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COM2008-00149 Final Tenant Improvement - COM Permit / Conditions - 4/20/2009
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NoiQnr'I o'3005-60i 14 PLEASE PRESS HARD BUILDING PERMIT APPLICATION tl'C�C1L 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 IN ORMATION WfoSON INc, Owner d l-�'ILAI Company Name 19POEM IT Maili Address Mailing Address • O 4 City • tate�Zip Code City t�EL"l=�l'VR St to�_ Zip Code Phone o2 Other Ph.3 D` 0I Phone 3b0- S- 673 Other Ph. Lien/Title Holder Contractor Reg. U4) E mail addressL' 1®°��- I es-&CM E Mail Address 'S '� 51alcll ►�f Drivers Lic.# Emomb DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic— Existing Septic Connect to Water System A Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description 3ii 6 IS I OM C �r'O of 5 .p7.� PTA Tit I S 100 Site Address(Please include street name, street number and ci ) 1 Directions to site U• R.f. 11_ Will timber be cut and sold in parcel preparation?Yes o Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff—EL Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye N TYPE OF JO - New Add Alt Repair Other PRI ARY RESIDENCE SEASONAL �] Use of Building escribe WorkTJe0w2 tm D /►FAIN' "2__3 No. of Bedrooms No. of Bitilrooms Square Footage- 1st Floor2Z21= - _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 information provided is accurate and grants employees of Mason County access to the above des p party and structure for review and inspection.This permit/application becomes null &void if work or authorized construction is not omm ced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY M S APR ESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION O 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: .Zfl ner/ ers Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted byrA WLJ J Date — DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins action 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 NOj�OtYI -&-11`40 BUILDING PERMIT APPLICATION E 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 0 Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR IN ORMATION Owner O ILL. Company Nam TFP4EM T101imsot'j.1 /NG Maili Address Mailing Address U t4XT City State.111414 _Zip Code City F-LrA-t k State W'of - Zip Code 5}- Phone 3W-RI S I)SQ-1 Other Ph.3(od' v li Phone jbd '27 5"Lo734 Other Ph. Lien/Title Holder 1?.QLA Contractor Reg. # 5ki9k,j 4(-M LW Exp. to 10 E mail address k� /�Q C/��� �f -eS•L-� E Mail Address .E'�C`� all+'�G•fr►-'f' Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic X — Existing Septic Connect to Water System _A Name of Water System Well Sewer System Name of Sewer System - PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description SAM B Ift-LE -%rl 404C ( CAV-2E0 1S L-)r:D OF 5 *m'n PT1'l T12 I SIoo Site Address (Please include street name, street number and cit ) N f f D - -y8 Directions to site E �t ' T• � P C dLl Will timber be cut and sold in parcel preparation?Yes AE03 Is property within 200'of Saltwater Lake - River/Creek Pond Wetland_ Seasonal Runoff Stream Slopes or Bluffs S 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye N TYPE OF JOB- NeW4 Add Alt Repair Other PRI ARY RESIDENCE SEASONAL ❑ Use of Building escribe WorkT�' � 1n�67�.�i�t�h —7.�Z l,� Q)`xr No. of Bedrooms No. of Bat ooms Square Footage- 1 st Floo 2nd Floor /dcr 3rd Floor Basement Deck Covered Deck Othe Sq. ft. _LEEx 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 information provided is accurate and grants employees of Mason County access to the above [despM-6�' perty and structure for review and inspection. This permit/application becomes null &void if work or authorized construction is ot ommced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY S APR ESS INSPECTION.INACTIVITYOF THIS PERMIT APPLICATION O 180 DAYS WILL INVALIDATE THEAPPLTCAT Date: ,ZO ner/_pdners 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 Buildincl Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee a D Other Wood/Gas/ Pellet Stove Fe State Fee Violation Fee Pre-Paid at Stittal- 4.�' Valuation $ (� — I TOTAL FEES k �� MASON COUNTY PERMIT NO,,., C_,i r 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 " On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner L . I L.1►. Company Name S E t''t t .. t, �.1 SCE/' ° hilt✓ Mailin Address Mailing Address . tG �S City T State .Zip Code City i3Gt 17411� State tt.' Zip Code Phone 30—A"?S QS01 OtherPh.3(CC` - UI Phone / Gay3�1 Other Ph. Lien/Title Holder LF:S7'El� Contractor Reg. � -t �L Exp. E mail address kt/t ' fit ed ICU r(euvioiW''I!f t,6.oF,;v7 E Mail Address ` C t Drivers Lic.# DOB I Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic X Existing Septic Connect to Water System X Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 12332Fire District Legal Description.SAm r THaI-L� 'S ��66C e cA i)f=t I , _ L I ) f7 Ei1"� its' ! S1CC' Site Address(Please include street name, street number and city) ' PIM6 t,3 E -II Lt, k t rq Directions to site C.6>RIA'tc' OF -5t k1 ` t, iav C I1 i'LL kU Will timber be cut and sold in parcel preparation?Yes Ow+ 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 actic?Ye No TYPE OF JOB,- Newr � Add Alt Repair Other PRI ARY RESIDENCE a SEASONAL ❑ Use of Building y 1 Describe Work'"r — 1 lr trYT �"►1 �^ ' 2.7 2 No. of Bedrooms. No. of BatHlrooms Square Footage- 1 st Floor2 Z'2 G-^ 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. 1 further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that 1 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 descjibeTptpperty and structure for review and inspection.This permit/application becomes null &void if work or authorized construction is Wmenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY S t#APR ESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION O 180 DAYS WILL INVALIDATE THE APPLICATION..,,,_, X • Date: .� f O ner LgAers Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date ' ) DEPARTMENTAL REVIEW APPROVED DENIED NOTES j Building Department i Planning DepartmentAM It Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee p Plumbing & Base Fee Planning Review Fee Mechanical& Base fee Other I Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES ' Valuation $ MASON.COUNTY PERMIT NO.. �` r 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION r Com an Name l' t i# ,' •.i #9�-a Owner_*€ t 11 � i A l �.. L IL p y / � Mailig Address t t Mailing Address IC'tVt-*'�t7Lfi'iti�--State'�� ' ', Zip Code f City i=` `�"` `` State Zip Code �� ?`, / t� _OtherPh. J I �. 1���. Phone , � t� /: ( Other Ph. Phone -'�-� `� Lien/Title Holder ILL ` TF T, r ` `` € °- Contractor Reg # t . it h t ie ijjL Exp. I " fr Eti: } .•`;a, Erma I #Address E mail address c. DOB Drivers Lic.# ssslmlswmffiw� DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System x Name of Water System Well Sewer System Name of Sewer Syste PARCEL INFORMATION - 12 Digit Parcel No. z Fire District Legal Description L`I't "' I I I t: t 1`6 '1, if; '( i L L 4 , ,- /'1, 1 ► I rti I i Site Address(Please include street name, street number and city) I• € L,i to "' I I°L iL Directions to site C L L� h� Will timber be cut and sold in parcel preparation?Yes 4 o. Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff-- Slopes or Bluffs 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye Nq TYPE OF JOB - Newer Add Alt Repair Other PRIMARY RESIDENCE Q..SEASONAL ❑ .i� ,r r.t 4r� t Describe Work . Use of Building 2nd Floor No. of Bedrooms. 5 No. of Bathrooms Square Footage 1st Floor:- ; 3rd Floor Basement Deck Covered Deck Other Sq. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year No Width Serial No. . of Bedrooms No. of Bathrooms Length Type of Heat Purchase Price$ Replacement Unit? Yes/ No No. Installer Name Certification 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 s 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; 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 OFAPR9,GRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OFti,180 DAYS WILL INVALIDATE THE APPLICATION. X Date 0 o�� -i ,t -....•� Owner/ Hers Fkepresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date f DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ' Planning Department Environmental Health Department i eV Fire Marshal FEES 1 Building Permit Fee Site Inspection EH Review Fee Plan Review Fee Plumbing & Base Fee 4 PlanningReview Fee - Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES Valuation $ FORM MUST BE COMPLETED IN INK PERMIT NO.( `4110 oZ0015- M1 -9 PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHA of CA 86PERMIT APPLICATION 426 Shelton (360)427-�67t% Belfair(360) 275-4467•Elma(360) 482-5269 n t e web www.co.mason.wa.us F NT INFORMATION CONTRACTOR! R ATION Company Name ddres Maili Address p �At2 State _Zip Code O City Gtn �-- Zip Code a a.? -0 2 her Ph3b0.13 ' 013 Phone �S Ot er Ph. +tom Ex . I Holder Contractor Reg. dress►l-��� ►ti'tuitiPS.Cd� 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. '1 Fire District Legal Description c P 9"? TR df Site Address (Please include street name, street number and city) Directions to site L "EAL elE 3 c 2©MANC t4l L i;?7 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- 1 st Floor _ 2nd Floor Basement Gara a Closet 7Bathroom G FIXTURES(Show Number of each) MECHANICAL UNITS ture No. of Fixtures Fees Fuel Type:Electric LPCz._ Natural Gas._- Heat Pump_ 2 Type of Unit No.of Units Fees Sink —� Furnace Bath Tubs Heatpumps Spot Vent Fan Showers Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood Dryer Vent Hosebibs Other Other Base Fee Base Fee TOTAL MECHANICAL TOTAL PLUMBING OVVNER/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�Gentitl entitled to receive es.If this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary pa I have required from any easement holderthis another duct the Woregarding ic paro inposge this application owner or agent on oown�behaffd in �ep�resents that the information per ion m them to apply Pe pro 'ded' ccurate and grants employees of Mason County access to the above described property and stn�cture for review and inspection. PRgo EANS OF A PROGRESS INSPE ON. Date:X ne Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date ! - -D8 _Bld Pd I 1—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 1 UFC Plan Review Fee Mechanical&Base fee Wood/Gas/Pellet Stove Fee Other " TOTAL FEES Violation Fee PERMIT NO. - MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-9967 0 ewelb irw(360)275-4467-Elma (360) 482-5269 Xy APPLICANT INFORMATION CONTRACTOR I ORMATION Owner ��ANC H I L�;t _L t� Company Name i Mailin Address- Zip C' ��� Mailing Address P- - City , x State cf�Zip Code �I kS'> City. " i e1 t Q - IQ Mate 1 — Zip Code ';kin ry7� ol;o L Other Phi oU 3 �i �_ Phone � Ot er Ph. Phone ; Contractor Reg. IK f Exp. Lien/Title Holder c <tx Z v 1C rl<t E mail address �°4 I 1 � per Xu etom,JVju+" +1E5 E Mail Address Drivers Lic.# DOBI 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. 1 Fire District Legal Description`-"'`"t i= TI i�L i t+� t fi�tL.e rAk i k'�s Lr Tf t G S I `73 Ili f l T" 1 fyt u U Site Address (Please include street name, street numper and city) XA k f Directions to site ��'1A: FJ�lk C`F t_L Is property within 200'of Saltwater l unoff___�__St eam Slopes or Bluffs � 15%e -River/Creek Pond Wetland Season TYPE OF JOB - New Add Alt Repair Other Use of Building r Location of Fixtures/Units- 1 st Floor _ 2nd Floor Basement Gara a Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric _ LPC Natural Gas_ Heat Fees Toilets Pump — Type of Unit No.of Units Furnace Bathroom Sink —.-- Heatpumps Bath Tubs Spot Vent Fan Showers F Water Heater Propane Tank G _ _ Clothes Washer Gas Outlets Wood/Gas/Pellet Stove — Kitchen Sinks Kitchen Exhaust Hood Dishwasher Dryer Vent Hosebibs Other I 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 byn signature below.I declare thatinl am the the application. declare t owners hat I ha a representative, the permission or the rfrom further theenneecessary p lare that I am des.if permission matitled to receive 's permit and to do the work as proposed' lication or the workproposed in the application,I have obtained required from any easement holder or any other parry in interest regarding th�The owner or agent on s behalf,represents that the information E permisgi i�i1rom them to apply for this permit and conduct the work proposed. and structure for review and inspector. proJtided isccurate and grants employees of Mason County access to the above described property PRC)QF, (b UATION OF WORK IS BY MEANS OF A PROGRESS INSPE7��N .... Date: X ! p e Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT d f Recei t No. Accepted by: I!�f Planning Pd Ck# Date ±) Bld P p DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou Tyoe Constr. P — lanning 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 PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL ox PERMIT APPLICATION Shelton (360) 427-96 the web iWw3`60o275-4467*Elma(360) 482-5269 On us APPLICANT INFORMATION CONTRACTOR INFORMATION . _' flit ' f e : Company Name . , Owner .� i , r /.-. Mailing Address 1 t Mailing Address State Zip Code g Cit li State Zip Code ` City d s i f°° a ► , i,;;s Phone _,` k ' �- Other Ph "} 4 6...I Phone + Other Ph Lien/Title Holder Contractor Reg � ' § �' " Li�~L' Exp. ,.,, ,.. t :: e'Lkj E Mail Address E mail address1- t ' DOB Drivers Lic.# DOB Drivers Lic.# SEPTIC INFORMATION - Connect to New Septi — Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No. _Fire District Legal Description s'r , L i it'4r.i-/,,:. _e -:�„ t � Site Address (Please include street name, street numper and city) Directions to site 1 Is property within 200'of Saltwater Lake River/Creek Pond Wetland—Seasonal Runoff X. —Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Closet Location of Fixtures/Units- 1 st Floor 2nd Floor. Basement Gara a PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Pump— Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC_ Natural GAS Heat Pump_ Toilets Type of Unit No. of Units Fees Furnace Bathroom Sink T HeaBath Tubs Spot Vent Ft Vent Fan Showers t Spot Water Heater Propane Tank Gas Outlets Clothes Washer, y C Clothe Sinks Wood/Gas/Pellet Stove Kithen Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other —.---- Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL O VNER/BUIL.DER 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 ament�dt f receive ois permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary part required from any easement holder or any n is 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 a owners a d inspection. on provided is accurate and grants employees of Mason County access to the above described property e for review PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Date: { X or Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: It Planning Pd Ck# Date i i Bid Pd Receipt No. DEPARj L REVIEW APPROVED DENIED NOTES Building Dt Occ Groue Constr. Plannin Department Environmlth Department FEES Plumbin eeSite Ins ection Mechani feeUFC Plan ReviewFee Wood/Gt Stove Fee Other Violation TOTAL FEES PERMIT NO.( 4'1 MASON COUNTY PLUMBING/MECHANICAL ox PERMIT APPLICATION ��,J04j , Shelton (360) 427-96 the welt ww360)2754 467- Elma (360) 482-5269 APPLICANT INFORMATION CONTRACTOR I ORMATIOtPbLinN h Owner Company Name MailingAddress Mailin Address 48 '�- City rL Iwi Gta e I,J)A Zip Code CityLd= �?. State j _Zip Code Y, Phone ^t`1 © - Other Phi • 3 : Phone Ot er Ph. Lien/Title Holder ALS !� VDI gr ►. Contractor Reg. I Ex �" f u Uoshet �C et ►Gtw�c�vYtmU.vtittr'5,C" E Mail Addresses E mail address DOB Drivers Lic.# DOB Drivers Lic.# SEPTIC INFORMATION - Connect to New Septic_._ Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No. Fire District Legal Description cWA Site Address (Please include street name, street number and city) Q Directions to site +�►� NGK €j� qr PT r ��'�migN( N f LL- i %� 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- 1 st Floor _ 2nd Floor Basement,.-Gara a Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric._ LPG,_ Natural Gas Heat Pump_ Toilets v Type of Unit No.of Units Fees Bathroom Sink Furnace Heatpumps Bath Tubs v Spot Vent Fan Showers Propane Tank Water Heater Gas Outlets Clothes Washer Wood/Gas/Pellet Stove Kithen Sinks -- ,(� Kitchen Exhaust Hood -� Dishwasher Dryer Vent �--= Hosebibs Other Other Base Fee Base Fee2TOTAL PLUMBING TOTAL MECHANICAL OWNF�/BUILDER Acknowledges submission of inaccurate' rmation 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 permiisr'iort om them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information pro ide I is Accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PR , F�F CONT UATION OF WORK IS BY MEANS OF A PROGRESS INSPECT ON. _ Date: X p ne Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# � Date� }-b _Bld PdiL_Receipt No. DEPARTME14TAL REVIEW APPROVED DENIED NOTES Building Department .- ` Occ Group-Type Constr- Planning DepartmAnt 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 THIS PARC EL INCLUQES PLANS, BWEPRINTS O.R. - O-VERS,IZE IMAGES [-.ARG.,E .FORMAT IMAGES HAVE BEEN. STORED IN FILE CABINETS) UNDER PARCEL --N- -UM13E--R- PARCEL # 233 CAS - 50 - 9D04�D E # (Dm li s� r� u-7-1� ��Y�r r Belfair Urgent Care-Kitsap Physical Therapy Tenant Improvements v 12/30/2008 0:00 Temporary Utilities $1,250 Underlayment 4,831 Frame Materials/Labor 5,500 Finish Labor 2,000 Supervision 5,000 T-Bar 7,313 Millwork/Locks 4,100 Insulation 11000 Fire Alarm 3,000 Fire Sprinklers 3,417 Toilet Accessories 750 Drywall 8,900 Carpet/Vinyl/Wainscoats 12,348 Painting 3,500 Plumbing 6,300 HVAC 14,000 Electrical 23,325 Cleanup & Labor 1,000 Shower Doors/Grab Bars/Etc. 1,500 75,040 Overhead,Arch Fees, Permits & Consultants 15,000 $90,040 i j 3 a 7 Look Up a Contractor, Electrician, Plumber or Elevator Professional License Detail Page 1 of 3 Information in Spanish I Topic Index I Contact Info Home Safety. Claims&Insurance Workplace Rights Trades&Licensing Find a Law(RCW)or Rule(WAC) Get a form or publication Return to List > Start a New Search > Printer friendly General/Specialty Contractor A business registered as a construction contractor with 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 STEPHEN JOHNSON UBI No. 600402443 INC Phone No. (360) 275-6734 Status ACTIVE Address PO BOX 488 License No. STEPHJ*199LW Suite/Apt. License Type i. CONSTRUCTION CONTRACTOR City BELFAIR Effective Date 6/16/1981 State WA Expiration Date 6/1/2010 Zip 985280488 Suspend Date 4) County MASON Previous License STANPC*202NF Business Type CORPORATION Next License JACKJC1182M1 Parent Associated Company License Specialty 1 GENERAL Specialty 2 UNUSED a Business Owner Information B Hide All Name Role Effective Date Expiration Date JOHNSON, STEPHEN J 01/01/1980 JOHNSON, LENITA A 01/01/1980 8 Bond Information t https:Hfortress.wa.gov/lni/bbip/Detail.aspx?License=STEPHJ*199LW 11/21/2008 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 .................................................. Home Safety Claims Et Insurance Workplace Rights Trades Et Licensing .................................................._, ........................................._........ : Find a Law(RCW)or Rule(WAC) Get a form or publication Return to List > Start a New Search > Printer friendly GeneraVSpecialty Contractor A business registered as a construction contractor with LCtI 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 STEPHEN JOHNSON UBI No. 600402443 INC Phone No. (360) 275-6734 Status ACTIVE Address PO BOX 488 License No. STEPHJ*199LW Suite/Apt. License Type i CONSTRUCTION CONTRACTOR City BELFAIR Effective Date 6/16/1981 State WA Expiration Date 6/1/2010 Zip 985280488 Suspend Date County MASON Previous License JACKJC*2261-6 Business Type CORPORATION Next License TNTEXL*97405 Parent Associated Company License Specialty 1 GENERAL Specialty 2 44 UNUSED Business Owner Information Hide All Name Role Effective Date Expiration Date JOHNSON, STEPHEN J 01/01/1980 JOHNSON, LENITA A 01/01/1980 :N Bond Information .j https://fortress.wa.gov/lni/bbip/Detail.aspx?License=STEPHJ*199LW 10/17/2008 .w nm o w w m CL O o a a X T m m m m o m m 0 G m v 0iv m o m 3 - r ao O c m 0 m Ov T o D D m v CD m m z T1 _i o > wm o 3 � "�y O � cpDO '0 Cf c p � � � ;u 0 m y v a CD .P 0 N =� OD —I Z � � m .n. m o 0' zmcw y D -n /� 0 � � ODJ °�- o O o c m D w -� 0 D 3 �y � 3 0 � wzm � n m 3 m cn 0 m ct Wo � 2Z co o QO v 'J v � 3 z Qca O 3 = oOZm cp Z o fD o � s o mpD '- = w rn o Z 02 � N 0 � o mz � 0''O pD = OC m CA CD m 0 F z m M m CL m � Zm cyl 0n ;o90 n O r. 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E \ \ @ o MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT r O' 426 West Cedar Street ♦ PO Box 186 ♦ Shelton, WA 98584 *% 4�-- (360)427-9670 EXT. 352 FAX(360)427-7798 HOME PAGE v Aftma� us Inspection Authorization Special Insp Project Owner: Romance Hill LLC Building Permit Number: COM2008-00149 Project A40ress: Kitsap Physical Therapy Architect of record: D.H. Briant&Associates In addition to the inspections required by International Building Code (IBC) Section 109, the owner or the engineer or architect of record acting as the owner's agent.shall employ one or more special inspectors who shall provide special inspections during construction on the types of work listed under IBC Section 1704. This form must be completed by the owner or the engineer or architect of record, prior to permit issuance, indicating who will perform the required special inspections for this particular project. The specified special inspector(s) shall perform the required special inspections during construction of the project, submit all inspection reports to the Building Department and provide a final signed report stating whether the work requiring special inspection was, to the best of the inspector's knowledge, in conformance to the approved plans and specifications and the applicable workmanship provisions of the IBC. The following checked items require special inspection: ❑ 1. Concrete. During the taking of test specimens and placing of reinforced concrete. (IBC 1704.4) ❑ 2. Bolts installed in concrete. Prior to and during the placement of concrete around bolts when stress increases permitted by Table 1912.2 and section 1912.5 are utilized. (IBC 1704.4) ❑ 3. Erection of precast concrete members. Periodic inspection per ACI 318: Ch 16. (IBC 1704.4) ❑ 4. Shotcrete. Continuous inspection per ACI 318: 5.9, 5.10 and IBC Chapter 19. (IBC 1704.4) ❑ 5. Reinforcing steel and prestressing steel tendons. Inspection of reinforcing steel including prestressing tendons. (IBC 1704.4) ❑ 6. Welding of reinforcing steel. Inspection of the welding of reinforcing steel according to AWS D1.4, ACI 318: 3.5.2, and IBC 1903.5.2. (IBC 1704.4) ❑ 7. Structural welding. Welding inspection shall be in compliance with AWS D1.1. (IBC 1704.3.1) ❑ 8. High-strength Bolting. The installation of high-strength bolts shall be periodically inspected in accordance with AISC LRFD Section M2.5. (IBC 1704.3.3) ❑ 9. Structural Masonry. Masonry construction shall be inspected and evaluated with the requirements of IBC section 1704.5. ❑ 10. Soils. Inspections for fills 12 inches or greater to be performed in accordance with IBC Section 1704.7. ❑ 11. Pile foundations. Inspector to be present when pile foundations are being installed and during tests. (IBC 1704.8) ❑ 12. Pier foundations. Special inspection of pier foundations for buildings are required in seismic Zone D. (IBC 1704.9) ❑ 13. Spray-applied fire resistant materials. Inspections shall be in accordance with sections 1704.11.1 through 1704.11.5. ❑ 14. Exterior insulation finish system(EIFS). Special inspection shall be required for all EIFS systems. (IBC 1704.12) Continued on reverse side ❑, 15. Smoke-control system. Smoke control systems shall be tested by a special inspector per IBC Section 1704.14. ❑ 16. Special cases. Special inspection shall be required for proposed work that is, in the option of the building official, unusual in its nature such as alternative methods and material of construction, unusual design applications, and materials and systems required to be installed in accordance with additional manufacturer's instructions that prescribe requirements not contained in the IBC or referenced standards. ❑ Installation of structural epoxies ❑ Installation of"high-load shear panels" ❑Structural Observation (IBC1709) Other: AC*- "f_ COL-WV 5-4smm Special Inspector Selection: The special inspection agency and special inspector shall be registered by the Washington Association of Building Officials(WABO)for the particular type of construction or operation requiring special inspection. Such inspector(s) shall be selected by the owner or the owner's agent and approved by the Building Official prior to issuance of the building permit. The owner's agent shall not be acting as, or employed by the special inspection agency or the contractor for this project. Name of Special Inspector or Agency: Type of Inspection: Registration Number: �J}{ T Lomw g- Assoc. Ave*mv:M Vs. Noi-nti-- Ca►NQW 5-0.1v.An 4-10 Authorization: I hereby state that I am the legal owner of the project property, or that I am the legal owner's agent who is not employed by a special inspection agency or contractor associated with this project. In addition, I agree mply with the special inspection requirements established by Chapter 17 of the International Building Code as a pted by Mason County. qLW,(,K S gnature Printed Name Owner ❑Agent Date i PURPOSE OF SPECIAL INSPECTION Special inspection is the monitoring of materials and workmanship which are critical to the integrity of the building m structure to assure that the approved plans and specifications are being followed and that relevant codes are being observed. Special inspections are in addition to those conducted by the county building inspector and by the engineer or architect of record. Special inspectors furnish inspection at all times that their presence is required by the code, the plans and specifications, and the enforcing jurisdiction. Good communication between the special I inspector and the designer, contractor, and building department is essential. DUTIES AND RESPONSIBILITIES OF THE SPECIAL INSPECTOR: Special inspectors are individuals with highly developed, specialized skills who observe those critical building or structural features which they are qualified to inspect. Duties of special inspectors and/or inspection agencies include the following: 3 1. General Requirements ? Special inspectors shall review approved plans and specifications for special inspection requirements. Special inspectors shall comply with the special inspection requirements of the enforcing jurisdiction. 2.Signify Presence at Job Site Special inspectors should notify contractor personnel and the enforcing jurisdiction of their presence and responsibilities at the job site. 3.Observe All Work for Which They Are Responsible Special inspectors shall inspect all work and perform or observe all tests requiring inspection and testing for conformance with the building-department-approved (stamped)drawings, specifications and applicable ' 4. Notification of Discrepancies Special inspectors shall bring all nonconforming items to the immediate attention of the contractor. If any such item is not resolved in a timely manner or is about to by incorporated in the work, the engineer or architect of record and the building official should be notified immediately by telephone or in person, and the item noted in the special inspector's written report. The special inspector shall write a separate report to be posted at the job site regarding noted discrepancies which should contain, as a minimum, the following information about each nonconforming item: •Description and exact location, • Reference to applicable detail of approved planstspecifications, • Name and title of each individual notified and method of notification, and • Resolution or corrective action. S.Reports A. Inspection reports The special inspector should complete written inspection reports for each inspection visit and provide the reports on a timely basis determined by the building official. The special inspector or inspection agency shall furnish these reports directly to the building official, engineer or architect of record, and others as designated. These reports should be organized on a daily format and may be submitted weekly at the option of the building official. In these reports, special inspectors should: • Describe inspections and tests made with applicable locations; • List all nonconforming items; • Indicate how nonconforming items were resolved; •List unresolved items, parties notified, and time and method of notification; and • Itemize changes authorized by the architectlengineer of record and approved by the building department, if not included in the nonconformance items. B. Final reports Special inspectors or inspection agencies shall submit a final, signed report to the building department stating that all items requiring special inspection and testing were fulfilled and reported and, to the best of their knowledge, in conformance with the approved design drawings, specifications, approved change orders and the applicable provisions of the code. Items not in conformance, unresolved items or any discrepancies in inspection coverage(i.e., missed inspections, periodic inspections when continuous was required, etc.)should be specifically itemized in this report. DUTIES AND RESPONSIBILITIES OF THE CONTRACTOR: The contractor's duties include responsibility for notifying the special inspector or agency regarding individual inspections required by the Building Department, or required by the International Building Code, Chapter 17. Adequate notice shall be provided so that the special inspector shall have appropriate access to the approved plans at the job site prior to the required inspection. The contractor shall not perform any work that requires special inspection without the special inspector present. Completion of this form, and the performance of special inspections does not relieve the contractor's responsibility to schedule required inspections by the Mason County Building Department prior to concealing any work. DUTIES AND RESPONSIBILITIES OF THE ENGINEER OR ARCHITECT OF RECORD: The engineer or architect of record is responsible for identifying which special inspections are necessary, developing a schedule of required special inspections, and assisting the owner in the selection of the special inspector. The engineer or architect or record shall review the special inspection reports to determine that all required special inspections have been performed and that all discrepancies(if any) have been resolved. DUTIES AND RESPONSIBILITIES OF THE PROJECT OWNER: The project owner, or the engineer or architect of record acting as the owner's agent, is responsible for the funding of all required special inspection activities in accordance with International Building Code Section 1704. I I MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 426 West Cedar Street ♦ PO Box 186 ♦ Shelton,WA 98584 (360)427-9670 EXT. 352 FAX(360)427-7798 HOME PAGE—www.co.masonma.us Special inspection policy Scope: To ensure compliance with all provisions of Local, State and International Building Codes in addition to all jurisdictional policies. Responsible Party: The owner or registered design professional acting as the owners agent is responsible to obtain, and have pre-approved by the jurisdiction,any and all Special Inspection Agencies and/or persons employed by such. Policy: Mason County allows two methods in which compliance may be obtained. Please read the following options carefully when choosing your method of compliance and special inspection agency: ❑Option I: Registration with WABO (Washington Association of Building Officials) The WABO registration gives the jurisdiction the assurance that the individual and or agency has met certain criteria and that the criteria is maintained. See WWW.WABO.ORG for listing of approved individuals or agencies. ❑Option II: Mason County will approve an individual or company,to perform inspections upon demonstration of competence for the particular type of construction or operation requiring special inspection. As proof of competence the individual or company will need to conform to all of the following criteria and provide supporting documentation. A.)Provide the name of the individual that will perform the particular type of inspection along with documents demonstrating competency including copies of all certifications and registration numbers pertinent to the inspection type. Examples: (ICC, ICBO,NICET,AWS) WA. State licensed Structural/Civil Engineers or Architects may also be accepted. B.)When laboratory testing and field inspection equipment will be required provide details of specific tests,the quality of the system,procedures to ensure test are performed properly and all policies for recording,reviewing and performing such test. An equipment log must be maintained and available for review. All calibration maintenance records must be traceable to the National bureau of Standards, calibrations must be performed frequently as set up per the standards. C.)When all required information has been submitted staff will review documentation and approve the acceptability of the special inspection competency or request additional information as deemed necessary. Authorization Form: After selecting option I or II please complete the"Special Inspection Authorization' form and submit it to Mason County for initial review. Approved By: Mark Core Date: 10-02-07