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CD r N N —h C (D (D (n N p O (D a �'.0 0 (a N C v 0- 0 0 0 p � N N 0 (n (n ° 3 �' N O CD c O .Z7 CD n N < 0 p o (0j N O N < 3' cn Q, c0i N 7 � [D (^CD - _0 fD n CD m N O n (D a v CD — 3 n O p m (D 0 0 cn p) a CD N 0 � (D (D 0 :. � D (D VCD o o o o v j o d 3.� m _3 mm (D(n ='. mrn,� -0 m o CT 4 a 0 � W0vm Cs5. ° 0 — 3 �_ 0ov � �' C) CD coC� !vmo N0 C (OD c' ((DD (D N (D 7 =" 0 �. 0 � � CCDD �v � c W� =0 (a aQ o CD C � m m o o N o N � n � m N 0 o m o 0 °' co — ° u, 3 3 0 — cn <n 0 0 m 3 (D Lrl 0 O A A M 3 � (Dmv � a iv cs �' v K 0 < 03 -� nm- 3 � D-0 00 N c �, "a N D m � � u) m in ca 00 n N cc 7 Q 0 ap N < Nj. T. QpO n � Qa (D 7 (D a -. < 7 v (n �. � A� � � 0 O cn V1 7 CD N n n O< Q 0 C) p 5 s N O 5 N cNNO 2N o o CD ' c CD � 3 or. Iry (n � a � 3 07 =' o Q o 3 Ll_ m WWcn .� � o : (n a °' � 0 m (D 4 O 0 0CD N = (D o (n 0 cn7 a co _O (p (D(n 0 ET cn — cn 3 3 0 O p� 0 (n a m 0 En p 0 n to a o N (D (<D D O =• n N (Q .„ cD ;74- 7 a C] 0 (D CS v O (p cn _. 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O 0 a CD n O `p00 o cr — 3a- oC)o x o 0- o O a ` $ CD C) 0) mg m < CD a 3 - 0 o m 0 0 = CD m 3 8 a . < o S. � a 0 0 �, 2 ( 0 c 0 0 CD O O O n CD _� O o Cn y CD 3 2 m 7R o j o " =. a CD Cu y CD (n C N - S CD CD 0 O O CD -0 7. - : CD N CD 7 O O' N. S 3 CD O :3 CD 3 � cDCD Q 3 CD 00 S O C1 m � < CD CD ° o 3 m ' O S 3 CD N 3 CD a 8 �j 0o ccn a o CD o < m a- o a 0- o x N. < �. CD Cu a C, c U1 O (D � O D (D CD C1 CU d a d O CO j' Lll � 3+ n � Cn 0. 3 CD 0 0 0 0 CD o 0CCDD. f1 o au � Tcn cu 00 0 o a� 73 0 3 0 -., 0 cO ? oCD. 5' m m m 0' f � 0 0 x- O -+. y ------------- 71 WELDING 4QKrazan & Associates , Inc . REPORT NO.: 344 GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: ��J/� CONTRACTOR: PROJECT#:�si}K ' ��� PERMIT NO: C044,21-20a ` 00073 PROJECT: r%r �'® %'�� /YNEX INSPECTOR: A/ 5,09,41VTMI—el LOCATION: a?�,{�'lJiL1 �%`�� JURISDICTION: 41,41 R, WA KRAZAN PROJECT MANAGER: WEATHER: CZ,60 3� TEMP: �fi off. l FIELD ElSHOP WELDING ElM.T. ❑ P.T. V.T. item(s)inspected: S T T O _PP 3 T L N �fl�y/t��PT'/t�/✓S ONG41 14-E R Z?,,E �F�-/� 1 r`, �OYl1 �4 T1.<EF.Y RV A/1 RDOF 1�V-42 1 %1 Position: FLAT VERITC RIZONT VERHE ❑ Filler Metal: �1 Process: SMA FCAW GMAW SAW ❑ Other: l Weld Type: FILL C.P. P.P. PLUG ❑ Other: Weld Size 3/1 1/4" 5/16" 38" ❑ Other: `in Codes: AAWW� AISC TITLE 21 TITLE 24 UBC ASME i 3 To the best of my knowledge,the ab a WAS WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: G' 1 I Serving the Western United States E��[rve D This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject t�' &pssocia�s' By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others ort kraz�" The information provided in this report is prepazed for the exclusive use of the client.This report may not be reproduced in any format without the written permission of t� /� i _--_-----------------------__---_------- - 5 1/4 X 14 PSL t E 171 t, 4 1 72 7 Q LC7 E x a �. X Z f i ED pi -6-2009 3. I N -j 5- 008 Aso •� •mow ` 204 ' 1 600# ---� - -- --- - nbse, -- --- associates' civii&structurai engineer$ o q r N R EV I D 9. CD Z DATE " a 10. j sc N L—..�—� •�w •mow S20 11. J Sl 3 CONTRACTOR M Y X w EXTEND TRUSS HORDS, to CON HE P%ART-TIME OR INTERMITTENT OBSERVATION OF WORK REQUIRING SP CTION cPN Y AN APPROVED SPECIAL INSPECTOR WHO IS PRESENT IN THE AREA AS BEEN OR IS BEING PERFORMED AND AT THE COMPLETION OF W �/�`� �,t\'� CTR � o\ CONCRETE CONSTRUC APPLIES TO FOOTINGS ONLY NOT FOUNDATION WALL 2 IBC 1704.4 � � R�Q� TABLE 1704.4 EXP 2-6-2009 REQUIRED VERIFICATION AND INSPECTION OF CONCRETE C NSTRU Iwo • 4 a IELCBC VERIFICATION AND INSPECTION CONTINUOUS PERIODIC REFERENCED STANDARD REFERENCE 1. Inspection of reinforcing steel, including prestressing tendons, and placement. X ACI 318: 3.5, 7.1-7.7 1913.4 SLf 2.-Inspection of reinforcing steel welding in AWS 131.4 accordance with Table 1704.3, Item 5b. ACI 318: 3.5.2 s 3. Inspect bolts to be installed in concrete prior to and during placement of concrete where X 1911.5 allowable loads have been increased. 4.Verifying use of required design mix. 19913.2,, d ty g q g X ACI Ch.4, 5.2-5.4 1913.2, � 1913.3 5. At the time fresh concrete is sampled to fabricate ASTM C 172 specimens for strenghth tests, perform slump and X ASTM C 31 1913.10 1 air content tests, and determine the temoerature ACI 318: 5.6, 5.8 of the concrete. O 6. Inspection of concrete and shotcrete placement 1913.6, for proper application techniques. X ACI 318: 5.9, 5.10 1913.7, 1913.8 7. Inspection for maintenance of specified curing X 1913.9 temperature and techniques. ACI 318: 5.11,5.13 8. Inspection of prestressed concrete: a.Application of prestressing forces. X ACI 318: 18.20 b.Grouting of bonded prestressing tendons in X ACI 318: 18.18.4 the seismic-free resisting system. • - 9. Erection of precast concrete members. X ACI 318: Ch. 16 — 10.Verification of in-situ concrete strength, prior to stressing of tendons in posttentioned concrete X ACI 318:6.2 and prior to removal of shores and forms from -beams and structural slabs. 11.Inspect formwork for shape, location and ACI 318:6.1.1 - ' L RIVI njj(7�; hi III MKIal ILL a.Where applicable see also Section 1707.1.Special insperfion for seismic resistance. 0 21 NE ROMANCE HILL ROAD BELFAIR, WA 98WbOD CONSTRUCTION TABLE 1704.7 WOOD CONSTRUCTION M p -1 (n m cn cn m a � cD O N L 0 o a ; m 0�0 CD CD N N 7 O fD fD .► n � •• CD O CD 3`G r C) �! cn z m � c * � m G) ° CA m 0 N CD D W CL M is Q• r X (A n r -n0 3 a 7o mn =l0 T! c -� C4 CA) � z 3 cn z -Ao0 3 CmC m r. p 0 D -i cn @ 0 90 � cn00 O eND c C) 0 G CDZ -uZ0 � 0 c y CA -n -n -n -n 10 °' 0 ' 3c o0m -4z D o °' .. .. .. c -& co @ o z � cn � � > > CAm � nO cn 0 a , o C/) � ° Z cn M .� o c ° D MCD � �' C 3 m � Nm n CD 3 3 3 cD cn 0) M. N rt N W cn r D OD W O .. O Z cn J J cn zam o � cD0O00 ODco C ma � mm Z m m 0) 3 aDch2 Z ° p m m m rn p eo vD W =_ C � m O rmm c� T N m -° m a T � 0 N X n O m - 3 W n D ic o 55 m x fr- n 00 C 3 '0 3 y z g --Ir Z :v CO) z m W CDm o m 0 --4 OT C 0 3 � � Wz ° � W o cn r' p o CD ca � � mC) m oo a o zo m m o °' ° r ZD 0 ° o" v 3 a (0 0 m o o yO co G) mn cn 7j co ct n D cc p Z CD = N• O 0 m CO) CA)- mC m N CDc) ° m .+ t/1 m m Z � ° '` y `i N — o m = z 3 3 % n v o ° n -1 m w y a W r- w z X -' CD •J •J @ O -' m C i+ 00 ; O Z C) � � ° O cO fir7 � C � -� n (n cu -° o m 0 �, O 0 3 v �, n O G O w m m d o o �, D O d o n -,D � °a. Z n ca.cc 3 3 C W < w m :. :. pnj W O = n Ti 3' cn C Z o ' m m 0) ?� = D y `< 0 T cn m NO rno. CD m y GYR -I m m m � r- � JJ o � I2 cggq o � (D o v -•, CY -� N OD a) O W cD D cD CCn CYS OV o N O O N W X V CD OD C) W N CA O) N N ti o )90 �• O =-a O W --- M O = CD w ° 0 oQ ° o °D0ov_a_ D 3onmr .Nm+ _ v, 3 w '' - 3 ?-p 0 oo ' fn Q ° 3 3 ° o ::r' m a) - - CL m CD a° ° o0 °0 D c v Qo. -, � - - I o v m c Ck) v m �:^ m CO N to O C = N' m y `nG: OC v OCDCDCDa: a CD 0 (DfD _ fl v � 'U �O QCfl . ? D O CD0 - � � m ? � 0 0 = O � m m Dm m Z oNmZ co CO) v0vcCDfn 3• mm ( uo mn o — o ? CL CD _ cr Z N n 3 wvv 0 o p � � m y 3 0 m 3 0 a 0) 0) m 0- CD — (OD CCDD 'n O ? 5 v v o CD cc y = 3 m ,_, Erc � m v°r►i 90 CA (n � p � (D m G� m � O 3 c .. - 3 -�. Dcn =ra) c O QO � n• o 0 c Z m � �' Z n 0 w � m 0- ° 0fn v► -i� 0_ 00 0D m p � �, v ° ° a * 0a) � Oz Ocn o m' ^� o l< 0 M. _. m = - is 3 m �p -"� = N O Z n� ro Z v o ,7 m 0 vv c> ,� ZZ 3 • Q. 2 mmm -Dca v dn � n0no -03cw � �o S. w c N N 0 W O NCL D C 7 3 = 0 pcn � O. 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(D. � \ / \ � 0' C = � k0 f CD f t & ate � k � � Ek CD I © EE CLce Ito agD k § C) a � 2 0 EJa OD 0 R 0 o 3 0 77 % Mkm � SE § � sox E « ; O 1 o CONCRETE -o MECHANICAL U s MANUFACTURED HOME "C C) Footkno!Setbacica as Dale �Y Ribbons (,m' o Interior Date By r or. / L/ ByDam By m 22 wterisx Date $tT•O$ By�6 INSULATION Exterior- _ ,,�, Point t:oad 1 isolated FdatIn" �r Si..Aa eta Date �y � Dade By Date By FIRE DEPARTMENT X Foundation Wails Fioors Date By O Date By Date By DECKS 3 a FRAMING wads D e By z Die Z mData By PLUMBING vaub Date By 2 - Date By OTHER r Oroundwork Attic Date By Type Date By Date By DRYWALL TO O D.W.V Int sfm*was Date By 3 Daft — ZT-09 lw,. Data By FINAL INSPECTION o water Line Firs Separation o Die sy Date By D 'J7c�_cs`�' By o 0 Pass or Request Inspect, c Type of Insp. Fail Date Date Done By Commits w ,STEM , . • r ,�v/�.oi-�� ,. llge,�T Xd!��/°mot g .�. ,jkj�T L-r— T,✓o 1 L 1�11��1 rri�,-n 5,i�� cam✓ Fl^lot- �s7T- 1 co 0 FORM MUST BE COMPLETED IN INK MASON BOUNTY PERMIT NO. � 3 PLEASE PRESS HARD 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 APPLICAA4T INFORMATI N CONTRACTOR I ORMATION Owner O [.E tLL- LLG. . CompanyName '�-TI+w a T.N Mailinq Address •'O• Mailing Address '0 City State /A• Zip Code QRSZ$ City WLPhla— State CIA. ZipCodeTXZ Phone --T�' SVL—Other Ph._6(aQ 1-8! L� Phone 3 Other Ph. Lien/Title Holder LeSES"I'L V RL4 . Contractor Reg. 2 Exp. I E mail address E Mail Address Y)2-+— Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic X Existing Septic Connect to Water System _g Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 40 Fire District Legal Description SAtA B. `4ELE 'S' P014E S G4R TRS Lt7T'.'O OF SP 5-2973 pw TR 1 S 100` Site Address (Please include street name, street numb and city)2-1 NE IZOM4NCC E41LL P-b 7 BEL.i P_ W Directions to site �O2JU�L Ot= ST• 1�3 A 2of- .oh e e t41 LL_ Qt�, . Will timber be cut and sold in parcel preparation?Yes N Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 159% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOB - New X Add Alt Repair Other 1 I PRIMARY RESIDENCE S ASONAL Use of Building I1 GAiI-� Describe Work PR¢Ox No. of Bedrooms No. of Bathrooms Square Footage- 1st Flo o 1 I a- 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 desc' property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is n com nced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY M =NSFAPROG S INSPECTIO ACTIVITY OF HI PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X �� LLL Date: I Z Owner/Own a esent ive/Contractor (indica which one) ers 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 f. QJ MASON t6tINTY PERMIT NO BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.maso0.wa.us APPLIC T INFORMATI N CONTRACTOR INFORMATION Owner 0 of C_ l L L L e— Company Name -���4"f_-j)j �N Mailin Address U Mailing Address 0 ' City l-I E A I CL._ State 1A1�. Zip Code QSZ S 7_3$ City al.Fl�l(�. ' �'Stat �d1� Zip Code C 2 Phone k0-)-_7"4 -PS0 -- Other Ph.�t�--7->, g[71 Phone t Other Ph. Lien/Title Holder 1-1c.2KEYL V-k ue,C,F '� Contractor Reg. Exp. II E mail address E Mail Address f-�A-C. V)e+ Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic X Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 33 1 &0O Fire District Legal Description SAM B• IMLEk'S nom E r G Ag TICS L' r:Q nF so o gqu pii� i-A 15 t uy' Site Address(Please include street name, street numb and city)Z1 NE Pt�t4.PJ CE N tL.t_ Qb- a-1 i-A i g,wA 9S U8 Directions to site i:22(00 CC Sl. P-1 3 a i or-f P<rje,e . FI �I-L t2 L Will timber be cut and sold in parcel preparation?Yes N Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 5 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes o TYPE OF JOB - New_.&Add Alt Repair Other 1. tkiSK'PRIMARY RESIDENCE ❑ S ASONAL Use of Building(.� 'e C�(U - Describe Work W`14 C� "� tl� No. of Bedrooms No. of Bathrooms Square Footage- 1 st oo_ <; ` Floor 3rd Floor Basement Deck_ Covered Deck Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year- Length—Width Serial No. No. of Bedrooms No. of 8bthrooms Type of Heat Purchase f ricef$ Replacement Unit? Yes/ NoLIWC.,ialZlb� Installer Name 1 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.,+)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 desc�tibed property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is n commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MNSOFAPROG E SINSPECTIO ACTIVITY OFHI PERMIT APPLICATIONOF18�0-DAYSWIL�NVAtL�IDATETHEAPPLICATION. X �- .... (,tn`t-4. 1 1. Date: Owner/Owners ep esenta ive/Contractor (indicat which one) J FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES 1�uildinq Permit Fee Site inspection n Review Fee EH Review Fee mbing & Base Fee ,e Planning Review Fee banical & Base fee I9 f Other /Gas/ Pellet Stove Fee State Fee i Fee .3 Pre-Paid at Submittal k4/53 `y$ 10 6 /J e✓e TOTAL FEES ` i n -ze..:-gat! _ .h^;..-__...—.-....�........._... ... ... Y..._�.q.._ MASON CbL NTY PERMIT NO. ( } 4. 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 APPLIC"T INFORMATION CONTRACTOR INFORMATION t 1Ctt. 1. Company _ . . Owner 1 r . �,,..L,.G. Com an Name t Mailing Address '•C. �.-7� Mailing Address t'.0 City_ L L 1 t State ° F Zip Code "`� 17.3 — City ( � t.�f�f n�- Stat �Li.!� Zip Code Phone -1 %/' Other Ph." : i.a�--711-� �;t-l?� Phone '�sk'�/ nv '"" t� Other Ph. Lien/Title Holder I�k`l .r- ' +mot Contractor Reg. 4 '> " 'x `' 1 LW Exp. ' E mail address E Mail Address A ' Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic_Y Existing Septic Connect to Water System _X Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 0 Fire District Legal Description 5AM 3. TI L F IC S LkPI L " G A k 1156 LC E!0 Of 5 f 0.)4i'i i t`ire I t<. I `., 1 Site Address (Please include street name, street numb �j and city) t ('�[ fa G.t`t tr f 1 ti, t k_:i i:i i ,r Directions to site GL. ;�iE �:.-. G"-t ILT _2 1 i `� ,�t i P 1 1 L L Will timber be cut and sold in parcel preparation?Yes(NQ) Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Slopes or Bluffs% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?YestNo) TYPE OF JOB - New_>(,Add Alt Repair Other ,1 PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building 1�1•.�"�� � Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1st Floors I`.,,, d 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 I 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 fpom 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 nqt commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROG ESS INSPECTIONANACTIVITY OF HIJ PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. t X �-� Date: ztt� Owner/Owners epresenta ive/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department (L41[3110 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 I I MASON tbUINTY PERMIT NO. x 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 ; . , ; ( 0 t t. L 4. -1 Company Name , Mailing Address Mailing Address City State ti Zip Code City , iir i ; State Zip Code Phone + ". ' Other Ph. ? ( t Phone Other Ph. Lien/Title Holder - Contractor Reg. # 1 a i.�,Iy' Exp. � 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 _-A-L 6 LL t< r ! o .:t`/ 2 Site Address (Please include street name, street number and city) Directions to site <L L Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff _3_� Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?YeslNo ` TYPE OF JOB - New Y, Add Alt Repair Other €i t "PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor l ' ` 2- d 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. ? 4 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 Irb 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 FORM MUST BE COMPLETED IN INK PERMIT NOLw' , ` PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL ox 6P�ERMIT APPLICATION Shelton (360) 427-Q670;Be" it(360)275-4467• Elma(360) 482-5269 Un the web www.co.mason.wa.us APPLICf4T INFORMATION j 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.# 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. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPC Natural Gas— Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Dr"toaS Showers Spot Vent Fan -r— Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher — Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OVMER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr. Planning Department Environmental Health Department FEES Plumbing&Base Fee Site Inspection Mechanical& Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATrOWA 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360) 427-�670•Belfair(360) 275-4467• Elma(360) 482-5269 n the web www.co.mason.wa.us APPLIC#4T INFORMATION / CONTRACTOR INFORMATION Owner 0CjC �ee_44/ 11 U-C 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.# 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. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site 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 Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixtur No. of Fixtures Fees Fuel Type:Electric_ LP atural Gas_ Heat Pump_ Toilets � Type of Unit ��r►'�y'N�'*7��` Fees Bathroom Sink Furnace Bath Tubs A!r Heatpumps 7 DrP i to t S Showers Spot Vent Fan Aeo' Water Heater "�— Propane Tank f� 0 Clothes Wash r Gas Outlets a Kithen Sinks a Wood/Gas/Pellet Stove v Dishwasher Kitchen Exhaust Hood �j Hosebibs �' Dryer Vent Other Fipd v Other g l Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL O VNER/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 interbst regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr. Planning Department Environmental Health Department FEES Plumbing& Base Fee Site Inspection Mechanical& Base fee UFC Plan Review Fee r Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO. PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O. Box 186, Shelton,WA 98584 Shelton (360)427-9670•Belfair(360)275-4467• Elma(360) 482-5269 Vn the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner P_ MA1Q Company Name SIQ3L_W:n 401' 'n . tNG P10- _11—Mailin AddressMailing Addrq�s_ City tate Lt)Ac Zip Code : City 3b0-a�S-61 t to W Zip Code Phone 360-2�5 QSQ� Other Ph D 013 Phone Other Ph. Lien/Title Holder L.ESr5k W"F 6 Contractor Reg.#'5TRP4'*I"L.bt) E p. t Oq E mail address A14yOSbeLl®ek-%CQTCCQhVVUAnihfS-001 nE Mail Address tfE®S.�I I'`GrviF Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic_ 'S Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No. 00 Fire Di trict Legal Description SAP413.�`S HOME. c CjAk 11ZS W-r t JD OF S P -Ag13 P� TR ( S I oO'r Site Address (Please include stre t n me str et n mber and ci�Y)2l F- (. B.1 tt* Directions to site CE�Y ne-e- Or b-Rb� 3 LLyx IQD�'►��Ak- 'll Pin Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff X _Stream Slopes or Bluffs 1 15% TYPE OF JOB - New Add Alt Repair Other Use of Building r Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPQL_ Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps 7 Showers '1 Spot Vent Fan Water Heater I01 Propane Tank Clothes Washer — Gas Outlets Kithen Sinks — Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information i is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. OF CO NUAMON OF WORK IS BY IVIFANS OF A PROGRESS INSPECTION. << L LL . Date: - 12)200g caner wn rs Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid 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 PERMIT NO. ;k Ptumatf /MECHANICAL PERMIT APPLICATION ,. 426 W.Cedar•P.O. Box 186, Shelton,WA 98584 Shelton(360) 427-9670•I3elfair(360) 275-4467• Elma(360) 482-5269 On the web www.co.mason.wa.us APPLICANT4NFORMATION CONTRACTOR INFORMATIO Owner V P OM SCE I+I L.L LLB Company Name 54le ^ �Kso-n, ,y1r, Mailin Address ;0. 9LI57 Mailin ress 41r5� City O.Em e Itate_U)4 Zip Code City t V, t to-WA Zip Code 13�— Phone 3�-2'75-O SD2 Other Ph. 0-' - pt 3 Phone�60'�7 S-670 Other Ph. Lien/Title Holder ULSTER. Contractor Reg. 4 5 EPI l#I'2 LJA) E p, t d9 E mail address<ky©5het l0 et�YA9I CQWML rtifieS. E Mail Address��� ®Sal VtiG. h��. 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. � Fire Diptrict Legal Description SAM 13 TRF- S NUMG `' GA[Z TRS L. r:0 OF SP ag15 PTI" TR 1 5 1001 Site Address (Please include stre t name str et number and ci y)21 NE R ArNCE ifo ,(, P_t) •_ GEt..FAt e L(A Directions to site eC�Y ry K ©V RkcxtQ 3 Ltn61 Qorncwt cam. `t i P_-oel 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 ENT 2 Location of;Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Sh-6.0,Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPG_ Natural Gas Heat Pump_ Toilets T e of of Uni Fees Bathroom Sink nace Bath Tubs Heatpumps Showers S Water Heater Gt Propane Tank Clothes Was Gas Outlets Kithen Sink Wood/Gas/Pellet Stove Dishwash Kitchen Exhaust Hood Hosebibs Dryer Vent Other ' Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL O VNER/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 rov ided is accurate and grants employees of Mason County access tolhe above described property and structure for review and inspection. O OF CqYTINUATION OF WORK IS BY MlEANS OF A PROGRESS INSPECTION. _OMAMU 411 . L L& . Date: 5 lUA' . I?;i 2W9 Owner wn rs Representative/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 Constr.- Planning Department Environmental Health Department FEES ` Plumbing & Base Fee Site Inspection r , Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pell . ,% Other Violation Fee 1 TOTAL FEES PERMIT NO. MASON COUNTY PLUMBIt4IGNECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O. Box 186, Shelton,WA 98584 Shelton (360)427-9670•Belfair(360)275-4467•Elma(360) 482-5269 n the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATIO Owner.ROM AtocCt Company Name tyti ' � � , ++-'C' Mailinq Address ;C). 1301 9 57 Mailing Add ress . OC City tate jq Zip Code � City &i t►� t to�) Zip Code y� Phone `a?5`© � Other Ph 13 Phone 67 Other Ph. Lien/Title Holder LFSt F-11?- GE1" Contractor Reg.# Exp. G , Gy Email address ALku0 ( 10 el'YOrt CC'OU Wi-lih eSS 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. l Fire Di trict Legal Description SAM A.Tt19-ME . HOME, " GA2 tkS 1-QT'+Ct OF` S P ' 173 a� N. 1 5 100, Site Address (Please include stre t name, str et number and city) 1 E N C H� et WA Directions to site 'ry r 01 `stu�E Zt.A.tt 3 o10 1&f-lavl aie.. %11 P.Cr 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 UPC C'rvT CAkE. Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC Natural Gas— Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs / Heatpumps 7 Spot Vent Fan Showers , P Water Heater ] t , Propane Tank Clothes Washer - V Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher � �— Kitchen Exhaust Hood Hosebibs '; Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF C9"NUATION OF-WORK IS BY M S OF A PROGRESS INSPECTION. "i` ...� ..t�s��CV4 tf ' L. Date: l:l C. UC Owner wners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grouo-Type Constr.- Planning Constr.- Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical &Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES f � 1 w . MASON COUNTY PERMIT No. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360) 427-�670•Belfair(360)275-4467• Elma (360) 482-5269 n the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner L -I/ ACC HILL L LC , Company Name 7c Mailing Address Ps Mailing A dress City u,LfAti�- State ,,j_A Zip Code City r tate �' Zip Code Phone a.t �75 L j . Other Ph.''oa '1 `i �S( 13 Phone I �"� L..7 Other Ph. Lien/Title Holder i I" # f K L tt I �" �++' Contractor Reg # , � ` i i.t ' k`iLAI-' Exp. �, 1,i 1: 'I E mail address I—, t 'A u . 14;"� �;: L rt Cu r tj;air; i IE Mail Address {t E f 1' 1 . Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic_ 'r Existing Septic. Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No. � % � . 7 <1 UL l _A Fire Di trict Legal Description:��1LI C_". Ti ki Lll (� k� i I�� t �.11t i t• `�, L_r:t" I_ t , r x'7 iSite Address ' Please include street name street n umber and city),,'l` t+4,E.} �x� �(;irI CI r,1'i L C. I_:-i:. � CL I' '1 i►'- UL,A D sections to( Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff )� Stream Slopes or Bluffs > 15% TYPE OF JOB - Newer Add Alt Repair Other Use of Building {_9,..,, f7 Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPC Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer ` Gas Outlets Kithen Sinks t Wood/Gas/PelletStove Dishwasher v Kitchen Exhaust Hood Hosebibs .' Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X _._•• ' i I i .# G Date: t, Ownerj,6wners Representative/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 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 Name R&K&ice 1�11. Uc Parcel# 12332 Sb 20040 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: hgp//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" 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- d cribed property for review and inspection as may be required. (20 VL , ��'ul r/Agen Contractor(circle one)Date: O 4 Page 2 of 2 MASON COUNTY PUBLIC WORKS DIRECTOR/COUNTY ROAD ENGINEER Shelton, Washington 98584 TO BE KEPT IN THE DATE: August 5. 2008 PARCEL FILE INTER-DEPARTMENTAL COMMUNICATIONS TO: Jim Scholz PARCEL# 12332-50-90040 Charell Holcomb FROM: John Sliva, Programs Engineer-PW PERMIT#: COM2008-00073 GRD2008-00007 SUBJECT: Stormwater Site Plan (SSP)/Grading NAME: Romance Hill LLC Jim and Charell The engineered stormwater/grading site plan for the proposed site at 21 Romance Hill in Belfair was received and reviewed by Public Works. The stormwater plan is written for an urgent care clinic and associated parking. Grading will involve the formation of the upper and lower parking lots and grading for the structure. Stormwater features include an existing stormwater infiltration gallery to the west side of the structure that will receive runoff from the roof and 3 existing area drains. The parking lots will convey runoff to two infiltration beds. The infiltration beds will have sediment tanks prior to the beds and are located to the south of the parking lots. The stormwater site plan (SSP) was sent for outside review by Public Works per request of Rick Krueger. ALKAI Consultants, LLC, reviewed the plan. ALKAI Consultants comment letter states that based on the documents supplied,ALKAI agrees that the proposed Stormwater Site Plan (SSP) meets the Mason County Permit minimum requirements as set forth in Chapter 14.48. The Stormwater Site Plan/Grading Plan will be considered acceptable by Public Works based on the information provided and recommendations of the outside reviewer,ALKAI Consultant's, LLC, if the applicant will accept the following conditions: 1. A Declaration of Covenants Associated with Privately Maintained Storm Drainage Facilities (Operations and Maintenance Agreement) is recorded. A copy of the Operations and Maintenance Agreement shall be provided to Public Works. 2. Engineer of record shall document the stormwater facilities were built to the drainage plan and drawings and note any changes upon completion of the stormwater facilities. This documentation shall be provided to the County for final acceptance of the completed stormwater facilities. E r 3. All retaining walls over 4 feet in height will be engineered and approved by the building department 4. Issues regarding the Transit Authority and Washington State Department of Highways concerning a transit stop, turn lanes, and sidewalks will be resolved between the applicant, planning, public works, and those two agencies. 5. Drainage ditch along Romance Hill Rd. will be improved to redirect runoff from the abandoned pond on the property by the parking lots to the pond across SR#3 as approved in GRD2003-00002. 6. Entrance CMP culvert on drawing shows 12". Culvert shall be minimum 18" Recommend 24" culvert. Comments and recommendations contained in the report should be incorporated into the site development plans and made conditions for permit issuance. Adequate erosion and sediment control features need to be implemented during land disturbing activities to protect neighboring properties and State waters from adverse stormwater runoff impacts. The migration or release of silty water or mud from the applicant's property will be considered a violation of County and State water quality protection regulations. Please feel free to contact me at 724 if you have any questions regarding these comments, or if you feel any features need further discussion or attention. cerely, ohn Sliva P ograms Engineer F lowMASON 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.mason.wa.us Special Inspection Authorization Project Owner: Romance Hill, LLC Building Permit Number: COM2008-00073 Project Address: 21 NE Romance Hill Rd, Belfair Architect of record: D.H. Briant&Assoc, Archt In addition to the i nspections required by International Building Code (IBC) Section 109, the owner or the engineer Pq(_-6 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 g who will perform the required special inspections for this particular project. The specified special inspector(s) shalt 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) ,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) /117. 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. X,0. Soils. Inspections for fills 12 inches or greater to be performed in accordance with IBC Section 170 4.7. ❑ 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) N ❑ 13. Spray-applied fire resistant materials. Inspections shall be in accordance with sections 1704.11.1 'through 1704.11.5. l} ❑ 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. 0 Installation of structural epoxies ❑ Installation of"high-load shear panels" // ❑Structural Observation (IBC1709) �IOther: 11L.1c 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: t`-R 'ZAl`� 'D SSoct p -S M Vvxr cry 1LVe-%%S Authorization: I hereby state that I am the legal owner of the project property, or that I am the legal owner's agent gwhn ' t employed by a special inspection agency or contractor associated with this project. In addition, I agree with the special inspection requirements established by Chapter 17 of the International Building Code as by Ma n County. to(Cq- P Punted Name '`'er ❑Agent Date J PURPOSE OF SPECIAL INSPECTION Special inspection is the monitoring of materials and workmanship which are critical to the integrity of the building 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 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: 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 i 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 be 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 plans/specifications, • Name and title of each individual notified and method of notification, and • Resolution or corrective action. 5. 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 architect/engineer 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. s i 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. (8/22/2008) Debbera Coker- Revised special inspection authorization form Page 1 From: Debbera Coker To: steve@sjinc.net CC: Anthony@dhbassoc.com; bait@nbse.com Date: 8/22/2008 8:54 AM Subject: Revised special inspection authorization form Attachments: Debbera Coker.vcf Hi Steve, I received a revised Special inspection form signed by Rick Krueger. The revision is not approved until all items relating to the special inspection requirements are addressed. Note that on Sheet S003 the engineer of record,Bart Needham has specified special inspection requirements. In addition there are also notes within the plans concerning structural observation,and it was found during review that acoustic tile installation shall require special inspection because of seismic location. Until the issues cited above are addressed in accordance to IBC Chapter 17 and as required elsewhere in the code the original special inspection form applies. Debbera Coker Mason County Building Department Lead Plans Examiner Phone: (360)427-9670 ext 510 FAX: (360)427-7798 e-Mail:dlc(dco.mason.wa.us DictA,556D Qeed h,, �C�ca.v r✓oole j/' N�0 N E � ►'�rn.zv��s f�e S' ,(ems eA,&tS C" a J; V, 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—wwwQ_4A+r�.e&i 3b Special Inspection Authorization .,? _'/. t i� 9J,q -,So• 9�© Project Owner V+IIo►14 `I i t LLC Building Permit Number CowlZOog--o00-73 Project Address Z E a ; Engineer/Architect of record a i In addition to the insp$eSo reqsuired by International Building Code (IBC) Section 109, the owner or the engineer or architect of record acting s the owner's agent shall employ one or more special inspectors who shall provide special inspections during con ruction on the types of work listed under IBC Section 1704. This form must be completed by t owner or the engineer or architect of record, prior to permit issuance, indicating who will perform the required sped I inspections for this particular project. The specified special inspector(s) shall perform the required special inspec 'ons during construction of the project, submit all inspection reports to the Building Department and provide a fin signed re rt stating whether the work requiring special inspection was, to the best of the inspector's knowledge, i confor nce to the approved plans and specifications and the applicable workmanship provisions of the IBC. The 11 checke ems require special inspection: i ❑ 1. Concrete. During the taking st cime nd placing of reinforced concrete. (IBC 1704.4) ❑ 2. Bolts installed in concrete. Prior t a during the placement of concrete around bolts when stress increases permitted by Table 1912. n 1912.5 are utilized. (IBC 1704.4) ❑ 3. Erection of precast concrete me bers. odi spection per ACI 318: Ch 16. (IBC 1704.4) ❑ 4. Shotcrete. Continu inspec i per A 5.10 and IBC Chapter 19. (IBC 1704.4) ❑ 5. Reinforcing steel and stressing steel tendo s. Inspection of reinforcing steel including prestressing tendons. (IBC 1704.4) ❑ S. Welding of reinforcin Inspectio of the weld g of reinforcing steel according to AWS D1.4, ACI 318: 3.5.2, and IBC 3.5.2. 17 . ) X7. Structural welding. Welding i ion sha be in comp' nce with AWS D1.1. (IBC 1704.3.1) a ❑ 8. High-strength Bolting. installatio gh-strength bol shall be periodically inspected in accordance with AISC LRFD Section M2.5. (IBC 1 ❑ 9. Structural Masonry. Masonry constr be inspected d evaluated with the requirements of IBC section 1704.5. ?' 10. Soils. Inspections for fills 12 inches or gr rformed in a ordance with IBC Section 1704.7. t ❑ 11. Pile foundations. Inspector to be present a ndations are ing installed and during tests. (IBC ' 1704.8) ❑ 12. Pier foundations. Special inspection of pier fo ings are r quired in seismic Zone D. (IBC 1704.9) ❑ 13. Spray-applied fire resistant materials. Inspection shall be in accordance wit ections 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 r ❑ 15. Smoke-control system. Smoke control systems shall be tested by a special inspector per IBC Section 1704.14. ❑ 16. Special cas . Special inspection shall be required for proposed work that is, in the option of the building official, unusual in its ture such as alternative methods and material of construction, unusual design applications, and materials and syst s required to be installed in accordance with additional manufacturer's instructions that prescribe requirements contained in the IBC or referenced standards. ❑ Installation of stru ural epoxies ❑ Installation of"high-load shear panels" ❑ Structural Observati (IBC1709) []Other: it jSpecial Inspector Selection: The special inspection agency and spe 'al inspec hall be registered by the Washington Association of Building Officials(WABO)for the particular type co tion or operation requiring special inspection. Such inspector(s) shall be selected by the owner or the own acfint and approved by the Building Official prior to issuance of the building permit. The owner's agent shal actin , or employed by the special inspection agency or the contractor for this project. Name of Special Inspector or Agency: Inspection: Registration Number: -br��a1y s o l3 cz. .00 P4UA)1__ Authorization: I hereby state that I owner o e project property, or that I am the legal owner's agent who is not employed by a special ins cy or co ractor associated with this project. In addition, I agree W-66 r�ply with the special inspecti uiremen establis d by Chapter 17 of the International Building Code as ado d by Ma on County. Signat a Pri d Name Owner ❑Agent Date PURPOSE OF SPECIAL INSPECTION Special inspection is the monitoring of materials and wo anship whic are critical to the integrity of the building structure to assure that the approved plans and speci being Ilowed and that relevant codes are being observed. Special inspections are in addition to those c ted by the unty building inspector and by the engineer or architect of record. Special inspectors furni ion at al 'mes that their presence is required by the code, the plans and specifications, and the enforcing is n. Goo mmunication between the special inspector and the designer, contractor, and building depart t is essential. DUTIES AND RESPONSIBILITIES OF THE SPE P R: Special inspectors are individuals with highly developed, sped kills wh bserve those critical building or structural features which they are qualified to inspect. Duties of p t and/or inspection agencies include the following: i t 1. General Requirements it Special inspectors shall review approved plans and sped tions 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. 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Cn a (D m O .r N C v o p x :3CD .0 .+ n �' iq 0 =r = ° o co um, n; W a � Qm q o / lir § G =r � % \ cr, CD E o i < i \ C) k ¢ § cr � co % CL— n � CDc r8 : 0 § o D0 � Z ■ � k_to 0 CDm /7cx q :3 £ ¥. 2 § $ 8 § CD Q co > \ CL . m � J % � 2 :3 % kk g -nE 2g� CD CD 8 � \ 0 � . a \ \ E 0CCD' 0 /k % CL � E � § Ek � / k . » FE CEe 7 � to agD k 0 'ao _a a § C) @ � 2 3 �« cn } cn8 « m 2' R 0 00 ( o � \ % M E m � � § j . E V Name RLVIanck t71��1/ 1 C', Parcel# �233 z 5-0 ct0040 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'. '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. 'Common 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. Surface Type Length X Width = Area *All dimensions in feet Buildings X = X = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: eaves/gutters) X = Driveways X = X = Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition above table X = Patios/Walks X = X = Any paved, gravel or packed area per definition above table X = Others X = her ' 11:1 ::.:. .. . f. ece..r 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 acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- sen d properly for revie and i ection may be required. U�AX caner/ ent/Contractor(circle one)Date, L" I e 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