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L�pzo BUILDING PERMIT APPLICATION � q 426 W. Cedar• P.O. Box 186, Shelton, WA 98594 I 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 ff, 4 , _ Company Name Mailing Address SZ A.U.�..�y c,�s C i Mailing Address City W41. State" Zip Code M-52f3 City State Zip Code Phone _36b-6Ly �/D�5� - OtherPh. - ��' Phone Other Ph. Yip „4/ /A� �. Lien/Title Holder sAc-A e.- Contractor Reg.# Exp. E mail address E Mail Address # Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic x, Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description Site Address(Please include street name,str et number and city) _O ME ' Directions to site 74 L '` Will timber be cut and sold in parcel prep ration?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB-New Add Alt Repair DK,,Other PRIMARY RESIDENCE E�SEASONAL ❑ 7' Use of Building +�? =c'�=� Describe Work No.of Bedrooms 3 No.of Bathrooms__L_Square Footage-1st Floor 101a0 2nf.Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft Garage Attached Detached Carport Vn 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/BUdDER 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 Canty access to the above described property and structure for review and inspection. PROOF NUATION OF WO tS BY F7' GRESS INSPECTION. Date- Owner/Owners Representative/Contractor dicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by. Date DEPARTMENTAL REVIEW A OVED DENIED NOTES Building Department 2- Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Buildinq 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 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/Ventilation Code Compliance Application Owner: S _ Parcel#: Type of project: Total Sq. Ft. 1 Floor: 2� floor: Heated Basement: of heated area:: f Ll+•� 1A;� p Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace O Heat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump O Boiler, specify fuel type: O Other. Specify: Glazing Compliance O Prescriptive Option (see reverse side) circle one: I II III Percentage: Method O Component Performance , Chapter 5— calculaSon worksheets required Check one:: O Other (specify): Check one O Whole House Ventilation system O Whole House Ventilation O Other, Ventilation using exhaust fans &window or Integrated with a Forced Air describe: System wall fresh air vents (M1508.4) System (M1508.5) Referencing WSEC Section 901, "Additional Residential Energy Efficiency Requirements," all NEW residential units must develop 1credit from Table 9-1. Identify and describe which option(s)will be used ENERGY to comply. If the table is not attached to this form you can access the table on our website at: CREDITS http://www Dev/index. h . Option: Description: Table 9-1 Window & Door Schedule (If needed, attach an additional sheet) Total Manufacturer Room/location U-Factor Size Quantity Square Feet Windows: r Windows: Total Sq. ft. Doors: Doors: Total Sq. Ft Total window and door area Total window &door area !(divided by) total sq. ft of heated area = %of glazing MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTON (360) 427-9670 BELFAIR (360)275-4467 Elma (360)482-5269 FAx: (360) 427-7798 WEB SiTE: www.co.mason.wa.us P.O. Box 186, SHELTON 98584 2009 Washington State Energy Code (WSEC) Effective January 1, 2011. Ventilation & Indoor Quality Ventilation code provisions are now located in the 2009 International Residential Code (/RC), 2009 International Mechanical Code (IMC), & 2009 International Building Code The following information will be required for the WSEC and ventilation code plan review: 1. Complete the Washington State Energy Code/Ventilation code application located on the reverse side including information about the project, proposed compliance methods and proposed energy credit(s) listed in Table 9-1 attached to this form. All dwelling units are required to develop at least one credit from Table 9-1. 2. Include all windows, skylights, sliding glass doors, french doors and any other door with 50% glass or more on the window and door schedule. Use rough opening dimensions to calculate size. It is always helpful to list the u-factors of windows and doors, if known. If you do not know u-factors, the plan reviewer will assume that all window & door glazing will have the required u-factor of the compliance option. When using the area weighted average methods to comply with prescriptive-path include calculations with submittal documents. 3. Identify the location and fuel type of the heating system, water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of proposed insulation for walls, floors, ceilings, and slabs on the building plans. Indoor and outdoor lighting shall be high efficacy luminaires that comply with WSEC section 505. To verify compliance, provide lighting information on plans. 4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. WSEC compliance information and code text is also available on the WSU-Energy Program website at: http://www.energy.wsu.edu/code/ Prescriptive Requirements °,' for Group R Occupancy Climate Zone 1, Table 6-1 Glazing Glazing U-factor ' Wall Wall a Area % Vaulted Wall int° ext4 Slab Door U- Above on Option of Floor Vertical Overhead Factor9 Ceiling2 Ceiling Grade below Below Floor 5 Grade grade Grade R-49 or R-21 R-21 I 13% .34 .50 .20 R-38 R-38 int TB R-10 R-30 R-10 adv R-49 or R-21 R-21 II* 25% .32 .50 .20 R-38 R-38 int TB R-10 R-30 R-10 adv R-49 or R-21 R-21 III Unlimited .30 .50 .20 R-38 R-38 int 1 TB R-10 R-30 R-10 adv *Reference Case/Call (350)427-9670 ext. 352 for footnote information. Log &solid timber wall with a min. avg.thickness of 3.5"are exempt from the above grade wall insulation requirements. 65F -01 S- MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPME Permit Processing/Inspections/Addressing Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98584 (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 REQUEST FOR BUILDING PERMIT EXPEDITION NAME: r: "I SN It, MAILING ADDRESS (1- ,4L «CITY_G l r-:r STATEWc-4 ZIP ,`;2 PARCEL:2-336 --53 cDDj1 LEGAL DESCRIPTION: SITE ADDRESS: REQUEST DUE TO: MEDICAL CONDITION FIRE-)( OTHER EXPLANATION OF HARDSHIP-.. l MUST INCLUDE SUPPORTING DOCUMENTS. THIS MAY BE A LETTER FROM A DOCTOR, INSURANCE CLAIM REPORT, OR REPORT OF FIRE DAMAGE FROM APPROPRIATE FIRE REPRESENTATIVE. I (WE) UNDERSTAND THE INTENTION OF THIS FORM IS TO DETERMINE AND DOCUMENT JUSTIFICATION FOR EXPEDITION OF A BUILDING PERMIT TO ALTER OR RECONSTRUCT A RESIDENCE ON THE ABOVE NAMED PROPERTY. SIGNATURE OWNE- AG EN � OLfI LY ENVIRONMENTAL HEALTH BUILDING DEPARTMENT PLANNING DEPARTMEN DEPARTMENT APPROVED ❑ APPROVED ❑ APPROVED DENIED ❑ DENIED ❑ DEN ED ❑ _ SIGNATURE SIGNATURE., SIGNATURE