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Home My WebLink AboutBLD94-1568 res - BLD Permit / Conditions - 1/6/1995 7 :c n 7m. Z Z Z 7-a 16 z Z I S 3E Am jV7 77 77 > :r >< z z z z 00 ol z Cl) 4� Z z > Yl 5:: lu -,I;- -vb 10 QL 00 00.z ems av 0-1 Imi 4;k -IC Is" 'ZI 3c CONCRETE °�' • �.� " MECHA CAL MOBILE HOME Footings et o� ' ` date O =_ by jQft2 Ribbons date 1 j `' by Gas P' ing date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMINGi O u s p s e z r ,c„� Walls FIRE DEPT. date/- 5/ c by /- 7 5' date date by PLUMBING Attic «,� to�,�„� �;.5f OTHER C✓- ry s �ar Groundwork t---) 5� date b date by �,� r 46y be•/fs �. .�� D.W.V. WALLBOARD NAILING date `L �.5 by date —( `C_r j by Water Li FINAL INSPECTION date i b S by date / jt by/ 9 date by 4i, E 7 V z 71 7:7 a77 S > 7Z,- 7:� T 77 b a z M OD C: z 0 >> rT7 cn N) z z 4 Z 10 >z �,n 0 CYI z OD Z ZE z 7T7 z > z 7 0 cn x 0 OD o C: l :3 Cf) awn 0 DO Q � z 0 0 (D 10 �. 00 CYI 00 ® O m A z - 1, q 0� Permit No. �� j 4 MASON COUNTY BUILDING PERMIT APPLICATION ��`��,�4 F .,,�f,. t�edar/P.O, Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 � �� it #1 wner..- �b C0-4-01 Qtr►Q� Phone# 'Address to 31 } !��-Fj/)!'�IX)h CfYJII.�"' Fire District# City f0^ —�` St (. n- Zip Directions to Job Site �'' 1 rwi�S tD (�eSt SMkac-ow5 Sri v`e t�il�Sloyroc�51„ r� fi C�rh.Q.r of or. ry'tC ��WS �,riv�e Owner Mailing Address P O 9,)q act 3d City iv- St1,Ja Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name C—ycAn 5 we'-'tt Cpr"'bt" LAL.;F 6- Contractor Reg#F�fANS -�3$gg Address P o goy- ab 3 o Expiration Date oa City �t� St L�-'A Zip 9S'S-�st4 Phone# 4Dw "4 C-O&�) #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply )� Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) ' q DD�i3 #4 P el No.4Do03 - TK Legal Description L4 t 3 W4 o Te.3 of ,5urv04 151 1Cib #5 Building Square Footage: (existing/proposed) 1st FI 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms 13 #bathrooms / a Garage /CD;14 Carport / (Circle. ttached r Detached?) Other sq. ft. / #6 Use of building 5!=2 Describe work YLQ-'-J cc) 4-r 1,C- ?o r #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION k)fk Model Year Make Model Length Width Serial No. # Bedrooms # Bathrooms Type of Heat Purchase Price$ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. a Toilets (.e•00 CIRCLE FUEL TYPE: Gas, Electric, Bath Basins 01.00 eatpum , Other Bath Tubs •OD No. Uni Fees Showers 3 .U- Furn BTU Hot Water Htr 3 .�� Heatpumps Laundry Washer -y Vent Systems t Sinks 3.0 Spot Vent Fans Floor Drains No. Boilers/Compressors tLaundry Basins 3.00 _ HP I Dishwasher 3 C)D No. Air Handling Units _Disposal _ cfm# Urinals No. Fire Protection Systems Other Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $54-0D No. Other Gas Outlets 1 Wood, Gas, Pellet Stove Z.S� NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY /rGj DATE DATE FOR OFFICIAL USE ONLY.Accept d by. Date: 'r ° DEPARTMENTAL REVIEW FOR OFFICE USE ONLY �Prov ed Cond. Hold Approval Planning: Environmental Health: Building Plan Review J Occupancy Group: _ Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check s` Plumbing Fee S� Mechanical Fee °O J6 Wood/Gas/Pellet Stove 2-SVrp- L-5 Q • Radon Monitor Xg, 7 yp Violation Fee Site Inspection 00 Building State Fee .� Other Other Building Valuation: / D `( TOTAL FEE i o fix O M CT, 0 SWASHI GTON Attachment B ENERGY Building Record WSEBContract# 91-19- CODE PROGRAM For Site-Built Residential Buildings Heated by Electric Resistance or Heat Pumps " (please check one) (please check one) L9•New Building ElAddition over 500 sq.ft. Single Family ❑Duplex Jurisdiction: S.e7t,' ❑Multifamily ❑Zero Lot Line Home ❑Planned Unit Development please check one: ❑ City County Permit# �?1_/ f1, File I D#(if different from Permit#) A. Site Information B. Owner Information Address Zo. �,ql Owner owner at time 01 construction receives utili a ment Cit Zip Com an p Assessor's Property Tax# (or attach legal escription): Address PC. Rel. _n 6 3 City e / Stat R Zipy Servicing Electric Utility Plltw Phone C. If Single Family, Zero Lot Line or D. Duplex E.If Multifamily(R-1) Planned Unit Development First Duplex Unit s .ft. Total#/Bld s. Total Conditioned Floor Area 1 J_'(7sq.—ft, Second Duplex Unit s .ft. Total#/Units A. Primary Space Heat Type B. Secondary Space Heat Type C. Water Heat Type (check one) (check all that apply) �� (check one) ❑ Electric Baseboard ❑ None , Electric ❑ Electric Wall Heater "Q Wood ❑ Gas ❑ Electric Furnace ❑ Electric Baseboard ❑ Other (specify below) Electric Heat Pump ❑ Other (specify below) ❑ Other NNW 0 wii 00,"A'"Ift-"I'loli—m--�o'—1-�x i1"r -�r WSEC Compliance Method For Heat Pump Only: �,Prescriptive Path Built to the Electric Date of Permit Application �0 -/9- �''� Date Building Permit Issued 9,5- ❑ Component Performance Require ents of WSEC? Date of Insulation Inspection ❑ System Analysis ❑ Yes If No Yes, Date of Final Inspection utility may offer incentive.) I hereby certify that this building or addition has been inspected for the measures required by the 1991 Washington State Energy Code(WSEC), that it is in substantial compliance with the WSEC, and that the WSEC checklist for this building is on file. Signature.of Building Official or Authorized Representative Date ■ Building Department:Return white copy to Kathleen Skaar,Washington State Energy Office,P.O.Box 43165,Olympia,WA 98504-3165. ■ Owner or Building Deparment: Forward canary copy to the servicing electric utility to trigger WSEC compliance payment. ■ Building Department: Retain pink copy for jurisdiction's building file. WSEO#94-015 2-94 Ac5-BUILT FORM - PAGE ONE R—i-ea 08/24/94 II PARCEL IDENTIFICATION I) II Applicant's Name o1j (J t?elrPV / -- ----__ II I( Permit Number SWG9 q3 - /� / Subdivision VaqtLH -Fe ld 7-le II Z�JI3ivision Znek/ II II Installer's Name IJ� �l �IN Ili ��3� Assessor's Parcel No. 42 00--7 -90 Q 33 II I( Designer's Name 6i,.. 1 -. - 174E ve- igi urn er) II II INSTALLER CHECKLIST I( L � II N/A Yes Prior to II II I. SEPTIC TANK Completion II II A) >5 ft from foundation? _ (( (( B) Bldg stubout to septic tank: cleanout if not 1-21-.? _ (( II C) Baffles intact and clean? (( �( D) Dividing wall intact? (( II II. D-BOX Leveled with water and/or speed leveler (circle) ? _ (( III. DRAINFIELD II II A) >10 ft from foundation and >5 ft from property lines? _ I) B) Laterals level to ±1 inch & end caps present if not looped? _ I( II C) System dimensions the same as shown on the design? v (( (I D) Gravel clean, properly sized, and proper depth? (I E) PRESSURE SYSTEM II II 1) Sand quality ASTM C-33? II 2) Head height uniform and Z24 inches? (I 3) Cleanouts and observation ports present? (I 4) Mound: Side slope 3:1? ) II (I 5) Owner informed electrical connections must be made-a IIg (I owner or licensed electrician and inspected by DLI? II IV. POTABLE WATER LINES II II A) >loft from field or double sleeved? — J�- I( B)"Wells >100ft from drainfield? II V. PUMP/PUMP CHAMBER II I( A) _ m used, or specs attached for equivalent pump? x T II (( B reen basket r effluent filter (circle one) installed? — I C) Riser installed for access? II I D) Alarm installed? II L J (( CERTIFICATION OF INSTALLATION II i II Installer: Check box from Row "A," check box from Row "B," sign and date the certification. II II F--1 � II (( A. u I certify that I installed the system U I certify that all deviations from () (( without any deviation from the design the design stamped "APPROVED" by MCDHS are (( II stamped "APPROVED" by MCDHS. shown on the reverse side of this form. it f-1 U �. II (( B. L-J I certify that I contacted the .. I did not contact the de- igner priorII (( designer and left the system open for to final cover because the designer I( II inspection up to 48 hrs prior to cover. waived the notification requirement. (( (( I further certify that all information contained on this form is accurate. I understand I( (I that if the information contained herein is not accurate, there will be just cause for II I( immediate suspension of my installer certification. IIMignatureo er ae (( The undersigned approves this install ion f behalf of Mason County Department of Health II (I Services. - II 11 2 '2 V II II ainspector/ nspec o a e IJ 4