HomeMy WebLinkAboutCOM2002-00077 2 Story Addition - COM Permit / Conditions - 5/27/2004 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)t27-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352
Shelton, WA 98584
P;4
COMMERCIAL BUILDING PERMIT COM2002-00077 '
OWNER: HARMONY HILL RECEIVED: 6/5/2002
CONTRACTOR: LICENSE: EXP: ISSUED: 5/27/2004
SITE ADDRESS: 7362 E STATE ROUTE 106 UNION EXPIRES: 11/27/2004
PARCEL NUMBER: 322334400040
LEGAL DESCRIPTION: W1/2 GOVT LOT 1 S 9/57 EX TAX 683-C, 669-C 7362 & 7361 E HIGHWAY 106 UNION
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
ADDITION NORTH ON 101 RIGHT ONTO 106 GO 7.3 MILES ON RIGHT SIDE OF
ROAD TO ADDRESS
General Information Construction &Occupancy Information
No. of Units: Type of Constr.: V-N
Type of Use: Insp.Area: No. of Bathrooms: Occ. Group: R-1
Type of Work: ADD Fire Dist.: 6 Valuation: $ 196,233.90 No.of Stories: 2 Occ. Load: 48
Building Height: 26
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building: 2,986
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline & Planning Information
Front: Ft. Shoreline: 100.00 Ft.
Rear: Ft. Slope: Ft. Water Body:Type IV stream Shoreline Desig.:
Side 1: Ft. SEPA?:No Comp.Plan Desig.: Rural
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Y Emergency Key Box?: Standpipe?:
Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?:
Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?:
COM2002-00077 /UV �r Please refer to the following pages for conditions of this permit. 1 of 5
6) All property lines shall be clearly identified at the time of foundation inspection. X C_ P
7) 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
X n-compliant wiifa.(�Aan County ordinances and building regulations.
8) SEE CORRECTIONS ATTACHED TO PLANS:C
X
9) Provide an emergency power shutoff switch within 75 feet, but no closer than 25 feet from the dispensing station. Provide a NO SMOKING sign on
tank. Provide a 20 BC rated fire extinguisher located within 75 feet of dispensing station. Provide protective bollards as follows: Guard posts
constructed if steel not less than 4 inches in diameter and concrete filled, Spaced not more than 4 feet between posts on center, Set not less than 3
feet feep in a concrete footing of not less than 15 inches in diameter, Top of posts not less than 3 feet above ground, Located not less than 5 feet
from the tank. An in�ecti�n by the Mason County Fire Marshall is required before the tank ios put into service.
X � Tj
10) Any changes in construction shall be reviewed by engineer of record and submitted in writing to the Mason County Building Department prior to
construction. All engineering documents are a part of the approved set of plans and must remain attached thereto. If engineering documents are
removed, approval will not be granted. In addition, a re-inspection fee of$47.00 per hour(minimum hV will be charged and must be collected
by this department prior to any further inspections being performed or approval granted.X c
11) Changes to approved building plans that affect compliance to the current non-residential Energy Code (NREC), ventilation and Indoor Air Quality
Code (VIAQ) Uniform kil frig/Plumbing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction.
X `V7-
12) Water quality is not to be dead to the detriment of the aquatic environment as a result of this project.
X z_
13) Proper erosion and sediment control practices must be used on the construction site and adjacent areas to prevent upland sediments from entering
stream waters. Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be
effective to prevent soil from being carried into surface water by stormwater runoff. Sand, silt, and soil will damage aquatic habitat and are
considered pollutants. Any discharge of sediment-laden runoff or other pollutapollutants to waters of the state is in violation of Chapter 90.48
RCW, Water Pollution Control, and WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington, and is subject to
enforcement action. aa
X l�
14) All upland areas disturbed or newly created b,Y,c struction activities shall be seeded, vegetated or given an equivalent type of erosion protection
(silt fencing or straw matting). X `{
15) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. Stream
setback reflects a 100' buffer and in one portion of site a 115' buffer (buffer average, an extra 15'contiguous to 100'stream buffer), as described in
HMP and on site m
X
16) All property lines shall be clearly identified at the time of foundation inspection. X C
17) The approval of this project is subject to the recommendations and specifications outlined in the Habitat Management Plan. The Habitat
Management Plan should remain attached to approved permit.
x
COM2002-00077 3 of 5
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 3 Additional Fixtures 23 EH Plan Review r.Fw R7r,nn S19nndnn
Lavatories 6 Ventilation Fan 7 Non-Res.Energy Code KAP(- 7/1/9nng aFg,in C1,)nnann
Showers 1 Propane Stove 1 Building State Fee KART 7/1/9nng ea rin ;19nninn
Water Closets (Toilets) 6 Dryer Vent 1 Building Permit Fee nnRr 7/1r9nng 1 c;aa Q5 c19nnann
Water Heaters 1 Mechanical Fee AARr, 7/1/,>nng ctrA nn S1gnnAnn
Bath Tubs 4 Mechanical Base Fee AAR(; 711/,?nng ,t9R Fn C1gnnAnn
Trap Primer 1 Plumbing Fee MRr: 7/1/9nng RlAF nn g19nnAnn
Clothes Washer 1 Plumbing Base Fee MRr, 7/1/9nng 4t9n nn g19nninn
UFC Plan Check Fee nnRrl 7/1/9nng gaQQ�,i C19nnAnn
Planning Review Fee nnn.l ruin/9nna r9FS nn S19nninn
Total $2,669.76
CASE NOTES FOR
COM2002-00077
CONDITIONS FOR
COM2002-00077
1) 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 Re-Inspection fee in the amount of$52.30 per hour(minimum 1 houl,*ill_be charged and must be collected by this
department prior to any further inspections being performed or approval granted. X
2) PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A
POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY
BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION
FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF
OWNER/CO��c R FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
3) The approved plot plan is required to be on-site for inspection purposes. If inspection is called for and plot plan is not on site, Approval WILL NOT
be granted. In addition, a Re-Inspection fee in the amount of$52.30 per hour (minimum 1 hour)will e c rged and must be collected by this
department prior to any further inspections being performed or approval granted. X -
. 4) 1997 UBC CHAPTER 17, SECTION 1701: IN ADDITION TO THE INSPECTION REQUIRED BY SECTION 108, THE OWNER OR THE
ENGINEER OR ARCHITECT OF RECORD ACTING AS THE OWNER'S AGENT SHALL EMPLOY ONE OR MORE SPECIAL INSPECTORS
WHO SHALL PROVIDE INSPECTIONS DURING CONSTRUCTION ON THE TYPES OF WORK LISTED UNDER SECTION 1701.5. THE
SPECIAL INSPECTORS DUTIES & RESPONSIBILITIES SHALL BE AS SPECIFIED IN 1701.2 AND 1701.3.
X 67 .�?
5) CONSTRUCTION PROCESS TO BFIEL.BjCORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM
BUILDING CODE.x
COM2002-00077 2 of 5
18) The proposal is near a type IV stream. The proposal incorporates a buffer adjustment, as noted in site plan and Habitat Management Plan, which
establishes a 100' stream buffer(and the 115 feet averaged buffer addition). A small portion to the south approximately 30' x 20', continguous to
100' stream buffer provides the stream buffer addition. No clearing or vegetative disturbance may occur within this stream buffer without additional
environmental review arrp itting.
x t
19) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are regt or this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X cT
20) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. As specified and
designed in the Habitat Management Plan, silt fencL sf4airrient traps, and construction berms must be installed and maintained until upland
vegetation has become established. X C. t5
21 The date or dat onstruction will be provided to the Mason Count Planning Department, at least 1 week prior to work.
p Y 9 P
X
22) Application acknowles hat the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is_Rural Tourist
X c z'
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 anytime 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 owneror the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to
the above described property and str cture for revie and inspection.
OWN ER OR AGENT: E DATE: 2 7
s
COM2002-00077 4 of 5
1
` CONCRETE Oil \ MEC NICAL MANUFACTURED HOME •`
o Footings /S tbacks Dated 9 66 Ribbons
o Date /D�S7i1 ryA& Gas Piping Date By
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NO --e-l-TIC SrSTE7'1 FACILITY SERVICED Or WASTE tU47ER SYS ...
OESkSeq BY 20,10 EM5NEEMW,JLJqE 2001.
NO ;BUILDING SET BACK FROM WELL 50'PER P4rDR0GE0LC'ly'0MP0W
DATED JAN 10,2e02.'A_-l-ECT CONSULT#45,I
HARMONY HILL OVERALL SITE PLAN
WELLNESS RETREAT CENTER PROPOSED BUILDING ADDITION
7362 EAST SR-1 06
UNION, WA 98592
PH:(360)898-2363 FX:(360)898-2364 * PRELIM I NARY * *
hh0hormonyhill.org www.hormonyhill.org
DATE DECEMBER 10. 2001 1 JOB: 230HAR DES/GNED BY A,C. WEBB CHECKED By-
DRAWN BY. C. WEBB
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Planning
Mason County Bldg. 1 411 N.5th
P.O.Box 279 Shelton,WA 98584
(360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968
July 11, 2002
Harmony Hill
Attn: David Short
7362 State Route Mailed and emailed 7/11/02
Union, WA 98502
RE: Permit no. COM2002-00077, addition to existing structure located at above address.
Dear Mr. Short:
Planning staff are currently reviewing your application for a building permit as referenced above.
Based on our review to date, this letter provides information on materials still to be submitted for
review, and questions we have about your project thus far.
HABITAT MANAGEMENT PLAN: To date we have not received your Habitat Management
Plan which is necessary for the small area of buffer averaging you propose. Based on our phone
conversation today, we look forward to receiving the plan in the near future.
OVERALL SITE PLAN (page A1.01 of plan packet): There are two areas which appear to
require revision on the site plan
1. Stream Typing and setback. The stream buffer is incorrectly shown as 90 feet. This is
a Type IV stream, and the buffer is 100ft. Since we had discussed this and pointed out
the error on an earlier map, I am assuming the error was simply carried forward.
2. Clearly show how addition and existing building are related: This proposal is being
reviewed as an addition to an existing building. Please show how the proposed addition
and the existing structure join. At present the overall site plan appears to have a space
in between, but the"Site Plan" page A0.01 shows them connected.
3. Location of averaged buffer addition: The averaged buffer addition (i.e. the area
where you propose to increase buffer to balance the small intrusion into it) is shown as on
the outside edge of the 115ft building setback line (100ft stream buffer plus 15ft building
setback). The buffer addition needs to be in a place directly connected to the existing
100ft stream buffer, rather 15ft from it, to provide for buffer and habitat continuity.
Please provide 3 copies of the revised page for inclusion in our review files.
We look forward to receiving the necessary information to continue our review. Please don't
hesitate to call me if you have any questions whatsoever (360-427-9670 ext 295).
Z
y,nett-Cumming, Senior Planner
MASON COUNTY PLANNING DEPARTME T
RECEIVED
April 19, 2004 APR 19 264
426 W. CEDAR ST.
To: Diane Marcus-Jones
Mason County Dept. of Community Development
Fm: Eric Blegen, Harmony Hill
Re: COM 2002-00077
As we discussed today, I am giving you copies of our correspondence with Mason
County regarding the above mentioned permit.
Things to note are that the Habitat Management Plan was reviewed by Fish& Wildlife
and appropriate parties as mentioned by Pam Bennett-Cummings in her email to us on
10/2/02: "Good news, no comments on the HMP!"
Also, in response to Pam Bennett-Cummings correspondence of 7/11/02, Mike Whalen
our architect for the project, responded with a revised map to correctly show the averaged
buffer addition located so as to directly connect with the 100 foot stream buffer. I have
enclosed our copy of this revision and associated correspondence for your information.
Please call if you require further information at 360-898-2363.
U BE KEPT IN THE-
PARCEL FILE
RECEIVED
April 12, 2004 APR 13 2004
Diane Marcus-Jones MCCD - PLANNING
Mason County Department of Community Development
A Retreat Center with Planning Department
Wellbeing Programs Mason County Bldg. I
7362 East SR 106 411 N. 5th
Union,Washington 98592 Shelton, WA 98584 TO BE KEPT IN TH c
Tel 360-898-2363
Fax 360-898-2364 r' • A LE
E-mail hh®harmonyhill.org �"
www.harmonyhill.org Dear Ms. Marcus-Jones:
Board of Directors Per our recent phone conversation and in reference to Building Permit number
President: COM2002-00077 I am sending this letter to clarify our request to finish the
Lu Farber
Vice President: permitting process for this project.
Susan M.Keith
Secretary&Treasurer: In the way of background, the reason the permitting process was not finished
Shirley Harris-Lee
Sarah Carlson in the fall of 2002 was that Harmony Hill lost the funding we had been
Carole Davison counting on to construct this building. However, we have recently received a
Mary
neGar and pledge from a major donor who has agreed to finance the cost of constructing
ElaiStan Lee this building, and we would like to move ahead with this project.
Executive Director:
Gretchen Schodde,ARNP,MN The last communication in reference to this permit was an email received on
Advisory Board October 1, 2002 from Pam Bennett-Cumming who stated, "Good news, no
Herb B ze
ell comments on the HMP! As far as planning is concerned we are read to sign
Andy Bell p g Y g
Miroslav R.Borysenko,Ph.D off as soon as the HMP with"Title Notification" cover page is recorded."
Lantrea Borysenko Pam faxed the proper form that day, but the plan was not filed at that time due
Hilke Faber to the loss of funding for the building. We did file the Habitat Management
Ray Hanson
Audrey Harris Plan with Mason County on 1/13/2004 (File# 1802034), however.
Larry Hill
Bob&Toni Hutchinson For your information, we do not intend to change the architectural plans as
Karen James
Carolyn Olsen submitted nor do we intend to alter the footprint of the building as submitted.
Thomas L.Purce,Ed.D
Cathy Rohman I appreciate your time spent on this matter and look forward to hearing from
Mike Towey
Harvey&Mildred Wamaca you to iet us know the next steps in this process. Please feel free to call me at
Brenda Wickersham 898-2363 if you have any questions.
Mary Williams
Health Professional Advisors
Foster Cline,MD
Tricia Conti,RN,LMP Warm Regards,
William Dean,MD -.
Stu Farber,MD �te_-C
Terry Mallory,ARNP U
Todd Pearson,MD Eric Blegen
Cathy Rogers,ND Business and Capital Project Manager
Frank Senecal,MD Harmony Hill of Union
Harmony Hill's mission
is to facilitate programs
that create transformational
and healing experiences for
mind,body and spirit in a
natural retreat environment.
Harmony Hill is nonprofit 501(c)(3)
tax exempt,charitable organization.
ti
e c t
t
Afichael Whalen, . .
V
1326 Fifth Ave
Memo Suite 640
Seattle, WA 98101
June 20, 2002 T206.621.8890
F 206.621.8893
To: Michael Grohs E mwhalen®seanet.com
Mason County Plans Examiner
T: 350.427.9670 x595
F:
From: Jeff Burke
Re: Harmony Hill
Permit Drawings
Michael
In response to your comments today.
Item
1. Construction Type.
Michael questioned whether all_the bearing walls (interior and exterior) should be
one-hour construction.
The project was submitted as Type V-N. The new expansion floor area (2,986 SF) is
less than that maximum allowed for Type V-N construction (max 6,000 SF, UBC
table 5-B). The only walls and floor elements that are One Hour (1-HR) rated are the
elements separating the dwelling units per UBC 310.2.2. Michael agreed with this
assessment.
2. Second Floor Egress.
Michael commented the second floor Bedroom (203) Window Type E may not meet
the egress requirements of UBC 310.4.
The dormer Windows Type A in the same Bedroom (203) meets the egress
requirements of UBC 310.4. There was some discussion whether the dormer area
was a separate room or part of the bedroom. It was clarified the dormer area is the
same floor level, same ceiling height and not separated by any walls or doors from
the bedroom area. The seating indicated on the plan is typical for the bedrooms (see
A2.01 Bedrooms 104, 106, 111, 115). Michael agreed with this assessment.
erg-1 P.Wi.i.rc.L.c.
I
Michael Grohs
Mason County Plans Examiner
Harmony Hill
June 20, 2002
2
3. Telephone Room (103)Accessibility.
Michael commented that a public telephone may not be required but if a public
telephone is provided it will be required to meet the accessible requirements of WAC
51-40. A fully accessible phone may not work in the space provided. We will
research if a phone is required and discuss this issue with the client to see if they
want to keep the public telephone.
4. Exit signs.
Michael requested additional exit signs be provided per UBC 1007.6.2 (Mason
County's interpretation) at the floor level. Michael requested one on each floor
needs to be located at the ends of the Hallway 102 and Hallway 200.
5. Fire blocking and penetration protection.
Michael requested information on the penetration protection material @ 1 hour
assemblies. .
We will add a note to the drawings that fireblocking shall conform to UBC 708.2.1.
We will specify penetration protection at rated assemblies as follows:
• For small voids flanking penetrations use Grace Products Firesafe 1900
intumescent/elastomeric firecaulk per manufactures specifications (or
approved equal.
• For larger voids flanking penetrations (up to 4" metal pipe). Firestop system
shall be a minimum 2-1/2" mineral wool insulation firmly packed into the
opening as a permanent form. A minimum 1/2"thickness mortar system
applied flush within opening, flush with both surfaces of wall. (UL WL 1039)
or approved equal.
6. Lateral Hold Down.
Michael commented the structural calculations on S1.02 (sheet no L-3) did not match
the hold down plan on S2.00.
The hold-downs along SW-5 shall be Simpson HD-8A per S1.02. This is incorrectly
shown on S2.00.
The hold-downs along SW-3 shall be Simpson HD-5A per S1.02. This is correctly
shown on S2.00.
Please feel free to call with any additional questions or comments.
Jeff
C: Michael Sumner Harmony Hill
Dean Ricker Ricker Construction
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Item
Revision
Harmony Hill
Permit Revisions
June 20, 2002
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Harmony Hill
Permit Revisions
June 20, 2002
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Z.ol =1l�s�F�aar� ��/tly Item 4A
Revision #1
Harmony Hill
Permit Revisions
June 20, 2002
e c r
t
y
1326 Fifth Ave
July 15, 2002 Suite 640
Seattle, WA 98101
Pam Bennett-Cumming T 206.621.8890
Senior Planner F 206.621.8893
Mason County Planning Department E mwhalen@seanet.com
PO Box 279
Shelton, Washington 98584
Re: Revision #2. Harmony Hill
Permit no. COM2002-00077, Corrections
Addition to existing structure located at
7362 SR106,
Union WA 98502
Pam
In response to your list of corrections dated July 11 please see our responses below.
Item
1. Stream Typing and setback.
Please see revised sheet A1.01 (revised in its entirety). The stream buffer was
incorrectly shown as.90' on our drawings. We have revised this to a 100' stream
buffer.
2. Clearly show how the addition and existing building are related.
Please see sheets A0.01 (roof plan), A2.01-A2.04 (plans), 1/A3.01 (elevation) and
1/A4.01 (building section). We have revised sheet A1.01 to show the roof plan.
3. Location of averaged buffer addition.
Please see revised sheet A1.01 (revised in its entirety). The averaged buffer
addition was located incorrectly on our drawings. We have revised this location to be
directly connected to the 100' stream buffer.
4. Construction Runoff Mitigation (Erosion & Sediment Control).
Although not requested as part of our corrections but as part of our overall sheet
revision we have taken the liberty of adding details to illustrate methods of
construction runoff mitigation.
We hope this answers your questions. Please feel free to contact us if you have
additional questions.
Jeff Burke, AIA
Via: Fed Ex
C: Michael Sumner Harmony Hill
Mlehad P.Whalen P.L.L.C.
MASON COUNTY PERMIT NO.: BLD
BUILDING PERMIT APPLICATION r ���
426 W.Cedar/P.O.Box 186,Shelton,WA 98584 V
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR IN RMATIO
Owner Contractor Name -J Jt c
Mailing Address 3 1 G Mailing Address 21-7 7 Mr—V,,g--1, L4t,.R S w
City C^L,ix ... State,_.4 Zip Code VS-9 z- Cit State w� Zip Code96 !�'f I.
Phone(3f,o- G lf• 7 3 r Ph.( 7�L Other Ph.
�—�
Lien/Title Holder N /� Contractor Reg. # ;ck r< iml is i ar
Address Expiration
i
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic �` Connect to Se Ll
System Name of Sewer System Well_r _Water System Name
Water System
PARCEL INFORMATION-12 digit Tax Parcel No."" L"W'S Nn, Fire District
Legal Description S-ec . -A
Site Address(Please include street name, street number and city) f G r1 w
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No) o ,1-
Is your property within 200' of the following: Body of Water (Name) Saltwater ?�
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Adder Alt '>c _Repair Other Use o By�Iding G�a..*r..�c•4 i�a ^'
Describe Work .��' .�, r-2 tiJ• Ji S+t` r
No. of Bedrooms 7 No. of Bathrooms SQUARE FOOTAGE- t Floor 2nd Floor a
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial No. No. of Bedrooms No. of Bathro ms
Type of Heat Purchase Price $ Replacement Unit ?(Yes/No)
Installer Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AJ ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. They owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conform erewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approv first obtaining approval.
X' Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by D a t e 03oubmittal AmoI.FTIt Duet�/ f Receipt No.
-DEPARTMENTAL EVIEW APPROVED DENIED CONDITION CO
Building Department ? /' C—L tv Q('7 S F g
Occ Group I--I Type Con tr. -*vr — 30-yZ
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing& Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES
�
MASON COUNTY PERMIT NO.:
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584 �J
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner KM,p/N Contractor Name
Mailing Address �13E� ��' / r Mailing Address !%Z-7 AYN��t'�'
City /CIV State f_ Zip Code qF'y I� City OL YMP/A State(v-,A Zip Code
Phone( �29 2?70 OtherPh.( Ph.( ) 2 Zl c OtherPh.(
Lien/Title Holder N Contractor Reg. # /c r-/�
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION - 12 digit Tax Parcel No. Fire District
Legal Description kr. J c Z Z
Site Address (Please include street name,street number and city) -7 36 Z E (,y,
Directions to site
Is your property within 200'of the following: Body of Water(Name) Saltwater _
Lake River/Creek Pond Wetland Seasonal Runoff h Stream
Slopes or Bluffs
TYPE OF JOB New Add Alt X Repair Other Use of Building trf t�E
Location of Fixtures/Units 1st Floor___Y,_2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane t�
Clothes Washer _ Gas Outlets i-(v
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent 1
Other Other V T,t/.'f 2
Base Fee 4 Tft] Base Fee
/NK TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approvall first obtaining approval.
X Dated��J- '�Z X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
AEPARTMENU R9VIE1N aPt't C?Vt Ci DENIEV CONRf 1 I(?N CL ISt^S
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
...:.................
5 —
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES
i