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INSULATION
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Data By BG I SLAB INSULATION FIRE DEPARTMENT ...... 0
Date By 0
Foundation Walls Floors Date By X
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Y DECKS
FRAMING WallsWalls Date By C—
Data By 0
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Vault Date By
PLUMBING Date By C
OTHER
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Date By
DRYWALL Type:
Int Brace Wall Date By
Date By Dale By r
FINAL INSPECTION
Water Line Fire Separation
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Date By Date By Date By, &
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Pass or Request Inspect. CD
Type of Insp. it Date Date Done By Comments
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MASON COUNTY 360-427-9670-Shelton ext.352
360-275-4467 Belfair ext.352
COMMUNITY SERVICES 360-482-5269 Elma ext.352
Inspection Hotline 360-427-7262
Building, Planning, Environmental Health,Community Health
90) 615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us
CORRECTIONANSPECTION REPORT
PERMIT/CASE NUMBER: &t) 2 C1( 2_ 1-,
ADDRESS/LOCATION: t C �,O y,,l C 1-
! "�
FINDINGS:
� 1G-7!� . /s, -//� �0 /11
cl G? i I � -1 yvt�C 22G2r "�-,
✓'ems / / 61
4l o
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
Call for re-inspection when corrections are made before proceeding with any further work.
❑ Make corrections, items will be checked on the next inspection.
❑ OK to
s
Date: Please contact our office regarding possible
Department: ( structural damage incurred by recent
Inspector: "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
MASON COUNTY 3 275-446 Shelton ext.352
360-60-275-4467 Belfair ext.352
COMMUNITY SERVICES
360-482-5269 Elma ext.352
Inspection Hotline 360-427-7262
Building, Planning,Environmental Health,Community Health
615 W.Alder St.Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us
CORRECTIONANSPECTION REPORT
PERMIT/CASE NUMBER: (-gyp 2W 7— oo Z f
ADDRESS/LOCATION:
FINDINGS
OAJ
tAJ
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Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
❑ Call for re-inspection when corrections are made before proceeding with any further work.
❑ Make corrections, items will be checked on the next inspection.
❑ OK to
Date:Wnt:
Please contact our office regarding possible
Depa � structural damage incurred by recent
t _ _ natural/man made"disasters.This is NOT a
Inspector: - CORRECTION NOTICE.
D OT REMOVE THIS TAG
MCC14.12
i
NamebT4 aS�l Parcel# ,S�G)�ri/`I 7rti/r! / � BLD#
Mason County RV 15
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Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (pagtYWLa)
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 = L
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
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios=alks X =
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
1�—I 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 r vie 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
'A irt,iz `
Name Parcel# BLD#
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 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) 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
100 W. Public Works Dr
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 400
415 N. 6th St—Bldg#8 lower level
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/Agent/Contractor(circle one)Date:
Page 2 of 2
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PERMIT ASSISTANCE CENT R: Permit No:-,B 8 t� G T
I•,>•BUILDING•PLANNING•PUBLIC=LTH•FIRE MARSHAL
' 615 W.Alder Street,Sn,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ����
Belfair.•(360)275-4467•Phone Elton:(360)482-5269. VEn
BUILDINC31 PERMIT APPLICATION MAR 15 201
8
PROPERTY OWNER INFORMATION: CONTRACTOR INFOiA ( 9;gld.,
it
NAME: :'` .J c- p C i/ i NAME: S t
MAILING ADDRESS: MAILING ADDRESS:
CITY: W,- —STATE: j at ZIP: CITY: STATE: ZIP:
PHONE#1: PHONE: CELL:
PHONE#2: EMAIL :
EMAIL: 0e, Z L&I REG#
PRIMARY CONTACT: OWNS ' � CONTRACTOR❑ OTHER❑
NAME EMAIL MAILING AD RESS _ CITY STATE (A)�_ ZIP! '-'`f
PHONE._ >' ` SELL
PARCEL INFORMATION: -j
PARCEL NUMBER(12 Digit Nutnber)_ 3� 2 I "j cl- 2 ZONING t jg
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICTAk J
SITE ADDRESS CITY
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOV"
1S PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
TYPE OF WORK: NEW ❑ ADDITION❑ ❑ [IALTERATION REPAIR❑ OTHER
USE OF STRUCTURE(Residence,Garage,Commercial Bk�,Etc.
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF AEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) ❑ YE (Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq. fl.
DECK sq. ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRE,D*
MAKE- MODEL_ YEAR lgqil LENGTH
WIDTH BEDROOMS__ BATHS 6,2 SERIAL NUMBER LI
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC IEWER❑ / NEW❑ EXISTING®-'
PLUMBING IN STRUCTURE? YES O❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED YES ❑ NO❑ EXISTING SQ.FT. L
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS Z
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.1 declare that I am the owner and I further declare that 1 am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including;ny 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/applic Lion 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
X �-IL- ./x
Signature ol OWNER(Mfist be inne by he'OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT JfiL �q 7-1 y
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
I
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