HomeMy WebLinkAboutBLD2007-1934 Final SFR - BLD Permit / Conditions - 9/10/2010 f I
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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'�j�
4ra,he-mfe www.co.mason.wa.us
APPLICANT INFOR*ATION CONTRACTOR INF RMATION
Owner c ✓ �" } Company Name "/O+'tRvc� �'�r'--
Mailing Address Maili Addre s 301 k/, uw
City State Zip Code City �1L7' LAcq ��bState Zip Code
Phone Other Ph. Phone 373 ! l f Other Ph.
Lien/Title Holder Contractor Reg. # -_X475591 Exp. S O9
E mail address E Mail Address 450 J D"+*,j
Drivers Lic.# DOB Drivers Lic.# DOB
xS9PTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to ter System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. I Uall Fire District
Legal Description " r 3 PL 033 '- 7 T j 0
Site Address (Please include street name, street number and city) XX X SNP waur�
Di ections to site �' _ o
�, ►U r-. dF +gv h.+ ..rT. 5T-+a `r, 1Sr A/ JC:
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% Js
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 [l�~ ASONAL ❑
Use of Building l2 r`,°t� "` `"' Describe VVork '`=-.� j�`�G `LI
No. of Bedroom No. of Bathrooms � Ie- Square Footage- 1st Flpor r
3rd Floor Basement —Deck Covered Deck I—Other Sq. ft.
Garage Attached 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 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
MEANS OFA PROGRESS IN PECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 D YS WI L INVALIDATE THE APPLICATION.
X Date: U
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date j- 11 r
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department YID ,4<<j• n
Planning Department
Environmental Health Department 44
14
Fire Marshal rn
FEES
Building Permit Fee 4 _ Site Inspection
Plan Review Fee a 016 `3 y EH Review Fee
Plumbing & Base Fee S~,Z 9G Planning 19 eview Fee
Mechanical & Base fee - 3 0 Other
Wood/Gas/ Pellet Stove Fee O=GL' State Fee
Violation Fee �- �3—O"� 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- 70•Belfair(360)275-4467•Elma(360) 482-5269
Kthe web www.co.mason.wa.us
APPLICANT INFORMAT N CONTRACTOR INFORMATION
Owner Sgimgvey D Company Name � lQfAd.
Mailing Address Mailin Addres ( "). 1j01
City State Zip Code City State-1eth- lip Code 53I
Phone Other Ph. Phone 37-1--L, Z`P Other Ph.
Lien/Title Holder Contractor Reg.49S& 4 WST Exp. �—
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. l7'A O c),dWf Fire District
Legal Description 3 --n" -y— PC.�� &
Site Address (Please include street name, street number and city) X'>c)c sugk &r
Directions to site D '�D 0 �^�
Qb F140 d 0, AV1%,L% vzJ..G"X-- I -UE 4R, 611ki
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- 1st Floor '�_2nd Floor Basement kf�:` 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 1
Bath Tubs Z Heatpumps
Showers I Spot Vent Fan 'f
Water Heater I Propane Tank 1
Clothes Washer I Gas Outlets
Kithen Sinks I Wood/Gas/Pellet Stove
—�
Dishwasher I Kitchen Exhaust Hood
Hosebibs �2 Dryer Vent 1
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: ���
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by lanning Pd Ck# Date - 0_7 Bid 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
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•Belfair(360)275-4467•Elma(360)482-5269
On the we www.co.mason.wa.us
APPLICANT INFORMAT N CONTRACTOR INFORMATION
Owner SY7gd Z 1v] Company Name 4501A F —�
Mailing Address Mailin Addres f W
City State Zip Code City. tate-le�� ip Code.!VMA
Phone Other Ph. Phone 3 Other Ph.
Lien/Title Holder Contractor Reg.AS&&6I0We_SSICTExp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. «A O - &.nf Fire District
Legal Description 3 B
Site Address (Please include street name, street number and city)
Directions to site O Rz. 1.5 C94 5 _
QZ7 17^to d f' RLG uAr 1 "- S
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New w 'Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floor ^2nd Floor Basement �' Garage. Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC Natural Gad_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace 1
Bath Tubs Heatpumps
Showers I Spot Vent Fan f
Water Heater Propane Tank 1
Clothes Washer I Gas Outlets
Kithen Sinks I Wood/Gas/Pellet Stove__
Dishwasher 1 Kitchen Exhaust Hood T—
Hosebibs Dryer Vent 1
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUIDB3 Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.1 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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. / 3Lao
--X Date:T '
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by' Planning Pd Ck# Date - Q Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grou-p—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
MASON COUNTY PERMIT NO.
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 INFORMATINIJSJ/J
/ CONTRACTOR INFORMATION
Owner 57-P-a /a U-,LPU(V'- 504. Company Name `�-,U ,.t L ,'� Cr; SILA►Z
Mailing Address T— KAnilinn Addres
City State Zip Code City � i7State �' ip Code
Phone Other Ph. Phone— �� Other Ph.
a Lien/Title Holder Contractor Reg.# " D� ��'�K
� ExPS
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. I? v o-'3 Fire District
Legal Description 1-r1t-- 3 PC rir- - 30`i- _ -
Site Address (Please include street name, street number and city) ?0xx IY11 2 u•'t'V4 Y'
Directions to site WEft 0�C -- i w .a cat��ic� 2D, `t-0 r='�D, k-l. ifr Ok
TU f-^4 k a F P4V 0;n4 r.-,r4 i '5 r P -iZ t G tic r- 1 -Q77 41.
Is property within 200'of Saltwater Lake River/Creek Pond
li Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New ' Add Alt Repair Other Use of BuildingSt9 +ac�
Location of Fixtures/Units - 1st Floor !n'2nd Floor Basement ►/� Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS ��//''
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LP(oNatural Gas` Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnacec&c - 1
2. Heat pumps
um
Bath Tubs P P
Showers I Spot Vent Fan �f
Water Heater ___I Propane Tank 1
Clothes Washer I Gas O
Kithen Sinks I W /Ga iPelletStove I
Dishwasher I Kitc en Pellet
Hood I
Hosebibs � Drye ent I
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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 parry 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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:_�I�A)•�".
Owner/Owners Representative/Contractor (indicate which one)
I
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: tanning Pd Ck# Date)1-13 -0-1 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
TOTAL FEES
Violation Fee
MASON COUNTY PERMIT NO.
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 INFORMATION
Owner 57- yr 1,..� t`I`,) /l` c - `:,. t r2 Company Name IrZ:.i t ;r(aw:`Ct: ':::�z1LAiL
Mailing Address Mailing Addres
} "_ C I'. State �'� i Code
City state Zip Code City p
Phone Other Ph. Phone 17 �>' I Other Ph.
Lien/Title Holder Contractor Reg.# ^I `�K Exp. C49—
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. I > - i c3 Fire District
Legal Description _ It +' %
Site Address (Please include street name, street number and city) xk 5tl+a,,ai �a17
Directions to site 1-0f ';i 11 V' r�4- 0 t"".,4 F'd 1*. 3Z.3�. �(1 BN B. E+ NY--T C:A!
4 , Tc: t ni. ` l�✓►c r1rt f'nJ( r-73k 14 )
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New 0004Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floor "f2nd Floor Basement ✓'r Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPC Natural Gas_ Heat Pump_
Toilets z Type of Unit No. of Units Fees
Bathroom Sink :5 Furnace I
Bath Tubs -2. Heatpumps
Showers I Spot Vent Fan -�
Water Heater Propane Tank I
Clothes Washer Gas Outlets
Kithen Sinks I Wood/Gas/PelletStove !
Dishwasher t Kitchen Exhaust Hood i
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. r
X Dater/ `' -
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by:aL lanning Pd Ck# Date III- 13 -0-1 Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grou T e 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
�f
Violation fee 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)427-960•Belb7hewea ww0275-4467•Elma(360)482-5269
comason.wa.us
APPLICANT INFORMAT N CONTRACTOR INFORMATION
Owner 5g7ld�y 1J A Company Name lc_ �6batwg
Mailing Address Mailin Add 1 L12, 11w
City State Zip Code City +ate-1 _ Zip bode 50."
Phone Other Ph, Phone— Other Ph.
Lien/Title Holder Contractor Reg. Exp.S —
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. «A O - - 3 Fire District
Legal Description Z_� 3 __V49nr-- I>L4 -- 23sy
Site Address (Please include street name, street number and city) X>cx' SU*,& 0J4
Directions to site U✓ "'m4 -hu291912a SE&
jf.g= 2.D. N-0 W40. Lff4 = 6Ai S
Atn%^1 ux-- 1 •WC 4K
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- 1st Floor ' ::�:12nd Floor. Basement ✓` Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPQ_ Natural Gas_ Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace 1
Bath Tubs Heatpumps
Showers 1 Spot Vent Fan 'f
Water Heater Propane Tank t
Clothes Washer I Gas Outlets
Kithen Sinks I Wood/Gas/Pellet Stove
Dishwasher I Kitchen Exhaust Hood
Hosebibs _2._ Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OMVER/BULDER 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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Lao
IL
X .J— - Dater3
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted byat,
lanning Pd Ck# Date -13 •0 Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grour)_Tvoe 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 or Plumber License Detail Page 1 of 2
Topic Index Contact Info
Claims 8k In'suranc�r itarkpiace lint Ira Licng
Find a Law or Rule Get a Form or Publication
............................................ ..............................................................
Look Up a Contractor, Electrician or Plumber
Printer Friendly Version
....................................................................................................................
GeneraVSpecialty 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.
.................
.........................................................................................................................................................
License Information
License SUNDAS19551(4
Licensee Name SUNDANCE SOLAR INC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602501577 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type CORPORATION
Address 1 3301 W HWY 16
Address 2
City PORT ORCHARD
County KITSAP
State WA
Zip 98367
Phone 3603731974
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 5/24/2005
Expiration Date 5/24/2009
Suspend Date
Separation Date
Parent Company
i
Previous License SUNDAS*066MG
Next License
Associated
License
.....................................................................................................................................................
.....
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=SUNDASI955K4 6/4/2008
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
November 19, 2007 PO BOX 1666 Shelton WA98584
Shelton (360)427-9670
Fax (360)427-8442
STEVE PAYSON Elma (360)482-5269
3301 W STATE ROUTE 16
PORT ORCHARD WA 98367 Belfair (360)275-4467
Case No.: BLD2007-01934 Parcel No.: 122307590034
Dear Applicant:
Your building permit cannot be approved by Mason County Environmental Health until
the following are completed and turned in:
In 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: NEED TWO PARTY WELL APPROVAL
11/19/2007 1 of 1 BLD2007-01934
B
�N.SrA MASON COUNTY
o Py A o c N DEPARTMENT OF COMMUNITY DEVELOPMENT
o N Z Planning Division
Zj lY y y P O Box 279, Shelton,WA 98584
7864 (360)427-9670
REQUEST FOR ADDITIONAL INFORMATION
February 05, 2008
STEVE PAYSON
3301 W STATE ROUTE 16
PORT ORCHARD WA 98367
Parcel No.: 122307590034
Project Description: NEW SFR
Dear Applicant:
You have submitted a permit application (case no. BLD2007-01934)for proposed
construction or development in the county. Upon review of your application, I require
additional information to complete the permit review process.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 363 if you have questions.
Sincerely,
rep
Kell=cAboy
Land Use Planner
Mason County Planning Department
2/5/2008 Page 1 of 2 BLD2007-01934
REQUEST FOR ADDITIONAL INFORMATION
2/5/2008 Case No.: BLD2007-01934
Comments: Your geotechnical report has been sent to and reviewed by Donald
Balmer, L.G. and James Harding, E.I.T. of Alkai Consultans, LLC.
According to the enclosed memorandum from Alkai, your geotechnical
report requires additional information to meet the requirements of the
Ordinance. These issues must be addressed before a building permit
can be approved.
cc. Curtis D. Cushman, Geotechnical Testing Laboratory
i
i
1
I
i
i
i
9
p
2/5/2008 Page 2 of 2 BLD2007-01934
THIS PARCEL
INCLUDES
PLANS, BLUEPRINTS
OR OVERSIZE
IMAGES
LARGE FORMAT
IMAGES HAVE BEEN STORED IN
FILE CABINETS) UNDER
PARCEL NUMBER
PARCEL # iz2- 30 - vs - q osV
CASE # /3 LD Z6D7 - O/g3y
�T .0 517-t- 1064Al
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 .D—Ag co- Date 1(Z7 O�
Mailing Address 3301 W. Pwy I(o Telephone 3CM0`3"23— IT?`f
Assessor's Parcel Number a;��
Type of Water System (Check One): Reason for Application (Check One):
❑ P , / unity water system(2 or ®w ' permit
eore connections ;New
ivate wo-P LiReplace Existing Structure
❑ e connection) ❑ Land use application,if so...
❑ Well ❑ Division of land
❑ Spring/surface water #of parcels?
❑ Other(explain) SPH2 -
❑ Boundary line adjustment
❑ Other(explain)
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated for adequacy:
Public Water System/Private Two-Party
Name of Water System .k _ Wg 1 '411
Water Facility Inventory()ATI)Number(enter"none"for Two-Party):
O The water purveyor has filed a letter granting blanket hookups to this water system.
❑ I am the manager of this water system. The water system has been approved for o _ services. There are
presently connections inuse. This will be the connection. Tl is water system is able and
willing to prove a water to this(these)connections without excee g the limits of the water system or any limits
set by state and local regulation.
Signature of Water System Manager -- �� Date
H:I WELL IWATERADI WP.DOC Update:March 22,1999
/ Individual Water Well
[fit Water well report(attach to application) Depth ft.
❑ Well capacity test(attach to application) gpm gpd
e we driller often performs well capacity tests at t e time the well is constructed. Test 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 drawdown and recovery data, must be
—/ er ormed b a licensed contractor.
L�' Satisfactory bacteriological test(attach to application)
Individual Spring/Surface Water
❑ WDOE WR permit(attach to application)
❑ Method of Disinfection
❑ I have reason to 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 this line.
PART 3: Health Department Ev at on (staff use only)
O SATISFACTORY DETER,A'ONATION: 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 inde,fnitely into the future, or guarantee compliance with
all applicable WDOE water resour0d regulations.
O 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
HJWELLIWATERAD3.WP.D0C Update:March 22,1999
Mason County Planning Intake Checklist
Owners Name: So r, ,4 h �n� I ,A Date:
Project: S Reviewed By: e n LLI
Commercial Developme • YES CNO Comments:
PLANNER: GBM TSC CMMBC RDH REC
Site Plan:
North Arrow
,de Property Dimensions: 18 7 X Ic ,
Streets and Driveways Shown. Road name: rim
tructures shown with setbacks
Well oca 'on, ptic and Drain-field Shown with setbacks
dents rface water (streams, ponds, shoreline, wetlands, n tural or historic drainage,
defined draina a P,a� 6n-4i['5 Pa.n
,eK Topography (slopes) o5-I o aeS
lid Proposed Structure Set acks (Direction/Setback):
F: a8 R: 327 / 1: ,�/ n S2: '70
Utility and Drainage Easements: Yes No (if yes enter condition #5022)
Other Easements
Accessory Appurtenances. Propa / +i
c' Does site plan show landing exits?
o Variance applied for: Yes No - parking spaces al teed. Yes / No
o County Access Permit Needed a d condition #0010)
o State Access Permit Needed (add condition #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?
rVIN
Is the site clearly marked? How? Address A+"briVe u_) y
❑ Name
Critical Areas: ❑ Other:
Setbacks: Shoreline: Slope:
Shoreline Designation: Comprehensive Plan: "I Zoning-
Not Applicable ❑ Agricultural / ] RR 2. 10 20
❑ Urban ❑ In-holding ❑ RMF
:5)
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ Conservancy IP5,Rural ❑ RI
❑ Natural ❑ RAC ❑ RNR
❑ Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban Growth Area ❑ MPR
El Unknown ❑ Unknown
Water Body (typ if unnamed):
SEPA: Yes/ N nknown Flood Plain: YES 0 Unknown Map#
Aquifer Recharge: YES/ Unknown ap#
Tags/Cases:
RLC/SPI Case: no 6-Year Dev. Moratorium: YE
Eagle Nest Tag: YES/ 0 Other YE NO
Revised: 07-10-2007