HomeMy WebLinkAboutBLD2010-00066 Final SFR - BLD Permit / Conditions - 6/13/2011 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
RESIDENTIAL BUILDING PERMIT BLD2010-00066
OWNER: ROB MILLER RECEIVED: 2/2/2010
CONTRACTOR: LICENSE: EXP: ISSUED: 4/9/20
SITE ADDRESS: 190 NE TIGER W 10
Y EAST BELFAIR EXPIRES: 10/9/210
PARCEL NUMBER: 123055000035
010
LEGAL DESCRIPTION: TIGER LAKE TRACTS TR 35 EX A, B & C PCL 1 OF SP#220 AF#312657
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR ST RT 3, L ON ST RT 300/ NORTH SHORE RD. R ON SAND HILL RD, L ON
BEARCREEK DEWATTO RD, R ON TIGHER WY EAST TO SITE ADDRESS
ON THE RIGHT SIDE
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: 4 Occ. Group: R3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:2,302 None
Valuation: Building Height: Occ. Status: Primary Basement: cov Mob 66
Manufactured Home Information Setback Information Shoreline&Planning Inform
Make: Length: Ft. Front: W 290.0 Ft. Shoreline: Ft. Water Body. -None
-None
Model: Width: Ft. Rear: E 20.0 Ft. Slope: Ft. es ShorelineDi
Side 1: N 75.0 Ft. g.: Not Applicable
Year: Serial No.: Side 2: S 195.0 Ft. Comp. Plan Desi
9.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type city. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Planning Review Fee GMM 2/2/2010 $205.00 S12010000
Hosebibs 2 Fireplace 1 Fire Warden Review GMM 2/2/2010 $73.00 S12010000
Kitchen Sink 1 Furnace<100K 1 Plan Check Fee GMM 2/2/2010 $1,097.30 §i2bibbbo
Lavatories 5 Gas Outlets 5 EH Plan Review KKK 2/2/2010 $103.00 S62010000
Showers 1 Propane Tank 1 Water Adequacy Plan Review KKK 2/2/2010 $103.00 S62010000
Water Closets (Toilets) 4 Ventilation Fan 6 Building State Fee DLC 2/25/2010 $4.50 S12010000
Water Heaters 1 Heat Pump 1 Building Permit Fee DLC 2/25/2010 $1,721.75 s12bi0000
Bath Tubs 3 Dryer Vent 1 Mechanical Permit Fee DLC 2/25/2010 $264.90 S12010000
Clothes Washer 1 Mechanical Base Fee DLC 2/25/2010 $28.50 S12010000
Plumbing Permit Fee DLC 2/25/2010 $154.10 S12010000
Plumbing Base Fee DLC 2/25/2010 $24.70 S12010000
ADJUST--Plan Check Fee DLC 2/25/2010 $21.84 S120i0000
Total $3,801.59
BLD2010-00066 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2010-00066
CONDITIONS FOR
BLD2010-00066
1) 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 e (silt fencing or straw matting).
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2) Approv d per imensions and setbacks on submitted site plan dated Mar. 9, 2010. Setbacks are measured from the furthest projection of the structure.
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3) 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/contracto is cknowleg that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
4) Temporary erosion control measures must be implemented to prevent water qu ity a radg ation of adjacent waters or properties. Silt fencing must be
installed and maintained until upland vegetation has become established. X L�—a!i
5) 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 800r647-098�h�rson signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
6) 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
Depart e prio�a�further inspections being performed or approvals granted.
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7) Ownef/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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BLD2010-00066 Please referto the following pages for conditions of this permit. 2 of 5
8) 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
remo gl ff ap rg dyed documents will result in failure of required building inspections.
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9) 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
Building D artjnen�r to any further inspections being performed or approvals granted.
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10) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Heat pump with Electric furnace, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58,
Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38.
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11) Per 2003 IRC-SECTION 1609-WIND LOADS- 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
XASI�EEDECOND GUST) the wind speed for Mason County is 85 MPH.
12) Per IRC-SECTION R905- REQUIREMENTS FOR ROOF COVERINGS- R905.1 Roof covering application. Roof coverings shall be applied in
X cor a e with plicable provisions of this section and the manufacturer's installation instructions.
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 acknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
BLD2010-00066 Please referto the following pages for conditions of this permit. 3 of 5
14) In addition to the inspections required in IBC, Section 109, the owner, the engineer or architect of record acting as the owner's agent shall employ one or
more special inspectors who shall provide inspections during construction on the types of work listed under Chapter 17 and as specified by the design
professional. The special inspectors duties & responsibilities shall be as specified in Chapter 17.
Special inspection reports shall be submitted to the Mason County Building Department, PO Box 186, Shelton WA 98584 and available for inspection.
Inspection reports shall be completed and submitted to the dept. prior to the framing inspection.
The engineer of record has specified recommended structural observation to verify that all framing elements be inspected prior to cover and inspection be
Mason County.
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
X arge a d sha II b� collected by the Building Department prior to any further inspections being performed or approvals granted.
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�ev9catio i
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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
Xdinanc or regu n`must be reviewed and approved by Mason County prior to construction.
19) 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
Inspecto s all be made to requesting additional inspections.
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BLD2010-00066 Please referto the following pages for conditions of this permit. 4 of 5
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 installation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
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21), All property lines shall be clearly identified at the time of foundation inspection. X
22) 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
X ason unty o�� c an�es and building regulations.
23) 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
holder h �veprevented action from being taken. No more than one extension may be granted.
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24) Owngr must show proof of satisfactory water sample and well log prior to temporary/permanent occupancy of the residence.
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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 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. / p
OWNER OR AGENT: DATE:
BLD2010-00066 Please referto the following pages for conditions of this permit. 5 of 5
o CONCRETE MECHANICAL MANUFACTURED HOME 3
o Footings!Setbacks Date Gas Piping '/J By Ribbons m
o Interior Date By Interior-Date i!-Z°t—lo By Data p,;
�L _.....
rn �cterior Date By Exterior-Date B Set-up O
INSULATION
Point Load!Isolated Footings -------- Date B w
BG 1 SLAB INSULATION
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By
Date By Data �4 7h �l By Lc/J DECKS .-__...
FRAMING J Walls Date B,;
Date f -Z`3/(� gyC� Data �_��� -/ o By / PROPANETANKS
PLUMBING Vault Date 13y
Date °y' OTHER
Groundvrork Attic f _
Date By Date By Type,
Date By
D.W.1/ DRYWALL Type.
Date L _ G g Type-
Int.Brace Wall Date
Date By FINAL INSPECTION 0
Water Line ' 11 Fin Seperetion N
Date/1'Zg'ID By C✓ Date By Date - By o
O
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments o
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T�_r__s ss - 1 AP
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0
WATER WELL REPORT
ot"WroOF
ECOLta=Y Original&V copy Ecolo 2Mco owner,.-3~co driller CURRENT'
ECr:}40GY 9 pY- BY. pY- PY- -
. a�:�.... .„ Notice of Intent No.W236881
Construction/Decommission(z„in circle)
QX Construction Unique Ecology Well ID Tag No. ALH 617
'Decommission ORIGINAL INSTALLATION Water Right Permit No:
Notice oflntentNumber
PROPOSED USE: x Domestic Property Owner Name Robert Miller
❑ ❑ Industrial ❑Municipal,
❑Dewaw ❑Irrigation ❑Test well ❑other Well Street Address 190 Tiger Way E
TYPE OF WORK Owner's number of well(if more than one) Belfalt Mason
City County
0 New well ❑Reconditioned Method., ❑Dug ❑Bored (;.Driven
❑ Deepened O DRotary Jetted Location NE-1/4-1/4 SW 1/4 Sec 5 Twn23 R 1 Ewm ❑ Check
DIMENSIONS:Diameter o well inches,drilled 1L (st t,r Still REQUIRED) Or � One
th t w l� ,M
CONSTRUCTION DETAILS Lat/Long Lat Deg Lat Min/See
Casing g Welded 6 Diam.from+1 It.to 91 ft.
Installed: ❑Lui'cr installed Diam.from &to S. Long Deg Lung IVIiI1/See
❑Threaded " Diam.From ft-to ft. Tax Parcel No.(Required) 12305500035
Perforations: ❑Yes E No
CONSTRUCTION OR DECOMMISSION PROCEDURE
Type of perforator used Formation:Describe by color,character,size of:material and stntcture,and the kind and
SIZE of perfs in.by in.and no.of perfs._from it to ft, nature of the matariai in each stratum penetrated,with at least one entry for.each change
of information. (USE ADDITIONAL SHEETS IF NECESSARY.)
Screens: (Eyes ❑No ZK-Pac Location 89
Manufacturers Name Johnson MATERIAL FROM TO
Type stainless Model No. Redish brown clay&gravel 0 8
Diem.5" Slot size 20 from 91 ft.to 96. 1L Gray rill 8 16
Diam. Slot size from ft.to ft. -Brown till with some water 16 33
Gravel/Filter packed: ❑ Yes ❑x No Size of gravel/sand Gray till 33 42
Materials placed from ft.to fi. Brown till 42 86
Surface Seal: (E Yes ❑ No To what depth? 20 ft. Brown sand&gravel with water 86 96
Material used in seal Betonite
Did any strata contain unusable water? ❑Yes 0 No
Type of water? Depth of strata
Method of sealing strata off
PUMP:Manufacturers Name OU
ldS
Type: sub. HT. 3/4
WATER LEVELS:Land-surface elevation above mean sea level 8.
Static level 78 AL below top of well Date
Artesian pressure lbs.per square inch Date
Artesian water is controlled by (cap,valve,etc.)
WELL TESTS:Drawdown is amount water level is lowered below static level
Was a pump test made? ❑ Yes ❑x No If yes,by whom?
Yield: gal./min.with ft.drawdown after 1trs.
Yield: gal./min.with ft.drawdown after hrs.
Yield: gaiJmin.with ft.drawdown after hrs.
Recovery data(time taken as zero when pump fumed off)(waterlevel measured from well APR 9 20
top to water level)
Time Water Level Time Water Level Time Water Level
Date of test:
Bailer Test 15 galJmin.with 2 ft.drawdown after I hrs.
Airtest gal./min.with stem set at R for —hrs.
Artesian flow &p.m. Date
Temperature of water Was a chemical analysis made? Yes. (]'No Start Date419/10 Completed Date 416/10
WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well
construction standards.Materials used and the information reported above are true to my best knowledge and belief.
ElDrill-0 Engineer❑Trainee Name(print) Matt Henning,n Drilling Company 'Davis Drilling
Driller/Engineedfrainee Signatur A Address P.O.Box 536
Driller or trainee License No. 307
City,State,Zip Belfarr WA 98528
IF TRAINEE:Drillers License No:
Conirattors
Drillers Signature: Registration No. DAVISDI1100A Date April 2010
SCY 050-1-20(Rev 06/08)Ifyou need this document in an altenate format,please call the Water Resources Program at 360-407-6600.
Persons t'oith hearing loss can call 711 for Washington Relay Service. Persons with a speech disability cari call 877-833-6341.
04/18/2011 14: 05 3607795150 TWISS ANALYTICAL LAB PAGE 01/01
` Viss
'I NA,CYF3:CAL INC.
26276 Twelve Tree Lane,Suite C
Poalsbo,WA 98370
(360)779.5141
COLIFORM BACTERIA ANALYSIS
Date mpl le d Type Sample Count
el Collected y
AM
on Day Year pM
Type of Water System(check only one t x)
❑Group A Public Private Household
13 Group B Public ❑Other
Group A and Group B Systems—Provide from Water Facilities Inventory(WFI):
ID#
System Name: G_ -�—
Contact Person:
Day Phone: Coll Phone:( )
Eve.Phone:( ) FAX:( )
Send results to:Trint full name,address and zip code}
Q
� r
j�p0
Q re*t e�l-- —w A
SAMPLE INFORMATION
Sample collected by nsrrA,
Specific lo0 tII ere Sa ple colle d(address le site,and t f ype of faucet):
Special in chons or comments: ✓
Type of Sample(must check only one bax-of 1#1 through#4 listed below)
1, Routine Distribution Sample 2.0 Repeat Sample(follow-up
rovi information be)ow.� to an unsatisfactory sample)
Chlorinated;Yes No Provide information below.
Chlorine Residual:Tofat_ Free_ Unsatisfactory routine Leb number:
3.❑Raw Water Source Sample
Required for Surface Water,GWI,and Unsatisfactory routine collect date.
some Spring Sources _� /
S Chlorinated:Yes No RECO ]jA J
Chlorine Residual:Total Frea �l L
�5ykrrr�mc�Pwae sass Nu'rber rrcxn nwF9
4.0 Sample'ly APR 1
Constriction Repairs Prvata Residence Other
426 W. CEDAR S f.
❑unsatisfactory Satisfactory
Total Coliform Present and
❑E.00li present ❑E.coli absent
❑Fecal coliforrn present O Fecal oolifom,absent
❑Replacement Sample Required
Sample not tested because: Test unsuitable because:
fl Sample too old(>30 hours) TNTC
❑Improper Container l]Turbid culture
Bacterial Density Results;plate Count /ml.E.coti
Total Coliform_ —--�J70oml.
/100m1.. Fecal:olifoun 1100m1.
Methoa C de: Date and Time Received;
MIC - 30 140 1340 2520
DafeAnalyzed: ) Date Reported:
010 Lab Use Only:
SaMN Number(DON number plus five dlpits) q? �rt
Frxm a337.3 revised 6/05)
t _
425.00 RECEIVED
1 PROPERTY OWNER NOTE: 1 F13 0 3 2010
CAREFULLY REVIEW ALL ASPECTS OF THIS SEPTIC
DESIGN. ANY COSTS INCURRED DUE TO CHANGES TO CpIJN—a
THIS DESIGN AFTER SUBMISSION TO MCHD AND BLDG DEPT MASON COUNTY
ARE THE SOLE RESPONSIBILITY OF THE PROPERTY OWNER. ij
B
PROPOSED WELL
I HAVE REVIEWED THIS SEPTIC/DESIGN, AND I
APPROVE IT FOR SUBMISSION TO MftHD AND BLDG DEPT.
110, "
PROPERTY OWNER/AG SIGNATURE AN N G•
+ BUILDING ENVELOPE t
'001 oQ ALL SETB ARE MEASURED
5 FRO TH ;URTHEST
FROJ TI0 . 0 BUILDING
ING
.0
19
ui
to \}
,�
uj
`y�o��:=` MASO C NT C L E
:W ` SIT Q N
lz� D TO SI
8 .o, '. oo V E NGE BE
TO A
: INSTALLER NOTE. ♦`'
ENSURE PUMP TANK IS �:- "'� � P Da
EQUIPPED WITH AN
ANTI-SIPHON DEVICE
EJ- _.
SJE-RHOMBUS TIMER 8 C 7 :r �A .• /// j/ �` /
AUDIBLE/VISUAL ALARM CURTAIN DRAIN
MODEL#TDIW914H4D8C21E /
/y EXISTING DRIVEI(AY'.
-0'EL I SOIL SURFACE
4 BS�RVATION PORTS/- -
PROSED
3-BR HOUSE I j \1 SLOPE
qq• SEASbNAL
P IMARY DRAINFIELD
A/F•ELEV. -2' Law REiA
106' I 2 --POLY SHEET
CURTAIN 0
I /
DRAIN N •.�S - ", 7/8'-I I/2' GRAVEL TO
46' WITHIN 12 OF SURFACE
Z
IMPERVIOUS LAYER
URTAIN. , USIALL 90 NO OdSERV N 4' 6'
ORA1N ) PITS Al END OF EACH LATE PERFORATED' 12--� MIN.DEPTH
�
u4 PIPE IN
nse:.s u::c•+ uw uela•.. utw-j*'__—u"tks--ue;x4.
+1 _q• CLEANOUT AND INSPECTION PORT
0 O� R REQUIRED FOR CURTAIN DRAIN.
CURTAIN DRAIN MUST EXTEND AT
r LEAST 6' INTO RESTRICTIVE LAYER,
REGARDLESS OF RESTRICTIVE
LAYER DEPTH
THIS IS NOT A SURVEY. ALL 'ROPER TY L/NES/BOUNDAR/ES HA VE"
BEEN DEMONS TRA TED B Y THE OWNERS) AND/OR THEIR A GENT(S). LEGEND
DRY WEATHER INSTALLATION AND SITE PREP REQUIRED.
PROTECT PRIMARY AND RESERVE DRAINFIELD AREAS FROM ANY VEHICLE TRAFFIC. SOIL LOG ACME DESIGN C .
NO FOUNDATION SPOILS OR BURNING ON DRAINFIELD AREAS. --- — NO BUILD ZONE
- DUE TO UNFORESEEN WATER TABLES, A CURTAIN DRAIN MAY BE REQUIRED. — — CLEARING LIMITS DATE- 26 JUNE 2009 P.O. BOX 2954
- DEPENDING UPON FINAL ELEVATIONS. A PUMP MAY BE REQUIRED. f: ;- >• LOW AREAS
�' DIRECT ALL DOWNSPOUT/SURFACE WATER AWAY FROM DRAINFIELD AREAS. NAME- ROBERT MILLER SILVEI?DALE, WA.
- ALL WELLS WITHIN 100 FEET OF PROP. BOUNDARIES HAVE BEEN SHOWN. (D — CLEAN OUT TAX ID- 12305500035 98383
— EXCEPT FOR THE DISPERSAL COMPONENT, ALL SEPTIC COMPONENTS MUST BE WATERTIGHT TO SURFACE. OO — 1,125—GAL SEPTIC TANK
WATER LINE MUST BE A MINIMUM OF 10' FROM ANY SEPTIC COMPONENT. 0 — 1,000—GAL PUMP TANK STREET- 190 TIGER WAY EAST TEL. 560.698.8488
— SEED AND MULCH FINAI_ DRAINFIELD COVER IMMEDIATELY UPON COMPLETION. Q = SPUTTER OR MANIFOLD — FAX. ,360.698.878"
LATERALS MAY BE NO CLOSER THAN 9' ON CENTER. 04 = RISER WITH COVER SCALE: n-r-j SITE PLAN f
Request To Revise AnApproved Plan
41t
Permit Number: BLD2006 - 0101QCa(v Name
Parcel Number -�- 000,_��,5 Phone Number da time �)
Project Address /J N j Mailing Address
Please provide a complete, detailed description of the proposed revisions to the approved plans:
Are two sets of the revised plans or addendum indicating the changes included? )i Yes ❑ No
Are the approved site plans included? 1 � Yes ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? Y( 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 chanties 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? 'Oj Yes ❑ No
If Yes, Is a revised site plan, with all new setback dimensions included with this request?
Al
Yes ❑ No
Additional Information:
Applicant's signature Date:
Office Use Only Received by:
Date Sent Assigned To Approved By Date
❑ B. Original Valuation: $
n` ' Additional Valuation: $
[IP. Sq.Ft. x$ $
Total New Valuation $
❑ P.W. Additional Fees:
Additional Planning Dept. $
Additional Plan Review $
Additional Conditions/Comments: Additional Building Permit $
Additional Plumbing $
Additional Mechanical $
Additional E.H. Dept. $
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. I<1
PLEASE PRESS HARD BUILDING PERMIT APPLICATION AJ,4n
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 ���G,
On the web www.co.mason.wa.us
APPLICA T INF MATION CONTRACTOR INFORMATION
• Owner e Company Name
• Mailing Address U Mailing Address
City State Zip Code 3?3 12 City State Zip Code
Phone ' 2 0-1a - , Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
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 Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No.4.%'S 0!5 000 31" Fire District -
Legal Description
Site Address (Please include street name, street number and city) 110 '
Directions to site
Will timber be cut and sold in parcel preparation?Yes I 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 - New V' Add Alt Repair Other_ PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building 16=17 Describe Work---
No. of Bedroomc_ 2 No. of Bathrooms Square Footage - 1st Floor s CnO 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMAT I - Make Model Year
�ength Width Serial No. No. of Bedrooms 110"_'%'� No. of Bathrooms
,ype;of Heat Purchal 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. 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X 'L.— t"'". Date�T
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Lr,, Date o'L
DEPARTMENTAL REVIEW PROVED DENIED r NOTES
Building Department
Planning Department h L ( (�
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee o'Z 1. 7.S Site Inspection
Plan Review Fee j ,41 oo q 1 / �. /� EH Review Fee
Plumbing & Base Fee ` /45y '6 Planning Review Fee
Mechanical & Base fee af h 4- `'0 Other 41
Wood / Gas / Pellet Stov Fee State Fee S_o
Violation Fee o�
S to Pre-Paid at Submittal /0 -2•C36
Valuation $ 901a TOTAL FEES
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MASON COUNTY PERMIT NO.BIC 1260 -- 000oCo
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
APPLIC T INF R ATION CONTRACTOR INFORMATION
• Owner CL, i IN ✓ I Company Name
Maili Address ,5 Mailing Address
City l VAL oyN- tate Li IN7 Zip Code R Y I City State Zip Code
Phone Rl•t7'110-5-93i Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. 4 Exp.
E mail address`06 D ck f'y\!^ .CAS- E Mail Address
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. SO 5 - 5 Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
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. of Fixtures Fees Fuel Type:Electric-X LPQ Natural Gas— Heat Pump k
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace I
Bath Tubs > Heatpumps I
Showers L Spot Vent Fan `6.W G
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs _ 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 QF CONT NUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X �/�' 4 Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYON HIS POINT
Accepted bV 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
ACCESS & GRADE INSPECTION BLD
ADDRESS:
INSPECTOR:
DRIVEWAY ACCESS
( ) need post at access of driveway with reflective address numbers
Length: Width: Surface:
Size of turn-around:
Condition of shoulders:
Vertical clearance:
I
GRADE OF DRIVEWAY %, OF ROAD %
ROAD ACCESS
Length: Width: Surface:
Condition of Shoulders:
Vertical clearance:
(_) BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
LOT INSIDE UGA—NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS 4 X 4 FIRES
2 X 3 FIRES
PASSED ( ) FAILED ( ) ON HOLD ( )
REMARKS: _
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Names O b ►m 1 L0-r Parcel# 00035 BLD#a,0 Q -Dc .P�e
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 =
��t� X = o�?al2 O Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X = CD
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
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
' 0 y a La U
�� .
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 I of 2
Name 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:
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 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 th 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 storrnwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone: ()60)-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.
Own /Agent/Contractor(circle one)Date:
�C
Page 2 of 2