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PERMIT NO.: MIS 17-O 7 71/
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLI O NT INFORMATION CONTRACTOR I RMATION
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Owner EAlPAL1 4 7� ^I0
IV z 4Ji Contractor Name /' t_7f. �o . �F�=
Mailing Addres S'el — — AC.E - Mailing Address Po &F7 OS
City=Ai`lOti140S StateLU4 Zip Code F&096 CitybgFL CAi State A Zip Code (n
Phone( Other Ph.( Other Ph.(
Lien/Title Holder Contractor Reg. #
Address Expiration
PARCEL INFORMATION-12 digit Tax Parcel No. / U / CC10 Fire District
Legal Description S 3lo TLUt=';c t H I e__ olt-1—S n
Site Address(include street name and city al J/47 A Fe
Directions to site, N/LEA IUESrO -r1 L11Al1) <r47-6 PA bAJ ?,/ 14r P op.
/ 4) k) _,c SITE /,S J77_iS1— 4ASr DF /�ORAE OIAJK N,0415E I
Will timber be cut and sold in parcel preparation? (Yes/No)NO
Is your property within 200' of the following: Body of Water (Name),40a,0 &A/A4, Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add /f Alt Repair Other Use of Building j
Describe proposed construction( DAVST2UCr Plea 4_41z ALL �A /� x S/U��aNSreucT"
Jlru ' .2o. ' rlOL)6L 2 X �O. E2 To fv2n o.' X otO. S( YP
SHORELINE PROJECTS New Replacement Repair Expansion
Bulkhead Material (concrete, rock, wood, etc.) Length Height
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the
ordinan)e requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued
will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall
first obtaining approval. be made without first obtaining approval.
! �l
X ` C. '4 % X Date
I
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by � Date / Submittal Amount Due Receipt No. -
DEPARTMENTAL REVIEW PP DENIED CONDITION CODES
Building Department
Occ Grp Type of Const.
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
FEES
Building Permit Fee Site Inspection
Plan Review Fee Other
UFC Plan Review Fee Other
Violation Fee Pre-Paid at Submittal ( )
T OTALFEE S
1
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
j date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by j
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07/18/2000 Information Summary for Case #: MIS99-00774
4:13:22 PM
Condition
Cond. Stall. Changed Updated
Code Title Hold Status Changed By Tag Updated By
0036 8 Inch Minimum Surface-Floating Not Met 04/25/2000 SLO
The rf c oaf ructures shall be a minimum of eight inches above the surface of the water.
X
0037 Intermittent Supports Not Met 04/25/2000 SLO
All floating structures sh I i clu inter i nt supports which run parallel to the shoreline to keep structures off the
tidelands at low tide.X i
0180 Safe Condition- Docks Not Met A ',� r�04/25/2000 SLO
Dock facilities must be maintained in a safe and sound condition.X
0200 Site Plan 0 Not Met / _ .� 06/09/2000 SKM
Approved per dimensions and setbacks on submitted site-plan.X
0499 PLANS REQUIRED ON SITE 0 Not Met 06/09/2000 SKM
All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site,
Appro al WILL NOT be granted. In addition,a Re-Inspection fee in the amount of$42.00 per hour(minimum 1 hour)will
be c1faraed a d must �yllected by this department prior to any further inspections being performed or approval granted.
X ll 0
1002 POST ADDRESS 0 Not Met 06/09/2000 SKM
PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR
ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET
OR ROAD FRONTING THE PROPERTY.MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE
COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE,BASED ON RATES AS
ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF
OWqERICONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
1002 POST ADDRES9 0 Not Met 06/09/2000 SKM
PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR
ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET
OR ROAD FRONTING THE PROPERTY.MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE
COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE,BASED ON RATES AS
ADOPT D BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF
OW /CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X (!� go
5004 ALL CONSTRUCTION 0 Not Met 06/09/2000 SKM
AL UCT,�J�(*MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS
X �
5026 Structure Setbac< 0 Not Met 06/09/2000 SKM
Proposed structure or portions thereof with an projection over 30"in h ' g �_Jae,must maintain a 5'separation
distance between adjacent structures and that furthest projection.X ra_
5030 Changes to Approved Plans 0 Not Met 06/09/2000 SKM
Changes to approved building pi ns that effect compliance to the 1991 Washington State Energy Code,1991 Ventilation
and Indoor Air Quality Code, a if ing Code and/or Mason County Regulations must be approved by Mason
County prior to construction
5045 Field Correct 0 Not Met 06/09/2000 SKM
CONSTRUCTION PROCESS TO BE FIELD CORRECT S R QUIRE P R MASON COUNTY BUILDING
DEPARTMENT AND UNIFORM BUILDING CODE.x
5510 Property Lines Not Met L/'.� /09/2000 SKM
All property lines shall be clearly identified at the time of foundation inspection.X
5510 Property Lines X, Not Met / �„/0��09/2000 SKM
All operty lines shall b lead identified at the ime of fou ation inspection.X
&VIr � �A e
Fee Trans. Create Created
Type Description Code Revenue Account No. Date By Amt.Due
PRMT Building permit.... 322.10 KW $61.87
PLCK Building plan check' 345.83 KW $178.59
SUBD Substantial Develop. ? KW $450.00
O7/18/2000 Information Summary for Case #: MIS99-00774
4:13:22 PM
Activity
Hold Updated
Activity Description Date 1 Date 2 Date 3 Disp. Level By Updated
MISA010 Application received 11/17/1999 11/19/1999 DONE KW 11/19/1999
MISB135 RLC Checklist Review 05/18/2000 DONE SLO 05/18/2000
MISB110 Building Plan Review 11/19/1999 06/09/2000 DONE SKM 06/09/2000
HOLD FOR REVISES"REAL"ENGINEERING.PLACED IN HOLD BIN.engineering recived review complete sent to case mgr.
MISB127 Planning Pre-Review 11/23/1999 11/23/1999 DONE MMS 11/23/1999
MISB128 Addressing 11/19/1999 11/23/1999 DONE GMM 11/23/1999
MISB130 Planning Review 11/23/1999 12/15/1999 DONE SLO 04/25/2000
INCOMPLETE APPLICATION. LINDA GILBREATH SENT LETTER ON 12/16/99.Application complete. conditionally approved by CC.
MISA900 Telephone Call 06/09/2000 DONE No Hold SKM 06/09/2000
KATHY S.GAVE ME A MESSAGE FORM LINDA GILBRETH PERMIT AGENT WONDERING WHATS UP WITH THE PERMIT,STILL
WAITING FOR STAMPED ENGINEERING FROM MANTEL INDUSTRIES.LEFT MSG ON MACHINE WITH THE MANTEL IND.PH#.
FILE PLACED BACK IN HOLD.
MISA050 Approved for Issuance 06/14/2000 DONE No Hold KS O6/14/2000
MISA500 Issue Building Permit 07/18/2000 DONE No Hold KS 07/18/2000
MISA900 Telephone Call 05/19/2000 DONE No Hold SKM 06/09/2000
LINDA G.CALLED WONDERING WHATS UP WITH THE PERMIT,ENGINEERING WAS REQUESTED FOR THE GANGWAY ON
1-21-00 AND HAS NOT BEEN RECIVED.ENGINEERS SEAL IS NEEDED ON THE DESIGN CALCULATIONS PRIOR TO ISSUANCE.
SHE WILL PROVIDE AS PER PHONE CONVERSATION.engineering recived and attached to the plans,sent to case mgr.review
complete.
Condition
Cond. Stat. Changed Updated
Code Title Hold Status Changed By Tag Updated By
0034 No Degradation of Water Quality Not Met 04/25/2000 SLO
Water litvjs nf�''o>;,,F�ng degraded to the detriment of the aquatic environment as a result of this project.
0040 Fisheries H.P.A. Not Met 04/25/2000 SLO
A Hydraulic Proj,.at pyffval frgm the Washington State Department of Fish&Wildlife must be granted prior to
construction.X /%{ o
0050 Corps Permit Not Met 04/25/2000 SLO
A Section 10 Permit(Rivers and Harbor Act of 1899)or� n m s be granted by the Army Corps of Engineers prior
to work within navigable waters of the United States.X C-I�ta�
0035 Recreational Piers Not Met 04/25/2000 SLO
Recreational piers shall be no highe t an 1 fee a ove mean higher high water. Piers and docks shall have at least an
eight foot span between pilings.X
0070 Shoreline Management Act Not Met 04/25/2000 SLO
The proposed project must be consistent with all applicable polici and ther rovisions of the Shoreline Management Act,
its rules,and the Mason County Shoreline Master Program.X �g�A
0100 Construction Debris Removal Not Met 04/25/2000 SLO
All constructs n and demolition debris must be removed from the beach after project completion. Proper disposal of
constructio de r' ust baop land in such a manner that debris cannot enter or cause water quality degradation of State
waters.X �(/�(
0141 Treated Pilings Not Met 04/25/2000 SLO
All new treated piling to be used for this project shall recieve post treatment vacuum of two hours at not less than 22
inches of mercury. Subsequent to release of the vacuum, a il' hal a teamed for a two hour period,followed by a
second vacuum of four hours at 22 inches of mercury.X
0140 Wood Treatments Not
Not Met 04/25/2000 SLO
Pressure treat o gust pletely dry prior to placement in water. Use of creosote or pentachlorophenol is
prohibited.X
5/23/2002
��. Conditions Associated With 11:42:58AM
T I D E M A R K Case#: NUS99-00774
COMPUTER SYSTEMS. INC.
Permit Condition Status Updated
item# Code Title Status Changed By Tag Date By
1) 34 No Degradation of Water Quality Met 4/25/2000 SLO
Water quality is not being degraded to the detriment of the aquatic environment as a result of this project.
X
2) 40 Fisheries H.P.A. Met 4/25/2000 SLO
A Hydraulic Project Approval from the Washington State Department of Fish&Wildlife must be granted prior
to construction.X
3) 50 Corps Permit Met 4/25/2000 SLO
A Section 10 Permit(Rivers and Harbor Act of 1899)or exemption must be granted by the Army Corps of
Engineers prior to work within navigable waters of the United States.X
4) 35 Recreational Piers Met 4/25/2000 SLO
Recreational piers shall be no higher than 11 feet above mean higher high water. Piers and docks shall have at
least an eight foot span between pilings.X
5) 70 Shoreline Management Act Met 4/25/2000 SLO
The proposed project must be consistent with all applicable policies and other provisions of the Shoreline
Management Act,its rules,and the Mason County Shoreline Master Program.
X
6) 100 Construction Debris Removal Met 4/25/2000 SLO
All construction and demolition debris must be removed from the beach after project completion. Proper
disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality
degradation of State waters.X
7) 141 Treated Pilings Met 4/25/2000 SLO
All new treated piling to be used for this project shall recieve a post treatment vacuum of two hours at not less
than 22 inches of mercury. Subsequent to release of the vacuum,the piling shall be steamed for a two hour
period,followed by a second vacuum of four hours at 22 inches of mercury.X
8) 140 Wood Treatments Met 4/25/2000 SLO
Pressure treated wood must be completely dry prior to placement in water. Use of creosote or
pentachlorophenol is prohibited.X
9) 36 8 Inch Minimum Surface-Floating Met 4/25/2000 SLO
The surface of floating structures shall be a minimum of eight inches above the surface of the water.
X
10) 37 Intermittent Supports Met 4/25/2000 SLO
All floating structures shall include intermittent supports which run parallel to the shoreline to keep structures
off the tidelands at low tide.X
11) 180 Safe Condition- Docks Met 4/25/2000 SLO
Dock facilities must be maintained in a safe and sound condition.X _
12) 200 Site Plan NOT MET 6/9/2000 SKM
Approved per dimensions and setbacks on submitted site-plan.X
13) 499 PLANS REQUIRED ON SITE NOT MET 6/9/2000 SKM
All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are
not on site,Approval WILL NOT be granted. In addition,a Re-Inspection fee in the amount of$42.00 per
hour(minimum 1 hour)will be charged and must be collected by this department prior to any further
inspections being performed or approval granted.X
Page 1 of 2 CaseConditions..rpt
5/23/2002
Conditions Associated With 11:42:58AM
T I D E M A R K Case#: NUS99-00774
COMPUTER SYSTEMS, INC.
Permit Condition Status Updated
item# Code Title Status Changed By Tag Date By
14) 1002 POST ADDRESS NOT MET 6/9/2000 SKM
PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS
OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE
FROM THE STREET OR ROAD FRONTING THE PROPERTY.MASON COUNTY BUILDING
DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE
INSPECTIONS. A REINSPECTION FEE,BASED ON RATES AS ADOPTED BY THE JURISDICTION
AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS
TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
15) 1002 POST ADDRESS NOT MET 6/9/2000 SKM
PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS
OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE
FROM THE STREET OR ROAD FRONTING THE PROPERTY.MASON COUNTY BUILDING
DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE
INSPECTIONS. A REINSPECTION FEE,BASED ON RATES AS ADOPTED BY THE JURISDICTION
AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS
TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
16) 5004 ALL CONSTRUCTION NOT MET 6/9/2000 SKM
ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS
X
17) 5026 Structure Setback NOT MET 6/9/2000 SKM
Proposed structure or portions thereof with an projection over 30"in height from grade line,must maintain a 5'
separation distance between adjacent structures and that furthest projection.
X
18) 5030 Changes to Approved Plans NOT MET 6/9/2000 SKM
Changes to approved building plans that effect compliance to the 1991 Washington State Energy Code, 1991
Ventilation and Indoor Air Quality Code, the Uniform Building Code and/or Mason County Regulations must
be approved by Mason County prior to constructionX
19) 5045 Field Correct NOT MET 6/9/2000 SKM
CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY
BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x
20) 5510 Property Lines NOT MET 6/9/2000 SKM
All property lines shall be clearly identified at the time of foundation inspection.
X
21) 5510 Property Lines NOT MET 6/9/2000 SKM
All property lines shall be clearly identified at the time of foundation inspection.
X
Page 2 of 2 CaseConditions..rpt
GARY YANDO,DIRECTOR
SON,STgTFO
o A°u DEPARTMENT OF COMMUNITY DEVELOPMENT
Z o T i PLANNING - SOLID WASTE - UTILITIES
N Y y BLDG. I • 411 N. 5111 ST. • P.O. BOX 57 pJ �p 8
1864 SHELTON,WA 98584 • (360) 427-9670
December 16, 1999
Linda Gilbreath
PO Box 1370
Allyn, WA 98584
RE: Incomplete Permit Application for the Peckenpaugh Dock, Ramp, and Pier
Dear Ms. Gilbreath;
Enclosed please find the ESA checklist that you recently submitted which is being returned for
further information. All questions need to have an answer supplied as the Hood Canal is listed'as
habitat for an endangered salmonoid species. To guide you through this process please contact
the WA State Department of Fish and Wildlife, the US Department of Fish and Wildlife, or the
National Marine Fisheries Service.
Permit review will resume when a complete checklist is submitted. Please contact this office at
275-4467, extension 295 if you have any questions.
Sincerely,
Shandra O'Haleck, Shoreline Planner
Department of Community Development
Recycled
Linda M. Gilbreath
Permit Agent
Post Office Box 1370
Allyn WA 98524.1370 _ n 1F 17 .
Telephone 360/277-3715
Fax 360/277-3715 E-Mail Igpermit@hcto.com DEC 13 1999
MMON G0.PLANNING DEPT.
10 December 1999
Mason County Department of Community Development
Planning - ATTENTION: Shandra O'Halleck
Post Office Box 578
Shelton, Washington 98584-0578
Re: Peckenpaugh Project, Previously Submitted 11-17-99
Dear Shandra;
In response to your request, I have enclosed my completed ESA Listed
Salmonids Checklist, supplement to the SEPA already completed.
Because the ESA checklist pertains almost entirely to watershed areas, most of
the questions were not applicable to this project. However, I did answer a couple
of questions that would be applied to this project.
I trust that this will be satisfactory. Please feel free to contact me with any
questions, comments or further instructions. Thank you.
Si rely,
Linda M. G' reath, P.A.
Enclosure: ESA Listed Salmonids Checklist