HomeMy WebLinkAboutBLD2007-00608 Final SFR with Decks - BLD Permit / Conditions - 9/8/2008 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 BLD2007-00608
OWNER: CHARLES BERGER
CONTRACTOR: RITZMAN CONSTRUCTION LLC 3608717454 LICENSE: RITZMCL001 BU EXP: 1/22009 RECEIVED: 4/12/2007
SITE ADDRESS: 417 NE BEAR CREEK DEWATTO RD BELFAIR ISSUED: 9/20/2007
PARCEL NUMBER: 123093190073 EXPIRES: 3/20/2008
LEGAL DESCRIPTION: LOT: 3 OF SP#2436 S 12/157 S 12/180
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR UP HILL ON BEAR CREEK DEWATTO RD. LESS THAN 1/2 MILE ON LEFT
1 STORY WITH DECKS IS EASEMENT RD TO ADDRESS 417 NE BEAR CREEK-DEWATTO RD.
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: 2 Occ. Group: R-3 Lot Size: Deck: 1,497
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,400
Valuation: Building Height: 15 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 280.0 Ft. Shoreline: Ft. Water Body: wetland
Rear: W 75.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: IN Ft. Desi Ft. g•: Not Applicable
Year: Serial No.: Side 2: S 62.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KS 4/12/2007 $726.02 S12007000
Hosebibs 3 Gas Outlets 2 Planning Review Fee KS 4/12/2007 $170.00 S1MWo00
Kitchen Sink 1 Propane Tank 1 Fire Warden Review NHS 4/17/2007 $64.00 s22oo70o0
Laundry Tray 1 Ventilation Fan 3 Building State Fee ARC 4/30/2007 $4.50 s22oo70o0
Lavatories 3 Propane Stove 1 Building Permit Fee ARC 4/30/2007 $1,010.55 s22ovoo0
Showers 2 Dryer Vent 1 Mechanical Fee ARC 4/30/2007 $163.75 s22oo7000
Water Closets (Toilets) 2 Mechanical Base Fee ARC 4/30/2007 $25.30 S22007000
Water Heaters 1 Plumbing Fee ARC 4/30/2007 $105.60 s22oo700o
Bath Tubs 1 Plumbing Base Fee ARC 4/30/2007 $22.00 S22007000
Clothes Washer 1 Additional Plan Check Fee ARC 6/21/2007 $84.26 s22oo7000
EH Plan Review TW 6/25/2007 $75.00 S220o700o
Total $2,450.98
BLD2007-00608 Please refer to the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
B LD2007-00608
CONDITIONS FOR
B LD2007-00608
1) This parcel is located in a smoke management zone. Please contact a fire warden at (360) 427-9670 ext. 459 for further information.
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2) Mason County Building Codes Chapter 14.17.160 and 14.17.060 (Minimum 12ft)between trees must be met.Also a post with reflective numbers for
addresses must be installed at beginning of driveway as well as top of hill. Because of length of driveway--a clear turn around needs to be
maintained.Nq o er issues for Fire/Ems.
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3) 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 cn ct 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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4) 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
g d and must be collected by the Building
Department pr further inspections being Performed or ap
provals granted.
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5) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that
require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from
the access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall.contrast with their
background.
Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as
adopted by the jurisdictiorh and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
inspections. a
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6) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the
Building Official. The ermit 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 Z
ved documents will result in failure of required building inspections.
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7) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
BLD2007-00608 Please refer to the following pages for conditions of this permit. 2 of 5
3)' 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 a en prior to any further inspections being performed or approvals granted.
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9) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: IV, Window(Max U-Factor):0.40, Skylight (Max U-Factor):0.58,
Doors (Type/Mc - actor):0.40 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-30, Slab Insulation R-10.
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10) 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
BASIC WIND (3-SECOND GUST) the wind speed for Mason County is 85 MPH.
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11) Per 2003 IRC - SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordance wft applicable provisions of this section and the manufacturer's installation instructions.
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12) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete wor exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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13) 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 s collected by the Building Department prior to any further inspections being performed or approvals granted.
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14) 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 revocatiI(
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15) 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 ct your project.
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BLD2007-00608 Please refer to the following pages for conditions of this permit. 3 of 5
16) All changes to "approved" building plans that effect compliance with the international codes as amended
Pp 9 P p am nd d and adopted, or any other Mason County
ordinance or regL(l must be reviewed and approved by Mason County prior to construction.
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17) 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 rrXde prior to requesting additional inspections.
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18) All property lines shall be clearly identified at the time of foundation inspection. X
19) 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 fin I inspection or to obtain approval will be documented in the legal property records on file with Mason County as being
non-compliant son County ordinances and building regulations.
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20) 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 Orevented action from being taken. No more than one extension may be granted.
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21) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, an alas ng. Install metal connectors approved for contact with the new types of pressure treated material.
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22) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. Structures
and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical r o assessment, may require a seperate permit. The geotechincal
report/ assessment shall remain attached to the approved building plans. X
23) 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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24) Landings and stairs ust meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site ' to ensure these structures are shown and meet the setback conditions listed.
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25) 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,-Theoerson signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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BLD2007-00608 Please refer to the following pages for conditions of this permit. 4 of 5
26) Water quality is n degraded to the detriment of the aquatic environment as a result of this project.
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27) Prior to final approval, all upland areas disturbed or newled by construction activities shall be seeded, vegetated or given an equivalent type of
III erosion protection (silt fencing or straw matting). X
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28) Approve er mensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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29) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X_7 i
This permit beoomes 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 a g ss inspection.The ner or the agent on the owners behalf,represents thatthe information provided is accurate and grants employees of
Mason County access to the ov sc ed property and ure for review and inspection. 2
OWNER OR AGENT: 7`� —_ '��✓-- DATE: o A7�
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BLD2007-00608 Please refer to the following pages for conditions of this permit. 5 of 5
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ACCESS & GRADE INSPECTION PERMIT
ADDRESS- A
IN PECTOR L)I DATE:L D�
1
DRIVEWAY ACCESS
Length: 1 SQ ` Width: Surface:
Size of turn-around:
Condition of shoulders:
Vertical clearance: —�
4—
=� need post at end of drivewa wit reflective addr numbers. ��'
GRADE,OF DRIVEWAY x-e,-V % OF ROAD 0/-
ROAD ACCESS /
Length: DCb Width: Surface: 6
Condition of shoulders:
Vertical clearance: F217
( ) BURN PE IT RE44ZIRED FrRLAND CLEARING FIRE.
( ) LOT INSIDE SMZ, 4X4 FIRES ONLY.
( ) LOT INSIDE UGA, NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS 4X4 FIRES.
REMARKS i _/',z �/�(, f?, OL D
(continue remarks on back)
E-equest To Revise An Approved PIan
PC grit Number: BLD200 "1 - 00400.7
Parcel Number Name_ RIO f-y��
Phone Number dx ime
Project AddressTO B TfifiNtE----- t L_____)
Mailing Address
Please provide a complete,detailed description of the proposed revisions to the approved plans: .
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Are two sets of the revised plans or addendum indicating the changes included? ❑
Are the approved site Plans ' �'� ❑ No
Are� p included? ❑e revisions Yes
lions C ❑ No
clearly y and accurately identified on the Tans or
Does the plan contain an engineer's or architects lateral or vertical addendum?
❑ Yes ❑ No
3's ❑ No
If Yes,Has the engineer or architect
Is a stamped and signed approved this revision? ❑ .Yes ❑ No
gn approval included with this request? ❑ Yes
J(Liote:No structural changes to a'desi ed" lan will be approved without the written C7 No
consent of o en "Weer and/or architect of record.
Does the proposed revision modify
_ fy the or location of the structure? El Yes ❑ No �
If Yes, Is a revised site plan, with all new setback dimensions included with this request?
AdditionalInformation: Alec. ❑ Yes Cl No
1P�A�lJ S D/Z.
Avt G v S/
Applicant's signature
Me Use only Date:
PReoeived by:
Date Sent Assigned To Approved By
$. Original Valuation: Q 1 p 2.00'T-0040 08
' g T s S 2�
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Z�o) Additional Valuation $
P.
�,0� Sq.Ft. 1 57 x$_ 26.35 $
E.H. nC Sq.Ft. x$ $
Total New Valuation S /p Z Zco ,ca
P.W. Additional eQes X 6 y' zs� 80 3 = S Y. Z46(
Additional Planning Dept. $
ew Setbacks: Front / Rear Additional Plan Review s Z52 , So
Sidel.
—/ T>;f 1:- A otm Building Permit $
/ Side2 / Additional Plumbing $
Additional Conditions tions/Comments: Additional Mechanical
-- cc�l _�!AW s '('p R .)i Additional E.H.Dept. —
S CE l4TT J}C, Other
Total Amount Due: $ 2
:30 Co 20 0� rec 3 �S
/0"30 ADD A-(read
(o fl G Amount To Be Paid Up-Fronts Tp r rot r�
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RECEIVED
MAY 2 4 1007
426 W. CED,4R Sr.
TRANSMITTAL: BERGER PERMIT SET REVISION
DRAWING SET AND CALCULATIONS
DATE: May 23, 2007
TO: Genie McFarland
Mason County Permit Assistance Center
Mason County Building III
426 W. Cedar— P.O. Box 186
Shelton, WA 98584
RE: BERGER PERMIT SET REVISIONS
(ARCHITECTURAL AND STRUCTURAL)
Genie,
Contained in this package you will find both architectural and structural
replacement sheets for the Berger permit set.
Architectural Drawings:
Please replace sheets A0.1, A2.0, A3.0, A3.2, A4.0, and A4.3 in your
NE permit set on file with those contained in this package.
Structural Drawings:
lO RGIEL
PP Please replace the entire structural drawing set with the one contained in
this package. The set contains S1.0, S1.1, 52.0, S2.1, S2.2, S3.0, S3.1,
S4.0, S4.1, and S4.2.
Structural Calculations:
Also, included are 8.5"x11" supplemental structural calculations for the
carport revision to be included with the calculations already on file.
Any help you that could give in expediting this project through the
permitting process would be greatly appreciated.
Regards,
Justin Helmbrecht
is>gp �(ZD)07 LEER' AP
REVIS.Ep
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
40o-�'�
WSEC/ VIAQ Compliance Application
Owner L Telephone �\ �6 Parcel#:
Type of project New Residence ( ) Addition ( ) Remodel
Total Sq. Ft. 1S Floor 2"d floor: Heated Basement:
of heated area:.-
Heating System Type: /f Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with I ctric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
Other: Specif C_- �O
Glazing Prescriptive Option (see reverse side) circle one: 1 II IV
Percentage: Compliance i
Method Component Performance , Chapter 5— Calculation worksheets required
% 'heck Systems analysis, Chapter 4
Whole House Ventilation system Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air
Recovery Ventilation System (i zI<�303.-�.-�)
System vents (I'/AO 303.-i.l)
Whole House Ventilation Integrated Whole House Ventilation using an inline
with a Forced Air System (114(()303.4.2) supply fan. 1110 303.4.3)
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows: t) � 1'-0111 5 '5
t�'I IWA Iooer' b 3'- IV,t 1'-V 35.G-) s
L 00 D '_ ►' �`1'-3` I 2 b� SF
HE1-1 I to k Ab '-8'I .
1)I '-'Y x '_ K 1R. 2_5
IDI� '-0" x 2-b I O . o S
0
f� 03 0 3'-S'lax '- " I 2-1 . 5 S
r, lob
-b1-,&L =,77.5 Windows: Total Sq. ft. 554• 4 W
Doors: D'& `-6, " S
ef
?3D. 3'- ' y- '-Io" 22 S Sg
Doors: i otal Sq. Ft
Total window and door area _
Total window& door area I(divided by)total sq.ft of heated area 7-M lb %of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 Elma (360)482-5269
FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2004 Washington State Energy Code (WSEC)
2003 Ventilation and Indoor Air Quality Code (VIAQ)
effective July 1, 2004
Code Compliance Application Form
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/ Ventilation and Indoor Air Quality Code
(WSEC/VIAQ)application located on the reverse side.
2. Complete the window and door schedule on the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location and fuel type of water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and
slabs,
4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. Additional
WSEC and VIAQ compliance information is available on the internet at:
http.//www.energy.wsu.edu/code/
Prescriptive Requirements °,'for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Area % of Vaulted Above interior' exterior Slab°
Option Floor „ U s Ceiling Ceiling Grade below °Below Floors on
10 Vertical Overhead Factor 2 12 grade Grade Grade
1 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
11 * 15%' .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
IN' Unlimited
Single
Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
(R-3)Only
'Reference Case/Call (360)427-9670 ext. 352 for footnote information. Log&solid timber wall with a min. avg. thickness of 3.5"are
exempt from the above grade wall insulation requirements.
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ VIAQ Compliance Application
Owner: Telephone: Parcel#:
Type of project ( ) New Residence ( ) Addition ( ) Remodel
Total Sq. Ft. 1 s Floor : 2nd floor: Heated Basement:
of heated area::
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: Specify
Glazing ) Prescriptive Option see reverse side circle one: 1 II IV
Percentage: Compliance � �
Method ) Component Performance , Chapter 5— Calculation worksheets required
Check one.-.
) Sy stems analysis, Chapter 4
Whole House Ventilation system ) Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air
Recovery Ventilation System (1�t_l��3ni.-�.4,
System vents (f'/AQ3o3.-t.t)
Check one
) Whole House Ventilation Integrated ) Whole House Ventilation using an inline
with a Forced Air System (114C)303.4.2) supply fan. IZlo3n3-4.3/
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows: vjeSC 10(oC' -i'L) �j`_ox-1,-40" I 22•Ss
A a-, ,
Windows: Total Sq. ft.
Doors:
Doors: Total Sq. Ft
Total window and door area
Total window& door area / (divided by) total sq. ft of heated area = %of glazing
Zoe �19� ZSD 7 MASON COUNTY PERMIT NO._ )
r BUILDING PERMIT APPLICATION Chtx_ k_ zo(.-
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 -7 -
n Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us 04�c4 r
APPLICANT INFORMATION, CONTRACTOR INFORMATION
Owner �� Company Name ` 1+ '-� i
Mailing Address o Mailing Address `'a
City ate Zip Code O City b Zip Code
Phone b' b Other Ph. Phone >J Other Ph.
Lien/Title Holder Contractor Reg. EX .
E mail address GJ Gt� E Mail Address(5►
Drivers Lic.# DOB Drivers Lic.# &IF DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic 46 Existing Septic
Connect to Water System Name of Water System
Well ISewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Pagel t - _ Fire District
Legal Description �� O -3 ' � 1- 1 d
Site Address (Please include street name, street number and city)
Directions to sit oLD ON70 ewA
U ILA, M 01J Soul SI D S A ` MR eD A 0 Y T&V OF L- T
Will timber be cut and sold in parcel preparation?Yes Alp.-' f\.
Is property within 200'of Saltwater 1- Lake River/Creek .Pond
Wetland�Seasonal Runoff Stream Slopes or Bluffs 15 0
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 ❑ SEASONAL ❑
Use of Building � escribe ork Ph
No. of Bedroom No. of Bathroom ' qu a Footage- 1 st Floo 2nd 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.
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 OFAPRROOGR_ESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 1$0 DAYS WILL INVALIDATE THE APPLICATION.
X C� ��- Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by::' IL,Y Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department r_r I -
Planning Department r6e,;l 5 0005
Environmental Health Department oo5-ono2.11 l
Fire Marshal 6m
FEES
Building Permit Fee Site Ins ectio
Plan Review Fee EH Review Fee
Plumbing & Base Fee 127. Lo Planning Review Fee
Mechanical & Base fee I$ ° Other
Wood MC01 Pellet Stove Fee State Fee
Violation Fee No LKIe• Pre-Paid at Submittal
TOTAL FEES
Valuation $ /2 2 y ?� •
MASON COUNTY PERMIT NO._
PLUMBING/MECHANICAL PERMIT APPLICATION 15
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360)427-967t0B -4467•Elma(360)482-5269
neO web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INF OATIOIJ
Owner Company Name
Mailing Address Rol � \ Mailin Address •d
City State�C�Zip Code 2 d-12 Cit Stat Zip Code �e��
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # G O Ex I�'�,
E mail address � � . Gd1�1 E E Mail Address CC
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 Z3 - Fire District
Legal Description
Site Address (Please include street name, street number and city) �.
Directions to site
Is property within 200' of Saltwater b4 Lake River/Creek ti 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_LPG Natural Gas_Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink — Furnace
Bath Tubs _ Heatpumps
Showers _ Spot Vent Fan
Water Heater PEm AND . Propane Tank =
Clothes Washer Gas Outlets * Z
Kithen Sinks Woo as ellet Stove /
Dishwasher Kitche1i'�Rhaust Hood /
Hosebibs Dryer Vent
Other t Other
lit tU�'4 �t� f Base Fee jjaj(CrL- fro 2 Base Fee
TOTAL PLUMBING - i4W;4,vv OTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may9esu t i a slop q rk 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 CONTINUATION OF RK MEANS OF A PROGRESS INSPECTION.X � e Date: s�.
1 �� d
Owner/ ers Rc�seu tive/Contractor (indicate which one)
FOR OFFICIAL USE BEYO D THIS POINT
Accepted b Planning Pd _.Ck# Date_ l9-6 Bid Pd Receipt No.
DEPART NTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group T e 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