HomeMy WebLinkAboutBLD2014-00861 SFR - BLD Permit / Conditions - 4/3/2015 Inspection Line(360)427-7262
�6aP COL�•'T? MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III
426 W. Cedar
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT
BLD2014-00861
OWNER: PIONEER BUILDERS RECEIVED: 9/16/2014
CONTRACTOR: LICENSE: EXP: ISSUED: 4/3/2015
SITE ADDRESS: 130 E CARDINAL CT ALLYN EXPIRES: 10/3/2015
PARCEL NUMBER: 122085112004
LEGAL DESCRIPTION: LAKEWOOD PLAT I BLK: 12 LOTS 4-6, 27-29 TGW S1/2 VAC MAPLE ST& N1/2 VAC PINE ST
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR ST RT 3 JUST PAST ALLYN, R ON ST RT 302, R ON BELWOOD LN, L ON
CARDINAL CT TO SITE ADDRESS ON THE RIGHT SIDE
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-1 Lot Size: Deck: 100
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:1,040 Garage-Attached 450
Valuation: $ 200,270.46 Building Height: Occ. Status: Basement:556
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 43.0 Ft. Shoreline: Ft. Water Body:
Rear: S 103.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 17.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: W 7.5 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 2 Furnace<100K 1 Plan Check Fee GMM 9/16/2014 $ 1,006.30 S1201400000001
Lavatories 3 Ventilation Fan 3 Planning Review Fee GMM 9/16/2014 $205.00 S1201400000001
Bath Tubs 1 Gas Outlets 2 EH Plan Review GMM 9/16/2014 $200.00 S1201400000001
Showers 1 Exhaust Hood 1 Building State Fee RTB 12/17/201 $4.50 S2201500000001
Water Heaters 1 Dryer Vent 1 Building Permit Fee RTB 12/17/201 $ 1,559.35 S2201500000001
Clothes Washer 1 Mechanical Permit Fee RTB 12/17/201 $73.70 S2201500000001
Kitchen Sink 1 Mechanical Base Fee RTB 12/17/201 $28.50 S2201500000001
Dishwasher 1 Plumbing Permit Fee RTB 12/17/201 $ 101.90 S2201500000001
Hosebibs 2 Plumbing Base Fee RTB 12/17/201 $24.70 S2201500000001
Plan Check Fee RTB 12/17/201 $7.28 S2201500000001
Total $3,211.23
BLD2014-00861 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2014-00861
CONDITIONS FOR
BLD2014-00861
1) 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 `V
2) On-site septic system final installation approval required prior to temporary/final occupancy. SWG2013-00079.
X `
3) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X �
4) All property lines shall be clearly identified at the time of foundation inspection. X �
5) 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 1 �
6) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or properties. Silt fencing, straw, or
surface matting must be installed and maintained until upland vegetation has become established. X -01
7) Concrete leachate and wash water must be contained during construction pouring, such that water quality degradation of adjacent waters does not occur.
X A-,
8) 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 11
9) 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
BLD2014-00861 Please refer to the following pages for conditions of this permit. Page 2 of 6
10) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Appprroo\ved Site Plan" to ensure these structures are shown and meet the setback conditions listed.
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 '_V
12) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are required for this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X -4;1
13) 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 `-t"
14) 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
15) SHEAR WALL INSPECTION-2012 IBC
A separate inspection in addition to the inspections required in IBC, Section 110 shall be required in accordance with the 2012 IBC, Section
1707.11.2. The additional inspection is required when shear wall fastener spacing is required to be less than 4-inches.
The shear wall schedule shown on sheet Al designate walls type 2 with fastener spacing less than 4-inches.
The required inspection may be performed by the Mason County Building Department, a WABO certified inspector, certified to inspect lateral
connections, the engineer of record(EOR), or an authorized representative of the EOR. The special inspectors duties & responsibilities shall
be as specified in Chapter 17. When a third party inspector is used to perform the inspection special inspection reports shall be submitted to
the Mason County Building Department, 426 West Cedar St, Shelton WA 98584 and also available for inspection. Inspection reports shall be
c mpleted and submitted to the dept. in a timely manner and shall be submitted prior to the framing inspections.
*
16) 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 -"-k.
BLD2014-00861 Please refer to the following pages for conditions of this permit. Page 3 of 6
17) 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 `_,^
18) All slabs within the heated space shall be insulated to a minimum 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 LA,\
19) 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 `.±,\
20) 2012 IECC/Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window(Max U-Factor):0.30, Skylight(Max
U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation min. R-49, Vault Insulation R-38,
and Slab Insulation R-10.
In addition the following credits from R406.2 shall be completed as follows: 5b, efficiency water heating, gas minimum E.F. .82, elec. minimum E.F. 2.0
X
21) A permanent certificate, completed by the owner, 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 105.4, and air leakage
results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 5 air changes per hour when tested
with a blower door in accordanve with IECC/.WSEC Section R402.4.
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 IECCNVSEC R401.3 & R101.4.3
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2012 Certificate" and are available in %<or'/2 sheets. The
Mason County Permit Center will also have some available.
X ^
22) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section
R404.1.
X __ 1
BLD2014-00861 Please refer to the following pages for conditions of this permit. Page 4 of 6
23) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation.
In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000.
X `�-
24) 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 --*
25) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances),
repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or created.
X —rl,
26) 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
27) 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 __�
28) 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
29) 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 �7
BLD2014-00861 Please refer to the following pages for conditions of this permit. Page 5 of 6
30) 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
IInspeector shall be made prior to requesting additional inspections.
31) 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.
X --*
32) 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 action from being taken. No more than one extension may be granted.
X —*
33) 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
34) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD WAY.
X —AN
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.
Sig ture Date
OWNER - REPRESENTATIVE - CONTRACTOR
Prlt1# ame (Circle one to indicate)
BLD2014-00861 Please refer to the following pages for conditions of this permit. Page 6 of 6
• Deer1"-�+&�kdILWA 7 A.M..F E
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Name CiAll �
Parcel# � (}� ✓� ' BLD# � w
(2'oco-f
426 W." AR
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:
hlWL/www.co.mason.wa—us/code/conunissioners/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)` it 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 alterative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850,Shelton WA 98584
Physical:415 N 6th St, Shelton WA 98584
If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT.352
Mail:P 0 Box 1666, Shelton WA 98584
Physical:426 W Cedar St,Shelton WA 98584
A condition will be added to the building permit that states,in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/—43.— 4 en ontractor(circle one)Date:
Page 2 of 2
1 22 o8 - 51 - l aoo`f
-50.00'
75.00'
A&
APPROVED
o KV30N COUNTY DCD PLANNING
o SITE PLAN REQUIRED TO BE ON SITE
CHAN 3ES SUBJECT TO APPROVAL
By Date
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LOT 64 BELIeSOOD
OUSTOM .JAY HAUGEN r:)E51 GNER
HOME PORT OROH, ,R Z AA
DESIGN (560) 5-1 I-554a
A SITE PLAN FOR
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Public
Always working for a safer Cl healthier Mason County
PO Box 1666,415 N 61h 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 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 system utilized.
3. Submit completed application,with attachments to the health department for review.
Part 1: Applicant/ Parcel Identification
Name on Applicant: PI Uh-ee✓ (� l I a er s Date:
Mailing Address: PO Eoy- Qogy Phone:: 3(00 " 91'4' 9311
Parcel Number.: a 0 85 11 P 00 1 LOT ( 3
Type of Water System Reason for Application
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(please indicate name of water
If you have more than one residence connected system below if applicable—no signature
to this well, check the Public/Community Water required)
System box.
Part 2: Water System Information
Complete the section appropriate for the type of water system being evaluated:
Public Water System
Name of Water System: f3cwwo0 P A
Water Facility Inventory(WFI) Number: d 55 4 7—
(write"none"for two-parry)'61 1 am the manager of thi$water system. The water system has been approved for 65 services.
There are presently 5z connection(s) in use. This will be the 3 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 a limits set by state and local regulation.
Signature of Water System Manager - Date
Revised 7/2013
Page 1 of 2
This form may be scanned and available for public view on the Mason County Web site.
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test (attached to application) gpm 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).
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ 1 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
In addition to providing the above statement, the applicant will need to arrange an on-site
inspection by Mason County Public Health prior to determining adequacy.
Departmental Use Only: Do not write below this line.
Part 3: Mason County Public Health Evaluation
Satisfactory Determination:
Applicant's water supply does appear adequate to meet the needs of its intended use.
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.
Unsatisfactory Determination:
Applicant's water supply does not appear adequate to m eet the needs of its intended
use for the following reason(s).
Reviewer's Signature: Date
Ker sed 7/2013
Page 2 of 2
This form may be scanned and available for public view on the Mason County Web site.
ACCESS & GRADE INSPECTION BLD
I3�
ADDRESS: G01
rt E
INSPECTOR: DATE OF INSPECTION: IqO N
FIRE SPRINKLER REQUIRED? (circle) ® YES
IF fire sprinkler required, was notification letter mailed? DATE MAILED:
DRIVEWAY ACCESS
()� need post at access of driveway with reflective address numbers
Length: 60 Width: JZ Surface: t, cvrt
Size of turn-around: "v\
Condition of shoulders: yet
Vertical clearance: YX6 bh�T j
GRADE OF DRIVEWAY �G�� %, OF ROAD %
ROAD ACCESS
Length: Width: Surface:
Condition of Shoulders:
Vertical clearance:
BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
(� 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 ( )
REMARKS:
N c) f-'+re-, ce- C"M S �55us
D.
OCT 0 a 2014
426 W. CEDAR Sb
SON coU�at MASON COUNTY PERMIT NO. 0 - '1 -
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
4 t County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
Jx 279,Shelton,WA 98584 (360)482-5269 Elma ext.352I I�
BUILDING PERMIT APPLICATION - �
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: �;p�,� 31 -466 )%A(. NAME: a wi -
MAILING ADDRESS:?1 Q 'box I Dh'i MAILING ADDRESS:
CITY-?,J Q.,\A,,J STATE: \,!A ZIP: �Ir63. b CITY: STATE: ZIP:
PHONE:3bD PHONE: CELL:
EMAIL:br4,� EMAIL :
v
L&I REG EXP. b /q/ 11_�,
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) FIRE DISTRICT_
LEGAL DESCRIPTION(ABBRE TED) :
SITE ADDRESS 01a4s- H CITY
DIRECTIONS'TO SITE ADDRESS ~ J
110
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO ❑
TYPE OF JOB: NEW Ig ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) `K15'{?'0 L I?
IS USE: PRIMARY❑ SEASONAL E NUMBER'OF BEDROOMS__ NUMBER OF BATHROOMS_
DESCRIBE WORK n EIIJ S�e
SQUARE FOOTAGE:
1ST FLOOR C;b sq.ft. 2ND FLOOR l�O_sq.ft. 3RD FLOOR sq.ft. BASEMENT sq. ft.
DECK 1[)0 sq.ft. COVERED DECK sq.ft.STORAGE sq.ft. OTHER_sq. ft.
GARAGE sq.ft. ATTACHED'X DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED ❑
MANUFACTU RMATION: *4 COPIES OF THE FLOOR PLAN
MODEL LENGTH
TH BEDROOMS BATHS SERIAL
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
INSP TION.IN IVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X 11- I`—)N
—7Signature of Applicant Date
X 29n4an ��1C"- OWNER/ EPRESENTATIV CONTRACTOR
Print Name (CIRCLE TO INDICATE)
DEPARTMENTAL REVIEW APPROVED D TE DENIED DATE TAGS/N
BUILDING DEPARTMENT 7 /
PLANNING DEPARTMENT 1, "T <014
FIRE MARSHAL 426 W.
cO° MASON COUNTY PERMIT N0.J31J;bA-N,)8(•¢
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg.III,426 West Cedar Street (360)275-4467 Belfair ext. 352
185a PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME: cr„2, --
MAILING ADDRESS: i 044 MAILING ADDRESS:
CITY�o=� 0. �Nn,j STATE:_ZIP: 6j b CITY: STATE: ZIP:
PHONE:3U q-t-� 2-�ll CELL:3ko 3, 1U ?,ny PHONE: CELL:
EMAIL:\y,u, EMAIL :
L&I REG#2 pN t)-;Ok 222}c£ EXP.L/ /
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER): )d,9 oL6- �) — 7�Z1 4
LEGAL DESCRIPTION(ABBREVIATED):
SITE ADDRESS: u (. ti ) fi CITY: A )i
DIRECTIONS T SITE ADDRESS
1�0
TYPE OF JOB
NEW ,/ ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS—1ST FLOOR f 2ND FLOOR ✓ BASEMENT GARAGE,_,,--OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL U/N�TS /
Type of Fixture No. of Fixtures Fees Fuel Type:Electric�'✓ LPG Natural Gas ✓ Heat Pump_
Toilets '? Type of Unit No. of Units Fees
Bathroom Sink 3 Furnace .
Bath Tubs I Heatpump
Showers I Spot Vent Fan 3
Water Heater I Propane Tank
Clothes Washer 1 Gas Outlets t rY) -
Kitchen Sinks 1 Wood/Gas/Pellet Stove
Dishwasher I Kitchen Exhaust Hood
Hosebibs 9 Dryer Vent 1
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 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 1800 DAYS WILL INVALIDATE THE APPLICATION.
X ,lam , I
Signature of Ap ant Date
X ' 1 Owner/Owners RepresentativelContractor
Print Name (indicate which one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS
_.
BUILDING DEPARTMENT / /
PLANNING DEPARTMENT �' 10�4
FIRE MARSHAL 426 W