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HomeMy WebLinkAboutBLD2011-00254 DDR2016-00045 SFR - BLD Permit / Conditions - 5/18/2011 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 Irflo Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2011-00254 OWNER: JOHN LANGE RECEIVED: 4/7/2011 CONTRACTOR: LICENSE: EXP: ISSUED: 5/18/2011 SITE ADDRESS: 260 E RASOR RD BELFAIR EXPIRES: 11/18/2011 PARCEL NUMBER: 122061390140 LEGAL DESCRIPTION: TR 14 OF SW NE TR 3 OF SURVEY 2/111 ALSO SEE SURV 30/13 TR A OF SP#422 AF#322230 PROJECT DESCRIPTION: DIRECTIONS TO SITE: New SFR ST RT 3 TO BELFAIR, L ON ST RT 106, L ON RASOR RD TO SITE ADDRESS ON THE RIGHT SIDE 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.: 2 No. of Stories: 1 Occ. Load: Building:1,264 Valuation: Building Height: Occ. Status: Primary Basement: cov porch 176 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: E 30.0 Ft. Shoreline: Ft. Water Body: na Rear: W 20.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 100.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: S 70.0 Ft. I Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Water Closets (Toilets) 2 Furnace<100K 1 Planning Review Fee GMM 4/7/2011 $205.00 S1 201 1 0001 Lavatories 3 Heat Pump 1 Fire Warden Review GMM 4/7/2011 $73.00 S12011000( Showers 2 Ventilation Fan 3 Plan Check Fee GMM 4/7/2011 $766.06 S12011000i Water Heaters 1 Exhaust Hood 1 EH Plan Review KKK 4/7/2011 $103.00 S620110001 Clothes Washer 1 Dryer Vent 1 Water Adequacy Plan Review KKK 4/7/2011 $103.00 S620110001 Kitchen Sink 1 Building State Fee DLC 4/25/2011 $4.50 S 120110001 Dishwasher 1 Building Permit Fee DLC 4/25/2011 $1,172.95 S120110001 Hosebibs 3 Mechanical Permit Fee DLC 4/25/2011 $85.70 S 120110001 Mechanical Base Fee DLC 4/25/2011 $28.50 S12011000i Plumbing Permit Fee DLC 4/25/2011 $101.90 S1 201 1 0001 Plumbing Base Fee DLC 4/25/2011 $24.70 S 120110001 ADJUST--Plan Check Fee DLC 4/25/2011 -$3.64 S12011000i Total $2,664.67 BLD2011-00254 Please refer to the following pages for conditions of this permit. Page 1 of 6 CASE NOTES FOR BLD2011-00254 CONDITIONS FOR BLD2011-00254 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 Department pr o any further inspections being performed or approvals granted. X 1�Q/ 2) Owne Age i responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 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 removi= documents will result in failure of required building inspections. X 4) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X v 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 Build Depa nt prior to any further inspections being performed or approvals granted. X 6) Washington State Energy Code Compliance has been approved as follows: Heat Type: Electric or other than electric, Compliance Method: Prescriptive option II, Window(Max U-Factor):0.32, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38 advanced or R-49 standard, Vault Insulation R-38, and Slab Insulation R-10. In addition the fo owing credit from Table 9-1 shall be completed: Option 6, small dwelling X BLD2011-00254 Please refer to the following pages for conditions of this permit. Page 2 of 6 7) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall _ and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air leakage results if a blower door test was conducted. Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA) when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing. Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate" and are available in '/4 or'/z sheets. The Mason County Permit Center will also have some available. X 8) inimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps). Refer2�- X 9) W LOADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85 MPH. X 10) R IREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacturer's installa ' n instructions. X 11) A Mahon 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/contr r is acl dging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X BLD2011-00254 Please refer to the following pages for conditions of this permit. Page 3 of 6 12) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such r ds with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X 13) All ebnstruction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washingto . Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in perm vocation X 14) Prl(visions 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, X 15) All changes to` approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinanc r reclulatio t be reviewed and approved by Mason County prior to construction. X 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 lnspeq6r shall be ade prior to requesting additional inspections. X 17) All rroperty 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 Maso ounty ordi -ces and building regulations. X 19) All�rermits 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 hold have preven action from being taken. No more than one extension may be granted. X r 20) R" twining walls needed to support a surcfaetge ch as uctures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X BLD2011-00254 Please refer to the following pages for conditions of this permit. Page 4 of 6 21) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM OR PAD WAY. X 22) rotemporary or final oc upancy until a current Operation and Maintenance report has been provided to Mason County Public Health. X 23) Pri4 o 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 24) Approvr per dime n ons d setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 25) By'refinition::�pfropane 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. X 26) Lafn ings and stairs must meet the same setback conditions as any permitted structure, and, must be shown on your site plan. Please check your "Approyq Site Plan" to su these structures are shown and meet the setback conditions listed. X 27) A gt(cat'gn ack X ( wledg at the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5. 28) Pridr'to final approval, all upland areas disturbed or ne reated by c struction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X / i 29) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical assessment that was prepared by Consolidated Engineering and dated 6/10/2004. All applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the registered design professional responsible for the assessment and may require special inspection by same. Structures a /or land modifications (grading, cuts, fills, etc.) required in the geotechnical assessment, may require a separate permit. The geotedflini ass a1-1-remain attached to the approved building plans. X BLD2011-00254 Please refer to the following pages for conditions of this permit. Page 5 of 6 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 Count access to the above described property and structure for review and inspection. OWNER OR AGENT: DATE: BLD2011-00254 Please refer to the following pages for conditions of this permit. Page 6 of 6 Building Permit # // , �J Y MASON COUNTY • f BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 • (360) 427-9670 CORRECTION NOTICE Job Location ;-1' This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listeoplow must be corrected to gain code compliance Te �. e C- ui ''y!�'a`-✓✓ L.� -/^'JT ex 5�,/Y /' 1�'��G�- 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 `C] OK to -✓�l/C � p This is not a complete inspection Department Date Inspector no* * NOOT ►&n Mk *V THII 00 o CONCRETE MECHANICAL MANUFACTURED HOME CD Footings I Setbacks Date By7/. Ribbons Gas Piping CD C) Inlen ot Date By interior-Date By Date By r1i C.n Exterior Date _!:-v 2—ABY_a Exterior-Date Sot-tip 0 INSULATION Point Load I Isolated Footing- Dale By z BG I SLAB INSULATION —------- Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS FRAMING Walls j I Date By Data —2 By _7� PROPANE TANKS Date By Vault Data Date By PLUMBING Date By OTHER Groundwork Attic Date //_2,3 J/ By Type. Date By Date By D.W.1v DRYWALL Type. ji -23 Int Brace Wall Date By 00 (f T Date B y Date Y 17,41W:2,. CD 1-4119 FINAL INSPECTION 0 0) IN) Cn Water Line __--4� Fire Separation CD CD I Date By Date by CD Date By 6 6 Pass or Request Ins pect. 0Q 5 Type of Insp. Fail Date Date Done By Comments CD 6 Ls- 0 04s CD /0 CA Wvj-- f 0 0� :3 a 0 CA Okvv 0 CD rEW 0G 3 PAO tsoe46-G ',X C= 6­0 "90 CD 0 Name T-04 441� e Parcel# z2D(,— /.3 �l o yd 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/d rain field 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 4 Owner Agent/Contractor(circle one)Date: �I Page 2 of 2 Name �o „:''� �•�� , ' Parcel# 1 2-2 G 6 —13 ' 704/O 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 surface2. '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 l Cakulate Impervious:Surfaces Please Complete This.Table Surface Type Length X Width = Area *All dimensions in feet Buildings X = U0use &11 X ' ' = f 7 (ov Measurements for buildings are taken at the perimeter of the farthest projections(example: G A,,f 11 Z " X 2 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 = X = Any paved, gravel or packed area per definition above table X = Others X = <' X = If the total impervious"area of theproposed 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 2 314. �PL)A,'Lf yn4nqa sGd/G I�S� �Cvsc 44n$2377 G d 4ob ly llorwecv p0.e-yregl"+,11� � _.� PLANNING --'�� M N COUNTY D LANNING PLA�G% SITE PLAN REOUI?ED TO BE 0 CHANGES SUu��i T TO APPROVAL ALL BACKS ARE MEASURED FROM THE FURTHEST By ---- Date I! PROJECTION OF THE BUILDING MASON COUNTY PERMIT NO. C� BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Z_ A/i L,4n , e Company Name Mailino Address 10-0, Peg 2377 Mailing Address City led; State iiEd Zip Code '7frl"2-4 City State Zip Code Phone 30- YOL iq'-16 Other Ph. Phone Other Ph. Lien/Title Holder 1cJo Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# iJ 1 19 DOB jl .z Drivers Lic. # DOB SEPTIC/WATER SYSTEM I�FFORMATION - Connect to New Septic Existing Septic �`/—�d 3yy Connect to Water System f/ Name of Water System Rz if" r %ygfe� ��nS-r4/ed Well Water System Name of Water System % PARCEL INFORMATION- 12 Digit Parcel No / i " ��'/yL' Fire District Legal Description Ed j'? -fit-g v�/2 &gam I j i •t 1? &4f ©F S f4q ,,C sPj;1-2 z Site Address (Please include street name, street number and city) .f20, jM de//4"- W,¢ 1*3­ Directions to site f Aze r R d 3 der,e !I�v e t?,9A?- Will timber be cut and sold in parcel preparation? Yes/ Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the suit of a Stop Work Notice, Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Rer,d,e•^<"'e Describe Work C ©r 67- -c1;en df f3,;/,114* No. of Bedrooms 2— No. of Bathrooms Z Square Footage- 1 st Fl( r 3rd Floor Basement Deck Covered Deck '12a,51c 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.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 INSPECTIO X Date* L� f `Owner/Owners RRrresentative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted b Date ' 1 DEPARTMENTAL REVIEW APPROV D ENIED NOTES Building Department LiO14 Planning Department Q7(� Environmental Health Department Public Works Department Fire Marshal FEES Buildinq Permit Fee 1 S Site Inspection i Plan Review Fee �t) 7 (oa . q P- EH Review Fee Plumbing & Base Fee eQ 7' 4- i0/.90 Planning Review Fee Mechanical & Base fee o?S'S'b ' f ?5.7C) Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal 7CP(o. O Valuation $ TOTAL FEES 9.� .� � o 9� �l x �C � � � � ro � �n II � J � � � � � PERMIT NO ld. I'i I ' CCA '54-T 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 �'��� 1--"-'i N Company Name e/7- Mailing Address P-0 ' A&l �3 77 Mailing Address City-6e Mate Zip Code 98S`2-8 City Mate Zip Code Phone,360-96L rtiyb Other Ph. Phone Other Ph. Lien/Title Holder lc;L L4. g e- Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic. DOB i i/i q /sLi Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Se tic. Connect to Sewer System Name of Sewer System cj./-G© g.e PARCEL INFORMATION - 12 Digit Parcel No. Fire District 3 Legal Description TR 3 SUS e v ✓0% 2 �'6' t t) TR iy of sw n� T'✓ti'!+ of—F'y-2 Site Address (Please include street name, street number and city) 240 E 692Q-- Ra fie164,' k -4 9,1-4 Directions to site 08-ul- 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 S;.o rc-4a iv Location of Fixtures/Units- 1 st Floord Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture , No. of Fixtures Fees Fuel Type:Electric-- LPCa_ Natural Gas_ Heat Pump_ Toilets '' Z Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs ��_ Heatpumps Showers Spot Vent Fan .3 Water Heater Propane Tank Clothes Washer I Gas Outlets Kithen Sinks Wood/Gas,'Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs 3 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 CONTINUATI N OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X = Date: t/ Owner/Owners Re entative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted b�i�.,4��- Planning Pd Ck# Date ` I Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Ins ection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES