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HomeMy WebLinkAboutBLD99-00624 Final SFR and Garage - BLD Permit / Conditions - 6/20/2003 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O, Box 186 Shelton, Washington 98584 0 Li I L_ C.) I N CA R E R I\A 1 T' FOR INSPECTIONS CALI 427 -9670 RETWCFN 5pm AND Sam 127- T262 BLD99-0624 PARCEI. :322365100014 PLAT PE:PI 0 D I V , OLK : 1 JOB ADDRESS ; 1O238 E: STATE ROUTE 106 UN I ON PERMIT OWNER : DANIEL_ WOl fENBARGER 360--90'?--5225 253--846 CONTRAC'I OR : NULL 8 VOID BY EXPIRATION LEGAL : PE9111F BEACH PARK TN 14-15 1 I.L. G 1E 10 TA I6 t 1.L. DATE 1" y2" BY CLASS, OF WORK . . :NEW BE V R 2 BATH : 2, HYPE AMOUNT BY DATE REPfIPo 11rf A0O0k1 BY RAIF liCENT TYPE OF- USE . . . , -SF STORIES . . . . . . . ..' OCCUP . GROUT' . . . :R 3 BLDG . HEIGHT . , .- O .Oft 1PICK $ 66t.21 KM 11188199 50833 JAPJ 1 94.25 TN 11102/99 52031 TYPE OF CON: T . . t5N FIREPLACES . . . . .. 1 jAODR 1 15.90 TN 11i121'99 5211i MCH 1 61.75 TV 11112199 52131 OCC;UP . I OAD , . . . : 0 WOODSTOVES . . . . 0 ►PRllI t 1162.25 TN 11102/99 52131 NLH1 1 22.fl1 TN i11/??99 52031 DWEL.1 .0N I TS . . . . t 0 PARKING SPP{;FS : 0 IFIV 1 143.01 TA 11112159 52131 AJ41t tuael tees eat Sheep Aere...... INSPECT ION AREA t 2 SHORELINE? — , -Y {FLAT $ 20.00 xN 11162199 52031 1014t 2314.46 VALOLAT1ON: tb456? SETBAGK,- . _.___. _... _.____ _ .__. TO! 1. FTS . . . . . . . . . . . 3 FUEL TYPES -.__.__. _.__ .. __ BOILER4,/COMP---- -- MOBILE. HOME - - FRONT . . .W 130 .0f1t RATH BASINS . . . . 3 : 1HP iELEI ! : 0 -3 HP . : 0 RFAR — A' 46 .Oft BATH TUBS . . . . . : 2 3 15 HP . : 0 MODEL : S I DF ( 1 ) .N 55 .0f t SHOWERS . . . . . . . . . :' FERN {_ 100 VTU t 1 15- 30 HP . t 0 --MAKE.--..- S ! DE ( 2_ ) .S 1 0 .0f t WATER HEATERS . . . . 1 FURN a 100K. BTU : 0 30-50 HP . : 0 SHRL. INF. ..N 120 .Oft CLOTHES WASHERS . . : 1 FUHN - FLOOR :, . : : 0 504- tip . : 0 YEAR-.— AREA _. _ __ _.... . K I TCHEN S I NKS . . . : 1 HEAT PUMP . . . . . . : 1 LOT :>I7E . . t FLOOR DRAINS . 0 VENT SYSTEMS . . . . 0 E�VAP COOLERSK 0 LENGTH : 0 RU I LD I NG . . . : 2209s f DR I NK.I NG FOUNT . 0 VENT FANS . . . . . . . 5 HOODS, . . . . I . . : 0 WIDTH . . 0 BASEMENT , . . . 2194sf LAUNDRY TRAYS . . 0 DOMES , INCIN .O SFR1 At. 1I DE:CVS . . . . . . : 4,5171s-f DISHWASHERS . . . . . . ; 1 AIR HANDLING UNIT" COMML . 1 NC 1 N :0 ' %A i- -:ARF' :N Osf GARB DISPOSALS . . , 0 A- 1FTOAId i: Em . 0 ftELUCIREPA1R t 0 AT, DT . :? -URINALS , . . . . . . . . 0 > 10000 cfm : : 0 OTHER UNITS . , 0 MISC RLM FIXTURESt 1 CAS OUTLETS . : 5 ' 3'�GG'9!"-�':'G::'Y.+^x��SK.:.tiL'R�'-31'dt'r.::��..:�xfi:-'S'fC.T..C.:Y.SfX'��"'if:II�I6.qC�'�^.:`Y"P.31RE.-�"<+:.'.3;.'.X.�fii'iF-Se'.ESe."p:»:...111ta�3T.fQ.i4:.':Xi�F.t7Ci:..�'<9C.tR'SY">"..T9::JSS6:XTtT..C.LS.'u'9tSIS7�4'4}��i:t��"'T'.::__d'.:"i-II3%.Si'C:S+.—••�•�•'.-.:S:.r:�kCP^�. . PROJECT 11011fS10ENCE AND 4A1#6[ PROJECT L000 ON:N1Y 116 TO FEBBLf AtCFSS ARE ACROSS BACK OF PRO►ER'lY THIS PEAUIT BECOMES NULL AND VOID IF 1019 OR CONS"TR.UCTION ANTHORIIER 1,� NOT CONMENCE1 1111010 1111 PAIS, OR If CONS111101011 CA 1039 IS SUSPE1813 FOR A PERIOD Of 180 DAYS Al ANY '1111f 01E1 NORK IS COMMENCED,. Ey APPROVED BEfO1E_ 801101Afi CAN 6E OCCUPIfI. ;1BEMCE OF CONTIN11AT10N Of iIORK IS A PROGRESS INSPECTION 11!TNIN 1Mf Ib8 DAY PERI01►. IINAI INSPECTION MOST Ff ' 0iNT R OR AGE IT:_ '" ...�._��G.�__—�—=`�£.��'.�.....�. OAT h RtU_�NMT, revs 1313119t ! COMPLIANCE TO ATTACHED CONDITIONS IS REQUIRED 9 CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date aRAMiNG by date by date by 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'23 -2c9D0 104,W0AT01,- Gt/,VA.s C3it� SST= 3 a-1- 2-000 .4 X- 7N eAGr - 2!- 2660 iV 4ll i 6CA6 ,EX%r•v Tso14/ 1-49SSt",p . t Page No. 1 CASE HISTORY FOR CASE NO.: BLD99-0624 DANIEL WOLFENBARGER A E130 PEBBLE BEACH LN UNION 03/15/00 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By mow- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDA010 Application received 07/07/99 / / 07/08/99 DONE KW 07/08/99 KW BLDA100 Approved For Issuance / / / / 11/02/99 DONE TW 11/02/99 TW BLDA500 (F) Issue building permit / / / / 11/02/99 DONE TW 11/02/99 NJP BLDA900 Telephone call / / / / 07/12/99 A MRS. ANDERSON CALLED TO INQUIRE ABOUT DONE SKM 07/12/99 WLC THE EXTENT OF THE CONSTRUCTION, I EXPLANINED WHAT WAS ON MY EDIT SCREEN AND INFORMED HER THAT HE MAY CLEAR/GRUB TO A DEPTH OF 12" BELOW GRADE , SET FORMS AND STEEL AND NOT PLACE CONCRETE UNTIL PERMIT HAS BEEN ISSUED. BLDB110 Building Plan Review 07/08/99 / / 07/29/99 TO JB ON 7/19/99 DONE JB 07/29/99 DLC BLDB120 WSEC Compliance Review 07/29/99 / / 08/17/99 hp w/electric bu 10% glazing DONE DC 08/18/99 DLC BLDB130 Planning Review 07/12/99 / / 08/16/99 SITE VISIT MADE TO VERIFY SITE DONE AHB 08/16/99 AHB CONDITIONS AND SETBACKS. AHB BLDB134 RLC Review / / / / 08/16/99 SOME SLOPES ON AREA SOUTH OF SR 106; DONE AHB 08/16/99 AHB BULKHEAD AND SMALL AREA NORTH OF SR 106. AHB BLDB135 Addressing 07/07/99 / / 08/05/99 DONE GM 08/05/99 GM BLDB138 Planning Pre-Review 07/09/99 / / 07/12/99 DONE MMS 08/16/99 AHB BLDB200 Environmental Health Review 07/07/99 / / 07/12/99 need satis pumpers report HOLD CEB 09/14/99 PSD see condition BLDB200 Environmental Health Review 09/13/99 / / 09/14/99 Need a pumper and or inspection report HOLD PSD 09/14/99 PSD and/or an inspection of the tank.psd BLDB200 Environmental Health Review 11/02/99 / / 11/02/99 rec tank condition from owner DONE CEB 11/02/99 CEB BLDB210 Water Adequacy 09/13/99 / / 09/14/99 The Peble Beach water system is agroup A DONE PSD 09/14/99 PSD water system, need their determination.psd 9/14/99 Per Cherri Payne, the water ['p�I.�N system is adequate.psd � r P LF a&r- f3o'c)cNL Aj Susr /Bcf�KG m c r 5r b90 N< O_ m c. -t cis ; x � ro O Z Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 IP10 Shelton,WA 98584 RESIDENTIAL BUILDING PERMIT BLD99-00624 OWNER: DANIEL WOLFENBARGER RECEIVED: 7/8/1999 CONTRACTOR: LICENSE: EXP: ISSUED: 12/30/2002 SITE ADDRESS: 130 E PEBBLE BEACH LN UNION EXPIRES: 6/30/2003 PARCEL NUMBER: 322365100014 LEGAL DESCRIPTION: PEBBLE BEACH PARK TR 14-15 &T.L. & NE 1/2 TR 16 &T.L. PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE AND GARAGE HWY 106 TO PEBBLE ACCESS ARE ACROSS BACK OF PROPERTY General Information Construction &Occupancy Information Square Footage Information No.of Bedrooms: 2 Type of Constr.: 5N Type of Use: SF Insp.Area: 2 No.of Bathrooms: 3 Occ. Group: R3 Lot Size:O Deck: 480 Type of Work: NEW Fire Dist.: 6 No.of Stories: 2 Occ. Load: 0 Building:2,209 0 Valuation: Building Height: 0 Occ. Status: Basement:2,194 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: 0 Ft. Front: W 80.0 Ft. Shoreline: 120.0 Ft. Water Body: Rear: E 46.0 Ft. Slope: Ft. SEPA?: No Model: Width: 0 Ft. Side 1: N 55.0 Ft. Shoreline Desig.: Year: Serial No.: Side 2: S 10.0 Ft. Comp. Plan Desig.: BLD99-00624 Please referto the followinges for conditions of pages this permit. 1 of 4 Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Building Permit Fee JRN 12/27/200 $581.13 61591 Additional Plan Check Fee JRN 12/27/200 $52.30 61591 Building plan check* KW $661.21 50833 Address Fee TW $15.00 52031 Building permit.... TW $1,162.25 52031 Plumbing Fee TW $103.00 52031 Plumbing Base Fee TW $20.00 52031 Adjust PI.Check Fee TW $94.25 52031 Mechanical Fee TW $60.75 52031 Mechanical Base Fee TW $22.00 52031 Propane Tank TW $9.50 52031 Fireplace TW $42.00 52031 Building State Fee TW $4.50 52031 RLC Checklist Fee Tw $70.00 52031 EH Plan Review TW $50.00 52031 Total $2 947.89 CASE NOTES FOR BLD99-00624 CONDITIONS FOR BLD99-00624 1) Approved per dimensions and setbacks on submitted site plan. X Ck� 2) The proposed project must be consistent V Alp "cable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program.X 3) Temporary erosion control measures must be implemented to prevent water quality degradation of adj e Pl;"r properties. Silt fencing or straw matting must be installed and maintained until upland vegetation has become established. X 4) Proposed structure or any portion thereof greater than 30" in height from g a li e, ma intain a minimum of 5'setback from all property lines, easements and 10'from all County and State Road right of ways. X 5) This appli�aC "- � to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036. X �((l�G 6) The use, handling and storage of hazardQq s materi or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. X BLD99-00624 Please refer to the following pages for conditions of this permit. 2 of 4 7) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within 25'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. X 8) 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$42.00 per hour(minimum 1 hour)will be charged and must be collected by this department prior to any further inspections being performed or approval granted. X 9) PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X 10) The correction list, along with the Energy Compliance Worksheet (when applicable) is part of the plans and must remain attached thereto. It is the responsibility of the applicant to make corrections indicated on the plans from the correction lists. Once the plans are marked APPROVED, they may not be changed or altered without authorization from the Building Official. The permit holder is reponsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply will result in failure of required building inspections. Every permit shall expire by limitation and become null and void if the building or work authorized by such permits is not commenced within 180 days from the date of issuance, or if the building or work authorized by$ p r ' s is suspended or abandoned at any time after the work is commenced for a period of 180 days. X ` 11) Any changes in cp ru io all be reviewed by engineer of record and submitted in writing to the Mason County Building Department prior to construction. X 12) UMC Chapter 7. In buildings of unusually tigpht c struction, fuel burning appliances shall obtain combustion air from outside (excluding cooking appliances and clothes dryers). X_� 13) Proposed structure or portions thereof wiZg� er 30" in height from grade line, must maintain a 5'separation distance between adjacent structures and that furthest projection. X 14) Placeme t of ructure must comply with standards setforth per 1997 UBC Chapter 18 regarding descending and/or ascending slopes. X A ( > 15) Changes to approved building plans that effect compliance to the 1991 Washington State Energy Code, 1991 Ventilation r r Quality Code, the Uniform Building Code and/or Mason County Regulations must be approved by Mason County prior to constructionX 16) CONSTRUCTION PROCE��}TO BE .FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x -� 17) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X BLD99-00624 Please referto the following pages for conditions of this permit. 3 of 4 L 18) 1997 UBC Chapter 17, Section 1701. In addition to the inspections required by UBC Section 108, the owner or the engineer or architect of record acting as the owner's agent shall employ one or more special inspectors who shall provide inspections during construction on the types of work listed under UBC Section 1701�55 special inspectors' duties & responsibilities shall be as specified in 1701.2 and 1701.3. Xi 19) Strong tie expoxy use will require a WABO Certified special inspector or a certified testing laborato to inspect the installation of grouted construction anchors as stated in the ICBO ER-5279 report. The agency shall complete complete,,a r o submit the findings to the Mason County Building Department for review and approval prior to the final inspection of the project. X 20) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder hay revented action from being taken. No more than one extension may be granted. X 4_ 21) Special Inspections are required for Structural Welding, Concrete that exceeds 2500 psi, and the use of Epoxy. The Special Inspection Authorization form attached to the "site copy"of the plans is required to be completed and submitted to Mason County Department of Community Development. X� 2 This permit becomes null and id if work or construction authorize . 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 nti uation of work is a progress iqsjaecmcn within the 180 day pen Final inspection must be approved before building can be occupied. OWN ER OR AGENT: _,e DATE: �� BLD99-00624 Please referto the following pages for conditions of this permit. 4 of 4 W � r CD CONCRETE MECHANICAL MANUFACTURED HOME 0 Footings / Setbacks Date By Ribbons � D ate B y Gas Pip ing Date B y Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMI G Walls FIRE DEPT DateoZ, 2 0 By �(S Date,��17 �j tZ- Date By PLUMBING Attic OTHER Groundwork Data, 7 d-f By Date By WALLBOARD NAILING D.W.V. Date �/ �j� Date B RLS FINAL INSPECTION 0 2 o y Water LIMP Date By v Date O 27 Q! By RLS Date By 0 2 g D 2 CD < Rv m 6 z G y O 2003 � 20D - / F 8 Ulf[ Frkts( � "� E r d o � N r 0 J * Lyk c� Re o9 1 lip o Via. ,►�'� —� � o � - • .. �A i { d � � a ---I • et I lie ZC t �� rip &or I /�� \ • a 'D` tip' � 1 �'a a NA5 + 4'!56!�; on 41 to s .. i :=ea. i� -' ( �� 4.ai h ' .. r ! -p " J w^•fit _� . •r� s;."7,� mod,! j -l.. National Evaluation Service, Inc. Participating Members: SECRETARIAT SBCCI-Public Safety BOCA Evaluation Services, Inc. ICBO Evaluation Service, Inc. Testing and Evaluation Services, Inc. 4051 West Flossmoor Road 5360 Workman Mill Road 900 Montclair Road, Suite A Country Club Hills, Illinois 60478-5795 Whittier, California 90601-2299 Birmingham, Alabama 35213-1206 (708) 799-2305 (310) 699-0543 (205) 591-1853 NATIONAL EVALUATION REPORT Report No. NER-420 Copyright v 1995,National Evaluation Service, Inc. Reissued September 1, 1995 INSEALATION SYSTEM FOAM PLASTIC INSULATING SEALANT substrates,and the underside of horizontal surfacesto fill gaps and ICYNENE INC. cracks in building materials to create an air seal. 376 WATLINE AVENUE MISSISSAUGA, ONTARIO L4Z 1X2 5.0 IDENTIFICATION CANADA All packages and containers of INSEALATION covered bythis report shall bear the manufacturer's name and/or trademark, the flame- 1.0 SUBJECT spread rating, the smoke-density rating, the shelf life expiration date,the number of this report,and the label of the quality control Insealation System Foam Plastic Insulating Sealant. agency (Inchcape Testing Services, NER-QA219) for field identification. 2.0 PROPERTY FOR WHICH EVALUATION IS SOUGHT 6.0 EVIDENCE SUBMITTED 2.1 Surface-burning Characteristics. 6.1 Manufacturer's descriptive literature and published installa- 2.2 Thermal Resistance. tion instructions. 6.2 Warnock Hersey Professional Services Ltd. prepared report 3.0 DESCRIPTION of surface-burning tests conducted in accordance with ASTM E 84; Reports Nos. 7171, 7171 B and 7171 C, File No. The INSEALATION System is a low-density, semiflexible plastic 03329-50296-C7-717700 signed by Bob Davison, C.E.T. dated foam that has an open-cell structure.The sealant is a spray-in-place July, 1988, November, 1988 and January, 1989. vapor permeable product used to insulate the building envelope and 6.3 Test on Icynene Foam Insulation for Determination of Ther- to seal areas such as plumbing and wiring penetrations, rim joist mal Insulating Characteristics,Report No.CR 5506-6 dated Febru- areas,window frames, overhangs, porch and garage ceilings. ary 22,1988,prepared by the National Research Council of Canada, Upon completion of expansion,the open cells contain only air.The signed by J.G.Theriault. chemical reaction that occurs while INSEALATION is being applied 6.4 Quality control manual dated January 31, 1989. takes place in seconds, with less than five minutes curing time needed. After curing,the seal remains semiflexible. 7.0 CONDITIONS OF USE When tested in accordance with ASTM E 84, INSEALATION has The National Evaluation Service Committee finds that INSEALA- been shown to have a flame-spread index of less than 75 and TION System described in this report complies with the 1993 BOCA smoke-density rating of less than 450,when installed at a maxi- National Building Code,the 1994 Standard Building Code,the 1994 mum thickness of 5.5 inches and a nominal density of 0.5±10 per- Uniform Building Code and the 1992 CABO One and Two Family cent pounds per cubic foot.The product has a thermal resistance Dwelling Code with 1993 Amendments, subject to the following of 5.7°F.ft2.hr/Btu when tested at a thickness of 1.6 inches in conditions: accordance with ASTM C 518-85 at a mean test temperature of 75°F 7.1 INSEALATION shall be separated from the interior of the /,Q N building by an approved 15 minute(index of 15)thermal barrier. 7.2 The applied material shall not have a thickness exceeding 5.5 4.0 INSTALLATION inches and shall have a nominal density of 0.5 pounds per cubic The manufacturer's Icynene Installers Manual,4th edition,October, foot±10 percent. 1991 shall be strictly adhered to and a copy shall be available on the 7.3 INSEALATION shall not be deemed to add to the structural jobsite at all times during installation. strength of any wall assembly or be used as a nailing base. The product is applied using spray equipment specified by the 7.4 INSEALATION has not been evaluated forweather resistance, manufacturer at the construction site on vertical and horizontal for use as a firestopping material or through-penetration system. This report is limited to the specific product and data and test reports submitted by the applicant in its application requesting this report.No independent tests were performed by the National Evaluation Service(NES),and NES specifically does not make any warranty,either expressed or implied,as to any finding or other matter in this report or as to any product covered by this report. This disclaimer includes,but is not limited to,merchantability. This report is also subject to the limitation listed herein. Page 1 of 2 Page 2 of 2 Report No. NER-420 The insulation is required to be protected from the weather after tions and this evaluation report along with the date, address of application. installation, company's name, installer's name and certification number. 7.5 INSEALATION shall be applied by contractors certified by the manufacturer to perform the specific application intended. The 7.6 This report is subject to periodic re-examination. For infor- installer shall provide the building jurisdiction with a letter noting mation on the current status consult the evaluation report listing or the installation was in accordance with the manufacturer's instruc- contact one of the participating members of the NES. National Evaluation Service, Inc. ICBO Evaluation Service, Inc. Supplement Participating Members: SBCCI-Public Safety BOCA Evaluation Services, Inc. ICBO Evaluation Service, Inc. Testing and Evaluation Services, Inc. 4051 West Flossmoor Road 5360 Workman Mill Road 900 Montclair Road, Suite A Country Club Hills, Illinois 60478-5795 Whittier, California 90601-2299 Birmingham, Alabama 35213-1206 (708) 799-2305 (562) 699-0543 (205) 591-1853 NATIONAL EVALUATION REPORT Report No. NER-420 Copyright© 1996,National Evaluation Service,Inc. Reissued September 1, 1996 INSEALATION SYSTEM FOAM PLASTIC INSULATING SEALANT ICYNENE INC. 376 WATLINE AVENUE MISSISSAUGA, ONTARIO L4Z 1X2 CANADA This report was re-examined and reapproved on September 1,1996,and will not be reprinted since there are no required technical changes.The previously printed report complies with the 1994 Uniform Building Code. The following editorial change makes the report compatible with the cur- rent code: CONDITIONS OF USE Reference should be to the 1994 Uniform Building Code. This supplement and the report are due for re-examination September 1, 1997. This report is limited to the specific product and data and test reports submitted by the applicant in its application requesting this report.No independent tests were performed by the National Evaluation Service(NES),and NES specifically does not make any warranty,either expressed or implied,as to any finding or other matter in this report or as to any product covered by this report.This disclaimer includes,but is not limited to,merchantability.This report is also subject to the limitation listed herein. Page 1 of 1 w PERMIT NO.: BLD q 7— �::62/ MASON COUNTY BUILDING PERMIT APPLICATION 7-� 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 AFPLICA T INFORMATION j CONTRACTOR INFORMATION Owner r / e LJj1`IL N K r 4- Contractor Name d W N k:-'2 11116-D Mailing Address el7cj r 2 &14 V4 a, Mailing Address City State� Zip Code y City State Zip Code Phon t3 ther Ph.( 3Gu ) 5 uz Ph.( Other Ph.0 Lien/Title Holder c fa do K Contractor Reg. # Address 2U wh 4&So L Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic bC.-Existing Septic Connect to Sewer System Name of Sewer System Well Water System k, Name of Water System a j h ! S/r,., min C— PARCEL INFORMAT ON-1 digit Tax Parcel,No. 2 2 / .5 / 000 / Fire District Legal Description A- le / cccc.`1 /"u✓ , _ - 4 72 f 111,05- Site Address(Plea a include street name, str et nufnber and city) Directions to sit�l,K z O 6 fu 0-S6/{ G e c esc /4-J Will timber be cut and sold in parcel preparation? (Yes/No) o / / Is your property within 200' of the following: Body of Water(Name) Y0 , << s < « ` Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New__Add Alt Repair Other Use of Building A - 3 Describe Work No. of Bedrooms 2- No. of Bathrooms 3 SQUARE FOOTAGE-1st Floor�roJu2nd Floor / h 3rd Floor Loft Basement_ Deck Other sq. ft. Garage Attached etached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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-]certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without appr first obtaining approval. X 4A4 I V" Date S 2/ A X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal a01610- Valuation $ s5 �5/1�/_ FEES Building Permit Fee �I a s Site Inspection Plan Review Fee We 1.Al55,! I UFC Plan Review Fee CP Plumbin Base Fee oe., Public Works Review Fee Mechanical & Base Fee p Other G'� O % ✓ Wood/Gas/Pellet Stave Fee DU Other Violation Fee ye SV Pre-Paid at Submittal ( CP TOT AL FEES PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-446. Elms 360 482-5269 Seattle 206 464.6968 APPLICANT INFO ION CONTRACTOR INFORMATION Owner_ f MA c Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone ' .�,,� �herPh.(96p ) Z -I,)t _S'ii� Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address ► e v Expiration SEPTIC INFORMATION-Connect to New Septic____,Existing Septic ,T Connect to Sewer System Name of Sewer System PARCEL INFORMATION-1 digit Tax Parcel No. ?'�2, /, / / Fire District Legal Description _ / Site Address(Please Include street name,street number and city) Directions to site Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New—. Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage , Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electrics_ Type of Fixture No. of Fees LPG Natural Gas 'Heatpum Toilets Type of Unit No. of Unl s Fees Bath Basins Furnace Bath Tubs 2 Heatpumps Showers 7•— Vent Fans Water Heater �— �����= Propane Tank Laundry Wsher�— Gas O s Sinks /. Woo /Gas ellet Stove Dishwasher Z Dire ent? Other S �rr�— Other Other / Other Base Fee Base Fee TOTAL PLUMBING °O TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTUREWNIT. 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 11AYS 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 the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done In conformance therewith. No changes shall be made without approval. first obtaining approval. Date S �` X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. i DEPAMENTAL RE1/1EW A 0R.O t1 [!:<:>.:;: �jIF 3. :::€ : >:>'>:>:: '"" .'.>CA.NDITI R t 04l, Building Department Occ Group Type Constr. Planning Department Other Other ..: :..::...:...........:..:.::..... ::::.:::....:::::::::.. F S. Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS MRD MASON COUNTY PROJECT SITE INFORMATION Case No. Name /1( i "' /LRCEL NUMBER. 3-2- 3(, 5 I 0 00-44 Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW I I �'acent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 i. l ,-i I Fadjacent property line I G r `� 1 121 n L511- ,� I --__ I I So Ut ►'�,` I I I 41'M I I I I adjacent property line- I C r <-adjacent property line SAMPLE SITE PLAN adjacent property lined aio' E-ddjacent property line D 30" rR�SCRvE 3o-)I CREEK \ I fi MOM t I Grxaeiu .1 I H o rt-S fc 1 j PrioPastD sap+..C- --'►I 1 I R I VAGn,T D0.oPoSCD I I� �\ T $O A6RZCLLlTLLRAL I 1 I I 80, i• I I � t..�.eLL I I I I I I j I adjacent property line- I , \; <—adjacent properfy line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dts+.ar.cQ to 2 S�w�, ru.Ltla.Y� Slops. f'o¢ - dis+ancQ /l to L ure ate