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HomeMy WebLinkAboutBLD2001-00631 ReRoof - BLD Permit / Conditions - 6/22/2001 PERMIT NO.: BLD MASON COUNTY Lt BUILDING PERMIT APPLICATION 1 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACt-Ok INFORMATION Owner Contractor Name 4p, Mailing Address Mailing Address City StateR Zip Code 's City State Zip Code Phone(��, 92r- & �YOther Ph.( ) ,, Ph.( Other Ph.(� Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic W Connect to Sewer System Name of Sewer System Well tr' Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Ja /S-O / Fire District— Legal Description Site Address(Plea7sg include street name, street number and city) Directions to site ,.,,.f nee.. .A /Irl a2 _ f Will timber be cut and sold in parcel preparation? (Yes/No) A10 0 vorr jer Is your property within 200' of the following: Body of Water(Name) I A&f(hT altwater j Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE,❑ TYPE OF JOB New Add, Alt Repair_ Other Use of Building Describe Work �, !a-''!ter- �A ./ a .AI v- �' j No. of Bedrooms No. of Bathrooms_SQUARE FOOT GE-1st Floor 2nd Floor APOOAf W1 3rd Floor Loft Basement Deck Other sq. ft. j Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. i I NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-[certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No es shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. k IDate X Date f FOR OFFICIAL USE BEYOND THIS P INT Accepted by__ 1�►,�^ Date�= Gbmittal Amount Due Receipt N� .. ::.:. D'ERI 1RTMENT' �VI!~W APPROVEP DENIED CCaNDITI+ ( C.plw Building DepartmenQ 0116Ay 01 Occ Group - Constr. Planning Department Environmental Health Department f Public Works Department I i Fire Marshal Valuation:?$ FEES' ._. Building Permit Fee .6 Site Inspection Plan Review Fee L a1 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 ( ) TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO.: BLD 3 PLEASE PRI SS HARD MASON COUNTY BUILDING PERMIT APPLICATION �s 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City ­aa2 State� Zip Code P?S� City State Zip Code Phone(.JGo�a2 GzS%YOther Ph.(� Ph.( Other Ph.(. ) Lien/Title Holder P Contractor Reg. # Address Expiration 'SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well ✓ Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. / 4-00 / Fire District—$' Legal Description f Site Address(Pleas& include street name, street number and city) Directions to site 41,2,j% Will timber be cut and sold in parcel preparation? (Yes/No) Aze) C9tJ« .3&V Is your property within 200' of the following: Body of Water(Name) a_�� Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stre m Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add _Alt Repair_ Other Use of Building IDescribe Work Auw, _saw ,uk, �Qe��z<i�c? s mr- .�/,.A.-a 01..t A No. of Bedrooms No. of Bathrooms_ SQUARE FOOTAGE-1st Floor 2nd Floor A""y 1JrAn7 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year s Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF { CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. Ng.WwMes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. :..:..:......:.:.. . :.:..<............:....:..: ENIE >::. .:.:..:..: ...::: »..,_.:.:........::.:.:.::.:;.;::.;:.::.: ::::.:::.::: ..:..:.:......,......:...:.:..:::.:...:...........;'.;:.>':.:>;:::•;;:::.;;;;;;:.::;:.;;:::.;:.> ... .... ... \.// ....... .:i::::::.:.�::::is:•::::::.::.:ii:::.i:.i:.i::. :• ...i..."•:' is:. viiiiiii:{•i;:iyiiio+:•i:•i:4:•i:•:4i:i:4: . .. :.:: :Y'EI ::'::L: - •. h.' ^:tititititi•isv:^:vi:4}:•i:•i:ti:^':IX':j;i:; Building Departmen Occ Group Constr. Planning Department Environmental Health Department �A Public Works Department Fire Marshal i i Valuation $ ANN G Building Permit Fee Site Inspection : '✓ i Plan Review Fee EH Review Fee ' Plumbing&Base Fee Planning Review Fee i Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) .. TOTAL FEES PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION � I� 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name • Mailing Aa&69s gi 6. Algvg fl, Mailing Address City State Zip Code ' City State Zip Code Phone ,JW-r-j,'V'"Other Ph. Ph.( Other Ph.( � Lien/Tit e Holder 4V Contractor Reg. # Addressito Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well I,— Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. / / Fire District Legal Description §0 Address(PlezO&include street name, street number and city) Directions to site d �-Clog* r —11v13X �^ Will timber be cut and sold inparcel preparation? (Yes/No) J j,05 O..f Is your property within 200' of the following: Body of Water(Name) {+ / Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair�Other Use of Building Describe Work "' No. of Bedrooms Z No. o Bathrooms_ SQUARE FOOTA E-1st Floor 2nd Floor jo� "I,fs �� 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Atta ►led Detached MOBILE HOME INFORMATION-Make Model 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. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No es shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. Date X Date ,a FOR OFFICIAL USE BEYOND THIS POINT .� Accepted byy ' Date! bmittal Amount Due ^► Receipt N� , 1PF'RQVEf� R;BNiD; C4NDITION 0aB. Building Departmen Occ Grou `Constr. Planning Department 54L`7 t610( Environmental Health Department Public Works Department Fire Marshal Valuation$ E - 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 ( ) TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION II Case No. Name..�ts3 r .4r�C PARCEL NLIMBER_qA2„J f Sn tgw 1� Date CC.ZgzZo/ SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site -plan Lot Dimensions Fences !u Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography UJ Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line- , I Fadjacent property line I O I m . Wtaa I 1 � � I ''inc S 04 Q I jQ' /n1 I I I 0 adjacent property line- I ' E-adjacent property line SAMPLE SITE PLAN adjar�nt property lined 3zc� _ _ f-adjacent property line a 30' rR�SCRvE 3�1 SFACO J AL ' a ,� _ et�K '� 1 I VAG►vT 1 c*AMAG S 1 % I�,`�\ I P1ioPmCD R T A&RLd"TWiAL 50, I 1 I 1 \ I \ /DO I I L—e-LL I I adjacent property lined ; I �. / hoc \; Fadjacent pro pert'line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dlstar.ca to ruci-ra.N� diS'�a Y+LG to SIOQ2 �'o¢ / 1 dis+an a� to 60/ tiL 0 Sign e D RECEIVED MASON COUNTY JUL -6 2001 DEPARTMENT OF HEALTH SERVICES July 05, 2001 PQ 8OX 1666 SHELTON,WA 98584 SHELTON (360)427-9670 PAX (360)427-7798 ELMA (360)482-5269 JAMES CIARK SELFAIR (360)275-4467 P.O. BOX 86 SEAT TILE (206)464-6968 TAHUYA WA 98588 Case No.:BLD2001-00631 Parcel No..322 1 9500001 9 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: r_< Approved septic records or p � approved septic design for bedrooms v: Please see Com ments at the end of this Letter. Please call me at (360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: We need an as built of your existing septic system. I have enclosed a list of designers that may help you with this. If you decide to do it yourself, you will need to expose the ends of the drainfield, d box and tank, dig a hole next to the drainfield hole to confirm the soil depth, apply for a review for $85.00 and we will draw up the as built. 6r.7�7 4 S 2,10 07/05/2001 1 of 1 f3L02001-00631 0� C � CD o dc� (DM a C- < v m CD I (p CD 0 o �' c �' 0, c �-' °' '� D y w c c °� � C G � aG ; fin o w CD -, m m 0 0 �• m -o Q m mmmZ a � D (n m nM � ZDv23 r o CD � pvT -um � 0 � z n (D cwn ° CD CD 0m0) 0m p -naC z zX0) X ;u co) co ((a � 0 o 3 Cl) �- 0 :3 -U N O p .n m °* m na o z m c Z o OfJ o pIz 00 a 0, m 0 C c0D 0 m (Znccer co Z c o 0 D v w CD -1 u� (n T W Z p m R m CL cl m N (D CD m o Cl. o �, n a) CD C = rt � C z n (p CD G m (n Z (D O O 2 CD a 2 (D •�-► -' o 0 O O O N am► N yo O Ul 2 0 N =-CD O O O 7 (G D Z 'n1 w O O O d 90 O O p 71 71 -1 -nn n O ji K Cif tQ > O �' C O CD V -I N r X H = co C_ C cc W Nr 00� OTo m N O o m w r -, o ao r Z �, v c c C 0 Om OD p N (D to n'o _ p Z 10 a lzO 0y mr: O X m -1 m Do 0o m -9 'o -n -n w O mw E. 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WALLBOARD NAILING date by by Water Lh FINAL INSPECTION to by date by date by zL2zjO-z m NY — Lz^o GD(nqu L"OQ2 gym' 2,lf9& l` J - J 1V O