HomeMy WebLinkAboutBLD2016-00108 SFR - BLD Permit / Conditions - 2/29/2016 Inspection Line(360)427-7262
�PeoN co& MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County
615 W Alder St e,2
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2016-00108
OWNER: BRIANNE WAITE RECEIVED: 2/17/2016
CONTRACTOR: TERRY EVANS CONSTRUCTION 1.360.426.3193 LICENSE: TERRYEC976KO EXP: 5/20/20, ISSUED: 2/29/2016
SITE ADDRESS: 240 E KUHN AVE UNION EXPIRES: 11/13/2016
PARCEL NUMBER: 322325053030
LEGAL DESCRIPTION: UNION HOOD CANAL LAND & IMP CO BILK: 53 LOTS: 28-32 &VAC ALLEY& E 1/2 VAC PORT TOWNSEND ST
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR BROCKDALE RD, MCREAVY RD, L ON KUHN AVE TO SITE ADDRESS ON
THE RIGHT SIDE( THIS ROAD IS REALLY BAD)
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: R3 Lot Size: Deck: 264
Type of Work: NEW Fire Dist.: 6 No. of Stories: 1 Occ. Load: Building:720
Valuation: $ 86,488.32 Building Height: Occ. Status: Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: S 10.0 Ft. Shoreline: Ft. Water Body:
Rear: N 57.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 5.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: W 71.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 1 Heat Pump 1 Plan Check Fee GMM 2/17/2016 $586.79 S1201600000001
Lavatories 1 Ventilation Fan 2 EH Plan Review GMM 2/17/2016 $205.00 S1201600000001
Bath Tubs 1 Exhaust Hood 1 Planning Review Fee GMM 2/17/2016 $205.00 S1201600000001
Water Heaters 1 Dryer Vent _ 1 Building State Fee JTL 2/23/2016 $4.50 S1201600000001
Clothes Washer 1 - opane a� 1 \ Building Permit Fee JTL 2/23/2016 $902.75 S1201600000001
Kitchen Sink 1 Gas Outlets 3 ) Mechanical Permit Fee JTL 2/23/2016 $58.40 S1201600000001
Dishwasher 1 Mechanical Base Fee JTL 2/23/2016 $28.50 S1201600000001
Hosebibs 2 Plumbing Permit Fee JTL 2/23/2016 $67.10 S1201600000001
Plumbing Base Fee JTL 2/23/2016 $24.70 S1201600000001
Mechanical Permit Fee JBN 7/21/2016 $79.20 S2201600000001
Mechanical Base Fee JBN 7/21/2016 $9.00 S2201600000001
Total $ 2,170.94
BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 1 of 7
CASE NOTES FOR
BLD2016-00108
CONDITIONS FOR
BLD2016-00108
1) 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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2) 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
Departmer,Ltprior to any further inspections being performed or approvals granted.
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3) 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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4) 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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5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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6) 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 Deyartment prior to any further inspections being performed or approvals granted.
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BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 2 of 7
7) 2012 IECC/Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine -4C, Window(Max U-Factor):0.30, Skylight(Max
U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation min. R-49, Vault Insulation R-38,
and Slab Insulation R-10.
In addition the following credits from R406.2 shall be completed as follows:
3d High efficiency HVAC equipment(0.5 Credits)
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8) A permanent certificate, completed by the owner, 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 105.4, 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 5 air changes per hour when tested
with a blower door in accordanve with IECCLWSEC Section R402.4.
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 IECC/WSEC R401.3 & R101.4.3
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2012 Certificate"and are available in %or'/z sheets. The
Mason County Permit Center will also have some available.
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9) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section
R404.1.
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10) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation.
In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000.
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BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 3 of 7
11) To perform an inspection the Mason County Building Inspector will need to access the interior of the structure. An electrical permit completed and
approved by Washington State Labor& Industries must be available on-site during the inspection.
The Mason County Building Inspector will inspect the following:
Verify that the system is installed in accordance with manufacturer specifications;
The inspector will check to make sure that the exterior unit is permanently installed and supported,
the exterior unit complies with required setbacks to property lines,
fuel tanks are located at least 10-ft from the system, a source of ignition,
all exterior penetrations are properly sealed,
condensate lines are installed and are properly supported, including proper material, slope, and that the condensate line terminates to a proper location
outside of the foundation,
copper refrigerant lines are insulated with '/2" thick continuous closed-cell foam insulation or better,
indoor units are located at least 3-ft from smoke and carbon monoxide alarms,
and that modifications made to the structure, to install the unit, does not affect existing structural members.
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12) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling.
EXISTING DWELLINGS shall beequipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances),
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repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or created.
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13) 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 reyp_cation.
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BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 4 of 7
14) Installation of heating equipment in a single-family residence shall meet the requirements of the current IECC/WSEC R403, applicable sections of the
IRC, and IMC.
Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.6. Heating and design load calculations for the purpose of sizing HVAC
systems are required and shall be calculated in accordance with accepted practice, including infiltration and ventilation. Design calculations shall be
available for inspection during inspection.
Referencing IRC M1601.4, all ducts, air handlers, filter boxes, and building cavities shall be sealed. All joints of duct systems and seams shall be made
substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Closure systems used with rigid fibrous
glass ducts shall comply with UL181A and shall be marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape.
Closure systems used with flexible air ducts and flexible air connectors shall comply with UL181 B and shall be marked 181 B-FX for pressure-sensitive
tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings shall be mechanically fastened.
Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181 B and shall be marked 181 B-C. Crimp joints for round metal ducts
shall have a contact lap of at least 1-1/2 inches (38 mm) and shall be mechanically fastened by means of at least three sheet-metal screws or rivets
equally spaced around the joint. Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation
instructions.
Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be insulated to R-8
DUCT TIGHTNESS TESTING shall be conducted by person(s) trained to perform such testing. A signed affidavit documenting test results in accordance
to IECC/WSEC Section R403.2.2 shall be provided to the Mason County Building Department prior to the final occupancy inspection. Affidavit forms are
available on at the WSU-Energy Program website titles, "Duct Leakage Affidavit" or"Duct Leakage Testing Results (Existing Construction)." Duct
tightness testing is not required if the air handler and all ducts are located within the heated space.
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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) Proposed structure(s) must maintain a minimum of a 5' setback from all property lines, easements and 25'from all County and State Road right of ways.
Setbacks are measured from the furthest projection of the structure.
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17) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENTAND 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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18) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 5 of 7
19) 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 Count/ordinances and building regulations.
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20) 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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21) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
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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 t,
23) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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24) ALL SURFACE WATERAND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITEAND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD WAY_. ._
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25) 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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26) Application aGkaowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural residential 2.5.
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BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 6 of 7
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 contractor. I further declare that I am entitled to receive this permit and to do the
work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s) for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if
construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
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Signature Date
S OWNER - REPRESENTATIVE - CONTRACTOR
Print Name (Circle one to indicate)
BLD2016-00108 Please refer to the following pages for conditions of this permit. Page 7 of 7
PLANNING
uhn Ave- I tog 0- 01,
P-1 I
DRIVEWAY POWER POLE WATER METER
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PLANNING :12'•2" 2'-5" 5'-9" G :3'-10" 5'-10" ! •..
ALL SETBACKS ARE MEASURED
'— — — FROM THE FURTHEST
v PROJECTION OF THE BUILDING I EXI5TING 5EPTIG TANK I
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EN RY
El ED Roc M '`5T
1'-8'x 11'cli
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18'
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K-A noA6A5A�6A Q bbe 2 a1(oFlu
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y- - - - - - - - -- - - -� 10' FROM DRAIN FIELD APPROVED �—
TO FOUNDATION I
LIVING AREA
MASON COW _'` ;BCD PLANNING I
(p`] +C) ?r0?AA` 4t-` 120 sgft ( ii SITE PLAN , E. .:!^E 1 10 BE ON SITE
L_Ir CHANGES Sis :_w i I'J APPROVAL
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Nam3V-IANNt WAITC Parcel# 3222.32—SQ_S3o;'J
mttv9f a—
BUILDING Mason County FEB 17
Department of Community Development 2U16
Small Parcel Stormwater Management Application/WgS4# !AMk
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 10 X = O 0
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X
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) �oo
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/Agen(ontractor ircle one)Date: 2—, I
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 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:
httr)//www.co.mason.wa—us/code/commissioners/'mdex.htin
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 Lois, The Small Parcel Slormwaler 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.
OwnerBuilder/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
1
PS�N CoU�T
MASON COUNTY Permit No:j3ld 201(P -Qb108
DEPARTMENT OF COMMUNI PF C 1 Y G BUILDING•PLANNING*FIRE MARS, (360)427-9670 Shelton ext. 352
http://www.co.mason.wa.us/community daub (360) 275-4467 Belfair!ext. 352
4
426 W Cedar Street, Shelton WA 98584
185 7 2��6 (360)482-5269 Elma ext. 352
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gg�5 W. Alder Street C1 rii,
BUILDING BUILDING PE��iVIIT APPLICATION R V,
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: l?-IA -'tJ WE- WA(TE. NAME: C-0 0% `TNQ C 1 O 1.)
MAILING ADDRESS:t2-50 6 Lt✓.0 MAILING ADDRESS: .O• Bo 5 S l
CITY: S µeL-To#J STATE: WA ZIP: ` 6 S CITY:sHE-To N STATE: W A ZIP: cS
PHONE: CELL:3 W -2-SO- 4.Q,102 PHONE: 316 0 - q 0-0(62CELL:
EMAIL: EMAIL f eV q v+5 bj't tci (--D ('l o"t' ,srtq i 1 .co wt
L&I REG SCE R N E G 9-1 to 14'O EXP.5 I /20/ I k p
CONTACT : OWNER ❑ CONTRACTOR\& BELOW ❑
NAME: MAILING ADDRESS:
CITY: S i;TE: ZIP: PHONE: CELL:
EMAIL: - -4(7o - 6! u a
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 3 -2. 32. - S O — 5 3'0 3 o FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED) :ITS 2.$ lo"v wN 32-3:Na4-j s1%)e or at.@c g 3. Noo-s C., y ft w�FTo
SITE ADDRESS 2-4-0 e- K-ugw Ave . CITY t)h II(OW 1
DIRECTIONS TO SITE ADDRESS
—
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ S IIEAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO�
TYPE OF JOB: NEW x C
ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE, 'GARAGE ETC.) �E
ES - I Ir. C-
IS USE: PRIMARY K SEASONAL❑ NUMBER OF BEDROOMS__ NUMBER OF BATHROOMS_
DESCRIBE WORK ?:0'3 t -b pew R.-GS 1 DeNLE
I
i
SQUARE FOOTAGE:
1ST FLOOR -7 Z O sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft.STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. ATTACHED ❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED ❑
MA CTURE I�FO:�AION: *4 COPIES OF THE FL UIItED
KE LENGTH
IDTH BEDROOMS BATHS SERIAL NUMBER
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit avocation.
Acknowledgement of such is by signature below. I declare that I am the owner or owner's legal representative. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the
necessary parties, including any easement holder or parties of interest regarding this project. The owner or legal
representative, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure(s)for review and inspection. This permit/application becomes null &void if
work or authorized construction is not commenced within 180 days or if construction work is suspended for a:period of
180 days.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42)
X 2--
Signature of OWNER Date
DEPARTMENTAL REVIEW APPROVE DATE DENIED DATE TAGS OTES/CONDITIONS
BUILDING DEPARTMENT 3--7'7 _
PLANNING DEPARTMENT n0 C,CO >4v-2.es5mQ�
=RFARSTIAT, �� - �- -1
FEE'S TOTAL VALUATION:
BUILDING PERMIT FEE FIRE ACCESS AND GRADE
PLAN REVIEW GEO-TECH REVIEW
PLUMBING&BASE FEE STORMWATER REVIEW
MECHANICAL&BASE FEE TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE VIOLATION FEE
... Coa ay, MASON COUNTY COMMUNITY SERVICES L
PERMITASSISTANCE CENTER: Permit No:
02-ol
•BUILDING•PLANNING•FIRE MARSHAL RECEIVED
®/
615 W. Alder St-Shelton, WA 98584 v 1 V
—. - Phone Shelton:(360)427-9670 ext. 352 Fax:(360)427-77981854 JUL 2 1 2016 !/ J Phone Belfair. (360)275-4467 Phone Elma: (360)482-5269
615 W. Alder Street
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER IN ORMATION: CONTRACTOR INFORMATION:
NAME: 0 , +-e— NAME:
MAILING ADDRESS: Z MAILING ADD S:
CITY: ���;(Q,n STATE: WA- ZIP: CITY: STATE: ZIP:
1 s'PHONE: PHONE: CELL:
2nd PHONE: EMAIL :
EMAIL: L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): Fj .Z 3 Z SD S3 D D Zoning.
LEGAL DESCRIPTION(Abbreviated):
SITE ADDRESS: CITY:
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS—I IT FLOOR 2'''D FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers Spot Vent Fan
Water Heater --Fro Dane
Clothes Washer Gas _ , Z�
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent Z, Zr)
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL - U
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit rev
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including
any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is
accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This
permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is
suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT PPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
Signature o pplicant Date //��
X �_r F— S Owner/Owners RepresentativeLC;ontracto
Print Name (Circle one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Visit us on-line: http://www.co.mason.wa.us/community_dev/ Rev:1/27/2016 13N