HomeMy WebLinkAboutBLD2013-00905 SFR - BLD Permit / Conditions - 10/27/2014 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
RESIDENTIAL BUILDING PERMIT BLD2013-00905
OWNER: GLENN MILLER RECEIVED: 10/11/2013
CONTRACTOR: LICENSE: EXP: ISSUED: 1/27/2014
SITE ADDRESS: 951 E STATE ROUTE 302 BELFAIR EXPIRES: 7/27/2014
PARCEL NUMBER: 122093290040
LEGAL DESCRIPTION: SW NW SW E OF R/W* LOT: 2 OF SP#1162
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New SFR HWY 302 to address
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: R3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,620 Garage-Attached 552
Valuation: $ 204,332.52 Building Height: 0 Occ. Status: Primary Basement: cov porch 120
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body:
Rear: Ft. Slope: Ft. SEPA?:
Side 1: Ft.
Model: Width: Ft. Shoreline Desig.:
-
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 2 Heat Pump 1 Plan Check Fee JWH 10/11/201: $ 1,028.14 S1201300000001
Lavatories 3 Ventilation Fan 3 Planning Review Fee JWH 10/11/201: $205.00 S1201300000001
Bath Tubs 2 Exhaust Hood 1 EH Plan Review SDW 10/11/201: $ 103.00 S6201300000001
Water Heaters 1 Dryer Vent 1 Water Adequacy Plan Revi SDW 10/11/201 $ 103.00 S6201300000001
Clothes Washer 1 Building Permit Fee DLC 11/12/201: $ 1,581.75 S2201400000001
Kitchen Sink 1 Mechanical Permit Fee DLC 11/12/201: $67.40 S2201400000001
Dishwasher 1 Mechanical Base Fee DLC 11/12/201: $28.50 S2201400000001
Hosebibs 2 Plumbing Permit Fee DLC 11/12/201: $ 101.90 S2201400000001
Plumbing Base Fee DLC 11/12/201: $24.70 S2201400000001
Building State Fee TW 1/27/2014 $4.50 S2201400000001
Total $ 3,247.89
BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 1 of 7
CASE NOTES FOR
BLD2013-00905
CONDITIONS FOR
BLD2013-00905
1) App ved er dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
2) Temporary erosion control measures must be implemented to prevent water quality degradation of adj cent*ers or properties. Silt fencing, straw, or
surface matting must be installed and maintained until upland vegetation has become established. X
3) All construction and demolition debris must be removed from the site after project completion P er isposal of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters.
4) All property lines shall be clearly identified at the time of foundation inspection. �a
5) 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 al h to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/con actor" acknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
6) Laiisa
nd stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Ad Site Plan"to ensure these structures are shown and meet the setback conditions listed.
X
7) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
a.eructures meet the setback conditions listed.
8) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
T re are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
-80 647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 2 of 7
9) 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 ranted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
D part nt prior to any further inspections being performed or approvals granted.
X
10) O ner 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
11) 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. T e 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
o re va f)pproved documents will result in failure of required building inspections.
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12) THV'F0'bINDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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13) 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
ap roval` ill 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
uil partment prior to any further inspections being performed or approvals granted.
X ky
14) 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: Options 1 C (ductless heat pump) and 5A(Electric water heater EF 0.93 or
better)
Max m heat equipment output: 24,998 Btu/Hr
X
BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 3 of 7
1 5) 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 IECC/WSEC R401.3 & R101.4.3
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2012 Certificate" and are available in Y4 or'/2 sheets. The
Ma G
unty Permit Center will also have some available.
X
16) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section
R
17) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MP .
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18) 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.
A dge shall be provided at eaves and gables of shingle roofs. (IRC 2012 R905.2.8.5)
19) 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/con ac is cknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan.
BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 4 of 7
20) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
Alar n\op
be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling.
X
21) 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
ther 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
ch rged a d shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
X
22) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State a�hington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
per it�etr c tion.
X 16�
23) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency(ORCAA).
It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been
identified and removed from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or
oper s obtained written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 www.orcaa.org
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24) 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 cated 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 pr ect.
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25) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
or inan or regulation, must be reviewed and approved by Mason County prior to construction.
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26) 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
Ins ect shall be made prior to requesting additional inspections.
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BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 5 of 7
27) All property lines shall be clearly identified at the time of foundation inspection. X
28) 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
MqgrNlCounty ordinances and building regulations.
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29) 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
holdef/ISte prevented action from being taken. No more than one extension may be granted.
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30) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPVZ,IES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR TILWAY.
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31) To perform an inspection the Mason County Building Inspector will need to access the interior of the structure. An electrical permit completed and
approved by Washington State Labor& Industries must be available on-site during the inspection.
The Mason County Building Inspector will inspect the following:
Verify that the system is installed in accordance with manufacturer specifications;
The inspector will check to make sure that the exterior unit is permanently installed and supported,
the exterior unit complies with required setbacks to property lines,
fuel tanks are located at least 10-ft from the system, a source of ignition,
all exterior penetrations are properly sealed,
condensate lines are installed and are properly supported, including proper material, slope, and that the condensate line terminates to a proper location
outside of the foundation,
copper refrigerant lines are insulated with %" thick continuous closed-cell foam insulation or better,
indoor units are located at least 3-ft from smoke and carbon monoxide alarms,
and t modifications made to the structure, to install the unit, does not affect existing structural members.
X
BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 6 of 7
OWNERf/ 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
PERM LI ATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
r �-7
Sign a Date
LI OWNER - REPRESENTATIVE - CONTRACTOR
Print Name (Circle one to indicate)
BLD2013-00905 Please refer to the following pages for conditions of this permit. Page 7 of 7
o CONCRETE MECHANICAL MANUFACTURED HOME �
o Date ��./� B^A?-a r'
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Date BY Data By FIRE DEPARTMENT Z
Foundation Walls Floors Date By
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t�atp - By Date By PROPANE TANKS
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Date BY OTHER
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Permit# MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location ��� ` I2T �z
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found' Items listed below must be corrected to gain compliance
G e.
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L' S- O L. �•
LA n%"a K C,1 v.- 6"1 AVpf - N're o ove— �� G✓'�✓1
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
® Make corrections, items will be checked on next inspection regarding possible structural
OK to �YVt�iL�(AT?.,- aycrz, damage incurred by recent
This is not a complete inspection "natural/man made"
❑ P P ,,//�� disasters.This is NOT a
Date lel
Department !J CORRECTION NOTICE.
Inspector L., (�1<i-
0* 4 N�, VT P inl* RI ' TH1 ,%k TA* mw
.Permit# � � .� /�� '
MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location In i5, 15T k,-r -,�o Z
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
tit GaAs -ry �,
t3•,• 1 vv�t-J ►•.� �irw-C cam'- ht��,
v �ctGl '
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
`N] Make corrections, items will be checked on next inspection regarding possible structural
OK to ,-v\j3 0 C-, i d V damage incurred by recent
"natural/man made"
❑ This is not a complete inspection disasters.This is_NOTa
Date 5T�1 L CORRECTION NOTICE.
Department
Inspector ]
nO 040 ,0T , 1v1 nV , ' THIS T * ME
Name g4aE�J ty in kL/-i?. Parcel# /0"aC)`1- BLD#
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:
http//www.co.mason.wa—us/code/commissioners/mdex htm
PIease 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 docum ent 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 IN rIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A)_A*—pe relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360�427-9670 EXT.450
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 p perty for review-an inspection as may be required.
X Owne Agmt/Contractor(circle one)Date: l 011/113
Page 2 of 2
• it r
AlFm
Name C,1—G. O I LZSk Parcel# /aAo%—`t,a—` M'c/C BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page I of 2)
Per Mason County Code, Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment', with more than 2,000 square feet of impervious surface?.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structw-al or impervious redevelopment.
?Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stonnwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
T -Calculate lmper►icius Suffices �leas� Goinplete This T�ab7�'_
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Pabos/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = 1f.the total'impervious area-of the proposed site
X = development is.grater than.20Do•square feet a
Small Parcel Store iwater,She'".Plan is Required
Total lmpervious.Surface Area-(sum bf all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet. please read,acknowledge and sign below.
Based Upon the information you have provided a Slormwafer Site Plan LS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
descnbed property for review and inspection as may be required.
X (�/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page I of 2
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. �qC)jc)L_ '- OgO,�,
PLEASE PRESS HARD BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner (:;/- C_:� ti ti In 11,LC � Company Name
Mailing Address �'n 304 Si4 I Mailing Address
City1_R Ez- EA-i 2—State l,0 1Zip Code �= 5 City State Zip Code
Phone 3 e,0 z.YD-fL_t`g Other Ph. Phone Other Ph.
Lien/Title Holder !'A-r l IL -_ Contractor Reg. # Exp.
Email address - E Mail Address
Drivers Lic. # ! DOBJ/ 1'z Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic_ X
Connect to Water System Name of Water System
Well_ X•_ Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. t a_�OS -3 a- 777-1 y 0 Fire District
Legal Descriptions c_) n S c, ) c o f- R C,-) /_0 T Q_ o t= S f ;;4
Site Address (Please include street name, street number and city) S 5 1 G 57. P, 3 RL E-A-I 2
Directions to site F Rey r , F6 k fR* 17 o c_ t� a ti3 1+uj Y ' 0 Q ► i r M- c kj'C
Will timber be cut and sold in parcel preparation?Yes kig:
Is property within 200' of Saltwater Lake — River/ Creek — Pond
Wetland Seasonal Runoff Stream Slopes or Bluff—�/o Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?Yes o
TYPE OF JOB - New�_Add Alt Repair Other PRIMARY RESIDENCE? SEASONAL
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms 0 Square Footage- 1 st Floor 2_0 2nd Floor
3rd Floor Basement Deck Covered Deck /a 0 Other Sq. ft.
Garage S S 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 decla
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
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the wo
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS I
MEANS A PROGR S.NSPECTION IN A'-JVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X -- - _ Date:
wner bwners Repregentative 1 Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW P OVED DENIED NOTES
Building Department i
Planning Department
Environmental Health Department •
Fire Marshal
FEES
Building Permit Fee / 1 � Site Inspection
Plan Review Fee O 8�• /�Z EH Review Fee
Plumbing & Base Fee cA q 70 /0/ 90 Planninq Review Fee
Mechanical & Base fee -- Co Other
Wood /Gas/ Pellet Stove Fee State Fee —"
Violation Fee Pre-Paid at Submittal i O�8
Valuation $ O V5,q. TOTAL FEES
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MASON COUNTY PERMIT NO.
PLUM BING/MECHANICAL PERMIT APPLICATION
426 W.Cedar• P.O. Box 186, Shelton, WA 98584
Shelton(360)427-9670•Belb (360)275-4467• Elma(360)482-5269
On the we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner l:� Lu ti /'R 1 LL E Company Name
Mailing Address PCB i3cO'4.- :Za. 1 Mailing Address
city 13 F-4-IPPr-t 2 Stat-G-1_A Zip Code , S 3 a City State Zip Code
Phone 3(z = _ _,Other Ph_ Phone Other Ph.
Lien/Title Holder 5-6- 3 9- Contractor Reg.# Exp.
E mail address _ E Mail Address
Drivers Lic.#j.uz gck-n._,-���DOB_dL DOB
SEPTIC INFORMATION -Connect to New Septic Existing Septic _ Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No, 13,'.a-09-3 D--900:!y y Fire District Q.-
Legal Description LO L-14) E o t= R ce'1 .. X-coT Q- c0 F= S f
Site Address(Please include street name,street number and city)9Si S i IzT 3o Z 3��t-�4�
Directions to site Elk r\ 3 r= cv _L2 r o kj"-OC y
Is property within 200'of Saltwater Lake _ River/Creek Pond -
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building 571 RE y c
Location of Fixtures/Units- 1 st FlooL-X,-- 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 Type of Unit No. of Units Fees
Bathroom Sink Fumace
Bath Tubs Heatpumps l Ov<Tc,zsS
Showers Spot Vent Fan
Water Heater 1 Propane Tank
Clothes Washer 1 Gas Outlets
Kithen Sinks t Wood/Gas/Pellet Stove
Dishwasher _�_ Kitchen Exhaust Hood t
Hosebibs a Dryer Vent l
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 1 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 --i'm1=01KI r%r•%U MY h4F-ANS OF A PROGRESS INSPECTION.
X =, -> = Date: CO
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical&Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES