HomeMy WebLinkAboutBLD2013-00506 Cancelled Additions - BLD Permit / Conditions - 1/29/2014 Inspection Line (3bU)42/-/162
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 279
Shelton, WA 98584 1
11flo
RESIDENTIAL BUILDING PERMIT BLD2013-00506
OWNER: JAMES ISON RECEIVED: 6/28/2013
CONTRACTOR: AA&E INC GENERAL CONTRACTORS 360.275.4006 LICENSE: AAEINGC136DK EXP: 3/11/: ISSUED: 7/29/2013
SITE ADDRESS: 451 EVICTOR RD BELFAIR EXPIRES: 1/29/2014
PARCEL NUMBER: 122212490041
LEGAL DESCRIPTION: TR 4-A OF GOVT LOT 2 EX PCL 1 OF BLA#96-53 AF#630749
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
TWO ADDITIONS TO SFR ST RT 3, R ON NORTH BAY RD, F LLOW TO ST RT 302, L ON VICTOR RD
TO SITE DR S ON THE LEF IDE
General Information Construction &Occupancy Informat n Square Footage Information
No. of Bedrooms: 1 Type of Constr.: B
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Gr p: /UUBuilding:540
ze: Deck: 0
Type of Work: ADD Fire Dis No. of Stories: 1 cc. oa Garage-Attached 438
Valuation: $ 99,553.08 Building Height: 2 O . S at ::: Pr a Basement: COV PORCH 144
Manufactured Home Informat' n Se a k In rmation j Shoreline& Planning Information
Make: Length: Ft. Fro S 1 Ft. reline: Ft. Water Body:
g Rea 2 0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Re 20.0 Ft- Shoreline Desig.: Not Applicable
ideYear: Serial No.: (id W 75.0 Ft. Comp. Plan Desig.: Rural
AbOr
Plumbing Fixtures Mechanical Fixtures FEES
Type Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 1 Dryer Vent 1 Plan Check Fee GMM 6/28/2013 $641.39 S120130000000i
Lavatories 2 Ventilation Fan 2 EH Plan Review GMM 6/28/2013 $ 103.00 S1201300000001
Showers 1 Planning Review Fee GMM 6/28/2013 $205.00 S1201300000001
Clothes Washer 1 Building State Fee LDK 7/25/2013 $4.50 S1201300000001
Laundry Tray 1 Building Permit Fee LDK 7/25/2013 $993.75 S120130000000i
Mechanical Permit Fee LDK 7/25/2013 $27.00 S120130000000i
Mechanical Base Fee LDK 7/25/2013 $28.50 S120130000000i
Plumbing Permit Fee LDK 7/25/2013 $ 52.20 S1201300000001
Plumbing Base Fee LDK 7/25/2013 $24.70 S1201300000001
Total $2,080.04
BLD2013-00506 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2013-00506
CONDITIONS FOR
BLD2013-00506
1) 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)4g7,9670, 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 1i a d approved.
X
2) Contrac r egistration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There ar pote tial r ,d monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-09 2. a person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
3) Owner/Agent YiKspo7nsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
4) Approved per dim sions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
5) Temporary erosion control measures must be implemented to prevent water quality degradation of adja waters or wetlands. Silt fencing, straw, or
matting must be installed and maintained until upland vegetation has ecome established. X
6) Prior to final approval, all upland areas disturbed or newly cr ed by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
7) All construction and demolition debris must be removed fromU site after project completion. Proper dis al of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
8) 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. X
BLD2013-00506 Please refer to the following pages for conditions of this permit. Page 2 of 6
9) All property lines shall be clearly identified at the time of foundation inspection. X V
10) Landings and sta ust meet the same setback conditions as'any permitted structure; and, must be shown on your site plan. Please check your
"Approved ' Ian"to ensure these structures are shown and meet the setback conditions listed.
X VIA
11) By definiti , ropane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures m r e setback conditions listed.
X
12) All approved pl ns 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. additio -a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Department pri o a further inspections being performed or approvals granted.
X
13) The plan review ch c ist 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 der 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 app documents will result in failure of required building inspections.
X
14) All wall cavities se . g as xterior walls, exposed during construction or remodeling work shall be insulated to the full depth of the wall cavity and
inspected prior to coveri . Insulation R-values shall be as follows: 2x4 wall cavities min. R-15 and 2x6 wall cavities min. R-21.
X
15) THE FOUNDATI SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
X
16) The"approved"Ue 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. I ddition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Building Departmek4ri o any further inspections being performed or approvals granted.
X
17) Washington State Ene y Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option III, Window(Max U-Factor):0.30, Skylight(Max U-Factor):0.50, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38 advanced or R-49 standard, Vault Insulation R-38,
and Slab Insulation R-10.-
In addition th II ing credit from Table 9-1 shall be completed: 6
X
BLD2013-00506 Please refer to the following pages for conditions of this permit. Page 3 of 6
18) A permanent certificate, completed by the builder or registered design protessional, shall be posted within three teet of the electrical distribution panel.
The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall
and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there
is more than one value for each component, the certificate shall,list the value covering the largest area. The certificate shall list the type and efficiency of
heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air
leakage results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA)
when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations
of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. The blower
door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required
for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate" and are available in '/4 or'/2 sheets. The
Mason CF
unty Permit Center will also have some available.
X
19) A minimu of 0 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC
Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall
be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or
installed in r around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps).
Reference 505.
X
20) REQUIRE S FO -ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's � allation instructions.
X
21) 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. f the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Hea 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 se Ic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor is acknowledging all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
22) Owner/builder assumes all responsibility if drainfield/reserve ar a i ncumbered.
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
BLD2013-00506 Please refer to the following pages for conditions of this permit. Page 4 of 6
23) 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 expose .to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
24) Carbon monoxide I) listed as complying with UL 2034 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
New and existing dweAws within which fuel-fired appliances are installed, and new dwellings with an attached garage shall be equipped with carbon
monoxide alarms. arbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms.
X
25) Any changes in posed 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 bq ected by the Building Department prior to any further inspections being performed or approvals granted.
X
26) 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. Occupa errs limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
X
27) 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 withi �of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.
X
28) Placement of struct must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
X
29) All changes to"approved" bui ding plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, p#t be reviewed and approved by Mason County prior to construction.
X
30) CONSTRUCTION PROC S TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENTAND 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 interna 'ono odes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall ade prior to requesting additional inspections.
X
BLD2013-00506 Please refer to the following pages for conditions of this permit. Page 5 of 6
31) 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 Kinal inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason Co u t dinances and building regulations.
X
32) All permits e b e 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 n exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have p v ted action from being taken. No more than one extension may be granted.
X
33) Pressure treated ood a'fiufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and flash i Install metal connectors approved for contact with the new types of pressure treated material.
X
34) Retaining walls needed to support a surcharge such as stru /res, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at 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 m ns 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 acce s o the above described property and structure for revi4w and ins 'ection.
OWNER OR AGENT: DATE: ��
U VV
BLD2013-00506 Please refer to the following pages for conditions of this permit. Page 6 of 6
o CONCRETE MECHANICAL MANUFACTURED HOME Fn
0
C)1
1;0 Footings !Setbacks Date By Gas Piping RIbbons 7
C) Interior Date By interior-Date By Date By C_
C) >
M - 9(D Exterior Date By 4L14 Exterior-Date By Set-up
0) INSULATION — ITI
Point Load I Isolated Footings BG I SLAB INSULATION Date By Cn
Date By Date By FIRE DEPARTMENT
Foundation Wails Date V-1 Floors Date By
2-1-5 ,3 y y-
Data B
DECKS
FRAMING Walls Date By
Date By Data
PROPANE TANKS
Vault Date By
PLUMBING Date By OTHER
Groundwork Attic
Type:
DateBy Date By
Data By
D.W.1v DRYWALL Type-
-0 Date By Int Brace Wall Date By 00
Date By
CD FINAL INSPECTION
2)
W Water Line Fire Seperation
CD C1
Date By Date By Date By -I
Pass or Request Inspect.
Type of Insp. Fail Date Date Done By Comments
CD C1
6 - -5 if-, Ali C2_
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CD r c�Lcs
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APPROUE.Q. ..
MASON COUNTY DCD PLANNING
517E PLAN. Ef LAAEb TO BE ON SITE
CHAUGES.S-UBJE;CT-T OAPpRovAL-
B
TOPOGRAPHY PROFIL
now
PLANIRYING
VS W4
Direction: cafe: Approval: for office use
Building Permit number: Building:
IJ I Planning:
Owner/Applicant:. ti'yl��j I S{j Date of
Parcel Number: LZZZI '1Ob!1 N���' application: Env. Health:
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TOPOGRAPHY PR ILE: 2013
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Direction: Cale: Approval: for oficeuse
Building Permit number: ��'� Building:
Owner/Applicant: VYl�lj 1 Sb Date of ,— Planning:
Parcel Number: (ZZZI — Z`1' — application: Env. Health:
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ Ventilation Code Compliance Application
® '`
Owner: l� IS00 Parcel#:l� 2 -cl � + Type of proje
Total Sq. Ft. 1ST Floor: 33to floor: Heated Basement:
of heated area:: � I n— ; r11��=�' e.'►4�� 4s �;v��
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other: Specify.-
Glazing Compliance Prescriptive Option (see reverse side) circle one: I II III
Percentage: Method Component Performance , Chapter 5— Calculation worksheets required
Check one::
J % Other (Specify):
Check one µ Whole House Ventilation system u Whole House Ventilation u Other,
Ventilation using exhaust fans&window or Integrated with a Forced Air describe:
System wall fresh air vents(M1508.4) System (M1508.5)
Referencing WSEC Section 901, "Additional Residential Energy Efficiency Requirements," all
NkW residential units must develop 1 credit from Table 9-1. Identify and describe which option(s)will be used
ENERGY to comply. If the table is not attached to this form you can access the table on our website at:
http://www.co.mason.wa.us/forms/CommuntyDev/index. h .
CREDITS Option: Description:
Table 9-1 r/ 9�
Window & Door )Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows:
2 x 7s
Windows: Total Sq. ft. .S-
Doors:
b X I
30 U 91
Doors: Total Sq. Ft
Total window and door area 6 ,S�
Contractors or Tradespeople Printer Friendly Page Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with LEH to perform construction work within the scope of � ' D /`./A
its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of =,
account and carry general liability insurance.
Business and Licensing Information
Name A A Ft E INC GENERAL CONTRS UBI No. 601011607
Phone 3602754006 Status Active
Address Po Box 730 License No. AAEINGC136DK
Suite/Apt. License Type Construction Contractor
City Belfair Effective Date 3/12/1987
State WA Expiration Date 3/11/2014
Zip 98528 Suspend Date
County Mason Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Business Owner Information
Name Role Effective Date Expiration Date
VANDIJK, JOHN Agent 01/01/1980
JENSON, PAUL S Agent 01/01/1980
VANDIJK, DEBBIE ANN Member 101/01/1980
Bond Information
- - - - - - - - -- - - - -
Bond Bond Company Name�Bond Account NumberlEffective Date�Expiration Date Cancel Date Impaired Date Bond Amount Received Date
8 JCBIC ISF0935 08/05/2003 jUntil Cancelled 08/17/2013 $12,000.0008/05/2003
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
Contractors
9 Bonding Et INSSF0935 08/05/2012 08/05/2014 $1,000,000.00 06/25/2013
Insuranc
8 CBIC INSSF0935 08/05/2008 08/05/2012 $1,000,000.0008/02/2011
7 C_BIC INSSF0935 08/05/2007 08/05/2008 $1,000,000.0007/31/2007
[6 ICBIC JINSSF0935 08/05/2003 08/05/2007 $1,000,000.00 04/13/2006
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 7/1/2013
Contractors or Tradespeople Printer Friendly Page Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with LEtl to perform construction work within the scope of
its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name A A&E INC GENERAL CONTRS UBI No. 601011607
Phone 3602754006 Status Active
Address Po Box 730 License No. AAEINGC136DK
Suite/Apt. License Type Construction Contractor
City Belfair Effective Date 3/12/1987
State WA Expiration Date 3/11/2014
Zip 98528 Suspend Date
County Mason Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Business Owner Information
Name Role Effective Date Expiration Date
VANDIJK, JOHN Agent 01/01/1980
JENSON, PAUL S Agent 01/01/1980
VANDIJK, DEBBIE ANN Member 01/01/1980
Bond Information
Bond Bond Company Name Bond Account N u mberl Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
8 JCBIC SF0935 08/05/2003 jUntil Cancelled 08/17/2013 1 1 $12,000.0008/05/2003
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
Contractors
9 Bonding& INSSF0935 08/05/2012 08/05/2014 $1,000,000.0006/25/2013
Insuranc
8 CBIC INSSF0935 08/05/2008 08/05/2012 $1,000,000.0008/02/2011
7 CBIC INSSF0935 08/05/2007 08/05/2008 $1,000,000.0007/31/2007
6 CBIC JINSSF0935 08/05/2003 08/05/2007 1 1$1,000,000.0004/13/2006
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 7/25/2013
MASON C:UUN I Y PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 ��n
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner JAtwl�� Il�O� Company Name AA�-g INC•6-W. CoOtNLyt �
Mailin Address I V Ct p Mailing Addressp D
City StateL� Zip Code Z city (tom State w� Zip Code
Phone's 7/DZ4'0( Other Ph. Phone 7 1- Z.6 6 Z Other Ph. -
Lien/Title Holder , Contractor Reg.#AAE/N1G-C(3bDK Exp.
E mail address -)amF�JI�� �' AVILQ 1(, - C-0[/V\ E Mail Address
AAA!L-- U
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X
Connect to Water System Name of Water System
Well--)( _Water System Name of Water System -
PARCEL INFORMATION - 12 Digit Parcel No Z - Z Fire District '
Legal Description - U �X L LA _ -S
Site Address(Please include street name,street number and city) 4SI `�1 GTbe. lZd D (2
Directions to site EOLL400 RUSY3OZ `F-120V0 &LLVU TO QE V1 Izd&P O
tie— Q S 0 N LE El
Will timber be cut and sold in parcel preparation? Yes
Is property within 200' of Saltwater Lake River/Creek if Pond
Wetland �Seasonal Runoff _-1 Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add,X__Alt Repair Other PRIMA? RESIDENCE SEASONAL ❑
Use of Building �S1 DE✓l tE Describe WorkA012 50 t21-?blh / ` )oem�c Q.AIr SIZE`
No. of Bedrooms—'37 No. of Bathrooms g Square Footage- 1 st Floor_ `-f L— 2nd Floor
3rd Floor Basement Deck_ tS- Covered Deck i Other Sq. ft.
Garage Attached— L Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price Replacement Unit? Yes/No
Installer Name Certification No.
O/VNER/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 words proposed. The owner or agent on owners behalf,represents that the information
provided is accu a and grants employees of Mason County access to ti-ke above described property and structure for review and inspection.
PROO OF C N ATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date'
weer/Owners Re resentative/Contractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department -7 S ,3 w i
Planning Department
Environmental Health Department L 7
Public Works 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
PERMIT NO.
MASON COUNTY
� IMBING/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- 1 CONTRACTOR INFOgMATION
Owner Company Name 61L%Y /NG- 6E0 r0147-12 12S
Mailing Addres 12 I NE UICT012, ZD,&'D Maili Address 'City I State lAIA-Zip Code City 112 State IAIA Zip Code Cf, Z
Phone - Other Ph PhoneQ ` 73f - Z6t�Z _ GOO
� Other Ph.
Lien/Title Holder Contractor Reg. #AAE/N r`C l Drti Exp.
E mail address-�A�I-S 1S TMAlL .0001k E Mail Address A F3El rA i1? 0 M,4fL "cowl
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic_ Connect to Sewer System
Name of Sewer System
PARCEL INFORMATI N - 12 Digit Parcel No IZZ - Z - C7d 1 _ _ Fire District _
Legal DescriptionTQ O� 07 Z F 0
Site Address (Please include street name, street number and city) S 7 V QO , .E I� Ld ,
Directions to site�f?L4w wA 30Z -'Q III 1( 2 A� LET OIU l C`111W Q0a3
nij L-
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland —Seasonal Runoff Stream — Slopes or Bluffs > 15%
TYPE OF JOB - New d Alt Repair Other Use of Building P-ESA
Location of Fixtures/Units- 1s Floor t�<— 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type-.Electric_LPG—Natural Gas_Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers f Spot Vent Fan
Water Heater Propane Tank
Clothes Washer l Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other may ` 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 aces to the above described property and structure for review and inspection.
PROOF O CO N OF WORK IS BY MEANS OF A PROGRESS INSPECTIO
X Date46 11500
ner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYO D TH 3 OINT
Accepted b�' -��Etanning Pd Ck# Date L"i Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group TVpe Constr. ZS 3 WJ
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