HomeMy WebLinkAboutBLD2011-00314 Cancelled SFR - BLD Permit / Conditions - 7/18/2019 Inspection Line (360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
1�
RESIDENTIAL BUILDING PERMIT BLD2011-00314
OWNER: KIRK & LYN BARRETT RECEIVED: 4/25/2011
CONTRACTOR: GIBSON CONSTRUCTION LLC 1.360.509.0775 LICENSE: GIBSOCL932D8 EXP: 4/7/2013 ISSUED: 6/8/2011
SITE ADDRESS: 62 E NORTH BAY RD BELFAIR EXPIRES: 12/8/2011
PARCEL NUMBER: 122205091531
LEGAL DESCRIPTION: ALLYN BLKS: 14-16 LOT 1 OF SP#3060 &T.L.
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr B
Type of Use: SF Insp. Area: No. of Bathrooms: 3 Occ. u Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ L a Building:2,399
Valuation: $ 243,809.45 Building Height: Occ. t u ri a Basement: cov entry80
Manufactured Home Information S ck of r do S horeline& Planning Information
Make: Length: Ft. Fa2:
0kt.
t. reli 35.0 Ft. Water Body: NORTH BAY
g .0 lope: Ft. SEPA?: No
Model: Width: Ft. Si .0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Si15 Comp. Plan Desig.: Rural
Plumbing Fixtures echanical Fixtures FEES
Type Qty. ype Qty. Type By Date Amount Receipt
Water Closets (Toilets) 3 Ventilation Fan 4 Plan Check Fee TW 4/25/2011 $1,137.34 S12011000,
Lavatories - 5 Propane Tank 1 Planning Review Fee TW 4/25/2011 $205.00 S12011000(
Bath Tubs 1 Gas Outlets 3 Water Adequacy Plan Review KKK 4/25/2011 $103.00 S62011000,
Showers 1 Propane Stove 1 EH Plan Review KKK 4/25/2011 $103.00 S620110001
Water Heaters 1 Exhaust Hood 1 Building State Fee DLC 5/13/2011 $4.50 S12011000
Clothes Washer 1 Dryer Vent 1 Building Permit Fee DLC 5/1 312 01 1 $1,800.15 S12011000,
Kitchen Sink 1 Boller 1 Mechanical Permit Fee DLC 5/13/2011 $228.60 S12011000i
Dishwasher 2 Mechanical Base Fee DLC 5/13/2011 $28.50 S120110001
Hosebibs 1 Plumbing Permit Fee DLC 5/13/2011 $145.40 S12011000i
Laundry Tray 1 Plumbing Base Fee DLC 5/13/2011 $24.70 3120110001
ADJUST--Plan Check Fee DLC 5/13/2011 $32.76 S 120110001
Total $3,812,95
BLD2011-00314 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2011-00314
CONDITIONS FOR
BLD2011-00314
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) 427-9670, 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 "finaled" and approved.
2) 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
X 80-67-09 1'he person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
3) 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.
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4) The proposed structure is located in an area known to have questionable soils due to wetland conditions. A soils report shall be required in order to verify
that soils are capable of supporting the proposed structure.
Provide a soils report prepared by a Washington State licensed geotechnical professional demonstrating that the soils supporting the proposed structure
will support a bearing value of 1500 psf or better. The soils report shall be submitted to the Mason County Building Dept. prior to the footing inspection
performed by the Mason County Building Department.
If modifications to the construction plans are required as a result of the soils investigation provide revised plans and details, stamped and signed by the
engineer of record, to the Mason County Building Department for review and approval prior to construction.
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5) 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
Department rior to any A r inspections being performed or approvals granted.
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6) The plan review check list 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 holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal ofapp�ed documents will result in failure of required building inspections.
)
BLD2011-00314 Please refer to the following pages for conditions of this permit. Page 2 of 6
7) 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 in epartniarAvlor to any further inspections being performed or approvals granted.
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8) Washington State Energy Code Compliance has been approved as follows:
Heat Type: LP Radiant boiler min EF .82, Compliance Method: Prescriptive option II, Window(Max U-Factor):0.32, 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 the following credit from Table 9-1 shall be completed: Option 5a
High efficiency water heatinq all water heating devices shall have a min. efficiency of.82 or better.
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9) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet 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 Sp_cific 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 Yz sheets. The
Mason County Permit Center will also have some available.
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10) A minimum of 50 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 or 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 W 5.
11) 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.
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BLD2011-00314 Please refer to the following pages for conditions of this permit. Page 3 of 6
12) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be appl,ied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
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13) 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 acknow that all components of the stormwater management system have been
installed as approved on the stormwater site plan. X
14) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved
access road. Roads a coed to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such ro s co with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
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15) Any changes in proposed 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 ar i shall IteCted by the Building Department prior to any further inspections being performed or approvals granted.
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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
permit revoc
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17) 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.
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18) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
BLD2011-00314 Please refer to the following pages for conditions of this permit. Page 4 of 6
1Y) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND 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 international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall b prior to requesting additional inspections.
20) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
meet the install equirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
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21) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not be used until the final inspection has been performed and approved by a Mason County building inspector.
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22) All property lines shall be clearly identified at the time of foundation inspection. X�
23) 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 a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason Count dMances and building regulations.
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24) 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 n ceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have p ented action from being taken. No more than one extension may be granted.
X 1'
25) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NO �NGREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD
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26) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. Shoreline setback is
measured from rner roof eave at second floor bedroom to the indent in bulkhead; that distance shall be 35 feet or greater.
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27) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason
County Shoreline Ma
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28) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X '
BLD2011-00314 Please refer to the following pages for conditions of this permit. Page 5 of 6
2� Trees in buffer shall remain as part of shoreline buffer during site preparation and construction of the development proposal; residence and
garage outsid be buffer to the wetland at the rear of the property.
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30) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan" to ensure
these structures meet the setback conditions listed.
X CL /
31) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved ite Pla "
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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 means 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 access to the above described property and structure for review and inspection.
NER OR AGENT: � — DATE: ' ���
BLD2011-00314 Please refer to the following pages for conditions of this permit. Page 6 of 6
CONCRETE MECHANICAL MANUFACTURED HOME 03
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N.L. OLSON & ASSOCIATES, INC.
ENGINEERING, PLANNING AND SURVEYING
June 17, 2011 Project Number: 7686-11
Attn: Gibson Construction
PO Box 1248
Allyn, WA 98524
Phone: (360) 509-0775
Subject: FOUNDATION SUBGRADE VERIFICATION
64 E NORTH BAY RD, BELFAIR
ALLYN, WA
MASON COUNTY PARCEL NUMBER: 12220-50-91533
Mr. Gibson
At your request, N.L. OLSON & ASSOCIATES, INC. (NLO) was on-site on 6/10/2011 and
6/14/201, to verify the proposed building foundation subgrade areas. At the time of our site
visit, NLO observed that the perimeter foundation of the building has been excavated down to
the bottom of foundation level. NLO's representative, Wesley R. Johnson, utilized a 1/2 inch
diameter steel T-Probe to verify the relative soil strength of the foundation subgrade. In areas
evaluated with the T-probed, soil penetrations ranged one (1) inch to three (3) inches indicating
a dense soil condition. In our opinion, the foundation subgrade that perimeters the building
should provide the allowable soil bearing pressure of 1,500 pounds per square feet (psf).
Should you have any questions or concerns, which have not been addressed, or if we may be
of additional assistance, please call our office.
Sincerely,
�.s
Wesley R. nson, P.E.
Geotechnical Services Manager
/1
GEOTECHNICAL ENGINEERING SERVICES
N.L. Olson&Associates, INC. 2453 Bethel Avenue, Port Orchard, Washington 98366
Phone(360) 876-2284 • Fax (360) 876 1487
Building Permit # r I `y y MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 19 V
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
f nd: Items Listed below must be corrected to gain code compliance
01
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
❑ Make corrections, items will be checked on next inspection
❑ OK to r-�
❑ This is not a complete inspection Department _- /�L
Date Inspector t.47
■ *U NOOT MOOV THI - , T ' ,01M
Building Permit # MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location
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 code compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
0,. Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
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(This is not a complete inspection Department k-436z?e
Date Inspector
moos NOOT MnV THIA" T Ol w
Permit# � ) 'U U`'� �
MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location C Z ✓ r /-��
This structure has been inspected by Mason County Building Department
and the fol��y�IPpwing VIOLATION of County Laws and Ordinances has been
ound: , l Items listed below must be corrected to gain compliance
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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 corrections, items will be checked on next inspection regarding possible structural
�J(OK to OCG v _ damage incurred by recent
"natural/man made"
❑This is not a complete inspe ion disasters.This is NOTa
Date / /-S / / Department >15 6 � CORRECTION NOTICE.
Inspector T'
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Name 2304_s H s Parcel# 7,? - ��- C 6 BLD#
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 stormwater 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'.
'Redevelopment 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/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area 'All dimensions in feet
Buildings L X Q =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X = zoo
X = Length of drive begins at the right of way
X =
Parking Areas X LU = 300
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 = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas)
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 property for review and inspection as may be required.
X Owner/Agen Contractor ircle one)Date: GJ 2Sr I
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page I of 2
Name `5 Parcel 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:
httt)//www.co.mason.wa—us/code/commissioners/index.htm
Please 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"
PLEASt INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
i
A) 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 property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
MASON COUNTY PERMIT NO. 0==D2_0(!— D"-D3
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
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name �
Mailing Address Mailin Address
City State Zip Code City 1 State 4J�__Zip Code 94�Kj�'
Phone Other Ph. Ph ,ther Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address in2- '33-Tel '
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System _
Well X Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No — Fire District
Legal Description
Site Address(Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes No
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff 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 - Iew Add Alt Repair ther PRIMARY RESIDENCE ❑ SEASONAL E]Use of Building c ` Describe Work J
No. of Bedrooms__�___No. of Bathrooms:—Square Footage- 1 st Floor L door
3rd Floor Basement_ — Deck —Covered Deck_7 Other Sq. ft. 23Z�
Garage Attached 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.
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 OF CO IN AT F WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date•
er wners Re resentative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW AP ROVED DENIED NOTES
Building Department ' - I ll.� Vt
Planning Department FW
Environmental Health Department
Public Works Departments
Fire Marshal
FEES
Building Permit Fee DO Site Inspection
Plan Review Fee 'r 93 EH Review Fee
Plumbing& Base Fee / �D f' Cr-' Planning Review Fee
Mechanical & Base fee •�Pdt Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee I Pre-Paid at Submittal //
Valuation $ 41.3��9• SAS TOTAL FEES
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MASON COUNTY PERMIT 1\104W Z 1 "
PLUMBING/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 INFOR TION CONTRACTOR INFO MATION ,
Owner IC i f 4 . 4 i�.� f'�' Company Name T � I e ,L
Mailing Address -7-- Mailing Address Z,L
City State Zip Code City tate �- Zip Code ` -z
Phone Other Ph. Phone-- <- CJ'�'�; Other Ph.
Lien/Title Holder Contractor Reg. Ex
E mail address E Mail Address <'a - h� - -, ,gyp
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System _
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. - c Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Is property hin 200'of SaltwaterTtS Lake - River/Creek A)() Pond
Wetland _Seasonal Runoff Stream Slopes or Bluffs > 15%
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
Type of Fixture No. of Fixtures Fees Fuel Type:Electric,.-X- LPG--)(- Natural Gas Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Zr J Heatpumps
Showers �— Spot Vent Fan
Water Heater i Propane Tank 1
Clothes Washer i Gas Outlets �
Kithen Sinks I Wood/Gas/Pellet Stove I
Dishwasher Kitchen Exhaust Hood i
Hosebibs 1 Dryer Vent
Other Other�,'�e-✓ I
Base Fee Base Fee
II 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 access to the above described property and structure for review and inspection.
PROOF OF ONTINU N OF WORK tS"BY MEANS OF A PROGRESS INSPECTION.
XIrl7 Date:
Ow er/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grou T e Constr.
Planning Department
Environmental Health Department
FEES
Plumbin & Base Fee Site Inspection
Mechanical & Base fee IUFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES