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BLD2007-02009 Cancelled SFR Replacement - BLD Permit / Conditions - 12/7/2007
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CD CD = O Err C 77 cr CD a o o < Q O O (Dc 7 CD "C-6, a 7 O (D Q O o_ 0) (D (D (D - cn -0 (cn 3 3 -u v C (D - (D Lylo 0 w N S O a) O 0n =� Ep O O N O a m CD (D O< N O v O o' o is p' o cn April 4, 2008 Mason County Building Department Attn: Mark Core Due to a change in plans we will no longer be needing the building permit for the following address: A. 30 Santa Maria, Belfair, Washington We would like to cancel the permit. Roger Thomas May 1 , 2008 This permit was cancelled. Should applicant change his/her mind, construction plans are located bottom drawer of case management for one year. If, after one year from this date, applicant has not paid for re-instating this permit said plans will be disposed of. 044/28/2008) Charell Holcomb- Permit Letter Page 1 From: Roger Thomas<rogerthomas49@hotmail.com> To: <cmh c@co.mason.wa.us> Date: 4/28/2008 9:31 AM Subject: Permit Letter Attachments: PERMIT LETTER.doc Here you go. Thanks. Back to work after baby—how do you know when you're ready? http://lifestyle.msn.com/familyandparenting/articieNW.aspx?cp-documentid=5797498&ocid=TO67MSN40 A0701A cmh@co.mason.wa.us April 4, 2068 Mason County Building Department Attn: Mark Core Due to a change in our plans we would like to cancel the building permit we have for the following address: 30 Santa Maria, Belfair. Case#: Bld2007O2009 If you have questions feel free to contact me at your convenience. Roger Thomas 1-360-275-3690 1-360-551-2757 1 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 web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner R o6EA '?211crI I A S Company Name- 1- �'�`�®fi e�'►f_S' Mailing Address & r I Mg 4",a-V S I_ V ri Mailing Address�0%3 Z 'O 4 Sri t City-,6.0-; Zip Code mad".9 City �;�% State-VA Zip Code 5 U3 QE Phone 124A -r-Tf X 1:7 Other Ph. Phone?-!!L_3 aO_s &9 4 Other Ph. Lien/Title Holder Contractor Reg.4 AaA Q f£U'I i!-1;. 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. 42-5310 5'� nnn 12 Fire District Legal Description S FpRD.5 COVE 37 r V' 4 " iR Site Address (Please include street name, street; number and city) :36 ,N E 5ANi et /Irlaa rA LAr ,,LasSL r./A Directions to site 426-4 <►pit- Lam_, Fw y� Rrc0—e,N�s bra .�s�/TsiGT y.i,�j a,tanl z- eAz Is property within 200'of Saltwater AIA—Lake -River/Creek ti'o' Pond ;✓0 Wetland r✓'L Seasonal Runoff__6Zo___Stream ,AtjA Slopes or Bluffs > 15% 4ja TYPE OF JOB - New Add Alt Repair Other Use of Building S IQ Location of Fixtures/Units - 1 st Floors 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric X LPQ_ Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace f Bath Tubs 2 Heatpumps Showers Spot Vent Fan / Water Heater j Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood F Hosebibs z 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. X 11 22 d .2S -3 --732�- !97 /t Date: /;Z - Z O7 Owner/Owner epr n a iv /Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Ins ection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO� -�����<� PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.U. Box 186, Shelton, WA98584 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 &aGEl2 Company Name 43F4�gA wga D l-laM"F S LI=C Mailing Address 4 // et/f LARS'64Z Jatyn Mailing Address`Vox Lu.//dam_ AD E Sv.ir 41- City a;EZFt,(?—State h/A Zip Code Iaf.0 — City State _w A Zip Code Phone 366•-S _/-.27.f`�!.OtherPh. Phone QC:3 .zo,�- QjUX - Other Ph. Lien/Title Holder Contractor Reg. #13 Ae 9W Kkp. E mail address E Mail Address Drivers Lic. # DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System N Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATI N - 12 Digit Parcel No. _ b _5'_1 000 ,rg Fire District Legal Description BIEAMI ,121,V L_. L_'C4, f A Site Address (Please include street name, street number and city) �SG .1✓E S`,q �q �/�4 fin/ 14,6 LFAr rl Directions to site o�t4&', G o.v LAtz s 01V R jyyox ''v Will timber be cut and sold in parcel prepp-a- ration. Yes/ Is property within 200' of Saltwater �Lake .9,0 River/Creek Pond IV�a Wetland�_Seasonal R u noff_�Stream v 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 _Add Alt Repair Other. PRIMARY F3ESIJDENCE 5d SEASONAL ❑ Use of Building .SCR Describe Work- E J ue_ _r c _ 4YlF-t_+ No. of Bedrooms No. of Bathrooms— Q - Square Footage- 1st Floor nd Floor 3rd Floor Basement Deck— Covered Deck _-Other Sq. ft. Garage_ Attached X 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 ' �T� CeAification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature bow.*1 ceCy�t�fat I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and t do e VP 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 olR ►q�1( glctpissry{r�t1Qjfl �(n to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents th�af 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 INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. x I C#4 G 6/1/ Date: 7 C7 7 Owner wners Representative Contractor (indicate ftich one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 r'" Shelton (360) 427-9670 • Belfair (3M) 275-4467 • Elma (360) 482-5269, G� On the web www.co.mason.wa.us APPLICANT INFORMATIO* CONTRACTOR INFORMATIOff Owner U - `a.. Company Name } Mailing Address • 717-11—= rd Mailing Address ; D �`- city a' State Q Zip Code City State Zip Code , Phone fi. 'w �.' tr Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. #: ` Sxp. E mail address E Mail Address Drivers Lic. # DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic '4 Connect to Water System L Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. L11 Fire District Legal Description '` ` Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes Is property within 200' of Saltwater Lake River/Creek Pond Wetland x�, Seasonal Runoff i,� Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New `�;` Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms mow;,. Square Footage- 1st F ` 2nd Floor 3rd Floor Basement Deck Covered Deck 4 �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 l 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 INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Lz, Date: Owner k owners Representative J Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NO ES Building Department Vv 1AL, n 0 — ° Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee 7 Site Inspection Plan Review Fee 19 EH Review Fee Plumbing & Base Fee '= p 9 Planning Review Fee Mechanical & Base fee 3o pO Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES Valuation $ 7S 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) 482-52690 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name A i�, Q Mailing Address Mailing City r' ' , State ��fA ZipCode City State. Laeli ZipCode '7911 � j Phone 116 Q- S1 I f ; Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. #f-3f, E mail address E Mail Address Drivers Lic.# DOB Drivers Lic. # -DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic— Existing Septic Connect to Water System 2S Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATIPN - 12 Digit Parcel No. '_,�2; ' /9 Fire District Legal Description-,`- V Site Address (Please include street name, street number and city) Directions to site t A iZ /j Z 2 1,vh Z - L",P-l" "v A/�Z Will timber be cut and sold in parcel preparation?Yes Is property within 200' of Saltwater Lake River/Creek Pond Wetland_4y _Seasonal Runoff t 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 Add Alt Repair Other PRIMARY RESIDENCE Q SEASONAL ❑ Use of Building ------Describe Work No. of Bedrooms No. of Bathrooms oil- Square Footage- 1st Floor 2nd Floor 3rd Floor Basement—Deck--Covered Deck i 14 L- Other —Sq. ft. Garage-j,_,' Attached Detached Carport— Attached Detached MANUFACTURED HOME INFORMATION - MakeI T 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 informaticin 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 OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner Owners_Representative)Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee I State Fee I ,Violation Fee Pre-Paid at Submittal lValuation $ TOTAL FEES I MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 21 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Pxp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or 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 Add Alt Repair Other PRIMARY RESIDENCE [j SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck_ Covered Deck 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 INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: Owner l Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES FORM MUST BE COMPLETED IN INK I 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 web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 96C>eg •7'-11ely1AS Company Name y'�`®®te as''►FS Mailing Address (s t I .;c_ I—&a.SAA/ 13 L V n Mailing Address 64�3'7 Aez,?,0A1 AZO 4 City-A-IF I rat,, State Zip Code� — City State Al,"— Zip Code 4�t �t -""� Phone -` 4A �rsZ _27� Other Ph. Phone Z.S73 20•; VS4 Other Ph. Lien/Title Holder Contractor Reg.# St=-A Mf -15i 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. 49,536 5;3 nnQ/g Fire District Legal Description B EA92 S COVE 32 r v* 4 L.c T f.4 Site Address (Please include street name, street number and city) ; N �Ai+TeE �YlAR�A Lqr F/l=�tr WA Directions to site 4 A11-1� LEFT .9-T S�Fa.4 Rrct~Te,N � .�i/T�G7 a �� r Is property within 200'of Saltwater ate— w take n River/Creek ti'o' Pond _✓0 Wetland 6'L Seasonal Runoff__L0___Stream ,AjA Slopes or Bluffs > 15% ,4J41 TYPE OF JOB - New Add Alt Repair Other Use of Building _!CF4 Location of Fixtures/Units- 1 st Floors_ 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC-L-- Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink — Furnace f Bath Tubs 2 Heatpumps Showers Spot Vent Fan ! Water Heater j Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood F 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 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� � �2 5-.3 _-Z32�- !9'2 / Date: /oZ =7 "" 07 Owner/Owner epr n a w /Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES Mason County Planning Intake Checklist Owners Name: Date: Project: s Reviewed By: Commercial Development: YES NO Comments: PLANNER` GBM TSC CMM PBC RDH REC Site Plan: p North Arrow p Property Dimensions: X p-, Streets and Driveways Shown. Road name: - � t , ! f o AWEAsting Structures shown with setbacks o -WeH-Location, Septic and Drain-field Shown with setbacks identify all surface water (streams, ponds, shoreline, wetlands, natural or historic drainage, defined drainage ditches) i\ �- u Topography (slopes) Proposed Structure Setbacks (Direction/Rtback): l l F: _/ 1 R: =L S1: J _ S2: / p Utility and Drainage Easements: Yes No (if yes enter condition #5022) 14 'Other Easements + 'Accessory Appurtenances: Propane / Heatpump { uz Does site plan show landings at all exits? -' La, Variance applied for:; Yes / No - parking spaces allotted? 'Yes / No -e—County Access Permit wed (add condition #0010)_t k'( 11 jo '� -L(t_I —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? Is the site clearly marked? How? 1 - Address ❑ Name Critical Areas: ❑ Other: Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: ❑ Not Applicable ❑ Agricultural -0 RR 2.5 (`5 ,10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy Q Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknow{i, , ❑ Unknown Water Body (type of water if unnamed): SEPA: Yes/("No Unknown Flood Plain: YES/NO (Unknown Map# Aquifer Recharge: YES/NO, Unknown Map# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES/NO Eagle Nest Tag: YES/NO Other YES/NO Revised: 07-10-2007 MASON COUNTY DEPARTMENT OF HEALTH SERVICES December 18, 2007 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 ROGER THOMAS Elma (360)482-5269 611 NE LARSON BLVD BELFAIR WA 98528 Belfair (360)275-4467 Case No.: BLD2007-02009 Parcel No.: 123305300018 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Report within the last three years from either a septic tank pumper or an Operation and Maintenance Specialist. 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: 12/18/2007 1 of 1 BLD2007-02009 Naive Parcel# %z J 36 T 3 a e6 f e 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' iCLt #E [##... tlS''. ff1f `$5: 1 E3$S+B. ..DUX) ./l'# 6lf�['�::.—" bEi$ Surface Type Length X Width = Area *All dimensions in feet Buildings 4i X :�-A 6,AteAGtF X ) - C Measurements for buildings are taken at the X - perimeter of the farthest projections (example: eaves/gutters) X = Driveways X = :2 X Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition X - above table Patios/Walks 14 X Z© _ go X = Any paved, gravel or packed area per definition X - above table Others X = X = :If. Ilibidt rnper,rlr €.t> e.:p , poe[l X + Itlxxtet�t gtat #hen�l#Jlaclua ft:>a..:.. i ri�ill:P :..;:. :. :::. .:.:<:.;; r�:81.`.�tt#1t €8#.5rt ..P1t3n..�s.R . :urd....... 1 .... ....::......................................:........:::..:. .:.::::;:.;. i:;.;.::::::::. rn. er�ri u : u fu.rr3.< .ill.; . ....>:::::: :.: :::::::::::::::::..:................. ......................:...reps.::::: 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 X. ` � Owner�ontractor(circle one)Date: / 2- ;7 d 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. Page 1 of 2 1 ,l Flame �/�'�C� /41r l�S Parcel# /.7 33a$7;3 pio gQ 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: httpHwww.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" 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 `�Y_ Owner/Agent/Contractor(circle one)Date: / Page 2 of 2 �- �i�2 c�L ► a 3 3 0,S3 Duo /8 ' S 7 /66 S /7- Lrs7 Loc���U .�1� � C3 N� SF�ti"7A /�'l�Ief� L�i✓� �,,v 3�L ���� w� • %G )(,51S T1414 .4-70i3i �F -Mov S 14AID S r'�i�s Ac 341 �20 r � ,iyo RTC, a i f r 70 F 3 � a ' MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health - "u Persona!Health A C E M F7Nrr ® P' /'J de. Le7 PO BOX 1666 SHELTON, WA 98584 11—T— ��%/� LOCAL(360)427-9670 (360)275-4467 Application for Determination of Adequacy BEL AIR FAX(360)427 7798 Instructions L,31' ' pPart (..:too ci0M.- i atlon can.be made unftlFart i:is fuiCv:cQmwlet Corrap[eteonly the p©rtio # plying tca the ryefwater system utiiied. 11h-nit completed p teatrori, y(:Eh,altachmoh s;to tl�h,-gltli departmen#for review. PART 1: Applicant/Parcel Identification Name of Applicant AeG eg s-, Date /-2 _7 -D `7 Mailing Address_4/1 ivF Zt)t{ dN BLVP $ir-� le ephone �,%,�1� 5�/�,7�5 7 Assessor's Parcel Number 1.;.3 6 S c cc$r T e of Water System Check One : Reason for Application Check One): Public/Community Water System(2 or more Building permit connections)— ❑ Land use application, if so.. ❑ Individual water source(one connection), ❑ Division of land: if so.. 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 �"'�� �`''� �'O- ���' � '%%�' viii L?mil 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 I connection(s)in use.This will be the I 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 dine the nature of this change: This water system is able and willing to provide water to this(these)connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date Update:April 2006 Individual Water Well Water well report(attach to application)Depth ft. Well capacity test(attach to application) gpm gpd The well driller often performs well capacity tests at the time the well is construoted.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 bythe applicant orif the water well report does not have a capacity test,a well capacity test, which provides stabilization ofdraw-down and recoverydata,must be erformed b a licensed contractor. Satisfactory bacteriological test(attach to application) Individual S rin /Surface Water WDOE permit (attach to application) Method of disinfection ❑ 1 have reason to believe 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. ��R ' I;e �ta Detmerat E1�3p # f( OrI S-AT S�AQ`T1SiF�Y DET� 140.A q` k ltr nt`s vo ter s tep#,y appears ad t taa �t me #tab r�eed&bf Its iratetided � Thrsclet+rrn7nafrQn d©e nl ar r de ua ofth Wstributibn y t in t ara fe an �dagae strppl of watr�Iir /y rat the future, or gtrarntee ©ripfrnce wlthl1 applicable W1�bE vt�a# I ` crce reg� iattc# s. Ui`I 4TiSEACTORY DE TIC(�11rI1I41AT f� �ppllcanVs watef st pt iy does h' t pea ddeuate#o meetthe needy ref is trf�et�ded use for the follovvtnO reasflisj:, p REVIEWER'S StG;NATURE DATE Update:April 2006