HomeMy WebLinkAboutCOM2014-00044 Garage to Office Space - COM Permit / Conditions - 6/4/2014 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670, ext. 352
Shelton, WA 98584
COMMERCIAL BUILDING PERMIT COM2014-00044
OWNER: SOUTH SHORE ENTERPRISES RECEIVED: 4/30/2014
CONTRACTOR: LICENSE: EXP: ISSUED: 6/4/2014
SITE ADDRESS: 300 E DALBY RD UNION EXPIRES: 12/4/2014
PARCEL NUMBER: 322325094008
LEGAL DESCRIPTION: UNION HOOD CANAL LAND & IMP CO BILK: 95 LOTS: 19-22, BILK 96 LOTS: 9-12 & 19-22, &W 1/2 LOTS:13 & 18, &VAC OAK
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RECAPTURF GARAGE SPACE INTO OFFICE SPACE. BROCKDALE RD RIGHTISH MCREAVY RD RIGHT DALBY RD HOOD
REMOVE ONE RESTROOM MAKE 2 NEW RESTROOMS CANAL COMMUNICATIONS ON LEFT
FOOTPRINT TO REMAIN SAME
General Information Construction &Occupancy Information
Type of Use: BUSINESS Insp.Area:
No. of Units: Type of Constr.:
Type of Work: REM Fire Dist.: 6 No. of Bathrooms: Occ. Group:
Valuation: $ 159,506.00 No. of Stories: Exit Design. Load:
Building Height:
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building:
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline&Planning Information
Front: Ft. Shoreline: Ft.
Rear: Ft. Slope: Ft. Water Body:Great Bend Creek Shoreline Desig.:
Side 1: Ft. SEPA?:No Comp. Plan Desig.: Rural Activity Ctr.
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Emergency Key Box?: Standpipe?:
Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?:
Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?:
COM2014-00044 Please refer to the following pages for conditions of this permit. Page 1 of 4
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Lavatories 2 Ventilation Fan 2 EH Minor Plan Review KARR 5/1/9n1A 1;1nn nn C79n1ann
Water Closets (Toilets) 2 Plan Check Fee Tw r,/7/9n1A -tAAA sa S99mann
Planning Review Fee TIA/ Fn/901A aiAn nn C99n1Ann
IFC Plan Check Fee Tw S17/9n1a U'19 17 g99n1Ann
Mechanical Permit Fee I AW 5/19/9(11A tiA nn g99n1Ann
Mechanical Base Fee 1 AIN F/19/9n1A R9R cn C99n1Ann
Plumbing Permit Fee i AWN r/19/9n1a 41d An g99n1Ann
Plumbing Base Fee 1 Aw F,/19/9MA �9d 7n (;99n1Ann
Total $1,832.51
CASE NOTES FOR
COM2014-00044
CONDITIONS FOR
COM2014-00044
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. X /0
2) 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.
X �
3) Install 2A10BC fire extinguishers per chapter 9 of the 2012 IFC and NFPA 10, with a maximum travel distance of 75 feet in any direction and
mounted no more than 60 inches above the floor to the top of the unit.
X
Install a knox box per section 506 of the 2012 IFC, please contact the local fire distrcit for more information and inspection.
X zVK
If the building has an exisitng fire alarm system, the system is required to be expanded into the section of the building being remodeled, a separate
permit applcation is required to be submitted and approved prior to the work being done.
X �'f'�>
4) All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be
granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and collected by the Mason County
Building Department prior to any further inspections being performed or approvals granted. X to--
5) THE FOUNDATION 5YSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
X YOO
COM2014-00044 Page 2 of 4
6) Changes to approved building plans that affect compliance to the current Washington State Energy Code (WSEC), ventilation requirements),
Building/Plumbir�q/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction.
X �lKVJ
7) 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.
X AU-)
8) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The
failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being
non-compliant with Mason County ordinances and building regulations.
X GIf n
9) 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.
X
10) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal
fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X ' v 4)
11) SWG2014-00086 must have final installation approval prior to temporary/final occupancy.
X
12) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X Ae �
13) Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Commercial
3 zone. �)
X 1
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 APP ICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.W �. - L�
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Co
Signature Date
&�9' l 2-�( OWNER - REPRESENTATIV - CONTRACTOR
Print Name a Circle one to' cate)
COM2014-00044 Page 3 of 4
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K CONCRETE MECHANICAL MANUFACTURED HOME 0
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Footings ISetbacks
Gas Piping Ribbons =
o Interior Date By Interior-Date By Data By cif)
CD
Exterior Date BYJJfA( Exterior-Date By Set-up 0
Point Load!isolated Footings INSULATION Date By m
FootingsBG I SLAB INSULATION
Date By Data By FIRE DEPARTMENT m
�r3 Z
Foundation Walls Floors Date By 4
Date y�j_�� B Bata By DECKS
FRAMING Walls Date By
Date jf'•fQ. ByrJj Data ey PROPANE TANKS
PLUMBING Vault Date By cn
Date By OTHER
Groundwork Attic
Dat® ?-49—/ By DatBJ2->✓��/ B Type
Date By
D.W.V DRYWALL Type 0
Int.Brace Wall 0
Date �•�. BY Date B Date By 9
Y FINAL INSPECTION N
Water Lin e��j Fire Separation C?
Date p By T/ Data By Date By I
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Pass or Request Inspect.
Type of Insp. Fail Date Date Dane By Comments
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Permit MASON COUNTY
BUILDING 111 426 W, CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTiON NOTICE
Job LocationlK�
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
1S.L -,
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 ❑ please contact our office
'❑ Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
"naturaUman made"
❑ This is not a complete inspection disasters. This is NOT a
Date Department CORRECTION NOTICE.
Inspector
. o* ,s NOT i ' 'Info 01 ' THI mah, TAF
SON Coz, L MASON COUNTY PERMIT N6L1)ff)2—,,)J
DEPARTMENT OF COMMUNITY DEVELOPMENT ��
BUILDING•PLANNING•FIRE MARSHAL D:) y
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
PO Box 279, Shelton, WA 98584 (360)482-5269 Elma ext. 352
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:-'�Octl-- �We- o f �",Q( i S(2 S L LC: NAME:
MAILING ADDRESS: PO f-;1)01. " MAILING ADDRESS:
CITY: Lu ion STATE: R ZIP:q SR Z CITY: STATE: ZIP:
PHONE: Sq S -315 S CELL: PHONE: CELL.
EMAIL: ir b L nc b C\-s� EMAIL :
L&I REG# EXP.
PARCEL INFORMATION: PX>-Se-1\
PARCEL NUMBER(12 DIGIT NUMBER) 3 2 232 S o • �I-} � FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED): 1AJ+ 14 oucl. Cw-44. Lo 5L4.e- 9S LQts I-S 4 23-5oe \1a"`„
SITEADDRESS 3/2 E LAL-Lby Kd jLrLLc-y, CITY
DIRECTIONS TO SITE ADDRESS �-d ri 1-zt: AA\0
mad C,L a
IS PROPERTY WITHIN 200 FT:
SALTWATER ❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[] NO (�
TYPE OF JOB: NEW ❑ ADDITION ❑ ALTERATIOON,�J REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) L FFJ Cr-- Du--(
IS USE: PRIMARY & SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS Z-
DESCRIBE WORKgecv� 24_ X=, ,e- F7V6-C-A. , C.X-Zt-o _5V&-Cl _ - 4+rzstt� I ;Zw�/Iavv1
ram- Z rAc,,D f-- �f to 11�rns: me
SOUARE FOOTAGE:
1ST FLOOR.Z D34• 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 ❑
MANUFACTU D HOME INF TION: S OF THE FLOOR PLAN
MAKE MODEL YE LEN
WID BE OOMS ATHS NUMBER
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 J O
INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPI �_ }rE D
x 24 1
gnature of Applicant Date y ?(�14
x ky�,1 Mclr,416, r_lti OWNER EPRESENTATlyg / NTRACTOR
Print Name CLE TO IN E V.
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT -; -/l-/4(
PLANNING DEPARTMENT
FIRE MARSHAL
COO MASON COUNTY PERMIT NO.
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
-t Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
1854 PO Box 279, Shelton, WA 98584 (360)482-5269 Elma ext.352
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Sow NAME:
MAILING ADDRESS: PC Z -9 MAILING ADDRESS:
CITY: Ll -";x� STATE: W Ili ZIP: gSQ92-- CITY: STATE: ZIP:
PHONE: -59 S-39 S 5 CELL: PHONE: CELL:
EMAIL: 'b Lk e e. h cc , r-v-* EMAIL :
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER): 3 22 32 SD • 4`�J �L{
LEGAL DESCRIPTION(ABBREVMTED):(.L�}Iocl Carno_2 Co
SITE ADDRESS: 3 12- C mod, (Lr� CITY:
DIRECTIONS TO SITE ADDRESS:
cy,
TYPE OF JOB o rFlc�s
NEW ADD ALT ✓� REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS—1ST FLOOR ✓ 2ND 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 Heat Pump_
Toilets Z Type of Unit No.of Units Fees
Bathroom Sink Z- Furnace
Bath Tubs Heatpump
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs 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 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.
x 'f�2911 SL
�S�ure�&App�ficant Date
X L4C AJ 0t^&-'e/S&GIi Owner/ wners Representative ontractor
Print Name in-c ica e w is one)
DEPARTMENTAL REVIEW APPR VED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT A U
2011
FIRE MARSHAL
`=''4.ki' ST
tan 01�Ao�
Co nn 2c > o c4q
OCCUPANT LOAD OF EXISTING AREA (INCLUDING BASEMENT - NO CHANGE): 35 OCC.
Office Office Office
EXISTING EXISTING EXISTMG
Conference '�`-'��1m0 226 SFil00 206 9F/100 ICA'
Foster EXISTING • I OCC. • 2 OCC-. -2 OCC.
338 SF/15
.23 OCC.
B fSEC.303.1r-__ 252
63
i W i l l a m s I ,-----------------
I
Architects DEDICATED ( , 133'
EXIT PATH
AREA WITH I 1 10$I Office
NO O"TR- I I
601 W.Railroad Ave. UCTIONS-� I Storage Storage I EXISTING LENGTH OF EXIT ACCESS TRAVEL
P.O. Box 102 j ; 1 EXISTW. EXIST NG I :3�� •86D,
Shelton,WA 98584 W _____—j 83 / r m3' g 200'MAX PER IBC TABLE 10162
0 OCC. - 0 Occ.
Ph:(360)426-0511 10B ccE 1 AccE-1 I
FAX:(360)426-2926 DN
I6D'I
e-filall. 1 O J (18TING EXIT
mail@fosterwiiiiams.com - Conference Storage I Men ome
NEW 199 5F/300
126 SPAS . I OCC.
-a OCC. S-1
I B fSEC.303.1 AGGE890RY I1F1 193'
342' 1613 SF UNENCLOSED AREA 203'
ON MAIN FLOOR f?�'1
Modifications to 6b' l
Hood Canal Communications Office 7NELLL) R1FICE Open Office EntryLM
OFFICE
Code Review Plans lei 42SSFAC EXISTIW 2 OCC. 4 Ofe-
Scale. 1/au - I'-0B
Existing
REVISED II120/14 TO REFLECT --- --- -- - Offices
DELETION OF NEW EXTERIOR EXIBTw.
DOOR TO OPEN OFFICE AREA EXIT
MAX.COMMON PATH OF EGRESS TRAVEL - 49B'
(41 OCC.TOTAL)-MAX.16'PER IBC TABLE 10143
OCCUPANT LOAD OF REMODELED AREA (INCLUDING MEZZANINE): 11 OCC.
Partial Main Floor (work area)
PARTIALLY REMODELED
3,212 SQ FT.AFFECTED AREA
(NO CHANGE IN FLOOR AREA)
J
I
Existing
arehous
1
WORK AREA
EXISTING
OFFICES A50VE
WITH WAREHOUSE
BELOW - 3,290 SF, 35 OCC.
TOTAL 50TH LEVELS -
SEE PLANS AT RIGHT
\ , EXISTING
GARAGE TO
5E REMODELED
FOR OFFICE USE -
Existing 2034 SF, 11 OCC.
INCLUDING MEZZANINE -
Off ice SEE PLAN AT RIGHT
0 Building EXISTING OFFICES
1 1 TO REMAIN WITH
NO REVISIONS -
2,60& Sa FT., 26 OCC.
EXISTING PARKING AREA `^
TO REMAIN - NO REVISIONS 1 (Dot F ► 4^
VtknetC >✓
I
APPROVED
ft A A ON COUNTY DCD PLANNING
S TE PLA REQUIRED TO BE ON SITE
HAt S B ECT TO APPROVAL
By Date
Dalby Road
Location Plan
No Sca Is
3 .99101F.P9 N
W R)
(0:91VDVA)
PLANNING4. 131)N3AY .3nooig
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66 ADO
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PLANNING:
j -
Xl ALL SETBACKS AREe r,
-',:.D
FROM THE FURT
PR OiCTION OF T!-1IF fi i G
All
�,��.��.VO VA)
-.-zil APPROVED
MASON COUNTY DCD
.!99.0�98 N 1 N G
"NA OD19
SITE PLAN REQUIRED TO BE ON SITE
4 3M -CHANGES Sl Ig IECI L---
By Date 71-6
001 A0018
Site Plan
Will, A Suite B•16521 Highway 99•Lynnwood,WA 98037-3199 Please Check After Doing Site Plan: ElSeptic and drainfield ❑Lot size Draw North Arrow in Circle
Town &Country` Everett: (425)258-4171 Puyallup: (253)840-9552 ❑Property dimensions ❑Sewer lines ❑Elevation of property
POST FRAME BUILDINGS Administrative24378 aToll Free:
-SW855 ❑Existing buildings ❑Setbacks of proposed&existing buildings ❑Bodies of water
FAX: (425)742-4378 Toll Free: 1-B00-824-9552
• Contractors Lic.1t:TOWNCPF099LT ❑Proposed building ❑Main road with name ❑Floorplan
� �' ' COB#: 129311 ❑Easements ❑Access to proposed building ❑Slopes&Contours(5'increments)
Q—Uo': our Future Depends On It` 'p
Job Name:_ _L]I L L 1�)U UTX'JC is Job Site Address: 020 C-85-1 DA k BY tf5 L 1)�1 c Legal Description: it N 10 S ( LI)A 985'�i t-
Tax Account#:
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DO NOT SIGN INCOMPLETE SITE PLAN:
Customer has verified and approved the location of the building,orientation of the b •ldmg to the North,an c� erifies that all white-Customer Copy Canary-Office Copy Pink-Accounting Goldenrod-Production
utilities are shown on this drawing in the correct location. O 1995 PertnaBilt Industries FR#34 5/98
Customer Signature: —• Lead#:
_ Site Plan
— MVTSuite B•16521 Highway 99•Lynnwood.WA 98037-3199 Please Check After Doing Site Plan: El Septic and drainfield El Lot size Draw North Arrow in Circle
OVM &COgLIM• Everett: (425)258-4171 Puyallup: (253)e40-9552 ❑Property dimensions ❑Sewer lines ❑Elevation of property
POST FRAME BUILDINGS Administrative 2-4378 Headquarters:Free:
4WO-8 4 ❑Existing buildings ❑Setbacks of proposed&existing buildings ❑Bodies of water (�
FAX: (425)742-4378 Toll Free: 1-800-824-9552
Contreetora LJc.N:TOWNCPFD99LT El Proposed building ❑Main road with name ❑Floorplan
CCB#; 129311 ❑Easements ❑Access to proposed building ❑Slopes&Contours(5'increments)
Qaaho•:Oar Ft—Depends On/[_'
Job Name: l L �!„�UIlT�x Job Site Address: 90 1=ASZ �A C BY rR JA n
Legal Description: i)N(A N F W A 9F�5922
reracoounrr S2232 Sn 99000
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Customer has verified and approved the location of the building,orientation of the byjlding to the North,an en lies that all white-Customer Copy Canary-Office Copy Pink-Accounting Goldenrod-Production
utilities are shown on this drawing in the correct location. J�re�' ��- L__
Customer Si ead#: C 19 m 95 PeraBilt Industries 1=1t#34 SN8
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Name 50cLvr\ _ql�31 Parcel# 322 32- SO •4 1-t BLD#
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Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code, Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'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 =
ql-N 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) — o
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 ��r►e�iiAgent/Contractor(circle one)Date: 2G�
/ TT
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.
Pagel of 2