HomeMy WebLinkAboutCOM2009-00016 Final Remodel - COM Permit / Conditions - 2/25/2009 0
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CONCRETE MECHANICAL MANUFACTURED HOME 0
co Footings!Setbacks Date
��� Ribbons 0)Gas Piping 00 InteriorO
Date By Interior-Date By Date Fly o Z
E7cter,ot Date>Z-� 8 y �Z Exterior Pate B Set-up
Point load I isolated Footings / INSULATION Date By n
BG I SLAB INSULATION
Date BY Data / L ,L �O By /7, FIRE DEPARTMENT T`
Foundation Walls Floors Date By
Date BY Date By DECKS
F RAM I N6 walls Date By
Date/Z -o7 By Data 7 - —/O By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic
Type:
Date By Dete e �O By bate By
o.w.rV DRYWALL /-/ �/� rye: C)
Int.Brace Wall O
Date /Z_ L By 7 Date t3 Date By ic
y FINAL INSPECTION hi
0
Water Line Fire Separation --, O
Date By Data By Date 2 ^Z<:,::>--/<-:!5 By 111 CU
O
Pass or Request Inspect. o
Type of Insp. Fail Date j Date Done By Comments a,
OA TO Or-lx-42No
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Request To Revise An'Approved Plan
Permit Number: BLD200 ci ......Doo l (o Name �Gc_ �
Parcel Number - 22 o6`5 Phone Number da time 3( 6a ) -7 —7 (c-)
Project Address Mailing Address Po c( 9
Please provide a complete, detailed description of the proposed revisions to the approved plans:
41
Are two sets of the revised plans or addendum indicating the changes included? _ia Yes ❑ No
Are the approved site plans included? 2 Yes ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? �a Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? W Yes ❑ No
If Yes, Has the engineer or architect approved this revision? 0 Yes ❑ No
Is a stamped and signed approval included with this request? p Yes ❑ No
Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? ❑ Yes 0 No
If Yes, Is a revised site plan, with all new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information:
Applicant's signature Date: to Z
Office Use Only Received by:
Date Sent Assigned To Approved 9 BY Date
Original Valuation:
❑ B. inal�b g $
Additional Valuation: $
IEJ P. Sq.Ft. x$ $
Sq.Ft. x$ $
❑ E.H. Total New Valuation $
❑IPW-
Additional Fees:
tttonal Planning Dept. $
d iti al Plan Review $
Additional Conditions/Comments: Additi nal Building Permit $
ional Plumbing $
S ditional Mechanical $
A itional E. H. Dept. $
e $
D otal Amount Due: $
Amount To Be Paid Up-Front$
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO M, LCC` �-
PLEASE PRESS HARD BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 rat_n'
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 U�I�
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATM
Owner _152 Sa va 6d--, Company Name -Ja g�k jih-14 44n j
Mai ' ss Mailing Address D Y L 19 Gd
City 93 h f' State, .Zip 6ode CitA'0 State LA2-A Zip Code
Phone 3d O 73!--7!Q 1 Other Ph.3W Z75- 400 Phone 3_D •-`7-4 Z>/ Other Ph.2 - ��1e�
Lien/Title Holder Contractor Reg. Wlii.4k-7-14 rQ`ZsN / Exp. 010
E mail address E Mail Address iA ^n
Drivers Lic. # DOB Drivers Lic. f 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. VZ Z- ;5 D Fire District
Legal Description
Site Address (Please include street Dame, street number a city) a
Directions to situ
1 �
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
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 BuildingC'o M W f?.c I Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floo 7 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
M EA
OFAPR ESSINSPECTION.INACTIVITYOFTHISPERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION.
X 'o, Date: Z- Z u�_ "a!F2
Owner/ wners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APP V DENIED NOTES
Building Department �I'1
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee 7 . CPO EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other _
Wood /Gas/ Pellet Stove Fee State Fee �� D
Violation Fee C) ��� Pre-Paid at Submittal
Valuation $ 22§g1OCR TOTAL FEES
Jack Johnson Construction, Inc
P.O. Box 1119 Proposal
Belfair, WA 98528
360-275-5400 Office 360-275-6400 lax Date Estimate#
2/23/2009 200929
Name I Address Job Site Address
Sweetwater Creek Properties,LLC 22721 NE State Route 3
P.O. Box 1119 Belfair,WA
Belfair,WA 98528 Parcel t1123325000063
P.O. No. Project
Description Qty Rate Total
REPAIR ROTTED WOOD AT FOUNDATION-BUILDING APPROX 740 SQ FT
Labor 40 40.00 1,600.00T
Materials 300.00 300.00T
Sub-Total 1,900.00
i
Thank you for your business. Subtotal $1,900.00
Proposal is valid for 30 days from the date contained above. Sales Tax (8.4%) $159.60
Contractor's License Number
JACKJC1*182M1 Total $2,059.60
I aged 0E21GLZ09E 9WIlHAHOX3 1141 Wd6S =E 600a SZ qa3
Request To Revise An'Approved Plan
C-Ory) �,,,
Permit Numb . V.
o �(� Nam Q— 030
e _J_0 hA(:�M
Parcel Number Phone Number daytime �)
Project Address Mil' Address
�1 � r�
Please provide a complete, detailed description of the proposed revisions to the approved plans:
I.
n
Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No
Are the approved site plans included? ❑ Yes 11No
Are the revisions clearly and accurately identified on the plans or addendum? X Yes D. No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? ❑ Yes I(Tgo
If Yes, Is a revised site plan,with all new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information:
Applicant's signature M Date: —
Office Use Only Received by:
Date Sent Assigned To Approved By Date
Original Valuation: $
Additional Valuation: $
P Sq.Ft. x$ $
Sq.Ft. x$ $
A D Total New Valuation $
Additional Fees:
Additional Planning Dept. $
Additional Plan Review $
Additional Conditions/Comments: Additional Building Permit $
Additional Plumbing $
Additional Mechanical $
Additional E.H. Dept. $
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
Request To Revise An'Approved Plan
Permit Numb �. �' ' Name__..- 6
Parcel Number -
32" 0004P3 Phone Number da time
Project Address Mailing Address
"3 N .Tpv r
Please provide a complete, detailed description of the proposed revisions to the approved plans:
I.
n
Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No
Are the approved site plans included? ❑ Yes AINo
Are the revisions clearly and accurately identified on the plans or addendum? )§1 Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? ❑ Yes -\-No
If Yes, Is a revised site plan,with all.new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information:
Applicant's signature Date:_Sr —
Office Use Only Received by:
Date Sent Assigned To Approved By Date
Original Valuation: $
Additional Valuation: $
P. _ - Sq.Ft. x$ $
-1 If Sq.Ft. x$ $
E.H. Total New Valuation $
Additional Fees:
6 Ti r Additional Planning Dept. $
Additional Plan Review $
Additional Conditions/Comments: Additional Building Permit $
.Additional Plumbing $
Additional Mechanical $
Additional E.H. Dept. $
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
Request To Revise An'Approved Plan
Permit Numb — ) Name i 6
Parcel Number 1 2332 50 0004r3 Phone Number daytime (__)
Project Address M iling Address
Please provide a complete, detailed description of the proposed revisions to the approved plans:
I.
n
Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No
Are the approved site plans included? ❑ Yes )�(No
Are the revisions clearly and accurately identified on the plans or addendum? )1k Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? ❑ YesTo
If Yes, Is a revised site plan, with all.new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information:
Applicant's signature Date:_ — 00
Office Use Only Received by:
Date Sent Assigned To Approv y Dap 4"Ov W Q
j Original Valuation: $ 4 77 B
9 Additional Valuation: $
p � Sq.Ft. x$ $
Sq.Ft. x$ $
E.H. Total New Valuation $
❑ P.W. Additional Fees:
Additional Planning Dept. $
Additional Plan Review $
Additional Conditions/Comments: Additional Building Permit $ 131. 23
. S 73.0 v .Additional Plumbing A $ 5 0 1,411 .
Ov4 Additional Mechanical $ _ 7t SD
Additional E. H. Dept. $
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
Request To Revise An(Approved Plan
Permit Number: $mQQ J: f Name_ A C._-Z o�l►�1£ l
Parcel Number I Z�332 C� Phone Number da time (__)
Project Address _ Meiling Address
Please provide a complete, detailed description of the proposed revisions to the approved plans:
Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No
Are the approved site plans included? ❑ Yes >irNo
Are the revisions clearly and accurately identified on the plans or addendum? 1k Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record
Does the proposed revision modify the footprint or location of the structure? ❑ Yes o
If Yes, Is a revised site plan,with all new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information:
Applicant's signature Date:_ — (oil
Office Use Only Received by:
jDate Sent HA�ssignedo Approved By DateOriginal Valuation: $
Additional Valuation: $
P.
�� Sq.Ft. x$ $
5 � � '1�C' ��� Sq.Ft. x$ $
E.H. Total New Valuation $
.1-I I
❑ P.W. Additional Fees:
Additional Planning Dept. $
Additional Plan Review $
Additional Conditions/Comments: Additional Building Permit $
.Additional Plumbing $
Additional Mechanical $
Additional E.H. Dept. $
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
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