HomeMy WebLinkAboutBLD2010-00789 MFG Home - BLD Permit / Conditions - 10/1/2010 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
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RESIDENTIAL BUILDING PERMIT BLD2010-00789
OWNER: THOMAS JOHNSON RECEIVED: 8/31/2010
CONTRACTOR: DB& R INC 360-269-3877 LICENSE: DBRIN**044JQ EXP: 4/10/2012 ISSUED: 10/1/2010
SITE ADDRESS: 130 E WHEELWRIGHT ST ALLYN EXPIRES: 4/1/2011
PARCEL NUMBER: 122205093000
LEGAL DESCRIPTION: ALLYN BLK: 93 EX 93-A& PTN OF VAC WHEELWRIGHT ST SEE S 8/69
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New MFG Home, Fire damage to existing stick built SFR, permit ST RT 3 TO ALLYN, L ON LAKELAND DR,
BLD2010-00325 was issued for the repair to residence then cancelled,
owners changed mind and went with new MFG
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.:
Type of Use: MH Insp.Area: No. of Bathrooms: Occ. Group: Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: Occ. Load: Building:
Valuation: Building Height: Occ. Status: Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make:KARSTEN Length: 66 Ft. Front: E 100.0 Ft. Shoreline: Ft. Water Body:
Rear: W 105.0 Ft. Slope: Ft.
SEPA?: No
Model:K-103 Width: 27 Ft. Side 1: N 135.0 Ft. Shoreline Desig.: Not Applicable
Year:2010 Serial No.: FACTORY Side 2: S 80.0 Ft. Comp. Plan Desig.: Urban Growth Area
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Planning Review Fee GMM 8/31/2010 $205.00 S12010000
Mobile Home Submittal Fee GMM 8/31/2010 $264.25 S12010000
Mobile Home Issuance Fee DLC 9/16/2010 $264.25 S12010000
Total $733.50
BLD2010-00789 Please referto the following pages for conditions of this permit. 1 of 6
CASE NOTES FOR
BLD2010-00789
CONDI11ONS FOR
BLD2010-00789
1) 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 Cou i an es and building regulations.
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2) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American
National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you
can confa 3rice of Manufacturing Housing (360) 725-2800.
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3) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including
installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be
clearly m ,thg installation instructions.
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4) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State
Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present
to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified
installer responsible for each major part of the installation. RCW43-63B.090
An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily
located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each
installer performe �d. certification number and signature of the certified installer responsible for each major part of the installation.
WAC365-210 X
5) This permit is for th gnt and installation of the manufactured home only and does not imply approval or review for any other items indidcated on
the plot plan. X _ J�
BLD2010-00789 Please referto the following pages for conditions of this permit. 2 of 6
6) Permanent Address must be posted and visible from the road
Deck must be safe and meet code for year building permit was issued. Rebuilt decks are required to meet current code. All guardrails and handrails
must be in good condition and meet code for year built or current code if replaced.
Skirting must be vented 1:150 and backfill sloped away from unit 2% for a minimum of 5' around the perimeter of the unit
Gutters and downspouts must be installed with splash blocks provided
All exterior penetrations must be sealed
HWT Pressure relief line and dryer vent must exit skirting a minimum of 6"with a maximum of 24" above grade.
The unit shall have a minimum of 16"x24" crawl space access provided HOWEVER, if the unit has not received a set up inspection and is skirted, 4
panels centrally located (one on each side of unit) shall be removed by the owner/applicant prior to requesting the inspection.
All conditions on the original or issued permit must be met
If the unit was installed by a WAINS certified installer/contractor since July 1, 2003, CTED Installer Tags must be available
It shall be the responsibility of the person requesting the inspection to provide the
manufacturer specifications, ANSI Standards or approved engineered design for the installation of the unit and have them available on site for inspection.
Each inspection required will be assessed a fee as adopted under Mason County current fee schedule. Re-Inspection fees will be assessed each time an
inspection is requested and required items are not completed prior to the inspection being performed
ENFORCEMENT PROVISION:
Any manufactured/mobile home and/or appurtenant structures found non-compliant with any county or state regulation are subject to enforcement action
and subsequent violation and penalties pursuant to the Mason County Code.
7) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all
responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the
inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason
County Building Dept., and will be assessed in addition to my original permit fe to resolve any questionable practices or problems that have been
discovered. I further understand that this investigation will be s edu lows. Until resolution of any/all problems no occupancy (Final
Inspection)will be granted for the residence.
OWNER/CONTRACTOR(indicate which) Signature
8) 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
1-809 0 2. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
BLD2010-00789 Please referto the following pages for conditions of this permit. 3 of 6
9) 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 o�r,onved documents will result in failure of required building inspections.
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10) This project is approved to use the Xi2 foundation system as approved by Karsten Homes, the maufactured home manufacturer. The system has been
engineered and approved for seismic design category D and 85 mph wind, with exp C.
The foundation system shall be installed in accordance to Tie-Down engineering specificationas included with the approved plans and manufactured
home installation specifications.
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11) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X `� �
12) 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
Xuil� �ent prior to any further inspections being performed or approvals granted.
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/contract$ o'wledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
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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 are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
suc onnect 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) 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 revos�it
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BLD2010-00789 Please referto the following pages for conditions of this permit. 4 of 6
16) 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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17) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
Xrdinanseo4g7 lation, must be reviewed and approved by Mason County prior to construction.
18) 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
spector st l ade prior to requesting additional inspections.
19) THE DEMOLITION AND DISPOSAL OF DEMOLITION DEBRIS MUST MEET REQUIREMENTS AS PER MASON COUNTY REGULATIONS. IT IS
UNLAWFUL FOR ANY PERSON TO CAUSE OR ALLOW THE DEMOLITION (OR MAJOR RENOVATION) OF ANY STRUCTURE UNLESS ALL
ASBESTOS CONTAINING MATERIALS HAVE BEEN REMOVED FROM THE AREA TO BE DEMOLISHED. WORK SHALL NOT COMMENCE ON AN
ASBESTOS PROJECT OR DEMOLITION UNLESS THE OWNER OR OPERATOR HAS OBTAINED WRITTEN APPROVAL FROM ORCAA, 2490 B
LIMITE _ VW, OLYMPIA WA 98502, 360-586-1044, 800-422-5623, WWW.ORCAA.ORG
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20) All property lines shall be clearly identified at the time of foundation inspection. X
21) 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
hold e prevented action from being taken. No more than one extension may be granted.
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22) Owner/Ag 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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23) Approve i p dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
24) Temporary erosion control measures must be implemented to prevent water qual �ad tion of adjacent-waters or properties. Silt fencing must be
installed and maintained until upland vegetation has become established. X
BLD2010-00789 Please referto the following pages for conditions of this permit. 5 of 6
25) Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Allyn UGA/R3
ResidenbakFope
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26) All construction and demolition debris must be removed from the site after project completion. P nosal of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degredation of State waters. X
This permit becomes null and void if work orconstruction 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 ogress 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.Theo er r the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described pe d ucture for re w a d inspection. �J
OWNER OR AGEN DATE:
BLD2010-00789 Please referto the following pages for conditions of this permit. 6 of 6
9W
o CONCRETE MECHANICAL MANUFACTURED HOME 0
o Date By
I? FootingsISetbacks Gas Piping Ribbons '5- 7146 Z
o Interior Date By Interior-Date BY pale ��� -�� ay O
mExterior Date By Exterior-Date B Set-upZ
Point Load J Isolated Footings INSULATION Date By =
Date By Data SLAB INSULATION By FIRE DEPARTMENT _ O
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Foundation Walla Floors Date By N
Date By Data By DECKS
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Datu By
Date By OTHER
Groundwork Attic
Type:
Date By pate By Date By
D.w.v DRYWALL Type
Int.Brace Wall Date By IA
Oats By pate By FINAL INSPECTION 0
m Water Line Fire Separation
Dale By Date By Date
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments -4
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Sep. 28. 201100 11 : 10AM No, 1135 P. 1/2
I I RECEIVED
SEP 2 8 2010
MAWN CO.UTILITIES
,MASON CO. DEPT. OF UTILITIES &WASTE MANAGEMENT
P.O. Box 578
SHELTON,WA 98584
(360) 427-9670
Customer's
Order No. W Dare r
Name ) i I
Address
11 Jar `} Phone
SOLO BY V 6ASH' .D. CHARGE ONACCT. MDSE.gETD. PAID OUT
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VI C.0/GVIV 14;00 CAA 0VV 441 1100 nAJvii ,v rznmii %,ln Wj VVG
_ 300-
r MASON COUNTY PERMIT NO,
BVILDING PERMIT APPLICATION jAh
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.wams
APPUCANIJNFOE,MAMQN CONTRACT CONTRACT69 INF. RMAPON
Owner Company Name
Mallin W. ��`/!�~ _ MaiN ess r
City �Sta�e_ Zip Tide City State 'LL�1 Zip Code
Phone M Other Ph. Phone 7 7 Other Ph._
Lien/Title Holdr:ir— Contractor Reg.N Exp. -V
E mail address — E Mail Address
Drivers Uc.fl [DOB Drivers Lic.a IP DOB
SEPTIC/WAIF ER SYSTEM INFOOMATION-Connect to New Septi Existing Septic
Connect toJdlator Sy stem Name of Water System
Well ✓ Water System N..me of Water System
PARCEL INFORMATION-12 Digit:Parcel No Fire District
Legal Description_.
Site Address(Please indud#+t(sAt name,itreet number nd ) � 6 re
Directions to sitF �:' 0/ '
Will timber be cent and sold in parcel preparation?Y /N
Is property within 20U of Saltwater Lake River/Creek Pond
Wetland _-.S-aasonal Runoff _Stream Slopes or Bluffs > 15%
Is this mmit submittal the It of a Stop Work Notice Correction Notice or other enforcement action?YeslNo
TYPE OF JOB- new d Aft_Repair thor P , RY RESII) N EASOi�t4L
Use of Building ( '' ' Describe Work / � t ory
-
No.of Bedrooms No.of Bathrooms�,.__Square Footage-1 st Floor 2nd Floor
3rd Floor _.,Basement Deck Covered peck Other Sq.ft.
Garage — Attached Detached C rt Attached Detached
MANUFACTURED HO+VIE INFORM TI Make '� Model - 0 Year ie'
io
Length&.�Midth S1_Serial No. No.of Bedrooms o.of Bathrooms
Type of Heat Purchase Price$ 000 Replacement Unit. Y /No
Installer Name Certification No.
OWNER/BUR D0 i Ackiwwledges sLbrrls'on of inaccurate kdormomon may result in a stop work«der or peW revocation.Acknowledgement of
such is by signature below.I declare that I aml3ho owner,owners legal represental ve,or the convactor,I further declare that i am enabled to receive this
pemnit and to do the work as proposed in the applicall m.I declare thal I have obtained the psmrission from all the rxrcessary parties.If permissionis
required from any e;sserw!nt holder or arty otter party in interest regarding this application or(he work proposed in the application,I have obtained
permission from them b y for dtls penTA and conduct Bte work proposed The owner or agent on owners behalf,represerrts that the information
ace rpa toyees oti;AAason CaxRy aooPss to Ube above descxtbed property and structure for►eview attd insection.
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iM 1`ION !TK IS BY MEANS OGRESS INSPECTION.
Date,
Owner I QwWri Ae reso /Cdntractor i►dioaro which on®
FOR OFFICIAL U'3E BE ND THIS POINT Accepted by: '' Date a
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department ',
Planning Department
Environmental 14ealth Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee_ EH Review Fee
Plumbft&Base Fee Planninq Review Fee
Mechanical&Base fee Other
W /Gas/Pellet S-:ove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
VI/L0/ LVLV LA;00 F&A 0VV 941 1rtl0 MAJVP1 VV rr.AAAL VLA tV4VVL
t MASON COUNTY PERMIT 10. U�0—
BUILDING PERMIT APPLICATION '41 Ar)
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360)482-5269 �I U �_
_ On the web www.co.mason.wa.us
APPUCAlT1114F0 N CONTRACTOR I F RMA14
Owner Company Name x i r-
Mallin dress, 11)cr 20!'r j1i~ Maili A ess °iC. J' 1 /
City Stale ��-� Zfp de City - `� State��Zip Code_
Phone )� d _Other Ph. Phone - 6 > 7 Other Ph.
Lien/Title Hoidor— Contractor Reg. Exp.
E mail address E Mail Address
Drivers Uc.# CDOB Drivers Llc.It DOB
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic j. Existing Septic
Connect to Y at,i!r Sy;tem Name of Water System
Well ✓ Water System Name of Water System
PARCEL INFORMATION-12 Digit Parcel No, Fire District
Legal Description—
Site Address(Please includes treef name,street number and ctity)
Directions to silt,_L -2 ��/ � E `r" .3
Will timber be cttt and sold in parcel p oparation?Y /N
Is property within tot I'of Saltwater Lake River/Creek Pond
Wetland _ S 3asonal Runoff _Stream Slopes or Bluffs > 15%
Is this permit submittal the It of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB le w •d . Aft Repair Qther PRIMARY RESID�N P,.S6E�SON4L
Use of Bulldln{l 4"' ',x f `' Describe_Work "!r ,''� I }t I]j t s , r CfAt Star
No. of Bedrooms_ No.of Batthrooms- ^Square Footage-1 st Floor_ ` ti r ' 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage _ Attached Detached G rt Attached Detached
MANUFACTURED HOME INFORM TI Make `tom � Model - �% Year; -4t,
Length 9c _RNidth _Serial No- ' .r No.of Bedrooms o.of Bathrooms
Type of Heat- ram'C Purckase Price$ ' - �r�'� Replacement Unit. Y / /�o
Installer Name , t ` c r ' Certification No.
OWNER/BULDER/Oi vwlodges whimi&von of inacaxafe irtfomtation may riawk In a stop work order or pemid revocation.PcfmWedgernent of
such is by sionatum below.I declare that I amnho 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 appllcallort.I declare that I have obtained the pemlission from all the nvoessary parties.If permission is
required from any e:isern,"holder or any ottier party in interest regarding this application or the work proposed in the application,I have obtained
permission from them tot y for tds permit and conduct the work proposed The owner tx agent on owners behalf,represents that the information
d is accwnatc and+ employees$Mason County awes to the above described property and structure for review and inspediom
OF(?FCONT,Uy PION tiff RK IS BY MEANS FA PROGRESS INSPECTION.
t n z -zy
Date:
Owner I Ct rb—Flo was !Cdntmotor indivare which one)
FOR OFFICIAL U aE BEYOND THIS POINT Accepted by: Date Cj
QEPARTMENIAL REVIEW APPROVED DENIED NOTES
Strilding Department -
Planning Department
Environmental Health Department jo — .'
Public Works Department
Fire Marshal
_ F ES
Building Permlt F'ee S Site Inspection
Plan Review Fee_ EH Review Fee
Plumbing&Base Fee Planninq Review Fee
Mechanical&Base fee Other
Wood/Gas/Pellet S-ove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
i 1
SEF r 31 2010
MASON COUNTY
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ALL SETBACKS ARE MEASURED (t�
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MASON COUNTY DCD PLANNING I ,A—`
SITE PLAN REQUIRED TO BE ON SITE
CHANGE SUBJECT TO APPROVAL ` I
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Name_] �I O'' Sl✓1 Parcel# 1.q2-20 56 93Z0 BLD# 20Id 00-76
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//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"
PLEASE INIT4AL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
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 wll6e 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-
descr' d prope eview, d inspection as may be required.
},,,,) Owner/Agent/Contractor(circle one)Date: 06'10
Page 2 of 2
NaMeIL Parcel# �2� tj� BLD# -2Z 10 06-1
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 X 2 _ 17,5Z
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X t, = 1�
X = Length of drive begins at the right of way
X =
Parking Areas X
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
X _ above table
Others X =
X If the total impervious area of the proposed site
X __ development is greater than 2000 square feet a
. s
Small Parcel Stormwater Site Plan is Required 1
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 Tesult ima 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 formation provided is accurate and employees of Mason County are granted access to the above-
de rope r re ie e i w Td inspection as may be required.
Owner/Agent/Contractor(circle one)Date: '-�D'lC)
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 1 of 2