HomeMy WebLinkAboutCOM2012-00022 Final Hood - COM Permit / Conditions - 11/20/2012 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670, ext. 352
Shelton, WA 98584
i�
COMMERCIAL BUILDING PERMIT COM2012-00022
OWNER: IVONNE BESS RECEIVED: 3/19/2012
CONTRACTOR: PHIL-SYSTEMS CONSTRACTORS LLC 1.253.887.7680 LICENSE: PHILSCL923DJ EXP: 3/11/20 ISSUED:
SITE ADDRESS: 24131 NE STATE ROUTE 3 BELFAIR EXPIRES:
PARCEL NUMBER: 123283290040
LEGAL DESCRIPTION: PCL 6 OF BLA#01-71 (R) PTN NW SW
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Intalling Type I hood, 54" Long, St Rt 3 to Belfair, go to the location of the Looney Bin
General Information Construction&Occupancy Information
Type of Use: BAR Insp.Area: No. of Units: Type of Constr.:
Type of Work: MEC Fire Dist.: 2 No. of Bathrooms: Occ. Group:
Valuation: No. of Stories: Exit Design. Load:
Building Height:
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building:
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline&Planning Information
Front: Ft. Shoreline: Ft.
Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.:
Side 1: Ft. SEPA?: Comp. Plan Desig.:
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Emergency Key Box?: Standpipe?:
Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?:
Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?:
COM2012-00022 Please refer to the following pages for conditions of this permit. Page 1 of 4
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Exhaust Hood 1
Total
CASE NOTES FOR
COM2012-00022
CONDITIONS FOR
COM2012-00022
1) A UL 300 fire suppression system is required to be installed, a separate permit application is required to be submitted and approved prior to the
installation of the s ern.
X
2) Contractor registrat n ws 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 1-800-647-09 2. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to
WA state law. X
3) All approved plans are req iMd to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be
granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be ch rged and collected by the Mason County
Building Department prior to any further inspections being performed or approvals granted. X
4) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs cordance with Mason County Title
14.28. `
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5) ALL CONSTRUCT14 MUST MEET OR EXCEED ALL LOCAL CODES AND THE INTERNATIONAL CODE R QUIREMENTS AND
OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF US JR OCCUPANCY WOULD
RESULT IN PERMIT REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x
6) Changes to j3pproved building plans that affect compliance to the current Washington State Energy Code (WSE , tilationrequirements),
Building/Plu ing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction.
X CI
7) CONSTRUG710 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 Coun Building Inspector shall be made prior to requesting additional inspections.
X
COM2012-00022 Page 2 of 4
8)' 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 son County ordinances and building regulations.
X
9) All permits expire 1 0 s after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the
time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control
of the permit hold Jr Tye prevented action from being taken. No more than one extension may be granted.
X
10) Per section 506.3.2.5 o the 2009 International Mechanical code.
Prior to the use or concealment of any portion of a grease duct system, an leakage test shall be preformed. Ducts shall be considered to be
concealed where installed in shafts or covered by coatings or wraps that prevent the ductwork from being visually inspected on all sides. The
permit holder shall be responsible to provide the necessary equipment and perform the grease duct leak test. A light test shall be performed to
determine that all welded and brazed joints are liquid tight. A light test shall be performed by passing a lamp having a power rating of not less than
100 watts through the entire section of duct to be tested. The lamp shall be open so as to emit light equally in all directions perpendicular to the
duct walls. A test shall be performed for the entire duct system including the hood to duct connection. The duct work shall be permitted to be tested
in sections, provid d that every joint is tested.
X
This permit becomes null and oid' ork 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 wor 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 Coun access to the above described property and structure for review and inspection.
OWNER OR AGENT: DATE: �� 1
COM2012-00022 Page 3 of 4
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N CONCRETE MECHANICAL MANUFACTURED HOME N
Dale By — (n
IV Footings/Setbacks Gab Piping Ribbons
o Interior Date By Interior-Date By pate By
O
--._._._. _
N Exterior Date BY Exterior-Date _ By
Setup Z
Point Load I Isolated Footings INSULATION oats By z
BG!SLAB INSULATION
Date By Data By FIRE DEPARTMENT
Foundation Walls Fioom Date By
Date, By Data By DECKS
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic
Date By Date By Type-
Date By
D.W.v DRYWALL Type: n
Int.Brace Wall 0
Date By oat e By Date By 9
FINAL INSPECTIONIQ
O
Water Line Fire Seperation
Date By Date By Date /1 "� a N
O
Pass or Request Inspect. o
Type of insp. Fail Date Date Done By Comments t'
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From: Jeromy Hicks <JHicks@mcfd2.com>
To: "Larry Waters (Law@co.mason.wa.us)" <Law@co.mason.wa.us>, "Debbera Coker...
Date: 11/20/2012 2:19 PM
3Ti jec : Black Bear Inspection
Permit#'s
2012-000046
2012-000022
Parcel Number: 12328-32-90040
On November 19th I conducted a hood and duct light test as outlined in the IMC chapter 5. Originally this
test failed showing that the top flange of the duct unit had not been welded. I advised the owner and
contractor that I was able to return at 5pm and re-inspect the system. When I returned I found that Larry
Kelly had been onsite in the afternoon and asked for them to mount the Class K fire extinguisher and
await my return to inspect the hood and duct as they (the contractor) had not completed the repairs yet.
The re-inspection showed that the entire duct had been properly welded and passed the light test. In
addition the UL 300 system was still in compliance, and the makeup air, and exhaust system worked
properly with the ancillary system.
In all the inspection is complete, and I signed off the inspection cards as requested. I advised the
business owner that she would need to send the cards in for DCD's records. A fire inspection was also
conducted with minor corrections that the owner address immediately.
If you have any further questions please do not hesitate to ask.
Thank you,
[MASON COUNTY DECAL final design]
Jeromy Hicks, Captain
Fire Inspections, Education, and Investigations
Mason County Fire District 2
360-275-6711 ext. 2 office
360-801-2020 cell
jhicks@mcfd2.com
Page 1 of 1
Larry Waters-black bear question
From: erick mayda<erickpmaydallc.com>
To: <law@co.mason.wa.us>
Date: 6/20/2012 3:20 PM
Subject: black bear question
Larry
We spoke with PUD and they advised us that the hood fan is ok in to blow on their wires. I had a
question about the stainless walls,the prints look as though they our three sided. There are only two
sides installed. The left side is where the walk in cooler is located. This wasn't mentioned when we
reviewed it. I will be meeting with the sheet metal company tomorrow, so if I can find out by 10 am if I
need him to make the other side.
Thanks
Erick Mayda .J
Mayda Mechanical
(360) 692-9003 office
(360) 509-1015 cell
erick(a maydallc.com
file:///C:/Users/law/AppData/Local/Temp/XPgrpwise/4FE1 EA59Masomnail10013379361... 6/20/2012
Page 1 of 2
r
Larry Waters - Hood information for the Black Bear Tavern from Mayda
r �..,111
From: "nicolle" <nicky(a-),maydallc.com>
To: "Larry Water" <law@co.mason.wa.us>
Date: 5/2/2012 2:35 PM
Subject: Hood information for the Black Bear Tavern from Mayda
CC: "Erik Aploks" <eaploks@airtecco.com>
Larry,
It was a pleasure to speak with you this morning. Please see the email below from the company we purchased
the hood system from that assisted in the calculations to gain the required 1800 CFM requested.
Please let me know if you have any additional questions.
Nicolle
Nicolle Myers
Office Manager
Mayda Mechanical
360.692.9003
360.692.9015 fax
nicky@maydallc.com
MAYDA
r h71n:r r,W Rc VeTxton- PAC• Sys d se cr
From: Erik Aploks [mailto:eaploks@airtecco.com]
Sent: Wednesday, May 02, 2012 2:02 PM
To: 'nicolle'
Subject: Your PO# 11764
Nicole,
In regards to the ILG#UBCA 13 UL762 kitchen hood exhaust fan we supplied to you on your PO# 11764, 1 am
offering the following comments:
Information Riven:
Existing grease hood exhaust duct 12" x 12"
Existing fan supposedly has a 10% inch centrifugal wheel and has a % HP motor, 115/1/60
Municipality/County indicates an air volume requirement of 1800 CFM for this application
A replacement fan is needed. Existing one did not do the job properly
Evaluating the above information and referencing code requirements
Velocity allowed in a grease duct, 1500 to 2500 FT/MIN
12' x 12"/144= 1 SQ FT area of grease duct.
EQUATION:VOLUME OF AIR ( CFM) =Area of duct( SQ FT)X velocity(FT/ MIN)
1800 CFM = 1 SQ FT X VELOCITY
VELOCITY= 1800/1 OR 1800 FT/MIN which is in the range of being acceptable per code
file:///C:/Users/law/AppData/Local/Temp/XPgrpwise/4FA 14621 Masonmail1001337936114... 5/2/2012
RECEIVED
PLANNING: MAR 0 82010
ALL SETBACKS ARE MEASURED !MASON COUNTY
FROM THE FURTHEST
PROJECTION Cr F
THE BUILDING i
APPROVE::
PLANNING
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a ,uJR• 9�S2g SITE PLA REQUIRED TO BL
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MASON COUNTY
CHANGE IN TENANT APPLICATION
Complete the Change in Tenant Application and return with a floor plan,site plan,septic pumper's report,septic records and
fee to the Mason County Permit Center,P.O.Box 186,Shelton,WA 98584. Evaluation of the Change in Tenant Application will involve
staff members from the Building,Fire Marshal,Environmental Health,Planning and Public Works offices who will identify compliance
requirements. This application is intended for tenant change only If construction or remodeling is proposed or required a building
permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued,schedule an
inspection by calling(360)427-7262.Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a
conspicuous place on the premises.
PROPERTY INFORMATION
Date: - Assessor's Parcel Number: ) � d
Legal Description:At
Building Site Address:.?Y f S
Method of sewage disposal: • Septic O Sewer-name of district:
Water source: O Individual Well O Community Well O Public System,name of system:
PEOPLE INVOLVED IN THE PROJECT
Name of Applicant: ballh t ill a - o _
Mailing address: `>f n
City:6 iq State: Zip: 9
Day p _ -� Contact Person: �ja Message phone:
PROJECT INFORMATION
Proposed business name:
Proposed use: Number of employees: ]--
Previous business name:
CIS
Describe previous use:
STRUCTURE DETAILS
Check one: J(Detached single level/single tenant O Single level/multi tenant
O Multi level/sin le tenant O Multi level/multi tenant
Age of structure: 3,Z Is structure c tly If not occupied,how long has it been vacant?
oceu ied? Ye un IYr. Mo. -
Square footage: Basement: Irst: ZLQ Mezzanine: Second: Third:
Is the struct�ated? Heating type:CirG
Circle one: No Elect' Liquid Propane Natural Gas Oil
Type of heat:Circle one: Furnace Heat Pump Electric baseboard or wall mount Radiant
Will there be any changes to the following?Circle yes or no,if applicable:
Floor lay-out: Yes (ED Lighting: Yes � Heating:Yes
Exterior Finishes: Yes Interior Finishes: Yes Parking:Yes
Number of restrooms provided: Number of fixtures in each
Is structure handicap accessible?Circle one es No
Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes o
Monitoring Station Name: IPhone number:
APPLICATION WILL NOT BE ACCEPTED WITHOUT:
1. Floor Plan(5 sets):
Draw the floor plan to scale • Locatti Use rooms
Room Dimensions on of all exits and windows(include dimensions)
• Location of plumbingand mechanical fixtures Interior doors with swing radius
2. Site Plan(5 sets): Note scale used
• Property lines,easements,&right of ways • Location of all existing structures&dimensions
• Distance,in feet,from property line&structures • Landscape buffer yards
• On-site sewage tanks and drain fields,&reserve • Well location
• Location of fire hydrants&vehicle access roads • Parking areas number&arrangement)
Jd. Septic records,pumper's report or O&M report.
4. Fees will be collected at time of submittal
Official Use Onl
Acce ted b 1 Date " 'i Submittal Amount$ Receipt number
Department Review Ini ials Date Comments
Building j
Environmental Health
Fire Marshal 3 V /v
Planning
Public Works
Occupancy Change? (circle one) Yes No Type of construction
Occupancy classification change from to Occupant load calculated: persons
Existing occupant load design persons. Land Use Designation:
Occupancy Classification:
Page 2 of 2
REQUIREMENT FOR PLACEMENT FAN:
Be UL762 listed, up blast discharge
Capability to move 1800 CFM
Uses a voltage of 115/1/60
Assuming .5 IN SP resistance through hood, .125 IN SP resistance in duct work for a total SP resistance of.625 IN
SP
Inlet venturl /bottom inlet of fan must be less than existing 12 x 12
Need fan right away/quick
FAN SELECTED:
ILG # UBCA13, UL762 LISTED,
1800 CFM @ .625 IN SP, FAN RPM 1488, BHP .45 (not including drive losses)
15%added to BHP for drive losses,% HP motor supplied (assuming existing wiring can support the amperage of
a 3/ HP motor @ 115/1/60)
Inlet venturi/bottom inlet opening off 11.34 inches in diameter
Voltage 115/1/60
INFORMATION PROVIDED AFTER THE FACT:
Hood style: single canopy, one side against the wall
56 inches wide ( approx.4.66 FT wide)
Municipality/County indicated a requirement of 400 CFM per lineal foot of hood = 1800 CFM approx.
This additional information confirmed that the correct selection had already been made.
If you have any questions, please call me.
Erik Aploks
AIR TEC COMPANY
85 SOUTH ORCAS STREET
SEATTLE,WA 98108
206 763 9911
file:///C:/Users/law/AppData/Local/Temp/XPgrpwise/4FA14621 Masomnail1001337936114... 5/2/2012
Range Hood Systems Report
DATE OF SERVICE TIME A.M. P.M.Peninsula Fire
Extinguisher Service ANNUA SEMI-ANNUAL I RECHARGE / INSTALLATION RENOVATION
Sales and Service & Safety Supply /
LOCATION OF SYSTEM CYLINDERS
P.O.Box 1744•20373 Viking Ave.NW /
Poulsbo,WA 98370 N��
(360)598-3300•Toll Free(888)214-3473 MANUFAaTURER
\�1� DEL NUMBER W T DRY CHEMICAL
Fax(360)598-3303 �SI t' )C)Z
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
//y� CUSTOMEER� y�j ' 7�''<, 1
Name (� >''/f � �� ���/`!"'+'�-��1� i!-� FUSE LINKS 360°F FUSE NKS 4Z50°F FUSE LINKS 500°F OTHER
FUE)_SHUT-OFF ELECTRIC GAS SIZE
Address
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
Clt
y 7
Telephone G.�� y��I/� Store NO. MANUFACTURER'S MANUAL REFERENCE
Owner or Manager �yy�� PAGE NUMBER: � ) DRAWING NUMBER:
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT ZC V
L
Z/ �v
1. All appliances properly covered w/correct nozzles L 20. Replaced fuse links ti pI L 1
2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks <'
3. Check positioning of all nozzles 22. Piping &conduit securely bracketed
4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame
5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance-flame to filters y
6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order
7. If system has been discharged, report same ✓ 26. All filters replaced
8. Pressure gauge in proper range (if gauged) 27. Fuel shut-off in ON position
9. Check cartridge weight(if applicable) 28. Manual & remote set/seals in place
10. Hydrostatic test date ''� 29. Replace systems covers
11. 6 year maintenance date 30. System operational &seals in place
12. Inspect cylinder and mount rr 31. Slave system operational
13. Operate system from terminal link 32. Clean cylinder&mount
14. Test for proper operation from remote 33. Fan warning sign on hood
15. Check operation of micro switch 34. Personnel instructed in manual operation of system
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced
18. Proper nozzle covers in place 37. Service &Certification tag on system
19. Check fuse links and clean NOTE DISCREPANCIES OR DEFICIENCIES BELOW
COMMENTS:
oc
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17, 17A, 96 and the manufacturer's manual and was operated according to these procedures with results indicated above.
X
SERVICE TECHNICIAN PERMIT NO. DATE TIME AM PM CUSTOMER'S AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
Range Hood Systems Report
DATE OF SERVICE TIME A.M. P.M.
Peninsula Fire
Extinguisher Service A,NUA L SEMI-ANNUAL I RECHARGE / INSTALLATION RENOVATION
Sales and Service & Safety Supply
LOCATION OF SYSTEM CYLINDERS
P.O.Box 1744•20373 Viking Ave.NW �1 1
Poulsbo,WA 98370
(360)598-3300•Toll Free(888)214-3473 MA.5ACTURER M DEL NUMBER WET DRY CHEMICAL
Fax(360)598-3303 f'
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
CUSTOMER
�e c �✓e�� FUSE LINKS 360°F FUSE LINKS 450°F FUSE LINKS 500°F OTHER
Name2l/Y, L �9�'.�'[
2�// f�cv ZEC Z
FUEL SHUT-OFF ELECTRIC GAS SIZE
Address 6
City ^/ SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
7 fi-` /_,!J �!((��
Telephone Store NO. MANUFACTURER'S MANUAL REFERENCE
Owner or Manager PAGE NUMBER: DRAWING NUMBER:
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT - i i Z N
1. All appliances properly covered w/correct nozzles 20. Replaced fuse links ,i-q jo
2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks
3. Check positioning of all nozzles 22. Piping &conduit securely bracketed
4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame '
5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance-flame to filters
6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order
7. If system has been discharged, report same ✓ 26. All filters replaced
8. Pressure gauge in proper range (if gauged) 27. Fuel shut-off in ON position
9. Check cartridge weight(if applicable) 28. Manual & remote set/seals in place
10. Hydrostatic test date ✓ 29. Replace systems covers
11. 6 year maintenance date 30. System operational &seals in place
12. Inspect cylinder and mount Y 31. Slave system operational
13. Operate system from terminal link �� 32. Clean cylinder&mount ✓
14. Test for proper operation from remote 33. Fan warning sign on hood
15. Check operation of micro switch A�_ 34. Personnel instructed in manual operation of system
16. Check operation of gas valve /( 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced
18. Proper nozzle covers in place ! 37. Service& Certification tag on system
19. Check fuse links and clean /� NOTE DISCREPANCIES OR DEFICIENCIES BELOW
COMMENTS:
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17, 17A, 96 and the manufacturer's manual and was operated according to these procedures with results indicated above.
X
SERVICE TECHNICIAN PERMIT NO. DATE TIME AM PM CUSTOMER'S AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
� S
RE"'"ED MASON COUNTY PERMIT N0.0m 2,01 2--66%219,
MAR 10ZDIPLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
CCUN-ffhelton(360)427-On 0;B ifeb ww360)275 on67-Elma(360)482-5269
us
APPLICANT INFORMATION._ CONTRACTOR INF RMATIO.
Owner NNC �tS Company Name � �4 -n� _
Mailin Address 2141 s\ Tit krl� 3 Mailing Address
City State *JA Zip Code !�9)SZ F= City N�tkw State —Zip Code 4 • Got
Phone �3- 7 1,0 Oth r Ph. Phone 2 8 `9Q[�z3 Other Ph. � v ,-7-
Lien/Title Holder Contractor Reg. # } \.Sc 3 a'Exp. �k t 2 \4
E mail address _ N"W K E Mail Address h� s.1 S PLC GZ a O •CEvN
Drivers Lic. # \ V V B Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to.N Septic Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel N L10 — Fire District
Legal Description (0 nF L \— —1 SVj
Site Address(Please include street name,street number and city) 'I A\31 3 4�*'C- �V:A1R- vJ 11,9 -Z
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—LPG—Natural Gas_Heat Pump_
Toilets Tvoe of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood = 13�ZLZ
Hosebibs Dryer Vent
Other Other _
Base Fee Base Fee 'c-)•
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF R 1 B MEANS OF A PROGRESS INSPECTION.
X Date: nb " 19
Owner/Owners Represe ate Con actor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted b Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW AP ROVED 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