HomeMy WebLinkAboutBLD2022-00243 SFR, ADU2022-00002 - BLD Application - 2/25/2022 . a
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MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER.-
BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 R
Phone Shelton:(360)427-9670 ext 352-Fax:(360)427-7798 Phone
Belfair.•(360)275-4467-Phone Elma:(360)482-5269
FED z 5
BUILDING PERMIT APPLICATION 615 W.
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: eet
NAME: NAME: t. byogs
MAILING ADDRESS: 116 G MAILING ADDRESS: 1136CP
CITY: y STATE:(Z) A ZIP: q,5a CITY: o STATE:_(,)ZIP:
PHONE#I: .3(aU CELL: a5.3 -77o-9.1y4J
PHONE#2: EMAIL : o
EMAIL: q.So bi � '' L&I REG# �L XP. l�l�?lJ
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME P G(d4�' c)6) EMAIL_1C4S6v1 P 0,1,1 Jt,J a) OYM-4Z, l.'C �,r�rt
MAILING ADDRESS l i n CITY l f- STATE( Y--J, ZIP 8
PHONE xo 0-S0-9 - 634 CELL
PARCEL INFORMATION: �r
PARCEL NUMBER(12 Digit Number) l c2di40 7 n J 3 9 Oda t) ZONINGV U I LD I
MG
LEGAL DESCRIPTION(Abbreviated)/ '' - FIRE DISTRICT
SITEADDRESS;[U [-, odL �t� t! P( l CITY 13,24i r
DIRECTIONS TO SITE ADDRESS i) - J /J b v 2i
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO�' SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW$ ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 2Q1;('dve-.
IS USE: PRIMARY ❑ SEASONAL NUMBER OF BEDROOMS r NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(Whole Bldg)A YES(Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK N ��;� A t� L'WWI—
SQUARE FOOTAGE: (proposed)
1ST FLOOR_gd5_sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT ' r¢ sq.ft.
DECK sq.ft. COVERED DECK-a 1 Z sq.ft. STORAGE sq.ft. OTHER I sq.ft.
GARAGE_Zq2q_sq.ft. Attached;l Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER% / NEW ❑ EXISTING NJ
PLUMBING IN STRUCTURE? YES NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOJV EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS_ TOTAL BEDROOMS ,2
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below. I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P RMIT APPJcI TION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
l/ COUNTY CODE 14.08.42)
X ,
Signature of OWNER(Must be sinned by the OWNER) ter— Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
MASON COUNTY COMMUNITY SERVICES Permit No:
ZZ- 3
PERMIT ASSISTANCE CENTER:
•BUILDING •PLANNING •FIRE MARSHAL
615 W. Alder St-Shelton, WA 98584 RECEIVED
ED
Phone Shelton:(360)427-9670 ext. 352• Fax:(360)427-7798
Phone Belfair:(360)275-4467• Phone Elma: (360)482-5269 FEB 2 5 2o22
PLUMBING & MECHANICAL PERMIT APPLICATtOBIW. '%er
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME: U .�%t Ybtrvs
MAILING A DRESS: I 10 MAILI G ADDRESS:// (t t
CITY: STATE: W. ZIP: a& CITY:u4)"l—awSTATE:
V PHONE: 3(10-.509 --0305 PHONE: 2 o?oZ CELL:,�s?,�"77d —day
2nd PHONE: EMAIL : UeCoA t),itt tm Ags + Cc m
EMAIL: Its L&I REG# "0,63,80 EXP. I/ 1_�J_Q3
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): Zoning: e 4
LEGAL DESCRIPTION (Abbreviated):
SITE ADDRESS: CITY: t r
DIRECTIONS TO SITE ADDRESS:
c— `\
TYPE OF JOB: OUILUING
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— Is.' FLOOk:j?—r— 2No FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless_
Toilets t' Type of Unit No.of Units Fees
Bathroom Sink % Furnace
Bath Tubs t Heat Pump
Showers Spot Vent Fan
Water Heater / Propane Tank
Clothes Washer / Gas Outlets
Kitchen Sinks I Wood/Gas/Pellet Stove
Dishwasher 4 Kitchen Exhaust Hood
Hose bibs 2. Dryer Vent
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge 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 C TINUATION 9 THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WIL ALIDA HE PPLICATION.
a-�-
ignature of Owner Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev: 1/27/2016 JBN
MASON COUNTY Mason County Permit Center Use:
COMMUNITY SERVICES
•\ ADv i i
Building,Planning,Environmental Health,Community Health
615 W.Alder St.—Bldg.8,Shelton,Wa 98584 n �`\ Date Rcvd off- 20?—
Phone:(360)427-9670 ext.352 ♦ Fax:(360)427-7798 (` .J�`J�_
RECEIVE[y30.00
Request for Administrative Variance for
Reduction in the Required Setbacks FEB 0 9 2022
For administrative review, the minimum variance on a setback request is 5ffjc5f*V f<dW6 e-Ubt
lines and 10 feet for front and rear lot lines or any access easement. Request for further reduction
requires a standard variance. Setbacks are measured from the furthest projection of the structure
including roof eaves and gutters.
Applicant/owners: MELANIE AND JASON PELLOW
Mailing Address: 110 E COULTER CREEK R D S
City: BELFAIR State: WA Zip: 98528
Telephone: 360-509-0309
Email: jasonpellow@gmail.com
If this reduction is tied to a building permit, please give permit case number.
BLD ADU2022 00002 -7j;—?51 d 2b2.2- 1X02L4 3
Parcel Number(s): 122093390050 Zoning RR5
Site Address: SAME
Requested setback variance:
10 ft. ❑ Front FD Rear ❑ Side
ft ❑ Front ❑ Rear ❑ Side
ft. ❑ Front ❑ Rear ❑ Side
ft ❑ Front ❑ Rear ❑ Side
Front Setbacks—From access easements and road right of ways. Minimum 10 feet.
Rear Setbacks—From the rear property line. Minimum 10 feet.
Side Setbacks—From the side property line. Minimum 5 feet except for certain shoreline designations.
An illustrated site plan is required.
Your site plan must show the following: north arrow, abutting street or easements, and set backs to all
property lines and existing buildings, slopes, surface water, wetlands, critical areas, septic, well and
driveway. Show all proposed new development.
FRONT AND OR REAR YARD REDUCTION REQUESTS:
For existing lots of record as of March 5, 2002;
You must meet one of the following:
1) One of the following exists on the lot (check all that apply):
❑ a) steep slopes, wetlands, or streams present;
❑ b) soils that restrict building or septic development;
❑ c) lot width at the front yard line of no more than 50 feet;
❑ d) lot size of no more than one-fourth acre;
El e) existing improvements of buildings, septic systems, and well areas.
SIDE YARD REDUCTION REQUESTS:
For existing lots of record as of March 5, 2002;
You must meet one of the following:
2) One of the following exists on the lot (check all that apply):
❑ a) steep slopes, wetlands, or streams present;
❑ b) soils that restrict building or septic development;
❑ c) lot width at the front yard line of no more than 50 feet;
❑ d) lot size of no more than one-half acre;
❑ e) existing improvements of buildings, septic systems, and well areas.
Explain how these circumstances preclude a reasonable development proposal from meeting the
setback standard for�Rural Residential 2.5, 5, 10, or 20 zones.
pL �6 -��- V_P -tYD w� bC� f ly y0✓b �a a�j u a .
Owner/ lease Agent indicate 2/ 11?166,1
g (P )
Signature Date
Official Use Only
Approved by: J � Date
Denied by: Date
Reason for denial:
For Mason County Permit Center use:
MASON COUNTY
0a COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health Recv'd b Plannertiab"�:__
6/5 WAlderSt.,Bldg 8, Shelton, WA 98584 Date Stamp Recv d:
Shelton Phone: (360)427-9670 eat 352 :• Fax (360)427-7798
RECEIVED
ACCESSORY DWELLING UNIT PERMIT 24 2��2
(Special Use Permit with AD criteria) BAN
615 W. Alcicr
Permit and Fee:
Special Use Permit (DDR) — application fee: $240.00
*frADU is within 200'ora shoreline you must applt,.ror a Shoreline Substantial Development Permit(SHR)—fee:$880.00
- Environmental Health fee: $
A "Special Use" is one that possesses unique characteristics due to size, nature, intensity of use, technological
processes involved, demands upon public services, relationship to surrounding lands, or other factors. The
purpose of this application is to provide for adequate oversight and review of such development proposals, in
order to assure that such uses are developed in harmony with surrounding land uses, and in a manner consistent
with the intent of the Development Regulations for Mason County; Ordinance No. 82-96. Acceptance of this
application by Mason County does not guarantee approval of request.
Applicant(s) Name: aA"ur,(,�/l.i,
Mailing Address: (' G �oI�I �e
Phone: v� �" �y E-mail: \ ( U nil m", �'V1
Property Owners Name: (if different than applicant)
Site Address:
Brief Legal Description:
Tax Parcel #: v 1 - ✓� - qOO ,5o Zoning:
Project Description:
0.. C, ro" r
i ms J-o� 6� )Pa-reams Allt 1.,i, A-41m6w
vi -,
Rev. anuary 268 ADU Pern it Page l of 4
r
❑ SITE PLAN CHECK-LIST Please provide a site plan that includes the following:
C, Indicate Scale and North Arrow.
Property line dimensions, easements, and right-of-ways.
The location of all existing and proposed structures. Include square footage of existing and proposed structures.
'�. Setback distance, in feet from all property lines and structures.
Existing and proposed road access to and from the site.
❑ Parking spaces.
❑ Location of OnSite Sewage System (OSS) components (including tanks, drainfields, reserve areas, etc.)
Location of existing and proposed wells, within 100ft. of property, shown with 100ft. radius.
Location of existing and proposed waterlines.
❑ Steep bluffs, wetlands, streams, and bodies of water.
❑ Surface and storm water run-off routes.
Mason County Code Title 17.03.029 requires the following criteria to be met for
consideration of an Accessory Dwelling Unit (ADU) Permit:
ACCESSORY DWELLING UNIT (ADU) REQUIREMENTS YES NO INFORMATION
1. Is the ADU in a shoreline jurisdiction? ❑
Please inquire with Mason County
1 a Are you in the Flood Plain? ❑ n Community Services staff, if unsure.
2. Will the owner of the lot reside in either the principal ❑
residence or the ADU?
3. Will the ADU be located within 150 feet of the principal ❑ j
residence or will the ADU be a conversion of an existing 11D�,11
structure i.e. garage)?
4. The ADU cannot exceed 80 percent of the habitable area ❑
of the primary residence, or 1000 sq.ft., whichever is lLY
smaller. Will your proposed ADU meet this criteria?
Please inquire with Mason County
5.Will the ADU meet all setback requirements? ❑ Community Services staff, if unsure.
Please see last page of this packet
6. Will all applicable health district standards for water and ❑ titled "ADU Environmental Health
sewer be met by the ADU? Requirements"
Rev.January 2018 ADU Permit Page 2 of 4
7. Recreational vehicles are not allowed as ADUs. Please �/ ❑
confirm (with YES)that you are not submitting a
Recreational vehicle for review.
8. Your property will only have one 1 ADU?
9. You have provided an additional off-street parking space
for the ADU?
(Ord. 108-05 Attach B.(part),2005)
❑ On a separate piece of paper (#of pages: ), state your reasons for requesting an Accessory
Dwelling Permit and be sure to address the following six criteria. Your request will be evaluated based on
these criteria and the Accessory Dwelling Unit Requirements from the previous section.
1. Will the proposed use be detrimental to public health, safety, and welfare?
No
2. Will the proposed use be consistent and compatible with the intent of the Comprehensive Plan?
yet)
3. Will the proposed use introduce hazardous conditions, at the site, that cannot be mitigated through appropriate
measures to protect adjacent properties and the community at large?
NLD
4. Is the proposed use served by adequate public facilities, which are in place, planned as a condition of approval
or as an identified item in the County's Capital Facilities Plan?
l 4)
5. Will the proposed use have a significant impact upon existing uses on adjacent lands?
No
6. jIf located outside of an Urban Growth Area, will the proposal result in the need to extend urban services?
N U
AApplicant's Signatur Date 4;5 —2_
Rev.January 2018 ADUPermit Page 3 or4
MASON COUNTY
COMMUNITY SERVICES
Buliding,Planning,Environmental Health,Cammunny Health
ADU ENVIRONMENTAL HEALTH REQUIREMENTS
YES NO INFORMATION
1.Will the ADU be served by an EXISTING Onsite Sewage System(OSS)? x
OSS's are sized off bedrooms.
Refer to the onsite sewage records
1(a). Total bedroom count from existing and proposed connected structures on file with Mason County to find
match the approved OSS records on file? your OSS approved size. If
�\ bedroom count exceeds system size,
contact a licensed septic designer
for upgrade options.
OSS application and design permit
2. Will the ADU be served by a NEW Onsite Sewage System(OSS)? must be submitted and approved
prior to EH approval of ADU
permits
-Foundation to Drainfield(s):I Oft
-Foundation to Reserve Area(s):
IOft
3. Will the ADU meet all setbacks to new or existing OSS components? -Foundation to Septic Tank(s): 5ft
Down gradient
Foundation/perimeter drains must
maintain 30ft to Drainfields.
\ / Attach a signed Sewer Adequacy
4. Will the ADU be served by a NEW or EXISTING sewer connection? X Form from Sewer System Manager
to this application.
5. Will the ADU be served by a NEW or EXISTING public water system Attach a signed Water Adequacy
Form from Water System Manager
(over 3 connections)? to this application g
6. Will the ADU be served by an EXISTING private well?
Well must be permitted and
7. Will the ADU be served by a NEW well that is not constructed yet? constructed prior to EH approval of
ADU pennits.
Mason County Code Title 17.03.029 requires EH approval prior to approval of ADU permit.
Environmental Health Review Pre-approval:
Comments:�OMA u o� W
APPROVED
\rd C04_mw� JAN 2 6 2022
MASON COUNTY ENVIRONMENTAL HEALTH
RET
(EH approval stamp with Initials of EHS)
ADU Permit Page 4 of 4
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,\ \ MASON COUNTY
COMMUNITY SERVICES
� Buddmg,Planning,Environmental Health,Community Health
415 N 61"Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 •'r Belfair:(360)275-4467 ext 400 {• Elma:(360)482-5269 ext 400
FAX(360)427-7787
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application,with any required attachments for review.
4. An approved building site Ian must accompany this application.
Part 1: Applicant/Parcel Identification
Name on Applicant: mFla6c .l 1ri-) Date: f.-,�,-2 Z
Mailing Address: J I EA _{ JPhone: ? .p SC C �?����-
Parcel Number: f -7 tC !7npes p
Type of Water System Reason for Application
Public/Community Water System(2 or more Rf Building permit
connections) ❑ Division of land:
Individual water source(one connection), #of Parcels? SPL
0 Spring/surface water Well ❑ Boundary line adjustment
Other
❑ Other(explain) ❑ (explain)
❑ Replacement or Remodel(please indicate name
If you have mityp than one residence connected of water system below if applicable-no
to this well, check the Public/Community Water signature required)
System box.
Part 2: Water Connection Information ��a2 CC
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System: l wtii�1" cy--� '� o1N �^��.�
Water Facility Inventory(WFI)Number:
(write"none"for two-party) JJ
ElI am the manager of this water system. The water system has been approved for services.
There are presently_Ji connection(s)in use.This will be the _:. connection.
❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system(i.e.: recreational to full time). Please indicate on the following line the nature
of this change:
This water system is able and willing to provide water to this(these)connection(s)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager Date
This form may be scanned and available for public view at www,ca.mason.wa.us.
J`.EH Forms',Drinking water Revised 112512018
Individual Water Well
�] Water well report(attached to application). Depth �� ft
Well capacity Test(attached to application) gpm 600D gpd.
t.
The well driller often performs well capacity tests at the time the well is constructed. Results from 5
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a capacity test,
a well capacity test,which provides stabilization of draw-down and recovery data,must be performed
by a licensed contractor.
Satisfactory bacteriological test(attach to application).
Water Resource Inventory Area (WRIA)
Development within which WRIA http://gis.co.mason.wa.us/planning 14 15 16 22
Water use or limitation recorded................................... NIA Yes
Well Drilled ......._...................................................... Date
Individual Spring/Surface Water
k?
.ry
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ I have reason to �rate
at this water source can at least B00 gallons per day;and/or
provides water at 2 g ased on the following observations.
teltatioship
ho tatement�aL�Al)1,AA.t ��, �1 Date
to Applicant
Part 3: Mason County Community Services Evaluation (staff use only)
Satisfactory Determination:
This determination does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6,Chapter 6 68.040•Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: / � � Date %
CSD Director: Date 2 ol'-
<< r
to L of Inf Is T min �. p
RR5 Zoning
Front Yard Setback.25'.
Side&Rear Yard Setbacks.Residential dwelling �•�'/ ,
and accessory structures is 20'. /•/
OR 10%width of lot if not more than 100'wide •�' �eP, ; ', `�
OR approved ADV
EH APPROVED
Rhonda Thompson 04/28/2022
Sewer connection,no septic setbacks j /
ADV2022-00011
Ile
/% Main house is 3,000 Square feet.ADU is limited to
1,000 sq.ft,Approximate size of living space is 900
sq.ft.
j 9 "p4 P ocwn iy
�/• v� /• W s,.,w ySwn
�• Ruedy
4\ APPROVED
,�►�' MASON COUNTY DCD PLANNING
5eM RVEDVAICP
tuo2022-00243
•\ ,/ v..Fl+c sine
•yy '�"� 6ELFW,-9M28
110 E COULTER CREEK RO S
WSU Code Compliance Calculator,WSEC 2018 BUILDING
a
Project lnforma /ReaJR
Medium SFR
3 Credits Review required for custom entries:-Doors-Vertical Glazing-Wall(above grade)-Floors
Proposed UA is better than baseline by 6%
Contact Informatl6tf -, UA-reduction meets selected Option 1 3
JASON 8 MELANIE PELLOW
110 E COULTER CREEK RD S,BELFAIR,WA 98528 RFISEIVED
ANALYSIS SET UP
What code compliance pathway are you using? Prescriptive Path Compliance with Option 1 referred 022
Project Building Type? New Construction
Occupancy Type? R3 Single family homes and duplexes 615 W. Alder Street
Code Version? WSEC 2018
Classification: Small Dwelling Unit--875 sq fit
Baseline Description: Code Baseline-Baseline and proposed window areas are equal
About Your Selection: Up to 15 sf exempt window and 24 sf exempt door allowable
RESULTS-Comparison of Baseline and Proposed Design
Component Performance.R occupancies Baseline Proposed Design
U Area UA U Area UA
Doors U= 0.300 18 5 3 0200. 18 3.6
Overhead Glazing U= 0.500 0 00 0 0.0
Vertical Glazing U= 0.300 122 36.6 0.284 122 34.6
Flat/Vaulted Ceilings U= 0.027 875 236 0.027 875 23.6
Wall(above grade) U= 0.056 820 459 0 050 820 41 0
Floors over Crawlspace U= 0 029 875 254 0 029 875 254
Slab on Grade F= 0.540 0 0.0 0 0.0
Below Grade Wall U= 0.042 0 00 0 0 0
Below Grade Slab F= 0 570 0 0 0 0 0.0
Baseline UA Total 1369 Proposed UA Total[1.
Required Credits 3 0 Proposed Creditsfrom Tables 406.2 and 406.3
UA Percent ReductionDifference
If the Proposed UA<_the Target UA,and the Proposed Credits from Table 406.2 are>_those required in Section R406.2,then the home meets the 2015 WSEC.
Table R406.2 Fuel Normalization Credits
Fuel Normalization
System No. Full Description Select System Type Credits 'Energy Credits Total Credits
4 For heating system based on electric resistance with a ductless mini-split heat pump system in Electric Resistance with Ductless C 5 2 5 30
accordance with Section R403 7 1 including the exception Heat Pump
Table R406.3 Energy Credits
Energy
Option No. Category Select Options Credits Brief Description of Selected Options*
1 Efficient Building Envelope Option 1.3 0.5 U 0.28 Windows/R-38 floors or R-10 Fully insulated slab Or 5%
reduction in UA
2 Air Leakage Control and Efficient Ventilation Option 2.1 0.5 3.0 ACH50/High efficiency fans/For R-2.0.3 cfm per 11:2 at 50 Pa.!
High efficiency fans
3 High Efficiency HVAC Option 3.4 15 Ductless Split System.Zonal Control.Min HSPF of 10.
4 High Efficiency HVAC Distribution System Not Selected NA -Not applicable to ductless system selected in Option 3
5 1 Efficient Water Heating Not Selected 0 0 -
5 2-5.6 Efficient Water Heating Not Selected 0 0
6 Renewable Electric Energy kWh Not Selected 0.0
7 Appliance Package Not Selected 0 C -
Total Energy Credits 2.5
'Refer to WSEC 2018 Table R406.3 for complete option descriptions and requirements
THERMAL ENVELOPE DETAILS-Pro
https/lhilinecorp-my sharepoint.com/personal/pwhitacre_hilinehomes_com/Documents/Preconstruction SHFiIB=ENERGY N PRINT/1003-1846 Fellow Binder/2018 Energy Form UNDER 1500.x1sm 1/7/2022
WSU Code Compliance Calculator.WSEC 2018
Conditioned Floor Area,Proposed Design Designj 875 sq.ft
Classification Small Dwelling Unit
Notes 8'Ceilin
Exterior Doors
Plan Component Door Width Height
ID Description Ref. U Ch. Feet "`" Feet "`" Area UA
Exempt Therma-tru Doors Custom 0 20 1 3 6 s 20 40 - --
Therma-tru Doors Custom 020 1 2 6 ' 18 36 -
0 00
0 00
0 00
0 00
0 00
0 00
Sum of Area and UA(excluding exempt door) 18 3.6
Exterior Doors Area Weighted U 0.200
Overhead Glazing
Plan Component Glazing Width Hei ht
ID Description Ref. U at. Feet 1-1, Feet '"`" Area UA
0
0
0
0
0
Sum of Area and UA 0 0
Overhead Glazing Area Weighted U
Vertical Glazing Schedule Rows to Show 5
Plan Component Glazing Width Height
ID Description Ref. U ot. Feet '"`" Feet '"`" Area UA
Exempt Mil and HS or SH Window Custom 0.25 1 4 3 140 350 Refer to WSEC R402.1
1 Therma-tru French Doors _ Custom 0.36 1 6 6 g 400 14.40 Refer to WSEC R402.1
2 Mil and HS or SH Window Custom 0.25 1 5 5 25.0 625 Refer to WSEC R402.1
3 Mil and HS or SH Window Custom 0.25 2 5 4 40.0 10.00 Refer to WSEC R402.1
4 Mil and FX Window Custom 0.22 1 2 5 100 220 Refer to WSEC R402.1
5 Mil and HS or SH Window Custom 0.25 1 1 2 3 70 1 75 Refer to WSEC R402.1
Sum of Area and UA(excluding exempt window) 122.0 34.6
Vertical Glazing Area Weighted U 0.284
Flat/Vaulted Ceilings
Plan Component Attic
ID Description Ref. U Area UA
R49 blown Attic STD baffled 10-7 0 027 875 236
Sum of Area and IJAI 875 23.6
Walls Above Grade
Plan Component Wall
ID Description Ref. U Net Area UA
R-23 Cavity 2 x 6 @ 16"oc Custom 0 050 820 41 Refer to WSEC R402.1
Sum of Area and UAI 820 41
Floor over crawl or exterior)
Plan Component Floor UA
ID Description Ref. U Area
R30 vented Joist 19.2oC Custom 0 C2 9 875 25 Refer m.user R41z
Sum of Area and UA 8751 25
https://hilinecorp-my.sharepoint.com/personaVpwhitacre_hilinehomes_com/Documents/Preconstruction SHa1Ft BIMENERGY N PRINT/1003-1846 Fellow Binder/2018 Energy Form UNDER 1500.x1sm 1--2-22
• WSU Code Compliance Calculator.WSEC 2018
f
Slab on Grade less than 2 feet belowgrade)
Plan Component Slab
ID Description Ref. F Slab Perim FP
Sum of Perimeter and FP 1 01 0
Below Grade Walls and Slabs
Plan Component Wall Wall Wall Slab Slab
ID Description Ref. U Area UA F Slab Perim UA
Sum of Area,Length and UA 01 0.01 01 0
Show Heating System Sizing?Show
Heating System Sizing-Proposed Design Try Out NEEA's Spec Pro: https:Pbetlerbuftlw.ConVnnourCes/hvaajidlto.M
Nearest Weather Station Grapeview
Indoor Design Temperature 70 F
Outdoor Design Temperature 30 F
Design Temperature Difference(nT) 40 F
Conditioned Floor Area 875 ft2
Conditioned Volume 7.875 ft3
Leave blank to use default of a 5 ft celhng height
System Type Heat Pump _
Location of Ducts Unducted
Sum of UA,including exempt door and window 136
Envelope Heat Load 5.426 Btu/Hour
Sum of UA X AT
Air Leakage Heat Load 3.402 Btu/Hour
((volume x 0 6)X DTI X ola))
Building Design Heat Load 8.828 Btu/Hour
Air Leakage+Envelope Heat Loss
Building and Duct Heat Load 8.828 Btu/Hour
For ducts located in unconditioned space Sum of Building Heat Loss X 1 1
For ducts located In conditioned space or ductless Sum of Buddmg Heat Loss X 1
Maximum Heat Equipment Output F 11,035 Btu/Hour
Building and Duct Heat Loss X 1 25 for heat pumps
Building and Duct Heat Loss X 1 40 for all other systems
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r
BRADFORD WHITE
W A T E R H E A T E R S
Residential Upright
Electric Water Heater
The Upright Electric Models Feature:
■ Fully Automatic Controls—Fast acting surface-mount thermostat with high
limit energy cut-off(manual reset)for safety.
■ Low Restrictive Brass Drain Valve—Durable tamper proof design.
■ Direct Heat Transfer with Immersed Elements—Transfers heat directly
and efficiently to the water. Screw-in style.
■ Factory-Installed Hydrojet®Total Performance System—Sediment
reducing device that also increases first hour delivery of hot water while
minimizing temperature build-up in tank.
■ Vitraglas�Lining—An exclusively engineered enamel formula that provides
superior tank protection from the highly corrosive effects of hot water.This
formula(Vitraglae)is fused to the steel surface by firing at a temperature of
over 1600'F(871'C).
■ Insulation System—Non-CFC foam covers the sides and top of the tank,
reducing heat loss.This results in less energy consumption,improved
efficiencies, and jacket rigidity.
■ Water Connections—3/4" (19mm) NPT factory-installed true dielectric
fittings extend water heater life and simplify water line connections.
■ Factory-Installed Heat Traps—Design incorporates a flexible disk that
reduces heat loss in piping and eliminates the potential for noise generation.
■ Protective Magnesium Anode Rod—Provides added protection against
corrosion for long-term,trouble-free service.
■ Simultaneous and Non-Simultaneous Operation Available—
Simultaneous operation indicates when both elements(if equipped)are being
heated at the same time. Non-Simultaneous operation indicates when one
element is being heated at a time.
■ Voltages Available-120V,208V,240V,277V,480V.
■ Single Phase or Three Phase Operation Available-120V&277V may
only be wired for single phase operation.
■ T&P Relief Valve—Installed.
■ Design evaluated by ETL in accordance with Part 280.707(d) of HUD
Photo Is of Mobile Home Construction and Safety Standards for Energy Efficiency.
RE350T6
Copper Screw Type Immersion Element
(I NCOLOY"type immersion element available upon request)
T 6 or 10-Year Limited Tank Warranties 16 or 10-Year Limited Warranty on Component Parts.
ETAETA s s P" For more information on warranty, please visit www.bradfordwhite.com
For products installed in USA,Canada,and Puerto Pico.Some states do not allow limitations on warranties.See complete
Interrek Intertek .. .. copy of the warranty included with the heater.
MANUFACTURED UNDER ONE OR MORE OF THE FOLLOWING U.S.PATENTS:5,682,666:7,634,976:5.660,165;5,954,492:6,056,542:6,935,280,.5,372,185:5,485.879:5,574,822;7,971.560, 7,992.526.
6,684.821 7,334,419:7,866.168:7,270,087,7,007,748.5.596,952:6.142,216,7,699,026,5.341,770;7,337,517:7,665,211:7,665,210;7,063.132,7,063,133:7,559,293, 7,900,589,5,943,984;8,082,888.
5.988,117:7,621,238;7.650.859:5,761,379:7,409,925;5,277,171:8,146,772;7,458,341.2,262,174.OTHER U.S.AND FOREIGN PATENT APPLICATIONS PENDING.CURRENT CANADIAN PATENTS:2,314,845;
2,504,824;2,108.186:2,143,031:2.409,271.2.548,958,2,112,515:2,476.685:2.239,007:2,092,105;2,107,012.Vitraglas'and Hydrojet"are registered trademarks of Bradford White'Corporation.
1201-A-0718
Residential Electric Water Heater `
Upright Model C.E.C.Listed
Model Nominal Recovery at A B C D E G Approx.
Number Gal. DOE 90°FRise* Floor to Jacket Floor to C/Lof Floor to Water Shipping
Capacity Rated First Top of Dia. Water Water T&P Conn. Weight
Storage Hour Uniform Heater Conn. Conn. Conn. NPT
U.S. Imp. Volume Rating Energy U.S. Imp.
Gal. Gal. (Gal.) (Gal.) Factor GPH GPH in. in. in. in. in. in. lbs.
RE35OT6 50 42 45 64 0.92 21 18 58'/a 22 60'/e 8 601/8 3/4 138
Model Nominal Recovery at A B C D E G Approx.
Number Liter DOE 50°C Rise' Floor to Jacket Floor to C/L of Floor to Water Shipping
Capacity Rated First Top of Dia. Water Water T&P Conn. Weight
Storage Hour Uniform Heater Conn. Conn. Conn. NPT
Volume Rating Energy Liters/
(Liters) (Liters) Factor Hour mm. mm. mm. mm. mm. mm. kg.
RE350T6 189 170 243 0.92 79 1495 559 1527 203 1527 19 63
For 10 year model,change suffix"6"to"10".
Based on 4500W/4500W,Non-Simultaneous operation.
Uniform Energy Factor and First Hour Rating is based on the latest AHRI directory listings.
Wattage Wattage
Limitations for Voltage Limitations for Voltage
simultaneous Non-Simultaneous
Operation 120V 208V 2 00V 277V 480V Operation 120V 208V 240V 277V 480V B
150OW/150OW yes yes yes yes yes 150OW/150OW yes yes yes yes yes
2000W/2000W no yes yes yes yes 2000W/20DOW yes yes yes yes yes
250OW/2500W no yes yes yes yes 2500W/2500W yes yes yes yes yes I 8.. I
3000W/3000W no yes yes yes yes 3000W/3000W yes yes yes yes yes
350OW/350OW no yes yes no no 350OW/350OW no yes yes no no ,1,
4000W/4000W no yes yes yes yes 4000W/4000W no yes yes yes yes I Y
450OW/450OW no Wnoyes
450OW/450OW no yes yes yes yes G G
5000W/5000W no SOOOW/5000W no yes yes yes yes ('�^
SSOIrV/550OW no nono SSOOW/SSOOW no yes yes no no
6000W/6OWW no 6000W/6000W no yes I yes yes yes lJU C&E
Recovery Recovery
GPH Temperature Rise°F LPH Temperature Rise-C
Wattage 60 80 90 100 120 Wattage 34 45 50 56 67
150OW 10 8 7 6 5 150OW 38 30 26 23 19
2000W 14 10 9 8 7 2000W 53 38 34 30 26
250OW 17 13 11 10 9 250OW 64 49 42 38 34 A
3000W 21 15 14 12 10 3000W 79 57 53 45 38 A(GPH based on
350OW 24 18 16 14 12 350OW 91 68 61 53 45 Non-Simultaneous
4000W 28 21 18 16 14 4000W 106 79 68 61 53
operation,when
450OW 31 23 21 19 15 450OW 117 87 79 72 57
Simultaneous
5000W 34 26 23 21 17 5000W 129 98 87 79 64 operation the GPH
550OW 38 29 25 23 19 550OW 144 110 95 87 72 will approximately
60DOW 41 31 28 25 21 6000W 1 155 117 106 95 79 double.)
General:
Meets NAECA Requirements
Model is ETL listed. Model is wired inter-locking (Non-Simultaneous, Single Phase) 240V with two 450OW elements, unless otherwise
specified.All water and electrical connections are 3/4"(19mm)NPT.Model certified at 300 PSI test pressure(2068 kPa)and 150 PSI working
pressure(1034 kPa.).
Dimensions and specifications subject to change without notice in accordance with our policy of continuous product improvement.
—BRADFORD WHITE IS— For field service,contact your professional installer or local Bradford White sales representative.
to Sales 800-523-2931■Fax 215-641-1612
AMO RICAN IBRADFORD NMITE Is Support 800-334-3393 Email techserv@bradfordwhite.com
STRONG- w•,, bler' e a, Warranty 800-531-2111 Is Email warrantyrgbradfordwhite.com
International:Telephone 1-215-641-9400 Is Email intemational@bradfordwhite.com/www.bradfordwhite.com
Built to be the Best-
1201-A-0718 02018,Bradford White Corporation.All rights reserved. Printed in U.S.A.
MITSUBISHI
1lk ELECTRIC M-SERIES
Changes for the Better
SUBMITTAL D.
111 BTU/H WALL-MOUNTED HEAT PUMP SYSTEM
Job Name: Location: Date:
Purchaser: Engineer:
Submitted to: For Reference Approval Construction
System Designation: Schedule NO.:
ur • 208/230V,1-Phase,60 Hz
a. iMinimum Circuit Ampacity(MCA)
Indoor/Outdoor(RBS) I A 1/9 (15A-Recommended Breaker Size)
Wireless Renate Controller a All electrical work shall comply with National(CEC)and local codes and regulations.
Indoor Unit
ACCESSORIES: Blower Motor(ECM) F.L.A. 0.76
Indoor Unit Blower Motor Output W 30
Anti-Allergy Enzyme Filter(MAC-408FT-E) SHF/Moisture Removal 0.740/2.5 pt./h
Field Drainpipe Size O.D. ln.(mm) 5/8(15)
Outdoor Unit Note:Mitsubishi Electric(MESCA) Outdoor
supports the use of only MESCA supplieA
Windscreens(ME-FR-12-17)
and approved Snow Guard/Wind Compressor77- DC INVERTER-driven Twin Rotary
Deflectors I Windscreens and accessories Fan Motor(ECM) F.L.A 0.5
for proper functioning of the unit(s).Use of
non-MESCA supported Snow Guard I wind
Deflectors)Windscreens and accessories u
Controls will affect warranty coverage.
Indoor DRY 145-170-237-321-399
W reless Controller(MHK1) g) S
�Wred Remote Controller PAR-40MAA(Requires MAC-3341F-E) (Colin WET 109 134 201-286 364 0
Thermostat Interface(PAC-US444CN-1) Indoor(Heating) DRY CFM 145 170 237-321�06
SPECIFICATIONS: Outdoor 1,229 11,172
Sound Pressure Level a
(QuietRated
Cooling'Conditions
Btum/W 12,000/920 Coding 19-22-30-37-45 n
Indoor
Heating_77719-22-30-37-43
Heating at 4r Fz Btuh W 14,400/1,100 dB(A) -
Coding 49 E
Capacity Range Minimum klaximum Outdoor
Heating 51 a
Coding' Btum 1,500 13,600External Dimensions
y
Heating at 4r F1 Btulh 2,000 18,100 a
Heating at 170 Fa Blum - 12,000 Indoor(H x W x D) 11-5/8 x 31-7/16 x 9-118
(295 x 798 x 232)
Heating at 50 F' Btum - 9,700 ln•(mm)
Otd H x W x D 21-5/8 x 31-1/2 x 11-1/4 „
'Cooling I Indoor 80°F(27°C)DB/67-Fit9°C)NiB:Outdoor 95°F(35°C)DB/75°F(24°C)W uoor
B' ( ) (550 x 800 x 285)
'Heating at 47-F I Indoor:70°F(21°C)DB/so-F(16°C)WB:Outdoor:47°F(8°C)DB 143.F(6o C)WB' o
'Heating in 17°F Indoor:70°F(21°C)DB/so-Fit 6°C)WB,Outdoor:17°F(-B°C)DB/15°F(-9°C)WB'
'Heating at 5°F I I ndoor:70°F(21°C)DB I60°F(16°C)WB.Outdoor:5°F(-15°C)DB/5°F(-15°C)WB Net Vileight
'Rating Conditions per AHRI Standard: i
Indoor 22(10) 1.
Operating
• Outdoor ) 81(37) a
Coding 90o F(320 C)DB/670 F(190 C)DB
u
External Finish
Heating 80"F(27o C)DB/700 F(210 C)DB
Operating Conditons(Outdoor Intake Air Temp.)Max./Min.) Indoor Munsell 1.OY 9.2/0.2 0
Outdoor Munsell No.3Y 7.8/1.1
Cooling' 115 F(46o C)DB/14-F(-10o C)DB
Heating 75o F(240 C)DB/-4p F(-20o C)DB R410A;2 lb.9 oz.
0
'Applications should be restricted to comfort cooling only:equipment cooing applications are not Refrigerant r • -
$
recommended for low ambient temperature conditions. `
Liquid(High Pressure) 1/4(6.35) �
In.(mm) 8
AHRI Efficiency Ratings Gas(Low Pressure) 3/8(9.52) Z
SEER/HSPF/EER 23.1/11.5/13.0 Max.Total Refrigerant 40(12) $
Pipe Length(Height Diff.)
COP at 470 F/170 F 3.84/3.1 Ft.(m) r
Max.Total Refrigerant 65(20) F
Yes Pipe Length(Length.) ca
ENERGY STAR products are third-party certified by an EPA—cognized Certification Body.
Specifications are subject to change without notice
0 2017 Mitsubishi Electric Sales Canada Inc. Page 1 of 2 Form#SB MSZ-GLI2NA-U1 MUZ-GLI2NAH-U2 202005
MSZ-GL12NA-U1 Unit:in.(mm)
7/16X1 Oblong hole 7/16X13/16 Oblong hole
Insiallation late 3-1/8 8 1/8 8 1/B 3-118 ,o
31-7/16
30-15/16 114 0
6-118 6-1/8 ao
2 3l 13-5/16 3 9/ 6 2-1/8
3116 9-1/8 Indoor unit A i In all hole #2-9/I6
V Insfollation plofe
Pi in
1-5/8
3/4 I-15/16. 24-3/8
I� 4-3/16,;, Drain hose
2-5/16„1 I 1� 1It3/4
Air out
Ehhose
e1-3/8 O.D Q
e114 19-11/16(Flared connection et/4)
o3/8 16-15/16
2 3/ 6 51 6 (Flared connection.e3/8(GLSSr09/12NA),e1/2(GL1SNAp-3/16 Insulation et-1/6 O.D Connected part e5/8 O.D £
d
MUZ-GL12NAH-U1 REQUIRED SPACE Unit in.(mm)
•1 4 in.(100 mm)or more when
front and sides of the unit are clear
15-3/4
U Q
At in Dram hale 01-21/32(GLO9112/16NA) mil ti
Drain hole 01-5/16(OL12/16NAN) 4 o kp0<a 5 i7oo A`O o�°
r
A^\ v A
u O At in
T w
c—ry E
m� 10
1-9/16
ar out 2-holes 3/Bx13n6 Service parel .`n.l2 ote 2 or
6 01 M �Orem�J
7/6 11/16 4z
N
W
g
HI '2 When any 2 sides of left,right o
Liquid refrigerant pipe joint and rear of the unit are clear
Refrigerant pipe(flared)01/4
_N "N m Gas refrigerant pipe joint o
N N ` Refrigerant pipe(flared)o 3/8(GL09112) o
N N T
T o 1/2(131-15) d
1--
i
T19-11/16
5-11/32 E
6-23/32
$
tch for installation -
v
31-1/2 1 1 2-3/4
rn
ETA US
� MITSUBISHI
�ntertek AW_ ELECTRIC
for a greener tomorrow -
Form#SS MSZ-GLI2NA-U1 MUZ-GLI2NAH-U2202005 Changes for the Better
Specifications are subject to change without notice_
www.Mitsu bish iElectric.ca
0 2017 Mitsubishi Electric Sales Canada Inc. Page 2 of 2
Ll,) Parcel# 1,,2d0 3 3qJ p o J BLD#" WV-C)O M
Mason County
tcee� Department of Community Developmen
h� q11tJG
flarcel Stormwater Management APPlication/Worke a
)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment', with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater. Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area * All dimensions in feet
Buildings X =
X = 3 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 =
Patios/Walks X = 57
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas) 3
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowl9dgement of s signature below. I declare that I am the owner,owner's legal representative,or the contractor.I
further owledg at the in rmation provided is accurate and employees of Mason County are granted access to the above-
descri f prope or review ,d�+inspection as may be required.
X V wne gent/Contractor(circle one)Date:
If the otal 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
Naive Parcel # 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:
httpHwww.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
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/Agent/Contractor(circle one)Date:
Page 2 of 2
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/• Parcel No.(APN) 12209339DOSD
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RESIDENTIAL 110 E COULTER CREEK RD S
VACATION AND CABIN BELFAIR,WA 98528
Builtling Area 2.901 SF
Laarea 43.560SF(1.00 ACRES) My Sit -
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P""Use 19
RESIDENTIAL 110 E COULTER CREEK RD S
VACATION AND CABIN
BWd.V Are. 2.904 SF BELFAIR,WA 98528
Ld Area 43.560 SF(1.00 ACRES) My SiteP/ah
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