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HomeMy WebLinkAboutCOM2019-00042 Remove Replace Gas Pumps - COM Application - 5/8/2019 • MASON COUNTY COMMUNITY SERVICES PermitNo:( /Om 2aIgi -Lovq2. PERMIT ASSISTANCE CENTER: .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone Belfair.(360)475-4467•Phone Elma:(360)482-5269 MAY 0 8 2019 Ort:� V&UILDING PERMIT PPLICATION PWRERTY OWNER INFORMATION: CONTR CAOR INFO O N�ZP OiV--eS NAME: . MAILING ADDRESS: MAILII`- CITY: STATE: ZIP: CITY:_ Z�_ Q PHO #1: --si :- PHONF �V PHONES: .� '�n EMAIL EMAIL: L&I RECi _EXP. PRIMARY CONTACT:- r ' ^ OWNER❑ CONTRACTOR❑ tr OTHER NAME �I:VG EMAIL MAILING ADDRESS L CITY STATE ' ZIP �+ MP I f.3 CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number)" 6 u ZONING 'T-eVCk, LEGAL DESCRIPTIOr�4Abbreviated) FIRE DISTRICT 44A&064 SITE ADDRESS jS'-1317 CITY Alisfyx DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOX 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❑ ADDITION❑ ALTERATION)( REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) 404� Sra r9— IS USE: PRIMARY K SEASONAL❑ . OIUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)❑ S(Parr/sl ojBldg)❑ NO❑ DESCRIBE WORK el.J SOUARE FOOTAGE:(propose t existing) I ST FLOOR sq.ft. 2ND FLOORgedEl sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DEsq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUF T 1O, FORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE DEL YEAR LENGTH BE OOMS BATHS SERIAL NUMBER VIRONME AL HEALTH: EWAG SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑ kIN STRUCTURE? YES❑ NO❑ If yes,attach completed Water Adequacy Form TER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS \� 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 I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null 8 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) Signature of OWNER(Must be signed by the OWNER) T Twat—e DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES Permit No: PERMIT ASSISTANCE CENTER: .BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL 5 W.Alder Phone Shelton 1(360)27-9670 ext.352 oFax:(360)427-7798 fIn U I L 1 MAY 0 8 2019 Belfair(360)2754467•Phone Elme:(360)482-5269 BUILDING PERMIT PPLICATION 615 W. Alder Street PROPERTY OWNER INFORMATION: CONT OR INFORMATION: NAME: 4Sly�-P.J C -�. NAME:; MAILING ADDRESS: MAII III """ CITY: STATE: ZIP: CITY:_ '� Z Q PHO #I: s )- PHONE L. N PHONE#2: 3 - EMAIL _ m EMAIL ^ L&I REG _EXP._ / 2PRIMARY CONTACT:, OWNER❑ CONTRACTOR❑ OTHER NAME r rk: EMAIL LJ M MAILING AQDRESS a, ?, t I CITY STATE= ZIP E CELL r PARCEL INFORMATION: _ I PARCEL NUMBER(12 Digit Numb �`' I ZONING LEGAL DESCRIPTION(Abbreviated) --, ' 1 FIRE DISTRICT 4. k )SITEADDRESS Jq `x- CITY dI SfVN DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOX V IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all thin apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ ST ❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION)( REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) e�_,_A / L� IS USE: PRIMARY& SEASONAL❑ . NUMBER OF BEDROOMS NUMBE �BATXH . ,, ` HEATED STRUCTURE? YES(Whole Bldg)❑ YES(PartlsjojBldg)❑ NO❑ DESCRIBE WORK Z "x. S . ►+ r SQUARE FOOTAGE: (propose,esisimg) o 1 ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. SEMENT sq.ft. `� O DECK sq.ft. COVERED DECK sq.ft. STORAGE sq. OTHER sq.ft. rill GARAGE sq.ft. Attached❑ Detached❑ CARPORT Attached tached❑ MANUFACTURED HOME INFORMATION: CO VTIHIFFL PLAN REQUIREW Q) MAKE MODEL RENGTH WIDTH BEDROOMS BATH SERI ENVIRONMENTAL HEALTH: SEWAGEISEWER SOURCE: SEPTIC❑ R❑ / N ❑ EXISTING❑ PLUMBIn,DROO URE? YES If yes, ach completed Water Adequacy Form p� PERIMEION DRAIN S ? YES❑ NO❑ EXISTING SQ.FT. V EXISTIN OPOSED BEDROO TOTAL BEDROOMS OWNER a owledges thatV in to information may resul a stop work order or permit revocation.Acknowledgement of such is by signature low.I deG t Ind I further declare that I entitled to receive this permit and to do the work as proposed.I have obtained p ission fro hry parties,inctuding any ease t holder or parties of interest regarding this project. The owner or legal represent ve,represent at anon provided is accurate grants employees of Mason County access to the above described property and struct (s)for review . This perniUappli_ation comes null&void if work or authorized construction is not commenced within 180 days or if construction work is pended for a period of 180 da PROOF OF CONTINUATION OF WORK ON IS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08A2) x �tµt z Owti t 2/a Signature of OWNER(Musf ned by the OWNER ate DEPARTMENTAL REVIEWZ APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH WSCO Petroleum #379 Ben's Deli Mart 18439 E State Rtu#3 Allyn, WA 98524 Parcel #12220-50-59001 Scope of work 1. Remove two gas dispensers. 2. Saw cut concrete of gas island 3. Install containment sumps for under the gas dispensers. 4. Prepare sumps for penetration of piping 5. Testing of piping system as well as sumps for dispensers 6. Pressure test of system and inspection if necessary 7. Install dispensers 8. Purge lines 9. Third party test of lines and tank connections Equipment to remain as is 1. Three USTs 2. TLS350 tank monitor 3. UST vent lines and fills Site owner is James Lee Contact: 360-275-3798 Contractor is Central Service Inc Contact: 541-550-7230 ICC: 00216125 CCB: SIPEPC825KZ Electrician is Boyles Electric inc. They will be applying for permits when needed. Contact: 503-663-2628. Coordinator: Mike Zirkle with WSCO Petroleum contact: 503-243-7713 a Pump and sump installation #379 Ben's Deli Mart 18439 E State Rtu#3 Allyn, WA 98524 Scope of work: to replaced 2 existing gas pumps with 2 Wayne Ovation 3+1 (gas and diesel)pumps. Also install underground containment sumps beneath the gas pumps. Equipment: pumps are Wayne Ovation II, hanging hardware is 1/4" conventional. Safety Plan 1) Area around pumps will be sectioned off to prevent public from wandering in work area. 2) Fire Extinguishers will be on site. 3) No smoking is permitted within work area. 4) Pumps will be removed in a safe manner as to protect employees and the public. 5) Site will be cleaned up and made safe for public before customers are allowed back in the area. Mike Zirkle Property Administrator WSCO Petroleum 18439 WA-3 - Google Maps Page 1 ot"? MAY 0 8 2019 615 W. Alder Sti 6, Google Maps 18439 WA-3 • 0 • Image capture:Oct 2018 ©2019 Google Allyn-Grapeview,Washington Google Street View-Oct 2018 https://www.google.com/maps/place/18439+WA-3,+Allyn,+WA+98524/@47.383208,-122.8291564,3a,51.1 y,322.49h,87.43t/d... 4/24/2019 18439 WA-3 - Google Maps Page 2 of 2 f Allyn Waterfront.Park 0 8439 W shin on 3 I Allyn hl`ouse In & Y North Bay Kayaks ALLYN f s https://www.google.com/maps/place/18439+WA-3,+Allyn,+WA+98524/@47.3 83208,-122.8291564,3a,51.1 y,322.49h,87.43t/d... 4/24/2019 18439 WA-3 - Google Maps Page 1 of 2 Google Maps 18439 WA-3 �U 9 P ZA j Google L Image capture:Oct 2018 ©2019 Google Allyn-Grapeview,Washington Google p( f/r�T���� '�1T�•�� v 5«r✓l�'J Street View-Oct 2018 f►�S L( � QjC�� �L.t.UJ https://www.google.com/maps/place/18439+WA-3,+Allyn,+WA+98524/g47.383208,-122.8291564,3a,51.1 y,322.49h,87.43t/d... 4/24/2019 18439 WA-3 - Google Maps Page 2 of 2 r Allyn Waterfront Park 0 18439 Allyn D No Al YN t© https://www.google.com/maps/place/18439+WA-3,+Allyn,+WA+98524/g47.3 83208,-122.8291564,3a,51.1 y,322.49h,87.43t/d... 4/24/2019 BUILDING Pump and sump installation #379 Ben's Deli Mart 18439 E State Rtu#3 Allyn, WA 98524 rn r Scope of work: to replaced 2 existing gas pumps with 2 Wayne Ovation 3+1 (gas and C' diesel)pumps. Also install underground containment sumps beneath the gas pumps. Q o Equipment: pumps are Wayne Ovation II,hanging hardware is 3/4" conventional. Co 0 CF �o 'Safety Plan ` 1) Area around pumps will be sectioned off to prevent public from wandering in work area. 2) Fire Extinguishers will be on site. • 3) No smoking is permitted within work area. 4) Pumps will be removed in a safe manner as to protect employees and the public. 5) Site will be cleaned up and made safe for public before customers are allowed back in the area. Mike Zirkle Property Administrator WSCO Petroleum WSCO Petroleum #379 Ben's Deli Mart 18439 E State Rtu #3 Allyn, WA 98524 Parcel#12220-50-59001 Scope of work 1. Remove two gas dispensers. 2. Saw cut concrete of gas island 3. Install containment sumps for under the gas dispensers. 4. Prepare sumps for penetration of piping 5. Testing of piping system as well as sumps for dispensers 6. Pressure test of system and inspection if necessary 7. Install dispensers 8. Purge lines 9. Third party test of lines and tank connections Equipment to remain as is 1. Three USTs 2. TLS350 tank monitor 3. UST vent lines and fills Site owner is James Lee Contact: 360-275-3798 Contractor is Central Service Inc Contact: 541-550-7230 ICC: 00216125 CCB: SIPEPC825KZ Electrician is Boyles Electric inc. They will be applying for permits when needed. Contact: 503-663-2628. Coordinator: Mike Zirkle with WSCO Petroleum contact: 503-243-7713 MASON COUNTY COMMUNITY SERVICES Permit No:(/om 20�qZ PERMIT ASSISTANCE CENTER: •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 �A Y + Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone e'Y'�I O 8 ANBelfair(360)2754a7•Phone Elma:(360)482-5269 N BUILDING PERMIT PPLICATION 615 W_ Alaer Street PROPERTY OWNER INFORMATION: CONT GTOR INFORMATION: NAME: 4`J`�"�� NAME: MAILING ADDRESS: .''mac',(' MAILII�" """"' CITY: STATE: ZIP: CITY: ZIP Q PHO #I: 3--sue >- �" n PHONE L. - (V PHONE#2: ' s� -� w EM IL EXP. / EMAIL - — — PRIMARY C_ONTACT:, OWNER❑ CONTRACTOR❑ OTHER NAME rK. EMAIL GJ r7 D MAILING AQDRESS '�?Z •I ` CITY STATEh ,Z ZIPS � T t 1 O C! CELL ram^/ r PARCEL INFORMATION: _ f I PARCEL NUMBER(12 Digit Number) � � �v v'� ZONING _T"�-tJ LEGAL DESCRIPTIO (Abbreviated) —' A 5 FIRE DISTRICT Jl�n;�J D SITE,ADDRESS J'� CITY QltVt'Y� DIRECTIONS TO SITE ADDRESS v IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOX 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❑ ADDITION❑ ALTERATION)( REPAIR❑ OTHER ❑ -USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) 6,14%)j;,NCs- Stb -V IS USE: PRIMARY K SEASONAL❑ . NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part/s)ojBidg)❑ NO❑ DESCRIBE WORK Z 5 SQUARE FOOTAGE:(prapose+existing 1 ST FLOOR 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❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ ! NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YES❑ NO❑ Ifyes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO❑ EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 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 I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK 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 'AAZ -Z:�'r__ cy'04t � Signature of OWNER(Mustbe waned by the OWNER) I- Date DEPARTMENTAL REVIEW APPROVED DATE DENIED I DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MAY 0 8 2019 Pump and sump installation 615 W. Alder Street #379 Ben's Deli Mart 18439 E State Rtu#3 Allyn, WA 98524 Scope of work: to replaced 2 existing gas pumps with 2 Wayne Ovation 3+1 (gas and diesel)pumps. Also install underground containment sumps beneath the gas pumps. T Equipment: pumps are Wayne Ovation II,hanging hardware is 3/4" conventional. Safety Plan = rn 1) Area around pumps will be sectioned off to prevent public from wandering in work area. 2) Fire Extinguishers will be on site. • 3) No smoking is permitted within work area. 4) Pumps will be removed in a safe manner as to protect employees and the public. 5) Site will be cleaned up and made safe for public before customers are allowed back in the area. Mike Zirkle Property Administrator WSCO Petroleum MAY 0 8 2019 WSCO Petroleum 615 W. Alder Street #379 Ben's Deli Mart 18439 E State Rtu#3 Allyn, WA 98524 Parcel#12220-50-59001 D T Scope of work 1. Remove two gas dispensers. = M 2. Saw cut concrete of gas island 3. Install containment sumps for under the gas dispensers. r 4. Prepare sumps for penetration of piping 5. Testing of piping system as well as sumps for dispensers 6. Pressure test of system and inspection if necessary 7. Install dispensers 8. Purge lines 9. Third party test of lines and tank connections Equipment to remain as is 1. Three USTs 2. TLS350 tank monitor 3. UST vent lines and fills Site owner is James Lee Contact: 360-275-3798 Contractor is Central Service Inc Contact: 541-550-7230 ICC: 00216125 CCB: SIPEPC825KZ Electrician is Boyles Electric inc. They will be applying for permits when needed. Contact: 503-663-2628. Coordinator: Mike Zirkle with WSCO Petroleum contact: 503-243-7713 184.39 WA-3 - Uoogle Maps Page 1 of 2 MAY 0 8 2019 Google MaPW5 04Q94YAN-�- j LLJ S t Google Image capture:Oct 2018 ©2019 Google Allyn-Grapeview,Washington Google Street View-Oct 2018 https://www.google.com/maps/place/I 843 9+WA-3,+Allyn,+WA+98524/@47.3 83208,-122.8291564,3 a,51.1 y,322.49h,87.43t/d... 4/24/2019 184J 9 W A-J - Uoogle Maps Page 1 of 2 Google Maps 18439 WA-3 9 p At 16 ..A MM1 tf. X Google b \y y� p Image capture:Oct 2018 ©2019 Google e Allyn-Grapeview,Washington ������� Google Street View-Oct 2018 � f�5�1� ��� �1j�5 `;7L.L,Ut�,� https://www.google.com/maps/place/18439+WA-3,+Allyn,+WA+98524/@47.3 83208,-122.8291564,3 a,51.1 y,322.49h,87.43t/d... 4/24/2019