HomeMy WebLinkAboutBLD2011-00409 SFR - BLD Permit / Conditions - 7/18/2011 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
0 Shelton, WA 98584
1�
RESIDENTIAL BUILDING PERMIT BLD2011-00409
OWNER: KIM DELANY RECEIVED: 5/19/2011
CONTRACTOR: LICENSE: EXP: ISSUED: 7/18/2011
SITE ADDRESS: 4192 E AGATE RD SHELTON EXPIRES: 1/18/2012
PARCEL NUMBER: 320242400010
LEGAL DESCRIPTION: TR 1 OF W1/2 GOVT LOT 2
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE WITH HEATED UNFINISHED BASEMENT AND HEATED HWY 3 TO AGATE RD TO STORE GO LEFT TO ADDRESS
ATTIC STORAGE
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 1 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Group: R3 Lot Size: Deck: 860
Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:2,374
Valuation: $ 202,578.70 Building Height: Occ. Status: Primary Basement:1,274
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: N 240.0 Ft. Shoreline: 65.0 Ft. Water Body: HAMMERSLY
Rear: S 65.0 Ft. Slope: Ft. SEPA7: No
Model: Width: Ft. Side 1: E 20.0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 2: W 20.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type City. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 4 Heat Pump 2 Plan Check Fee GMM 5/19/2011 $1,028.14 S120110001
Lavatories 4 Ventilation Fan 2 Planning Review Fee GMM 5/19/2011 $205.00 S12011000i
Showers 1 Exhaust Hood 1 Fire Warden Review GMM 5/19/2011 $73.00 S12011000(
Bath Tubs 2 Dryer Vent 2 EH Plan Review KKK 5/24/2011 $103.00 S62 01 1 00 01
Kitchen Sink 3 Boller 1 Water Adequacy Plan Review KKK 5/24/2011 $103.00 S620110001
Water Heaters 1 Building State Fee DLC 6/30/2011 $4.50 S12011000i
Clothes Washer 2 Building Permit Fee DLC 6/30/2011 $1,570.55 S12011000,
Dishwasher 2 Plumbing Permit Fee DLC 6/30/2011 $180.20 S12011000i
Hosebibs 2 Plumbing Base Fee DLC 6/30/2011 $24.70 S12011000,
Laundry Tray 1 Mechanical Base Fee DLC 6/30/2011 $28.50 S12011000,
Mechanical Permit Fee DLC 6/30/2011 $103.80 S1 201 1 0001
ADJUST--Plan Check Fee DLC 6/30/2011 -$7.28 S120110001
EH Waiver Review KKK 7/8/2011 S113.00 S620110001
Total $3,530.11
BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 1 of 7
CASE NOTES FOR
BLD2011-00409
CONDITIONS FOR
BLD2011-00409
1) 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.
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2) 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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3) 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 revocation.
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4) 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.
X
5) 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.
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6) 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 and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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7) 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 ;!!20
BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 2 of 7
8) 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 be made prior to requesting additional inspections.
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9) THE FOUNDATION SYSTEM SHALL BE PLACED ON FIRM, NATIVE SOIL OR COMPACTED FILL. WHEN PLACED ON FILL A COMPACTION
REPORT, APPROVED BY THE LICENSED GEOLOGIST, SHALL BE SUBMITTED TO THE MASON COUNTY BUILDING PRIOR TO THE FOOTING
INSPECTION. A COPY OF THE WRITTEN REPORT SHALL ALSO BE AVAILABLE ON-SITE FOR INSPECTION.
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10) 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 County ordinances and building regulations.
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11) 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
such roads connect 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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12) PER TITLE 14 MASON COUNTY BUILDING CODE- CHAPTER 14.17, STANDARDS FOR FIRE APPARATUS ACCESS ROADS- 14.17.110:
A fire apparatus access road in excess of 14% grade and more than 150'to new residential or commercial structures will require an automatic
fire sprinkler system installed. Contact the Mason County Fire Marshal at(360)427-9670, extension 352, for further information.
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13) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical assessment prepared by David
Strong of Bradley Noble Geotechnical Services and dated 4/25/11. All applicable recommendations and specifications shall be applied to the development
on this site. Any deviation requires stamped written approval from the registered design professional responsible for the assessment, and may require
special inspection by same. Structures and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical assessment, may require a
separate permit. The geotechnical assessment shall remain attached to the approved building plans.
X
14) 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 Site Plan" to ensure these structures are shown and meet the setback conditions listed.
X
BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 3 of 7
15) 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 WSEC 505.
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16) 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 Specific 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 %<or%sheets. The
Mason County Permit Center will also have some available.
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17) 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 have prevgnted action from being taken. No more than one extension may be granted.
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18) 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 of approved documents will result in failure of required building inspections.
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19) 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 prior to a��rther inspections being performed or approvals granted.
20) Owner/applicant must obtain a seperate permit for the placement of any size propane tank serving a fixed appliance within a dwelling structure or unit
prior to the placement of the tank. X 6 Q
21) All property lines shall be clearly identified at the time of foundation inspection. X �J
BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 4 of 7
22) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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23) Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X 4�)
24) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
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25) 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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26) The area within 50'of the shoreline is considered to be a shoreline buffer. Native vegetation within this biller is to be retained and may be
enhanced with additional native vegetation. Please see the Mason County Resource Ordinance Fish & Wildlife Habitat Conservation Areas
Chapter for those activities allowed within the buffer both with and without a Mason Environmental Permit. X i
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 Master Program.X
28) This project is approved as a single-family dwelling unit in accordance with the 2009 International Residential Code (IRC) and is not intended
for use by more than one family.
To finish the structure for use by other than one-family shall require a separate building permit along with details demonstrating compliance to
fire-resistive construction requirements specified in Chapter 7, and fire protection systems in accordance with chapter 9 of the 2009
International Building Code.
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29) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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30) 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 Department prior to any further inspections being performed or approvals granted.
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BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 5 of 7
31) An inspection performed by a representative of the geologist, or their authorized representative, hall be completed on-site prior to the footing
pour to verify that earthwork and foundation installation activities are consistant with and comply to the Geotechnical assessment
recommendations.
In addition a final inspection report,prepared by a representative of the geologist or their authorized representative shall be required to verify
that erosion control, drainage and final work is completed in accordance to the Geotechnical assessment recommendations.
Reports shall be submitted to the Mason County Building Dept., PO Box 186, Shelton, WA 98584, prior to the footing and final inspections and
available for inspection.
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32) 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
33) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD WAY.
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34) Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option II (19% glazing), Window (Max U-Factor):0.32, No Skylights, 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 1a or 1c:
High efficiency HVAC Equipment using a LP boiler with minimum AFUE of 92% or better
OR
ductless split system heat pump, zonal control. In home where the primary space heating system is zonal electric heating, a ductless heat pump system
shall be installed and provide heating to at least one zone of the housing unit.
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35) Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5.
Approved for single family use only. X
BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 6 of 7
36) This project is approved for the construction of a single-family dwelling unit with a heated basement and upper floor(attic) used for storage
only, not as habitable space. Plumbing fixtures and exhast fans aill be roughed for future use. The heated spaces shall be finished to meet
minimum Washington State Energy Code thermal and afire sealing requirements.
To finish the basement and attic areas and change the use of the areas to other than storage space a separate building permit shall be
submitted to Mason County for approval before making the changes.
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37) The roof structures over approved decks, shown on the elevation plan pages, have not been reviewed or approved by the Mason Couunty
Building Department. The approved plans pages do not contain framing details or information for the roof framing, post support or footings.
To construct the roof structures as shown, provide construction details that have been reviewed and approved by the engineer of record, MC
Squared, to the Mason County Building Department prior to construction of the structure(s). Include roof framing details, post support,
connection information, and footing details for the roofed structures.
X
38) Owner must show proof of satisfactory water sample prior to temporary/ permanent occupancy of the residence.
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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.
OWNER OR AGENT: DATE:
BLD2011-00409 Please refer to the following pages for conditions of this permit. Page 7 of 7
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SITE PLAN REOUI TO BE.ON SITE { f t
CHANGES SUBJkCT TO APPROVAL �"
Date ?�� ,
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Name Parcel# 3oZ00,`i 24-00C) I V 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) ZThe relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
n 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-Oz" Owne Agent/Contractor(circle one)Date: S'/�/ • //
Page 2 of 2
Name Parcel# 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 surfacez.
'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.
2Common 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 =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections (example:
eaves/gutters)
X =
Driveways X =
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
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/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
qu\,eb-+�rD
MASON COUNTY PERMIT NO. �CJ�� I
BUILDING PERMIT APPLICATION CD�q
q 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 INF RMATION CONTRACTOR INFORMATION
Owner Company Name
Mailinq Address /eot Mailing Address
City She LK State L OA Zip Code 9�eV City State Zip Code
Phone_q�-y32- vF1p`/ Other Ph _ ��-_2&& Phone Other Ph.
Lien/Title Holder /tfefl7e- Contractor Reg. # Exp.
E mail address /��sImo,iiF;7/c Sc C=hcc.��f E Mail Address
Drivers Lic.# DOB 1-/5•.52 Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well--ZL—Water System Name of Water System
PARCEL INFORMATION -12 Digit Parcel No - - G�C�� i c Fire District s
Legal Description
Site Address(Please include street name, street number and city)
Directions to site 4 Acja-fe -k,,,2 /C l 0 92- cafe .
Will timber be cut and sold in parcel preparation? Yes/ o
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_ Add Alt Repair Other PRIMARY RESIDENCE 14 SEASONAL (�
Use of Building !�L°�icic;�� Describe Work K2,Li LCA, V4 S 1c l,ILC— Ly
No. of Bedrooms 2 No. of Bathro Square Footage- 1 st Floor /2 7Z/271 2nd Floor f�� %7
3rd Floor Basement 2 7Z eck `ib' Covered Deck Other Sq.ft. NDc7
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make ef-M`re�TS` 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 Cp"NUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
x /vi"r ' C? Date:
Owner/Owners Re r ative/Contractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: —�, Date
DEPARTMENTAL REVIEW APFfflOVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee p 5 Site Inspection
Plan Review Fee /O a O EH Review Fee
Plumbing & Base Fee ;:q U 1, v? 7v Planning Review Fee
Mechanical& Base fee 4OIJ . ?b of f Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
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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 INFO MATION CONTRACTOR INFORMATION
Owner .714 10C ICI 17 Company Name
Mailing Address Mailing Address
City State 4-J,4 ZipCode `����'�`
City Mate Zip Code
Phone 2 - oP, � Other Ph. ZLO _2&6 c' Phone Other Ph.
-
Lien/Title Holder— i /4nu Contractor Reg.U Exp.
E mail address t E Mail Address
Drivers Lic.# XA1 DOB iS S/' 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. 3 2 V Z v 2- yu c c , Fire District_
Legal Description i/,2 / L'L L-) /z Gc t Let Z
Site Address (Please include street name, street number and city) 2- �1� � re 1� y he/�zri
Directions to site _ <<' Le,6 fP 2-
Is property within 200'of Saltwater X Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New >C Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1st Flood— 2nd Floor X Basement_ Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fix $sM Fuel Type:Electric LPC— Natural G Heat Pump_
Toilets - a i Type of Unit NoiEC
sIJA.'n U1� s
Bathroom Sink `% r '' �A� Furnace
Bath Tubs * / Heatpumps
Showers B- Spot Vent Fan Water Heater 7 `e ! Propane TankClothes Washer _ 1 Gas Outlets
Kithen Sinks S, _t j_ Wood/Gas/Pellet StoveDishwasher — Kitchen Exhaust Hood-HOtorsebibs Dryer Vent 1e Other 3 /�T B se Fe � BaTOTALPL MBIN T ANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocatl n.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 CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X �n ,/ /i: Date:
Owner/Owners Represent e/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 GrouQ_Tvpe Constr.
Planning Department
Environmental Health Department
FEES
Plumbin & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Nood /Gas/Pellet Stove Fee Other
iolation Fee TOTAL FEES