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Home My WebLink AboutBLD28415 Raised House and Deck - BLD Permit / Conditions - 6/19/1991 BUILDING PERMIT APPLICATION MASON COUNTY j DEPARTMENT of GENERAL SERVICES V/ P.O. BOX 186 SHELTON, WASHINGTON 98584 /r/9 p 427-9670 DATE ISSUED(cam // / PERMIT NO. NAME MAIL ADDRESS CITY dSTATE ZIP PHONE OWNER Mr . Robert Gilbert NE18581 N . ShoreRd . Tahuya , Wa . 98588 275-2615 DIRECTIONS Same address as above . TO JOB SITE q 32219-24-00020 DESCR. Tr . 2 , GL 3 , &TL LEGAL ' s , Sec . 19 , Twp . 22N . Rge . 3WWM NAME MAILADDRESSNEW ADDITION ALTERATION REPAIR XX MOVE REMOVE WORK Raise existing residence approx . 16" , place conc . foundation under same as per plans . CARPORT NOTICE BEDROOMS — DECKS Y OR N TOTAL SQ.FT. _ DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SO.FT. TOTAL SO.FT CONDITIONING. NO.OF STORIES — BASEMENT YORN THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. _ — TOTAL SQ.FT. CHECK ONE ABANOONEDFORA PERIOD OF 1800AY5 AT ANV TIME AFTER WORK IS COMMENCED. PERMANENT FIREPLACE -- ATTACHED SEASONAL SHORELINE _ — DETACHED OWNERSAFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW ROW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE ON APPROVAL FROM ROM THETHEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAININGAPPR L FROM THE BUILDINGA. TMENT. XOWNER ' DATE 5/29/91 XBY DATE FOR OFFICE USE ONLY APPROVED APPROVED BUILDING VALUATION '� J DEPARTMENT YES rvo DEPARTMENT YES No PUBLIC WORKS FEE HEALTH � ' FIRE BUILDING PERMIT PLANNING \Y D.O.T. BUILDING (�((� .�( — / PLAN CHECK Y SPECIAL CONDITIONS BUILDING GROUP 3 PRE-INSPECTION SHORELINE T, WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE �/S STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK Br AP PROVED FOR ISSUANCE PERMIT VALIDATION TOTAL S L� f /�� •'>9-y/ BY 6"—" I/ CASH cK MO MASON COUNTY DEPARTMENT of GENERAL'SERVICES Courthouse Annex 411, N. Fourth &W. Cedar APPROVAL OR P.O. Box 186, Shelton,Washington 98584 LOAN POLICY M (206)4263-5561 building environmental health maintenance parks&recreation planning sewer&water WATER SUPPLY $22.50 SEWAGE SYSTEM $40.00 1) Private Wells 1) If system on record Water Sample taken by health official; inspection of Tank pumped; receipt obtained and submitted with facilities application, then call for Inspection 2) Community water system 2) If no system on record If on an approved community system, no inspection Tank pumped, receipt obtained, submitted with or sample is necessary. However, approval is _ application, portion of drainfield lines exposed to subject to adequate sample history x 7 verify size and existence of drainfield Checks Payable to: WATER & SEWAGE $52.50 Mason County Treasurer APPLICATION FOR REPORT ON INDIVIDUAL SEWAGE DISPOSAL SYSTEM AND/OR WATER SUPPLY It is the established practice of many lending institutions to obtain information from the local health department pertaining to the acceptability of the Individual sewage disposal systems and/or water supplies. INFORMATION REQUESTED ON: Q INDIVIDUAL SEWAGE SYSTEM fit WATER SUPPLY R Located at: NE Numtxr=- street city Zip Directions to Property: CONT T ROBFRT TT RFRT AT (906197 S 9h i 5 nR gr'nTT nTT R.R- AT Legal Description: s a Tn T n Owner or Builder. Year Home Built: +' Purchaser. HPFTNANrE Number of Bedrooms: -- Send Report to: Name j Ity p Address / u Phone:- (?or,) 975-2Ftc Signature of Applicant: _ __- ------------------------------ FOR HEALTH DEPARTMENT USE ONLY - DATE: w '2 FEE _/ 'C RECEIPT # SEWAGE DISPOSAL SYSTEM Date—Site Inspection ouse Occupied ❑ House Vacant Date—Final Inspection Is the opinion of this health department that this Individual sewage system Is functioning satisfactorily at the time of inspection. Sewage was discharging on the surface of the ground. There are Indi cations that this system may malfunction at times. There Is Indication of malfunction on nearby properties. Other. WATER SUPPLY: �t1 I�� The supply does conform with drinking standards of this department. ` Remarks: r 1 Date - DISKS 11113(RI 81) / STATE OF WASHINGTON DEPARP{L7fff OF SOCIAL AND HEALTH SERVICES ' WATER BACTERIOLOGICAL ANALYSIS = _. SAMPLE COLLECTIOWfREAID INSTRUCTjONS ON BACK DFCALDENRODCOFX i-- If instructions are not followed, sample will be rejected DATECOLLECTeQ, TIMLCOLLECIED I COUNTY NAME MONTH Y YEAR ❑ AM PM ' PE OF SYSTEM IF PUBLIC SYSTEM,COMPLETE: CIRCLE CLASS ❑ P;�LI° I I.D. No. t z a a INDIVIDUAL NAME QF3'j'ST M t TIOT nI rr SPECIFIC LOCATION WHERE SAMPLE COLLECTED SYSTEM OWNER/MGR.NAME AND TELEPHONE NO. IH•ncn••rm a xrod.ure a�•�w..�oum•ml SAMPLE C LL TED BY' SOURCE TYPE ❑ SURFACE CCYWELL ❑ SPRING ❑ PURCHASED ❑ COMBINATION w OTHER SENUREPORT TO:IYncl FW m��s.((('''��ae aM iiP��, s � •s ., - WASMNGTON _ TYPE OF SAMPLE. - 1a.n o�ow m 11.•cavnN 1. IP.�DRINKINGWAT ER-- �❑ Chlorinated(Residual:_Total_Free) r check I::--'-lent iltered , ` Untreated or Other 2.'QRAW SOURCE WATER 3. ❑ NEW CONSTRUCTION or REPAIRS 4. ❑ OTHER(Specify) COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE PREVIOUS LAB N0. PREVIOUS SAMPLE COLLECTION DATE I — F)EMARKS: - t LABORATORY RESULTS(FOR LAB USE ONLY) MPN-COL-1 141 STD PLATE COUNT SAMPLE NOT TESTED - BECAUSE: - - - r MPNq TEST UNSUITABLE ❑ Sample Too Old T• ❑ Confluent Growth ❑ Not in Proper Container MF 2 ❑ TNTC Insufficient Inlormation❑ Provided—Please Read Instructions on Form 3. ❑ Excess DebrisFEC❑ 4 ❑ fly FORD INKING WATER SAMPLES ONLY,THESE RESULTS ARE - ^TISFACTORY- " ° ❑ UNSATISFACTORY �R REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. - _ DATE.TIME RECEIVED— -Y RECEIVED BY J ..a DATE REPORTED LABORATORY: - REMARKS CLASS t •DSHS REGIONAL OFFICE ®a EVERGREEN SEPTIC TANK SERVICE, INC P.O. BOX 4026 BREMERTON, WA 99312 PHONE 373.0158 0 I [3 Customer's - Order No._ ! ,." � 1pote A,yU 1t9( Address�U��•u• fs_3 � _' k�t+Y �- S•e% , SOlO r USH C.O.D. ARG NACP RETp. PAID OUT OUAN. DESCRIPTION PRICE AMOUN7 4�- 1.41 _.t_ �,� N•S� ,a 1� v TOTAL 501-A All doims and mlwm .d Roods MUST be =ompan..d by Ih'u b II ReCd by r M RwuwudgIKM 1 .. .. .. �AF�ECO EXHIBIT 'A' DESCRIPTION: Order No.: Q-84317 A tract of land in Government Lot 3, Section 19, Township 22 North, Range 3 West, W.M., in Mason County, Washington, described as follows: COMMENCING at the Southeast corner of said Government Lot 3, which is identical with the Northeast corner of the plat of Sportmen's Waterfront Tracts at Bald Point on Hood Canal; thence South 88' 26' West, along the South line of said Government -Lot 3 and the North line of said plat of Sportsmen's Waterfront Tracts, 585.54 feet; thence North 4' 23' 25" West, along the Westerly right of way line of the county road as now established, 454.00 feet to the initial point of the tract Of land hereby described; thence continuing North 4' 23' 25" West, along the Westerly right of way line of said county road, 80.83 feet; thence South 81' 07' 30" West 42.03 feet,-more or less, to the Westerly line of said Government Lot 3; thence Southerly following along the Westerly line of said Government Lot 3, to a point thereon which is South 81' 07' 30" West from the said initial point; thence North 81' 07' 30" East to the said initial point. ALSO, all tidelands of the second-class, as defined by Chapter 255 of the Session Lava, formerly owned by the State of Washington, situate in front of, adjacent to or abutting upon the above described upland. t 7 ire i y Ch@cksd Derr Plat V*L__eQ Order N- SKETCH Of PROPERTY SET UT IN ATTACHED ORDER To assist in locating the premises. It is of based on a survey, and the company assumes no liability for variations, any, in dimensions and location. S -- ._� x 4 Q.iZL'S 2 3O• SLR . • yt a4 ! _ r� i�c " it ✓w • � - ir jo, "„ a _� •—Y.` - , .,�✓' . •:i•r .Y:k�T ., ..Scar. •:�L L.M o. .. r ♦ w. •rf..T Note—'Phis map does not purport to show all highways, roads or easements affecting the property. j . PACIFIC WEST MORTGAGE CO., INC. 207 S.W. 153rd BURIEN, WASHINOTON 981M Tuly 29, 1987 JUL 3 0 1987 Mason County Dept. of General Services P. o. Box 186 GENERAL SERVICES Shelton, Wa 98584 Attn: Nancy RE: Septic and Water Inspection GILBERT, Robert C. NE 18581 N. Shore Rd. Tahuya, Wa 98588 Dear Nancy, Please find enclosed a copy of the water sample report prepared by Laucks Testing Laboratories for the above mentioned property. Please forward your report on the septic system and water system as soon as possible. If you have any questions or concerns please contact myself or Margaret George at (206) 433-7700. Sincerely, i Scott Gilbert ` Account Executive SG/mg Enclosure aucks Testing Laboratories, Inc. Certificate 940 South HarreySt-Seatt1eWa5h1n9t0n 98108 (206)767-5060 Chemistry Miaobdogy.and Technical Services CLIENT: Pacific West Mortgage LABORATORY NO. 4757 P.O. Box C DATE: July 15, 1987 Seattle, WA 98166 ATTN: Scott Gilbert REPORT ON: WATER SAMPLE IDENTIFICATION: Submitted 07/02/87 and identified as shown below: Robert C. Gilbert Property N.E. 18581 North Shore Rd. Tahuya, WA_98588 275-2615 TESTS PERFORMED AND RESULTS: Darts per million OWL) I' Nitrate as N L/0.2 Key L/ indicates "less than Respectfully submitted, Laucks Testing Laboratories, Inc. J. M. Owens JMO:la3 III I y � rn.wv«t.ne..n.a t«m...naw w.«m.v.+�.w^�'+".•«m'o«ron w.no....mn..w.sm..a..M w a u»w..d m+m.o.ro«+m w«�oTW` •mow c n.o«.ean.,e.at bi tM Cv V. ^n^c.dPM n�« " w ww"M n moo.f M W<cawq a III I, II V 3 aaVC',_ GCoac, Shorelines: ('4 `1'a 1 Plumbing: Setback: Mechanics : Special Interior: Conditions: FINAL: Mobile cme:�_ Smoke Detector: Remarks: oozing: Setback: Foundation Walls: Framing: Fireplace: Wood Stove: TYPE - -RAISE RESIDENCE (FOUNDATION) Permit No. 28415 No. Floors 1 Sq Ftg Owner. GIL Tel— -L615 Date -1 -91 Address NE 18581 N. Shore Rd Tahu a Zip Contractor Seir D#A% Rna�n p Address L T Legal Description - - Nortn ore R Direction to project site Tahu a p un ing _ Mec anica Sewer Woo Stove Fireplace Deck arage _ arport Basement —Loft —other RAISE HOUSE AND DECK NNLY 5 7 ' &WL *VY'G731 Shorelines: Plumbing: Setback: Mechanical: Special Interior: Conditions: FINAL: Mobile Hcme: Smoke Detector: Remarks: Footing: Setback: Foundation Walls: Framing: Fireplace: Wood Stove: TYPE (�-- Permi o. No. Floors Sq Ftg Add Teh Address Zip Contractor Address Zip Legal Description Direction to project site Plumbing Mechanical Sewer Wood Stove Fireplace Deck age =Z sport Basement ----Loft Other