Loading...
HomeMy WebLinkAboutBLD2004-00165 SFR - BLD Permit / Conditions - 7/30/2004 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 lr Shelton, WA 98584 f,, RESIDENTIAL BUILDING PERMIT BLD2004-00165 OWNER: MICHAEL FISH RECEIVED: 2/13/2004 CONTRACTOR: BRAD WILSON CONST INC 426-0277 LICENSE: BRADWC1033DF EXP: 3/6/2005 ISSUED: 7/30/2004 SITE ADDRESS: 425 E RAUSCHERT RD GRAPEVIEW EXPIRES: 1/30/2005 PARCEL NUMBER: 121181300011 LEGAL DESCRIPTION: TR 1-A OF GOVT LOT 2 & TAX 655A-1 PCL 2 OF BLA#01-22 425 E RAUSCHERT RD GRAPEVIEW PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE HWY 3 TO GRAPEVIEW LOOP TURN RIGHT GO TO RAUSCHERT RD GO TO 425 TURN LEFT General Information Construction & Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: V-N Type of Use: SF Insp. Area: No. of Bathrooms: 3 Occ. Group: R-3, U-1 Lot Size: Deck: 0 Type of Work: NEW Fire Dist.: 3 No. of Stories: 2 Occ. Load: Building:2,070 Garage-Attached 575 Valuation: Building Height: 26 Occ. Status: Primary Basement:540 Cov. Decks 526 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: N 500.0 Ft. Shoreline: 55.0 Ft. Water Body: PICKERING PASSAGE Rear: S 55.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: W 65.0 Ft. Shoreline Desig.: Urban Year: Serial No.: Side 2: E 10.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Planning Review Fee NJP 2/13/2004 $155.00 S22004 Hosebibs 3 Furnace<100K 1 Public Works Review AT 3/11/2004 $39.22 S12004 Kitchen Sink 1 Gas Outlets 2 EH Plan Review CEW 7/12/2004 $75.00 S12004 Lavatories 3 Propane Tank 1 Adjust Plan Check Fee JRN 7/20/2004 -$58.24 S12004 Showers 2 Ventilation Fan 5 Building State Fee JRN 7/20/2004 $4.50 S12004 Water Closets (Toilets) 3 Heat Pump 1 Building Permit Fee JRN 7/20/2004$1,430.55 S12004 Water Heaters 1 Propane Stove 1 Plumbing Fee JRN 7/20/2004 $89.00 S120b4 Clothes Washer 1 Dryer Vent 1 Plumbing Base Fee JRN 7/20/2004 $20.00 S12004 Mechanical Fee JRN 7/20/2004 $153.20 S12004 Mechanical Base Fee JRN 7/20/2004 $23.50 S12004 EH Permit Revision CEW 7/22/2004 $35.00 S12004 Total $1,966.73 BLD2004-00165 Please referto the following pages for conditions of this permit. 1 of 7 CASE NOTES FOR BLD2004-00165 CONDITIONS FOR BLD2004-00165 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 risk laud monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982. The peon signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) The Uniform Fire Code_rgquires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved access road. Roa s are nequired to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads; with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X 3) 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 n d ' n, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department p y further inspections being performed or approvals granted. X 4) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located in such a position as to be plainly visible and legible from the street or road fronting the property. Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee-based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or contractor fail to-post the address on site prior to requesting inspections. X 5) The plan review check list and corrections, along with the Energy Compliance Worksheet (when applicable)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 chan filtered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of tans on site for tion of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. P P 1 P Y PP q 9 � P X 6) All slabs within the heated space shall be insulat orimui R-10 for at least 24". Monolithic slabs shall be insulated around the perimeter from the top of the slab to the bottom of the footing X po 7) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X BLD2004-00165 Please refer to the following pages for conditions of this permit. 2 of 7 8) The "approved" plot plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" plot plan is not on site, then approval will not be e2�"In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Depart o any further inspections being performed or approvals granted. X 9) 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 docum ne emoved, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and s e ted by the Building Department prior to any further inspections being performed or approvals granted. X 10) All construction must me or teed all local ordinances and the 1997 Uniform Building Code requirements as adopted and amended by Mason County and the State of hi ton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit o X -11 11) Proposed structu r igns thereof, must maintain a 5' separation distance between adjacent structures and that furthest projection. X 12) The construction of the er fitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the Uniform s mended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall b ac for to requesting additional inspections. X ✓' 13) All propane tanks must be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All propane tanks filled on site must be located a minimum of 10' from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system air intake (direct vent appliance,_ventilation air intake, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Propane tanks less than 125rLi4sro o be located a minimum of 5'from any building opening (foundation vents, windows, doors etc), property line or easement. If a propane ted to probable vehicular damage, protective bollards must be installed. X 14) All propane tanks must be ' stalled in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All Propane tanks between 125 and 500 gall n u be�oeated a minimum of 10'from any building, property line, public way, possible source of ignition (electrical outlets, electrical fixtures, comp o c ;and/or any weeds, grass, brush, trash or any other similar combustible materials. If a propane tank is exposed to probable vehicular da r tive bollards must be installed. X 15) All propane tap s e installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All propane tanks must meet the installatio it is and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks. X 16) Fuel piping shall be ' s e a �r the installation of gas piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the time of inspection pr sure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall not be used unt� pection has been performed and approved by a Mason County building inspector. X BLD2004-00165 Please referto the following pages for conditions of this permit. 3 of 7 17) The placement of small propane tanks are noVnor al subject to a permit review by the Planning Department; however, propane tanks are subject to Planning Department regulations. Such regupr arily consist of setbacks from shorelines and features considered to be critical areas (streams, wetlands, slopes, etc.) If you think such featuon or nearby your property, please contact the Planning Department so that exact setback requirements can be determined. X 18) 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 pr to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances d building regulations. X 19) All permits expire 180 day 'a r�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 ing 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have prevent i om being taken. No more than one extension may be granted. X 20) Pressure treated wo.6d/m' u a` ed 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. X 21) Water quality is not t e faded to the detriment of the aquatic environment as a result of this project. X 22) Proper erosion and sediment control practices must be used on the construction site and adjacent areas to prevent upland sediments from entering shoreline waters. Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be effective to prevent soil from being carried into surface water by stormwater runoff. Sand, silt, and soil will damage aquatic habitat and are considered pollutants. Any discharge of sediment-laden runoff or other pollutapollutants to waters of the state is in violation of Chapter 90.48 RCW, Water Pollution Control, and WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington, and is subject to enforcement action. Any work in or adjacent to waterways that will adversely affect water quality must receive specific prior authorization from the Department of Ecology pursuant to WAC 173-201A-110. A sh&VVer ater quality standards modification may be issued if the proponent agrees to a number of specific construction practices and techniques de . minimize water quality impacts. All areas disturbed or newly created by construction activities must be revegetated using bioengineering tec clean durable riprap, or some other equivalent type of protection against erosion when other measures are not practical. X 23) All upland areas disturbed or new e t rbyconstruction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 24) The proposed project must be consistent with if appl cable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program.X ' 25) All construction and demolition debris must be removed from the beach after project completion. Proper AS clof nstruction debris must be on land in such a manner that debris cannot enter or cause water quality degredation of e waters. X 26) Temporary erosion control measures must be implemented to prevent water q dction of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. X BLD2004-00165 Please refer to the following pages for conditions of this permit. 4 of 7 27) Approved per di ��sions and setbacks on submitted site plan received by Planning Department 7/28/04. Setbacks are measured from the furthest projection of s�l`ucture and include a 55' setback from the OHWM (or top of Bluff)from shoreline and 27' setback from the OHWM of the stream to furthest proj i long west side of structure. X 28) Application a/4 es that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5 X 29) Site is located within an unstable Landslide Hazard Area. Adequate drainage/siltation control/stormwater plan must be submitted for review prior to development, clearing, grading, or construction on the site. Plan must be approved by Mason County Planning, Building, and Public Works prior to development. Developm nt should be designed to preserve the natural drainage courses in the area. Surface drainage, including downspouts, shall not be directed onto or wit 50 feet above or onto the face of a Landslide Hazard Area or it's associated buffer. If drainage must be discharged from the top of a Landslide K� eato below it's toe, it shall be collected above the top and directed to below the toe by tight-line drain and provided with an energy dissipati at the toe. X 30) The Mason County Resource Lands and Critical Areas Ordinance requires vegetative management of the site. ThereYshI imum disturbance of trees and vegetation in order to minimize erosion and stabilize Landslide Hazard Areas. Vegetation shall not be dist removed from the slopes of banks between the ordinary high water mark and the top of the bank due to the potential for erosion.X 31) Regulations which apply for GRADING of the site (per Mason County Resource Lands and Critical Areas Resource Ordinance): A. No grading shall be performed in Landslide Hazard Areas or slide prone areas prior to obtaining a grading permit subject to approval by the Director and based on recommendations contained in the geotechnical report with slope stability analysis and grading recommendations. B. Clearing, grading, and other construction activities shall not aggravate or result in slope instability or surface sloughing. C. Undergrowth shall be retained to the extent feasible. D. Clearing methods which minimize soil disturbance shall be used. E. No fill, d ation (slash/stumps), or other foreign material shall be placed within a Landslide Hazard Area. X 1 32) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are re this proposed development and construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X # " 33) All changes to" d" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance or regulation, r viewed and approved by Mason County prior to construction. X 34) All property lines shall be clearly identified at the time of foundation inspection. X Mir BLD2004-00165 Please referto the following pages for conditions of this permit. 5 of 7 35) The approval of this project is subject to the recommendations and specifications outline e attached geotechnical report or assessment. Structures and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical rep sment, may require a seperate permit. The geotechincal report/assessment shall remain attached to the approved building plans. X 36) The approval of this project is subject to the recommendations and specifications outlined in the Habitat Management Plan. The Habitat Management Plan should remain ME the approved Building permit. x 37) The subject property fronts Pickering Passage and is also located within a protected buffer of a Type IV stream. Pickering Passage is regulated under the Shoreline Master Program and the Mason County Resource Ordinance. The stream is regulated under the Mason County Resource Ordinance. Regulations require building a� buffer setbacks from shorelines and streams. Based upon the Hearing Examiners Decision of the Resource Ordinance the proposed struT ed to be placed 55'from the OHWM of the shoreline and 27' from the Type IV stream. (See site map). X 38) The existing etative buffer and wetland adjacent to the stream shall remain undisturbed by any construction and/or development on the parcel. x-------------- - -- ----- ----------------------- 39) The Riparian buffer restoration should incorporate supplemental plantings as set forth in the HMP. Riparian buffer restoration and plantings should also include nearshore/esturary interface portions of the stream and the riparian corridor in closest proximity to proposed development. Removal of the.can r e am structure should be included as part of the riparian corridor restoration. x �� 40) Provisions for/the Sh elite bluff buffer plantings shall be as set forth in the Habitat Management Plan. V 41) A site inspectign. y g staff is required prior to final permit approval. Please contact Diane Marcus Jones at(360)427-9670 ext 363 to schedule the inspection. X 42) The monitoring of the site will begin the first fall following the tree plantings and maintained on a seasonal basis. Information outlined in the HMP will be included in annual repo itonng will be in effect for the duration of three years and report submitted on an annual basis to Mason county Department Of Community Dev-1i 80% success/survival rate will be required of plantings during course of three years. lx---------------------=-----=-- ----------------------------- BLD2004-00165 Please referto the following pages for conditions of this permit. 6 of 7 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 any time 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 th ers behalf, represents that t informati provided is accurate and grants employees of Mason County access to the above described property an �truc re for eview and inspec ion. OWNER OR AGENT: �� DATE: , BLD2004-00165 Please referto the following pages for conditions of this permit. 7 of 7 "P o * `ft(NCRETE ME CH NIC L MANUFACTURED TOME CD — Footings / Setbacks Date Z By Ribbons ID zo o Date By Gas Piping Date By cn rn Foundation Walls Date 01 (40O By � Set-up Date :�r_./Z -691f By " > INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date By Date ��" ��� By r_-,,,1 Date By PLUMBING Attic OTHER G roundwoyk Date By Date COD.,&tl By L WALLBOARD NAILING D.W.V. Date By Date l7— u7 lcqB FINAL IPSPECTION Water Wne Date - '��'` ` By T Date ('Z ©-I oL By -) Date By a CD -may r e-,✓ Nit GSA GtE CMW 10A' p 5% � O 6 l 0Fore m RPA m.:- r4r__,A4.T_ 1_6D Q40V 14&71tv 6:5ae Alffitltiio - n Arm I Z10i11*V 4oYO((' W7 8 wPt ttaoal-t-4 ' 3� o y �r D S r mew Cal o{ C6 R15 P I s --a,C FILE T&LkELOP 6161S 1,0E_ 011045.1 60)OF1651 LP " k ,3L b�- opt 10 t 145S g L god— LP 6frs PA 1J, 1--k , 4( �ss60 s 1 q Imo- s C�_ P-) 0 288' well �anal seplic new lank. garage 572 sq. this stake was placed by dianne marcus Tones on ft' W27 as 22'setback. building edge will be 5' approx• east of this stake.stake r 1T to remain during construction black line represents new o-r red line 0000 building footprint. 00000 E 00000 represents (includes °o°o°00 *0 existing covered 8 I °oga°a°ova building porches)new s 0000o Po ) q 27' footprint( footage of m 00000 11005 g 0000 q proposed house 00000 this stake was placed by 0a0a ft) onlyfootprint is 00000 P dianne marcus tones on c 000000000 1209 sq.feet. 7127 as 45'setback. building edge will be 10' T north of this stake.stake to remain during A construction hatched area with stars I represents section of original house restoration zone that will be moved to the east.native U') 1000 sq.ft. plantings will replace this section edge of marine bluff edge of marine bluff case inlet PLAN WIVED REVISION DATE -3=- --- PLAN LOT REVISION IVED D E_ r BUILDING &50, m o g� 50 � water 0 drgre Sewertine d� w y w rn F _ house 4,100,South of north prof.line y S O S N Request To Revise An Approved Plan Permit Number: BLD200� - DD �,6,�5 Name Ki K(- l� ( �j�acX�j( SCAN Parcel Number - - Phone Number daytime ) D-,,7-13 7 Project Address -� �l '� Mailing Address D CAP5T 1)`-• u ticyv W 2- Please provide a o plete, detailed description of the proposed revisions to th pprov d lans: c u �± ;Oti l��s c Chola Are two sets of the revised plans or addendum indicating the changes included? g2i� Yes ❑ No Are the approved site plans included? 03 Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? K Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes W_No If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? Ei Yes ❑ No (Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.] Does the proposed revision modify the footprint or location of the structure? ❑ Yes &L No If Yes, Is a revised site plan,with all new setback dimensions included with this request? RECEIVED ❑ Yes ❑ No Additional Information: M926 W. CEDAR ST- ��L �1610 App icant's signa a Date: Office Use Only Received by: Date Sent Assigned To Approved By Date ❑ B. Original Valuation: $ ��. Additional Valuation: $ Sq.Ft. x$ $ ❑ P. Sq.Ft. x$ $ ❑ E.H. Total New Valuation $ Additional Fees: io P.W. Additional Planning Dept. $ Additional Plan Review $ New Setbacks: Front / Rear / Additional Building Permit $ Sidel / Side2 / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ Tah Wtiil RevUed SRG grM2003 Request To Revise An Approved Plan v�V 2.� _ 9& o-04 II Permit Number: BLD20 - Name �j 1'zr(� L S d/✓ Parcel Number .Z l / 1 / av D Phone Number(360 Project AddressL L— • k c{S e 1;;e 'Maihng Address b P, eel MCFAle h l,* n5-Y le.prov.ide a complete detailed description of the prop sed revisions to the approveplts: -t ad r Are the site building plans, approved by Mason County, included with this application? }Yes ❑ No Are two sets of the revised plans or addendum indicating the changes included? F-Yes ❑No Are the revisions clearly and accurately identified on the plans or addendum? id Yes ❑No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes it No If Yes,Has the engineer or architect approved this revision? ❑Yes ❑No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural changes to an engineered plan will be approved without the written consent of the engine=or architect of record.) Does the proposed revision modify the footprint or location of the structure? D(Yes ❑ No If Yes, Is a revised site plan,drawn to scale, included with this request? P.Yes ❑No Additional Information: 7 /U Applicant's signature �-� VV �— Date: Received by: _ _Date:_ Office Use Only Forward to departments indicated below: Approval/Date Original Valuation: —_ Building J Additional Valuation: - Sq Ft x -- Sq Ft x —_ ❑ Environmental HealthZ)enf Total New Valuation: Additional Fees: ❑ Public Works JAdditional Plan Review —_ Additional Building Piermit Additional Conditions/Comments: Additional Plumbing Additional Mechanical Other -- Total Amount Due: $ MASON COUNTY DEPARTMENT OF HEALTH SERVICES February 18, 2004 PO BOX 1666 SHELTON, WA 98584 SHELTON (360) 427-9670 FAX (360)427-7798 ELMA (360)482-5269 MICHAEL FISH BELFAIR (360) 275-4467 1610 PARK TERRACE SEATTLE (206) 464-6968 ALBANY OR 97321 Case No.:BLD2004-00165 Parcel No.:121181300011 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Report within the last three years from either a septic tank pumper or an Operation and Maintenance Specialist. Please call me at (360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: 2/18/2004 1 of 1 BLD2004-00165 ,jtd- doo-t- 0oi (VA,, oboy b000P� RECEIVED Al, J U L 2 8 2004 MASON CO. PLANNING DEPT. 288' AP P Off E D well MASON C NT CD PLANNING SITE PLAN REQU RED TO BE ON SITE CHANGES SUB ECT TO APPROVAL By Date N .Pac new 1.*. garage this stake was placed by 572 sq. dianne Marcus jones on O ft. 7127 as 27 setback. building edge will be 5' approx. east of this stake.stake s 17' to remain during construction black line represents new 000000 red line building footprint. A 40o0°00 00 represents (includes 000000000 existing covered 625' tl 000000000 building g porches)new sq. —27' footprint( footage of 00 0`� 1100 sq.q proposed house 000000000 ft') only footprint is this stake was placed by 000000000 1209 s feet. dianne marcus Jones on a 0000 q' 7/27 as 45'setback. --building edge will be 10' —��.- north of this stake.stake - to remain during construction hatched area witl�stars represents section of original house that will be restoration zone - moved to the to east.native in 1000 sq.ft, plantings will replace this section edge of marine bluff edge of marine bluff case inlet } PLAN PLO REVISION PLA<PJLO REVISION IVED IVED DATE— DATE - — G----►— P ANNING Rg m e m � o o� 0o � N Wetar a Q die "Ower; N C w Use j. 8%th ofnorth A-0P.line Co _s 0 m m m MASON COUNTY PERMIT NO.RJl1)2j-1' BUILDING PERMIT APPLICATION CDIUS 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 nFF APPLIC T I FORM IO CONTRACTOR I OR TION Owner Company Name k e.G Mailing Address, el C Mailing Address Y City G YA�r tP �State JA& Zip Code City UFO/i/ State Zip Code � Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor eg. a '013 DF Exp. o E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Pleas include street name, street number and city) Fr • Directions to sit i 3 Tv v, lD� + c_ ti KV Will timber be cut and sold in parcel pre ation?Yes/N Is property within 200'of Saltwater Lake River/Creek - Pond Wetland Seasonal Runoff Stream 4-- Slopes or Bluffs > 15% 1- ­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 OtherT PRJYARY RESIDENCE F4] SEASONAL ❑ Use of Building Describe Work t' No.of Bedrooms a No. of Pathrooms2l2.Square Footage- 1 st Flo r /5-70 2nd Floor /D z.y 3rd Floor Basement Deck Covered DeckOther Sq.ft. Garage -2- Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width erial No. ` No.of B rooms Nn,of Bathrooms Type of Heaturchase Pric'ej Replac ent Unit? Yes/ 110" 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 permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in inters e ardinq this applica- tion or the wor roposed in application, I have obtained permission from them to apply for this permit and c osed. X oi0`G4c IVt' Date: � y U X Owner/Owners epresentative/Contractor (indicate which one) fFEB 13 1004 FOR OFFICIAL USE BEYOND THIS POINT 42A W �hDAR ST. Accepted by: Planning Pd Ck# Date Bld Pd eceip o. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee ►- Ss Site inspection Plan Review Fee 4co EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee — ther Wo Wood/Gas/Pellet Stove Fee State Fee LlViolation Fee Pre-Paid at Submittal Valuation $ 35 TOTAL FEES 2 a- Cav vo PIP � syo 3 n�5 30 03Lk �� 640w PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(360)'1754467 Elma(360)482-5269 APPLICANT INFORM ON CONTRACTOR IN ORM TION Owner Contractor Name Irl( So N Mailing AddYress L P Mailing Address U D Pl s• . City U:-( ge 0i o"t %I) State Zip Code - City U k) IQ ate Zip Code Phone( ) Other Ph.( Ph. -o Other Ph.( ) Lien/Title Holder Contractor Reg. # D Address - Expiration / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. 72- 1 /_T 0 m 0 Fire District Legal Description Site Address(Please include street name,street number and city) & Directions to site !(J V U �- 1'4o v 5; u L Is your property within 200'of the following: Body of Water(Name) \ Saltwater Lake River/Creek Pond Wetland(_Seasonal Runoff Stream Y Slopes or BQft TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No Fixtures Fees LPG Natural Gas Heatpump Toilets IV rs Type of Unit No.of Units Fees Bathroom Sink N3 Furnace I Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer _� Gas Outlets Kitchen Sinks T Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent OtherOther � Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. Q X Date X ' "�j FOR OFFICIAL USE BEYOND THIS POINT FEB 13 2004 Accepted by Date Submittal Amount Due .Receip .N 426 w. ,ts -- DEPART.NiEN1A ;Rt'}1tE5N /kPPRO1lED C3ENIEt7 GONC)frIO1V CORES Building Department Occ Group Type Constr. Planning Department Other Other ... FI'E Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES