HomeMy WebLinkAboutBLD2010-00393 Park Model - BLD Permit / Conditions - 6/18/2010 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 186
Shelton,WA 98584
F to
RESIDENTIAL BUILDING PERMIT BLD2010-00393
OWNER: MELISSA RATHBUN RECEIVED: 5/19/2010
CONTRACTOR: LICENSE: EXP: ISSUED: 6/18/2010
SITE ADDRESS: 30 E ODESSA CT BELFAIR EXPIRES: 12/18/2010
PARCEL NUMBER: 122091390010
LEGAL DESCRIPTION: TR 1 OF SP#3044
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New Park Model (Approved ADU DDR2010-00001) S. R. 3 right on North Bay Road, Left on Coulter Creek Rd, Right on Marvin
Road, Right on Odessa Drive, Left on Odessa Court.
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 1 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:
Valuation: Building Height: 16 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
:
y
Make:VSI Length: 40 Ft. Front: N 50.0 Ft. Shoreline: Ft. Water Body:
Rear: S 200.0 Ft. Slope: Ft.
Model:LAKE MERE Width: 12 Ft. Side 1: E 50.0 Ft. Shoreline Desig.: Not Applicable
Year:2008 Serial No.: Side 2: W 150.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Gas Outlets 3 Mobile Home Submittal Fee PIB 5/19/2010 $264.25 S12010000
Propane Tank 1 Planning Review Fee PIB 5/19/2010 $205.00 S12010000
EH Plan Review SJC 5/19/2010 $103.00 S72010000
Water Adequacy Plan Review SJC 5/19/2010 $103.00 S72010000
Mobile Home Issuance Fee LDK 5/25/2010 $264.25 S12010000
Mechanical Permit Fee LDK 5/25/2010 $79.20 512010000
Mechanical Base Fee LDK 5/25/2010 $28.50 S12010000
Address Fee TW 6/17/2010 $173.50 S12010000
Total $1,220.70
BLD2010-00393 Please referto the following pages for conditions of this permit. 1 of 6
CASE NOTES FOR
BLD2010-00393
CONDITIONS FOR
BLD20 1 0-00 3 93
1) 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
Depar t prior to any further inspections being performed or approvals granted.
X �J�/�/�
2) Owners/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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3) 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.
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4) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X A9
5) 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.
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6) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State
Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present
to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified
installer responsible for each major part of the installation. RCW43-63B.090
An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily
located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each
installer performed or in Iled. certification number and signature of the certified installer responsible for each major part of the installation.
WAC365-210 X
7) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American
National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you
can contact the Afffice of Manufacturing Housing (360) 725-2800.
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BLD2010-00393 Please referto the following pages for conditions of this permit. 2 of 6
8) 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 12 ,
9) 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 *VI —
10) 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 -nA
11) 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.
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12) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all
responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the
inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason
County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been
discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy(Final
Inspection)will be granted for the residence.
OWNER/CONTRACTOR(indicate which) Signature X
13) This permit is for the placement and installation of the manufactured home only and does not imply approval or review for any other items indidcated on
the plot plan. XIQ�
14) 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.) 044�
BLD2010-00393 Please refer to the following pages for conditions of this permit. 3 of 6
15) Placement of structure must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
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16) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
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rdinance o�gulation, must be reviewed and approved by Mason County prior to construction.
17) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall bem de prior to requesting additional inspections.
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18) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including
installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be
clearly marked in the installation instructions.
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19) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks filled
on site must be located a minimum of 10'from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system
air intake (direct vent appliance, ventilation air intake, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Propane
tanks less than 125 gallons must also be located a minimum of 5'from any building opening (foundation vents, windows, doors etc). Setback to the public
way, or access easements shall be the greater of 25-ft or as specified in the Mason County Development Regulations. Setback to property lines shall be
the greater of 5-ft or as specified in the Mason County Development Regulations. If a propane tank is exposed to probable vehicular damage, protective
bollards must be installed.
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20) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All Propane tanks
between 125 and 500 gallons must be located a minimum of 10' from any building, possible source of ignition (electrical outlets, electrical fixtures,
compressors, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Setback to the public way, or access easements
shall be the greater of 25-ft or as specified in the Mason County Development Regulations. Setback to property lines shall be the greater of 10-ft or as
specified in the Mason County Development Regulations. If a propane tank is exposed to probable vehicular damage, protective bollards must be
installed. ,,��
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21) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
meet the installation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
22) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not be used until the final inspection has been performed and approved by a Mason County building inspector.
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BLD2010-00393 Please referto the following pages for conditions of this permit. 4 of 6
23) The placement of small propane tanks are not normally subject to a permit review by the Planning Department, however, propane tanks are subject to
Planning Department regulations. Such regulations primarily consist of setbacks from shorelines and features considered to be critical areas (streams,
wetlands, slopes, etc.) If you think such features exist on or nearby your property, please contact the Planning Department so that exact setback
requirements can be determined. X AP__
24) All property lines shall be clearly identified at the time of foundation inspection. X PK_l
25) 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.
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26) 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.
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27) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors,�nd flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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28) Retaining walls needed to support a surchuch as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
29) 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.
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30) Landings and stairs must meet the same setback conditions as any permitted structure, and, must be shown on your site plan. Please check your
"Approlan" to ensure these structures are shown and meet the setback conditions listed.
ve S P
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31) 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
1-800-64747� The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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32) Approved per
dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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33) Approved with conditions of Accessory Dwelling Unit permit DDR2010-00001.
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BLD2010-00393 Please referto the following pages for conditions of this permit. 5 of 6
34) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure for review and inspection.
OWNER OR AGENT: " to k.-s Sc.- DATE: Le 0
BLD2010-00393 Please refer to the following pages for conditions of this permit. 6 Of 6
00
o CONCRETE MECHANICAL MANUFACTURED HOME D
O Date By
o Footings f Setbacks Gas Piping Ribbons W
o Interior Date By Interior-Date By Date By C
w Extefw Date By Exterior-Date By
Set-upZ
Point toad I Isolated Footings INSULATION Date �'. I (, " f 8 By ( 1 M
BG r s�Ae INSULATION �
Date By Data By FIRE DEPARTMENT r-
Foundation Walls Floors Date By Ch
D
Date By Data By DECKS
FRAMING walls Date By
Date By, Data By PROPANE TANKS
PLUMBING Vault Date 13y
Date By OTHER.
Groundwork Attic
Type.
Date By Data By Data By
O.W.)f DRYWALL Type.
Int.Brace Wall Date By W
Gate 8y Date By FINAL INSPECTION 0
m water tine Fire Separation
Date By Date By Date o
Pass or Request Inspect. c
0 Type of Insp. Fail Date Date Done By Comments
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To: Melissa Rathbun May 15, 2010
Purchaser
I understand and agree with this initial proposal. You will be putting a park model trailer
(approx. 400 sq ft)on the land you intend to buy as per our discussions.
Tim Nelson���f�
Seller /
Melissa Rathbun
P.O. Box 14
Allyn, WA 98524
May 15, 2010
Tim Nelson
Owner-seller
P.O. Box 564
Allyn, WA 98524
Dear Tim:
Herds the promised summary of where we are on the land piece I would like to purchase
from you. If you disagree with anything Pve written, let me know.
Lot 1, N 1/2, SW '/4,NE '/4 . 9-22. Range 1 West, W.M.
This is the lot across the road from you bordered by Marvin Road, Odessa Place,
the Taylors'property, and the VanNash property. It is my intention to reach an
agreement with you in the near future on a price and terms. In the meantime I
would like to agree to my having the right-of-first-refusal on the piece so I may
plan to move onto the site.
Pll check with you once more before this plan goes into effect. I hope we can come to
some terms that are mutually satisfactory without involving intermediaries. Please sign
this to show your agreement.
Sincerely,
Melissa Rathbun
3
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MASON BUILDING INSPECTOR
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Documents attached to approved plans:
Site plan:
Plan review checkli t: YGS Pages
Engineering: Y Lateral Vertical
Number of pages
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MASON COUNTY PERMIT NO. -13 Zi C10Z3
BUILDING PERMIT APPLICATION Afl"C'
426 W. Cedar • P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269T)o
_l On the web www.co.mason.wa.us
CAPPLIC NT INFORMATIO CONTRACTOR INFORMATION
® Owner ��sL�\ SSG ��Dv`r Company Name
o Mailing Address I Mailing Address
t City State 1AAZip Code City Stat Zip Code
Phone Other Ph. O- - $ Phone Other Ph.
jaiiii11 U t'l :`7 �' t Contractor Reg. # Ex
E Mail Address _
�jEw�1j2— P Drivers Lic. # �-V'n Il SOB
a SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
o PARCEL INFORMATION - 12 Digit Parcel No 220 - t — 9b 0 1 Fire District
Legal Description L_o� N 1I2- 4 S W 9 . N E t14 9 - 2 2 Rar`gD. 1 We5 r W NA
6 Site Address(Please include street name, street number and cit ) 3 U '�_:: D rl sSc"_ Ca�f� . \k-c iy- wA °I9S2'
Directions to site T4 o wa f c&S -trwrrr\ lJt ! n Coy.\ Cr (�
n 'C� 2itand
cti� 4 Tv.f v� V o +
Will timber be c sold in parcel preparation? Yes/No
Is property within 200' of Saltwater W 0 Lake River/Creek 1Q_Pond�t 1�
Wetland _Seasonal Runoff _ND__S1ream__N_D _Slopes or Bluffs > 15% NJ
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y 2 .
/No
TYPE OF JOB - New Add Alt Repair Other_ PRIMARY RESIDENCE SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make \jc ck�on Model 1, o.ka VY\4,rw,, Year 200E
P�L- Length 440 Width St rig II No, Kn'0k`f e ww,4:�, for r . of Bedrooms \ No at rooms
Type of Heat �urchase Price$ OCO Replacement Unit? Yes Nn
Installer Name � � ��� . �r� A _ Certification No. MKIP SS :11KL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: 5/ 1(pltD
Owner Owners Representative/Contractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Da;iT71 Zzii
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department r0 a*
Planning Department b LX)Eo` -
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
PERMIT NO ?
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar-P.O. Box 186, Shelton,WA 98584
Shelton (360) 427-9670-Belfair(360) 275-4467- Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.#_ DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city) Q
Directions to site
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPQ-L Natural Gas— Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets ,_
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
CWgER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other parry in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building De$artment Z
Occ Grou 1L- T e Constr.V "Oil
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
Name Mal 1 SSA Parcel# 1,_�a09 - 13- 9 001 U BLD#AO lb - �c
- C&A)VUn
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 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 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
tTBuildings X =
X 10 = Measurements for buildings are taken at the
X _ perimeter of the farthest projections (example:
eaves/gutters)
NX =
Driveways 1EX 1 =
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 =
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 are �00 -) i�`
If the Total Impervious Surface Area is LESS quare 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.
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 ( n Owner Age Contractor(circle one)Date:
If the Total Impervious Sur ce Area is GREATER THAN 2000 Square Feet, please rea knowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
Name 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.
y 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