HomeMy WebLinkAboutBLD2010-00272 SFR - BLD Permit / Conditions - 9/30/2011 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
RESIDENTIAL BUILDING PERMIT BLD2010-00272
OWNER: MARTIN REYNOLDS RECEIVED: 4/9/2010
CONTRACTOR: LICENSE: EXP: ISSUED: 9/30/2011
SITE ADDRESS: 21 E BLACKWELL ST ALLYN EXPIRES: 3/30/2012
PARCEL NUMBER: 122205052002
LEGAL DESCRIPTION: ALLYN BLK 52 LOT 2
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE(PLAN BEING STOCKED#2006-0057)
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: R-3/1_1 Lot Size: Deck:
Type of Work: NEW Fire Dist.: No. of Stories: 2 Occ. Load: Building:1,600 Garage-Attached 308
Valuation: $ 170,799.16 Building Height: 26 Occ. Status: Primary Basement: COV PORCH 40
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 20.0 Ft. Shoreline: Ft. Water Body:
Rear: W 40.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: N 5.0 Ft. Shoreline Desig.:
Year: Serial No.: Side 2: S 5.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets(Toilets) 3 Dryer Vent 1 Plan Check Fee TW 4/9/2010 $900.74 S120100001
Lavatories 3 Ventilation Fan 4 Planning Review Fee TW 4/9/2010 $205.00 S12010000i
Bath Tubs 1 Exhaust Hood 1 Address Fee TW 4/9/2010 $173.50 S120100001
Showers 1 Address Fee TW 4/9/2010 $173.50 S12011000(
Water Heaters 1 EH Plan Review KKK 4/13/2010 $103.00 S620100001
Clothes Washer 1 Water Adequacy Plan Review KKK 4/13/2010 $103.00 S62010000(
Kitchen Sink 1 Building State Fee LDK 4/26/2010 $4.50 S120110001
Dishwasher 1 Building Permit Fee LDK 4/26/2010 $1,391.35 S12011000i
Hosebibs 2 Mechanical Permit Fee LDK 4/26/2010 $58.20 S12011000(
Mechanical Base Fee LDK 4/26/2010 $28.50 S12011000i
Plumbing Permit Fee LDK 4/26/2010 $110.60 S120110001
Plumbing Base Fee LDK 4/26/2010 $24.70 S120110001
Additional Plan Check Fee LDK 4/26/2010 $141.00 S120110001
Total $3,417.59
BLD2010-00272 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2010-00272
CONDITIONS FOR
BLD2010-00272
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
1-800-6479 The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
2) Owner/Age54 responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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3) 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 be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Department p � to any further inspections being performed or approvals granted.
X ZE
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
removal of appr ed documents will result in failure of required building inspections.
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5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 492
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
approval 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
Building Department prior to any further inspections being performed or approvals granted.
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.
Exception: 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
underside of oof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
BLD2010-00272 Please refer to the following pages for conditions of this permit. Page 2 of 6
8) Per IRC -SECTION R905- REQUIREMENTS FOR ROOF COVERINGS- R905.1 Roof covering application. Roof coverings shall be applied in
accoromiW with the applicable provisions of this section and the manufacturer's installation instructions.
X
9) 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 to consult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contractor-iaacknowledging that all components of the stormwater management system have been
installed as approved on the stormwater site plan. X
10) 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 foundation drains within 30ft, down gradient of drainfield/reserve area.
X 60
11) Stock Plan Identification number:
This project is approved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department,
original building plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building
Inspector arch required inspection.
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12) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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13) 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
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged an hall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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14) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit rev n.
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BLD2010-00272 Please refer to the following pages for conditions of this permit. Page 3 of 6
15) Installation of heating equipment in single family residences shall meet the requirements of the current Washington State Energy Code.
The furnace to be installed shall not exceed 150% of the heating and cooling design load. Heating and design load calculations for the purpose of sizing
HVAC systems are required and shall be calculated in accordance with accepted engineering practice, including infiltration and ventilation. Design
calculations shall be available for inspection during the framing inspection.
Warm-air furnaces shall have a minimum efficiency of 78%AFUE or higher or 80% combustion efficiency. All ducts shall be securely fastened and
sealed with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric systems or tapes installed in accordance with manufacturers installation
instruction uct tape is NOT permitted as a sealant on any ducts. Ducts in unheated spaces shall be insulated to R-8.
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16) 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 Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 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.
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17) Placement tructure must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
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18) 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.
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19) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector sA be made prior to requesting additional inspections.
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20) All property lines shall be clearly identified at the time of foundation inspection. X�
e
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 County�dinances and building regulations.
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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 a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder hav�ented action from being taken. No more than one extension may be granted.
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BLD2010-00272 Please refer to the following pages for conditions of this permit. Page 4 of 6
23) ` Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connector nd flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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24) Retaining walls needed to support a surcharge s, .ch as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X�
25) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
X
,o.
26) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Sit n"to ensure these structures are shown and meet the setback conditions listed.
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27) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at
(360)427-9670, ext. 450. The building permit will not be"finaled" until the permit holder can show proof that the access permit from Public Works has
been "final ed' approved.
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28) Approved peLiJknensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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29) Application acksowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Allyn UGA R-2 zone.
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30) Prior to final approval, all upland areas disturbed or newly crea y construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
31) 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 to consult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contractor is wledging that all components of the stormwater management system have been
installed as approved on the stormwater site plan. X
BLD2010-00272 Please refer to the following pages for conditions of this permit. Page 5 of 6
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 any
time 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 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 property and structure for review and inspection.
OWNER OR AGENT: DATE:
BLD2010-00272 Please refer to the following pages for conditions of this permit. Page 6 of 6
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CONCRETE MECHANICAL s MANUFACTURED HOME m
o Footings /Setbacks Date S 6 Z gY Ribbons O
7 Gas Piping
o Interior Date By Interior-Date By Date By r
Ntxterror Date ` By 7/ , Exterior-Date By Set-up (AI
Point load!Isolated Footings INSULATION Date [3y �
Date By Date SLAB INSULATION
By FIRE DEPARTMENT �~ .....4 _._ D
M
Foundation Walls Floors Date By �
Date By Data By DECKS Z
FRAMING Walls Date By
Date J'f6- L By Data By PROPANE TANKS
PLUMBING vault Date B`'�__
Date By OTHER
Groundwork Attic
/ Type.
Date By Date — / By Date By
o.w.v DRYWALL Type.
_ Int Brace Wall pate By W
T Date Z BY Date By r
m FINAL INSPECTION 0
v
(D Water line Fire Separation ICD N)Dale By Data By Date By
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o Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments �
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t F"\ R.O.S. Vol. 27 t
coPage 59
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� 'Found 5/8'
and Cop
LSJJ3I23 \ �! •
Found 5/8-reboi
and Cap LS/19646 �� \
NsuRva►vR's ears
This surveyls based upon Record-ef-Survey
Vol.20 Page 60 and VoL7 Page 128
Property corners and line stakes shown were the only points set during
this survey. Except
as shown• oil property lines were not checked for
encroachments.
No title report was furnished to the surveyor. There may exist other
documents of record that would affect this parcel.
�Y \
\ Survey/or use by original purchaser o1 surrey only.
This mop is not intended to show oil matters related to the property
including, but not limited to easements, restrictions and encroachments.
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``� `�� \ Encroachments fence, vegetation, m ovemenfs, drivewa etc. may,
891: 10, 1 at tines, establish lines of ownership. property owner should seek legal
•• \�� , `` 'oaby�NPy advice in these casesLEGAL DASCRIPMN
^S
Found 5/8"rebor LOTS I AND 2, BLOCK 52, TOWN!1F ALLYN, VOLUME 1 OF PLATS. PACE 17,
and Cap LS110238 \ RECORDS Ole MASON COUNTY. WASHfNCTON.
\ 30• *S57Tk;,�� v`v PJWCIDUJW t 170U1P2flW
l l '\ Standard field traverse with Nikon 1' Total Station and steel
tape. This survey meets minimum standards as set reth in
` / r 00• `v \ .j ln. , WA C. 332-130-090.
\ •'t: l I \ I round j"rebar LEGAPD
and Cop LS/102J8�
- • Set y2-rebe flush with ground with yellow cap
/ imprinted -SEO. 20795-with 2-x2"white quord
stake. D
Record-of-surVoy'�"
3 �, \ / / / ya(.20 Pope 60 \� O Found survey point as noted. j
I / e
V _ / ! / �\\\ / / �\\ ..- / (D) Deed measurement �
s� l l (M) Measurement per this survey.
Calculated
zg Position per /
\ I\ l
l Found 5/8'rebr J 1
R.O.S. Vol- 27 �;:•r' and Cap LSJ102J8
Page 59 , / l � , � l �
GRAPHIC SCALE
ti Calculated
Nm: Position per gi /
R.O.S. Vol. 27
Page 59
t teat.- eo n
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AUDITORS CERTTFICATE SURI•£YORS CERTIFICATE Record of Survey for
Fled for record this��day of I=Cftbr/ This mop correctly represents o survey mode by E AES MARTY REYNOLDS SHT
2D��_ote the p^v t,of AES Consu/toots lnc. me or undr my dkwtion in conformance with ��N• -0r�
Uf:►'OFU,�.r l�l — the requirnents of the&irwy Receding Act at y�`"'''t -."4�;' Situate in the, I
w AUDITOR —U the reque, o, MARTY RErNaDS _ A�.4
ULTANTS, INC. W 1 t�,
Srr r� _ n ANnOV. 2007 `�i 7L1'mii a eap-(�MW- Snr�•/4 T/tY�/��• 1 OF
Audh ,,deCCNo. 1931uZ 1 _—. _ t�' /�f'zw7 B.J.N. SE.0. SEC. CO f IIr W,
Vol.. ">-A'S page—�r - -- _. _-- P.L.Sa20795 mr w 1?/bJ/07 M' 4878 RG. W, W.M. J
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13d,ng e r m i t # /lam- MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRE TION NOTICE
Job Location 2 /
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
AI
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
�A OK to Z'2-1
❑ This is not a complete insp ction DepartmentC�
Date '�'�"��f Inspector .
■ �K NnT M4 *V THI TmL014i
Buildirig Permit # O2 72' MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location a / 4Z,
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
f und:, ,,�,,11ems Listed below must be corrected to gain code compliance A?C
C <1 10 i c)
erQ
A J/ F O -/ford
vi"'I c(,
r✓ o G o �
In-170S'
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OKto oKT�
�q This is not a complete insp on Department dr�
Date Inspector
moos COOT F1 ; MO OV � THLO TA ,��
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Austin Engineering
Civil Engineering and Land Surveying Services
2182 NE Eton Lane, Bremerton, Washington 98311-9529
Voice: 360-698-1661 Cell: 360-271-1772 email: austinengr@gmail.com
Date: 23 July 2012
Subject: 21 E. Brady Loop, Allyn
Mason County,DCD, Building Dept
P.O. Box 186
Shelton, WA 98584
To whom it may concern;
I have reviewed the Inspectors comments and the work done to date. The builder will install a
2x8 under the double top plate to carry the triple roof/second floor truss load to the footing and a 2x4
will be added to the edge of the 2x8 to keep it from flexing. This will be done on both sides of the
open area. See attached picture.
A second stud will be added to the wall in the center of the triple truss, see attached picture.
The front porch will be poured to include the existing post bases as well as the entry steps.
This will include removal of the excess loose soil materials around the bases at that time. These posts
are carrying the porch cover and are not an excessive load. See attached picture.
E. Paul Austin PE&LS WA
# 16968
cc: File: 12-04
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FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NoFj.D 2pu—
PLEASE PRESS HARD BUILDING PERMIT APPLICATION nD2L-V_
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner W.4d T ZN Of Yy-0LQC Company Name 4sfe
Mailing Address-UM/ f A& Mailing Address
City BllI",.',- State 1 2 Zip Code.295 L y City State Zip Code
Phone 360- 3y0- 60Z Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # MA1ey"sR49fAC?Exp. 6d. i/
E mail address mra cJA�< i ble - GA.. E Mail Address
Drivers Lic.# DOB of �� 7 Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System X Name of Water System 3tf-� Cc,rcx s
Well Sewer System_ Name of Sewer System JC-,}l( OF,* S e—,
PARCEL INFORMATION - 12 Digit Parcel No. /222051--65-Z.o0Z Fire District Y
Legal Description 8/,e SZ 1 Q,/ 3 S. 3S�/ b'3"'
Site Address(Please include street name, street number and city)
Directions to site aJ Af 1-3, F Tv/� Vr, Lwhu( lvrrj h { T✓�^�
✓i i{ r i
Will timber be cut and gold in parcel preparation'. Yes
Is property within 200'of Saltwater y s Lake ti a River/Creek Pond �✓
Wetland Aja Seasonal Runoff ,y J Stream ,V- Slopes or Bluffs /o
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New_)L_Add Alt Repair Other PRIMARY RESIDENCE Rr SEASONAL ❑
Use of Building Pe-J N4—t Describe Work A'k -.x—
No. of Bedroom- 7 No. of Bathrooms Z�P'T' Square Footage- 1 st Floor -7 7 0 2nd Floor
3rd Floor X Basement Nc Deck x Covered Deck h Other X Sq. ft. A
3�Y x Detached �X Carport A Attached k Detached
Garage Attached P
MANUFACTURED HOME INFORMATION - Make k Model Year''
Length k Width x Serial No. Y No. of Bedrooms NO. of Bathrooms
Type of Heat 5- Purchase Price $ h Replacement Unit? Yes/ No
Installer Name 4 Certification No. v
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. 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 OFA PROGRESS INSPECTION.INACTIVITYOF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X Date: y-2-- /b
Owner/Ovrhers Representative ontra (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted ry: Lf Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
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
Valuation $ TOTAL FEES
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL 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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address ' Mailing Address
City State Zip Code City 'AFA3-�a State Zip Code
Phone Other Ph. Phone ��'�` 40 Other Ph.
Lien/Title Holder Contractor Reg..4 =>'L Exp.
E mail address = E Mail Address AV,
Drivers Lic. # DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System
Name of Sewer System fir+ v'Z
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair__Other _Use of Building
Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPC7L-- Natural Gas Heat Pump_
Toilets Type of Unit No. of Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers t Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or 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 CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type 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