HomeMy WebLinkAboutBLD2022-00183 Final Solar Roof - BLD Permit / Conditions - 3/23/2022 Mason County
?� Mason County - Division of Community Development
615 W. Alder St. Bldg.8
584
360 427-9610 ext 98352
www.co.mason.wa.us
B DD2022-00183 SOLAR PANEL-RESIDENTIAL
PROJECT DESCRIPTION: ROOF TOP SOLAR INSTALLATION: 12 SPR- ISSUED: 02/15/2022
X22-360-WHT-AC MODULES WILL BE GRID TIED
SITE ADDRESS: 1980 NE TAHUYA BLACKSMITH RD TAHUYA EXPIRES: 08/14/2022
PARCEL: 223305000215
APPLICANT: WIDELL KEVIN J &GERALDINE A OWNER: WIDELL KEVIN J&GERALDINE A
1980 NE TAHUYA BLACKSMITH RD 1980 NE TAHUYA BLACKSMITH RD
TAHUYA, WA98588 TAHUYA, WA98588
360-301-2220
CONTRACTOR: POWER TRIP ENERGY CO
83 DENNY AVEPORT TOWNSEND,WA98588
360.463.3080
GENERAL CONTRACTOR'S LICENSE: POWER TRIP ENERGY CO License: POWERTE964JN
83 DENNY AVEPORT TOWNSEND,WA98588 Expires: 04/15/2022
360.463.3080
FEES: Paid Due
Solar/PV Fee $19.00 $0.00
Final Inspection $80.00 $0.00
State Fee-Residential $6.50 $0.00
Technology Surcharge $1.60 $0.00
Solar/PV Base Fee $30.00 $0.00
Totals : $137.10 $0.00
REQUIRED INSPECTIONS
BLD-Final Inspection
CONDITIONS
Printed by:Ariane Paysse on:02/15/2022 01:50 PM
Page 1 of 3
Mason County
Mason County - Division of Community Development
615 W.Alder St. Bldg.8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
SOLAR PANEL-RESIDENTIAL BLD2022-00183
The installation of solar(thermal or photovoltaic)energy systems to provide space heating or cooling, hot water and
swimming pool heating shall conform to Chapter 23 of the International Residential Code, Chapter 14 of the International
Mechanical Code, Uniform Plumbing Code, the International Fire Code, and be shall be listed and labeled in accordance
with UL1703.
Roof mounted panels shall weigh no more than 4 Ibs per square foot. Supports for solar panels are to be installed to spread
the dead load across as many roof-framing members as needed to ensure that no point loads in excess of 50-Ibs are
created. Panels may be installed on roof assemblies with a single layer of roofing material. Roof assemblies with more than
one roofing material layer shall require an engineered analysis demonstrating that the roof will support the additional load of
the solar panel system. Attachment to the roof shall be in accordance with manufacturer specifications provided during the
inspection by the Mason County Building Inspector.
Roof mounted equipment shall comply with the International Fire Code Section 605.11, including signage and access
pathways. Roof access points shall not be located in areas where access ladders would block window or doors openings.
Not less than two-3-foot wide access pathways shall be provided from the eave to ridge.
Ground-mounted panels and modules, installation must be in accordance with the manufacturer's instructions and be
available at time of inspection.
Inverters shall be listed and labeled in accordance with UL 1741. Systems connected to the utility grid shall use invertors
listed for the utility interaction
Collectors and thermal storage units shall be listed and labeled to show manufacturer's name, model number, serial number,
collector weight, collector maximum allowable temperatures and pressures, and the type of heat transfer fluids that are
compatible with the collector.
Connections to potable water supplies shall be provided with backflow protection in accordance with the Uniform Plumbing
Code. Solar energy systems containing pressurized fluids shall be protected with a temperature and pressure relief valve
and be protected from freeze damage. Systems shall be equipped with means to limit the maximum water temperature of
the system fluid entering or exchanging heat with any pressurized vessel inside the dwelling to 180 degrees Fahrenheit.
Solar energy collectors, controls, dampers, fans, blowers and pumps shall be accessible for inspection, maintenance, repair
and replacement. The roof shall be constructed to support the loads imposed by roof-mounted solar collectors and shall be
constructed of noncombustible materials, flashed and sealed to prevent entry of water, rodents, and insects. The building
inspector may require additional information, including an engineered design, to verify that existing roof or floor construction
are adequate to support the additional load of the solar energy equipment. When required provide an engineered design for
inspection.
" All construction must meet or exceed all local and state ordinances in addition to the International Codes requirements as
adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted
classification. Any non-approved change of use or occupancy would result in permit revocation.
All furnace installations shall meet the minimum efficiencies set forth in the current edition of the Washington state energy
code(WSEC). any portion of the mechanical system that is altered or replaced shall meet the minimum standards set forth
in the WSEC and international mechanical code.
* Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries,
Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an
unregistered contractor. Further information can be obtained at 1-800-647-0982. The person signing this condition is either
the homeowner, agent for the owner or a registered contractor according to WA state law.
Printed by:Ariane Paysse on:02/15/2022 01:50 PM
Page 2 of 3
Mason County
Mason County - Division of Community Development
615 W.Alder St. Bldg.8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
SOLAR PANEL-RESIDENTIAL BLD2022-00183
" 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.
The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency
(ORCAA).
It is unlawful for any person to cause or allow the demolition (or major renovation)of any structure unless all asbestos
containing materials have been identified and removed from the area to be demolished. Work shall not commence on an
asbestos project or demolition project unless the owner or operator has obtained written approval from ORCCA.2490 B
Limited Lane NW, Olympia WA98502, 360.586.1044/800.422.5623 www.orcaa.org
Applicant has indicated this is a replacement unit. Prior to Mason County allowing any occupancy of the new proposed
unit, the existing unit which is on-site and is being replaced MUST be removed from the parcel.
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to give authority to violate or cancel
the provisions of any other state/local law regulating construction or the performance of construction.
Issued By: #1� ;l2 M?a Se
Contractor or Authorized Agent:Issued to Buddy Via email w/ Power Trip Energy Date: 2/15/2022
Printed by:Ariane Paysse on:02/15/2022 01:50 PM Page 3 of 3
1p
. 0 q 2 $
Q 2 2 m \. \ \
+ --I --Im n
K § § � m
/ / � #
7 m m m
ƒ o
] / 7 %
z ¥ R h \
@ m c o
j \ \ N)
/ / \
\ / C /
m «
�
k \ \ m
/ \
. \ m
>
n 7
) m v v T _
, O O m 0 7
D
m x 0 0
2 2 L. L. C cn
_ - o D \ 2 T
m \ q q f
ƒ m 2 m § � 2 0
x > u $ \ S(P �
\ d \ CD cn O 0
> = 3 c z
K > 22 = U
/ \ 00 co 7 Ln
2 cO o em
§ \ M0 /
@
;a k / %/
\ cn
> I P:.
m9 s
C2 \
CA ;a / j.
g \ 2
2
v q \ s
m / \
7 7 /
k
m m / >
o \ \ / /
3 w w w =
2 g o c
\ / o
_ \ / $
�
0
l
MASON COUNTY 360-427-9670 Shelton ext.352
360-275-4467 Belfair ext.352
COMMUNITY SERVICES 360-482-5269 Elma ext.352
Building,Planning,Environmental Health,Community Health
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: -Z-0 ZZ.-0�1 f3
ADDRESS/LOCATION: �� (� N G �a�nu� Ck T---)\C-L6e
FINDINGS
Y� y—
�r
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, i ins will be checked on the next inspection.
OK to
Date: ZZ ❑ Please contact our office regarding possible
Department:, L. structural damage incurred by recent
Inspector: p "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
X SUN P EWER°
FEB 10L22
g15 W, Alder Street
Sunftwer®X-Series: X22-370 I X22-360
SunPowere Residential
AC Module
Built specifically for use with the SunPower Equinox'""system,the only fully
integrated solution designed,engineered,and warranted by one
manufacturer.
P Maximum Power. Minimalist Design.
AFss
®� Industry-leading efficiency means more power and savings
®® per available space.With fewer modules required and
hidden microinverters,less is truly more.
Highest Lifetime Energy and Savings
Designed to deliver 60%more energy over 25 years in
real-world conditions like partial shade and high temperatures.'
M150% ----------------------------------
A
3 140% —
Fundamentally Different. o. 13096
:e 120% Up to
And Better. > 1109 60%
100% More
w 90ve y a, Lifetime
W 80% �4}� EnerSY
i w � �r��
60%
N 0 5 10 15 20 25
The SunPower8Maxeon®Solar Cell Years of Operation
• Enables highest-efficiency
modules availablez Best Reliability, Best Warranty
• Unmatched reliability
• Patented solid metal foundation With more than 25 million modules deployed around
prevents breakage and corrosion the world,SunPower technology is proven to last.That's
why we stand behind our module and microinverter l
with the industrys best 25-year Combined Power and
Product Warranty,including the highest Power Warranty
in solar.
100%
Factory-i ntegrated M i cro i nverter . 96
y 96%96
• Simpler,faster installation o 9c%
• Integrated grounding,wire a g 12%
management,and rapid shutdown c say � � More
• Engineered and calibrated by eevs " g`a �E Power
10 849b '�i k tilihyi 9
SunPower for SunPower AC modules 9%6 4') a I i a 4_s iG y 4 in
Year
0 5 10 15 20 25
Years of Operation
X-Series:X22-370 X22-360 SunPower®Residential AC Module
IEEE 1547a-20144
SRD Profile (default settings) CA Rule 214
min./nom./max. min./nom./max.
Frequency(Hz) 59.5/60.0/60.5 58.5/60.0/60.5
Power Factor 0.99/1.00/1.00 0.85 lead./1.00/0.85 lag.
Reactive Power t169 Var
Volt-VAr
Voltage @240 V 211.2/240/264 V
@208 V 183/208/228.8 V
Max.Current @240 V 1.33 A
@208 V 1.54 A
DC/AC CEC Conversion Efficiency @240 V 96.0%
@208 V 95.5%
Max.Units Per 20 A Branch Circuit @240 V 12(single phase)
@208 V 10(two pole)wye
Power 320 W,320 VA
No active phase balancing for 3-phase installations
X22-370-D-AC X22-360-D-AC Warranties 25-year limited power warranty
Nominal Powers(Pnom) 370 W 360 W 25-year limited product warranty
Power Tol. +5/-0% UL listed to UL 1741 SA
SRDs:IEEE 1547-2003,IEEE 1547a-2014,
Efficiency 22.7% 22.1% CA Rule 21 Phase 1
Temp.Coef.(Power) -0,29%/o C PV Rapid Shutdown Equipment
Equipment Grounding
-Three bypass diodes UL 6703,UL 9703 Connectors and cables
Shade Tolerance •Integrated module-level maximum (load break disconnection)
power point tracking Certifications UL 1741 AC Module(Type 2 fire rating)
Enables installation in accordance with:
NEC 690.6
NEC 690.12 Rapid Shutdown(inside and outside the array)
NEC 690.15 AC Connectors,690.33(A)-(EK1)FCC
Operating Temp. -40°F to+149°F(-40°C to+65°C) and ICES-003 Class B
Max.Ambient Temp. 1220F(50°C) When used with InvisiMount racking(UL 2703):
Integrated grounding and bonding
Max.Load Wind:62 psf,3000 Pa,305 kg/mz front&back Class A fire rated
Snow:125 psf,6000 Pa,611 kg/m2 front
Impact Resistance 1 inch(25 mm)diameter hail at 52 mph(23 m/s) PID Test Potential-induced degradation free
280 mm
Solar Cells 96 Monocrystalline Maxeon Gen III (11.02In]
Front Glass High-transmission tempered glass with
anti-reflective coating 0
Environmental Rating Outdoor rated 1107mm js r
Frame Class 1 black anodized(highest AAMA rating) [aa 6In] 1(4.mn]
Weight 45.5 Ibs(20.6 kg) 30 mm
Recommended Max. [1.21n)
Module Spacing 1.3 in.(33 mm)
(61. mm S
cxm suwan vmry
ry xvo axnoowH
O pMENI
1 SunPower 360 W compared to a Conventional Panel on same-sized arrays(260 W,16% D TE LIS
efficient,approx.1.6 m2),4%more energy perwatt(based on third-party module Please read the safety and Installation 1nsLrUCilonS for details. nbdI ve,ro.mo�w:TyP,2
characterization and PVSim),0.75%/yrslower degradation(Campeau,Z.et al.SunPower
Module Degradation Rate,SunPower white paper,2013).
2 Based on search of datasheet values from websites of top 10 manufacturers per IHIS,as of
January 2017.
3#1 rank in"Fraunhofer PV Durability Initiative for So la Modules:Part3".PVTech Power
Magazine,2015.Campeau,Z.et al.sunPowerModule Degradation Rate,Sun Powerwhite
paper,2013.
4 Fact oryset to 1547a-2014 default settings.CA Rule 21 default settings profile set during
commissioning.Seethe Equinox Installation Guide#518101 for more information.
5 Standard Test Conditions(1000 W/m'irradiance,AM 1.5,25°C).NREL calibration
standard:SOMS current,LACCS FF and voltage.All DC voltage is fully contained within the
module.
See www.sunpower.com/facts for more reference information.
For more details,see extended datasheet www.sunpower.com/datasheets withoutnoti s
Specifics[ionsindudedinthisdatasheet are subjecttochangewithoutnotice. � C D��
02018 SunPower corporation.All Rights Reserved.SUNPOWER,the SUNPOWER logo L R
and MAXEON are registered trademarks of SunPower Corporation in the U.S.and
other countries as well.
1-800-SUNPOWER 527025 RevB
Solar Agent:Andy Cochrane Client Name: Widell Residence
Power Trip Energy Corp F �
83 Denny Ave, Port Townsend, WA 98368 6 02022
(360)643-3080 �514 22
r` r
www.powertripenergy.com "d(Dr
LIC: POWERTE964JN St/'��t
Project:Widell Residence Tahuya Client: Kevin Widell
Phone: (360) 301-2220 Address: 1980 NE Tahuya Blacksmith Rd,Tahuya,WA 98588
System Description: 4.32 kW Residential Grid-tied PV
Solar Modules:
Branch Circuit A-12 AC Circuit Combiner Panel:
Model: SPR-X22-360-WHT-AC South Ext Wall Adj to meter
Micro inverter max power output 320 watts
South Roof
AC System Disconnect:
(For Rapid Shutdown of AC Modules)
South Ext wall adj to meter
Utility Grid:_Mason PUD#3_
Net Meter:
South Ext Wall
Meter#: 144 058 350
Customer Owned
Production Meter:
South Ext wall adj
to meter
Main Service Panel (LOAD):
Interior, mechanical room, on
South ext wall adjacent to meter
February 10, 2022 -3 -
,
Solar Agent:Andy Cochrane Client Name:Widell Residence
uA
Power Trip Energy Corp
Project: Widell Residence Tahuya
Client: Kevin Widell
Phone: (360) 301-2220
Address: 1980 NE Tahuya Blacksmith Rd,Tahuya,WA 98588System Description: 4.32 Residential Grid-tied PV
Project Photos and Notes:
February 10, 2022 -4-
Solar Agent:Andy Cochrane Client Name:Widell Residence
k„a
i
K99 �
W ✓
e
i
,
✓off i� I �� t' E
i`" ✓ ✓r ,
February 10, 2022 -5 -
®°N CI°°�' MASON COUNTY PERMIT NO. 22
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352 ��' V
1854 Shelton,WA 98584 (360)482-5269 Elma ext. 352
FEB 10 2V22
PLUMBING & MECHANICAL PERMIT APPLICATI0ti15
OWNER INFORMATION: CONTRACTOR INFORMATION: r et
NAME:Kevin Widell NAME:Power Trip Energy
MAILING ADDRESS:1980 NE Tahuya Blacksmith Rd MAILING ADDRESS:83 Denny Ave
CITY:Tahuya STATE:WA ZIP:98588 CITY:Port Townsend STATE:WA ZIP:98368
PHONE:(360)301-2220 CELL: PHONE:(360)643-3080 CELL:
EMAIL:kevinwidell@gmail.com EMAIL :buddy@powertripenergy.com
L&I REG#POWFRTE964JN EXP. 4 /15 /2022
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER):223305000215
LEGAL DESCRIPTION(ABBREVIATED):HAVEN LAKE TRS 215-216#20-23 AF#2143409,S 50/59
SITE ADDRESS:1980 NE Tahuya Blacksmith Rd Tahuya,WA 98588 CITY:
DIRECTIONS TO SITE ADDRESS:Head NE on WA-3 N toward E Beil Rd from Shelton(22.7 mi),Continue on WA-300 W.Take NE Belfair Tahuya Rd and NE Haven Way
to NE Tahuta Blacksmith Rd(10.5 mi),destination will be on Right toward lake.
TYPE OF JOB
NEW x ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS—1ST FLOOR 2ND FLOOR BASEMENT GARAGE OTHER House Roof
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel SPR-X22-360-WHT-AC(12)
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 4�' 2/10/2022
nature of Applicant Date
X Andy Cochrane Owner/Owners Representativ won rac or
Print Name (indicate which one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
I ~
OVER-THE-COUNTER BUILDING PERMIT CHECKLIST FOR RESIDENTIAL SOLAR
PHOTOVOLTAIC SYSTEMS: ROOFTOP MOUNTED
Contractors can ap ly for an Over-The-Counter(OTC)permit where the PV system meets the requirements listed
in this Checklist.All project plans and supporting documentation must be provided on site for the inspector.
--------TO BE COMPLETED BY APPLICANT------_ r� cJE�/VE
Q Project Information FEB 10 2022
Property Owner Name: Kevin Widell61 VV
Project Address: 1980 NE Tahuya Blacksmith Rd Parcel# der Street
City: State. ZIP:
Tahuya WA 98588
Day Phone: (360) 301-2220
Contractor Name Power Trip Energy
Contractor License#: POWERTE934QE Contractor day phone: (360) 643-3080
Describe project: Conventionalfromed built dwelling or garage,
Pole structure,steel building,etc.
Note: Manufactured/ obile homes require L&I Approval 4.32 kW residential grid-tied roof-mounted PV
PV system descript on 12 SPR-X22-360-WHT-AC modules will be grid-tied and installed on
(include manufaCtL rer the house roof at the residentail address of 1980 NE Tahuya
and model#of PV Blacksmith Rd in Tahuya, WA 98588. There is a micro-inverter on the
modules and back of each module, EnPhase IQ7XS-96-ACM-US(12 at 320 Watts per MI)
inverters):
®Determine f your project qualifies for expedited permitting:
Yes No
1. PV system is designed and proposed for a detached one-or two-family dwelling or
townhouse not more than three stories above grade or detached accessory structure that X ❑
is code compliant to setbacks and height,or code allows expansion of nonconformity for
solar modules. [IRC 101.2]
2. Modules on pitched roofs do not exceed the highest point of the roof unless approved by X ❑
the local jurisd ction.
3. Rooftop is made from lightweight material such as a single layer of composition shingles, X ❑
metal roofing, ightweight masonry,or cedar shingles.
4. The installatior shall comply with the manufacturer's instructions. [IRC M2302.2] X ❑
5. The installatior shall meet the requirements of NFPA 70 National Electric Code,and all
required electr cal permit(s) must be obtained from the Authority Having Jurisdiction to X ❑
administer the electrical code. [IRC M2302.2]
6. The installation shall meet the requirements of the International Fire Code as amended X ❑
by WA State. [IRC M2302.2]
7. The PV system is designed for the wind speed of the local area, and will be installed per X ❑
the manufacturer's specifications. [IRC M2302.2.1(1)]
8. The ground snow load does not exceed 70 pounds per square foot. [IRC M2302.2.1(2)] X ❑
9. Total dead load of modules, supports, mountings, raceways and all other appurtenances X ❑
weigh no more than four pounds per square foot. [IRC M2302.2.1(3)]
1
r '
Enter total dead load of system (Ibs/ft2): Click here to enter text. 2.57 Pounds persquare foo
10. To address uplift, modules are mounted no higher than 18"above the surface of the X ❑
roofing to which they are affixed. [IRC M2302.2.1(4)]
11. Supports for solar modules are installed to spread the dead load across as many roof-
framing members as needed to ensure that no point load exceeds fifty(50) pounds. X ❑
[IRC M2302.2.1(5)]
12. The photovoltaic modules and supporting structure shall be constructed of
noncombustible materials or fire-retardant treated wood equivalent to that required for X ❑
the roof construction. [IRC M2302.2.1]
13. Roof and wall penetrations shall be flashed and sealed to prevent entry of water, ❑
rodents,and insects. [IRC M2302.2.2]
14. PV modules are listed and labeled with a fire classification in accordance with UL 1703. X ❑
[IRC M2302.2.3]
Comments: Click here to enter text.
if you answered yes to all of the above questions,the project qualifies for the over-the-
counter permitting process.
Q Submit this Checklist, Site Plan, and other required permit application forms to:
[insert contact info for jurisdiction having authority]
As the property owner or authorized representative of the above listed property, I attest that
all information in this checklist is accurate to the best of my knowledge.
Applicant Signature: / Date:
.R %�dC/fiLCLrL2 2/9/2022
Applicant Name(Please Pri t): Andy Cochrane
--------TO BE COMPLETED BY MASON COUNTY STAFF------
Qualifiesfor OTC Building Permit? ❑Yes ❑No Permit Application#:
Staff Initials Date:
2