HomeMy WebLinkAboutBLD2017-00408 SFR - BLD Application - 5/10/2017 ��UL1 cope MASON COUNTY COI+ MUNII-Y SERVICES
.� PERMIT ASSISTANCE CENTER: Pcl Writ No:-6 20/,7 — 00403
•BUILDING•PLANNING •PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 RECEIVED
Phone Shelton:(360)427-9670 ext. 352.Fax:(360)427-7798 Phone
Belfair.(360)275-4467•Phone Elma:(360)482-5269
1834 MAY 10 2017
BU1LD1 N %�o BUILDING PERMIT APPLICATION
615 W. Alder Streau
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:END ► "b ?OE S WEThWiC H S R. NAME:
MAILING ADDRESS: I'll Rp. MAILING ADDRESS:
CITY: STATE: A ZIP:"SZ4 CITY: STATE: ZIP:
PHONE#1:(3`0) a0!•s o 3 5 PHONE: CELL:
PHONE#2: EMAIL :
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER B CONTRACTOR❑ OTHER❑
NAME CbW"b""=`f EMAIL
MAILING ADDRESS A, o .A CITY STATE ZIP
PHONE L
PARCEL INFORMATION: Alin U6
PARCEL NUMBER(12 Digit Number) / Z•Z.[ 7 53 Qpm 5Z ZONING R- I h
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT_ _
SITE ADDRESS 19I E . SeDE k BE R C-% R OR D CITY--Aq L G -01
DIRECTIONS TO SITE ADDRESS &, • xr Q. xT, Q-4-)
E, s4-D 0eAA/C# R D , AT, o N J'Op&)eQ&X% lei ls-77 e N Lem
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO X
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Jam+ ADDITION❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) RG S 1 D Gc AJ cE
IS USE: PRIMARY N SEASONAL ❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)X YES(Part f]of Bldg) ❑ NO ❑
DESCRIBE WORK NCL W M ol!1E CpM Tiltuer/dp J
SQUARE FOOTAGE: (propose+existing)
1 ST FLOOR sq.ft. 2ND FLOOR 3 8ol sq. ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK—VW sq.ft. STORAGE sq.ft. OTHER sq. ft.
GARAGE )tyGUq. ft. Attached D( Detached❑ CARPORT sq.ft. Attached❑ Detached❑
M UFACT +"OME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE EAR
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER / NEW EXISTING❑
PLUMBING IN STRUCTURE? YES X NO❑ If yes, attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES ❑ NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
OWNER 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 and 1 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 permil/appiication 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
x 040, xLW6&;k SXe Aof y
Signatur f OWNER(Must be signed by the OWNER) ' Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT "—`
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
r
MASON COUNTY BUILDING RECEIVED
1 COMMUNITY SERVICES
MAY 10 2011
Building,Planning,Environmental Health,Community Health
615 W. Alder Street
Physical and Mailing Address: 615 W Alder St., Bldg 8, Shelton, WA 98584
Shelton Phone: (360)427-9670 ext 352 •: Fax (360)427-7798
PLUMBING & MECHANICAL PERMIT APPLICATION Permit#: f9_5LD201 7-004tok
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: EDWA00 .TO C S ly l4-kGeVItN ?R. NAME:
MAILING ADDRESS: 0/ E.A@A& &Wd RD MAILING ADDRESS:
CITY: A L LY A STATE: WA ZIP:9,0 S CITY: STATE: ZIP:
1 St PHONE:�� Gol Rm 1 - 16 3 S PHONE: CELL:
2nd PHONE: EMAIL:
EMAIL: &A SW E*46 V i-N A I AIA 11. -CoiM L&I REG# EXP. I l
PARCEL INFORMATION: Rill >n WSA
PARCEL NUMBER (12 Digit Number): / Z•Z 1 77 53 OOOSZ Zoning: Uu1'`- I P
LEGAL DESCRIPTION (Abbreviated):
SITE ADDRESS: / f/ E, So DE RdsERCH ROAD CITY: A I. I.Y
DIRECTIONS TO SITE ADDRESS:
i
i yy
TYPE OF JOB/WORK: NEW n ADD ALT REPAIR OTHER
USE OF BUILDING )R&C S)b. "C_E
PLUMBING FIXTURES MECHANICAL UNITS [] Electric in-wall heaters(no fee)
Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel Type Fees
Toilet(s) 'Furnace / [E/G/LPG]
Bathroom Sink(s) Heat Pump [E/G/LPG]
Bath Tub(s) Z. O Ductless H.P. [E/G/LPG]
Shower(s) 3111 Spot Vent Fan
Water Heater(s) / [E/G/LPG] Propane Tank I ( gal.]
Clothes Washer(s) I [E/G/LPG] Gas Outlet(s) �2
Kitchen Sink(s) Heat Stove
Dishwasher(s) 1rKitchen Exhaust Hood 1
Hose bib(s) s Dryer Vent /
Other Solar Panel
Other Other
Plumbing Subtotal Mechanical Subtotal
Plumbing Base Fee Mechanical Base Fee
Final Inspection Fee Final Inspection 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
I 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 ;0o AZo/7
Signa a of Applicant Date
x ED IVA it D Soco 5 W C -VV 0%1 i e-A Mt Owner/Owners Representative/Contractor
Print Name (Circle one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
O Building
O Fire Marshal
O Permit Tech (OTC permit only)
us,c'..li. Jn;tv_-Iev/
Permit number BLD
Mechanical Permit Checklist
• Name of owner: 0D/0RRD Jar— Sw t+&Wcj1/Name of Installer: &AN Al
• Fuel Type? LPG _ Nat Gas Electric Other
• if propane, what is the proposed size of tank(s)? V2 SQ
• What type of mechanical unit will be installed?(i.e.freestanding stove,forced air furnace, etc.)
• If the unit is a wood stove,provide: Make Model
Year Label Number
• What is the use of the structure? (Circle one) Commercial
(A permit application for a commercial mechanical permit wil�pupron satisfactory review by staff. Include a floor plan
showing the location of unit(s)and layout of duct work with the permit application)
• Type of structure: (Circle one) CEZD Manufactured Home Other
• What room will the mechanical unit be located? trA&I y Ro oln
• Will the unit be located in a basement? (circle one) Yes No
• How will combustion air be supplied to the mechanical unit? (Describe, i.e. direct vent, air inlets, etc.)
D/Re. Y E wj T
• How will the mechanical unit be exhausted to the outside? Applies to appliances using gas, oil or wood fuel.
(Indicate B-vent, direct vent,Uvent,etc.) J R-e C-T' V E N T
• What year was the structure constructed? Was this structure part of a PUD upgrade?
• What type of controls will be installed? (i.e. thermostat, etc.)
• Will the proposed mechanical unit be a heat source?(circle one) es No
• Additional information:
Signature of Applicant P&-e— Date ;V/0/Zo l 7
Typical mechanical fees:
Forced air furnace $ 18.30
Heat pump 18.20
Propane tank 73..00
Gas Outlets 6.20 additional outlets over 1-5 ($1.20 each after 5)
Mechanical base fee 28.50 or $ 9.00 if base fee was paid on an active building or mechanical permit
Freestanding unit, fireplace,pellet stove or wood stove$73.00
Final Inspection fee 73.00 -
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/Ventilation Code Compliance Application
Submit with heating/cooling system size worksheet (see instructions #4)
Owner: Parcel#: Type of project:
hZ4 Aab ?o*_ S /Z.2/7 s3 oemsz- SF4
Total Sq. Ft. 1 Floor: 2 nd floor: Heated Basement:
of heated area:: Mrg 30 c-�—
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
%jI-ieat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other:
Specify:
K Prescriptive Option Table R402.1.1 (see table on previous page)
Compliance
Method ElComponent Performance, R402.1.3 — Calculation worksheets required
Must Check one::
❑ Other (Specify):
Check one El us
House Ventilation system Whole House Ventilation
Ven using exhaust fans&window or wall Integrated with a Forced Air ElOther, describe:
fresh air vents(M1507.3.4). If using System (M1507.3.5)
n System window vents be sure to order
windows with vents.
Referencing Table R406.2, "Additional Residential Energy Efficiency Requirements," all residential units
must develop credits as specified in Table 406.2. Identify and describe which option(s)will be used to
comply. If the table is not attached to this form you can access the table on our website at:
http://www.co.mason.wa.us/forms/Community Dev/iecc wsec.pdf
Additional a) Description: Small dwelling units: less than 1,500 sq. feet of heated or cooled floor
area and less than 300 sq. ft fenestration area (skylights, doors, windows, etc).
Energy *Including additions to existing building that are greater than 500 sq. ft. of heated floor
Efficiency Requirem but less than 1,500 sq ft of floor area. Requires 1.5 credits
ents b) edium dwelling units that are not included in (a) above {small dwelling), OR (c) below
Energy large dwelling} Requires 3.5 credits
credits
EXCEPTION: Dwelling units serving R-2 occupancies shall require. Requires 2.5
required: credits. See page two for description.
c) Large dwelling unit is a dwelling unit that exceeds 5,000 sq. ft. of heated or cooled
floor area. Requires 4.5 credits
d) Additions less than 500 sq feet. Requires .5 credits
(Fenestration is defined in the IECC as skylights, roof windows, vertical windows, opaque
doors, glazed-doors that include products with glass and non-glass glazing materials.)
Describe Energy Credit Option(s):
Using Option Issi ` so
number(s): I O
5R ' s
.5 r,s
MAY 10 2017
615 W. Alder Street
`' FENESTRATION SCHEDULE
USE FOR ENERGY CREDIT, a) SMALL DWELLING OPTION & COMPONENT PERFORMANCE COMPLIANCE
List all windows, doors, skylights. (If needed, attach an additional sheet)
'Fenestration is defined in IECC Chapter 2 as skylights, roof windows, vertical windows, opaque doors, glazed-doors
that include products with glass and non-glass glazing materials.
Manufacturer Location U-Factor Size Quantity Total
(rough opening) Square Feet
Total Fenestration: windows, skylights and door area
Energy Credits
4
(2015 WSEC -• Table 406.2)
OPTIO DESCRIPTION CREDIJ(S)
1 a EFFICIENT BUILDING ENVELOPE la: 0.5
Prescriptive compliance on Table R402.1.1 with the following modifications:
Vertical fenestration U/—0.28
Floor R-38
Slab on grade R-10 perimeter and under entire slab
Below grade slab R-10 perimeter and under entire slab
or
Compliance based on Section R402.1.4: Reduce the Total UA by 5%.
lb EFFICIENT BUILDING ENVELOPE lb: 1.0
Prescriptive compliance is based on Table R402.1.1 with the following modifications:
Vertical fenestration U =0.25
Wall R-21 plus R-4
Floor R-38
Basement wall R-21 int plus R-5 ci
Slab on grade R-10 perimeter and under entire slab
Below grade slab R-10 perimeter and under entire slab
or
Compliance based on Section R402.1.4: Reduce the Total UA by 15%.
1c EFFICIENT BUILDING ENVELOPE lc: 0
Prescriptive compliance is based on Table R402.1.1 with the following modifications:
Vertical fenestration U =0.22
Ceiling and single-rafter or joist-vaulted R-49 advanced
Wood frame wall R-21 int plus R-12 ci n
Floor R-38 '';_ ` z% • AMP,Basement wall R-21 int plus R-12 ci
Slab on grade R-10 perimeter and under entire slab
Below grade slab R-10 perimeter and under entire slab
or
Compliance based on Section R402.1.4: Reduce the Total UA by 30%.
Ida EFFICIENT BUILDING ENVELOPE I d: 0.5
Prescriptive compliance is based on Table R402.1.1 with the following modifications:
Vertical fenestration U=0.24
2a AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2a: 0.5
Compliance based on R402.4.1.2: Reduce the tested air leakage to 3.0 air changes per
hour maximum
and
All whole house ventilation requirements as determined by Section M1507.3 of the
International Residential Code shall be met with a high efficiency fan(maximum 0.35
watts/cfin),not interlocked with the furnace fan.Ventilation systems using a furnace
including an ECM motor are allowed,provided that they are controlled to operate at
low speed in ventilation only mode.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the maximum tested building air leakage and shall
show the qualifying ventilation system.
2b AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2b: 1.0
Compliance based on Section R402.4.1.2: Reduce the tested air leakage to 2.0 air
changes per hour maximum
and
All whole house ventilation requirements as determined by Section M1507.3 of the
International Residential Code shall be met with a heat recovery ventilation system
with minimum sensible heat recovery efficiency of 0.70.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the maximum tested building air leakage and shall
show the heat recovery ventilation system.
5
6PTION DESCRIPTION CREDIT(S)
2c AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2c: 1.5
Compliance based on Section R402.4.1.2: Reduce the tested air leakage to 1.5 air
changes per hour maximum
and
All whole house ventilation requirements as determined by Section M1507.3 of the
International Residential Code shall be met with a heat recovery ventilation system
with minimum sensible heat recovery efficiency of 0.85.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the maximum tested building air leakage and shall
show the heat recovery ventilation system.
3a HIGH EFFICIENCY HVAC EQUIPMENT 3a: 1.0
Gas,propane or oil-fired furnace with minimum AFUE of 941/o,or
Gas,propane or oiled-fired boiler with minimum AFUE of 92%
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the heating equipment type and the minimum
equipment efficiency.
HIGH EFFICIENCY HVAC EQUIPMENT 3b:
Air-source heat pump with minimum HSPF of 9.0
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the heating equipment type and the minimum
equipment efficiency.
3 c° HIGH EFFICIENCY HVAC EQUIPMENT 3c: 1.5
Closed-loop ground source heat pump;with a minimum COP of 3.3
or 10
Open loop water source heat pump with a maximum pumping hydraulic head of 150
feet and minimum COP of 3.6
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the heating equipment type and the minimum
equipment efficiency.
3d HIGH EFFICIENCY HVAC EQUIPMENT 3d: 1.0
Ductless Split System Heat Pumps,Zonal Control:In homes where the primary space
heating system is zonal electric heating,a ductless heat pump system shall be installed
and provide heating to the largest zone of the housing unit.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the heating equipment type and the minimum
equipment efficiency.
4 HIGH EFFICIENCY HVAC DISTRIBUTION SYSTEM: 1.0
All heating and cooling system components installed inside the conditioned space.
This includes all equipment and distribution system components such as forced air
ducts,hydronic piping,hydronic floor heating loop,convectors and radiators.All
combustion equipment shall be direct vent or sealed combustion.
For forced air ducts:A maximum of 10 linear feet of return ducts and 5 linear feet of
supply ducts may be located outside the conditioned space.All metallic ducts located
outside the conditioned space must have both transverse and longitudinal joints sealed
with mastic.If flex ducts are used,they cannot contain splices.Flex duct connections
must be made with nylon straps and installed using a plastic strapping tensioning tool.
Ducts located outside the conditioned space must be insulated to a minimum of R-8.
Locating system components in conditioned crawl spaces is not permitted under this
option.
Electric resistance heat and ductless heat pumps are not permitted under this option.
Direct combustion heating equipment with AFUE less than 801/o is not permitted
under this option.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the heating equipment type and shall show the
location of the heating and cooling equipment and all the ductwork.
6
tSPT DESCRIPTION CRE ITS)
5a EFFICIENT WATER HEATING 5a: 0•
All showerbead and kitchen sink faucets installed in the house shall be rated at 1.75
GPM or less.All other lavatory faucets shall be rated at 1.0 GPM or less.` '
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the maximum flow rates for all showerheads,kitchen
sink faucets,and other lavatory faucets.
5b EFFICIENT WATER HEATING 5b: 1.0
Water heating system shall include one of the following:
Gas,propane or oil water heater with a minimum EF of 0.74
or
Water heater heated by ground source heat pump meeting the requirements of Option
3c.
or
For R-2 occupancy,a central heat pump water heater with an EF greater than 2.0 that
would supply DHW to all the units through a central water loop insulated with R-8
minimum pipe insulation.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the water heater equipment type and the minimum
equipment efficiency.
5c EFFICIENT WATER HEATING 5c: 1
Water heating system shall include one of the following:
Gas,propane or oil water heater with a minimum EF of 0.91
or
Solar water heating supplementing a minimum standard water heater.Solar water
heating will provide a rated minimum savings of 85 therms or 2000 kWh based on the
Solar Rating and Certification Corporation(SRCC)Annual Performance of OG-300
Certified Solar Water Heating Systems
or
Electric heat pump water heater with a minimum EF of 2.0 and meeting the standards
of NEEA's Northern Climate Specifications for Heat Pump Water Heaters
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall specify the water heater equipment type and the minimum
equipment efficiency and,for solar water heating systems,the calculation of the
minimum energy savings.
5d EFFICIENT WATER HEATING 5d: 0.5
A drain water heat recovery unit(s)shall be installed,which captures waste water heat
from all the showers,and has a minimum efficiency of 40%if installed for equal flow
or a minimum efficiency of 52%if installed for unequal flow.Such units shall be
rated in accordance CSA B55.1 and be so labeled.
To qualify to claim this credit,the building permit drawings shall include a plumbing
diagram that specified the drain water heat recovery units and the plumbing layout
needed to install it and labels or other documentation shall be provided that
demonstrates that the unit complies with the standard.
6 RENEWABLE ELECTRIC ENERGY: 0.5
For each 1200 kWh of electrical generation per each housing unit provided annually
by on-site wind or solar equipment a 0.5 credit shall be allowed,up to 3 credits.
Generation shall be calculated as follows:
For solar electric systems,the design shall be demonstrated to meet this requirement
using the National Renewable Energy Laboratory calculator PVWATTs.
Documentation noting solar access shall be included on the plans.
For wind generation projects designs shall document annual power generation based
on the following factors:The wind turbine power curve;average annual wind speed at
the site;frequency distribution of the wind speed at the site and height of the tower.
To qualify to claim this credit,the building permit drawings shall specify the option
being selected and shall show the photovoltaic or wind turbine equipment type,
Provide documentation of solar and wind access,and include a calculation of the
minimum annual energy power production.
a.Projects using this option may not use Option la,lb or lc.
b.Projects may only include credit from one space heating option,3a,3b,3c or 3d.When a housing unit has two pieces of
equipment(i.e.,two furnaces)both must meet the standard to receive the credit.
c.Plumbing Fixtures Flow Ratings.Low flow plumbing fixtures(water closets and urinals)and fittings(faucets and
showerheads)shall comply with the following requirements:
1.Residential bathroom lavatory sink faucets:Maximum flow rate-3.8 L/min(1.0 gallmin)when tested in accordance
with ASME A112.18.1/CSA B125.1.
2.Residential kitchen faucets:Maximum now rate-6.6 L/min(1.75 gal/min)when tested in accordance with ASME A112.1&1/CSA B125.1.
3.Residential showerheads:Maximum flow rate-6.6 Lmin(1.75 gaVmin)when tested in accordance with ASME A112.18.VCSA B125.1
7
1 Date Received:
N ��h MASON COUNTY RECEIVEp
COMMUNITY SERVICES DEPARTMENT
BUILDING• PLANNING•FIRE MARSHAL MAY 10 2ow
= Mason County Bldg.8,615 W.Alder St 615 W
1854 Shelton,WA 98584 www.co.mason.wa.us 360-427-9670 ext 352 W. der Street
Permit#: 6WZ917-
04-109
Property Owner's Authorization Letter
I (we): E'bWft?> -_ Sw gn f KQV 1 G h 4A,
(Print Property Owners Name/Firm i Organization)
Hereby Authorize: I—ol4 ,E 5 w Gf dCoy i c-H
(Applicant-Name of Person to Sign Permit)
Representative of: M Y5 e-t- F
(Applicant Company Name i Organization)
To apply for, sign, and pick-up building permits for the following proposed work:
N t w
(Brief Description of Work to be Done)
Job Location: S0b4ER66Q67 10 D, X LL Yee 4tA
(Property Site Address)
As property owner(s),I(we)hereby grant permission to the applicant referenced above to apply for, sign, and pick-
up the building permit for the work as indicated above.All work performed must meet all provisions of the
Building Codes and the Laws of Mason County and the State of Washington, as applicable,whether specified or
not.Residential Contractors are required to have a current State of Washington Contractors License (RCW 18.27).
ove, �? f
S2./7
(Property f
ner Signaiw (Date)
RECEIVED
MAY 10 2017
615 W. Alder Street Rev.03.10,2016j1bn
me 3oe54MfY+V'40arce10 jZ.Z/ 7 s3 4065-7- BLD4 ,20I 7- C)O qy
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 th The
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
100 W. Public Works Dr
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 400
415 N.6th St— Bldg#8 lower level
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 wne gent/Contractor(circle one)Date: sO
Page 2 of 2
Name4bHAADToC. SwctKO Pa'r /Z1X7 f 3 OOOSZ• BLD# 20) ! — �D
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 = /
X = / yb Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X O
X = Length of drive begins at the right of way
X =
Parking Areas y0 X � = ZO
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks Z. X (O = 7 Y
YO d P y X 0 = Z Any paved, gravel or packed area per definition
_ above table
X
Others X =
4t44 L(,, X = If the total impervious area of the proposed site
CANT* X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas) 08
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 004 fi+�i� Owne Agent/Contractor(circle one)Date: 7 /0 /7
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. RECEIVED
Page 1 of 2
615 W. Alder Street