd r61 r Name�n�r Yl L� �� l z-tom Parcel# f - t.� ,;� - ��,�- j��;�'; ;Z( BLD# i 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 stonnwater 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. 'Common 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. `: : : ::: :::y:::: : ii : :: ;::::::::'::::; s : : ;:;:;:;;:;: ...................:::::::::::::::::....... ::�u......:..::.�irt..�..�nrrnrrs.. .�. ��n:�:.Ain s,�:>. .o�t-.�`c� �..7'. .. . �:.;:.;:.;;:.;:.::,;:.;:.>:.:::.;:.;:.>::.:;:;::.;::.:::;:.;:;.::.: Surface Type Length X Width Area, *All dimensions in feet Buildings X = X = Measurements for buildings are taken at the X = perimeter of the farthest projections (example: eaves/gutters) X = Driveways X ; X = Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition above table Patios/Walks X = Any paved, gravel or packed area per definition above table X = Others X = X - !f 11 fI lc�:p$I�t�t#� a�tflt� #��iQ ::::<.:::.;;::.;:.;:.;:.;;:.;:.77777= «.:.:.:............................................................... ::::::::::::::: taE,.trnperviou + uaeA€ea sutof:.all.:arts :.;::.:.;:.:.:.;::.;:.;::.:.; :::: :::::::::::::.:..::::.::::::::::::.::::::::::.:::.::::::..:::.:::;:.;:.:; 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 i the information provided on page 2 of 2. Page 1 of 2 Name Parcel# BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) Based Upon the information you have provided a Stormwater 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: http//www.co.mason.wa—us/code/conunissioners/index,htm 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" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) 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. 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 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 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: Page 2 of 2 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 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system utilized. 3. Submit completed application,with attachments to the health department for review. PART 1: Applicant/Parcel Identification Name of Applicant_y �` ��l/2 Date Mailing Address Telephone r.25 3) Assessor's Parcel Number I a 2 322 900 3 1 Type of Water S stem Check One): Reason for Application Check One): ❑ Public/Community Water System (2 or more p( Building permit connections)~ ❑ Land use application, if so.. (7 Individual water source(one connection), ❑ Division of land if so.. #of Parcels? SPL - Spring/surface water ❑ Boundary tine adjustment ❑ Other(explain) ❑ i0ther ex lain) tf you have more than one residence placement lease indicate name of water system connected to this well,check the Public box. ►ow i 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) ❑ 1 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. ❑ 1 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)connections)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 Individual Water Well Water well report(attach to application)Depth 2:_ft. Well capacity test(attach to application) gpm gpd e well driller often performs well capacity tests 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 orif the waterwell report does not have a capacity test,a well capacity test, which provides stabilization of draw-down and recoverydata must be rfonned b a licensed contractor. Satisfactory bacteriological test(attach to application) Individual Sprin_qlSurface Water WDOE permit (attach to application) Method of disinfection ❑ 1 have reason to believe that this water source can provide at least 800 gallons per day andlor 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 V`nLL 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: Health Department Evaluation (Staff Use Only) i SATISFACTORY DETERMINATION: Applicant's water supply appears adequate to meet the needs of its intended use. This determination does not address adequacy of the distribution system, guarantee an adequate supply of water indefinitely into the future, or guarantee compliance with all applicable INDOE 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 SIGNATURE DATE Update:April 2006 Mason County Planning Intake Checklist Owners Name: r w. Date: Project: ►'t M ), L, - Reviewed By: Proposed use(s)of cture(s) L i U I Y-)c Commercial Development: YES NO " PLANNER: GBM TSW PBC RDH_,PEC JMS Site Plan: _. e' North Arrow a Survey required in Allyn UGA - o AF# ❑ Monuments �a� Property Dimensions: 3QG X 3 -..,'Streets and Driveways Shown.Road name: n vc_tL. .n� - c7�F p V . 1z' sho wi etbacks and use E x iSf v i c. ��ri c J V ce 11 Locatio Septic and Drain-fiel&Shown with setbacks �9---Id su rrstr,�ns;-fonds,shoreline,wetlands, natural or historic drainage,defined drainage ditches) e, .,`a-Topography(slopes)�{, .,`a- �, Minimum Structure Se44ks (Directibn/Setback F: WjI_ `1� R: _G_ / r7-7 Si: /ems S2: �J L9rl �L Ex�Sf r�.G1 Utility and Drainage Easements: Yes No (if yes enter condition #5022) 6-7(IL c�p `,,z" Other Easements .e' Accessory Appurtenances; Twanid /Ctpump", e❑' Does site plan show landings III exits? o Variance applied for: Yes / o} parking spaces allotted? Yes,% No sae County Access Permit Needed (add condition #0010)" , ,,a-'State Access Permit Needed-(add condition #0020) /' Ex 1:6+-i r7 Standard Conditions to be added to all Building perm that planning �ews: #5019 and #0700 Site Access: Are there any impediments(dogs/gates)that my restrict access to your site? Is the site dearly marked? How? ,_13- Address , d ;t k�� c . c�__�.#" ❑ Name Zoning: ❑ Other: Comp. Plan: Rural Zoni UGA Zoning: 0"Rural 0 RR 2. 5)10 20 ❑ RT/RTC o R-1 ❑ R-S 0 HC 0 BI 0 RAC ❑ RMF ❑ Unknown ❑ R 1P 0 R 10 ❑ LTA ❑ VC 0 .Allyn UGA ❑ RC 1 2 3 0 Agricultural ❑ R-iR 0 PD 0 FR ❑ T 0 Belfair UGA 0 RI ❑ In-holding b R-2 0 PF ❑ MU ❑ MHP .❑ Shelton UGA ❑ RNR ❑ LTCFL ❑ R-3 0 POS .❑ GC ❑ BP ❑ Tribal ❑ GC-CI Critical Areas: (streams, ponds,shoreline,wetlands, steep slopes) Shoreline Designation: ,XN/A q Urban ❑ Rural D Conservancy ❑ Natural ❑ Unkown Water Body(type of, if unnamed): V)01 \ .SEPA: Yes/NoJnknown Flood Plain: YES/N Unknown Map# Aquifer Recharge: YES/NOKUnknowr,) Map# - Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: Y Eagle Nest Tag: YES 0 Other Y NO Revised: 02-07-2008 I:\RANNMVACNK.ANNING INTAKE