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HomeMy WebLinkAboutBLD2012-00312 SFR - BLD Permit / Conditions - 1/2/2013 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County Bldg. III 426 W. Cedar P.O. Box 279 Shelton, WA 98584 to RESIDENTIAL BUILDING PERMIT BLD2012-00312 OWNER: JOHN HOON RECEIVED: 5/9/2012 CONTRACTOR: HILINE HOMES 253-840-1849 LICENSE: HILINH*981BT EXP: 2/10/2013 ISSUED: 1/2/2013 SITE ADDRESS: 1305 E ALTA DR BELFAIR EXPIRES: 7/2/2013 PARCEL NUMBER: 122057890113 LEGAL DESCRIPTION: TR 11/12A OF SURV 12/129 TR B OF BLA#94-20 TR 3 OF SP#2521 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW SFR HILINE HOME 1940 ST RT 3, R ON ALTA DR, TO SITE ADDRESS AT THE END, ON THE LEFT, UNNAMED EASEMENT WITH SHARED ADDRESSES 1301,1303,1307 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: 2 Occ. Group: R-3/U Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,940 Garage-Attached 528 Valuation: $ 220,052.60 Building Height: 18 Occ. Status: Primary Basement: Manufactured Home Information I Setback Information Shoreline&Planning Information Make: Length: Ft. Front: E 25.0 Ft. Shoreline: Ft. Water Body: SEPA?: No Model: Width: Ft. Rea(."W 100.0 Ft. Slope: Ft. Shoreline Desi Side 1: N 50.0 Ft. 9.: Not Applicable Year: Serial No.: Side 2: S 50.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Water Closets (Toilets) 2 Dryer Vent 1 Plan Check Fee GMM 5/9/2012 $ 1,086.38 S1201200000001 Lavatories 3 Exhaust Hood 1 Planning Review Fee GMM 5/9/2012 $205.00 S1201200000001 Bath Tubs 2 Ventilation Fan 3 Fire Warden Review GMM 5/9/2012 $73.00 S1201200000001 Showers 1 Furnace<100K 1 EH Plan Review MRB 5/9/2012 $ 103.00 S520120000000i Water Heaters 1 Heat Pump 1 Water Adequacy Plan Revi MRB 5/9/2012 $ 103.00 S520120000000i Clothes Washer 1 Building State Fee LDK 5/24/2012 $4.50 S1201300000001 Kitchen Sink 1 Building Permit Fee LDK 5/24/2012 $ 1,671.35 S1201300000001 Dishwasher 1 Mechanical Permit Fee LDK 5/24/2012 $85.70 S120130000000i Hosebibs 2 Mechanical Base Fee LDK 5/24/2012 $28.50 S1201300000001 Plumbing Permit Fee LDK 5/24/2012 $ 110.60 S120130000000i Plumbing Base Fee LDK 5/24/2012 $24.70 S120130000000i Total $3,495.73 BLD2012-00312 Please refer to the following pages for conditions of this permit. Page 1 of 6 CASE NOTES FOR BLD2012-00312 CONDITIONS FOR BLD2012-00312 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 �4 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 prior to any further inspections being performed or approvals granted. X a 3) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. 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 approved documents will result in failure of required building inspections. X t5,#- 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 Department prior to any further inspections being performed or approvals granted. X 0K 7) Washington State Energy Code Compliance has been approved as follows: Heat Type: Electric or other than electric, Compliance Method: Prescriptive option III, Window(Max U-Factor):0.30, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38 advanced or R-49 standard, Vault Insulation R-38, and Slab Insulation R-10. In addition the following credit from Table 9-1 shall be completed: 1A X BLD2012-00312 Please refer to the following pages for conditions of this permit. Page 2 of 6 8) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC)of fenestration. Where there is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air leakage results if a blower door test was conducted. Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA) when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing. Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate" and are available in %or'/sheets. The Mason County Permit Center will also have some available. X S?t 9) A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps). Reference WSEC 505. X S J9 10) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacturer's installation instructions. X SIq 11) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 9-31 12) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations. B. Septic tank(s) requires 5ft setback from all footing/foundations. C. No foundation drains within 30ft, down gradient of drainfield/reserve area. X BLD2012-00312 Please refer to the following pages for conditions of this permit. Page 3 of 6 13) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X S '1- 14) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X M 15) 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 shall be collected by the Building Department prior to any further inspections being performed or approvals granted. X 16) 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 revocation X 17) 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`tkie 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 9114 18) Placement of structure must comply with standards set forth per the international codes regarding descending and/or ascending slopes. X 19) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. X V/ 20) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. X BLD2012-00312 Please refer to the following pages for conditions of this permit. Page 4 of 6 21) All property lines shall be clearly identified at the time of foundation inspection. X YIr 22) 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 ordinances and building regulations. h 23) 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 (older have p71 vented action from being taken. No more than one extension may be granted. 24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. X 01�1' 25) Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X I'Al` 26) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these structures meet the setback conditions listed. X 3111Y 27) 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'Rlan"to ensure these structures are shown and meet the setback conditions listed. X 28) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X f1 29) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing or straw matting must be installed and maintained until upland vegetation has become established. X fle - 30) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 5"r 31) All construction and demolition debris must be removed from the site after project completion. Proper disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X � BLD2012-00312 Please refer to the following pages for conditions of this permit. Page 5 of 6 i 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 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: BLD2012-00312 Please refer to the following pages for conditions of this permit. Page 6 of 6 Request To Revise An Approved Plan Permit Number: BLD2(:' 12 -DO_;5 IZ Name __ 6 h rl 460 r1 Parcel Number l a a S - _- I I Phone Number daytime Cam) 0 1 S— 9OCEC, PrV10--i t A ess 13oS � A I� A le . Mailing Address W,4 q852f� Ple Irovide a c plete, dqailed description of the proposed visions to approved plans: Are two sets of the revised plans or addendum indicating the changes included? `21 Yes ❑Zo Are the approved site plans included? ❑ Y s � Are the revisions clearly and accurately identified on the plans or addendum? ;Iles ❑ Now Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes o1N0 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 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? Ces ❑ No If Yes, Is a revised site plan, with all new setback dimensions included with ",request? Pes ❑ No Additional Information: Applicant's signature Date: -ODO1`j Office Use Only Received by: Date Sent As To Approved By Date Original Valuation: $ De"B_. 52.a LlO L L41L 1�Z5113 Additional Valuation: $ � - v„a S . x$ $ eLl x$ $ `f � T al New Valuation $ i✓ � Additional Fees: ❑ P.W. Additional Planning Dept. $ Additional Plan Review $ Additional Conditions/Comments: Additional Building Permit $ Additional Plumbing $ Additional Mechanical $ Additional E.H.Dept. $ Other $ eO Total Amount Due: $�_ Amount To Be Paid Up-Front$ bfiqCustomer: Sul �. Site Address: t D A N z� Jr N Mailing Address: 30)( a o _ + 0- Cb ,P J Parcel ( �a05-78 ` C)113 #: w p d p j >( a ..� gypUj �t J 0 / . </ 1 ;(yY) 0 APPR VED �✓ ' c � 05 7MI MAS COUNTY D PLAN G sl - SfTE P N REQUIRED O BE ON Plot Map Drawn to Meet HiUne Homes CMAN SUBJET T PSO �( ® (/ specifications.Any Revisions to Be Made By the By De Homeowner. 4— _ Customer: Dr 0 Site Address: - _ Mailing Address: Lnoz l- ,►� W '�:f 2 V J Parcel #: J aN 4- GS- �iG! APPR V PDLANN G -� MAS COUNTY r -}- S[TE P N REQUIRED '0 BE ON SI CHAN FSSU&JETT PPROVAL Plot Map Drawn to Meet HiLine Homes Specifications.Any Revisions to Be Made By the BY Da — Homeowner. PUS PLOT RLVVISiG RECEIVED -;26 MAY 2 0 2013 426 W. CEDAR SL K ECEWED BUILDING "T" It 201Z BUILDING PERMIT INFORMATION FORM - PLAN 1940 :"•.�,SC�� C;Ol�1\ `! CONTRACTOR INFORMATION Creative Design Builders d.b.a.HiLine Homes 11306 62nd Ave. E Puyallup,WA 98373 253-840-1849 HILINH*983BD/UBI#601-584-067 expires: 11/08/2013 This will be a New Single Family Residence Type of work: NEW HOME CONSTRUCTION HOME INFORMATION: (sq.ft.) MAIN/1ST 1940 #of stories 1 SECOND Bedrooms 3 TOTAL 1940 Bathrooms 2 GARAGE(attached)528 Porch CONSTRUCTION METHOD: WOOD FRAME HEATING SYSTEM: NOTE:BE SURE TO CHOOSE THE INFORMATION BELOW THAT COOROLATES WITH THE HEAT SYSTEM YOU HAVE ORDERED NOTE:HVAC/MECHANICAL CONTRACTOR IS THE SUB INSTALLING HEATING SYSTEM CADET/WALL MOUNT/ZONE HEATERS(STANDARD COMPONENTS) INSTALLER EVERGREEN STATE ELECTRIC CONTACT Justin Chamberlin LICENSE# EVERGRSE066JA PHONE (253)770.0656 EXPIRES LOCATION Orting MANUF. Cadet BRAND Register Plus MODEL RM202; RM162 KW: 7/AMPS: 20 HEAT PUMP w/FURNACE w/HOT WATER HEATER INSTALLER CHEHALIS SHEET METAL CONTACT David Pyles LICENSE# CHEHASM252MH PHONE (360)748.9221 EXPIRES 09/24/13 LOCATION Chehalis MANUF. TRANE MODEL 4TEC3F31*4TWB4030 TONAGE 2.5 HSPF 8.5 KW 10 LRA/LRC 68.2 EFFICIENCY 100% SEER 14 NATURAL GAS FURNACE w/HOT WATER HEATER INSTALLER CHEHALIS SHEET METAL CONTACT David Pyles LICENSE# CHEHASM252MH PHONE (360)748.9221 EXPIRES 09/24/13 LOCATION Chehalis MANUF. TRANE MODEL BTU 60,000 EFFICIENCY 95% WATTS 997 PROPANE GAS FURNACE w/HOT WATER HEATER INSTALLER CHEHALIS SHEET METAL CONTACT David Pyles LICENSE# CHEHASM252MH PHONE (360)748.9221 EXPIRES 09/24/13 LOCATION Chehalis MANUF. TRANE MODEL BTU 60,000 EFFICIENCY 95% WATTS 997 PLUMBING CONTRACTOR INSTALLER K&M PLUMBING CONTACT Shawn Moody LICENSE# KMPLUS1995K5 PHONE (253)503.2676 EXPIRES LOCATION University Place toilets 2 kitchen sink! 1 bath sinks 3 water heater. 1 tub/shower 1 clothes wash 1 showers 1 dishwasher 1 soaking tub 1 ENERGY COMPLIANCE INFORMATION:OPTION#3 UNLIMITED(per WSEC 2009) TOTAL Sq.Ft.of glazing(glass)divided by total sq.ft.of heated area=glazing% please see enclosed window schedule 'swinging doors and skylights are not counted in this configuration because they meet all min.requirements Continuously operating Whole House Ventilation System using exhaust fans&window fresh air vents Whole House Ventilation System:IRC M1508.4 Discrete Spot&Whole House manufacturer Broan Model# QTRE110 CFM:110 Bathroom one-bulb heater/fans:Quantity(PER UNIT): manufacturer Broan Model# 162 CFM:70 I ACCESS& GRADE INSPECTION BLD DI - FIRE AL ADDRESS: 1`3aJ L A I+A '*-DY l i f 1= 1._ F, I C,,-LI Z INSPECTOR: -r/� j� DATE OF INSPECTION: _ Z FIRE SPRINKLER REQUIRED? (circle)ONO YES IF fire sprinkler required, was notification letter mailed? DATE MAILED: DRIVEWAY ACCESS ( ) need post at access of driveway with reflective address numbers Length: Width: Surface: Size of turn-around: Condition of shoulders: Vertical clearance: GRADE OF DRIVEWAY %, OF ROAD % ROAD ACCESS Length: Width: Surface: Condition of Shoulders: Vertical clearance: BURN PERMIT REQUIRED FOR LAND CLEARING FIRE. L_) LOT INSIDE UGA-NO OUTDOOR BURNING PERMITTED. LOT TOO SMALL FOR: BURN PERMITS 4 X 4 FIRES 2 X 3 FIRES PASSED ( ) FAILED ( ) ON HOLD ( ) CE n C-A L+A \brl U 1301 130 o - - J '1k 1 !. 2012 MASON COUNTY, MASON COUNTY PERMIT NO.AIJ&�jl -��Id� BUILDING BUILDIeNG PERMIT g APPLIC6, Shelton, ATION TION426 W. A l41'u Shelton (360) 427-9670 - Belfair (360) 275-4467- Elma (360) 482-5269 l _ 5 On the web www.co.mason.wa.us APPLICANT INFORMATION f CONTRACTOR INFORMATION Owner -5 W--14 `� S 1 y L,e V- 1 f 2 n! Company Name j-lj'Ll1)e h60e S Mailing Address .,c Mailing Address 11.30G (e2^e ,4w. E City State Zip Code City a State i vA Zip Code `>$373 Phone "70-F Other Ph. Phone 25 'R40-ITg9 Other Ph. Contractor Reg. # N I LI H 1► 3 8 P Exp. 11 -0 8-20 t 3 F , nel fjdrPSS E Mail Address r4ri%.AQrQ UG-4 Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No 122-0 57890//3 Fire District Legal Description Site Address (Please include street name,street number and city) OS n Directions to site Will timber be cut and sold in parcel preparation? Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - Newer Add Alt Repair Other PRIMARY RESIDENCE © SEASONAL ❑ Use of Building f PS"4106-is I — Describe Work 5- c-k -6 vi It Ll c MCrete JSy Cda -" No. of Bedrooms 3 No. of Bathrooms 2 Square Footage- 1 st Floor 12LI D 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage 52'9 Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ 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. PRO ONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date. �4�—i r/Z- 6wne Owners finrfirntp which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by Dat�' 5-071� DEPARTMENTAL REVIEW APPROVED DENIED QNOTES Building Department Z L1& Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection 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 r-' Valuation$ TOTAL FEES I`+� MASON COUNTY PERMIT NO.-hId ao 1 a -Q031Z_ 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 INFORMAQN CONTRACTOR INFOpRMATION Owner U—C)h - I U I I Y l Company Name Mailing Address Mailing Address 113 0(e City State Zip Code City ?may State Zip Code 99373 Phone Other Ph. Phone 25 3- eL42- (IRy 9 Other Ph. Lien/Title Holder Contractor Reg. # N I LI IJ H 9 83 B a Exp i i- o g-2 013 E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic x Existing Septic. Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No. 1 2205 7 8g01 1 3 Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New )r 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 Type of Fixture No. of Fixtures Fees Fuel Type:Electric—LPG—Natural Gas—Heat Pump_ Toilets 2- Type of Unit No.of Units Fees Bathroom Sink 3 Furnace 1 Bath Tubs T Heatpumps I Showers '� I Spot Vent Fan 3 Water Heater i Propane Tank Clothes Washer Gas Outlets Kithen Sinks I Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood f Hosebibs Z Dryer Vent I Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or 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 CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group Type Constr. ?mil /Z ✓3 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