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HomeMy WebLinkAboutBLD2018-01350, 01348 Addition - BLD Application - 12/24/2018 MASON COUNTY COMMUNITY SERVICES PERMIT ASSISTANCE CENTER: Permit No: "D)� •BUILDING•PLANNING.PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone R t E Iv Belfair.(360) Phone Elma:(360)482-5269 185 PFC 2 4 2018 UILDING PERMIT APPLICATION PROPERTY'OWNER INFORMATION: CONTRACTOR INFOIMATION: AN NAME: N D4:;4Z NAME: CS SIMPSeki MAILING ADDRESS: . Rd/AM5 WW.U�r MAILING ADDRESS: 2Z9 1 P,. CITY: SR& bw STATE:W A ZIP:9 CITY:6fZA MVIDN STATE: WA ZIP: PHONE#1: 36 5. 42.7 • (0612M& PHONE: CELL:360-q63•CZ Z'7 PHONE#2: EMAIL :6i 0 psenbul Id ri In(„ m Ygh00.C'01''` EMAIL: 4Rb Ie' 01 • GD(h L&I REG# 51 M PSC_ QS2 L.OEXP. / / PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER n NAME ANN EMAIL b.4qzle, oq/ •C_All MAILING ADDRESS f7p �• Ot�4S Q6 CITY SE +�1+T W SfATE "N ZII' S PHONE 3Lo • fate Z CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) I Z.I 19 ` S ('' coo I ZONING QRS1 C EJV-rI,4L LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT .(p• .,rj SITE ADDRESS E7" E. R31 KM5 C941 & WI=57 CITY I�iV DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO g IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW❑ ADDITION e' ALTERATION ❑ REPAIR❑ OTHER ❑ I� OO�C USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 2F—S tCZNy5 IS USE: PRIMARY,K SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part[s]of Bldg) 0 NO ❑ DESCRIBE WORK •'T}{ I4DDrT��D� SQUARE FOOTAGE: (propose+existing) 1 ST FLOOR sq.ft. 2ND rCIOR 4W sq.ft. 3RD FLOOR sq.ft. BASEMENT t A sq. ft. DECK I SZ sq.ft. COVERED DECK 8e sq.ft. STORAGE -W-' sq.ft. OTHER sq.ft. GARAGE IV sq.ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: • SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING [� PLUMBING IN STRUCTURE? YES ❑ NO ❑ Ifyes, attach completed Water-Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ ,,( NOfn EXISTING SQ.FT. EXISTING BEDROOMS Z- PROPOSED BEDROOMS (U TOTAL BEDROOMS 7— OWNER acknowledges that submission of inaccurate Information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permittapplication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) LX i v / Signature of OWNER(Mustsioned by the OWNELD Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES Building Planning Environmental Health,Community teal. UILDING RE- 7.�q,' i— Physical and Mailing Address: 615 W Alder St., Bldg 8, Shelton, WA 98584 DEC 2 h 20.8 Shelton Phone: (360)427-9670 ext 352 Fax (360)427-7798 PLUMBING & MECHANICAL PERMIT APPLICATION Permit#:'IIci 26I6 " �l �J Co OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: 41M ALE NAME: 45+1 Il M PAN MAILING ADDRESS: 46M E• f6l N-IF-5 ZRJl Je W;✓S t MAILING ADDRESS:ZZ 1 E. N L4 .172. W CITY: S+4FA'6N STATE:W A ZIP16594 CITY:6e*N-V19IV STATE:WA ZIP: 151 PHONE: 7 • L� PHONE: CELL:346 . 4A& •02Z7 2nd PHONE: EMAIL :Slrhosanb-nL4-cSI nL o ylhlao •C.0— EMAIL: q bdSq 1 e G q •c,orv\ L&I REG# 51 APSL 45Z LO EXP. PARCEL INFORMATION: PARCEL NUMBER (12 Digit Number): IZI�9 — CJ� —C)00t( Zoning:[ Sl0S#Tr'1NL LEGAL DESCRIPTION (Abbreviated): SITE ADDRESS: _661 F• POM5 7 ZoVE WEB CITY:SHzL.•PW DIRECTIONS TO SITE ADDRESS: TYPE OF JOB/WORK: NEW ADD ALT REPAIR OTHER MEYCML-�- USE OF BUILDING 12'W1 ce1l"'OV-1 PLUMBING FIXTURES MECHANICAL UNITS [ ] Electric in-wall heaters (no fee) Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel Type Fees Toilet(s) ( Furnace PG/LPG] Bathroom Sink(s) 1 Heat Pump PG/LPG) Bath Tub(s) 1 o Ductless H.P. PG/LPG] Shower(s) Spot Vent Fan Water Heater(s) [E/G/LPG] Propane Tank gal.] Clothes Washer(s) [E/G/LPG) Gas Outlet(s) Kitchen Sink(s) Heat Stove [E/G/LPG/W] Dishwasher(s) Kitchen Exhaust Hood Hose bib(s) Dryer Vent Other Solar Panel Other Other Plumbing Subtotal Mechanical Subtotal Plumbing Base Fee Mechanical Base Fee Final Inspection Fee Final Inspection Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative,or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x ignature A�-p ' nt x4wner wners Representative/Contractor Print Name ( one) DEPARTMENTAL REVIEW APPROVED T DENIED DATE TAGS/NOTES/CONDITIONS O Building t 3 O Fire Marshal O Permit Tech (OTC permit only) littp-l/mhrly.co.mlason.Waa.us/conimun':U_dev/ Rev:3/08,12017 Per David Carnahan, General Manager, Hartstene Pointe Water Sewer District: "This form is not needed because this project is a remodel to an existing house that already has water and sewer hookup." David Carnahan email: gmPhpwatersewer com office: (360) 427-2413 R 1 ---� WAT - ! MASON COUNTY - COMMUNITY SERVICES �h'1Gj " Building,Planning,Environmental Health,Community Health 415 N 61 Street, Bldg 8, Shelton WA 98584, Shelton: (360)427-9670 ext 400 :• Belfair: (360) 275-4467 ext 400 Elma: (360)482-5269 ext 400 FAX(360)427-7787 Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application, with any required attachments for review. 4. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: 1-it ckl C 12 r k Date: lie) Mailing Address: (p C1 . 7 p i ?I+CAS T)( Phone: 3 0 - 9 L4 C� - ��' i 6 Parcel Number: j 2 0oo 15 Type of Water System Reason for Application 15� Public/Community Water System (2 or more Building permit connections) ❑ Division of land: ❑ Individual water source(one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other (explain) ❑ Other (explain) ❑ Replacement or Remodel (please indicate name If you have more than one residence connected of water system below if applicable- no - to this well, check the Public/Community Water signature required) System box. i1L KJOIE P F/art 2. Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory (WFI) Number: (write "none"for two-party) ❑ I am the manager of this water system. The water system has been approved for services. There are presently connection(s) in use. This will be the connection. ❑ 1 am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these) connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date This form may be scanned and available for public view at www.co.rnason.wa.us. JAEH Forms`,Drinking Water Revised 125i2018 R Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test (attached to application) qpm gpd. The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test, which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. ❑ Satisfactory bacteriological test(attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA http://gis.co.mason.wa,us/planning 14_ 15_ 16_22_ Water use or limitation recorded................................... N/A Yes Well Drilled ............................................................... Date Individual Spring/Surface Water ❑ WDOE permit (attach to application) ❑ Method of disinfection ❑ I have reason to believe that this water source can provide at least 800 gallons per day; and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) ❑ Satisfactory Determination: This determination does not address adequacy of the distribution system, guarantee an adequate supply of water indefinitely in the future, or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for the following reason(s). Reviewer's Signatures: Environ. Health: Date CSD Director: Date 2 of Name AJW QD60,= Parcel# 1 Z 1 11—51-CCO I& BLD# Obl 1)1 - 666 Mason County Department of Community Development _ Small Parcel Stormwater Management Application/Works ( a 4 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. 'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete-This Table Surface Type Length X Width = Area All dimensions in feet Buildings X = 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 = X = Any paved, gravel or packed area per definition above table X = Others X = X = If the total impervious area of the proposed site X = development is greater than 2000 square feet a p Small Parcel Stormwater Site Plan is Required Total Impervious Surface Area(sum of all areas) W Ft If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- dscribed roperty for re w and inspection as may be required. 10. X' j ` caner circle one))gent/Contractor DX" �g If the Total Impervious S ace Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 Name Parcel # BLD# Mason County Department of Community Developments Small Parcel Stormwater Management Application/Workshet•WA 2) Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website: http//www.co.mason.wa—us/code/commissioners/index.htm Please follow the links to "Title 14,Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout' PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at: Phone: 360-427-9670 ext 450 100 W. Public Works Dr Shelton.WA 98W If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or any other,parcel.You may also wish to consult with the septic design professional involved with the project. Mason County Division of Environmental Health can be reached at: Phone: 360-427-9670 ext 400 415 N.6th St—Bldg#8 lower level Shelton.WA 98594 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 F. PLANNING K7I Kle D6c.K E-rtsTt►44, —cv=cX } f-Vd5T: A2:f U%E q - x O oor po qm-6 M.\kV� Wit'! N - 9� C9-7 Antes CWVr wart F-laNms P" xwr - DEC 2 4 2018 A P P RR PL-D 615 W. Alder Simc-,t F MASON COUNTY PCD PLANNING � f SITE PLANREOI!I`?ED TO BE ON SITE I , t CHAN ES S; : �'T TO APPROVAL 107 By__ --- D ae • IV m4ct . ONLY 'o 4EA PLANNING: } 1 ALL SETB KS ARE MEASURED ►LXfl __UW[75 AUE LCMr <.AL— FROML FURTHEST f7m _(K- 4(Z- 1ArW - �U- PRgJECTtor HF BUILDING I -- _. A ppr a4f to w1 wvti ter. 's.a ; �rz° . 1 UM S CV .l�Iwrr{s} 4zvn WT 'X>0r D T© rH TQ eE tU1L�cat E j ( offip i won she ;t=q-pzl tQT NT C) �oN cot" MASON COUNTY COMMUNITY SERVICES PERMIT ASSISTANCE CENTER: Permit No: •BUILDING•PLANNING •PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 985a r•. �, Phone Shelton:(360)427-9670 exl.352•Fax:(360)427-7798 Phone RE _ Belfalr:(360)275-4467•Phone Elma:(360)482-5269 DEC 2 4 2098 l83 BUILDRBUILDING� PERMIT APPLICATION 615 W. Alder Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: � C,�•r NAME:_ M— /C�?aL- Mtn► NAME: Jmii lei M r' MAILING ADDRESS: 564 MAILING ADDRESS: I r-. CITY:VANca46(Z, STATE-WAt ZIP:q 66 CITY: V1E\N STATE:WA ZIP: 544 PHONE#1:3[p • 9 4q • 106? PHONE: CELL:�• 3 -M Z,7 PHONE#2: 3A�o• �94,56 EMAIL : St nbu1 I.4rS►nc ♦ yghw .Ce++% EMAIL: jc%rle„1000 O i •(Cqn L&I REG# ZIM 55 15Z.�4 EXP. PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ NAME CD _J_ EMAIL +=-W Jct,rl< 1000 Q Qr'►'141b_C-On MAILING ADDRESS NW tN Is CITY_WNCONS112, STATE WA ZIPS&663 PHONE 360 CELL (.o • 4mq• IS(A PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) I ZI I c1- 51-cx:16(5 ZONING R2$5I iD&Jr1Ali LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICTS. CAD. SITE ADDRESS_ (CP7 E.A%&71ES 4:> . V6 WEST' CITY 5�1`/ DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOZ IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK ❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑ TYPE OF WORK: NEW❑ ADDITION B' ALTERATION❑ REPAIR❑ OTHER ❑ QMOPG` USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Me) (.71.DiE&Xw'E IS USE: PRIMARY❑ SEASONAL ' NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Pariftigf yldg) NO❑ DESCRIBE WORK BATHt2WN1 Ami-TIOIV SQUARE FOOTAGE: (prc ' ng) 1ST FLOOR sq.R. 2NITFLOOR sq.ft. 3RD FLOOR 1, ft. BASEMENT - iq. (l. DECK sq.ft. COVERED DECK _ sq.ft. STORAGE_ �f _sq.ft. OTHER sq. ft. GARAGE —sq.ft. Attached❑ Detached❑ CARPORT N/A sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL IIEALTII: SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING g PLUMBING IN STRUCTURE? YES,K NO ❑ If yes, attach completed Water.Adequacy Form PERIMETER(FOUNDATION DRAINS PROPOSED? YES N9K EXISTING SQ.FT. EXISTING BEDROOMS 7— PROPOSED BEDROOMS <6 TOTAL BEDROOMS Z OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction Is not commenced within 180 days or if construction work Is suspended for a period of 180 days. PROOF OF CON NUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT AP ION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42) 1 ��i L X Signature of OWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED D14TEr DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENTTY K 9ffK PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY µ COMMUNITY SERVICES n,I I -= -- Building,Planning,Environmental Health Community Health Physical and Mailing Address: 615 W Alder St.,Bldg 8, Shelton, WA 98584 '} Shelton Phone: (360)427-9670 ext 352 Fax (360)427-7798 PLUMBING $ MECHANICAL PERMIT APPLICATION Permit# ��2��� OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: InM (.'_4aAW" C420, GUA, NAME: JADSH- SI Mf'SOP/ MAI Q NG ADDRESS:-S •1 KJW WNN-PUT_ST MAILING ADDRESS:Z961 5• MA56M LAIN P0. WI• CITY. AKX0W>_IL STATE:V,JA ZIP:Cl;r=63 CITY: V/1521 STATE: Vim/$_ZIP:18-946 1s1 PHONE: 360• `1 • 9�1$ PHONE: CELL: 2% �3 .bZZ7 2mdPHONE::�60. 46a 9465 EMAIL:Str*%pson but ld2,r-Si or-o yj koo •cor^ EMAIL: ad ci-gry. low a irmll COK L&I REG# 511APSL '15Z1-0 EXP. PARCEL INFORMATION: PARCEL NUMBER (12 Digit Number): 5 —Qpl�ls Zoning: 12051T1�C� LEGAL DESCRIPTION (Abbreviated): SITE ADDRESS: �� E R�INTS �� W Sr CITY: SHM--rot4 DIRECTIONS TO SITE ADDRESS: TYPE OF JOB/WORK: NEW — ADD�C _ ALT REPAIR OTHER USE OF BUILDING +-b E PLUMBING FIXTURES MECHANICAL UNITS f Electric in-wall heaters(no fee) Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel Type Fees Toilet(s) 1 Furnace PG/LPG] Bathroom Sink(s) 1 Heat Pump [E/G/LPG] Bath Tub(s) o Ductless H.P. [E/G/LPG] Shower(s) 1 Spot Vent Fan 1 Water Heater(s) [E/G/LPG] Propane Tank [ gal.] Clothes Washer(s) [E/G/LPG] Gas Outlet(s) Kitchen Sink(s) Heat Stove [E/G/LPG/W] Dishwasher(s) Kitchen Exhaust Hood Hose bib(s) Dryer Vent Other Solar Panel Other Other Plumbing Subtotal Mechanical Subtotal Plumbing Base Fee Mechanical Base Fee Final inspection Fee Final InSper.tign Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 dayp or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIV �THISRMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. 12,s��� 1 S�i9nature of Applicant x 10 G(.�_ Owner/ wners Representative/Contractor Print Name ne) DEPARTMENTAL REVIEW APPROVED DATE I DENIED DATE I TAGS/NOTES/CONDITIONS O Building ` 3 ' Qr O Fire Marshal O Permit Tech (OTC permit only) 1511 1I> .wd.us, o—i—lun T.N_L ev F:2 C��1s;%1l li Name 'ODD �Aat Parcel# ' l 5' Q� BLD# BUILDINP 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: hi!pHwww.co.mason.wa—us/code/commissioners/index.htm Please follow the links to "Title 14, Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at: Phone: 360-427-9670 ext 450 100 W. Public Works Dr Shelton.WA 98584 If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or any other, parcel. You may also wish to consult with the septic design professional involved with the project. Mason County Division of Environmental Health can be reached at: Phone: 360-427-9670 ext 400 415 N. 6th St-Bldg#8 lower level Shelton.WA 98584 A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met prior to a request for final inspection of the building permit. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- described property for review and inspection as may be required. X Owner/Agent/Contractor(circle one)Date: Page 2 of 2 Name Parcel# IZ �9 ..5�-Q�15 BLD# Mason County RIC, V L_l D Department of Community Development , 01., Small Parcel Stormwater Management Application/Worksheet (page 1 of 2) Per Mason County Code,Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface 2. 'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width = Area *All dimensions in feet Buildings 1 Z' X 7•S = q & 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 = X = Any paved, gravel or packed area per definition above table X = Others X = X = If the total impervious area of the proposed site X = development is greater than 2000 square feet a Small Parcel Stormwater Site Plan is Required Total Impervious Surface Area (sum of all areas) CVLJ�P 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 acknowledg the information provided is accurate and employees of Mason County are granted access to the above- described property or re iew and inspection as may be required. (.(J 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. Pagel of 2 z's RECEIVED DEC ° 2 4 2018 I �rsYi�tle DCz.K ;=x�Sr,NL ��C � 615 W. A:der Street .- . I I LWW. 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