HomeMy WebLinkAboutBLD2019-00254 DIS2019-00254 Repair Garage Fire Damage - BLD Application - 3/22/2019 MASON COUNTY COMMUNITY SERVICES Permit No: " C)
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL C Ei
615 W.Aider Street,Shelton,WA 98584 LJ
Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone �(D
Belfair(360)275-4467•Phone Elma:(360)482-5269 �Tir"[ Z
41:
BUILDING PERMIT APPLICATION 6
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Aid8 Steer
NAME: Be.c,n n'l•t,(✓i.N NAME: Ki 'e Z�I!1('
MAILING ADDRESS: 4 0 tt=�t'Sr {voK o MAILING DRESS: Y,'VO -W 13c G
,D
CITY: Kcjr STATE-WN ZIP: Z - CITY:157ov STATE: L^- ZIP:
PHONES#1: —5lle 0 3Z-$ '?s(o(o _ PHONE: —4 gb'f 941s' CELL: 3 Z-71 6,714
PHONE#2: EMAIL: &(,-4 e U
EMAIL: 5tAAQ4 L&I REG#
NAME EMAIL K M r
MAILINGA MSS r I ku, CITY STATE W V ZI
PHONE 3bo %610 F Zj 4'i; CELL-'-- y -7-•7 1 - 5 74Lo
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) /ZZL/�d/ L,Of// ZONING
LEGAL DESCRIPTION(Abbreviated) ;W O-IZWVT LdY•j jLr6✓.-;W,6a FIRE DISTRICT
SITE ADDRESS A-soy 3le
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[ NO❑
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkanthat gpry):
SALTWATER IR LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR D< OTHER ❑
USE OF STRUCTURE(Residence.Gmnge,Cawnrrrcial Bktg,Etc)�Z'^Is t W S'V W
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS Z NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(WhaleB1V❑ YES(P-fs]ofBldg)X NO❑
DESCRIBE WORK r �1 D� SfMo
SQUARE FOOTAGE:(propose+existing)
1ST FLOOR i)V'i sq.& 2ND FLOORS sq.fR 3RD FLOOR sq.& BASEMENT sq.ft.
DECK sq.& COVERED DECK sq.& STORAGE sq.& OTHER sq.&
GARAGE_1�sq.& Attached❑ Detached❑ CARPORT sq.& Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALT
SEWAGEISEWER SOURCE: SEPDOX SEWER / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES Q— NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that 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 and 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 legal
representative,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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Signature of OWNER(Must be signed by the OWNER) Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDTTIONS
BUILDING DEPARTMENT S T
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
Z �oi c,ctl'
v�
1
COMMUNITY SERVICES MAR 2 2 2019
® Building.Planning,Environmental Health,Community Health
MASON COUNTY
BUILDING RECEIVED
Physical and Mailing Address: 615 WAlder St., Bldg 8, Shelton, WA 98584 '615 W. Alder Street
Shelton Phone: (360)427-9670 ext 352 1- Fax (360)427-7798
PLUMBING & MECHANICAL PERMIT APPLICATION Permit#:
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: 1(A NAME: {Yl
MAILING ADDRESS:111t S MAILING A DRESS: GI I
CITY` STATE:WA ZIP'13576 CITY: k- STATE: ZIP: I
1st PHONE: LP 0 �52 t 3U W-I PHONE: " ' j CELL: (2 1 f21,11
2nd PHONE: EMAIL: Gl)I ic 4 ( W
EMAIL:sse c UJQ C L&I REG# . EX I I
PARCEL INFORMATION:
PARCEL NUMBER (12 Digit Number): Zoning:
LEGAL DESCRIPTION (Abbreviated: S � 7W // ��Go ��� �syQdEy 3o/zv3
SITE ADDRESS: 3*&Z CITY:
DIRECTIONS TO SITE ADDRESS: Z%y o-v/ .5'e2e"
TYPE OF JOB/WORK: NEW ADD ALT REPAIR .X,__ OTHER
USE OF BUILDING
PLUMBING FIXTURES MECHANICAL UNITS [] Electric in-wall heaters(no fee)
Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel Type Fees
.Toilet(s) —i�F� Furnace PG/LPG)
Bathroom Sink(s) Z I, N6w Heat Pump 01ELPG]
Bath Tub(s) o Ductless H.P. � PG]
Shower(s) — Spot Vent Fan 2 �i.4'l <lt4V tt lr*f
-Water Heater(s) Ot /GILPGIPG] Propane Tank gal.]
Clothes Washer(s) N Gas Outlet(s)
•Kitchen Sink(s) Heat Stove [E/G/LPG/W]
1bishwasher(s) Kitchen Exhaust Hood _I
Hose bib(s) Dryer Vent f
.Other Solar Panel
Other Other irkAir c e/1,-' A t(J. �<
Plumbing Subtotal �R ld1frA7,W jZ Mechanical Subtotal
Plumbing Base Fee Mechanical Base Fee
Final Inspection Fee Final Inspection 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 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.
X `'S - - .3s--
Signature of Applicant Date
X �� '-W-e-t vim Owner/Owners Representative/Contractor
Print Name (Circle one)
DEPARTMENTAL REVIEW APPROVED DATE, DENIED DATE TAGS/NOTES/CONDITIONS
O Building
O Fire Marshal
O Permit Tech (OTC permit only)
. , O,"i-. �'tNtht/L'.CO.I" •,SOi�.1Nc _;SJC 1 �., i`_Lt:�. - _. �/l$/>:i�
WAT -
MASON COUNTY
-; COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
415 N V1 Street, Bldg 8, Shelton WA 98584, ��CF
Shelton: (360)427-9670 ext 400 • Belfair. (360)275-4467 ext 400 Eima: (360)482-5269 ext 400
FAX(360)427-7787 #4R LJ
Application for Determination of Water Adequacy s� q'
Instructions der
1. Complete Part 1. No determination can be made until Part 1 is full com let StrE�t
2. Complete only the portion of Part 2 applying to the type of water connection utl M✓N
3. Submit completed application, with any required attachments for review. HC M N'rA
4. An approved building site plan must accompany this application. C
Part 1: Applicant/ Parcel Identification
Name on Applicant: Gn W1,V� r\ Q_ Date:
t Mailing Address: -34 16 O f SR ?,OZ VRG4 Phone: -2y,, O 328 3(.6-7
Parcel Number: I .ZZZ \ -- 'Z , — 00 k I k
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more ❑ Building permit
connections) ❑ Division of land:
lr/Individual water source (one connection), #of Parcels? SPL
Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other (explain)
❑ Other(explain)
Replacement or Remodel (please indicate name
If you have more than one residence connected of water system below if applicable— no
to this well, check the PubliclComm unity Water signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System:
Water Facility Inventory (WFI) Number:
(write "none" for two-party)
❑ 1 am the manager of this water system. The water system has been approved for services.
There are presently connection(s) in use. This will be the connection.
❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature
of this change:
This water system is able and willing to provide water to this (these) connection(s)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager Date
This form may be scanned and available for public view at www.co.mason.wa.us.
J:\EH Forms\Drinking Rater Revised 112512018
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) gpm gpd.
The well driller often performs well capacity tests at the time the well is constructed. Results from
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a capacity test,
a well capacity test, which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
❑ Satisfactory bacteriological test(attach to application).
Water Resource inventory Area (WRIA)
Development within which WRIA http://gis.co.mason.wa.us/planning 14_ 15_ 16_22_
Water use or limitation recorded................................... N/A Yes
WellDrilled ............................................................... Date
Individual Spring/Surface Water
❑ WDOE permit (attach to application)
❑ Method of disinfection
❑ 1 have reason to believe that this water source can provide at least 800 gallons per day; and/or
provides water at a rate of 2 gallons per minute based on the following observations.
Author of Statement Date
Relationship to Applicant
Part 3: Mason County Community Services Evaluation (staff use only)
❑ Satisfactory Determination:
This determination does not address adequacy of the distribution system, guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
El Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date
CSD Director: Date 2 of
MASON COUNTY Shelton (360)427-9670 ext. 352
V DEPARTMENT OF COMMUNITY SERVICES Belfair(360)275-4467
Mason County Bldg. 8, 615 W. Alder Street
} Shelton, WA 98584 Elma (360)482-5269
- - www.co.mason.wa.us
REQUEST FOR BUILDING PERMIT EXPEDITION FILE
Date: -i�"���/1 COPY
Permit No.:
Name: RECE!VE
Mailing Address. 3y8o ,er S2 3DZ D
�,�L Fiq/�, �,✓� 9esz8 MAR 22 2019
Parcel Number: izLz/ - z/-dO/// 615 VV A/d@r Street
Site Address: 3yAZ a; s.P .3oz
4!!�?.OFG/"Ai2, W-9 9®SZQ
Request due to: ❑ Medical Hardship ),'Fire Damage ❑Other
Explanation of Hardship: &C+f0(oe- 4 18 - FM 0t9 S"9
Must include supporting documents.This may be a letter from a doctor, insurance claim report, report of fire damage
from appropriate fire district representative or other relevant documentation.
I (WE) understand the intention of this form to determine and document justification for expedition of a building
permit to alter or reconstruct a structure on the above named property.
Signature Owner/Agent:
OFFICIAL USE ONLY
Request: O Approved Denied Date:
Request denied for the following reasons: l S No -r A,u &11 �GY,
jjGp Zoog -00 302 JJg# /Z FIAJAi- n "X4'P
Signature:
Director of Community Services
03/15/2019 FRI 11, 12 FAX 3602756224 — Mason Bldg Dept IQJoo1/o0j
(q -(D0 40 So
03/15/19 MASON COUNTY SHERIFF'S OFFICE 1388
11 : 13 FIRE Incident Table: Page: 1
Fire Incident
Number 18-FM0059
Nature 24A.Structure
Addr✓ 3480 E STATE ROUTE 302 Area F110 2V-VICTOR
City Belfair ST WA ZIP 98528 Contact YES
Caller
Numbr 236400
Last Melvin Fst Brian Mid M
DOB 07/21/60 SSN - - Adr 3480 E State Route 302
Race W Sx M Tel (360)277-3038 Cty Grapeview ST WA ZIP 98546
Details
Condition Codes FIRE Reported FIRE Observed
Circumstances
Firefighters F05-Any Unit F03-Any Unit F02-Any Unit
Rsp Firefighter E51-Any Unit Agency FMAR
Received By Wadycki,Shayla
How Received T Telephone CAD Call ID 18-063767
When Reported 07 :13 :27 12/24/18 Last RadLog 10: 02 :51 12/24/18 CM
Occurrd between 07 :13 :08 12/24/18 Disposition ACT Disp Date 12/24/18
and 07 :13 :08 12/24/18 Misc Entry
MO
Narrative
Narrative
Supplement
INVOLVEMENTS:
Type Record ## Date Description Relationship
NM 236400 / / Melvin, Brian M *Complainant
CA 18-063767 12/24/18 07 : 13 12/24/18 24A.Structure *Initiating Call
FIRE Conditions Detail :
Fire Condition Codes
Seq Code
1 FIRE Fire of Undetermined Type
�t UX5
. 1
03/15/2019 FRI 11: 13 FAX 3602756224 ... Mason Bldg Dept I0002/003
y
FIRE Incident Responder Detail
Responding Officers
Seq Name Unit
1 FOS-Any Unit FOS
2 F03-Any Unit F03
3 F02-Any Unit F02
4 FSOD F50D
5 CHA CHA
6 E51-Any Unit E51
7 E21-Any Unit E21
8 E31-Any Unit E31
9 Yates,Greg F503
10 FDZ1 FDZ1
11 ES8-Arty Unit E58
12 T46-Any Unit T46
13 M51-Any Unit M51
14 M57-Any Unit M57
15 T92-Any Unit T92
16 E57-Any Unit E57
17 FM1400 FM1400
18 Patti,Mike F501
Main Radio Log Table:
Time/Date Typ Unit Code Zone Agnc Description
10 : 02 : 51 12/24/18 f E51 CM F110 FOS incid#=18-5F6170 Completed Cal
10:02: 51 12/24/18 f F501 CM F110 FOS incid#=18-5F6170 Completed Cal
09 : 41 :47 12/24/16 f F501 CLRH F110 FOS (MDC) , call=17f
09: 19 :59 12/24/18 f F501 AR F110 FOS incid#=18-5F6170 Arrived on Sc
08 : 53 : 43 12/24/18 1 1T25 CM L110 MCS incid##=18-24036 Completed Call
08 : 53 : 31 12/24/18 1 1T25 CL L110 MCS incid#=18-24036 Clear, back in
08 :43 : 08 12/24/18 1 1T25 ST L110 MCS HOR
08 :41 : 03 12/24/18 f M51 AVL F110 FOS incid#=18-5F6170 Available cal
OB :37 :36 12/24/18 f F501 ER F110 FOS incid##=18-5F6170 Enroute to Ca
08 :33 :56 12/24/16 1 1T25 ST L110 MCS
08 :28 : 1B 12/24/18 f E58 RET F110 FOS incid##=18-5F6170 Returning fro
08 : 21: 1B 12/24/18 f T92 RET F110 P09 incid#=18-9F0411 Returning fro
08 : 17 : 54 12/24/18 f T92 AR F110 F09 incid##=18-9FO411 Arrived on Sc
08 : 03 :43 12/24/18 f T46 AR F110 F04 incid#=18-4F1443 STAGING ON RD
08 : 02 :41 12/24/16 £ E57 AR F110 FOS incid4=18-5F6170 Arrived on Sc
07 : 55:24 12/24/18 f M57 AR F110 FOS incid#=18-5F6170 Arrived on Sc
07 :51 :39 12/24/18 f E58 AR F110 FOS incid##=18-5F6170 Arrived on Sc
07: 50 : 16 12/24/18 f E58 NOTE F110 FOS incid#=18-5F6170 2 MIN OUT cal
Q7 : 45 :41 12/24/18 f FM1400 ASN F110 FMAR incid#=18-FM0059 Assigned to C
07 :43 :59 12/24/18 f F503 AR F110 F05 incid#=18-5F6170 SAFETY call=l
07 :43 :20 12/24/18 f E57 ER F110 FOS incid#=18-5F6170 Enroute to Ca
07 :41 :40 12/24/18 f T92 ER F110 P09 incid#=18-9FO411 Enroute to Ca
07 :40 :48 12/24/18 f E51 AR F110 FOS Assigned as Responsible Unit f
07 :40:44 12/24/18 f M57 ER F110 FOS incid#=18-5F6170 Enroute to Ca
07 :40:27 12/24/16 f F503 AR F110 FOS incid#=18-5F6170 Arrived on Sc
07 : 39: 02 12/24/18 f M51 AR P110 F05 incid#=18-5F6170 Arrived on Sc
07 :36 :4B 12/24/18 1 1T25 ST L110 MCS incid#=18-24036 HOR call=171
07 :36 :47 12/24/18 1 1T25 AR L11O MCS incid#=18-24036 TRAFFIC CONTRO
03/15/2019 FRI 11: 13 FAX 3602756224 --- Mason Bldg Dept 14003/003
Time/Date Typ Unit Code Zone Agnc Description
07 :34 :58 12/24/18 f M51 ER F110 FOS incid#=18-5F6170 Enroute to Ca
07 :31 :37 12/24/18 1 1T25 AR L110 MCS incid#=18-24036 Arrived on Sce
07 :31 :24 12/24/18 f E21 AR F110 NMFA incid#=18-2F2543 Arrived on Sc
07 ;30 : 57 12/24/1B f E31 AR F110 F03 incid#=18-3FO690 Arrived on Sc
07 : 30 :04 12/24/18 f T46 ER F110 F04 incid4=18-4F1443 Enroute to Ca
07: 29 :24 12/24/18 f E58 ER F110 FOS incid4=18-5F6170 Enroute to Ca
07 : 27 :40 12/24/18 f F02 NOTE F210 NMFA 201 AVAIL
07: 27 : 08 12/24/18 f E21 NOTE F110 NMFA TONE DUTY OFFICER OUT OF DIST
07 :25:22 12/24/1B f FDZ1 ASN F110 FDZ1 incid#=18-FZ0020 Assigned to C
p7 :23 : 12 12/24/1B f E51 AR F110 F05 incid#=18-5F6170 302 COMMAND c
;07122 :48 12/24/18 f ES1 AR F110 F05 incid#=18-5F6170 Arrived on Sc
07:21 :23 12/24/19 f F503 ER F110 FOS incid#=18-5F6170 Enroute to Ca
07 :20 : 11 12/24/18 f E31 ER F110 F03 incid#=18-3FO690 Enroute to Ca
07 :18 :59 12/24/18 f E21 ER F110 NMFA incid#=16-2F2543 Enroute to Ca
07 :17 :48 12/24/18 f E51 ER F110 FOS incid4=18-5F6170 Enroute to Ca
07 : 15 :22 12/24/16 f CHA ASN F110 CHA incid4=18-CH0185 Assigned to C
07 : 15 :22 12/24/18 f F50D ASN F110 F50D incid#=1B-ODO112 Assigned to C
07: 14 : 57 12/24/18 f F02 ASN F110 NMFA incid#=1B-2F2543 Assigned to C
07 :14 : 57 12/24/18 f F03 ASN F110 F03 incid#=16-3F0690 Assigned to C
07 : 14 : 11 12/24/18 f FOS ASN F110 F05 incid#=1B-SF6170 Assigned to C