HomeMy WebLinkAboutBLD2013-00137 Final Remodel - BLD Permit / Conditions - 9/6/2013 co
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ Ventilation Code Compliance Application
Owner: U>ly-) Parcel#: Type of project:
Total Sq. Ft. 1 Flo r: 2" floor: Heated Basement:
of heated area:: P e— Y1G
Heating System Type: O Electric wall heater O Electric Centr I FUDLce O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace 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— calculation worksheets required
Check one::
O Other (Specify):
Check one 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 1 credit 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 htt ://wvw✓.co.mason.wa.us/forms/Communi Devfindex. 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: ,
0.
n�
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 (IRC), 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
o�
p Requirements for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor i2 int ext Wall Wall 6
Area % Wall 4 4 Slab
Door U- Vaulted Above on
Option of Floor Vertical Overhead Factor Ceiling Ceiling Grade below Below Floor e Grade
grade Grade
R-49�r
C_ _
I 13% .34 .50 .20 R-38 R-38 int R B R-10 R-30 R-10
adv
int TB
R-49 or
-21
II* 25% .32 .50 .20 R-38 R-38 R-2i TS
int TB R-10 R-30 R-10
adv
R-49 or
III Unlimited .30 .50 .20 R-38 R-38 int TB R-2i TB R-10 R-30 R-10
adv
`Reference Case/Call (360)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.
/f3�1r-D 2-(:D i 3 -L03-7
MASON COUNTY PERMIT
426BUILDING PERMIT APPLICATION L
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.rnason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner1,_1W ,R E-7U_,C_7l5- 5 Fy Company Name
Mailing Address-?-G/oZ 9 NE y0 St Mailing Address
CitylRE,Dm-O V O State�Zip Code 210 S3 City State Zip Code
Phon�6'-�GS'G i/_ OtherPh.,P( /-aS/s' Phone Other Ph.
Lien/Titie Holders A Contractor Reg.# Exp.
E mail address C.R m A w/ Ar_(®a.O"ai r'. e-e'w' E Mail Address
Drivers Lic.#EUF k/ a DOB "yam Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic A0011�
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No �2 2,312 SZ) DD 0,73 Fire District
Legal Description _
Site Address (Please include street name,street number and city) 0217 ` f
Directions to site PhS6 1364,c4lip ST PARk fD.�.� LJpD7�iV ,cA.t�r p8'�'�fr
5/C N s R/Cfr1 on/ M-r. d/�� Q e.
Will timber be cut and sold in parcel preparation?Yes
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 Noti ,CorrectiQnAotice., r other enforcement action?Yes/No
TYPE OF JOB -New Add Alt - Repair Other PRIMARY RESIDENCE❑ SEASONAL
R
Use of Building 1/09C T/o N Describe Work 1/��J90/7.Z
No.of Bedrooms_ n No.of Bathrooms_I Square Footage-1st Floor 900 2nd Floor
3rd Floor Basement Deck Covered Deck L-" —Other Sq.ft
Garage Attached Detached Carport '0' 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 AclmovAedges 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
permiit 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:
i1-i43
Owner/Owners Representative/Contractor Ort&&ate which one)
FOR OFFICIAL USE BEYOND THiS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department 7,�,i3 Apr
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Buildinq Permit Fee Site Ins ection
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
PERMIT NO. Te
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar•P.O. Box 186, Shelton, WA 98584
Shelton (360)427-9670•Belb (360)275-4467•Elma(360)482-5269
On the we www.co.mason.wa.us
i; APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner d.by 0LI y—_1Jt VS '/?/9/YI S Y Company Name
Mailing Address A 4,!o .Z 9 /V E yo Sf' Mailing Address
City R612m0-yn State -* Zip Code p8,243 City State Zip Code
Phone S 6 - S// Other Ph'06''3o1--?6'IS Phone Other Ph.
Lien/Title Holder- Contractor Reg. # Exp.
E mail address ��"t�w�'�'UE�� 4'�• f&— E Mail Address
Drivers Lic.# DOB-&-.24,-S/3 Drivers Lic.# DOB
SEPTIC INFORMATION- Connect to New Septic Existing Septic. 1-1/ Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No 2 .23 / 9 S'-P oo.? Fire District
Legal Description
Site Address(Please include street name,street number and city) 4isl /ham. /Ji�w ,O.t. //J/lvyf! 98'
Directions to site
Is property within 200'of Saltwater Lake -04075112V 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 Fixture No.of Fixtures Fees Fuel Type:Electdc✓LPG_Natural Gas_Heat Pump
Toilets Type of Unit No. of Units Fees
Bathroom Sink Fumace
Bath Tubs Heatpumps D'yf le,
—
Showers / Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Ga Outlets
Kithen Sinks / Gas/Pellet Stove /
Dishwasher Kitchen Exhaust Hood
Hosebibs 12 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 �ep m�� Date: •Z -.Z��/-3
Owner/Owners Representative/Contractor dicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid I'd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr. /3LA
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
R�6 51'Atf o
Department of Labor and Industries PROPERTY OWNER
Electrical Program � -
�N+iee=a°i
www.Lni.wa.gov ELECTRICAL WORK PERMIT APPLICATION
Permit expires one(1)year from date of last activity
(except for annual permits)
This is an application form it is not a valid permit until
you receive the actual permit from the department.
To assist us in providing better service,please fill out the application paying particular attention to the following items:
1.Complete all sections of the form.(Zip Code is mandatory for the address of inspection.) UN! P-RE PERT 1.1
2.Provide a brief description of the installation&mark all appropriate items on the Fee Workshe&e- ft 1'204
3.Provide written driving directions to the jobsite from the nearest main street,highway,or intelsi4416201,J i o:,le.-Ce 14
4.Provide a phone number where we can contact you at during the day.
5.Make checks payable to the Department of Labor and Industries(L&I).
6.The property owner must sign this application.
Permits can also be purchased online at www.elecinspect.lni.wa.eov.
Property Owner's Name C lephone Number Fax Number
1\5 — G 2-3 9e�
O er' Mj iling ddress If Different from Address of Inspection (Street or PO Box Address,City,State&Zip Code)
Email Address:
h'Jt3Gv ��lL i-�icc�( e��
Address of Inspection(Street Address,City,State,&Zip Cod)
Is this property within city ❑Yes(If yes,please verify with the ci o see if they perform their own electrical
limits? inspections)
/X U 1 ❑No
Electrical Power Company/Serving Utility(Contact the power company to see if they have additional requirements)
IPv ,0 -;9 3
Provide a description of electrical work being done
As authorized under RCW 19.28.261.,I, _ hereby
(Name of property owner,renter,or lessee)
apply for an exemption from the electrical licensing and certification requirements of chapter 19.28 RCW by submission of this
affidavit.
I do swear under penalty of perjury that I am the:
Must mark one
0�Owner of real property;or
❑ Renter or lessee of real property(NOTE:You must provide a copy of the rental or lease agreement showing you
are allowed to perform electrical work on the property.);
❑ A nonprofit corporation that holds a current tax exempt status as provided under 26 U.S.C. Sec.501(c)(3)or a
nonprofit religious organization,and the total value of the electrical work does not exceed 30 thousand dollars.
And
Must mark
have not applied for this exemption within the past two years on a different property;
F500-094-000 property owner elec work permit app 07-2012
And the property is:
Must mark one
❑ A single family residence that is not intended for rent,sale,or lease and I will be personally doing the electrical
work and I will occupy the residence for at least 24 months after completion of the electrical work;
❑ An existing 1,2,3,or 4 unit residential property that is intended for rent sale or lease and myself and/or a
regularly scheduled and paid employee(s)will be doing the electrical work;
❑ A new 2,3,or 4 unit residential property that is intended for rent,sale or lease and I,personally,and/or a
regularly scheduled and paid employee(s)will be doing the electrical work and I will occupy one of the units for
at least 24 months after completion of the electrical work;
❑ A farm and I,personally,and/or a regularly scheduled and paid employee(s)will be doing the electrical work;
❑ An existing place of business and 1,personally,and/or a regularly scheduled and paid employee(s)will be doing
the electrical work;
❑ A new place of business that is not intended for rent,sale,or lease and 1,personally,and/or a regularly scheduled
and paid employee(s)will be doing the electrical work;or
Other property that is not intended for rent,sale,or lease and 1,personally,and/or a regularly scheduled and paid
employee(s)will be doing the electrical work(Describe the property).
I am a nonprofit corporation that holds a current tax exempt status as provided under 26 U.S.C.Sec.501(c)(3)or
a nonprofit religious organization,and the total market value of the electrical work does not exceed 30 thousand
dollars,and the electrical work will be performed by appropriately certified electricians or certified and
supervised trainees who are volunteering and not being compensated for electrical work per RCW 19.28.091(7).
As such,I believe that I should be exempt from the requirements to obtain a license or use a certified electrician as provided
under RCW 19.28.261.
I hereby certify that the statements on this affidavit are true and accurate. (See chapter 19.28 RCW and chapter 296-46B WAC
for penalties for false statements or material misrepresentations.)
02 /12 l
3 - ..�8� L��- --
Date Signature of Property Owner,Renter,or Lessee
In the space below provide detailed written directions to the jobsite from the nearest
main street, highway, or intersection.Ala
,
G� �7
F500-094-000 property owner elec work permit app 07-2012
' Page 1 of 1
Receipt
Washington State Department of Labor and Industries
Customer: Linda Ramsey
Address: 26629 NE 40th Street
City: Redmond State: WA Zip: 98053
-- Fiscal Transaction Receipt --
Fiscal Transaction: 103819015
Created: 2/12/2013
Payments: $90.30
-- Payments --
Type Amount Payer Reference
Check $90.30 LINDA RAMSEY 1204
-- Services --
EP2198998
Description Reference Quantity Price
Single or Multifamily Resident EP2198998 1300 $90.30
NOTE:All refund requests must be made in writing. Refunds may require processing through
central office and we cannot guarantee immediate refunding of services.
http://field-services.apps-inside.lni.wa.gov/FrontCounter/FCRevRecWeb/ReceiptPrint.asp... 2/12/2013
Page 1 of 2
POST ON JOBSITE PRIOR TO BEGINNING OF WORK
Department of Labor and Industries
INDIVIDUAL OWNER
ELECTRICAL WORK PERMIT # EP2198998
Contractor Name License Number Installation Description:
Min. 1300 sq ft for remodel per Clay
Purchaser's mailing address
26629 NE 40th Street Services to inspect:
Redmond WA 98053 Description Quantity Amount
Telephone number FAX Number Sin le or Multifamily �Residential
(425)623-5574 ( )' New Construction 1300 90.30
Premises owner's name Inspection fee: $90.30
Ramsey, Linda The department will perform 1 inspection for
permits where total fee paid on permit is less
Address of inspection 451 Mt. View Dr. than $86.19. For more than 1 inspection,
TAHUYA additional fees are required.
Additional Fees May Be Assessed Upon Field
Power company Inspection
MASON COUNTY PUD#3 - BELFAIR
This permit expires in one(1)year from date of last activity.
Applied: 2/12/2013 Expiration: 2/12/2014
Date Approved By Date Approved By
WALLS
InsuLaLon Only SERVICE
Cover 4�1% e S.W FEEDER
CEILING
Insulat my THERMOSTAT
Cove ( DITCH
i H
Inspection Date Area, Building or Equipment Inspected Action Taken Electrical Inspector
Property Owner: This is your permanent record of inspection
FAILURE TO POST PRIOR TO BEGINNING WORK WILL RESULT IN CIVIL PENALTIES
Attention Applicant! The Department will not conduct this inspection if there are unrestrained
animals on the premises. Failure to comply with this requirement may result in additional
inspection service fees and delay in service.
http://field-services.apps-inside.lni.wa.gov/pairspermit/rptPermit.aspx?AppID=10l 2/12/2013
Page 2 of 2
DO NOT POST THIS AT THE WORKSITE
You have purchased an electrical work permit.
You must request inspection prior to covering any electrical work, no later than three
business days after completing the work or one business day after any part of the
installation has been energized,whichever occurs first.
Failure to request an inspection of the work may result in civil penalties.
We will strive to get to your inspection within 48 hours of the date of the request. However,
due to staffing reductions, it may take longer, especially if you are in a remote area.
SAVE TIME AND MONEY BY MAKING YOUR INSPECTION REQUESTS ONLINE
This is your permit number: EP2198998
Use this authorization code: 61857
To submit an inspection request, view inspection results or pay additional fees, go to the
Electrical homepage at: www.Ini.wa.vov/tradeslicensinv,/electrical and select Permits Fees and
Inspections
To request an inspection:
1 Select Request an Inspection
a. If you are a contractor, select Contractors (when applicable)
b. Select Online here, enter your permit number& authorization code.
2 If you are not a contractor, select Property owners
a. Select Online here, enter your permit number& authorization code.
3 Select Next
Please provide a description of what you want inspected and comments regarding the
location of the work and special access instructions. Additional trip fees will be assessed if
the inspector is not able to locate or access your installation.
Note: SUBSCRIBERS of the EPIS system do not need to use an authorization code to request
or view inspections through Secure Access Washington
Close
http://field-services.apps-inside.lni.wa.gov/pairspertnit/rptPermit.aspx?AppID=101 2/12/2013
From: Debbera Coker
To: Palama, Joran (LNI)
Date: 2/7/2013 12:30 PM
Subject: Agency Request form, 451 NE Mtn. View Dr, Tahuya
Attachments: BCC2012-00052 Agency request dated 2.7.2013.pdf; BCC2012-00052, taken 2.6.2013
by TFR, #2 of 16.jpg; BCC2012-00052, taken 2.6.2013 by TFR, #16 of 16.jpg
Hello Joran,
An agency request concerning a site located in Tahuya along with photos taken by the building inspector
on 2.6.2013 is attached to this email.
Debbera Coker
Mason County Building Department
Building Inspector IV/Code Enforcement
Phone: (360)427-9670 ext 510
FAX: (360)427-7798
e-Mail: DLC@co.mason.wa.us
PO Box 279
426 West Cedar Street
Shelton, WA 98584
Building Permit # 2-012 Z COUNTY
MASON
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
qS360) 427-9670
CORRECTION NOTICE
Job Location 1145% Mi T OV-ki/
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
7� � �f�o�k Fl�� / / A�17 - r1
ti
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
❑ This is not a complete inspection Department 'Otjo
Date 2- -L-3 Inspector 72
DO NOT REMOVE THIS TAG
r
Department of Labor and Industries AGENCY REQUESTED
Electrical Program " a
Complete&mail this form to the local L&1 Field Office INSPECTION
Visit us online for office locations Permit#
www.Lni.wa.eov
Location of Investigauor(address) Describe problem observed Date observed
451 NE Mt.View Dr
City State Zip Code
Tahuys wa 98588 In response to a complaint the building inspector
Property Owner's Name Telephone Number observed what appears to be elelctrical work. See
Linda Evetts-Ramsey/Trsee photos enclosed with email.
Property Owner's Address
26629 NE 40th St
City Stale Zip Codo
redmond wa 98053
Agency Making Request
Mason County Dept.of Community Dev.
Agency contact name Telephone number
Debbera Coker 360A27.9670 s 510
Agencv's Mailing Address
PO 279
City State Zia Code Directions from nearest main crossroad
Shelton WA 98584
Power ComrW Electrical Serving Utility
POD
Signant Arid t'tie
X f``
REPORT OF INSPECTION DO NOT REMOVE
or De grime t of Labor and Industries use only
— Information only
❑ Corrections needed—Permit required
The electrical safety corrections attached are hereby ordered and must be completed within 15 days; Date ofinspection
failure to do so may result in issuance of a citation with monetary penalties or disconnection of electricity. 98584
Inspector's Stamp
F500-025-000 agency requested inspection 12.2005
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Department of Labor and Industries AGENCY REQUESTED
Electrical Program Rf. i^rF
Complete&mail this form to the local L&I Field Office INSPECTION
Visit us online for office locations aw
www.Lni.wa.eov Permit #
Location of Investigation(address) Describe problem observed Date observed
451 NE Mt.View Dr
City State Zip Code
Tahuya wa 98588 In response to a complaint the building inspector
Property Owner's Name Telephone Number observed what appears to be eelctrical work. See
Linda Evetts-Ramsey/Trsee photos enclosed with email.
Property Owner's Address
26629 NE 40th St
City State Zip Code
redmond wa 98053
Agency Making Request
Mason County Dept.of Community Dev.
Agency contact name Telephone number
Debbera Coker 360.427.9670 x 510
Agency's Mailing Address
PO 279
City State Zip Code Directions from nearest main crossroad
Shelton WA 98584
Power Compa Electrical Serving Utility
P
Signa d title
X
REPORT OF INSPECTION DO NOT REMOVE
or De artme t of Labor and Industries use only
nformation only
❑ Corrections needed—Permit required
The electrical safety corrections attached are hereby ordered and must be completed within 15 days; Date of inspection
failure to do so may result in issuance of a citation with monetary penalties or disconnection of electricity. 98584
Inspector's Stamp
F500-025-000 agency requested inspection 12-2005
h Q
r �'"'' ��1 1 5-6—Q L-*�" Case Number: —E)CC-M
I Mason County Investigation Report Form
Parcel Number: - -
Violation Site Address:
Property Owners : 4 5 mil!✓ �'�`' D
P �Y O Phone#:
Mailing Address:
Tenant/Contractor/Operator on site:
Directions to Site:
Description of Concern:
Under the provisions of the Public Disclosure Law, RCW 42.56.240, the complainant may indicate a desire
for disclosure or non-disclosure of their identity. If non-disclosure is chosen, this portion of this form will
not be released to the public unless this case is filed in court. If filed,your name will be disclosed if you are
a witness in the case.
Mason County investigates possible violations on a complaint basis only. Therefore,the name of the person riling
the complaint should be provided.
Please check one of the following:
❑ Please do not disclose my identity. I understand that disclosure may be required by court order or if this
matter goes to court.
❑ You may disclose my identity.
Name(please print):—'i — Phone:
Address:
Street City State Zip
Signature of Complainant: Date:
THIS
SECTION FOR MASON COUNTY USE ONLY
Complaint Received by: Date:
Complaint Received by: ❑ Phone ❑ Email ❑ Web Site ❑ In Person
Department of Concern: ❑ Building ❑ Planning_ ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other
- �
Investigation Date and Findings: 2—l�� ,p S /�7►7C -
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Date Closed: Reason Closed: Initials:
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811111.9)1NG 111 426 W.MOAN ,.
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CORRECTION NOTICE
Job Location.
This structure has fern inspected by Mason County Building Department
'= and the following VIOLATION of County Law$and Ordinances has been
soft _
found:
You are hereby notified that the above corrections shall be made 0
BEFORE PROCEEDING WITH ANY FURTHER WORK
DO MOT REMOVE THIS TAG
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02/06/2013 02/06/2013
I
�y C.L.Ramsey
M L.L.Evetta-R�,nsey
26629 N.E.4OSt
Redmond WA 980&3
df
�s.
•,.-.r••-.. «.....,..... ,f..._,........r. .. ___�. .. ..... _. �"e
/ - "�'--" . �t INF7 Clay Micheau
Electrical/Compliance InspecteJ
Department of Labor and Industries
Region 3 Bremerton II
600 Pacific Avenue Suite 400 360-414-4013
Bremerton WA 98337.1904 mIcc235QLnI.v'a.gov
a
I
A �r� Customer Sendce 360-415-4030
www.Lni.wa.gov/TradeeLleensingtElectdcal
---
It f —
Invoice
Date Invoice#
ALL CLIMATE 12/18/2012 52712
17527 NE 67th Ct. Redmond, WA 98052
(425)746-3077
• '
Job Site Bill To
Linda Ramsey Linda Ramsey
451 Mountain View Drive 26629 NE 40th Street
Tahuya, WA 98588 Redmond,WA 98053 j l
425-301-2515
Description Serial# Rate Amount
Install one Sanyo ductless heat pump system: one 3,500.00 3,500.00T
CH0971 outdoor unit and one KHS0971 indoor unit
with remote control, all per proposal DU-0509
Sales Tax 8.40% 294.00
1r
Recommendation
Total $3,794.00
Payments/Credits $-1,897.00
Balance Due $1,897.00
Job Complete Job Incomplete X
1.5%charged per month on Past due accounts Contractor's Lic. #ALLCLCH966C6