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BLD2009-00364 Final Demo MFG Home - BLD Permit / Conditions - 2/3/2010
Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton,WA 98584 RESIDENTIAL BUILDING PERMIT BLD2009-00364 OWNER: DEBRA GAU RECEIVED: 5/11/2009 CONTRACTOR: COOK CONSTRUCTION INC. LICENSE: EXP: ISSUED: 11/6/2009 SITE ADDRESS: 16550 E STATE ROUTE 3 ALLYN EXPIRES: 5/6/2010 PARCEL NUMBER: 122311100050 LEGAL DESCRIPTION: TR 5 OF NE NE PROJECT DESCRIPTION: DIRECTIONS TO SITE: Demo of MFG Home replacing with Stick Built State Route 3, to site address on the right side,just this side of Allyn General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: V-B Type of Use: SF Insp.Area: No.of Bathrooms: 3 Occ. Group: R-3, U-1 Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:2,864 Garage-Attached 430 Valuation: Building Height: Occ. Status: Primary Basement: cov deck 274 Manufactured Home Information Setback Information Shoreline&Planning Information : y Make: Length: Ft. Front: W 96.0 Ft. Shoreline: Ft. Water Body: No Model: Width: Ft. Rear: E 91.0 Ft. Slope: Ft. Shoreline Desi Side 1: N 96.0 Ft. 9.: Not Applicable Year: Serial No.: Side 2: S 133.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee GMM 5/11/2009 $1,373.94 S12009000 Hosebibs 3 Furnace<100K 1 Plan Check Fee GMM 5/11/2009 $1,373.94 612009000 Hosebibs 1 Ventilation Fan 4 Planning Review Fee GMM 5/11/2009 $205.00 S12009000 Kitchen Sink 1 Woodstove 1 EH Plan Review GMM 5/11/2009 $41.00 S12009000 Lavatories 4 Heat Pump 1 Water Adequacy Plan Review GMM 5/11/2009 $41.00 S12009000 Lavatories 1 Dryer Vent 1 EH Plan Review ADR 5/19/2009 $62.00 612009000 Showers 1 Building State Fee RTB 5/20/2009 $4.50 612009000 Showers 1 Building Permit Fee RTB 5/20/2009 $2,113.75 B12009000 Water Closets (Toilets) 3 Mechanical Permit Fee RTB 5/20/2009 $167.70 B12009000 Water Closets (Toilets) 1 Mechanical Base Fee RTB 5/20/2009 $28.50 al2bbkbo Plumbing Permit Fee RTB 5/20/2009 $128.00 612009000 Water Heaters 1 Plumbing Base Fee RTB 5/20/2009 $24.70 612009000 Water Heaters 1 Mechanical Base Fee GMM 11/6/2009 $12.40 S12009000 Mechanical Permit Fee GMM 11/6/2009 $43.50 S12009000 Total $5,619.93 BLD2009-00364 Please refer to the following pages for conditions of this permit. 1 of 5 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line i e s60)ext7352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 lip,$ Shelton,WA 98584 RESIDENTIAL BUILDING PERMIT OWNER: DEBRA GAU B1 2009-00364 CONTRACTOR: COOK CONSTRUCTION INC. LICENSE: EXP: RECEIVED: 5/11/2009 SITE ADDRESS: 16550 E STATE ROUTE 3 ALLYN ISSUED: 6/4/2009 PARCEL NUMBER: 122311100050 EXPIRES: 12/4/2009 LEGAL DESCRIPTION: TR 5 OF NE NE PROJECT DESCRIPTION: DIRECTIONS TO SITE: Demo of MFG Home replacing with Stick Built State Route 3, to site address on the right side,just this side of Allyn General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: V-B Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R-3, U-1 Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:2,864 Garage-Attached 430 Valuation: Building Height: Occ. Status: Prima Basement: cov deck 274 Manufactured Home Information Setback Information Shoreline & Planning Information Make: Length: Ft. Front: W 96.0 Ft. Shoreline: Ft. Water Body: Rear: E 91.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 96.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: S 133.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee GMM 5/11/2009 $1,373.94 S12009000 Hosebibs 3 Furnace<100K 1 Plan Check Fee GMM 5/11/2009 $1,373.94 612009000 Kitchen Sink 1 Ventilation Fan 4 Planning Review Fee GMM 5/11/2009 $205.00 S12009000 Lavatories 4 Woodstove 1 EH Plan Review GMM 5/11/2009 $41.00 S12009000 Showers 1 Heat Pump 1 Water Adequacy Plan Review GMM 5/11/2009 $41.00 S12009000 Water Closets (Toilets) 3 Dryer Vent 1 EH Plan Review ADR 5/19/2009 $62.00 612009000 Water Heaters 1 Building State Fee RTB 5/20/2009 $4.50 B12009000 Bath Tubs 2 Building Permit Fee RTB 5/20/2009 $2,113.75 B12009000 Clothes Washer 1 Mechanical Permit Fee RTB 5/20/2009 $167.70 B12009000 Mechanical Base Fee RTB 5/20/2009 $28.50 812009000 Plumbing Permit Fee RTB 5/20/2009 $128.00 612009000 Plumbing Base Fee RTB 5/20/2009 $24.70 612009000 Total $5,564.03 BLD2009-00364 Please referto the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD2009-00364 s CONDITIONS FOR BLD2009-00364 1) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations. B. Septic tank(s) requires 5ft setback from all footing/foundations. C. No foIT- 2) on drains within 30ft, down gradient of drainfield/reserve area. X_All other necessary permits from Mason County, Washington State and/or Federal Agencies that ar uired for this proposed development and construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X 3) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department p �t X_ o any further inspections being performed or approvals granted. '�� Q 4) Owner/Agresponsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 70, 5) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of a=oved documents will result in failure of required building inspections. X-���tiy/` 6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X ( � 7) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building DeparIV r to any further inspections being performed or approvals granted. X BLD2009-00364 Please referto the following pages for conditions of this permit. 2 of 5 8) Washington State Energy Code Compliance has been approved using the following: Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab Insulation R-10. Exception: R-30 insulation may be installed up q f. to 500 s . t , in single rafter or Joist vaulted ceilings where the distance of the top of the ceiling and the underside of sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation. X L 9) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. *NOTE if Stormwater Management option"A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to cons with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is ack� w that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 10) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work e sed to the weather shall have a minimum compressive strength of 3000 psi (I RC Table R402.2). X 11) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If docume s are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and sh�fr Collected by the Building Department prior to any further inspections being performed or approvals granted. X 12) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washi> ccu ancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocatio X 13) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be to ' in 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. X BLD2009-00364 Please referto the following pages for conditions of this permit. 3 of 5 14) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or r ti rl,�rnust be reviewed and approved by Mason County prior to construction. 15) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building IInspectorshall b prior to requesting additional inspections. 16) All property lines shall be clearly identified at the time of foundation inspection. X _ ( 222 17) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason Count rd�irya ces X and building regulations. ( �,t- V 18) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a riod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder hate v ; action from being taken. No more than one extension may be granted. X 19) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment.All applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the registered design professional responsible for the report/assessment, and may require special inspection by same. Structures and/or land modifications (gradi ts, fills, etc.) required in the geotechnical report/assessment, may require a separate permit. The geotechnical report/assessment shall rema n at the approved building plans. X 20) Pressure wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, conne for an hing. Install metal connectors approved for contact with the new types of pressure treated material. X 21) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure theses l s meet the setback conditions listed. X 22) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Approvedr�"to ensure these structures are shown and meet the setback conditions listed. X 23) X Water quali ii t to be degraded to the detriment of the aquatic environment as a result of this project. BLD2009-00364 Please referto the following pages for conditions of this permit. 4 of 5 24) Prior to final approval, all upland areas disturbed or ne y by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 25) Temporary erosion control measures must be implemented to prevent water q 99V tion of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. X 26) AID a imensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 27) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. All applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the registered design professional responsible for the report/assessment, and may require special inspection by same. Structures and/or land modifications (grading, cuts fills, etc.) required in the geotechnical report/assessment, may require a separate permit. The geotechnical report/assessment shall remain a the approved building plans. X This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progr ction.The owner or agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described pro rty ands ucture r re - 7and' spection. OWNER OR AGENT: , DATE: BLD2009-00364 Please refer to the following pages for conditions of this permit. 5 of 5 o• r CONCRETE MECHANICAL -eee� �/ MANUFACTURED HOME D O Date Y Z -d B /Footings ISetbacks Gas Piping g CD Ribbons C o Intenor Date By Interior-Date By Date By IT!�/Exterior Date 7j% ! BY/^T/� Exterior-Date By set_up Point Load I Isolated Footings INSULATION Date By Date By BG I SLAB INSULATION - Date By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS FRAMING .Etsac - Walls Date By Date ///2 ,ter By Data I 1 `/- a By l.--) PROPANE TANKS PLUMBING vault Date By Date J/ --2 BY l OTHER Groundwork Attic Date By Date By Type: Date By O.W.V . DRYWALL Type: Date By Int Brace Wall Date By to /� Z �U� Date By FINAL INSPECTION p v Water Line j� Fire Seperatlon C Dale ,p By /1 Date BY Date z -3 By O co tD Pass or Request Inspect. O Type of Insp. 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Ef p 0 CD C > 0 cn n O N � =r m 0 d .�+ (D3 (n y (D m 3 C a) O co Co. < 'a 03 m cn "0 c CL (D 0 O O y :3CDc p O N CL .f N cn a o cnN 0 c (C CD w D y Ncn :3 C N 08 � vw3 0 R. m :' 0 l< y a s m v) Z ' v U)CL D y 'ay a _ r. m n N o c O 3 0 N = =r y m FORM MIDST BE COMPLETED IN INK MASON COUNTY PERMIT NO. `i PLEASE PRESS HARD BUILDING PERMIT APPLICATION 4;a r� 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 r 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 COOK Cw ah -7QO.- Mailing Address a Mailing Address D 30 1 O City State Zip Code Ci EPx State W Zip Code R 383 j Phone -o Other Ph. ----- Phone Other Ph.31ob-Sa4-`fQ Lien/Title Holder b rl� Contractor Reg. aK OXf. Z Exp. o g'2Z-09 E mail address D era U S r►� E Mail Address IrtG- Drivers Lic.# R OB A'd w Drivers Lic.#Ccr in1�.*J q46 PA DOB Wow I SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X Connect to Water System Name of Water System Well._ Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. aZ o Fire District Legal Description R N Site Address(Please include street name, street numper and city) E ,3 1 Directions to site 3 ortth n Ve_ua Will timber be cut and sold in parc6f preparation?Yes o lra,,property within 200'of Saltwater ""' Lake River/Creek Pond Wetland" — Seasonal Runoff Stream ` Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes TYPE OF JOB - NewAdd Alt Repair Other PRIMARY RESIDE CE S SONAL ❑ Ise of Building % escribe Work o w A' F No. of Bedrooms No. of Bathrooms Alba Square Footage- 1st Floo a 2nd Floor Sa 3rd Floor Basement _Deck Covered Deck Other Sq. ft. 0e Garage.�Attached Detached Carport Attached Detached j ANUFACTURED HOME INFORMATION - Make Model Year ngth 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 I 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 M S 0 �OG SS INS ,ECTION.INACT`VITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X °��Yt , �r� Date: �II O ner/ hers Representative/Contracto (indicate which one) FOR OF USE BEYOND THIS POINT Accepted by' DateJ• 0-o l DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee _ 7307 Site Inspection Plan Review Fee 7 - EH Review Fee Plumbing & Base Fee 2 P" 04/ .2 ?D Planning Review Fee Mechanical & Base fee q f- 70 •J'b Other Wood/Gas/ Pellet Stove Fee 3- PO State Fee S� Violation Fee s—� � Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT Na kj o;009 — PLUMBING/MECHANICAL PERMIT APPLICATION ' Ary) 426 W.Cedar- P.O.Box 186, Shelton,WA 98584j-S Shelton (360)427-�670-Belfair(360) 275-4467- Elma(360) 482-5269 n the web www.co.mason.wa.us APPLIC T INFORMATION CONTRACTOR INJFORMATION Owner r 6-&k4 Company Name- Y_ Mailinq Aldres O ;t� Mailing ddre s 0 fl City r I _ O��tate W It Zip Cod Sa City $ O tate Zip Co _ 3 3 3� Phone Other Ph. Phone3&0" 9 $ )q Other Ph VD 601-1g Lien/Title Holder IQ0tne- -- ----- - Contractor Reg.;# -QQ40,:Q 03&►42Ex E mail address b&a-t-I 540 MSS , E Mail Address n Cor►S�R u nC'Cam Drivers Lic.#6ct u 2-$X AD3�-aCSDOB 6 Drivers Lic.#COOK /ZT4'4'6�D DOB I o SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit IPaarcel No. — 1 — Do O Fire District Legal Description Site Address (Please include street name, str et number and city) I loSSO 1 3 n NA qgSaq Directions to site 2A4e3 i Ve Is property within 200'of Saltwater River/Creek Pend Wetland SeasonalRunoff Stream ===::: " Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building�5E EIS Location of Fixtures/Units- 1st Floor_ 2nd Floor Basement__,_---- Garage--)L--Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric� LPC;G/Natural Gasiff Heat Pump-� Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace I Bath Tubs .— Heatpumps Showers I Spot Vent Fan Water Heater I _ Propane Tank Clothes Washer I Gas Outlets Kithen Sinks I Wood/Gas/PelletStoveZ Dishwasher Kitchen Exhaust Hood 1 Hosebibs _ 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. PRQ,OF O C NTINLIAMON QF WORK IS BY M S OF A PROGRESS INSPECTION�I ' �� (�O Pv- Date: w r wners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYON TH S �OINT Accepted b lanning Pd Ck# Date m5 I I d Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e 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 Mason County Planning Intake Checklist Owners ame: Date: 5A I /o R Project: Reviewed By. Proposed use(s) of structure(s) ❑ Commercial Development: YES O PLANNER: GBM TSW PBC RC AHB Site Plan: _,a' North Arrow ❑ Survey required in Al — o AF# ❑ Monuments p., Property Dimensions: 335 X .� Streets and Driveways Shown. Road name: ri -� o �F P�3 g Stru s s wit cks and use :�ra��elLocati n, Se 'c an�fln-fieldts, wn with setbacks s atem , shoreline, wetlands, natural or historic drainage, defined drainage ditches) n" ',1:: Topography(slopes)�opes -6uxc J_4— 2_uXs-� � Minimum Stru re Setbacks(Direction/Setback): F: W/ lqtp R: E J G I Si: ►n /19La S2: Utility and Drainage Easements: Yes No (if yes enter condition #5022) X Other Easements -,-d Accessory Appurtenances: Pe / tpum ,,a- Does site plan show landings�I exit? ❑ Variance applied for: Yes /Mom`parking spaces allotted? Yes No ❑ County Access Permit Needed (add condition #0010) . >( State Access Permit Needed (add condition #0020) EXIST-i n ln u EU.) Standard Conditions to be added to all Building permits that plann ng reviews: #5119 and #0700 Site Access: Are there any impediments (dogs/gates)that my restrict access to your site? no Is the site clearly marked? How? Address f1C.m.#, ed a-+- ❑ Name rLU EW, Zoning: ❑ Other: PI n: R 1 Z UGA Zoning: jr al 0 RR 2. 5 10 20 ❑ RT/RTC 0 R-1 ❑ R-5 ❑ HC ❑ BI ❑ RC ❑ RMF ❑ Unknown ❑ R-1P ❑ R-10 ❑ LTA 0 VC ❑ Allyn UGA ❑ RC 1 2 3 ❑ Agricultural ❑ R iR ❑ PD 0 FR ❑ T ❑ Belfair UGA ❑ RI ❑ In-holding 0 R-2 ❑ PF ❑ MU ❑ MHP 0 Shelton UGA ❑ RNR 0 LTCFL ❑ R-3 ❑ POS ❑ GC 0 BP ❑ Tribal ❑ GC-CI Critical Areas: (streams, ponds, shoreline, wetlands, steep slopes) Shoreline Designation: XN/A ❑ Urban 0 Rural ❑Conservancy ❑ Natural ❑ Unkown Water Body(type of water if unnamed): no SEPA: Yes/ No U 0knon Flood Plain: YES/NO U o Map# Aquifer Recharge: YES/NO U kno n Map# Tags/Cases: RLC(SPI Case: n 0 6-Year Dev. Moratorium: Y Eagle Nest Tag: YES/� Other/North Bay Sewer Y NO Revised 01-13-2009 DEPARTMENT OF LABOR AND INDUSTRIES REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST # EXP. DATE u�. v COOR 'CONSTRUCTION INC PO BOX 3910 SILVERDALE WA 98383---------------- F625-052-000(8L47} i. CHANGE IN STATUS: Incorporated (Effective 01/01/97) CHANGE IN NAME: Cook Construction, Inc. FEDERAL ID#: #91-1762514 U.B.I. #: #601-768-216 EMPLOYMENT SECURITY # 892030-00 5 DEPT. L & I #450, 188-01 WA CORPORATION ACCT #2-554696-1 OFFICERS: Richard J. Cook- President Karla J. Cook-Vice President a s � " OP ID RB DATE(MMroD/1111) ACORD CERTIFICATE OF LIABILITY INSURANCE COOKCO2 09/09/OS PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Edgren Hecker & Lemmon Ins Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 986 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Poulsbo WA 98370 Phone: 360-779-4448 Fax:360-697-4598 INSURERS AFFORDING COVERAGE NAIC4 i INSURED INSURER A: dan.xal Pid.lity Insuranc.co. INSURER B. Cook Construction, Inc. INSURERC: Richard & Karla Cook PO Box 3910 INSURER D: Silverdale WA 98383 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR M/ TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MDD/1'1') LIMBS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY BAG0006099-00 09/05/08 09/05/09 pREMISES(Eeoccurence) $50,000 CLAIMS MADE X❑OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY 7 P1ERO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS - (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E1 DISEASE-EA EMPLOYEE $ It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS RE: Contractors Registration; UBI 601768216 CERTIFICATE HOLDER CANCELLATION DEPTLA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Dept. of Labor and Industries NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Contractor Registration Sect. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT'S OR P.O. Box 44450 Olympia WA 98504-4450 REPRESENTATIVES. 'i A IZE EPRESEI'JT l ACORD 25(2001108) ©ACORD CORPORATION 1988 1 Look Up a Contractor, Electrician, Plumber or Elevator Professional License Detail Page 1 of 3 Information in Spanish I Topic Index I Contact Info I ? ;E Home Safety Claims li Insurance Workplace Rights Trades&Licensing Find a Law(RCW)or Rule(WAC)_ Get a form or publication Return to List > Start a New Search > 4 Printer friendly General/Specialty Contractor A business registered as a construction contractor with I-Ed to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Verify Workers' Comp Premium Status Check for Dept. of Revenue Account Name COOK CONSTRUCTION UBI No. 44 601768216 INC Phone No. (360) 698-8019 Status ACTIVE Address PO BOX 3910 License No. COOKCI*036N2 Suite/Apt. License Type CONSTRUCTION CONTRACTOR City SILVERDALE Effective Date 8/22/1997 State WA Expiration 8/22/2009 Date Zip 98383 Suspend Date Jo County KITSAP Specialty 1 44 GENERAL Business Type Corporation Specialty 2 ._ UNUSED Parent Company 9 Other Associated Licenses License Name Type Specialty Specialty Effective Expiration Sti 1 2 Date Date COOKC**210N2 COOK CONSTRUCTION GENERAL UNUSED 8/22/1979 8/22/1997 ARC CONSTRUCTION CONTRACTOR a Business Owner Information B Hide All https:Hfortress,wa.gov/lni/bbip/Detail,aspx 5/28/2009 JEROLD AXELROD & ASSOCIATES, A.I.A., P.C. 66 Harned Road Commack, NY 11725 ARCHITECTS / PLANNERS TEL: (631) 864-5788 NCARB 8848 NY 8735 W 5276 FAX: (631) 864-3387 CONN 4877 FLA 5106 MD 3896 WWW.PERFECTHOMEPLANS.COM TO Bt KEPT ! MA 6089 KY 4181 AR COPYRIGHT/MODIFICATION LICENSE The bearer of this notification has been provided a set of reproducibles and granted the right to modify the drawings and construct one single residence therefrom, subject to conditions noted in a red stamp on the drawings. Purchaser's Name: bo k Plan #: C q Dear Plan Purchaser: Your order for reproducibles is being fulfilled herewith. These reproducibles may be erased with the use of a white pencil eraser containing pumice such as Eberhard Faber No. 73 machine eraser strips. These drawings are readily reproduced in any blueprint machine or photocopy machine. You will find that the use of an electric machine eraser will make erasing easier. Hand erasing will be somewhat tedious. Since these reproducibles are readily changeable, we cannot assume any liability for changes made on them and have noted as such on the drawings. We offer to make changes and in fact do it on a regular basis for homeowners and builders around the country. If you would like us to quote on the cost for making specific changes please mail or fax your requirements to us;please be as specific as possible. Provide a daytime telephone number and we will call you with a quote. If we provide the changes we can certify the plans. Please be aware that although you have been provided with a reproducible of our design,no relaxation j of out copyright is provided other than the bearer's right to modify the drawings and build a single residence from them. These reproducibles cannot be used for any other purpose without the likelihood of copyright infringement. That includes redrawing or incorporating all or parts of these plans on another design professional's drawings, the resale of these drawings or copies therefrom, or building more than one residence. The 1990 amendments to the Federal copyright laws are very clear and provide for significant statutory damages for willful violation. Your cooperation is appreciated. Name CA u Parcel# / 2 2 3 / i 1 oo o So BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 1 of 2) Per Mason County Code,Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development, or redevelopment', with more than 2,000 square feet of impervious surface 2. 'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. �.t."_ d• Zt 1.�3. , .; � 3t.. �I��a n: Surface Type Length X Width = Area *All dimensions in feet Buildings X Gx i s r,uG = 2 S 8 8 X NIE w E5 = R t ` Measurements for buildings are taken at the X _ perimeter of the farthest projections (example: %fl r�`• 2$ eaves/gutters) X = Driveways X = X = Length of drive begins at the right of way X = Parking Are X = `` X = Any paved, gravel or packed area per definition X — above table Patios/W lkj6& X = X = Any paved, gravel or packed area per definition X _ above table 33 r �' Others X = �y�� � ���'�',�3� �� '�'�'�7 X �. 4 u X = 328 � If the Total Impervious Surface Are s LES AN 2000 Square Feet, se read,acknowledge and sign below. Based Upon the information you have ed a Stormwater Site Plan IS 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 propperty for review and inspection as may be required. �o o Z C o.'t 5,rA crioxr /A.7-C X ,2 _ Owner/Age t/Contractor circle one)Dater If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign the information provided on page 2 of 2. Pagel of 2 P 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/commissioners/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" it 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/AgentAContracto 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 a lication, with attachments to the health de artmentfor review. PART 1: Applicant/Parcel Identification Name of Applicant D-e�M L Date �v o Mailing AddressP0 3a� o�`f a /►4 f 1 n���$� Telephone 3(oo'0 9^0/ 9 Assessor's Parcel Number / as 31 -- 11--000 SO Type of Water System Check One): Reason for Application Check One): ❑ Public/Community Water System(2 or more 0, Building permit connections)** ❑ Land use application, if so.. Individual water source(one connection), ❑ Division of land: if so.. X Well #of Parcels? SPL - ❑ Spring/surface water ❑ Boundary line adjustment ❑ Other(explain) ❑ Other(explain) "* If you have more than one residence ❑ Replacement(please indicate name of water system connected to this well, check the Public box. below if applicable—no signature required) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water System Name of Water System Water Facility Inventory (WFI) Number: (write "none"for two party) ❑ I am the manager of this water system. The water system has been approved for services. . There are presently connections) 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 IAEH FORMSIWATERAD4.DOC Update:April 2006 Individual Waterll Ll We Water well report(attach to application) Depth S�7- � ft. Well capacity test(attach to application) gpm 9, O gpd The well driller often perfor mm well - 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 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 O 1 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 Evaluation (Staff Use Only)' 0 SATISFACTORY[3ETERMINATION: 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 supplytif water indefiriitelyinto"the.future, or',guarantee compliance.with; all applicable:WDOE 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 I.EH FORMSIWATERAD4.DOC Update:April2006 4 L, 27I.74 CPall \ o_ O J T IfNA / 1 m 114, in w -r, n � � ,:•a i � / okA 10, - y M J• AA Iw x M r C-)� 00 � I too 5� 1 0 � car ( E 0-q> ago A) f zrz ve�®> / COmC 'M �C - p c.. 2 2 Q-71- C7 ®®� D 2 to cry x am tea - zo M CA ri �' Z cM > C) � � C I� E ^ - O o Z cc, W W N