HomeMy WebLinkAboutBLD2009-00424 SFR, Storage, Garage, Spa, Porch - BLD Permit / Conditions - 12/15/2011 -, Inspection Line(360)427-7262
r MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. 111426 W. Cedar P.O. Box 186
Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2009-00424
OWNER: EDWIN PAYNE RECEIVED: 5/26/2009
CONTRACTOR: LICENSE: EXP: ISSUED: 8/5/2009
SITE ADDRESS: 2492 E GRAPEVIEW LOOP RD GRAPEVIEW EXPIRES: 2/5/2010
PARCEL NUMBER: 121182290033
LEGAL DESCRIPTION: TR 3-B OF GOUT LOT 4 TR 2 OF SP#2087
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New Single family residence/storage area/garage/hot tub room/covporch ST RT 3, R ON GRAPEVIEW LOOP RD TO SITE ADDRESS ON THE RIGHT
SIDE, NEAR MCLANE COVE
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 5 Occ. Group: R-31LI Lot Size: Deck: 215
Type of Work: NEW Fire Dist.: 3 No. of Stories: 3 Occ. Load: Building:2,684 Garage-Attached 1,438
Valuation: Building Height: Occ. Status: Primary Basement: COVPORCH 462
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 132.0 Ft. Shoreline: Ft. Water Body: MCLANE COVE
Rear: W 113.0 Ft. Slope: Ft.
SEPA?: No
Model: Width: Ft. Side 1: N 63.0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 2: S 20.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type City. Type City. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 2 Plan Check Fee GMM 5/26/2009 $1,399.42 S12009000
Floor Drain 1 Furnace<100K 1 Planning Review Fee GMM 5/26/2009 $205.00 S12009000
Hosebibs 5 Pellet Stove 1 EH Plan Review GMM 5/26/2009 $41.00 S12009000
Laundry Tray 1 Ventilation Fan 7 Water Adequacy Plan Review GMM 5/26/2009 $41.00 512009000
Lavatories 6 Woodstove 1 ADJUST--Plan Check Fee ARC 6/5/2009 $72.80 Si2009000
Lavatories 2 Dryer Vent 1 Building State Fee ARC 6/5/2009 $4.50 S12009000
Showers 2 Building Permit Fee ARC 6/5/2009 $2,264.95 S12009000
Kitchen Sink, w/disposal 1 Mechanical Permit Fee ARC 6/5/2009 $262.70 S12009000
Water Closets (Toilets) 5 Mechanical Base Fee ARC 6/5/2009 $28.50 S12009000
Water Heaters 1 Plumbing Permit Fee ARC 6/5/2009 $197.60 512009000
Bath Tubs 1 Plumbing Base Fee ARC 6/5/2009 $24.70 S12009000
Clothes Washer 1 EH Plan Review CEW 8/4/2009 $62.00 Si2oo9oob
Total $4,604.17
BLD2009-00424 Please referto the following pages for conditions of this permit. 1 of 6
` CASE NOTES FOR
BLD2009-00424
CONDITIONS FOR
BLD2009-00424
1) 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.
X
2) All 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 p o any further inspections being performed or approvals granted.
X -
3) Owner/Ag=ponsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
4) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
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 ap r documents will result in failure of required building inspections.
X
5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
6) The "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, then
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 De nt prior to any further inspections being performed or approvals granted.
X
7) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation R-10.
Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
underside of eathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
BLD2009-00424 Please referto the following pages for conditions of this permit. 2 of 6
8) Per 2003 IRC - SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WI ED (3-SECOND GUST) the wind speed for Mason County is 85 MPH.
X
9) Per IRC -SECTION R905- REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordance w' applicable provisions of this section and the manufacturer's installation instructions.
X
10) 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 ac dging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
11) 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 expo the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
12) 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 c i a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
13) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged and shal cted by the Building Department prior to any further inspections being performed or approvals granted.
X
14) All construction must meet or exceed all local ordinances and 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 revo
X
BLD2009-00424 Please referto the following pages for conditions of this permit. 3 of 6
15) Installation of heating equipment in single family residences shall meet the requirements of the current Washington State Energy Code.
The furnace to be installed shall not exceed 150% of the heating and cooling design load. Heating and design load calculations for the purpose of sizing
HVAC systems are required and shall be calculated in accordance with accepted engineering practice, including infiltration and ventilation. Design
calculations shall be available for inspection during the framing inspection.
Warm-air furnaces shall have a minimum efficiency of 78%AFUE or higher or 80% combustion efficiency. All ducts shall be securely fastened and
sealed with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric systems or tapes installed in accordance with manufacturers installation
instructions. Duct t=is NOT permitted as a sealant on any ducts. Ducts in unheated spaces shall be insulated to R-8.
X
16) 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.
X
17) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regul , must be reviewed and approved by Mason County prior to construction.
X
18) 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 co s as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall b p 'or to requesting additional inspections.
X
19) All property lines shall be clearly identified at the time of foundation inspection. X
20) All building permits shall have a final inspection performed and approved by the 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 ordinand building regulations.
X_
21) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have prevented m being taken. No more than one extension may be granted.
X
BLD2009-00424 Please referto the following pages for conditions of this permit. 4 of 6
22; An inspection performed by a representative of the geologist, their authorized representative, or engineer of record, shall be completed on-site prior to the
footing pour to verify that earthwork and foundation installation activities comply with the Geotechnical report or assessment recommendations.
In addition a final inspection report, prepared by a representative of the geologist, their authorized representative, or engineer of record shall be required
to verify that erosion control, drainage and final work is completed in accordance to the Geotechnical report or assessment recommendations.
Reports shall be submitted to the Mason County Building Dept., PO Box 186, Shelton, WA 98584, prior to the footing and final inspections and available
for inspection
X
23) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and g. Install metal connectors approved for contact with the new types of pressure treated material.
X
24) Retaining walls needed to support a surcharge s structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
25) 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" sure these structures are shown and meet the setback conditions listed.
X
26) This existing garage structure has NOT been reviewed or approved as an Accessory Dwelling Unit(ADU): A second dwelling unit detached from an
existing single-family dwelling for use as a completely independent or semi-independent unit with provisions for cooking, eating, sanitation and sleeping.
ADUs are required he requirements under Mason County Development Regulations 17.03.029.
X
27) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason
County Shoreline Master Program. If at a f e the garage is to be used as an accessory dwelling unit, a Shoreline Substantial Development Permit
will be required prior to that use. X t
28) Prior to final approval, all upland areas disturbed or ne y c y construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
29) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report. All applicable
recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the registered
design professi sponsible for the report and may require special inspection by same. Structures and/or land modifications (grading, cuts, fills, etc.)
required in nical report may require a separate permit. The geotechnical report shall remain attached to the approved building plans.
X
30) The Hold Harmless Statement required by the Mason County Resource Ordinance Landslide Hazard Area Chapter, Section (F)was recorded within the
Mason County Auditor's copy of the recorded document was provided to Mason County Planning prior to final inspection of the primary
residence. X
31) The existing native v d buffer located on the marine bluff between the construction site and the ordinary highwater mark of Pickering Passage must
remain intact g tation.
X
BLD2009-00424 Please referto the following pages for conditions of this permit. 5 of 6
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at anytime after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure for review and inspection.
OWNER OR AGENT: _ DATE:
BLD2009-00424 Please refer to the following pages for conditions of this permit. 6 of 6
s
00��
N CONCRETE MECHANICAL MANUFACTURED HOME D
CD Date p �i_
CD Footings !Setbac / -Z a By Ribbons Z
�aas Piping m
o Intenor Date By Interior-Date By Date By
Exterior Date 9 _ BY Exterior-Date By
Set-up v
Point Load J Isoiat4d FootlA INSULATION Date By C
Date �, �y BG!SLAB INSULATION Z
Data By FIRE DEPARTMENT
Foundation Wails Floors Date By
Date y�' By Data Z ,/ yy By DECKS
F RAM I NG Walls Date By
Date -29—IC-2 By Data By PROPANE TANKS
PLUMIING Vault By Date By
Date
Groundwork 9 Lg"'a9' OTHER
p1J�ffS� Attic Type. /�f7-
Date -2 Z By Date By Data G .z r�(� By
o.W.V DRYWALL Type-
Date _ B
Int Brace Wail Date By
B . W
�i p ^
Date By FINAL INSPECTION 0
v Water Line Fire Separation N
Date �i By Data By Date Z By p
m CO
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments
CD
e<
i.t n k-110
CD
rev ��i' -2 L 1
(D L `�
i a✓
Tl,Guyc--
0
Arm it eft- V MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location L �4�
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
itw CL
0,4' I/ ' ^Lv�.✓ Fob lj�>��j y
10
G
�' �✓�'�= U T U
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
"natural/man made"
❑ This is not a complete inspection disasters.This is NOTa
Date - 6 -/G, CORRECTION NOTICE,
Department
Inspector Z X
Do jo NOT REMO V / THIS TA*Alff
Permit#'D -cv L q MASON COUNTY -
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location ��E vz��% y
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
- a6c /ti S e-C
/✓ c� „�' Q S o >3
90
/.r
,6 /r✓ / G tit'— v .0 / 11� 1
n/ / _ Cvti/ .✓
ago
cz�- G�.S ,C
42,
S C c%G Ll/ y'/� /y!� _ .sT7P�All ivy
Y kX-11R,
e here notifi dth . t the a ove xrecti nS small be made
EE �i�0 EL��ING IT I NY FUR
ER Re �
I@W 11 /.✓
for re-inspection when corrections are made before continuing ❑ Please contact our office
❑ Md�Fce corrections, items_wi I be c ec a on next inspection regarding possible structural
G/ ,�1Th'!��✓� �� G' ,,�� damage incurred by recent
❑ &K t c. -� r o Gc�✓
y��T "natural/man made"
❑ This is not a complete inspection / `�s� 9 � disasters.This is NOTa
Date ��,7-lam Department CORRECTION NOTICE.
Inspector�� ��� 07��—
�wv%rotech �wg�weer�wg
RECEIVED
Geotectiwical° EvW%rOvLnLetAtal°Draiwage °Roadway
August 18, 2009
426 W; CEDAR ST
Mason County Department of Community Development _
PO Box 186 ,
���1011
Shelton, Washington 98584
RE: Geotechnical Inspection for Payne Single Family Residenc "
Mason County, Washington
To Whom It May Concern,
Please find enclosed, results from a geotechnical inspection completed for the referenced
project.
Please contact Michael Staten at 360-275-9374 if you have any questions or require
additional information.
Yours Truly,
Envirotech Engineering
Michael Staten, P.E.
Project Director
-4 NE�-hurd Road
gelfair' washiHatovL98.528
D f F: 360-275_93'-4
Cell: 360-689-604.5
Fax: 360-275-4789
evw%rotech@peotech vuca llw f o.cowti.
f 1
ewv%rotech �wg%weert,wg
c,eoter, vAjcaL° 6V VLrOKWKeVUtaL°praLwage°Roadway
August 18, 2009lc�2UC�1 - 2� RECEIVE®
Ed Payne OW 2A,
PO Box 570
Grapeview, Washington 98546 a?5 W: CEDAR ST.
RE: Geotechnical Inspection for Property Located at 2492 E. Grapeview Loop Road,
Parcel Number 12118 22 90033, Mason County, Washington
Dear Mr. Payne,
Envirotech Engineering (Envirotech) completed site visits, field inspection and
conclusions for the planned single family residence at the referenced location. The site
visits were conducted on August 11, and August 14, 2009 in order to observe the soil
conditions, assess the suitability of the founding soils for use as bearing strata, examine
temporary erosion control measures, and ensure building setbacks are in compliance
with the geotechnical report. The geotechnical report, dated April 27, 2009, was
prepared by Envirotech. Information pertaining to the project was provided by Mr. Payne,
owner of the property. Information collected from site observations, and field testing was
completed by Michael Staten with Envirotech.
With relation to the initial site visit by Envirotech, building setbacks and vegetation
buffers are in compliance as presented in the aforesaid geotechnical report.
Temporary erosion control measures include a gravel driveway (construction entrance),
and silt fencing. These measures appear to be adequate for preventing excessive
sediments from leaving the project. The owner should periodically inspect these
facilities, and maintain as necessary. Additional erosion control will be required, if
existing systems are not performing satisfactory.
The foundation bearing soils appear to be relatively undisturbed native soils. The
planned footings appear to be primarily continuous strip footings. Upon the second site
visit, the excavation has been completed, except additional excavation is required as
noted below. The native soils directly beneath the anticipated foundations are primarily a
Silty Sand (SM) with some gravel and clay. The fines content exhibited low to medium
plasticity. The bearing strata was field measured to be medium dense to dense. Relative
density was assessed by measuring the resistance from pushing an approximate 1-inch
diameter rod within several locations of the foundation excavation.
74 N5 hturd Road
gel fair, Wash%wgtow 98528
Of : 360-271.5-93YI4
C,8U: 360-609-6045
FOX: 360-2Y15-4789
e+nvi.ratech@aeotech vu,ca Live,fo.covu
a . '
Significant loose soils were encountered at one location of the excavation, in which
Envirotech field marked. This area (less than 10 If) required 12-inches of over-
excavation. This was subsequently accomplished by the owner's contractor. A significant
area at the northwest portion of the planned home consisted of an insufficient foundation
depth with loose to medium dense soils. This area of the foundation was increased from
a 15-inch to a 20-inch footing width.
It is concluded that the existing bearing soils and conditions are suitable for a structural
pressure of no more than 1500 psf for foundation widths ranging from 15 inches
to 20 inches. Significant wet weather could be detrimental to the bearing soils if
foundations are not in place. A qualified professional should be notified if this occurs.
If you have any questions or need any further assistance, please contact Michael Staten
at 360-275-9374.
Sincerely,
Envirotech Engineering
PAL CLYDg SJ
WASy�� y)
i� 700V
-�0- wg
(IINAL
Michael Staten, P.E.
Project Director
cc Mason County Department of Community Development
Page 2 of 2
�v�v%rotech �v�.giv�,eer�v�g RECEIVED
4eotecnwdc9L° Ev vt rov4n&evkbR1°Draiv-aae°t Dndwcl�
December 5, 2011 DEC 0 7 2011
426 W. CEDAR W,
Ed Payne
PO Box 570
Grapeview, Washington 98546
RE: Geotechnical Inspection for Property Located at 2492 E. Grapeview Loop Road,
Parcel Number 12118 22 90033, Mason County, Washington
Dear Mr. Payne,
Envirotech Engineering (Envirotech) completed multiple site visits, field inspections and
conclusions for the single family residential development at the referenced location. A previous
geotechnical inspection letter, dated August 18, 2009, addressed the foundation and other initial
development aspects of the project. The most recent geotechnical inspection was conducted on
December 5, 2011 in order to observe final construction, and assess the development from a
geotechnical standpoint. The original geotechnical report, dated April 27, 2009, was prepared by
Envirotech. Information pertaining to the project was provided by Mr. Payne, owner of the
property. Information collected from site observations, and previous field testing was completed
by Michael Staten with Envirotech.
Although we were not present on-site during the entire construction phase, it is apparent that
development of the single family residence conformed to the intent of our geotechnical report. It
is important for the homeowner to maintain drainage facilities, and maintain vegetation after it is
established. The homeowner should notify Envirotech in the event of excessive shoreline
erosion, sloughing of the slope, or drainage problems.
If you have any questions or need any further assistance, please contact Michael Staten at 360-
275-9374.
Sincerely,
Envirotech Engineering
PtiL LLYpE ST
J
IDS//r'
STV�F�
Michael Staten, P.E.
Proiect Director
nr Mason County Department of Community Development
Po Box 984
�elfaCr, Wa51�Lv�G!tov�98.52P
off: 360-25-93 $
CeU: 360-68°/-6045
�aX: 360-2��-4�8A
evLv%rotech@Ueotech�.Cca Lunf o.covu
�wv%rotech �wg�v�,eer%wg RECEIVED
c,eote,,—nA cc(L o EmV61oww-.ewtRL o pf-241,26ke o ROOWWU� DEC 0 7
2011
Member 5.. 2011 426 W. CEDAR ST,
Mason County Department of Community Development
Building Department
PO Box 186
Shelton, Washington 98584
RE: Final Geotechnical Inspection for Edwin Payne(BLD 2009-00424),Mason County,
Washington
To Whom It May Concern:
Please find enclosed our final inspection report for the referenced project.
Please contact Michael Staten at 360-275-9374 if you have any questions or require additional
information.
Yours Truly,
Enviroteo Engineering
Michael Staten, P.E.
Project Director
PO Kox 994
1�.eLfa�r,WgSK"tovk'.92s2?
off, soo-27.5-93 �
CCU: 36D-�89-60 45
Fax: 300-275-4789
evtv%rotecNCr�eotech vicali,v�fo.cowe.
TZ)
----------
-T ;o
AEj- a ru 1 47 N a
NosduuoH-L
f It
Name G W 1w e;;� hE- Parcel# j "f - !00-23 BLD#REC Erypn
Mason County MAY 2 6 2009
Department of Community Development �+n
Small Parcel Stormwater Management Application/Workshe"Pgg2%W
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:
httpHwww.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 INUIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) rhr evant 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�pp�t g to parcel drainage and stormwater management Mason County's Public Works
Depart,BE 1}�fpEri�TANO ntructions,guidance and examples.(Section 14.48.130)contact Public works at:
PARCEL FILE Phone:(360)-427-9670 EXT.450
Mail: P 0 Box 1850,Shelton WA 98584
hysical: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
ir
t
Name EdWly\ �Qex nQ- Parcel# �,Z �'f- - 9��33 BLD#
t Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment', with more than 2,000 square feet of impervious surface'.
'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.
T(i iCalclafe 1r ` ¢,ions:. s m e �T � �`ah9� 9
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
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
X _ above table
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas)
If the Total Impervious Surface Area is LESS 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. 1 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:
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
oN.STA MASON COUNTY
o P� A o N DEPARTMENT OF COMMUNITY DEVELOPMENT
> S N i Planning Division
o Y y P O Box 279, Shelton, WA 98584
of 186 �o (360)427-9670
4
.11r.,ft
REQUEST FOR ADDITIONAL INFO x IV
July 09, 2009
10`33
EDWIN PAYNE
P O BOX 570
GRAPEVIEW WA 98546
Parcel No.: 121182290033
Project Description: New Single family residence/storage area/garage/hot tub
room/covporch
Dear Applicant:
You have submitted a permit application (case no. BLD2009-00424) for proposed
construction or development in the county. Upon review of your application, I require
additional information to complete the permit review process.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 360 if you have questions.
Sincerely,
zl� .AC1cr
Grace Miller
Land Use Planner
Mason County Planning Department
719/2009 Page 1 of 2 BLD2009-00424
r
f
REQUEST FOR ADDITIONAL INFORMATION
7/9/2009 Case No.: BLD2009-00424
Comments: Planning staff conducted an inspection of your proposed residence on
7/2/09. It appears that the proposed setback of the residence meets
the average shoreline setback of the adjacent residences. All native
vegetation between the residence and the shoreline are considered as
a vegetative shoreline buffer that must remain intact.
It appears that the existing garage is currently being used as a
residence. If you intend to continue to use the garage as a residence
once the primary residence is built, it would then be considered an
accessory living quarter under the Mason County Shoreline Master
Program Policies and Use Regulations. In order to retain it as an
accessory dwelling unit after the construction of the primary residence,
an approved Shoreline Substantial Development would be required. I
have enclosed the shoreline process for your informationm. Your
Building Permit has been conditionally approved with the requirements
for an additional permit necessary if the use is continued.
If you do not intend to use the existing garage as an accessory
dwelling unit after the construction of the residence, please let the
Planning Department know how you intend to alter the use of the
structure in order for it to no longer be considered a residence. For
example, removal of the use of the kitchen?
The property is located within a potential Landslide Hazard Area. The
development is proposed within slope's buffer and 5' from the edge of
the slope itself, therefore, Mason County will require that a Hold
Harmless Agreement be recorded acknowledging that you are aware of
the potential for landslides and impact to the structure. Please see the
enclosed section (F) Applicant Hold Harmless Statement of the Mason
County Resource Ordinance Landslide Hazard Area Chapter. Also
enclosed is a blank Landslide Hazard Agreement. This agreement
must be completed and then recorded within the Mason County
Auditor's Department. The Auditor's Office is located within Building I,
411 North Fifth Street, Shelton, WA 98584.
Once the document is recorded, please submit a copy to the Planning
Department where it will be placed within your parcel file.
Please let me know if you have any questions. Thank you.
7/9/2009 Page 2 of 2 BLD2009-00424
PIONEER DIGGING, INC.
3083 E. Mason Benson Rd.
Grapeview, WA 98546
360-426-1803 fax 360-427-2353
Inspection Date:
Customer:
Ed Payne
PO BOX 570
Grapeview, WA 98546
<9�))17-A
Site Address: Grapeview Lp Rd. Parcel #: 12118-22-90033
System Type: Glendon BioFilter Yr of Install: May 2006
Next Inspection Date Size: 4 Bedrooms
INSPECTION • D • •
Septic tank need pumping? Yes No
System functioning properly? Yes No
Note: A satisfactory inspection does not warrantee the system. This report reflects conditions found at the time of the inspection.
Upon observation of surfacing sewage or other sign of overt system failure,CMS will immediately contact the Health Department
and provide technical assistance,as appropriate,to the homeowner.
Certified Maintenance Personal/ Homeowner Verification:
I certify to the best of my knowledge that the enclosed information is an
accurate reflection of the system condition. I understand that these results may be
verified through a follow-up Quality Control inspection by the Mason County
Department of Health.
G' 1 C� 3(n tete Homeowner
(PAL
CMS Personal Da
��I��/'�
PIONEER DIGGING, Inc. CUSTOMER;. 5! INSPECTOR
ONSITE SEWAGE SYSTEM INSPECTION REPORT
Pg. 1 of 2 % NSPECTION DATE
CONTROL PANELCOUNTER
Current ON Time: - C Current Reading: D-_c,)a
Current OFF Time: ,,u w Previous Reading:
a S 5
Changed ON Time: Total Cycles:
X
Changed OFF Time: Gallons Per Circle:
T
Type of Pan simpl duplex): �f Number of Days: `
Control Panel Functioning: Gallons per Day: 3 �?
PUMP TANK
Component appears to be functioning as intended: c
Component Scum accumulation(inches):
Component Sludge-accumulation (inches);
Pumping needed:
Approximate gallons to be pumped (if needed):
SEPTIC TANK
Component appears to be functioning as intended: s
All required baffles in place:
Effluent Filter Cleaned:
Effluent level within operational limits: S
Compartment 1 Scum accumulation (inches):
Compartment 1 Sludge accumulation (inches):
Compartment 2 Scum accumulation (inches):
Compartment 2 Sludge accumulation (inches):
Pumping needed:
Approximate Gallons to be pumped (if needed):
MEDIA FILTER: Gicndon BioFiltcr
Component appears to be functioning as intended: S
Equalized dosing: f r�
Slope integrity maintained: S
Sludge Accumulation:
Pumping needed:
Approximate Gallons to be pumped (if needed):
CUSTOMEI
PIONEER DIGGING, Inc. _ r 1NSPECT01
ONSITE SEWAGE SYSTEM INSPECTION REPORT
Pg. 2 of 2 C INSPECTION DATI
! rGRAVITY
Component appears to be functioning as intended:
Ponding present:
DRAINFIELD: PRESSURE
Component appears to be functioning as intended:
Lateral lines flushed:
Average squirt height (if performed) in feet:
Ponding present:
Aerobic
Component appears to be functioning as intended:
Aerobic Mechanism appears to be functioning as per specifications:
ATU serviced per manufacturers requirements, including cleaning any filters:
Trash Comartment solids accumulation within operational limits:
Aerobic Chamber solids accumulation within operational limits:
Clarifying chamber solids accumulation within operational limits:
Pumping needed:
Approximate Gallons to be pumped (if needed):
GENERAL SITE & SYSTEM CONDITIONS
All Components accessible for maintenance,secure and In good condition: i
All Components appear to be watertight-no visual leaks: S
Surfacing effluent from any component:
Improper encroachment (roads, buidlings,etc.) onto components: i
Component settling problems observed:
Abnormal ponding present for one or more of the disposal components:
Subsurface components adequately covered: S
Site maintenance required (repairs, landscape,etc.):
NOTES
Li, , S &6 S f C Lti 0F kI L 1 iZL�
T i !/ S
Operation & Maintenance Report
❑Residential ❑Motel ❑ Food Service Restaurant
❑ RV Park ❑Youth Camp ❑Other, Please Describe:
❑Campground ❑ Mobile Home Park Space#
Property Owner Phone#
Business name(if applicable)
Mailing address City State Zip
Site address City
Tax parcel# -- --
Components Inspected
❑Yes ❑ No O N/A Grease Trap
❑Yes ❑ No ❑ N/A Septic Tank
❑Yes ❑ No ❑ N/A Pump Tank
❑Yes ❑ No ❑ N/A Pump
❑Yes ❑ No ❑ N/A Control Panel
❑Yes ❑ No ❑ N/A Pretreatment Unit
❑ Sandfilter ❑ATU Specify Type:
•Yes ❑ No ❑ N/A Disinfection Unit Specify Type:
❑Yes ❑ No ❑ N/A Drainfield Specify Type:
Comments and Recommendations:
Inspection Results: ❑ Satisfactory ❑ Unsatisfactory
Operation & Maintenance Specialist Signature:
Company Name:
Date of Service
Findings and determinations of this inspection reflect conditions as they existed on the day the septic system was serviced.
No claim is made by this company, either expressed or implied, concerning success or failure of the septic system.
Mason County Department of Health Services • 426 W Cedar• Mason County Building 111
PO Box 1666 • Shelton, WA 98584 • (360)427-9670 ext. 352
White copy—Health Department Yellow copy—O&M Specialist Pink copy—Owner
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.'6IdAQQ I - COS 2_4
PLEASE PRESS HARD BUILDING PERMIT APPLICATION " -�
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATIOJ� CONTRACTOR INFORMATION t
Owner jtjw I �Y Company Name Owh ert'�tG�oc-
Mailing Address PO GOX 1 �'*70 _ Mailing Address
City cr=. Q State t-t)A Zip Code $S�l City State Zip Code
Phone 3 D Other Ph360` 6 " $ Phone Other Ph.
Lien/Title Holder Eduir.1% -4 Contractor Reg. # Exp.
E mail address w► C 6D t "mcL l E Mail Address
Drivers Lic. #PA N tE y DOB S-g 3 Drivers Lic. # DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing SepticX
Connect to Water System Name of Water System
Well_ Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description 1,e-1 4 0 7 11 P`/V -Ov
Site Address (Please include treet name, street numb r and city) "r
Directions to site
oPt-(tmL-ke :RA
Will timber be cut and sold in parcel preparation?Yes No
Is property within 200' of Saltwater ems—Lake River/ Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs S15% k
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes
TYPE OF JOB - NewXc�Add Alt Repair Other PRIMARY RESIDE.NCE� SEASONAL ❑
Use of Building v eSt escribe Work °uS¢" ttttol- rJb oom .
No. of Bedrooms 3 No. of Bathrooms _s ' Square Footage - 1 st F oo Floor. g
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Ga rag e____10_LLD Attached —X--Detached Carport Attached � Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER /BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permiUapplication 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 OFAPROGRESS INSPECTION.INACTIVITYOF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date a0�
wn epresentative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by' Date D�
DEPARTMENTAL REVIEW APPROVED DENIED r NOTES
Building Department 2 in'015130
Planning Department
Environmental Health Department ,Lb l Jt— • I
Fire Marshal `
FEES r
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood / Gas / Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
MASON COUNTY PERMIT NO.'P7lGP DOc1 00�2'-�
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORM ON CONTRACTOR INFORMATION
Owner tv% Company Name Ownerr/Ga��cac�er
Mailing AddressMailing Address
City ravtet,A Stated /�i Zip Code City State Zip Code
Phone 3&AQ3- '75'- ?' ,0110 Othe Ph - Phone Other Ph.
Lien/Title Holder Contractor Reg.#—_ Exp.
E mail address E Mail Address
Drivers Lic.# - DOB 5"1* 3(6 Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic_ . Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District 3
Legal Description 1,61 SS5d ,16$rI, PTN C—oy Lwi 14 4 4 l
Site Address (Please include tree name, street num er and city) C_ -r U e
Directions to site r��^^ -rb yetu[ y CAM0 R�
I
Is property within 20( Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% JK_
TYPE OF JOB - New DLAdd_—Alt Repair Other _Use of Building tr'e31 �GQ✓
Location of Fixtures/Units - 1st Floor -9 2nd Floor be.- Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric—)(- LPC,_ Natural Gas Heat Pump_
Toilets o Type of Unit No. of Units Fees
Bathroom Sink 43,so Furnace { 1g 0
Bath Tubs I .'7b Heatpumps
Showers T_ Spot Vent Fan .o
Water Heater 1, 10 Propane Tank
Clothes Washer 1 3? :70 Gas Outlets
Kithen Sinks $, r7b W as eletSto '73.00
Dishwasher _R•7o Kitchen Exhaust Hood 1 26,_�O
Hosebibs A3--5 1-5 14, 140 Dryer Vent 1 g -
Other-6Ar S-'-9 I Other
J Base Fee r70 Base Fee ►0
po '02 `4/ TOTAL PLUMBINGj1b. & TOTAL MECHANICAL =z
O VNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONT TIO WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: S-A- .2009
Owne / ers R esentative/Contractor (indicate which one)
FOR OFFICIAL USE BEY NDT IS POINT
Accepted by Planning Pd Ck# DaI&I21Q09. Bld Pd Receipt No.
DEPARTME14TAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/ Pellet Stove Fee Other
Violation Fee TOTAL FEES
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. y-12-4
PLEASE PRESS HARD BUILDING PERMIT APPLICATION -
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5 i f II 1
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic. # DOB Drivers Lic. # DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200' of Saltwater Lake River/ Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage - 1st Floor 2nd Floor
3rd Floor 4:5 JZ Basement Deck Covered Deck Other 320 Sq. ft.
Garage ttached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. 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 OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date:
Owner/Owners Representative /Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPRt)TIED DENIED NOTES
Building Department
Planning Department ---��
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Z Z Site Inspection
Plan Review Fee rl� 7Z EH Review Fee
Plumbing & Base Fee Z—Z -L •3C) Planning Review Fee
Mechanical & Base fee rL0 Other
00 / P 9 t Stove Fee State Fee S0
Violation Fee Q L�r Pre-Paid at Submittal
Valuation $ j 2 7 . TOTAL FEES
b-4Z