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MASON COUNTY PERMFF NO.J21J U1� • C071M
BUILDING PERMIT APPLICATION I I�
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 HjC_Et�l'1`l, L-EC-_tJ 1-k0 9 Company Name 151281e, C-a1-JSk-k'aO T161Lt,C,
Mail�i !g Address 301 b N Mailing Address -cO, 0 1 SSt
Cityj%_L.i NLtAA0A State\N ? r_��A �i 22b 2i City S E —01-� State�^ Zip Code S
Phone3co0 131 55370ther Ph. Phone 3L C, O—ot k2- Other P
Lien/Title Holder Contractor Reg.#it= EGA 7b1 p 20-
E mail address E Mail Address fie,'-tA S
Drivers Lic.# J DO I4 Drivers Lic.#5vA#JS;%W 40o n�(DOB 1l' 2-9-(cE
SEPTIC/WATER SYSTEq INFORMATION -Connect tp New Septic. Existing Septic
Connect to Water System 2S Name of Water System re-SAL-f-e B'66c'N Wye°' `► S T��M
Well Water System Name of Water System
PARCEL INFORMATION- 12 Di it Parcel No 1 Z 2 lk 5 i a00 11 Fire District
Legal Description PE6ZLAEt AC,+1 PAOLa Z R-S : I t- 13 P P-/W
Site Address (Please include street name,street number and city) 100 e MULE SSAC-tA
Directions to site (*o 00-r Hw� 1'0 Ip fAs t 10 #41 c.6 t-/k�+�- t o p-J RI tortT OW
E c-F eAc" L F-1toAT ({ovr-E tS oV "A tcot-t
Will timber be cut and sold in parcel pr�,paration?Yes No
Is property within 200'of Saltwater r I_alce River/Creek Pon _
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 Aft Repair Other PRIMARY RESIDENCE ❑ SEASONAL
]�
Use of Building VA:-AZ%o Hb0,%0escribe WorklaA 0%.ovJ SwA t_ CAbttJ A'A AD ZI p-tt,t�(
No. of Bedrooms No.of Bathrooms 1 Square F -1 st Floor 3 V- i 2nd Floor
3rd Floor Basement Deck 20 overed D Other Sq.ft
Garage Attached Detached 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 Aclmowledges submission of inaccurate information may result in a stop work order or permit revocation.Admowledgement 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 appric ation or the work proposed in the appliation,I have obtained
permission from them to apply for this pem-d 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 COhMNU ON OF WORK IS BY MEANS OF A PROGRESS INSPECnON-.
X Date*
Owner/61wriers Representative/ ntractor ( dcate which one)
FOR OFFICIAL USE BEYOND THI DINT Accepted by. Date`F -Z-
DEPARTMENTAL RE IEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building 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
MASON COUNTY PERMIT No a l,-A20 (�'' W Z 70
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner TAt`KettA- t_aEr�NodTs Company Name TEV¢'`-� E*�'"5. C. YiTP'jaitot�,
0
Mailing Address 30 1 b Ntat,r�v�-r°1 S� . Mailing Address P•o. 1Ssk
1f-
City�eAA-u-'btJykM StatewA Zip Code 4bZZ(a-421k City 5NE-�-�ot, State%,�A Zip Code
Phone36 o Z 39 5531 Other Ph Phone36 0 4q o O( (o2-- Other gh. _
Lien/Title Holder Contractor Reg. #=ej!�"lec- Ex 6-Z� 11
E mail address ry, _ [ tit •GOr'ti'1 E Mail Address-�e�arts b� l dar w kc tRt� C,o w1
Drivers Lic.# DOB 1 Drivers Lic.#EV^#Jc--T W 4QLAM DOB t kZq"lo0
SEPTIC INFORMATION - Connect to New Septic Existing Septic_ Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No ZZ (o O 0 O k Fire District
Legal Description Pr-&SLE FS�► .rry • R-%s E C>jn
Site Address (Please include street name,street number and city) 1010 •E- t3 PE3Lc F-Ellf-A-k 1-t-' • U Nt vV
Direct' ns to site &,a oV-C F-kuj 10to PoksT 10 µ•ttt,E. to^04-� `T•.rwv-' Rtbti T
ot� Lis G�VGtt I1.- I'.Ibtt i PST ToP of oUsc IS W t1c44e
Is property within 200' of Saltwater Lake River/Creek SPond
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
jype of Fixture No. of Fixtures Fees Fuel Type:Electhc_LPG—Natural Gas_Heat Pump_
Toilets I Type of Unit No. of Units Fees
Bathroom Sink 1 Fumace
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
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.
PROO OF CONTINU :ION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: 4' 1?S,
Owner X.Owners Representativt=R
(indicate which one)
FFICIAL USE BEYO D HIS POINT
Accepted b nning Pd Ck# Date�~�'� Bid Pd 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
PLANNING MASON COUNTY PERMIT NO.J21C1 U I • �2Za
BUILDING PERMIT APPLICATION A1I,4 n
426 W. Cedar• P.O. Box 186, Shefton, WA 98584
Shefton(360) 427-9670•Beffwr (360) 275-4467•Efma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Hic,"{�A 1, L��� iAc0 s Company Name lilZi?y E�At-'S C-c'g`'S�a�� iio�1.1,G
Maili g Address 3 C71 b N r1izA ST Mailing Address hO, hc
City City S KE(.+TO W State`-f-J iA Zip Code `
Phone'-�too 7 31 55 er Ph. Phone 3L C cl C ct kZ Other P
Lien/Title Holder Contractor Reg.# 1 G��U
E mail address i E Mail Address *(5 �S �-�'� `L kc-�mNK�m l • C ttit
Drivers Lic.# J DOB Q Drivers Lic.#EVAOSTW 402-(�`(DOB )l- Z9-(,C
SEPTIC/WATER SYSTEq INFORMATION-Connect t9 New Septic Existing Septic
Connect to Water System ,2C Name of Water System r erg$�-E 'N WA74 �► sz'Fc
Well Water System Name of Water System
PARCEL INFORMATION-12 Di it Parcel No Fire District
Legal Description FGe'eA_t Z'r�- L+l PAR- - Z R-S {l- 13 O F )' 'W
Site Address (Please include street name,street number and city) 100 ?F-EaL.c Saz-t't i--N
Directions to site (`10 013T Etwy 1•0 to ?Ar.T 10 etcc.E t"LAA-r-e4-- Rm t ttT OW
7E c.^ BeAcw I_tj IF-14,kT 't0P of At4k- Rn35.6 is moN zk-tt�t-t
Will timber be cut and sold in parcel preparation?Yes No
Is property within 200'of Saltwater r Lake River/Creek Pon
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB -New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL IQ
Use of Building Vitr:..A lmoW N4'%,Describe Wo iaA ' OowO StAL' C..AbtN At-to A155 14 "V-- D p-2�k�(
No. of Bedrooms t No.of Bathrooms 1 S�Fest Floor 2nd Floor
3rd Floor Basement Deck Gt* Other Sq.ft
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION -Make Model Year
Length Width Serial No. No.of Bedrooms No.of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUDDER Acimowledges submission of inaccurate ir> rra5on may result in a stop work order or permit mvocatiorL Aclmowledgement of
such is by signature below.I declare that I am the owner,owners legal representafive,or the contractor.I further declare that I am entitled to receive this
PBm t and to do the work as proposed in the appricafion.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 rtxest regarding this application or the work proposed in the appfication,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 descimbed property and structure for review and irtspection.
PRODf OF CONTiNU ON OF WORK IS BY MEANS OF A PROGRESS INSPEGnDN.
X_'aLA� Date-
owner/6wners Representative/ nt actor ( cbcate whi:h one)
FOR OFFICIAL USE BEYOND THIS DINT Accepted b . Date�; 4 -Z- l
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department'
Public Works Department
Fire Marshal
FEES A hi
Buildinq Permit Fee Site Inspection r LM I NN 11 hN G ,
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
OR "Iffl3
Valuation$ TOTAL FEES
426 W. CEDAR S?
Name �.,E�'fl hDl�-F� Pa*cel� _��7lIJ�51 " C'MI I BLD#c:)0l1 3 r UDZg-B)
Mason County
Department of Community Development
Small Parcel Stormwater Management ApplicatioaiWorksheet (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?.
'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 stru=e,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated wi,structural or impervious redevelopment.
'Common irap=,Aous 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 stonnwater.Open,uncovered retentionMotention facilities shall not be considered as impervious surfaces.
t�.ta�cilate: rri ev,�_�ous rces.: leasE_Goi
- l p777 ee`.7`iais 3"afi7 ''-'
^Surface Type Length X Width I = III Area *All dimensions in feet
Buildings � X =
>rYY101J 15 1'�1 = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
m i Q = eaves/gutters)
-386
X =
C�UA4� = Length of drive begins at the right of way
X =
Parking Areas X =
X _ Any paved, gravel or packed area per definition
above table
X =
PatiosMalks X =
X _ Any paved, gravel or packed area per definition
above table
X =
Others
X = "if,the total.mpe.rytous area of the proposed site
X _ evelopmenit is.granter tf tata.20DD square fleet a
_ all Parcel:Stomryrater;Site.Plan:is Required..__
Total im etvious.Surfac6 Area uM-eta areas
p - HI
If the Total.Impervious Surface Area is LESS THAN Ap Sqdkre F eet,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,owrim's legal representative,or the contactor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
descnb property for revi and inspection as may be required
X owner/Agent/ ontractor(c' cle one)Date:
If the Total Impe us 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
Dame Parcel# BLD#
Mason County
Department of Community Development
SmaIl Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Storrnwaler 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.m as o m wa---us/cod e✓commis s i on ers/m dex.htm
PIease 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 instaIIed 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 Storm-water Site Plan
on the pages that begin with"Handout"
PLEASE II' TT BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) 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 9858-4
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 feral 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 aclmowledge 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
Page 2 of 2
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ Ventilation Code Compliance Application
Owner:M«KfAt._ LtdP Koo- S Parcel#: 3ZZ3 b- St- 000t Type of project:ADS I d�
Total Sq. Ft. 3 9 1 Floor: 2" floor: Heated Basement:
of heated area:: 'g
Heating System Type: XElectric 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: k., 160 U Sg
Glazing Compliance O Prescriptive Option see reverse side circle one: I II !II
Percentage:
Method O Component Performance , Chapter 5— Calculation worksheets required
2 I % Check one::
O Other (Specify):
Check one k Whole House Ventilation system o Whole House Ventilation O Other,
Ventilation using exhaust fans&window or Integrated with a Forced Air describe:
System Fall 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 htt ://vw✓w.co.mason.wa.us/forms/Communi Dev/index. la .
Option:to Descriptio :
Table 9-1 r�/ 0
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Roomllocation U-Factor Size Quantity Square Feet
Windows:
1'lt I-to A-A.,I> B oo ► 30 ��(aI lo '' ( (o
3 o
✓ _ 3 fl Ito„� b, -2> (o 7 5
aZ�w-oo 3 o x I' ro�� l Z , LS
o ` 0" ' b0 2 S
G�-os�T 3 1 � l Z ,
Windows: Total Sq. ft.
Doors:
Doors: Total Sq. Ft
Total window and door area Qj 2-
Total window & door area a 2- 1(divided by) total sq. ft of heated area 3 $5 = � %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 Count Community Development at 360 427-9670 ext. 352. WSEC
y y p ( ) C 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 12 Wall Wall s
Area % Wall 4 4 Slab
Door U- Vaulted Above int ext on
Option of Floor Vertical Overhead Factor9 Ceiling2 Ceiling3 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
III Unlimited .30 .50 .20 R-38 R-38 R-21 R-21 R-10 R-30 R-10
adv int TB
*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.
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