HomeMy WebLinkAboutBLD2009-00926 Final 2 Story Detached Garage and Determination of Adequacy - BLD Permit / Conditions - 10/20/2009 ' Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2009-00926
OWNER: DAN NORDSTROM RECEIVED: 10/20/2009
CONTRACTOR: LICENSE: EXP: ISSUED: 2/23/2010
SITE ADDRESS: 7261 E STATE ROUTE 106 UNION EXPIRES: 10/22/2010
PARCEL NUMBER: 322335000017
LEGAL DESCRIPTION: SUNNY BEACH PCL 5 OF BLA#04-58 &T.L.
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW 2 STORY DETACHED GARAGE WITH STUDIO ON 2ND FLOOR ST RT 106 PAST UNION TO SITE ADDRESS ON THE LEFT SIDE
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Group: R3U Lot Size: Deck: 176
Type of Work: ACC Fire Dist.: 6 No.of Stories: 2 Occ. Load: Building:1,141 Garage-Attached 1,160
Valuation: Building Height: Occ. Status: Seasonal Basement: storage 112
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: S 25.0 Ft. Shoreline: Ft. Water Body: HOOD CANAL
g SEPA?: No
Model: Width: Ft. Rear: N Ft. Slope: Ft. Shoreline Desi
Side 1: E 23.0 Ft. 9.: Rural
Year: Serial No.: Side 2: W 10.0 Ft. Comp. Plan Desig.: Rural
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BLD2009-00926 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
F BLD2009-00926
CONDITIONS FOR
BLD2009-00926
1) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
x 4 /T,
2) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X �z /
3) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
x
4) The proposed project must be consistent with all p ' a ►e policies and other provisions of the Shoreline Management Act, its rules, and the Mason
County Shoreline Master Program.X I
5) Approved per dime sions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
6) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982._TFjf on signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
7) All approved plans are required to be on-site for inspection purposes. If an inspection is,called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Department prio
Y any further inspections being performed or approvals granted.
X
8) Owner/Agent is respon ible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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BLD2009-00926 Please referto the following pages for conditions of this permit. 2 of 5
9)- The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal of approved documents will result in failure of required building inspections.
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10) This garage area of this structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for,
a change of use permit shall be applied for, reviewed and approved prior to the change.
X
11) The"approved"site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Building Departm ntt Vior any further inspections being performed or approvals granted.
X / /
12) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation R-10.
Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
underside f th�,roof she hing is less than 12-inches and there is 1-inch vented airspace above the insulation.
13) Per 2003 IRC - SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WIND SPEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH.
X /��i�
14) Per IRC -SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
X accordance with h I* able provisions of this section and the manufacturer's installation instructions.
15) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting 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. By calling for a final inspection of
the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
BLD2009-00926 Please referto the following pages for conditions of this permit. 3 of 5
16) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved
access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X 44 X-- '
17) . Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
X
18) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocati9l�
X_�/`�C/r
19) Demolition actitvities must conform with all State and local County regulations as a condition to the issuance of this permit. The applicant/owner is directed
to conatct Olympic Air Pollution Control Authority(ORCAA) IT IS UNLAWFUL FOR ANY PERSON TO CAUSE OR ALLOW THE DEMOLITION (OR
MAJOR RENOVATION) OF ANY STRUCTURE UNLESS ALL ASBESTOS CONTAINING MATERIALS HAVE BEEN REMOVED FROM THE AREA TO
BE DEMOLISHED. WORK SHALL NOT COMMENCE ON AN ASBESTOS PROJECT OR DEMOLITION UNLESS THE OWNER OR OPERATOR HAS
OBTAINED WRITTEN APPROVAL FROM ORCAA, 2490 B LIMITED LANE NW, OLYMPIA WA 98502, 360-586-1044, 800-422-5623,
WWW.ORCAA ORG
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20) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project ,e
21) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
X ordinance or regultio m t be reviewed and approved by Mason County prior to construction.
22) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall b a or to requesting additional inspections.
X
23) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2009-00926 Please referto the following pages for conditions of this permit. 4 of 5
21) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall be made prior to requesting additional inspections.
X
22) All property lines shall be clearly identified at the time of foundation inspection. X
23) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason County ordinances and building regulations.
X
24) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have prevented action from being taken. No more than one extension may be granted.
X
25) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
X
26) This structure has NOT been reviewed or approved as an Accessory Dwelling Unit(ADU): A second dwelling unit detached from an existing single-family
dwelling for use as a completely independent or semi-independent unit with provisions for c,�pkin ea anitation and sleeping. ADUs are required to
meet the requirements under Mason County Development Regulations 17.03.029. X
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the 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.
OWNER OR AGENT: DATE:
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BLD2009-00926 Please refer to the following pages for conditions of this permit. 5 of 5
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PERMITO_ ! "
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
On the web www.co.mason.wa.us
APPLIC NT I F RMA' CONTRACTOR I FOfi� TIO
Owner Company Name �—'
Mailin Address I J Maili g A rpss &
City State� Zip Code City Rtnt Q Zip Code S
Phone Other Ph. Phone v" 4`-f they Ph.
Lien/Title Holder Contractor Reg. #1001 Q A 5 C09 Exp.
E mail address E Mail Address VI ;Y`
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 Cj ct�r_ Fire District
c—
Legal Description ,�
Site Address(Please includ street name, street number and city) E
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 - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNI S
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas_Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace X
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas✓Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other TQ
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 Date: /- p
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT a7�
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. v'
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 �.
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MASON COUNTY PERMIT NO. , lj aGC[
BUILDING PERMIT APPLICATION ,i�i-5
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
helton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Amy and Dan Nordstrom Company Name West Bellevue Construction LLC
Mailing Address 3621 90th Avenue NE Mailing Address 2535 85th Avenue NE
City Yarrow Point State WA Zip Code 98004 City Bellevue State WA Zip Code 98004
Phone (425) 941-4223 Other Ph. Phone (206) 819-5330 Other Ph.
Lien/Title Holder TWANCH TRUST GL.C. Contractor Reg. # WESTBBC951DU Exp.03-31-2011
E mail address dan@outdoorresearch.com E Mail Address Markwbconst(iaol.com
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Yes Existing Septic
Connect to Water System ves Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No 32233 50 00017 Fire Distric
Legal Description SW 114.SE 1/4 SECTION 33.TOWNSHIP 22 NORTH. RANGE 3 WEST.W.M.
Site Address(Please include street name, street number and city)7323 E State Hwy 106, Union, WA 98592
Directions to site Proiect Site is on Hood Canal. aooroximately 2 miles.w" of Union on Hiahwav 106
MA Sn
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200' of Saltwater Yes Lake No River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%Yes. south end of orooerty
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Yes Add—Alt—Repair— Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building sinole family Describe Work_ I seoarate oaraae
No. of Bedrooms. No. of Bathrooms Square Footage- 1st Floor 2nd Floor.
3rd Floor x Basement x De Covered Deck Other Studio Sq. ft. 1,141
Garage Attached Detache 1.160 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 dedare 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' a rate and grants employees of Mason County access to the above described property and structure for review and inspection. N
PROOF O O ON VWRIK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: /U _ZO 06
O n Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by:C21An U Date 10 20 O
DEPARTMENTAL REVIEW APPROVED DENIED NOTES N
Building Department LA E I
Planning Department
Environmental Health Department
Public Works 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
6t A PERMIT NO� ICI o�,C�OCf ^Gl� I Z '
SON COUNTY
1�pl
HANICAL 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_PAN g Amy 1000-0 5TRo K Company Name W %;► a0z_(.EVu6 Cdw STRuc-t?ow
Mail' Address 3(iZ1 4oTKAVENuE V Mailing Address 2S'3s'ES- 77h AVEHuc arc
City w RNN ate WA- Zip Code 19 02' City—At Lc-eVuE State L-JA,- _ Zip Code 29
Phone 42-5-•q41. Q_2_3 Other Ph. Phone 2aG• 8 f q-S 33 c:3 Other Ph.
Lien/Title Holder Contractor Reg..#1YE6r bbC4571DU Exp.
Email address 460%0 oUf , ---cg(a e_� c. A-r E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic X Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. 2 0 00o t 7 Fire District
Legal Description Sw t/4 SE 1/q. S_fTGA3 33 1ZW, .6tr /�ZZ tooP7n KANcEg 3 LVSS7 W. Al,
Site Address (Please i Zclude street name, street number and city) -7 E t w UNId w z
Directions to site n
r'� OM f OoD G"Z APPRor-f 2 WIDE UN/o.N
Is property within 200'of Saltwater VPE5 Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%_YES r SuC0q"cw46 of �i2po�
TYPE OF JOB - New X, Add Alt Repair Other Use of Building .rl�'4� N'(f ,y
Location of Fixtures/Units- 1 st Floor.4_ 2nd Floor: X _ Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LP(' Natural Gas Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink _I Furnace _
Bath Tubs Heatpumps _
Showers Spot Vent Fan _
Water Heater Propane Tank
Clothes Washer _ Gas Outlets
Kithen Sinks _ Wood/Gas/Pellet Stove_
Dishwasher 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
provided is acc tea g nts employees of Mason County access to the above described property and structure for review and inspection.
PROOF OFP VdAY0N0F)kQRK IS BY MEANS OF A PROGRESS INSPECTION.
;&7
X Date:.
Ow r/ wners Representative/Contractor (indicate which one)
Ja=i= S460,0A- 0e0&-K7 t""'ey A
FOROFFICIAL USE BEYON THIS POINT
Accepted by Planning Pd Ck# Date O Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ GroUD-Type Constr.-
Planning Department
Environmental Health Department
FEES
Inumbing & 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 r
BUILDING PERMIT APPLICATION
Ctl� 426 W. Cedar• P.O. Box 186, Shelton, WA 98584
IL��helton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Amy and Dan Nordstrom Company Name West Bellevue Construction LLC
Mailing Address 3621 90th Avenue NE Mailing Address 2535 85th Avenue NE
City Yarrow Point State WA Zip Code 98004 City Bellevue State WA Zip Code 98004
Phone (425) 941-4223 Other Ph. Phone (206) 819-5330 Other Ph.
Lien/Title Holder TWANOH TRUST Lt.c. Contractor Reg. # WESTBBC951DU Exp.03-31-2011
E mail address dan@outdoorresearch.com E Mail Address Markwbconst0aol.com
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Yes Existing Septic
Connect to Water System ves Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No 32233 50 00017 Fire Distric
Legal Description SW 1/4.SE 1/4 SECTION 33.TOWNSHIP 22 NORTH.RANGE 3 WEST.W.M.
Site Address (Please include street name, street number and city)7323 E State Hwy 106, Union, WA 98592
Directions to site Proiect Site is on Hood Canal. aDDroximately 2 milesaw of Union on Hiahwav 106
IM
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Yes Lake No River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Yes. south end of Dronertv
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Yes Add Alt Repair_ Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building single family Describe Work_ J separate aaraae
No. of Bedrooms. No. of Bathrooms Square Footage- 1st Floor 2nd Floor. K
3rd Floor x Basement x De Covered Deck Other Studio Sq. ft. 1,141
Garage i. Attached Detache 1.160 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 parry 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 r
provided' a rate and grants employees of Mason County access to the above described property and structure for review and inspection. N
PROOF O O ON K IS BY MEANS OF A PROGRESS INSPECTION.
X Date: /U —20 —G�9
O n Owners a resentative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date 1 20 '0
DEPARTMENTAL REVIEW APPROVED DENIED NOTES N
Building Department
Planning Department r c
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee / Site inspection
Plan Review Fee 978;',ef O EH Review Fee
Plumbing & Base Fee °o f o3 76 Plannina Review Fee
Mechanical & Base fee 335�� Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal p, p
Valuation$ 1026 . TOTAL FEES
4 .... ASON COUNTY PERMIT NO� IG'�a6 —1 _60 I Z '
P -B HANICAL 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 QAN4 1414Y PCHR-05TZOK Company Name Wc 5 gtLIL-EVu6 CdwSMUCa•Taw
Mailin Address 34Z1 °ln'nfAVEYVuE tjC Mailing Address ZS3E ES' 77r AV6Nuc ^rc
City AR w Ngtate wA- Zip Code-4$ 004 City �G-c-CVuE State WA- Zip Code 281204-
Phone 42S•g41.42 Z3 Other Ph. Phone-2o6. 8 f 2'E 33 e3 Other Ph.
Lien/Title Holder Contractor Reg.#WE6r bbciyeu Exp.
Email address 514(01Cc7 E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic X Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. Z o O00 17 Fire District La
Legal Description Sw l/q- SE V-4 S€:=_fT0A4 3 TGwAJ.6ty oo2z- NoR-TI�-/ RI�IV4e 3 !yEST
Site Address (Please include street name, street number and city) -7 37 E t AriF ty IV y 10G tJN WN,4/ -z
Directions to site r ON f" Oo0 CAov Gz, AFPRoxI �L 2MIL-OE45 UN 10^3
Is property within 200'of Saltwater 7751 Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%__YES SoLnscwd of /Qoilkwm
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_ LPCzW Natural Gas_. Heat Pump_
Toilets _ Type of Unit No. of Units Fees
Bathroom Sink _I Furnace
Bath Tubs Heatpumps _
Showers _ Spot Vent Fan _
Water Heater Propane Tank _
Clothes Washer — Gas Outlets I -
Kithen Sinks _ Wood/Gas/PelletStove _�&
Dishwasher _ Kitchen Exhaust Hood _2�W
Hosebibs _ Dryer Vent �4
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 accwatea garants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF ORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
Ow r/ wners Representative/Contractor �—
p (indicate which one)
401
FO OFFICIAL USE BEYON TH S POINT
Accepted by Planning Pd Ck# Date O Bld Pd-4—k 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
Y YY .�c MASON COUNTY PERMIT NO
BUILDING PERMIT APPLICATION ,1�i-5 _.
et 426 W. Cedar• P.O. Box 186, Shelton, WA 98584
helton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Amv and Dan Nordstrom Company Name West Bellevue Construction LLC
Mailing Address 3621 90th Avenue NE Mailing Address 2535 85th Avenue NE
City Yarrow Point State WA Zip Code 98004 City Bellevue State WA Zip Code 98004
Phone (425) 941-4223 Other Ph. Phone (206) 819-5330 Other Ph.
Lien/Title Holder TWAIMOH TRUST t L C. Contractor Reg. # WESTBBC951DU Exp.03-31-2011
E mail address dan@outdoorresearch.com E Mail Address MarkwbconstOaol.com
Drivers Lie.# DOB Drivers Lie.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Yes Existing Septic
Connect to Water System ve5 Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No 32233 50 00017 Fire Distric
Legal Description SW 1/4.SE 1/4 SECTION 33.TOWNSHIP 22 NORTH.RANGE 3 WEST.W.M.
Site Address(Please include street name, street number and city)7323 E State Hwy 106, Union, WA 98592
Directions to site Proiect Site is on Hood Canal. aooroximateiv 2 mile of Union on Hiahwav 106
IM
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200' of Saltwater vPs Lake No River/Creek Pond
Wetland Seasonal Runoff-Stream-Slopes or Bluffs > 15% Yes. south end of orooerty
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - Newyes Add Alt Repair_ Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building sincile family Describe Work- d separate aaraae
No. of Bedrooms. No. of Bathrooms Square Footage- 1st Floor 2nd Floor.
3rd.Floor x Basement x De Covered Deck Other studio Sq. ft. 1,141
Garage Attached Detache 1.1 00 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 fhe information r
provided is acgurate and grants employees of Mason County access to the above described property and structure for review and inspection. N
PROOF O O ON K IS BY MEANS OF A PROGRESS INSPECTION. Q
X Date: lU —2.0
O n Owners ftepresentative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date 1 ZO O
DEPARTMENTAL REVIEW APPROVED DENIED NOTES N
Building Department E I 5
Planning Department
Environmental Health Department Il 009-
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee .06
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Qt�r (, Oct
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
Environmental Health - Personal Health
PO BOX 1666 SHELTON, WA 98584
LOCAL(360)427-9670
BELFAIR(360)275-4467
Application for Determination of Adequacy FAX(360)427-7798
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water system utilized.
3. Submit completed application,with attachments to the health department for review.
PART 1: Applicant/Parcel Identification
Name of Applicant7Arn-Am nords-6,atn Date IT 0109
�Loa.l
Mailing Address 90 14uE h Telephone 425• q41 - L4aa3
Assessor's Parcel Number 0a233- 56 -OHO t7
Type of Water System Check One): Zeason for Application Check One):
Public/Community Water System(2 or more Y Building permit
connections)** o Land use application, if so..
❑ Individual water source(one connection), ❑ Division of land:
if so..
Well #of Parcels? SPL -
Spring/surface water ❑ Boundary line adjustment
❑ Other(explain) e
**If you have more than one residence Replacement(please indicate name of water system
connected to this well, check the Public box. below if applicable—no signature required)
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated:
Public Water System
Name of Water System •
Water Facility Inventory (WFI) Number:
(write "none"for two party)
❑ I am the manager of this water system. The water system has been approved for services.
There are presently connections)in use. This will be the connection.
❑ I am the manager of this system.This connection will be to upgrade or change the use of an
existing connection on this system(ie:recreational to full time Please indicate on the following
line the nature of this change:
This water system is able and willing to provide water to this(these)connection(s)without
exceeding the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager Date
Update:April 2006
Name PAN � I1�/I-\ Parcel# 322-73 7 DO0(7 BLD#_t_�IaabDq— Wga_5
'41605 E Mason County Oo qa cP
( CtaAa Department of Community Development
Smalf 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:
http//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)_X1 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-
described p ope or review inspection as may be required.
X Ow r/Agent/ ntractor(circle one)Date:
Pa e 2 o m
Name Parcel# 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 2.
'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.
2Common 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.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings X
X = Measurements for buildings are taken at the
perimeter of the farthest projections (example:
X = eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
Parking Areas X
_ Any paved, gravel or packed area per definition
above table
X =
Patios/V1/alks
X = Any paved, gravel or packed area per definition
above table
X =
Others X
X If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas)
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
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the 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