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Mason County
Department of Community Development
Small 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 mill 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 STORMR'ATER MANAGEMENT PLAN FOR THIS SITE
The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
m th it 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 property for review and inspection as may be required.
X Owner/ gen Contractor(circle one)Date: hr)
Page 2 of 2
Name Parcel 4 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.
'Common 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 = S 3 Measurements for buildings are taken at the
X = perimeter of the farthest projections (example:
eaves/gutters)
X =
Driveways X = 2 D1-I
X = Length of drive begins at the right of way
X =
Parking Areas X = 1 2
X = Any paved, gravel or packed area per definition
X
above table
=
PatiosMalks X = .Z 50O
Anv navari nraval or area ner defniti—
X • 1
X
above table
=
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 THANT 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/ ge Contractor(circle one)Date:
If the Total Impe ions 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
MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST
Owner's Nar C 00 Y> VrI _ b&& Date. tO " a• 15 Reviewed By.
Do .
Building Permit Application Completed Stormwaur Chec '
Planning Intake Checklist Completed,
IN Site plan includes:Allowable building area,roofZ?N
s,decks,etc.
Fire Apparatus Access Road info required? Yes
Energy Code Application Form-O Electric wallO Electric central furnace O LPG Furnace
•Heat pump with electric furnace O Heat pump with LPG furnace O Boner(heat type
O Dnctless Heat Pump O Other.Specify.
✓,vlechanical/P�hing Application-WATER HEATER FUEL OC ATION
✓Engineering? Y o Snow load: Seismi ._D2 —R
Stock Plan—approved snow load: Seismic: D2
M OR PLANS
Foundation Type: ANS e method Engineered footing/fovndatio3i Base t
Decks: Coveerred? Uncovered over er 30"? Construction uur5d_
C()nS92 ' n PZans:_✓3 COMPLEDZ SETS
Flans Legible y/ ogiuzed Scale �vation Vews _✓ cross Section
Foundation Plan _✓Roof Framing Plan ✓Floor Plan-Use of rooms noted(all floors)
✓Floor FramingPlan-atl floor levels including loft;crawlspace,etc. (Q00 S.F.??—stairs?) /&q_
COW,64.Deck Framng Plan,incl cov.porch 5
a,-hv Q Zx Cv�-�.-�-L-n J�o
Plan DetaiZs: ( L
--A c,of framing details,truss lay-out may be need lc�anrd gir' de!l I'M, n F A tq'j Ca X I a
all Framing-Does bearing-wall height exceed I '?(Engineeringj�ay be required) 144
Floor framing Floor joists(size&spacing):_I I.1 8-FI JS+ i(OO�beams: qXID
_LZ'Window headers. Typical header. Ai y i r) Garage header. )C I()
IF umdation:footing size,reinforcement
Ecrete Walls-Does Concrete Wall Height Ex 88'?(Engineering may be required see details)
dings at all exits?Less than 30"above v O,
eated By Furnace-Location of Fro nace Fuel type:J Q'Lie I U
Fireplace/Stove Information Shown-Fuel T e? Location(s):
endow Sizes Marked on Plans L (' O rf
Braced wall panels(shear walls)marked on plans or lateral g? �
W00d �A�GJC..-tc� AK
c s: '
ENGINEERING REQUIRED
Braced wall panels/brace wall limes are not marked on plans(R602.10)
Amount and location of bracing does not meet minimum required.in Table R602.10.1
DESIGN CRITERIA All notes and details required as a result of the"engineered analysis shall be transferred onto proposed
buuilding plans. W-md 85 MPH, Exposure B(imless proven otherwise). Seismic Zone: ,Snow_psf
IRREGULAR BUllDINGS R301.2.2.2.2
Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be .
considered to be irregular when one or more of the following conditions occur:
I)Exterior braced wall line or BWP cantilevered or offset by more than 4'
2)Roof or floor is not laterally supported on all edges
2A)Portion of roof or floor extend more than 6 ft beyond the braced wall line.
3)End of BWP extends more than 1 ft.over an opening more than 8 ft in width below.
4)Opening in a floor or roof exceed the lesser of 12 f L or 50%of the least floor or roof dimension.
5)Portions of floor level are offset vertically
6)Shear wall lines do not occur in two perpendicular directions.
7)When a story above grade is includes masonry or concrete construction(exc: fireplaces, chimneys,and veneer).
When this applies the entire story shall be designed.In accordance with accepted engineering practice.
H:\permit tech building checklist-doc Revised 11-29-2007
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PARt7EL NO, RLS
12229-41-a0020 Checked By
LEG4L DESCRIPTION: LAW
S 1/2 GOUT LOT d• t TAX 411-G Site Plan Sheet Number
SITE ADDRESS: Scele: I' 30'-0-
'1100 E GRAPEVIEW LOOP RDA /t r�
ALLYN,WAS"W.TON A2
iON Co
MASON COUNTY 1 � � �
ermit No:'6 1 d 26 15-66q8q
t. DEPARTMENT OF COMMUNITY DEVELOP MA
BUILDING•PLANNING•FIRE MARSHAL (360)427-9670 Shelton ext. 352
(360)275-4467 Belfair ext. 352
426 W Cedar Street, Shelton WA 98684 (360)482-5269 Elma ext. 352
BUILDING PERMIT APPLICATION -Ai lAn
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NbF-Ot=-°-4-ei LISA- WyN M NAME: GLINt:`. CDN5TF- C 10N
MAILING ADDRESS:A�7 I U- (ol s-T-AyE Nt- MAILING ADDRESS: I,F I W Fl?F-nsoN P-D.
CITY: SI✓h3 tl. STATE: VVA ZIP: 11_I Cr. CITY:16 1= -MN STATE: Wes}- ZIP: g�4
PHONE: C-2-OIO)ADO- ":ZW CELL: PHONE:(?,(xb)19 D-%�U0 CELL.
EMAIL: EMAIL : m1 Ac nc G' C>J cA-a +• ►1Gf-
L&I REG#LLWgC, Jqb EXP. lP /z1/ Le
CONTACT : OWNER ❑ CONTRACTOR ❑ BELOW S
NAME:f�)s-tr-R 4 W ILLIAMS AGt-t I DE&Ds MAILING ADDRESS: Pb JVX I OZ
CITY: S HF-L N STATE: W6 ZIP: a bFb+ PHONE:(3VQ) `2U-C05 l l CELL:
EMAIL: h(LDt[Ala Fps tN I�l IaNy1s f DYYI
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 1222 •b0 Q2 0 FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED) • 5 1 2 g 0 EM 4 1i&,X -6-
SITE ADDRESS 1DO r- VP- Iz:b CITY .^-I--LYN
DIRECTIONS TO SITE ADDRESS 1 VIEW
LD o r P-A. fQLA M 17D -7 I
IS PROPERTY WITHIN 200 FT:
SALTWATER ff� LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM ❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES El NO 9
TYPE OF JOB: NEW a ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) V-iF—S It)I=U Cam'
IS USE: PRIMARY❑ SEASONAL 1!� NUMBER OF BEDROOMS t NUMBER OF BATHROOMS
DESCRIBEWORK Nt-:VV 4-.plQ SQ- 1" Slbl✓NC N���1N INISHAD
SQUARE FOOTAGE: 74 bo✓G" t�CcXG
uN��NISN��
1ST FLOOR IQ sq. ft. 2ND FLOOR 15 sq. n �Jr�FLOOR _sq. ft. BASEMENT sq. ft.
DECK ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. ft.
GARAGE gq�.
sq.ft. ATTACHED S DETACHED ❑ T _sq.ft. ATTACHED ❑ DETACHED
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REOUIRED
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
OWNER 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 or owner's legal representative. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the
necessary parties, including any easement holder or parties of interest regarding this project.The owner or legal
representative, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure(s)for review and inspection. This permit/application becomes null &void if
work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42)
x
ignature of Date
DEPARTMENTAL REVIEW APPROVE TE, DENIED DATE TA(,S/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
FEE'S TOTAL VALUATION:
BUILDING PERMIT FEE FIRE ACCESS AND GRADE
PLAN REVIEW GEO-TECH REVIEW
PLUMBING&BASE FEE STORMWATER REVIEW
MECHANICAL&BASE FEE TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE VIOLATION FEE
MASON COUNTY *AaPVRMIT NO.�(dZ���' ��
s " DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
_ WWW.CO.MASON.WAUS (360)427-9670 Shelton ext.352
f: Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: ND�-UA7-_42T4 LL1V, VAN p,AM NAME:GLWNV, c_DNGT�zU,CnDN
MAILING ADDRESS: 5-71 W - U 15_t_-/kVP_ N tF MAILING ADDRESS: 141 \ti FI2r DSON R-D.
CITY: St=�TTy4-- STATE: 1NA ZIP:9 61 Dr5 CITY: s}iE jN STATE: W A - ZIP: q 4
PHONE:C20Lp)2D0 `r82lpCELL: PHONE:(?,W-)I I D-S 6 V 0 CELL:
EMAIL: EMAIL : I-n7 cj l n�o [DY1 (art. n 6
L&I REG# EXP. LP /_�I/_(
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER): 12229 pp2 y
LEGAL DES CRIPTION(ABBREVL4TED): S I)2 M VT. L_CT 'J'Y, 4 t�X j 11- �T
SITE ADDRESS: l 100 e C-1'R-A-F;---V W_VV LDD P Pb CITY: IFLILYN
DIRECTIONS TO SITE ADDRESS: }1 1 N 61-_1y 1"H D N H V ' ; •R N p I�[ffT D N
1- I#-W L_DO P 4Zp - fb U.bw 1D -71 D D .
TYPE OF JOB
NEW C ADD ALT REPAIR OTHER USE OF BUILDING R r-S 1t>F_NGE
LOCATION OF FIXTURESILMTS- I ST FLOOR /- 2ND FLOOR BASEMENT GARAGE X OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
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 `t Furnace
Bath Tubs I Heatpump
Showers Spot Vent Fan �1r
Water Heater ► Propane Tank J i—
Clothes Washer
Kitchen enUq Efd2as/NlIet
Stove 2-
ehn Dishwasher aust `t
Hood t
Hosebibs 1p Dryer Vent I
Other
fR45PAt N k '2 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 contractor.I further declare
that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including
any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is
accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This
permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is
suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x I G 15
Signat tYA6pficant Date
X S hH Ns Ownerl rs Representatrve/Contractor
Print Name (indica e w ich one)
DEPARTMENTAL REVIEW APPROVED DA DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL