HomeMy WebLinkAboutBLD2009-00704 Replace SFR - BLD Permit / Conditions - 10/2/2009 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton,WA 98584
L�
RESIDENTIAL BUILDING PERMIT BLD2009-00704
OWNER: KOEHUBREEDEN RECEIVED: 8/18/2009
CONTRACTOR: LICENSE: EXP: ISSUED: 10/2/2009
SITE ADDRESS: 12921 NE NORTH SHORE RD BELFAIR EXPIRES: 4/2/2010
PARCEL NUMBER: 322345000014
LEGAL DESCRIPTION: MADRONA MORNINGSIDE BCH TRACTS TR 14 &T.L.
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
REPLACEMENT SFR ST RT 3 TO BELFAIR, L ON ST RT 300/NORTH SHORE RD TO SITE
ADDRESS ON THE LEFT SIDE.
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R3 Lot Size: Deck: 88
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:2,233
Valuation: Building Height: Occ. Status: Seasonal Basement: cov deck 306
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 54.0 Ft. Shoreline: 55.0 Ft. Water Body: HOOD CANAL
Rear: S 55.0 Ft. Slope: 110.0 Ft.
SEPA?: No
Model: Width: Ft. Side 1: E 5.0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 2: W 5.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee GMM 8/18/2009 $1,060.90 S12009000
Hosebibs 4 Fireplace 1 EH Plan Review GMM 8/18/2009 $103.00 S1200900o
Kitchen Sink 1 Furnace<100K 1 Water Adequacy Plan Review GMM 8/18/2009 $41.00 512009000
Laundry Tray 1 Gas Outlets 4 Planning Review Fee GMM 8/18/2009 $205.00 S1200900o
Lavatories 3 Propane Tank 1 Building State Fee DLC 9/22/2009 $4.50 s120o9000
Showers 1 Ventilation Fan 4 Building Permit Fee DLC 9/22/2009 $1,654.55 S120o90o0
Water Closets (Toilets) 3 Heat Pump 1 Plumbing Permit Fee DLC 9/22/2009 $136.70 S120o9000
Water Heaters 2 Dryer Vent 1 Plumbing Base Fee DLC 9/22/2009 $24.70 s12bb§bbb
Bath Tubs 2 Mechanical Permit Fee DLC 9/22/2009 $246.90 S12009000
Clothes Washer 1 Mechanical Base Fee DLC 9/22/2009 $28.50 S12009000
ADJUST--Plan Check Fee DLC 9/22/2009 $14.56 S12009000
Total $3,520.31
BLD2009-00704 Please refer to the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2009-00704
CONDITIONS FOR
BLD2009-00704
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- 2. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
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*bDead. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Derior to any further inspections being performed or approvals granted.
X
3) Owner, nt i responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
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
remo a proved documents will result in failure of required building inspections.
X
5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
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
approv,q will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Build rtment prior to an further inspections being performed or approvals ranted.
p Y P 9 p pp 9
X
7) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation R-10.
Exc io R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
un i f the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
BLD2009-00704 Please refer to the following pages for conditions of this permit. 2 of 5
8) Per 2003 IRC - SECTION 1609-WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimu wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASTr SPEED (3-SECOND GUST) the wind speed for Mason County is 85 MPH.
X
9) Per IR - ECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accor iith the applicable provisions of this section and the manufacturer's installation instructions.
X
10) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may,also wish M mnsult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contracto Wedging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
11) The use, handling and storage of haza serials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of
the Mason County Fire Marshal. X
12) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
there I documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
cha n shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
X
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*Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
per v ation.
X
14) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Ma n C n Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be to ed in 25 of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project
X
15) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
X
BLD2009-00704 Please referto the following pages for conditions of this permit. 3 of 5
16) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the - ernational codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspe or I be made prior to requesting additional inspections.
X
17) All props t nks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
meet t i I'xtion requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
X
18) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of pection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not b u u it the final inspection has been performed and approved by a Mason County building inspector.
X
19) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to
Planning Department regulations. Such re at ns primarily consist of setbacks from shorelines and features considered to be critical areas (streams,
wetlands, slopes, etc.) If you think such a xist on or nearby your property, please co tact the Planning Department so that exact setback
requirements can be determined. X
20) All property lines shall be clearly identified at the time of foundation inspection. X
21) 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 My ordinances and building regulations.
X
22) 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
�aeperiod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder evented action from being taken. No more than one extension may be granted.
X
23) Retaining walls needed to support a surcharguch as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall.X �
24) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/Reserve requires a 10ft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No f rt ation drains within 30ft, down gradient of drainfield/reserve area.
X J
25) Approv M
r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
BLD2009-00704 Please refer to the following pages for conditions of this permit. 4 of 5
26) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason
County eli a Master Program.
X
27) ' Prior to final approval, all upland areas disturbed or ne yl re ed by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
28) Temporary erosion control measures must be implemented to prevent water quali grads n of adjacent waters or properties. Silt fencing must be
installed and maintained until upland vegetation has become established. X
29) All construction and demolition debris must be removed from the shoreline area after project completion. Prop e po of construction debris must be
on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X
30) The applicant acknowl W
at this development was sited such that further shore protection measures will not be required for protection of the new
development. X
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 ins p ction.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described prope nd ru e f r review and inspection.
OWNER OR AGENT: DATE: llq i
l"�
BLD2009-00704 Please referto the following pages for conditions of this permit. 5 of 5
MASON COUNTY PERMIT NO. rJ 2 '
BUILDING PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
IAPPLICANT INFORMATION CONTRACTOR INFORMATION
Owner C/N A K0�1 t l_.. / S 1 AAJ y5 f ;eot 1`� Company Name
MailingAddress to e E; i tp-)IO P(,° 06 Mailing Address
City V_If?r-U Q State W _Zip Code `� '�'3'. _ City State Zip Code
Phone 41!�" $Zj 7-b(7 Other Ph. Phone Other Ph.
Lien/Title Holder bVVL OF ATIMC ' Contractor Reg. # Exp.
E mail address 1_KL-G C' Cti ml'AS 1 t13C"f E Mail Address
Drivers Lic.# h Z L DOB / 13.6¢ Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION ; Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System S Name of Water System 111181PE VI
PARCEL INFORMATION- 12 Digit Parcel No ' 775Q 14 _ Fire District
Legal Description AD126&,A ill t()pN f2L- B/FCf--t 1 8- - T 14 °t- -TiDeUANOS
Site Address(Please include street name, street number and city) 12101 N� ND►2TK 5tFb2E ; SE I FA 11C �2�
Directions to site WeJ'T at" NCr'r H G"tI2i , ID
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater X _Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o
TYPE OF JOB - New_)Add Alt Repair_.Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building 'FAW IE`3 Describe Work 1t-gQ i2i1 STICK- MAOAE
No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor I C45' 2nd Floor iCl`I
3rd Floor Basement Deck_ `iI Covered Deck 2-�'l --*> Other Sq.ft. —
Garage _ Attached Detached _ Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTI �N N OF�ORK IS BY MEANS OF A PROGRESS INSPECTIOcN�. c
X >�U'ly � ��� -- Date: �J 1 ��' I
Owner/Cwners Re resentaW6/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED I DENIED NOTES
Building Department
Planning Department Itryl LO 5 11! OG' -rc17 c1
Environmental Health Department
Public Works Department Goloo -
Fire Marshal
FEES
Building Permit Fee .57 5- Site inspection
Plan Review Fee -0 /q /D EH Review Fee
Plumbing & Base Fee/' / {p,70 a 7 Planninq Review Fee
Mechanical&Base fee t S� Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee v/�� q.� o Pre-Paid at Submittal
Valuation $ TOTAL FEES
/ox -7 3�
a ox i� �20
1 �3 x
10
) 0 -77
o E� as
Co✓ereo/ L�c� ZZ,
154
t L-4-8
�g
MASON COUNTY PERMIT NA Id 3W q-M701
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360)427-9670•Belb (360)275-4467•Elma(360)482-5269
On the we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Gil/VA KDEHL-Z Bel/}Ill 6R6CDc Ay Company Name
Mailing Address I4r 0i� tH &)E Mailing Address
City KIP-KUAIL D State WA Zip Code `� �� �' City State Zip Code
Phoneme r5--9Z7- 2 17 Other Ph. Phone Other Ph.
Lien/Title Holder &4NIL OE AIKII IC'?h Contractor Reg. # Exp.
Email address kOHI" i L C 01C45 r •LET E Mail Address
Drivers Lie.# RC�_�� 2 __ OB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. '3Z�4-34E 000014 Fire District
Legal DescriptionTADCO&6 OPAIflllE,S,Ob f36.467-1 TAP rS , 14 r1 `4 T1oeeAIVOS
Site Address(Please include street name,street number and city)(Oft F 1 ATE NO2TH Si10,e6
Directions to site W'e�1 tom; NCEI{ St 0-) 1712001 F.'-FAI CrztOL c?N £�LF�I�' Ti�ffUTA A_
T 21VC4VA * CAST ON /ku ESs R A►, CpT 1-0 OSE, aN RILH
Is property within 200' of Saltwater X. Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% !1
TYPE OF JOB - New_ Add Alt Repair_._Other Use of Building t-
Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric X LPG K Natural Gas_Heat Pumpx
Toilets _`� Type of Unit No.of Units Fees
Bathroom Sink Furnace —�
Bath Tubs -' Z Heatpumps
Showers I Spot Vent Fan
Water Heater 'L oN UFMA*)D Propane Tank I
Clothes Washer Gas Ots i
Kithen Sinks ( WoocKg&5 '"ellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs 4 _ Dryer Vent
Other/- Other
T Base Fee Base Fee
TOTAL PLUMB►NG TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and stricture for review and inspection.
PROOF OF CONTIN TION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. f
X /V`'U e Date:
Owner Owners Representative Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by:__. Planning Pd Ck# Date 1 S Doi Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group TVpe Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical& Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
i
do
Request To Revise An'Approved Plan
Permit Number: BLD200q - D Name 4106G1 L 1Y)ru-,d-tq-,
Parcel Number,5 Phone Number
Project Address ja92.i no Mailing Address
had; o A
Please provide a co pl e, tailed description of the proposed revisions to the approved plans-
Ada n -fir 0rc- S X
n
Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No
Are the approved site plans included? ❑ Yes ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? ❑ Yes ❑ No
If Yes, Is a revised site plan, with all new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information: �a / o?.5-1";4
Applicant's signature
Office Use Only Received by:
-�qAu)
Date Sent Assigned To Approved-By Date �+
B. r a3 Original Valuation: �Y ✓ $ I70
/ Additional Valuati n:
Sq.Ft. x$� $
Af t�-,tA- v Sq. Ft. x$ $
Total New Valuation $
Additional Fees:
_Additional Planning Dept. $
-� W-I ,Additional Plan Reviewa $�
Additional nditio /Comments: Additional Building Permit $
( Additional Plumbing $
Additional Mechanical $
Additional E.H. Dept. $
Other $
Total Amount Due: $
� Amount To Be Paid Up-Front$
Request To Revise An'Approved Plan
Permit Number: BLD200 - 007104 Name 4P�( /
Parcel Number Phone Number daytime �)
Project Address Mailing Address
Please prrovi`d a complete detaile escription of th roposed revisions to the approved plans:
r-k]ct cal y�COcy Co l
1 D yK
5
Are two sets of the revised plans or addendum indicating the changes incl�? tee"Yes ❑ No
Are the approved site plans included? �d Yes ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? O-Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? El Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.
Does the proposed revision modify the footprint or location of the structure? ❑ Yes IP!('No
If Yes, Is a revised site plan, with all new setback dimensions included with this request?
El Yes q/No
Additional Information:
Applicant's signature /Z �g D
Date:
Office Use Only Received by:
Date Sent Assigned To Approved By Date
B. 12- .Original Valuation: $
` D L Additional Valuation: $
❑ Sq. Ft. x$ $
Sq. Ft. x$ $
Total New Valuation $
❑ P.W. �� Additional Fees:
Additional Planning Dept. $
Additional Plan Review $
Additional Conditions /Comments: Additional Building Permit $
Additional Plumbing $
Additional Mechanical $
Additional E. H. Dept. $
' Other $
Total Amount Due:
`�' Amount To Be Paid Up-Front$
Name Parcel BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impervious 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.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area * All dimensions in feet
Buildings X 4MI .33 = `953. 5�;,
of,rj X /,3, �J?j = 7G• ?4 Measurements for buildings are taken at the
perimeter of the farthest projections(example:
D X . O = �2�' '� eaves/gutters)
(Imp. r,r-�Cx) S .0 x .v
Driveways _50 X !I = 5 6U- d
ZSc AZViN(y nkt5c._kkNAX 0 Length of drive begins at the right of way
CDUC-, ulrf JAN11 LUOC-, W Cc,
Parking Areas Set,, Vlr X =
X = Any paved, gravel or packed area per definition
above table
X =
PatioslWalks X 4-5 = 40.19
�,S X 1 •�3 = 1 f, �O 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)
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. 1
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
Name �Gi'f'(( � j1; N Parcel# `'�ZZ�jy SOLO I�' BLD# O UM— 8D I 0 tA
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:
http//www.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)X—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/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.352
Mail:P 0 Box 1666, Shelton WA 98584
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described roperty for review and inspection as may be required. 7
X Owner/ gent/ ontractor(circle one)Date: —/ /09
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