HomeMy WebLinkAboutBLD2010-00226 SFR - BLD Permit / Conditions - 4/29/2010 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262
Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2010-00226
OWNER: ANTHONY WOODRUFF
CONTRACTOR: ADAIR HOMES, INC. 1.360.448.6050 LICENSE: ADAIRH'262RZ EXP: 1/9/2011 RECEIVED: 3/30/2010
SITE ADDRESS: 411 E AYCLIFFE DR SHELTON ISSUED: 4/29/2010
PARCEL NUMBER: 321275000129 EXPIRES: 10/29/2010
LEGAL DESCRIPTION: LAKE LIMERICK 1 LOT: 129
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE HWY 3 TO E MAOSN LAKE ROAD LEFT ON E BALLENTRAE DIRVE RIGHT
ON E AYCLIFFE GO A MILES TO SITE ON THE LEFT
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 2 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:1,154
Valuation: Building Height: Occ. Status: Seasonal Basement: covered po 120
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft.
Water Body:
Rear: Ft. Slope: Ft.
SEPA?:
Model: Width: Ft. Side 1: 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
Dishwasher 1 Exhaust Hood 1 Plan Check Fee GMM 3/30/2010 $641,39 S12010000
Hosebibs 2 Ventilation Fan 3 Planning Review Fee GMM 3/30/2010 $205.00 S12010000
Kitchen Sink 1 Dryer Vent 1 EH Plan Review KKK 3/30/2010 $103.00 S62010000
Lavatories 2 Water Adequacy Plan Review KKK 3/30/2010 $103.00 S62010000
Showers 1 Building State Fee DLC 4/16/2010 $4.50 S12010000
Water Closets (Toilets) 2 Building Permit Fee DLC 4/16/2010 $1,088.95 S1201oo00
Water Heaters 1 Mechanical Permit Fee DLC 4/16/2010 S4920 S12010000
Bath Tubs 1 Mechanical Base Fee DLC 4/16/2010 $28.50 S12010000
Clothes Washer 1 Plumbing Permit Fee DLC 4/16/2010 $93.20 S12010000
Plumbing Base Fee DLC 4/16/2010 $24.70 S1201o000
ADJUST--Plan Check Fee DLC 4/16/2010 $66.43 S12010000
Total $2,407.87
BLD2010-00226 Please refer to the following pages for conditions of this permit 1 of 5
CASE NOTES FOR
BLD2010-00226
CONDITIONS FOR
BLD2010-00226
1) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at
(360) 427-9670, ext. 450. The building permit will not be "finaled" until the permit holder can show proof that the access permit from Public Works has
been "finaled" and approved.
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2) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No f9undation drains within 30ft, down gradient of drainfield/reserve area.
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3) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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4) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and must be collected by the Building
Department prior to any further inspections being performed or approvals granted.
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5) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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6) 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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7) 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.
BLD2010-00226 Please referto the following pages for conditionsof this permit. 2 Of 5
8) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electricwall mount, Compliance Method: Prescriptive option IV, Window (Max U-Factor):0.35, Skylight (Max U-Factor):0.58, Doors (Type/Max
U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception).
Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
underside of the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
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9) Per 2003 IRC - SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WIND SPEED (3-SECOND GUST) the wind speed for Mason County is 85 MPH.
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10) Per IRC - SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordance with the applicable provisions of this section and the manufacturer's installation instructions.
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11) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. 'NOTE if Stormwater Management option "A" was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor-is acknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
12) 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
perr�a+'t evocation.
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13) Demolition actitvities must conform with all State and local County regulations as a condition to the issuance of this permit. The applicant/owner is directed
to conatct Olympic Air Pollution Control Authority(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 REMOVED FROM THE AREA TO
BE DEMOLISHED. WORK SHALL NOT COMMENCE ON AN ASBESTOS PROJECT OR DEMOLITION UNLESS THE OWNER OR OPERATOR HAS
OBTAINED WRITTEN APPROVAL FROM ORCAA, 2490 B LIMITED LANE NW, OLYMPIA WA 98502, 360-586-1044, 800-422-5623,
WWW.ORCAA.ORG
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BLD2010-00226 Please referto the following pages for conditions of this permit. 3 of 5
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 projec�
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15) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
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16) 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 be made prior to requesting additional inspections.
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17) All property lines shall be clearly identified at the time of foundation inspection. X
18) 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
Xajson&)County ordinances and building regulations.
19) 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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20) OwneclA gent 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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21) Xppr�(�per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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22) 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 ;2
BLD2010-00226 Please refer to the following pages for conditions of this permit. 4 of 5
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 AG ENT: _ �1 DATE: �` S�
BLD2010-00226 Please refer to the following pages for conditions of this permit. 5 of 5
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Date By Data By DECKS Z
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Date - By ,T Data 7" PROPANE TANKS
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Date By OTHER
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Date By Type
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Building Permit # MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTI E
Job Location yl! A V gA;4 t Or
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 code compliance
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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
❑ Make corrections, items will be checked on next inspection
❑ OK to
❑ This is not a complete inspection Department
Date Inspector y
moos NOOT MOOV THIqllh, T ' ,* w
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, Mit MASON COUNTY
BUILDING Ill 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location A yCC�
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
kund:u,nItems listed below must be corrected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
[a 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
recent
❑ OK to p� yd wJ "natural/man yc�Ti�^ damage incurred"natural/man made"
This is not a complete inspection disasters.This is NOT
Date Department Z3( CORRECTION NOTICE.
Inspector L—
RtO N* ,#T , r1* ,04 ' THUnk T'fi— * mn
Permit#COL Z� MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location �l C-L/,q-
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
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GYou are 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
damage incurred by recent
"natural/man made"
This is not a complete inspection disasters.This is NOT
Date 7 -/ /� Department 13 � CORRECTION NOTICE,
Inspector
D* N* ,#T , I 'r1* ,s4 ' ' TH/ 0 TArmoz
Permit# G
MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location / C Ll i4�
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
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Cell 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
❑ o DD Ni Si CC- C yh/ C damage incurred by recent
"natural/man made"
This is not a complete inspection disasters.This is NOT
Date -/�/d L CORRECTION NOTICE.
Department
Inspector Tz�
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PLOT PLAN
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ADRESS: 52U k�6 TbN
CITY: ni IMPf a q 5-CD f COUNTY: _TI-IU►2� OI�J STATE: WA
HOME PHONE #: �JE:G� ��� ALT PHONE#:
PROPERTY ADRESS: /III -9�_ nh J6—
CITY: � �J
/'� COUNTY: STATE: WA
LEGAL ADDRESS: TS R 3 ) SEC 2-7 TAX LOT#
THE INFORMATION ON THIS PLOT PLAN HAS BEEN PROVIDED AND REVIEWED BY THE PROPERTY
t OWNER WHO IS SIGNING BELOW ANO I)ACKNOWLEDGES AND ACCEPTS FULL RESPONSIBILITY
SCA LE A = O FOR IT'S ACCURACY AND COMPLETENESS 2)IS RESPONSIBLE TO ENSURE THAT THE
IMPROVEMENTS TO THE SITE TAKE PLACE IN CONFORMANCE WITH THIS PLAN J)WILL
ESTABLISH ALL CORNER IRONS.LOT LINES,AND CODE REQUIRED SET BACKS REQUIRED OF
THIS PROPERTY
DATE: 3— V-I U ANY CHANGE TO THIS PLAN MUST BE PRE-APPROVED BY THE GOVERNMENTAL AGENCIES
WITHIN THE JURISDICTION AND THE MORTGAGE LENDER THE CONTRACTOR SHALL BE
DOCUMENTED ON THE CHANGES
OWNER SIGNATUR OWNER SIGNATURE
0 NER SIGNATURE OWNER SIGNATURE
APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHAN ES SUBJECT TO APPROVAL
By Date t4 ?� t�
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NAME:
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ADRESS:
CITY: �MPI A + U �PJETd I COUNTY: -("AA 392 TONJ STATE: WA
HOME PHONE #:�3�c'j� �� ALT PHONE#: �( �> (� � Tc �cEu-
PROPERTY ADRESS:
CITY: y�-� I COUNTY: i
GLp{/L STATE: WA
LEGAL ADDRESS: TS R SEC 2--T TAX LOT# �'
THE INFORMATION ON THIS PLOT PLAN HAS BEEN PROVIDED AND REVIEWED BY THE PROPERTY
t OWNER WHO IS SIGNING BELOW AND 1)ACKNOWLEDGES AND ACCEPTS FULL RESPONSIBILITY
SCA LE A = O FOR ITS ACCURACY AND COMPLETENESS 2)IS RESPONSIBLE TO ENSURE THAT THE
IMPROVEMENTS TO THE SITE TAKE PLACE IN CONFORMANCE WITH THIS PLAN 3)WILL
ESTABLISH ALL CORNER IRONS,LOT LINES.AND CODE REQUIRED SETBACKS REQUIRED OF
THIS PROPERTY
DATE: 3- V-'U ANY CHANGE TO THIS PLAN MUST BE PRE-APPROVED BY THE GOVERNMENTAL AGENCIES
WITHIN THE JURISDICTION AND THE MORTGAGE LENDER THE CONTRACTOR SHALL BE
DOCUMENTED ON THE CHANGES
OWNER SIGNATUR OWNER SIGNATURE
O NER SIGNATURE OWNER SIGNATURE
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NameOo�t'u Parcel# 3CQ I �� o�Q�,�� 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 1S 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.
�{ Owne gent/Contractor(circle one)Date: v��3 p/h()
Page 2 of 2
Name IIV rJ ry-� Parcel# 32 I t2 7,620M f a q BLD#
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'.
'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.
'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 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 = qp
9� X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
Driveways X = Isbf>
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 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 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 Owner/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 1 of 2
Name
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
FEE CALCULATION WORKSHEET DETERMINATION
Occupancy Type Square Footage Valuation Total Valuation
Amount (sq. ft. x valuation)
Residence /Addition /Basement a $98.95 $ r
Garage /Storage $37.87 $
Unfinished Basement $15.00 $
Deck $14.34 $
Carport /Covered Deck $20.38 $ a {L
Other $
TOTAL VALUATION $9
i
Estimated Plan Review Fee: $ L0,4i
Planning Dept. Review Fee ($205,$330,$70): $
GEO - Geo-technical Review Fee ($255.00). $ N /
Addressing Fee ($173.50): $ N
Fire Access & Grade Review Fee ($73.00): $ l a
Other: $
TOTAL DUE WHEN PERMIT IS SUBMITTED: $ ,
The estimated plan review fee is based upon information provided at the time of application and is subject to change. Planning
Department fee is a flat fee which is due when permit is submitted. Building permit fee, mechanical, and plumbing permit fees will be
calculated during plan review. The balance of all other fees will be collected when permit is issued.
ESTIMATED BUILDING PERMIT FEES
Building Permit Fee (ICC, Table 1 — Building Valuation Data) $
Estimated Mechanical Fees (U.M.C. , Table 1-A) $
Estimated Plumbing Fees (U.P.C. ,Table 1-1) $
State Fee:
$ 4.50
Other:
Estimated Building Permit Fees WHEN PERMIT IS READY $
GRAND TOTAL $
MASON COUNTY PERMIT No.i'�)(
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 INF ,J�MATION
OwnerJ Company Name <.ta Pei-i t e5
Mailing A dress Mailin Address ' ` ' - —vv
City State �w; Zip Code Gib, YE'I City State ' Zip Code IfL.Q.
Phone Other Ph. Phone i - — Other Ph. 2t
Lien/Title Holder Contractor Reg. # � Exp.
E mail address E Mail Address "il1,•t.�iP
Drivers Lic.# DOB Drivers Lic.# DOB
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 1 E,
PARCEL INFORMATION - 12 Di it Parcel No___ Fire District
Legal Description — —Site Address(Please include street name, street number and city)
Direc ions to jte 1 fi /" c>1. 1�
Will timber be cut'a d sold in parcel pre aration?Yes o
Is property within 200' of Saltwater Lake �r , River/Creek ���. Ponce
Wetland j`Jr Seasonal Runoff Stream iV r Slopes or Bluffs > 15% c;
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New_X Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms _Square Footage- 1 st Floor 1� �� 2nd Floor /`1
3rd Floor Basement Deck Covered Deck IaO Other Sq. ft.
Garage 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.1 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,1 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/ wners Re resentativ ontractor,) indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APR VED DENIED NOTES
Building Department f _ 16. _ /C)
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee D 9 Site Inspection
Plan Review Fee 6, — 7 O Z. 8 EH Review Fee
Plumbing & Base Fee �` -?-� Planning Review Fee
Mechanical & Base fee aC) Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee c� Pre-Paid at Submittal
Valuation$ // c, G TOTAL FEES
X
!ti
30 FY6
l Z?� 2P, .5
3) Cq> �3 ! L4
I115
r��
MASON COUNTY PERMIT NO.
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 we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFO�YATION
Owner At Company Name $r
Mailing Address % 4 LJ Mailing Address
City ) -e State \" Zip Code 0i 5L-1 City w �� State �,1 Zip Code
Phone Other Ph. Phone 2_- 4 Other Ph.
Lien/Title Holder Contractor Reg. # AM tl xp.
E mail address E Mail Address 4' ' 1i c '''0-
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 Parc I No. 3:� l d�` Fire District
Legal Description — / — - l- :fi /, e
Site Address(Please include street name, street number and c'ty) l
Directions to site J y h Ht
- r +uv
1-
Is property withi 200'of S Itwateir Lake �River/Creek Pond
Wetland Seasonal Runoff L !C Stream �� Slopes or Bluffs > 151/0 L r;
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floor ,L.� 2nd Floor Z. Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No, of Fixtures Fees Fuel Type:Electric X LPG_Natural Gas_Heat Pump_
Toilets Type of Unit No. of Unb Fees
Bathroom Sink Furnace
Bath Tubs I Heatpumps
Showers ► Spot Vent Fan
Water Heater I Propane Tank
Clothes Washer I Gas Outlets
Kithen Sinks I Wood/Gas/Pellet Stove
Dishwasher = Kitchen Exhaust Hood I
Hosebibs :2 Dryer Vent
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 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 CO NUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X ZG Date:
Owner/Owhers Repres ntat /Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr.
Planning Department k'
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