HomeMy WebLinkAboutBLD2023-00571 Raise, Remodel - BLD Inspections - 7/15/2024 a° 615 W.Alder St.Bldg 8, SHELTON,WA 98584
MASON COUNTY SHELTON: 360-427-9670, EXT 352
COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 352
Building,Planninq,Environmental Haailh,Community HealUi ELMA: 360-482-5269, EXT 352
www.co.mason.wa.us
INSPECTION CARD AND CERTIFICATE OF OCCUPANCY**
To schedule an inspection call or visit http://www.co.mason.wa.us/community-services/bid-inspection.php
Permit Number BLD2023-00571 Date Issued 06130/2023 Issued By
Project RAISE EXISTING HOUSE-2'ABOVE BFE&REMODEL
Site Address 13841 E State Route 106
Applicant RICKETT SCOTT&SANDRA M
Contractor RAINIER CONSTRUCTION
Contractor Phone 1.360.265.0914
Primary Code UPC IBC, IRC,IFC, IEC,IMC, & Type
Permit Type ADDITION OR REMODEL- Occupancy
RESIDENTIAL
-APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS.
-DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED.
-THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION, FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY.
-ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION.
-OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION.
**THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED.**
PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET
Public Works Access/Driveway Other
Health Septic Well
Deptartment
Planning Site Inspection
Department
Fire Marshall Fire Apparatus Access Fire Sprinkler
Auto Fire Alarm Hood and Duct
Other Final
Building Building Official: Community Services Designee
Department
Concrete Setbacks Slab
Footing Perimeter Point load Footing
Footing Interior Footing Decks/Porches
Foundation Stem Walls`-, Other
Rough-In Groundwork Plumbing Framing Z9 DEn
Groundwork Mechanical Plumbing 1_1[6_II { C)M
Groundwork Gas Pipe Mechanical
Gas Piping Shear Wall Nailing
Underfloor _
Other
i Insulation Slab Ceiling
4 Floor Vaulted Ceiling
Wall — -�, i� Vapor Barrier
Other
Wallboard Interior Wall Brace Panels Fire Walls
� Nailing
Other
Final Building
Manufactured Setbacks Setup
Home
Concrete Foot/ Runners Final
Other
fay
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MASON COUNTY 360-427-9670 Shelton ext.352
COMMUNITY SERVICES 36 60482-52 Belfair ext.352
360-482-5269 Elma ext.352
Building,Planning,Environmental Health,Community Health
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.masoncountywa.gov
CORRECTIONIINSPECTION REPORT
PERMIT/CASE NUMBER*
ADDRESS/LOCATION: ` E, A �0 (Q
FINDINGS:
1
L
cn
Ye ��
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
❑ Call for re-inspection when corrections are made before proceeding with any further work.
ake corrections, items will be checked on the next inspection.
❑ OK to
Date: \—\-I ❑ Please contact our office regarding possible
Department: structural damage incurred by recent
'natural/man made'disasters.This is NOT a
Inspector: B t(f ,S CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
MASON COUNTY 360-427-9670 Shelton ext.352
360-275-4467 Belfair ext.352
COMMUNITY DEVELOPMENT 360-482-5269 Elma ext.352
Building,Planning,Fire Marshal
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.masoncountywa.gov
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: BLD:2023 -00S1 1
ADDRESS/LOCATION: 13$'-><'1 6- STATE R001E i o G
FINDINGS:
h,r--k,-h inn Ito rjer,4-CAtc5 / f'o.,ncao-Af -0 401, ,
erL h1 S k
a k, 4o Si--d D Ao Lo S 4 d D b08SoA-)&,ma SvnJGoa ouy t,a,q,rJ o v
0/1
q
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
/A Call for re-inspection when corrections are made before proceeding with any further work.
og jMake corrections, items will be checked on the next inspection.
OK to 1 'F p rgo n S
Date: q2-S-a 9 ❑ Please contact our office regarding possible
Department: A LM structural damage incurred by recent
Inspector: "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
MASON COUNTY 360-427-9670 Shelton ext.352
360-275-4467 Belfair ext.352
COMMUNITY DEVELOPMENT 360-482-5269 Elma ext.352
Building,Planning,Fire Marshal
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.masoncountywa.gov
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: 13I Dao13 -o0SI I
ADDRESS/LOCATION: 13dQ/ E 5ute izoo7c /o6
FINDINGS•
^- LJ/E(.L Li !ice' !X! r oCC�%•^ Grl R / it�G/'
6tn117 P00709 TO LDIb&0 W /AJArfOAJ Co U A T11JA Co
or
79q '?7y
IRAmm)6 PASS 7flIS' a1TE
%I* OkAy to Dkyw k L4, o i NER /AREAS
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
Call for re-inspection when corrections are made before proceeding with any further work.
ak Make corrections, items will be checked on the next inspection.
N. OK to ,WQ ?,101 DS
Date: cr-,?y ❑ Please contact our office regarding possible
Department: structural damage incurred by recent
Inspector: ��(� "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
MASON COUNTY 360-427-9670 Shelton ext.352
".p. 360-275-4467 Belfair ext.352
COMMUNITY DEVELOPMENT 360-482-5269 Elma ext.352
Building,Planning,Fire Marshal
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.masoncountywa.gov
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: F)&D,2ta?3— caS- 'I
ADDRESS/LOCATION: 138yI E SWC- 10AITC !OG
FINDINGS
r t 7s , f3oo4 U2 n S' mx v,r C :n 4e
OK 4 o {. '2�p4a-o.S -to 1W ZY44.Gov
l90 DAe TE•"P OCCUPANC-Y
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
Call for re-inspection when corrections are made before proceeding with any further work.
Make corrections, items will be checked on the next inspection.
OK to ft-M S'
Date: q-11-,g q ❑ Please contact our office regarding possible
Department: -D structural damage incurred by recent
Inspector: "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
DocuSi f i Envelope ID:A227FD94-05A2-4421-A014-40010BE88F4B
Special Inspection Requirements
MASON COUN Y
COMMUNITY SERVICES
r3/-vzo23- 0051I Etc 14-+- lZew ,e; 22-2-2- l - Zq- 0032-y
Permit Number Project Title Project Address/Parcel Number
Applicants of projects requiring Special Inspection or Testing per Chapter 1704 &1705 of the International
Building Code, as amended by Washington State. Please acknowledge and return this form to the Mason
County Permit Center.
THESE INSPECTIONS ARE NOT PERFORMED BY THE BUILDING DEPARTMENT AND MUST BE
PERFORMED BY QUALIFIED SPECIAL INSPECTORS, HIRED BY THE OWNER AND APPROVED
BY THE COUNTY PERMIT CENTER. Individuals certified in a special inspection category by
Washington Association of Building officials(WABO)or individuals employed by a recognized testing
laboratory and under the direct supervision of a Registered Professional Engineer are typically
considered qualified at the discretion of the local jurisdiction having authority for enforcement.
BEFORE A PERMIT CAN BE ISSUED: The Owner or his/her representative, on the advice of the
responsible Project Engineer or Architect, shall fill out completely, sign and submit two (2) copies of the
attached"Structural Tests and Inspection Schedule"to this Department for review and approval including
any requirements related to the Mason County Municipal Code.
The Owner, General Contractor, and Inspection/Testing Agency, where applicable, shall also
acknowledge the following conditions applicable to Special Inspection and/or Testing.
1. Inspection/Testing Agency shall submit names and qualifications of on-site Special Inspectors
to the Building Inspection Permit Center for approval PRIOR TO PERMIT/S BEING ISSUED.
2. All Special Inspections shall be noted on the approved plans or attached approved
documents.
3. All special inspections shall be approved by the County or as recommended by the Engineer
of Record (EOR).
4. It is the responsibility of the General Contractor to review County approved plans for additional
inspection or testing requirements that may be noted or required per IBC as noted on
approved plans.
5. The General Contractor is responsible for proper notification to the Inspection/Testing
Agency for items listed on this form.
6. Special Inspectors shall provide detailed reports on company letterhead to the Building
Inspector of all required inspection activities. These may also be provided when the inspector
visits the jobsite for the scheduled inspection but must be completed before the subject of
inspection is approved by the building inspector.
7. Copies of all ongoing laboratory and testing reports shall be sent directly to the Building
Inspector by the Inspection/Testing Agency or other responsible party within a reasonable
time to test results.
8. BEFORE A CERTIFICATE OF OCCUPANCY APPROVAL CAN BE ISSUED: The
Inspection/Testing Agency shall submit a FINAL REPORT LETTER stating that all items
requiring testing and inspection have been fulfilled and reported and a final inspection report
shall be provided. A copy of the statement is to be maintained at the jobsite for the Building
Inspectors review prior to final inspections.
Page 1 of 4
r
DocuSign Envelope ID:A227FD94-05A2-4421-A014-40010BE88F4B
Special inspection Requirements
MASON COUNTY -
COMMUNM SERVICES
ACKNOWLEDGEMENTS
Prior to issuance of a building permit, the Owner, on the advice of the Project Engineer or Architect, shall
complete, sign,and submit this form to the County Permit Center.
Declaration of Owner
I, as the owner of the project, declare that the testing agency firms or individual/s listed herein are hired by me to
perform "Special Inspections" and/or "Structural Testing" in accordance with the provisions of the International
Building code(IBC)Chapter 17. .-
Scott A. Rickett 6/16/2023 1 1:59 PM PE
Owner(print) Owner igriature) (date)
Declaration of Registered Professional Architect/Engineer
I, as the design professional in responsible charge of the project listed herein, declare that the special
inspection listed herein are required for this project in accordance with the provi W* W(plltl p4n ernational
Building Code (IBC) Chapter 17. C, -D PR0 1/
Luke Heath 92726P
Architect/Engineer(print)
GO
Architect/Engineer Stamp/Signature(date) SAT 12,
F A. HE
J I
EXPIRATION DATE:06/30 2023
TestingAgency Name/Contact Wes Mahan
g y Krazan and Associates
info:
The Special Inspection/Testing Agency listed above must have a current Portfolio of Qualifications
on file with the County prior to performing work.
Declaration of the General Contractor
1, as the General Contractor of the project, agree to comply with the"Contractor Responsibility" items
noted herein.
eloeuflpn.a W.
Jeremy Nelson Rainier Construction LLC �ti'[�h N4, s&, 6/19/2023 1 7:43 AM PD
General Contractor(print) _G�E40'a-TrMlfractor Signature (date)
Page 2 of 4
DocuSidn Envelope ID:A227FD94-05A2-4421-A014-40010BE88F4B
larl",
IS
Special Inspection Requirements
MASON COUNTY
COMMUNITY SERVICES
Required Special Inspections
International Building Code; Chapter 17:
A completed and signed copy of pages 1 through 4 of this form shall be submitted to the
"Permit Center" prior to building permit approval.
Engineer shall check the applicable items:
❑ Special inspection of fabricated items 1704.2.5
❑ Submittals to the building official 1704.5
❑ Structures over 75' in height located in Seismic Design Category D, 1704.6.1
❑ Structures classified as Risk Category III or IV located in Seismic Design Category D, 1704.6.1
❑ Steel construction& structural Steel 1705.2.1
❑ Cold form steel deck 1705.2.2
❑ Open-web steel joists & girders 1705.2.3
❑ Cold form steel trusses spanning 60 feet or greater 1705.2.4
❑ Concrete construction 1705.3 &Table 1705.3
❑ Shotcrete 1705.3
❑ Welding of reinforcing bars 1705.3.1
❑ Material Tests 1705.3.2
❑ Masonry Construction 1705.4
❑ Empirically designed masonry, glass unit& masonry in Risk Category IV 1705.4.1
0 Vertical masonry foundation elements 1705.4.2
❑ Wood construction 1705.5
❑ High Load Diaphragms 1705.5.1
❑ Metal-plate connected wood trusses spanning 60 feet or greater 1705.5.2
❑ Soils 1705.6 & Table 1705.6
❑ Driven deep foundations 1705.7 &Table 1705.7
❑ Cast in-place deep foundations 1705.8 & Table 1705.8
❑ Helical pile foundations 1705.9
❑ Fabricated items 1705.10
Page 3 of 4
DocuSign Envelope ID:A227FD94-05A2-4421-A014-40010BE88F4B
Special Inspection Requirements
MASON COUN-TY
COMMUNM SERVICES
❑ Special inspections for wind resistance 1705.11
❑ Structural wood 1705.11.1
❑ Wind resisting components 1705.11.3
❑ Cold formed steel light frame 1705.11.2
❑ Special inspection for seismic resistance 1705.12
❑ Special inspection for structural steel per 1705.12.1
❑ Seismic force-resisting systems 1705.12.1.1
❑ Structural steel elements 1705.12.1.2
❑ Special inspection for structural wood per 1705.12.2
❑ Special inspection for cold-formed steel per 1705.12.3
❑Designated seismic systems 1705.12.4
❑Architectural components 1705.12.5
❑Plumbing,mechanical& electrical components 1705.12.6
❑ Storage racks 1705.12.7
❑ Seismic isolation systems 1705.12.8
❑ Cold-formed steel special bolted moment frames 1705.12.9
❑Testing for seismic resistance 1705.13
❑ Structural steel 1705.13.1
❑ Seismic fore-resisting systems 1705.13.1.1
❑ Structural steel elements 1705.13.1.2
❑ Nonstructural components 1705.13.2
❑ Designated seismic systems 1705.13.3
❑ Seismic isolation systems 1705.13.4
❑ Sprayed fire-resistance materials 1705.14
❑Physical and visual tests 1705.14.1
❑ Structural member surface conditions 1705.14.2 (1705.14.3 through 1705.14.6.3)
❑ Mastic& intumescent fire-resistance costings 1705.15
❑ Exterior insulation&finish systems (EIFS) 1705.16
❑ Fire-resistance penetrations and joints 1705.17
❑Penetration firestops 1705.17.1
❑Fire-resistant joint systems 1705.17.2
❑ Testing for smoke control 1705.18
❑ Testing Scope 1705.18.1
Page 4 of 4
Page 1 of 1
20 23 -o o S�
QKmzan&Associates, Inc. Field
Geotechnical Engineering.Environmental Engineering Report NO.:10623226DFRIO232023JP
Construction Testing and Inspection
DATE: 10/23/2023 Set Count: CONTRACTOR: Rainier Construction
PROJECT#: 10623226 PERMIT#: BLD2023-00571
PROJECT: Rickett SFR INSPECTOR: John Pontius
LOCATION: 13841 E State Route 106 JURISDICTION: Mason County
KA P.M.: Wes Mahan WEATHER: Partly Cloudy TEMP:60°F
I arrived on site and met with the contractor.We went over the scope of services for today's observation,which entailed post-
installed epoxy-injected rebar dowels.
37 Holes were already drilled prior to my arrival.The contractor explained they had used a Hilti drill and a 3/4"drill bit,and I
noted that both were on site.The holes were drilled at 6 V2"to 7 11/z"depth,and I verified the embed depth.The epoxy the
contractors used was Simpson Strong-Tie SET-3G,expiration date:5/22/2025,Lot#1000360737.I observed the contractor
clean the holes with compressed air and brush,followed by the injection of epoxy and insertion of the#5 rebar dowels.I noted
that the bars had been cut to 53-inch lengths.There was no information found in the general structural notes on the plans
regarding the specific epoxy to use.However,based upon my observations,I determined that the epoxy-injected rebar dowels
were installed in accordance with the manufacturer's installation instructions and the available plan specifications.
Geoffrey
Reviewed By: Fisher —I ASTM Test#: Asset Numbe s :
To the best of my knowledge,the above WAS performed in accordance with the approved plans,specifications and
regulatory requirements.
Superintendent/Representative: Technician:
John Pontius
Krazan and Associates, Inc.
Offices Serving the Western United States
Lynnwood(425)485-5519•Poulsbo(360)598-2126•Tacoma(253)939-2500
The information provided on this report is prepared for the exclusive use of the client.This report may not be reproduced in any format without the written permission of the client and Krvmm&Associates.This report
indicates our inspectors ob—tion and testing results based on site conditions and contractor activities.This information is subject to review prior to final submittal.By signing this report,our inspector does not accept
responsibility for validity of results.The sane information has been provided by others on site.The test results apply only to the speck locations,and items inspected or tested.Template date 4/20/2023
Pate 1 of 4
l�'aZ�l1 &Associates, Inc. Field
Geotechnical Engineering i, Environmental Engineering Report NO.:10623226DFRIO2723EI
Construction Testing and Inspection
DATE: 10/27/2023 Set Count: CONTRACTOR: Rainier Construction
PROJECT#: 10623226 PERMIT#: BLD2023-00571
PROJECT: Rickett SFR INSPECTOR: Ethan Iris
LOCATION: 13841 E State Route 106 JURISDICTION: Mason County
KA P.M.: Wes Mahan WEATHER: Clear TEMP:51
The field rep arrived on site as requested.Upon arrival,the field rep met with the contractor to discuss plans and ongoing site
activities.The purpose of the visit was to perform an inspection for the hold down rebar reinforcement being epoxied in to the
foundation.The rebar was#5 rebar and the embedment depth for the rebar was specified at 6"and each vert was placed at 32"
OC.All the drilled holes were cleaned with compressed air and brush before injected with epoxy.The epoxy used was
Simpson Strongtie SET 3G high strength epoxy set#I3622-N lot#10003653 72 EXP:06/18/25.Based upon my observations,
the epoxy-injected installation of the rebar was performed in accordance with the manufacturer's installation instructions and
the applicable plans.
TION JOINTS
L
4. it
4.
- T C'yN
Offices Serving the Western United States
Lynnwood(425)485-5519 a Poulsbo(360)598-2126 a Tacoma(253)939-2500
The information provided on this report is prepared for the exclusive use of the client.This report mmy not be reproduced in my format without the written permission of the client mid K sn&Associates.This report
indicates our inspectors observation and testing results based on site conditions and contractor activities.This information is subject to revim prior to final submittal.By signing this report.our inspector does not accept
responsibilm for validity of results.The same information has been provided by others on site.The test msuhs apph.only to the specific locations.and items inspected or tested.Template date 10/4/2023
��]] Page 2 of 4
��a� n &Associates, Inc. Field
Geotechnical Engineering.Environmental Engineering Report NO.:10623226DFRIO2723EI
Construction Testing and Inspection
L kL
P
yes:
3 .
p
r2, ,
Offices Serving the Western United States
Lynnwood(425)485-5519 a Poulsbo(360)598-2126 a Tacoma(253)939-2500
The information provided on this report is prepared for the exclusive use of the client.This report—not be reproduced in my format without the written permission of the client and Kr &Associates.This report
indicates our inspectors observation and testing resuhs based on site conditions and contractor activities.This information is subject to mrim prior to final submittal.By signing this report,our inspector does not accept
responsibility for validih of results.The same information has been provided bA others on site.The test results apple only to the specific locations.and items inspected or tested.Template date 10/42023
Page 3 of 4
&Associates, Inc. Field
Geotechnical Engineering *Environmental Engineering Report NO.:10623226DFR102723EI
Construction Testing and Inspection
I
A
} R
rtw'a
a„+
Offices Serving the Western United States
Lynnwood(425)485-5519•Poulsbo(360)598-2126•Tacoma(253)939-2500
The information provided on this report is prepared for the exclusive use of the client.This report may not be reproduced in any format without the written permission of the client and Kr-an&Associates.This report
indicates our inspectors observation and testing results based on site conditions and contractor activities.This information is subject to review prior to final submittal.By signing this report,our inspector does not accept
responsibility for validity,of results.The same information has been provided b%others on site.The test results apply only to the speck locations,and items inspected or tested.Template date 10/4/2023
Page 4 of 4
_Krazan &Associates, Inc. Field
Geotechnical Engineering. Environmental Engineering Report NO.: 10623226DFRIO2723EI
Construction Testing and Inspection
Geoffrey
Reviewed By: Fisher ASTM Test#: Asset Numbers
To the best of my knowledge,the above WAS performed in accordance with the approved plans,specifications and
regulatory requirements.
Superintendent/Representative: Technician:
Offices Serving the Western United States
Lynnwood(425)485-5519•Poulsbo(360)598-2126•Tacoma(253)939-2500
The information provided on this report is prepared for the exclusive use of the client.This report may not be reproduced many format without the H tten permission of the client and Kra an&Associates.This report
indicates our inspectors observationreview prior and testing results based on site conditions and contractor activities.This information is subject to revi prior to final submittal.By signing this report.oar inspector does not accept
responsibility for calidih.of results.The same information has been provided be others on site.The test results apph,only to the specific locations.and items inspected or tested.Template date 10/42023
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StrtictLasiSrdmimis S2A01
a«uM T..—I IMrllaxl FOUNDATION PLAN
wxw.C(t tulKl;ea.(m)
Mason County
Mason County - Division of Community Development
615 W. Alder St.
H'C Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
FREMODEL
3-00571 ADDITION OR REMODEL-
RESIDENTIAL
DESCRIPTION: RAISE EXISTING HOUSE -2' ABOVE BFE & ISSUED: 06/30/2023
ESS: 13841 E STATE ROUTE 106 BELFAIR EXPIRES: 12/27/2023
PARCEL: 222212400320
APPLICANT: RICKETT SCOTT& SANDRA M OWNER: RICKETT SCOTT&SANDRA M
13841 E SR 106 13841 E SR 106
BELFAIR, WA 98528 BELFAIR, WA98528
425-736-9973
OWNER'S REP: Teresa Fortino
4001 35th AVE NW
GIG HARBOR, WA 98335
253-318-7078
GENERAL CONTRACTOR'S LICENSE: RAINIER CONSTRUCTION License: RAINIC'840138
3404 57TH ST CT, SUITE B Expires: 02/05/2024
GIG HARBOR,WA 98335
1.360.265.0914
VALUATIONS: FEES: Paid Due
Project Valuation (BID, 421006.67 $421,006.67 Plumbing Fees $72.00 $0.00
ESTIMATION..) State Fee-Residential $6.50 $0.00
Technology Surcharge $104.65 $0.00
Plan Check Fee $1,995.81 $0.00
Building Permit Fee $3,070.48 $0.00
Mechanical Base Fee $30.00 $0.00
Planning Review Fee $240.00 $0.00
Plumbing Base Fee $25.00 $0.00
Mechanical Fees $39.00 $0.00
Building Permit Fee $404.35 $0.00
Total: $421,006.67 Totals : $5,987.79 $0.00
FIXTURES
Printed by:Amber Selby on:06/30/2023 11:36 AM
Page 1 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2023-00571
Qty Mechanical Fixtures City Plumbing Fixtures
1.0000 Heat Pump(s) 1.0000 Number of Kitchen Sinks
2.0000 Spot Vent Fan(s) 1.0000 Number of Showers
1.0000 Number of Water Heaters and or Vent
2.0000 Number of Toilets
3.0000 Bathroom Sink
REQUIRED INSPECTIONS
Setback Inspection Framing Inspection
Footing Inspection Rough- Plumbing Inspection
Foundation Wall-Pre-Pour Inspection Mechanical Inspection
Underfloor Inspection Insulation Inspection
Shearwall Inspection BLD-Final Inspection
CONDITIONS
All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor
increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way.
Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
" 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).
Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance
with Mason County Title 14.28 and 14.17.
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 1-800-647-0982. The person signing this condition is either
the homeowner, agent for the owner or a registered contractor according to WA state law.
A minimum of 90 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance
with IECC/WSEC Section R404.1.
Printed by:Amber Selby on:06/30/2023 11:36 AM
Page 2 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
lil Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2023-00571
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 acknowledging that all components of the stormwater
management system have been installed as approved on the stormwater site plan. 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.
* All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building
Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration.
Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No
more than one extension may be granted.
* Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer
specifications and in accordance with IRC Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level
of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of
fuel burning appliances), repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or
created.
* All building permits shall have a final inspection performed and approved by 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 ordinances and building regulations.
* The foundation/footing must be placed on undisturbed, firm-native soil. Proper frost depth shall be observed below grade
in undisturbed soils.
* Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a
permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor
& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-
4000.
* Adopted Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine -4C, Window(Max U-
Factor):0.30, Skylight (Max U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation
R-30, Ceiling Insulation min. R-49, Vault Insulation R-38, and Slab Insulation R-10.
* The stamped 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, 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.
Printed by:Amber Selby on:06/30/2023 11:36 AM
Page 3 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2023-00571
* 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 Site Plan"to ensure these structures are shown and meet the setback conditions listed.
* Before renovating or remodeling activities in pre-1978 residential buildings or child occupied facilities and to ensure your
compliance with applicable Washington lead regulations, contact the WA State Department of Commerce Lead Paint
Program at; (360) 586-5323 or email Ibpinfo@commerce.wa.gov. Visit www.commerce.wa.gov/lead for further information.
* When parcel development requires direct access to state road(s), a Road Access Permit or Approval must be granted and
approved by the Washington State Department of Transportation. For more information contact Washington State
Department of Transportation, at (206)357-2620, ext. 630.
* The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more
than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards
for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to
another fire apparatus access road which connects to a county maintained public road.
* All construction must meet or exceed all local and state ordinances in addition to 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 revocation.
* 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
contact the Mason County Public Works Department prior to construction at Ext 450
* Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly
corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of
pressure treated material.
* The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility
of the applicant, owner or contractor to make the required 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 approved documents will result in failure of required building inspections.
* OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit
revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or
contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained
permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County
access to the above described property and structure(s) for review and inspection. This permit/application becomes null &
void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
* WIND LOADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind
speed for Mason County is 85 MPH.
* 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 shall be made prior to requesting
additional inspections.
Printed by:Amber Selby on:06/30/2023 11:36 AM
Page 4 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
4100 Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2023-00571
The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not
allowed without the approval of the Mason County Fire Marshal.
* All property lines shall be clearly identified at the time of foundation inspection.
* All RED stamped 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 prior to any further inspections
being performed or approvals granted.
* Installation of heating equipment in a single-family residence shall meet the requirements of the current WSEC R403,
applicable sections of the IRC, and IMC.
Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.7. Heating and design load calculations for the
purpose of sizing HVAC systems are required and shall be calculated in accordance with accepted practice, including
infiltration and ventilation. Design calculations shall be available for inspection during inspection.
Referencing IRC M1601.4, all ducts, air handlers, filter boxes, and building cavities shall be sealed. All joints of duct
systems and seams shall be made substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other
approved closure systems. Closure systems used with rigid fibrous glass ducts shall comply with UL181A and shall be
marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape. Closure systems used
with flexible air ducts and flexible air connectors shall comply with UL181 B and shall be marked 181 B-FX for pressure-
sensitive tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings
shall be mechanically fastened. Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181 B
and shall be marked 181 B-C. Crimp joints for round metal ducts shall have a contact lap of at least 1-1/2 inches (38 mm)
and shall be mechanically fastened by means of at least three sheet-metal screws or rivets equally spaced around the joint.
Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation
instructions.
Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be
insulated to R-8
DUCT TIGHTNESS TESTING shall be conducted by person(s)trained to perform such testing. A signed affidavit
documenting test results in accordance to IECC/WSEC Section R403.3.3 shall be provided to the Mason County Building
Department prior to the final occupancy inspection. Affidavit forms are available on at the WSU-Energy Program website
titles, "Duct Leakage Affidavit"or"Duct Leakage Testing Results (Existing Construction)." Duct tightness testing is not
required if the air handler and all ducts are located within the heated space.
* REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable
provisions of the current code and the manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs.
* 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.
* No expansion of the existing footprint is permitted.
Printed by:Amber Selby on:06/30/2023 11:36 AM
Page 5 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
N`C Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2023-00571
FOUNDATION IN FLOOD HAZARD (A&AE)ZONE WITH A BFE
This project is approved construct a dwelling structure with a new foundation system in accordance with the Mason County
Flood Damage Ordinance and the 2018 International Residential Code Section R322. The location of the structure is
identified as an AE Flood Hazard area in accordance with FEMA determination. Minimum construction criteria are as follows:
The floor of the structure shall be elevated at least one-foot (1'0") above the Base Flood Elevation (BFE) (BFE=14.00 for this
site). The finished floor must be at{15.00) or above.
The design professional that prepared the Elevation Certificate must perform an inspection of the foundation and placement
prior for pour.
The crawlspace shall be provided with at least 2-openings on each side of the enclosed crawl space and be equal to at least
1 sq. inch for each sq. ft. of enclosed area. The openings shall allow for the automatic entry and exit of floodwaters and be
placed such that the bottom of each flood vent is not more than 1-foot above the lowest adjacent exterior grade and interior
grade. (IRC R322.2.2.1)
Electrical systems, equipment, heating, ventilation, air conditioning, plumbing appliances and plumbing fixtures, duct
systems, and other similar systems shall be located at or above the BFE unless designed to prevent water from entering or
accumulating within the components and to resist hydrostatic and hydrodynamic loads and stresses. (IRC R322.1.6)
All building materials used below the BFE shall be pressure-preservative treated in accordance with AWPA U1 or be
naturally resistant to decay. In addition, materials and installation methods used for flooring and interior and exterior walls
and walls coverings shall conform to the provisions of FEMA/FIA-TB-2. (IRC R322.1.8)
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 and shall be collected by the
Building Department prior to any further inspections being performed or approvals granted.
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of work will be complied with whether
specified herein or not. hNf
permit does not presume to give authority to violate or cancel
the provisions any o ew regulating construction or the performance of construction.
Issued By•
Contractor or Authorized Agent: Date: &
Printed by:Amber Selby on:06/30/2023 11:36 AM
Page 6 of 6
U.S. DEPARTMENT OF HOMELAND SECURITY OMB Control No.1660-0008
Federal Emergency Management Agency Expiration Date:06/30/2026
National Flood Insurance Program
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2) insurance agent/company, and (3)building owner.
SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name: SCOTT& SANDRA RICKETT Policy Number:
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: Company NAIC Number:
13841 E STATE ROUTE 106
City: BELFAIR State: WA ZIP Code: 98528-8529
A3. Property Description (e.g., Lot and Block Numbers or Legal Description)and/or Tax Parcel Number:
TPN 22221-24-00320
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.): RESIDENTIAL
A5. Latitude/Longitude: Lat. 47.382318' Long.-122.941500' Horiz. Datum:❑ NAD 1927 ® NAD 1983 ❑WGS 84
A6. Attach at least two and when possible four clear color photographs(one for each side)of the building (see Form pages 7 and 8).
AT Building Diagram Number: 6
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s): 720 sq.ft.
b) Is there at least one permanent flood opening on two different sides of each enclosed area? ® Yes ❑ No ❑ N/A
c) Enter number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade:
Non-engineered flood openings: 0 Engineered flood openings: 4
d) Total net open area of non-engineered flood openings in A8.c: 0 sq.in.
e) Total rated area of engineered flood openings in A8.c(attach documentation-see Instructions): 1000 sq.ft.
f) Sum of A8.d and A8.e rated area(if applicable-see Instructions): 1000 sq.ft.
A9. For a building with an attached garage:
a) Square footage of attached garage: 168 sq.ft.
b) Is there at least one permanent flood opening on two different sides of the attached garage? ®Yes ❑ No ❑ N/A
c) Enter number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade:
Non-engineered flood openings: Engineered flood openings: 2
d) Total net open area of non-engineered flood openings in A9.c: 0 sq. in.
e) Total rated area of engineered flood openings in A9.c(attach documentation-see Instructions): 500 sq.ft.
f) Sum of A9.d and A9.e rated area(if applicable-see Instructions): 500 sq.ft.
SECTION B-FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1.a. NFIP Community Name: UNINCORPORATED MASON COUNTY B1.b. NFIP Community Identification Number: 53011
B2. County Name: MASON COUNTY B3. State:WA B4. Map/Panel No.: 53045CO315 B5. Suffix: E
B6. FIRM Index Date: 06/20/2019 B7. FIRM Panel Effective/Revised Date: 06/20/2019
B8. Flood Zone(s): AE B9. Base Flood Elevation(s)(BFE)(Zone AO, use Base Flood Depth): 14
B10. Indicate the source of the BFE data or Base Flood Depth entered in Item 139:
❑ FIS ® FIRM ❑Community Determined ❑Other:
B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 ®NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ® No
Designation Date: ❑CBRS ❑OPA
B13. Is the building located seaward of the Limit of Moderate Wave Action(LiMWA)? ❑Yes ❑No
FEMA Form FF-206-FY-22-152 (formerly 086-0-33)(8/23) Form Page 2 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
13841 E STATE ROUTE 106
Policy Number:
City: BELFAIR State: WA ZIP Code: 98528-8529
Company NAIC Number:
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction` ® Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones Al—A30,AE,AH,AO,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO,
A99. Complete Items C2.a—h below according to the Building Diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: SmartNetNA Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h) below.
❑ NGVD 1929 ® NAVD 1988 ❑Other:
Datum used for building elevations must be the same as that used for the BFE. Conversion factor used? ❑ Yes ® No
If Yes,describe the source of the conversion factor in the Section D Comments area.
Check the measurement used:
a) Top of bottom floor(including basement,crawlspace, or enclosure floor): 11.9 ® feet ❑ meters
b) Top of the next higher floor(see Instructions): 16.0 ® feet ❑ meters
c) Bottom of the lowest horizontal structural member(see Instructions): ® feet ❑ meters
d) Attached garage(top of slab): 13.6 ® feet ❑ meters
e) Lowest elevation of Machinery and Equipment(M&E) servicing the building
(describe type of M&E and location in Section D Comments area): 16.0 ® feet ❑ meters
f) Lowest Adjacent Grade(LAG) next to building: ® Natural ❑ Finished 7.0 ® feet ❑ meters
g) Highest Adjacent Grade(HAG) next to building: ® Natural ❑ Finished 13.7 ❑ feet ❑ meters
h) Finished LAG at lowest elevation of attached deck or stairs, including structural
support: 3.8 ® feet ❑ meters
SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by state law to certify elevation
information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any
false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑No
❑Check here if attachments and describe in the Comments area.
Certifier's Name: Daniel B. Johnson License Number: 28408
-..Joy
Title: Managing Director
Company Name: Aspen Land Surveying LLC
Address: 15510 92nd Street NW �`•. o
City: Gig Harbor State: WA ZIP Code: 98329 Adss
Telephone: (253) 303-0270 Ext.: Email:danjohnson@aspenland.com
ooe. N.11d o.n.ie.onnxn
/J ON:�n-o.ni.i B.Jw,nwn.o=ap.n—s�uc.o.-A
C-. -y�Yy�gG—_� landsur..yYgLLc..ne�a.npnmon�a,p.nhne.wm.ous Place Seal Here
Signature: Y a.M..d'7.12 3==:�-0r� Date: 07/12/2024
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company, and(3)building owner.
Comments(including source of conversion factor in C2;type of equipment and location per C2.e; and description of any attachments):
C2.e): Heat Pump C2.h): Bottom of Piling
See attached certification for engineered flood vents.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(8/23) Form Page 3 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
13841 E STATE ROUTE 106
Policy Number:
City: BELFAIR State: WA ZIP Code: 98528-8529
Company NAIC Number:
SECTION E—BUILDING MEASUREMENT INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO,ZONE AR/AO,AND ZONE A (WITHOUT BFE)
For Zones AO,AR/AO, and A(without BFE),complete Items E1—E5. For Items El—E4, use natural grade, if available. If the Certificate is
intended to support a Letter of Map Change request, complete Sections A, B,and C. Check the measurement used. In Puerto Rico only,
enter meters.
Building measurements are based on: ❑Construction Drawings' ❑ Building Under Construction` ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
El. Provide measurements(C.2.a in applicable Building Diagram)for the following and check the appropriate boxes to show whether the
measurement is above or below the natural HAG and the LAG.
a) Top of bottom floor(including basement,
crawlspace, or enclosure)is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor(including basement,
crawlspace,or enclosure) is: ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),the
next higher floor(C2.b in applicable
Building Diagram)of the building is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage(top of slab)is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown The local official must certify this information in Section G.
SECTION F—PROPERTY OWNER(OR OWNER'S AUTHORIZED REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without BFE)or Zone AO must
sign here. The statements in Sections A, B, and E are correct to the best of my knowledge
❑ Check here if attachments and describe in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Telephone: Ext.: Email:
Signature: Date:
Comments:
FEMA Form FF-206-FY-22-152 (formerly 086-0-33)(8/23) Form Page 4 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
13841 E STATE ROUTE 106 Policy Number:
City: BELFAIR State: WA ZIP Code: 98528-8529
Company NAIC Number:
SECTION G—COMMUNITY INFORMATION (RECOMMENDED FOR COMMUNITY OFFICIAL COMPLETION)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Section A, B, C, E, G, or H of this Elevation Certificate. Complete the applicable item(s) and sign below when:
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer, or architect who is authorized by state law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2.a. ❑ A local official completed Section E for a building located in Zone A(without a BFE),Zone AO, or Zone AR/AO, or when item
E5 is completed for a building located in Zone AO.
G2.b. ❑ A local official completed Section H for insurance purposes.
G3. ❑ In the Comments area of Section G,the local official describes specific corrections to the information in Sections A, B, E and H.
G4. ❑ The following information(Items G5—G11) is provided for community floodplain management purposes.
G5. Permit Number: G6. Date Permit Issued:
G7. Date Certificate of Compliance/Occupancy Issued:
G8. This permit has been issued for: ❑New Construction ❑ Substantial Improvement
G9.a. Elevation of as-built lowest floor(including basement)of the
building: ❑ feet ❑ meters Datum:
G9.b. Elevation of bottom of as-built lowest horizontal structural
member: ❑feet ❑ meters Datum:
G10.a. BFE (or depth in Zone AO)of flooding at the building site: ❑ feet ❑ meters Datum:
G10.b. Community's minimum elevation (or depth in Zone AO)
requirement for the lowest floor or lowest horizontal structural
member: ❑feet ❑ meters Datum:
G11. Variance issued? ❑Yes ❑ No If yes,attach documentation and describe in the Comments area.
The local official who provides information in Section G must sign here. 1 have completed the information in Section G and certify that it is
correct to the best of my knowledge. If applicable, I have also provided specific corrections in the Comments area of this section.
Local Official's Name: Title:
NFIP Community Name:
Telephone: Ext.: Email:
Address:
City: State: ZIP Code:
Signature: Date:
Comments(including type of equipment and location, per C2.e; description of any attachments;and corrections to specific information in
Sections A, B, D, E,or H):
FEMA Form FF-206-FY-22-152(formerly 086-0-33) (8/23) Form Page 5 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
13841 E STATE ROUTE 106
Policy Number:
City: BELFAIR State: WA ZIP Code: 98528-8529
Company NAIC Number:
SECTION H— BUILDING'S FIRST FLOOR HEIGHT INFORMATION FOR ALL ZONES
(SURVEY NOT REQUIRED) (FOR INSURANCE PURPOSES ONLY)
The property owner,owner's authorized representative, or local floodplain management official may complete Section H for all flood zones
to determine the building's first floor height for insurance purposes. Sections A, B, and I must also be completed. Enter heights to the
nearest tenth of a foot(nearest tenth of a meter in Puerto Rico). Reference the Foundation Type Diagrams(at the end of Section H
Instructions)and the appropriate Building Diagrams(at the end of Section I Instructions) to complete this section.
H1. Provide the height of the top of the floor(as indicated in Foundation Type Diagrams)above the Lowest Adjacent Grade(LAG):
a) For Building Diagrams 1A, 1B,3,and 5-8.Top of bottom ❑ feet ❑ meters ❑ above the LAG
floor(include above-grade floors only for buildings with
crawlspaces or enclosure floors)is:
b) For Building Diagrams 2A, 213,4,and 6-9.Top of next ❑feet ❑ meters ❑ above the LAG
higher floor(i.e.,the floor above basement,crawlspace,or
enclosure floor)is:
H2. Is all Machinery and Equipment servicing the building(as listed in Item H2 instructions)elevated to or above the floor indicated by the
H2 arrow(shown in the Foundation Type Diagrams at end of Section H instructions)for the appropriate Building Diagram?
[:] Yes ❑ No
SECTION I— PROPERTY OWNER(OR OWNER'S AUTHORIZED REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and H must sign here. The statements in Sections
A, B, and H are correct to the best of my knowledge. Note: If the local floodplain management official completed Section H,they should
indicate in Item G2.b and sign Section G.
❑ Check here if attachments are provided(including required photos)and describe each attachment in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Telephone: Ext.: Email:
Signature: Date:
Comments:
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(8/23) Form Page 6 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
BUILDING PHOTOGRAPHS
See Instructions for Item A6.
Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
13841 E STATE ROUTE 106
Policy Number:
City: BELFAIR State: WA ZIP Code: 98528-8529
Company NAIC Number:
Instructions: Insert below at least two and when passible four photographs showing each side of the building (for example, may only be
able to take front and back pictures of townhouses/rowhouses). Identify all photographs with the date taken and"Front View,"'Rear View,"
"Right Side View,"or"Left Side View." Photographs must show the foundation.When flood openings are present, include at least one
close-up photograph of representative flood openings or vents,as indicated in Sections A8 and A9.
E
u
Photo One
Photo One Caption: NORTHWEST SIDE 7-9-2024 Clear Photo One
Photo Two
Photo Two Caption: EAST SIDE 7-9-2024 Clear Photo Two
FEMA Form FF-206-FY-22-152(formerly 086-0-33) (8/23) Form Page 7 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
BUILDING PHOTOGRAPHS
Continuation Page
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
13841 E STATE ROUTE 106
Policy Number:
City: BELFAIR State: WA ZIP Code: 98528-8529
Company NAIC Number:
Insert the third and fourth photographs below. Identify all photographs with the date taken and"Front View,""Rear View," "Right Side
View,"or"Left Side View."When flood openings are present, include at least one close-up photograph of representative flood openings or
vents,as indicated in Sections A8 and A9.
1
f
Photo Three
Photo Three Caption: SOUTH SIDE 7-9-2024 Clear Photo Three
Photo Four
Photo Four Caption: Typical Engineered Flood Vent Clear Photo Four
FEMA Form FF-206-FY-22-152 (formerly 086-0-33)(8/23) Form Page 8 of 8
ESIcc
ICC-ES Evaluation Report ESR-4332
Reissued March 2020
Revised May 2021
This report is subject to renewal March 2022.
wwwAcc-es.org 1 (800)423-6587 1 (562) 699-0543 A Subsidiary of the International Code Council®
DIVISION: 08 00 00—OPENINGS 3.2 Engineered Opening:
Section: 08 95 43—Vents I Foundation Flood Vents The FV complies with the design principle noted in
REPORT HOLDER: Section 2.7.2.2 and Section 2.7.3 of ASCE/ SEI 24-14
(2021, 2018 and 2015 IBC and IRC) [Section 2.6.2.2 of
SMART PRODUCT INNOVATIONS,INC. ASCE/ SEI 24-05 (2012, 2009, 2006 IBC and IRC)] for a
maximum rate of rise and fall of 5.0 feet per hour
EVALUATION SUBJECT: (0.423 mm/s). In order to comply with the engineered
opening requirement of ASCE/ SEI 24, Freedom Flood
FREEDOM FLOOD VENTTm AUTOMATIC FOUNDATION Vent" FVs must be installed in accordance with Section
FLOOD VENT: MODEL FFV-1608 4.0 below. See Table 1 for vent size and maximum
allowable area coverage for a single vent.
1.0 EVALUATION SCOPE 4.0 DESIGN AND INSTALLATION
Compliance with the following codes: The model FFV-1608 Freedom Flood Vent- is designed to
be installed into walls or overhead doors of existing or new
■ 2021, 2018, 2015, 2012, 2009 and 2006 International construction. Installation of the vent must be in accordance
Building Code®(IBC) with the manufacturer's instructions, the applicable code,
■ 2021, 2018, 2015, 2012, 2009 and 2006 International and this report. In order to comply with the engineered
Residential Code®(IRC) opening design principle noted in Sections 2.7.2.2 and
2.7.3 of ASCE/SEI 24-14 (2021, 2018 and 2015 IBC and
Properties evaluated: IRC) [Section 2.6.2.2 of ASCE/ SEI 24-05 (2012, 2009,
■ Physical operation 2006 IBC and IRC)], the Freedom Flood Vent" must be
installed as follows:
■ Water flow ■ With a minimum of two openings on different sides of
■ Weathering each enclosed area.
2.0 USES ■ With a minimum of one FV for every 250 square feet
The model FFV-1608 Freedom Flood Vent'" is used to (23.2 m2)of enclosed area.
equalize hydrostatic pressure on walls of enclosures ■ Below the base flood elevation.
subject to rising or falling floodwaters. With the cover ■ With the bottom of the vent located a maximum of
removed, the model FFV-1608 also provides natural air 12 inches (305.4 mm) above the higher of the final
ventilation. interior grade or floor and the finished exterior grade
3.0 DESCRIPTION immediately under each opening.
3.1 General: 5.0 CONDITIONS OF USE
The Freedom Flood Vent- described in this report
The model FFV-1608 Freedom Flood Vent' is an complies with, or is a suitable alternative to what is
engineered mechanically operated in-wall flood vent (FV) specified in,those codes listed in Section 1.0 of this report,
that automatically allows floodwater to enter an enclosed subject to the following conditions:
area and exit. The FV is comprised of a polycarbonate
frame with mounting flange and a polycarbonate 5.1 The model FFV-1608 Freedom Flood Vent unit must
horizontally pivoting door. When subjected to rising water, be installed in accordance with this report, the
the model FFV-1608 Freedom Flood Vent- door is applicable code and the manufacturer's published
activated and pivots to allow water and debris to flow in installation instructions. In the event of a conflict, the
either direction to equalize hydrostatic pressure from one instructions in this report shall govern.
side of the enclosure to the other. The FV features a 5.2 The model FFV-1608 Freedom Flood Vent" unit must
removable polycarbonate cover. The FV door will activate not be used in place of"breakaway walls" in coastal
and pivot when subjected to rising water with or without the high hazard areas, but are permitted for use in
polycarbonate cover installed. conjunction with breakaway walls in other areas.
ICC-ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed,nor are they to be construed
as an endorsement of the subject of the report or a recommendation for its use.There is no warranty by ICC Evaluation Service,LLC,express or implied,as C
to any finding or other matter in this report,or as to any product covered by the report
Copyright 0 2021 ICC Evaluation service,LLC. All rights reserved. Page 1 of 4
ESR-4332 I Most Widely Accepted and Trusted Page 2 of 4
5.3 Use of the Freedom Flood Vent as under-floor space 7.2 The report holder's contact information is the
ventilation is outside the scope of this report. following:
6.0 EVIDENCE SUBMITTED SMART PRODUCT INNOVATIONS,INC.
Data in accordance with the ICC-ES Acceptance Criteria 430 ANDBRO DRIVE, UNIT 1
for Mechanically Operated Flood Vents (AC364), dated PITMAN,NEW JERSEY 08071
August 2015(editorially revised February 2021). (800)507-1527
www.freedomfloodvent.com
7.0 IDENTIFICATION info(&freedomfloodvent.co
7.1 The Freedom Flood Vent- model described in this
report must be identified by a label bearing the
manufacturer's name (Smart Product Innovations,
Inc.)and the evaluation report number(ESR-4332).
TABLE 1—FREEDOM FLOOD VENT TM
MODEL NAME MODEL NUMBER MODEL SIZE COVERAGE(sq.ft.)
Freedom Flood VentT" FFV-1608 153/4'X 8'/,s" 250
For SI: 1 inch=25.4 mm
FIGURE 1—MODEL FFV-1608 FREEDOM FLOOD VENTT"":SHOWN WITH COVER REMOVED
FIGURE 2—MODEL FFV-1608 FREEDOM FLOOD VENT TM:SHOWN WITH FLOOD DOOR PIVOTED OPEN
ESICC
ICC-ES Evaluation Report ESR-4332 CBC and CRC Supplement
Reissued March 2020
Revised May 2021
This report is subject to renewal March 2022.
www.icc-es.org 1 (800)423-6587 1 (562) 699-0543 A Subsidiary of the International Code Council°
DIVISION: 08 00 00—OPENINGS
Section: 08 95 43—Vents/Foundation Flood Vents
REPORT HOLDER:
SMART PRODUCT INNOVATIONS, INC.
EVALUATION SUBJECT:
FREEDOM FLOOD VENTTM AUTOMATIC FOUNDATION FLOOD VENT: MODEL FFV-1608
1.0 REPORT PURPOSE AND SCOPE
Purpose:
The purpose of this evaluation report supplement is to indicate that the Freedom Flood Vent- Automatic Foundation Flood
Vent: Model FFV-1608, described in ICC-ES evaluation report ESR-4332, has also been evaluated for compliance with
codes noted below.
Applicable code edition(s):
■ 2019 California Building Code(CBC)
For evaluation of applicable chapters adopted by the California Office of Statewide Planning and Development(OSHPD)and
Division of State Architect(DSA), see Sections 2.1.1 and 2.1.2 below.
■ 2019 California Residential Code(CRC)
2.0 CONCLUSIONS
2.1 CBC:
The Freedom Flood Vent- Automatic Foundation Flood Vent: Model FFV-1608, described in Sections 2.0 through 7.0 of the
evaluation report ESR-4332, complies with CBC Chapter 12 provided the design and installation are in accordance with the
2018 International Building Code® (IBC) provisions noted in the evaluation report and the additional requirements of CBC
Chapters 12 and 16, as applicable.
2.1.1 OSHPD: The applicable OSHPD Sections and Chapters of the CBC are beyond the scope of this supplement.
2.1.2 DSA: The applicable DSA Sections and Chapters of the CBC are beyond the scope of this supplement.
2.2 CRC:
The Freedom Flood Vent- Automatic Foundation Flood Vent: Model FFV-1608, described in Sections 2.0 through 7.0 of the
evaluation report ESR-4332, complies with the 2019 CRC, provided the design and installation are in accordance with the
2018 International Residential Code®(I RC)provisions noted in the evaluation report.
This supplement expires concurrently with the evaluation report, reissued March 2020 and revised May 2021.
ICC-ES Evaluation Reporls are not 10 be construed as representing aesthetics or anv other attributes not.specifically addressed,nor are they io be construed
as an endorsement of the subject of the report or a recommendation for itsuse.There is no warranty by ICC Evaluation Service,LLC,express or ineplied,as
to any finding or other matter in this report,or as to any product covered by the report.
Copyright 0 2021 ICC Evaluation Service,LLC. All rights reserved. Page 3 of 4
r�
ESIN
ICC-ES Evaluation Report ESR-4332 FBC Supplement
Reissued March 2020
Revised May 2021
This report is subject to renewal March 2022.
www.icc-es.org 1 (800) 423-6587 1 (562) 699-0543 A Subsidiary of the International Code Council®
DIVISION: 08 00 00—OPENINGS
Section: 08 95 43—Vents/Foundation Flood Vents
REPORT HOLDER:
SMART PRODUCT INNOVATIONS, INC.
EVALUATION SUBJECT:
FREEDOM FLOOD VENTTm AUTOMATIC FOUNDATION FLOOD VENT: MODEL FFV-1608
1.0 REPORT PURPOSE AND SCOPE
Purpose:
The purpose of this evaluation report supplement is to indicate that Freedom Flood Vent' Automatic Foundation Flood Vent:
Model FFV-1608, described in ICC-ES evaluation report ESR-4332, has also been evaluated for compliance with the codes
noted below.
Applicable code editions:
■ 2020 Florida Building Code—Building
■ 2020 Florida Building Code—Residential
2.0 CONCLUSIONS
The Freedom Flood VentTm Automatic Foundation Flood Vent: Model FFV-1608, described in Sections 2.0 through 7.0 of the
evaluation report ESR-4332, complies with the Florida Building Code—Building and the Florida Building Code—Residential,
provided the design requirements are determined in accordance with the Florida Building Code—Building and the Florida
Building Code—Residential, as applicable. The installation requirements noted in ICC-ES evaluation report ESR-4332 for
the 2018 International Building Code® (IBC) meet the requirements of Florida Building Code—Building and the Florida
Building Code—Residential, as applicable.
Use of the Freedom Flood Vent' Automatic Foundation Flood Vent: Model FFV-1608 has also been found to be in
compliance with the High-Velocity Hurricane Zone provisions of the Florida Building Code—Building and the Florida Building
Code—Residential.
For products falling under Florida Rule 61G20-3, verification that the report holder's quality assurance program is audited
by a quality assurance entity approved by the Florida Building Commission for the type of inspections being conducted is the
responsibility of an approved validation entity (or the code official, when the report holder does not possess an approval by
the Commission).
This supplement expires concurrently with the evaluation report, reissued March 2020 and revised May 2021.
ICGLi.S Evaluation Reports are not to be construed as representing aesthetics or anv other attributes not specifically addressed,nor are they to be construed �:��' 0
as an endorsement of the subject of the report or a recommendation for its use.There is no warranty by KC Evaluation Service,LLC,express or implied,as �
to any finding or other mailer in this report,or as to any product covered by the report. v ...
Copyright 0 2021 ICC Evaluation Service,L.L.C. All rights reserved. Page 4 of 4