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Home My WebLink AboutBLD2012-00166 Cancelled - BLD Application - 8/1/2016 BUILDI , kIASON COUNTY PERMIT NO. h2a 20 d= BUILDING PERMIT APPLICATION ir( Dal 426 W. Cedar• P.O. Box 136, Shelton, WA 985S4 Shelton (360) 427-9670•Belra360)275-4467•Eima (360) 482-5269 On the web v.�v�+.co.mason.wa.Ls APPLICANT INFORMATION CONTRACTOR INFORMATION Owner /0:� �c2�S Company Name Mailing Address Mailing Address City State Zip Code city- Phone Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.. Exp. E mail address E Mail Address Drivers Lic.4 DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION-12 Digit Parcel No ) t o< <1 Fire District s 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/j1j 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?YesJNo TYPE OF JOB-New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No.of Bathrooms Square Footage- 1 st Floor rand Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft 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. OV ERI BUILDER Fbuiowiedges submission of inaccurate irriormabon may resat in a stop work order or print revocation.A--kmowiedgemarit SL&is by signattze balow.I declare tat I am the owner,owners legal representative,or the contractor.I further declare that I am eniited to rzreive permt and b do the work as proposed m the appFcation.I declare that I have obtained the permission from all the necessary parties_tf Fbot iss r-�aired from arty easement hoider.or arty ofhar party in interest regarding this application or the work proposed in the appficaion,I havpaT iission from them to apply for tttis pem rt and conduct the work proposed. The owner or agent on owners behalf,represena that th provided is are rates and grants employe--s of Mason County amass to the above descrtbad property and str txe for review and insp.- PROOF O NTINUATION OF WO IS BY MEANS OF A PROGRESS INSPECTION. Date: � Owner wners Representative/Contractor Cindimte which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by. e DEPARTMENTAL REVIEW APPROVED DENIED NO Building Department (o Iow Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site 'ont Plan Review Fee f 1 Cv 78` EH Review Fee Plumbing&Base Fee V Planning Review Fee Mechanical &Base fee + 1 — Other Wood/Gas/Pellet Stove Fee State Fee � -- Violation Fee Pre-Paid at Submittal 1 `I-�� %Faivation$ 3 O s TOTAL FEES l •� R f l J ♦ h A ILI, L -ci f7) � l kx1"7 �o� o e -�( o MASON COUNTY PERMIT NO. 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 INFORMATION CONTRACTOR INFORMATION Owner o � �� Company Name Mailing Address 6`� 3 J Mailing Address City �'��/ State�Zip Code T2- City State Zip Code Phone E�� ''�S=L/7/ --(Other Ph,�4o >5-1 le ofD Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer Systen)t)_ ),"-//4 Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No -3's,0 e' Fire District Legal DescriptionSite Address(Please include street name,street number and city) Directions to site �� - �v '' `j Is property within 200, of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. off Fees Fuel Type:Electric—LPG—Natural Gas_Heat Pump_ Toilets Tvoe of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater �— Propane Tank Clothes Washer D— Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher _�— Ktchen Exhaust Hood - Hosebibs Z Dryer Vent �- Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or 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 NUATION OF WORK IS B�MEANS OF A PROGRESS INSPECTION. X ��---- Date: E�/Z Owner/Ow 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 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 ''lame Parcel# /Z 2—U 3 60/0 BLD# Mason County BUILDIN 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 11 2 X 2-0 X 2 = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: eaves/gutters) X = Driveways 10, X X = Length of drive begins at the right of way X = Parking Areas f() X 2.0 X = Any paved, gravel or packed area per definition above table X = Patios/Walks 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) 6 k, 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/Agent/Contractor(circle one)Date: 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 Name �G. 4—ew Parcel# $-Z) ; 6Q0 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: htti)//www.co.mason.wa—us/code/commissioners/index.htrn 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 INITIAL 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 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 prope r review and inspection as may be required. X �- Owne Agent/Contractor(circle one)Date: 3 Page 2 of 2 i , r i f 1 ' • r 1 ; r I • 1 , r i 1 I _ r , I , r 1 91 �� , • 0*ove D 1 s i v 4 r ) 1 � _ I 1 I 1 " T j � o � Ilk o / ■■■■■■■■■■■■■■■■■■■■■■■■M■■■■N■■■ ■■■E ■■■■■■■■■■ M■MMMEE ■MMMMM■ ■ ■EME ■■■■■■■■■■ ■■■■■■■ MEMEMEM ■ MEM■MMEMEMEMEMM MEMEMMEMM■MMEMEM MMMO■■EM■MMEM■MEMMEMEMM ME■NEN■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■N09, ■■ ■■■■■■■■■■�■ ■■■■■■■ ME■EM■MME■■ ■EMMNMMMEMMMM■MEM■■MEMM■MEMMM■■■ ■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■M■EMEMEEMEM■■■■■■■■■■■■■■■■■■■■ ■■M■■EMEMEMM■M■M■■■MEN■■■■■■■■■■ ONE■■■ ■■■■■■■■■■■ ME■E■■■■■■■■■ ■EN ■■ ■ OMEN ■■ON MENNEN MENEM ME■ MMEM MMEN ME MEN MEN NONEE MEMMENEEMEEM ■EMM■MNEM■■■E MENE■ MM■MMO■MEMEM MEMMEM■MEN■■■ ■■■NN NEEEEN■N■NMMME■■■EMMEMN■■M N■NEE ONENNNNE NONM■■■■■■■■■ONNNE ■NEE■ ikv') �r All I y �. �7�2 vv A� APPROVED M. MASON COUNTY L)CD PLANNING SITE PLAN REQUIRED TO BE ON SITE CHANGES SU E;TO APPROV L By Date - F (� C--L-EVA 1 lot) i jGr+Le � ti wc5T aLEVA s t � s S r- r CLL--IJIA-'to+J 1 i 1 ° fi3u , Nk F I t� r i r Ili' O' r UtibOJ , j ;;Yol pip ,1�� 1 ems . ti it I I - 1 1 i 11 1 i Y ( I ! G _ cy. tip .r^s- i a 74 40 - 2 t - - r- i , j F � • � I i � y I� IYO77 _ 1 � 019 � xr 3- Lj UJA i l r � � I - i y es 32) " i� �I - --- ---a/� b'7- off - - t 1 � f ; _y I