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BLD2020-00084 FLD2020-00003 Elevation Certificate - BLD Permit / Conditions - 5/29/2020
Mason County Mason County - Division of Community Development o 615 W.Alder St. Bldg. 8 . Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us BLD2020-00084 NEW SINGLE FAMILY RESIDENCE PROJECT DESCRIPTION: DEMO OF EXISTING AND CONSTRUCTION ISSUED: 05/29/2020 OF NEW SFR SITE ADDRESS: 12681 NE NORTH SHORE RD BELFAIR EXPIRES: 11/25/2020 PARCEL: 322355000006 APPLICANT: CHERYL L ROOSENDAAL ET VIR OWNER: CHERYL L ROOSENDAAL ET VIR KEVIN MCFARLAND KEVIN MCFARLAND OLYMPIA,WA 98506 OLYMPIA, WA 98506 DESIGNER: SCOTT HOMES INC License: SCOTTH1022R3 3016 10TH AVE NE Expires: 08/25/2020 OLYMPIA, WA 98506 1.360.357.9167 VALUATIONS: FEES: Paid Due R-3 VB Residential, one- 1320.00 $160,036.80 Technology Surcharge $54.29 and two-family Mechanical Fees $82.00 Covered Deck/Carport 240.00 $5,280.00 Plumbing Fees $113.00 Mechanical Base Fee $30.00 Building Permit Fee $1,493.52 Plan Check Fee $970.79 $0.00 Planning Review Fee $240.00 $0.00 State Fee-Residential $6.50 Plumbing Base Fee $25.00 Building Plan Review/Change of $110.00 $0.00 Use- Onsite Sewage Water Adequacy Review $110.00 $0.00 Total: $165,316.80 Totals : $1,430.79 $1,804.31 FIXTURES City. Mechanical Fixtures 0 ty Plumbing Fixtures 1.0000 Dryer Vent(s) 1.0000 Number of Clothes Washers 1.0000 Kitchen Exhaust Hood(s) 1.0000 Number of Dishwashers Printed by:Genie Mcfariand on:05/29/2020 08:38 AM Page 1 of 8 Mason County l 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 NEW SINGLE FAMILY RESIDENCE BLD2020-00084 (3ty Mechanical Fixtures Qty Plumbing Fixtures 1.0000 Furnace(s) 1.0000 Number of Kitchen Sinks 1.0000 Heat Pump(s) 1.0000 Number of Water Heaters and or Vent 2.0000 Spot Vent Fan(s) 2.0000 Number of Hose Bibs 2.0000 Number of Showers 2.0000 Number of Toilets 3.0000 Bathroom Sink REQUIRED INSPECTIONS Setback Inspection Framing Inspection Footing Inspection Rough-Plumbing Inspection Foundation Wall-Pre-Pour Inspection Mechanical Inspection Underfloor Inspection Insulation Inspection Slab Insulation BLD-Final Inspection Shearwall Inspection CONDITIONS The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. * All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way. " By definition, propane tanks and heatpumps are structures,which must meet setback conditions. Please check your "Approved Site Plan"to ensure these structures meet the setback conditions listed. Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed. * All property lines shall be clearly identified at the time of foundation inspection. " Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration. Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No more than one extension may be granted. * Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. Printed by:Genie Mcfarland on:05/29/2020 08:38 AM Page 2 of 8 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 NEW SINGLE FAMILY RESIDENCEBLD2020-00084 * Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. " A permanent certificate, completed by the builder or registered design professional, shall be posted on a wall in the space where the furnace is located, a utility room, or an approved location inside the building. When located on the elctrical panel, the certificate shall not cover or obstruct the visibility of the circuit directory label, service disconnect labek, or toher reqyired Iabels.The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC)of fenestration. Where there is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section R401.3& R402.4.1.2, and air leakage results if a blower door test was conducted. Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 5 air changes per hour when tested with a blower door in accordanve with IECCLWSEC Section R402.4.1.2. The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required for additions less than 500 square feet. Reference IECC/WSEC R402.4.1.2. Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2015 Certificate"and are available in '/<or'/sheets. The Mason County Permit Center will also have some available. * Installation of heating equipment in a single-family residence shall meet the requirements of the current IECC/WSEC R403, applicable sections of the IRC, and IMC. Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.7. Heating and design load calculations for the purpose of sizing HVAC systems are required and shall be calculated in accordance with accepted practice, including infiltration and ventilation. Design calculations shall be available for inspection during inspection. Referencing IRC M1601.4, all ducts, air handlers, filter boxes, and building cavities shall be sealed. All joints of duct systems and seams shall be made substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Closure systems used with rigid fibrous glass ducts shall comply with UL181A and shall be marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape. Closure systems used with flexible air ducts and flexible air connectors shall comply with UL181 B and shall be marked 181 B-FX for pressure- sensitive tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings shall be mechanically fastened. Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181 B and shall be marked 181 B-C. Crimp joints for round metal ducts shall have a contact lap of at least 1-1/2 inches (38 mm) and shall be mechanically fastened by means of at least three sheet-metal screws or rivets equally spaced around the joint. Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation instructions. Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be insulated to R-8 DUCT TIGHTNESS TESTING shall be conducted by person(s)trained to perform such testing. A signed affidavit documenting test results in accordance to IECCM/SEC Section R403.3.3 shall be provided to the Mason County Building Department prior to the final occupancy inspection. Affidavit forms are available on at the WSU-Energy Program website titles, "Duct Leakage Affidavit"or"Duct Leakage Testing Results (Existing Construction)." Duct tightness testing is not required if the air handler and all ducts are located within the heated space. Printed by:Genie Mcfariand on:05/29/2020 08:38 AM Page 3 of 8 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 NEW SINGLE FAMILY RESIDENCE BLD2020-00084 * REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacturer's installation instructions. A drip edge shall be provided at eaves and gables of shingle roofs. " A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. "NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting 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. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. " When parcel development requires direct access to state road(s), a Road Access Permit or Approval must be granted and approved by the Washington State Department of Transportation. For more information contact Washington State Department of Transportation, at(206)357-2620, ext. 630. * A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section R404.1. Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within 25'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. Printed by:Genie Mcfadand on:05/29/2020 08:38 AM Page 4 of 8 G;P,Mw 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 NEW SINGLE FAMILY RESIDENCE BLD2020-00084 Adopted IECC/Washington State Energy Code Compliance has been approved as follows: Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window(Max U- Factor):0.30, Skylight(Max U-Factor):0.50, Doors(Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation min. R-49, Vault Insulation R-38, and Slab Insulation R-10. 1b- EFFICIENT BUILDING ENVELOPE 1b: Prescriptive compliance is based on Table R402.1.1 with the following modifications: Vertical fenestration U = 0.25 Wall R-21 plus R-4 ci Floor R-38 Basement wall R-21 int plus R-5 ci Slab on grade R-10 perimeter and under entire slab Below grade slab R-10 perimeter and under entire slab or Compliance based on Section R402.1.4: Reduce the Total UA by 15%. 2a-AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2a: Compliance based on R402.4.1.2: Reduce the tested air leakage to 3.0 air changes per hour maximum and All whole house ventilation requirements as determined by Section M1507.3 of the International Residential Code shall be met with a high efficiency fan (maximum 0.35 watts/cfm), not interlocked with the furnace fan. Ventilation systems using a furnace including an ECM motor are allowed, provided that they are controlled to operate at low speed in ventilation only mode. To qualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the maximum tested building air leakage and shall show the qualifying ventilation system. 3b-HIGH EFFICIENCY HVAC EQUIPMENT 3b: Air-source heat pump with minimum HSPF of 9.0 5c-EFFICIENT WATER HEATING 5c: Water heating system shall include one of the following: Gas, propane or oil water heater with a minimum EF of 0.91 or Solar water heating supplementing a minimum standard water heater. Solar water heating will provide a rated minimum savings of 85 therms or 2000 kWh based on the Solar Rating and Certification Corporation (SRCC)Annual Performance of OG-300 Certified Solar Water Heating Systems or Electric heat pump water heater with a minimum EF of 2.0 and meeting the standards of NEEA's Northern Climate Specifications for Heat Pump Water Heaters " CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. * The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility of the applicant, owner or contractor to make the required corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. Printed by:Genie Mcfarland on:05/29/2020 08:38 AM Page 5 of 8 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 NEW SINGLE FAMILY RESIDENCE BLD2020-00084 All building permits shall have a final inspection performed and approved by Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. * All RED stamped approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections being performed or approvals granted. * 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. * 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. * The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. * All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. * When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at (360)427-9670, ext. 450 or 100 W Public Works Dr. Shelton. The building permit will not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled and approved. * Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. " Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC Section R315. Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling. EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances), repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or created. * The foundation/footing must be placed on undisturbed, firm-native soil. * 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. Printed by:Genie Mcfadand on:05/29/2020 08:38 AM Page 6 of 8 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 NEW SINGLE FAMILY RESIDENCE BLD2020-00084 Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28 and 14.17. " Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor & Industries(L&I). For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415- 4000. The stamped approved site plan is required to be on-site for inspection purposes. If an inspection is requested and the approved site plan is not on site, approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. * WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85 MPH. " Habitat Management Plan prepared by Sound Native Plants dated May 7, 2019 shall be implemented on site by applicant including but not limited to recommendations, Best Management Practices, and Monitoring with submittal to County as outlined in Plan. Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. RR5 * A separate inspection in addition to the inspections required in the IBC, Section 110 shall be required in accordance with the 2015 IBC, Section 1705.12.2 and Section 1707.1. The additional inspection is required when shear wall fastener spacing is required to be 4 inches or less. The shear wall schedule shown on sheet S2 designate wall(s)type B with fastener spacing 4 inches or less. The required inspection may be performed by the Mason County Building Department, a WABO certified inspector, certified to inspect lateral connections, the Engineer of record (EOR), or an authorized representative of the (EOR). The special inspectors duties and responsibilities shall be as specified in Chapter 17. When a third party inspector is used to perform the inspection, special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton, WA 98584 and also available on site for review by the Building Official. Inspection reports shall be completed and submitted to the Mason County Building Department in a timely manner and shall be submitted prior to the framing inspection of said project. * FOUNDATION IN FLOOD HAZARD (A&AE)ZONE WITH A BFE This project is approved construct a dwelling structure with a new foundation system in accordance with the Mason County Flood Damage Ordinance and the 2015 International Residential Code Section R322. The location of the structure is identified as an AE Flood Hazard area in accordance with FEMA determination. Minimum construction criteria are as follows: The floor(slab)of the proposed structure shall be elevated at least one-foot(1'0") above the Base Flood Elevation (BFE). The finished floor must be at 15'+1'+ 16"finished floor(Slab) If structural fill is used compaction report is required. The design professional that prepared the Elevation Certificate must perform an inspection of the foundation and placement prior for pour. All building materials used below the BFE shall be pressure-preservative treated in accordance with AWPA U1 or be naturally resistant to decay. In addition, materials and installation methods used for flooring and interior and exterior walls and walls coverings shall conform to the provisions of FEMA/FIA-TB-2. (IRC R322.1.8) Printed by:Genie Mcfariand on:05/29/2020 08:38 AM Page 7 of 8 .p 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 NEW SINGLE FAMILY RESIDENCE BLD2020-00084 * Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered. A.NY'Drainfield/Reserve requires a 1 Oft setback from all footing/foundations. 6,� Septic tank(s) requires 5ft setback from all footing/foundations. 4.) No foundation/Perimeter Drains within 30ft, down gradient of Drainfield/Reserve area. b.) No Cut Bank(s) (greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/Reserve area. 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: Contractor or Auto zed Agent: Date: ( l Printed by:Genie Mcfadand on:05/29/2020 08:38 AM Page 8 of 8 MASON COUNTY COMMUNITY SERVICES Permit No: PERMIT ASSISTANCE CENTER: E C C'`v`E D ',•BUILDING.PLANNING•PUBLIC HEALTH•FIRE MARSHAL c 015 W.Aker Sheet,Shelton.WA 00584 •% Phaw M Wton:(361p427-067o sxt 352•Fa+:(360)427-7788 Ptww JA N 2 2 2020 Belteir.(360)2754467•Phone Ekne:(360)462.5260 BUILDING PERMIT APPLICATION 615 W oWor Street PROPERTY OWNER INFORMATION: j CONTRACTOR INFORMATION: i ---- - -NAME: H Ef?A- 160 -N� AL NAME: MAILING ADDRESS: I TH MAILING ADDRESS:•3S>)l�. /6' 7TL— i D 1 CITY: 1 0 STATE: I N G CITY:OLVtA?)W STATE: Z[P. -��' L, PHONE#1 PHONE:' '' CELL: EMAIL ^ '�C �-lfiHr'Yh,cS CF1'YI PHONE#2: I 1 o_ EMAIL: t^ L&1 REG# PRIMARY TA `OWNER❑' CONTRACTORg, OTHE NAME ' EMAIL ^ c MAILING AD�RES$' 1 - CITY !A` ATE ✓ ZIP__`11F PHONE r ) CELL i PARCEL INFORMATION: i PARCEL NUMBER(12 Digit Numbed 06000(o ZONING LEGAL DESCRIPTION(Abbreviated) ITISOh.14jZ00N HND Ck^- IMQo FIRE DISTRICT M RFA I SITE ADDRESS f2LaI NC- t3R-[�St�02.r1✓ ROAD cITY75EL : A I R I DIRECTIONS TO SITE ADDRESS S'R 60-r6 LkmjlN 3Hmke21)., 12 4 rm I I el V14it4 f=�1 Q } IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YFS2� NO❑ IS PROPERTY'A THIN 200 FT OF THE FOLLOWING: Wfi t•8 rho,yrh/: SALTWATER LAKE❑ RIVERICREEK❑ POND❑ 1A'ETLAND❑ SEASONAL RUNOFF❑ STREA\!❑ TYPE OF WORK: NEW I ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Beth ur,G—m,e C—e-hd ytdit 1,1:) IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS_ i HEATED STRUCTURE? YES inn 8)dp 41 YES,p'wjq of 8tdp_l NO❑ � DESCRIBE WORK (lpy_, C42in 5-4-►-w C +r ,SQUARE FOOTAGE:tprnpn+em IST FLOOR r7qq sq.ft. -aND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.A. DECK sq.ft. COVERED BECK Lt sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.fl- Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATIQN: *4 COPIES OF THE FLOOR PLAN REQUIRED' MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC:R SEWER❑ / NEW❑ F.XISTINGJZ PLUMBING IN STRUCTURE? YES Vf NO❑ 1(;ves,attach completed Water Adequacy Form PERIME•TER)FOUNDATION DRAINS PROPOSED" YES(-j NO)$ EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 2— OWNER adurowied0es Ihat submission of neomirste information may resLdt rn a stop wok order or perm revocation.AduaMedgement of such is oY sgnetwe below.I dedare that I am the owner end I(a#w dedem that I am orW$*d to receive this pemvt and to do the work as proposed.I have obleiried permission from all the necessary parties,indudep any emenrerd holder or parties of interest reWdinp this project. The owner or bps! 1 mpreeematrve,represents thM the kdormom provided is aeeuraie and grants er4soyees of Mason County aCefef to yre above described property erd sh ftu*s)for review and inspeetim. This permlU"Okstim becomes mi&void 6 work or euflrorized eoruW eYon is rot commemoed*Alhim ISO j drys or if caraincbm work r suspended for s penod d IN asys. t PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTPATY OF THIS PERMIT APPLICATION 9f 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON LINTY CODE 14.08.42) X C �C�OI�C�' ! /Q �QZ© f tgna OWNER(Must be stoned by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTES(CONDITIONS BUILDING DEPARTMENT a2-/ -ZD PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES Permit PERMIT ASSISTANCE CENTER: •BUILDING •PLANNING •FIRE MARSHAL REC E I VE. s t 615 W.Alder St-Shelton,WA 98584 t r www.co.mason.wa.us JAN 2 2 2020 Phone Shelton:(360)427-9670 ext. 352• Fax:(360)427-7798 Phone Helfair:(360)275-4467• Phone Elma:(360)482-5269 -615 W_ PLUMBING & MECHANICAL PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:r-Hi✓Zyl_T-,15nSF.N i)AAL NAME: t e G MAILING ADDRESS: 19 io E.irT ' A ► MAILING ADDRESS: '-� �^ uyroli CITY: STATE:W_Z :q666 6 CITY: O i• STATE: �" ZIP: C S 0 - I ISI PHONE:�6U B 7a 25605 PHONE: 3s �J CELL: 2"t PHONE: EMAIL : ' 1^ �. , EMAIL:C,(a <,-eir b aS'1-Al i L&I REG# �(���7l++`-D: EXP. l T ? PARCEL INFORMATION: 6 06 b b PARCEL NUMBER(12 Digit Nunrbcr): 2 5� Zoning: 'RR c LEGAL DESCRIPTION (•tbbreviatcd):?Ai 156>J-EXbUlM 1466D CAHPL -lRS R la ► T.L , SITE ADDRESS: 126 61 NE K16Q-1__lh_Sti�2E 'R D CITY: ELi A i i DIRECTIONS TO SITE ADDRESS: STL �, Ta Not H S�te2E. '�' t2•� M;c_�C FP -1 'RELf-A TYPE OF JOB: NEW ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FIXTURES/UNITS— I s' FLOOR_)�=2"'FLOOR_b,_BASEMENT GARAGE,OTHER PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHAN, Z ITS Type of Fixture No.of Fixtures Fees Fuel Typ :Electric LPG Natural Gas_Ductless Toilets Tvpe of L • No.of units Fees Bathroom Sink Furnace Bath Tubs CJ Heat Pump I Showers Spot gent Fan Water Heater j Propane Tank- Clothes Washer / Gas Outlets Kitchen Sinks --I Wood/GaslPellet Stove Dishwasher I Kitchen Exhaust Hood I Hose bibs Dryer Vent I Other Solar Panel Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER acknowledge 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 permitlapplication becomes null&void f 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 OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 1811 DAYS WILL V IDATE THE APP"ATION. Sign re of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL APPROVED MASON COUNTY DCD PLANNING PLANNING: RECEIVED SITE PLAN REQUIRED TO BE ON SITE ALL SETBACKS ARE MEASURED KEYNOTES o W C N S SUBJECT TO APPRO A FFROM THE FURTHEST W _ 3 D1. EXISTING ASPHALT TO JAN 2 2 2020 By Date v !/ v PROJECTION OF THE BUILDING REMAIN. Q � � o- D2. EXISTING ASPHALT TO BE Q o 615 W. Alder Sbvd REMOVED. D3. EXISTING CONCRETE CURB � Z REMAIN. --- �,� O STING SHED REIv1AM$ <n E ILL(STING RESIDENCE TO BE Z Z 4 REMOVED,INCLUDING Q o E - - - - - - - FOOTINGS AND N Pt ANNINGFOUNDATION.-�—- - D6 EXISTING MASONRY_ N RETAINING WALL TO Q NE NORTH SHORE ROAD NE NORTH SHORE ROAD REMAIN. < D7, EXISTING SEPTIC �i CLEAN-OUT REMAINS. O Y P L N N I N G. D8. EXISTING BOAT RAILS AND ,o RAMP TO BE REMOVED. ALL SETB KS ARE MEASURED 49,14 49.14 � D9. EXISTING CONCRETE WALK AREA TO BE REMOVED. FROM HE FURTHEST DI � _ D1O.EXISTING WOOD STAIRS TO w E PROJECTION OF THE BUILDING ASPHALT DRIVE i� D6 ASPHALT DRIVE BE REMOVED- z L O> o h . NDb m REMAIN. o o I I o cqI DI3.EXISTING WOOD DECK TO E - 3 _ ry N o BE REMOVED. 0 3 u m cv D14,ORDINARY HIGH WATER 17 D7 rl o ��� SHED —I MARK/EXISTING �o ASPHALT ( ASPHALT BULKHEAD. - ----------- i N1. NEW ASPHALT AREA _ N l N3 N2. NEW CONCRETE CURB TO1.4e D2 -I'22'-2" I 24'-T 13'-G' 10'-2M/, 1 3'-0" MATCH EXISTING_ c N3. NEW RESIDENTIAL 4 STRUCTURE, NEW EXIST. q N4. PROTECT EXISTING SEPTIC N N �I RESIDENCE I RESIDENCE I CLEAN-OUT. I N5. NEW 4"CONCRETE SLAB _ 576 SF N2 744 SF L ' CONC I p. ANDSCAP WALK AREA,FLUSH WITH `'` +`}=: ADJACENT DRIVEWAYS. Q DS D1O Dl I NS N$ N6. NEW LANDSCAPE AREAS. Q N7. NEW,'TREX"DECKING ACID 11FDECK "? LANDSCAPE NEW DECK o Z v ? NEW 36'NIGH STEEL LU Q c� N6 w RAILING. V) 3 v l go N8. NEW TREATED WOOTR O N N I I w 'TREX'ST EPS TO DECK? O o N9.PROTECT EXISTING WELL Q' Q U- D12 D13 D14 I o HEAD. m N9 N7 Io O Uf tY v U = p D9 BAY/BEACH �I o qI� BAY/BEACH I U U O 1 CD "'__ I Lu W off Lu so.Z2' _ so.�Z. _ W Z p Dl4 �- �- Q N be _ z < o N U O < Z z IL Lu w 00 '0 N I DEMOLITION SITE PLAN N 2 NEW SITE PLAN DATE: 11/18/2019 A-1 1" = 20'-0" A-I 1 20'-0" 2877 REGISTERED ARCHITECT JOB: 19-07 DRAWING THOMAS J.SANFORD STATE OF WASHINGTON A- 1 SHEET 2 OF 7 SHEETS Name Parcel# BLD# .1seet Mason County j �JJ. �do�epartment of Community Develo ment g15 P II 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 surface2. '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. 2Common 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 y = l7G 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/Walks X ,,l = 01 yQ X = Any paved, gravel or packed area per definition 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) qg� 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 i formation provided is accurate and employees of Mason County are granted access to the above- desc ' e pro r revie 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. I Page 1 of 2 I I I 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 I 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 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/Agent/Contractor(circle one)Date: Page 2 of 2 I r A MASON COUNTY Mason County Permit Center Use: COMMUNITY SERVICES FLDz a _ D Building,Planning,Environmental Health Community HealthI E D 615 W.Alder Street—BIdg.8,Shelton,WA 98584 Date Rcvd 20 Phone:(360)427-9670 Ext.352 ♦Fax:(360)427-7798 1 1 A Ll 9 jmut f n No fee if )MJ3 > �i r Street FDPO Development Permit Application Applicant: Contractor: Cheryl Roosendaal Scott Homes Mailing Address: Mailing Address: G 1910 E. 4th Ave., PMB 97 3016 10th Ave. NE VLAW City, State, Zip City, State, Zip Olympia,WA 98506 Olympia,WA 98506 Phone: (360) 870-3605 Phone: ( 360 ) 357-9167 Email: croosendaal comcast.net Email: chris@scotthomes.com Parcel Number: Property Address. 322355000006 12681 NE North Shore Road Belfair,WA 98528 I understand I am making application for a permit to develop in a designated flood hazard area. The undersigned agrees that all such work shall be done in accordance with the requirements of the County Flood Damage Prevention Ordinance, building codes and all other applicable Local, State and Federal regulations. This application does not create liability on the part of the County or any officer or employee thereof for any flood damage that results from reliance on this application or any administrative decision made lawfiilly thereunder. f� Applicants Signature: v ��M Date: r/5 ✓2'62�) Official Use: A. Description of Work (complete for all work): 1. Proposed Development Description: X New building/Addition ❑ Manufactured home ❑ Fill/grade ❑ Other: ❑ Commercial (see section D) ❑ Remodel/repair to existing building (see section C) 2. The parcel has been identified in the following Flood Hazard Area: ❑ A X AE ❑ AO ❑ VE 3. Are any other Federal, State or local permits required? Must attach copies of permits. ❑ Yes JC No If yes, list type: 4. Is the proposed development in an identified floodway? ❑Yes SNo 5. If yes to#4, a No Rise Certification must be attached. 0 Yes 0 No � ICI r B. Complete for New Structures and Building Sites: 1. A FEMA Elevation Certificate is required, must be completed by a Washington State licensed Surveyor. Must attach a copy of certificate. 2. Base Flood Elevation at the building site: _15 feet NAVD 88 3. Required lowest floor elevation (including basement floor): 16 feet NAVD88 4. In flood hazard areas without a base flood elevation (BFE), what is the highest adjacent Grade? (HAG) Structure must be a minimum of two (2) feet above the HAG. The required finish floor height is C. Complete for Alterations, Additions, or Improvements to Existing Structures: ******(See attached Substantial Improvement & Substantial Repair)******* 1. What is the estimated market value of the existing structure? $ 2. What is the cost/valuation of the proposed construction? $ Percentage 3. if the cost or valuation of the proposed construction equals or exceeds 50 percent of the market value of the structure, then the substantial improvement/repair provisions shall apply. Is the proposed work a substantial repair/improvement ❑ Yes ❑ No D. Complete for Non-Residential Floodproofed Construction: 1. Type of floodproofing method: 2. The required floodproofing elevation is: feet NAVD88 3. F000dproofing certification by a registered engineer is attached: ❑ Yes ❑ No E. Complete for Subdivisions and Planned Unit Developments: 1. Will the subdivision or other development contain 50 lots or 5 acres? ❑ Yes ❑ No 2. If yes, does the plat or proposal clearly identify base flood elevations? ❑ Yes ❑ No 3. Are the 100 Year Floodplain and Floodway delineated on the site plan? ❑ Yes ❑ No Administrative 1. APPROVED: DENIED: statement attached 2. Elevation Certificate attached: lames ❑ No 3. As-built lowest floor elevati n: feet NAVD88 Comments/Conditions: r J4. Mason C unty Flood Damage P evention Ordinance #41-17 & International Building Codes U.S. DEPARTMENT OF HOMELAND SECUi; OMB No. 1660-0008 Federal Emergency Management Agency ECE��ED Expiration Date: November 30, 2018 National Flood Insurance Program IAN ELE A, TIOU8PRTIFICATE Imporidfv v � on pages 1-9. G A N N IN Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance a n company, and(3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Kevin McFarland A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number: Box No. 12681 NE North Shore Rd City State ZIP Code Belfair Washington A3. Property Description(Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Tract 6 Pattison Brown Hood Canal Tracts and Tidelands, TPN 322355000006 A4. Building Use(e.g., Residential, Non-Residential,Addition, Accessory,etc.) Residential A5. Latitude/Longitude: Lat.47°21'34.23" Long.123`02'09.28" Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 580.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0.00 sq in d) Engineered flood openings? ❑Yes 0 No A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community Name&Community Number B2. County Name B3. State Mason County 530115 Mason Washington B4. Map/Panel 85, Suffix B6, FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 0120 C 05-17-1988 05-17-1988 AE 15.00 per Mason Co Planning Dept 810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69: ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑x Other/Source: Mason Co Planning Department B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 x❑ NAVD 1988 ❑ Other/Source: 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ❑x No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 12681 NE North Shore Rd City State ZIP Code Company NAIC Number Belfair Washington SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ❑x Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2 Elevations—Zones Al—A30,AE, AH, A(with BFE),VE,V1—V30,V(with BFE), AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AP./AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. Benchmark Utilized: GPS Static Observation Vertical Datum. NAVD 88 Indicate elevation datum used for the elevations in items a)through h)below. ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement, crawlspace,or enclosure floor) 14.0 ❑x feet ❑ meters �b) Top of the next higher floor 16.7 ❑x feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A ❑ feet ❑meters d) Attached garage(top of slab) N/A ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 15.4 ❑x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 14.8 ❑x feet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 16.7 ❑x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including f 8 14. ❑ feet structural support ❑ meters SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that arly-" statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑Yes ❑No ❑Check here jf attachments. A Certifier's Name License Number Blair Prigge WA PLS 29278 11 Title W R/CC ig President Company Name �OZ MTN2COAST, LLCM Address h 2320 Mottman Rd SW, Suite 106 29 78 City State ZIP Codej�FClSIEg�c� Tumwater Washington 98512 ON�L I.A Signature Date Telephone Ext. 04-11-2019 (360)688-1949 Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner. Comments(including type of equipment and location, per C2(e), if applicable) C2(e)is mechanical piping in crawl space, bottom elevation of pipe. Top of concrete stem wall-elevation 16.7 Bottom of floor joist-elevation 16.1 FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 12681 NE North Shore Rd City State ZIP Code Company NAIC Number Belfair Washington SECTION E—BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A(without BFE), complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG) a) Top of bottom floor(including basement, crawlspace,or enclosure) is ❑feet ❑meters ❑above or ❑below the HAG. b) Top of bottom floor(including basement crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions), the next higher floor(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of ptatform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or ❑below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt, Unit, Suite, and/nr Rldg. No.)or P.0 Route and Box No. Policy Number: 12681 NE North Shore Rd City State ZIP Code Company NAIC Number Belfair Washington SECTION G—COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only,enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments(including type of equipment and location, per C2(e), if applicable) I I I I ❑ Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2013 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number. 12681 NE North Shore Rd City State ZIP Code Company NAIC Number Belfair Washington If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken, "Front View"and"Rear View", and, if required, "Right Side View"and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. ,t Photo One Photo One Caption Side View Clear Photo One Photo Two Photo Two Caption Side and Back View Clear Photo Two FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 12681 NE North Shore Rd City State ZIP Code Company NAIC Number Belfair Washington If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View' and 'Rear View", and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. t= i 4^ Photo Three Photo Three Caption Front and Side view(water side) Clear Photo Three t,45fil�ti 1115tt11 1 R i I,titlq. Photo Four Photo Four Caption Crawl Space view Clear Photo Four FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6