HomeMy WebLinkAboutBLD2013-00942 Final Replacement SFR - BLD Permit / Conditions - 6/12/2015 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line (36U)4"L7-7Z6"L
Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 279
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2013-00942
OWNER: HENRY MCKEEN RECEIVED: 10/25/2013
CONTRACTOR: LICENSE: EXP: ISSUED: 12/17/2013
SITE ADDRESS: 20 E ADELLE LN ALLYN EXPIRES: 6/17/2014
PARCEL NUMBER: 122322200070
LEGAL DESCRIPTION: TR 7 OF NW NW
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
REPLACEMENT.. REMOVING MFG HOME BEFORE FINAL INSPECTION, FOLLOW ST RT 3 TOWARD ALLYN, R ON HARDING HILL RD, LOCATED ON
NEW CONSTRUCTION OF STICK BUILT THE CORNER OF HARDING HILLS RD &ADELLE LN
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:1,729
Valuation: $ 190,691.41 Building Height: 15 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: S 242.0 Ft. Shoreline: Ft. Water Body:
Rear: N 20.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 95.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: W 128.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Clothes Washer 1 Dryer Vent 1 Plan Check Fee JWH 10/25/201 $ 977.18 S1201300000001
Bath Tubs 1 Exhaust Hood 1 Planning Review Fee JWH 10/25/201 $ 205.00 S120130000000i
Dishwasher 1 Heat Pump 1 EH Plan Review SMK 10/25/201 $ 103.00 S720130000000(
Hosebibs 2 Ventilation Fan 3 Building State Fee MAU 11/27/201: $4.50 S120130000000i
Kitchen Sink 1 Mechanical Base Fee MAU 11/27/201: $28.50 S120130000000i
Lavatories 2 Mechanical Permit Fee MAU 11/27/201: $67.40 S120130000000i
Showers 2 Plumbing Base Fee MAU 11/27/201: $24.70 S1201300000001
Water Closets (Toilets) 2 Plumbing Permit Fee MAU 11/27/201: $ 101.90 S120130000000i
Water Heaters 1 Building Permit Fee MAU 11/27/201: $ 1,503.35 S1201300000001
Total $ 3,015.53
BLD2013-00942 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
` BLD2013-00942
CONDITIONS FOR
BLD2013-00942
1) Approved per dimensions and setbacks for new site-built residence on submitted site plan. Setbacks are measured from the furthest projection of the
struj`
X
2) Applica i n ayknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5 zone.
X ;�f !
3) Applicant has indicated this is a replacement unit. Prior to Mason County all wing any occupnacy of the new proposed unit, the existing unit which is
on-site and is being replaced MUST be removed from the parcel. X t✓l
4) All construction and demolition debris must be removed from the site after project completion. Prope is os I of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X � n�
5) Temporary erosion control measures must be implemented to prevent water quality degradation of adjac§!gt w�tMr wetlands. Silt fencing, straw, or
surface matting must be installed and maintained until upland vegetation has become established. X f z f'f
6) Prior to final approval, all upland areas disturbed or new cre to by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X ZZW
7) 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/contractoyys,�clygowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
8) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
A r v d Site Plan" to ensure these structures are shown and meet the setback conditions listed.
BLD2013-00942 Please refer to the following pages for conditions of this permit. Page 2 of 6
9) ' By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved bite Plan" to ensure
these structures meet
meet the setback conditions listed.
X
10) Retaining walls needed to support a surchaFge Ruch structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X y
11) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
X�� jo any further inspections being performed or approvals granted.
12) Owner Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X V )a)
13) The "approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Build��ert_r�e�t prior to any further inspections being performed or approvals granted.
X �V �
14) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X z"L,) �
15) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling.
X /—/ZI
16) 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. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
per vo�tio„nq
mits
X /� /y,/
17) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordin c / ulation, must be reviewed and approved by Mason County prior to construction.
X ��'GG
18) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2013-00942 Please refer to the following pages for conditions of this permit. Page 3 of 6
J) ' All building permits shall have a final inspection pertormed and approved by the Mason county nilding uepartment prior to permit expiration. i ne failure
to request p,,ffnal inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
X Mason ntygr)dina and building regulations.
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, riod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder ha ;�e action from being taken. No more than one extension may be granted.
X
21) FEfll
ted wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
fflr?ng. Install metal connectors approved for contact with the new types of pressure treated material.
22) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647- e ppi signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X 1' Y
23) THE ��� TITYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
24) 2012 IECC/Washington State Energy Code Compliance has been approved as follows:
Heat Type: DUCTLESS HEAT PUMP +ELCTRIC ZONE HEAT, Compliance Method: Prescriptive option Marine-4C, Window(Max U-Factor):0.30,
Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation min. R-49, Vault
Insulation R-38, and Slab Insulation R-10.
In addition the following credits from R406.2 shall be completed as follows: 1.5 credits required:
Option 3D (1.0 credit): Ductless split system heat pump with zonal control
Optiion 5A(0.5 credit): Electric water heater EF 0.93 or better
Maximum heat equipment output: 24,116 btu/hr
X
BLD2013-00942 Please refer to the following pages for conditions of this permit. Page 4 of 6
z,,)) • /-\permanent cerzlncate, complete(] Uy U I e UwneI, Uunuel UI It y IJleleu utjbIYII I./IUICJJIUIIdI, bIIdlI UC YUJleU WIUIIII II II CC Ieel UI UIC UICI Ull dl UIJII IUUIIUII
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 105.4, 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 5 air changes per hour when tested
with a blower door in accordance with IECC/.WSEC Section R402.4.
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 IECC/WSEC R401.3 & R101.4.3
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2012 Certificate" and are available in %<or'/z sheets. The
Mason Co4,nty Permit Center will also have some available.
X �
26) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section
R404.1.
XT
27) WIND LOADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MPH.
X �
28) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs. (IRC 2012 R905.2.8.5)
x ,Z 1�4 Y4
29) 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 Xproject.
BLD2013-00942 Please refer to the following pages for conditions of this permit. Page 5 of 6
• 30) ' CONS I RUC I ION PRUCtSS I U tit FItLU CUKKLC I tU H5 NtZUUIKtU NtK IVIHJUN UUUN I Y IJUILUINU Ut:!-AK I IVItIN I HINU I hit/AUUN I tU
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County.Building
Xspeygr„sh�ly be made prior to requesting additional inspections.
OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by
signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the
work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s) for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if
construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
Signature e Date
'/1/RY OWNER - REPRESENTATIVE - CONTRACTOR
Print Name (Circle one to indicate)
BLD2013-00942 Please refer to the following pages for conditions of this permit. Page 6 of 6
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C) Date'a 3J7 Al By
Footings I Setbacks Ribbons m
Gas Piping M
0 Interior Date By Interior Date By Data ay z
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Exter*r Date B Exterior-Date By
Set-up
Point Load I Isolated Footings INSULATION Date By M
BG I SLAB INSULATION z
Date By Date By FIRE DEPARTMENT ;0
Foundation Walls Floors Date By
Date IJ� By L Data -92 -& a Y, DECKS
FRAMING Walls Date By
Data 5 P 2-11 Lf X_ - - -
Date Ry PROPANETANK S
PLUMBING Vault Dito
Date By
OTHER
Groundwork AM
Datl B Alel Type
Date By 14-Cl 9?M Date
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Int Brace Wall Date co
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permits 1 q C MASON COUNTY .
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location
#is-structure has19vn inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
fund: Items listed below must be corrected to gain compliance `-`"�,yr�'�
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You are Wereby notified that the above cor�ec` tons shall 6 maaae
E,ORE PROCEEDING WITH ANY FJJRTHER WORK
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Call for re-inspection when corrections are made before continuing please contact our office
Make corrections, items will be checked on next inspection regarding possible structural
OK t0 damage incurred by recent
"natural/man made"
❑This is not a complete inspection �1 disasters.This is Nora
Date 3 � Department L�/ CORRECTION NOTICE.
Inspector Lvov/
s4k s NCOT , MUV THIa T-` 0ftqu
Permit# ,� w,?V z MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location '00
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
Make corr ctions, items will be checked on next inspection regarding possible structural
OK to damage incurred by recent
"natural/man made"
❑This is not a complete inspe tion disasters.This is NOTa
Date 42 00 • Z Department 1/11.19 CORRECTION NOTICE.
Inspector 020�
NnT ' 'inIVU ' ' THIqx T' -oqff
Request To Revise An Approved Plan
Permit Number: BLD2013 - 0Q 1'-1 a Name
Parcel Number J X�32 - _- r 70 Phone Number daytime ( t 1)
Project Address Mailing Address -
Please provide a complete, detailed description of the proposed revisions to the approved plans:
C1c1i►'1c eCL. - G E
Y01 co ,�A —S WEYYl -Trv`hi
Are two sets of the revised plans or addendum indicating the changes included? VYes ❑ No
Are the approved site plans included? ❑ Yes ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? /Yes ❑ No
If Yes, Is a revised site plan, with all new setback dimensions included with this request?
[; Yes ❑ No
Additional Information: I l I iY
P nS.
Applicant's signature Date: ( - 1 1- 2.01 `i'
Office Use Only Received by:
Date Sent Assigned To Approved By Date
1 rn U Original Valuation: $
B• ( j� l,�D• Additional Valuation: $
Sq.Ft. x$ $
o Sq. Ft. x $ $
E.H. nD+ LOZ�eci rLa" Total New Valuation $
Additional Fees:
❑ P.W. Additional Planning Dept. $
Additional Plan Review $ ,OO
Additional Conditions/Comments: Additional Building Permit $
Additional Plumbing $
Additional Mechanical $
Additional E.H. Dept. $
Other $
Total Amount Due:
Amount To Be Paid Up-Front$
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., BUILDING
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OCT 31 2013
' 426 W, CEDAR
FORM MUST BE COMPLETED IN INK MASON,COUN i`Y PERMIT NO.
PLEASE PRESS HARD BUILDING PERMIT APPLICATION
l G 426 W. Cedar- P.O. Box 186, Shelton, WA 98584
' Shelton (360) 427-9670 • 7 Belfair (360) 275-4467 - Elma (360) 482-5269 ` `A n
On the web www.co.mason.wa.us / 1
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Re.n R u A 41 e K e- e--vt Company Name 141 b b s Cc N S4Ry-e-f r o n
Mailing Address 'Pr) Bn4 J317 Mailing Address 3 tz/q yy74 !pr. Ct E
City I I� State w�Zip Code. q� � � City; ._State u}a Zip Code 4939,' 7
Phone,36D -.295-.5.57/ Other Ph. Phoned x g- Ll7- 7 9 79 Other Ph.&s-7-3t9-/f24
Lien/Title Holder o N 6 Contractor Reg. #NIB fi5 C' /n/ PC Exp. la-a- ,2 Q V
E mail address E Mail Address
r ,
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic_ '
Connect to Water System Name of Water System
WeIL_.Z— Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. o 7 Q Fire District
Legal Descripbon7R 7 o$ tv w NW i
Site Address (Please include street name, street number and city) (- A l
Directions to site 14;g� 2 7�-e m% I e pos4- i q R ' t !an J' 'I w�
4-e 2 s e v, t,c 7 -+ U
Will timber be cut and sold in parcel preparation?Yes/
Is property within 200'of Saltwater 410 Lake ND River/Creek A/P Pond 7VO
Wetland No Seasonal Runoff & D Stream lI/D Slopes or Bluffs > 15% A/O
Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New—Add Alt Repair Other P =RYESIDEN EX SE,4,SONAL ❑
Use of Building Describe Work
No. of Bedroom,-, No. of Bathrooms -2 Square Footage- 1st Floor /7 .2 9 2nd Floor Ii/ON(L
3rd Floor 116?YP Basement wDNe- Deck .voN P Covered Deck NoNi Other NONE Sq. ft. �--
Garage N n Attached A'e Detached --ALQ_ Carport /V o Attached 1V Detached A'y
MANU ACTURED FJQME INFORM - Make Mod Year
ength Widt �a No. o �drooms No. Bathrooms
Type of Heat Purchase Price $ Replacer nit? Yes/ No
Installer Name Certification No.
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 regardir 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 access to the above
described property and structure 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
MEAN FA PROGRESS lP!SP CTIO .INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X a -6& - Date:
Owner/Owners Rep esentative/Contractor (indicate which one)
FO FFICIAL USE BEYOND THIS POINT Accepted by: Date a I
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department -11
Planning Department
Environmental Health Department
Fire Marshal
FEES
Buildinq Permit Fee Site Inspection
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. IC
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton,WA 98584 I h
Shelton (360)427-9670•Belfair(360)275-4467•Elma(360)482-5269
On the we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner � e-N rC V a]C Kc c VA Company Name 4 1' 6 b s
Mailing Address D x 3 Mailing Address2 3 8 t 4
City 66 6 State I DA- Zip Code Q 8,�2- Cityi:�eO n A w a-u State w A Zip Code ?R 3 k 2
Phi )ther Ph. Phone3b6-St4 7- 79 7 9 Other Ph.2 s3-312-14.D
Lien/Title Holder 410 A7 Contractor Reg.# LiRRSC /n/ PC Exp.1n _Al az c'i y
E mail address E Mail Address
Drivers Lic.# /`'lc fir-E#H.57/0 P DOB - /7-l9 Y3 Drivers Lic.# 9;91�17 Ku) 9o7, 0 DOB R-
SEPTIC INFORMATION - Connect to New Septic Existing Septic_ Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. 12, 2 3 2 — 2, — o c� 0'>/� Fire District
Legal Description T t? r/ -F N u) Ar 22
Site Address(Please include street name,street number and city) L 4A z It i;i 1A1i P_W�[A,rc„r1(�n;uL
„ 4l ll 4Directions to site I- A d�a1 , am `
p �-�- �/, ,t � T-4- t P i o V r
s property within 200'of Saltwater �/19 Lake Ain River/Creek -yam1LPond
Wetland 4Z- Seasonal Runoff 110 Stream 4Z 0 Slopes or Bluffs > 15% d
TYPE OF JOB - New X Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floors 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNI
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 Spot Vent Fan
Water Heater ( Propane Tank
Clothes Washer I Gas Outlets
Kithen Sinks I Wood/Gas/Pellet Stove
Dishwasher --� Kitchen Exhaust Hood
Hosebibs Dryer Vent i
Other Other Oacfta X
Base Feel Base Fee
TOTAL PLUMBING TOTAL MECHANICAL `-' 1
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 access to the above described property and structure for review and inspection.
PROOF CO IUATI WO K IS BY MEANS OF A PROGRESS INSPECTION.
X C Date: G
wrier wners Re esentative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted b .: Planning Pd Ck# Date l Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr.
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
aa '
i
APPROVED
MC PUBLIC HEALTH
OCT 2 8 2013
-_ LM
01,3 ,00 9�i�,
a52 �vcJ laa3,;', - as - 00 Q
a.
Name u We P�e" ' 4arcel 9 I —,-2 2.,_ ''��7 lZ
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code, Title 14,Chapter 14.48 a sormwater site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface=.
"Redeve1opment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detmtion facilities shall not be considered as impervious surfaces.
eru�nvs Sur#aces.: leaseo 1efe.This
._
P -
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X _ 112 9 Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
Driveways J1,5 X n
X Length of drive begins at the right of way
X =
Parking Areas q X 0 _ rL
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X
X = ifae fatal impervious area of the proposed site
= development is.greater Shan.2000•square feet a
X
.... . 5m - Required
_ aI1 Pagel:Stom�►water,Site.Plan;is _
Total im ervioi3s.Surface Area:$vm-bf.`all areas _
p ( - l 2q
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read, acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described riy fofor}review and inspection as may be required.
X (/C .. C —UAQ Owne Agent/Contractor(circle one)Date: IoI2 Z
If th otaI Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,ackn ledge and sign
the information provided on page 2 of 2. jko i # M tug
Page I of 2 42r, W opnapc3i
Name Parcel# 1.2:t 3._a — ;Z,2 — 6r)A BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
http//v,ww.co.mason.wa—us/co,de/co=issioncrs,rmdex.htm
PIease follow the links to "Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48.section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist.
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A)X The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850, Shelton WA 98584
Physical: 415 N 6th St,Shelton WA 98584
If this development has, or will have,a septic/drainfield system you may need to contact 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.Mason
County Division of Environmental Health can be reached at: "
Phone: (360) 427-9670 EXT.352
Mail:P 0 Box 1666, Shelton WA 98584
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent 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,owner's legal representative, or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described p erty for review and ins ection as may be required.
XAgent/Contractor(circle one)Date 2
Page 2 co) 2 --�
d2�1�•60qg2
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APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE 0 4 SITE
j CHANGES SUBJECT TO APPR )VAL
�f By 111A Date t
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PLANNING
/1 r` ALL SETBACKS ARE MFASURU
FROM THE FURTHEST
PROJECTION OF THE BUILDINC
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OCT 3 1 2013
426 W. CEDAR Sl
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DISCLAIMER AND LIMITATION OF LIABILITY:
The data used to make this map have been tested for accuracy,and every effort has been
made to ensure that these data are timely,accurate and reliable.However,Mason County LEGEND
makes no guarantee or warranty to its accuracy as to labeling,dimensions,or placement or
location of any map features contained herein.The boundaries depicted by these data are Roads [_j i. a°Lards
approximate,and are not necessarily accurate to surveying or engineering standards,and are
intended for informational purposes only.Mason County does not assume any legal liability ram✓Highways City of Shelton
or responsibility arising from the use of this map in a manner not intended by Mason County. Rivers 8$treems County boundary IpNR)
In no event shall Mason County be liable for direct,indirect,incidental,consequential,
special,or tort damages of any kind,including,but not limited to,loss of anticipated profits parcels Commiss[orwr Districts
or benefits arising from use of or reliance on the information contained herein
(� Sections takes
2009-Mason County GIS
100 W.Public Works Dr Townships Puget Sound IS Ma)or Lake'_
Shelton,WA 98584
http://mapmason.co.mason.wa.us/servlet/com.esri.esrimap.Esrimap?ServiceName=amaso... 10/25/2013