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HomeMy WebLinkAboutMIS95-0832 Propane - BLD Permit / Conditions - 10/13/1995 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 M I S C E L L A N E O U S PERM I T FOR INSPECTIONS CALL 427-9670 MIS95-0832 PARCEL : 12317419O1O1 PLAT : DIV : BLK : LOT : JOB ADDRESS : NE 2071 OLD BELFAIR HWY BELFAIR APPLICANT : RANDY CAUBRE 275-2213 OWNER : RANDY L CAUBRE 275-2213 LEGAL : TR 13 OF ME SE TR B-1 OF SP 11681 ME 2171 OLS BELFAIR HWY PROJECT DESCRIPTION : PROPANE TANK AND STOVE PROJECT LOCATION : FROM BELFAIR ABOUT 4 MILES DOWN OLD BELFAIR HWY ACROSS FROM "APPLE BUTTER FARM" (LIGHT GRAY WITH BLACK TRIM HOUSE ) PROJECT NOTES : TYPE AMOUNT BY DATE RECEIPT MCFE $ 37 .00 KS 10/ 13/95 814 MCBS $ 15 .00 KS 10/ 13/95 814 TOTAL : 52 .00 OWNER OR AGENT DATE MIS—PRMT, rev: 04/01/92 r MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 nr! 1 E L_ I_ A N 1= C3 U t:3 P f- R h4 1 _1._ FOR INSPECTIONS CAt_t. 427- 967O MIS95-0832 PARCEL : 1231741901O1 PL.ATn DIV : BLK ; LOT : JOB ADDRFSSr NF 2071 OLD BEL.FAFR HWY BEL.FAIR APPLICANT ! RANDY CAUBRF 275-2213 OWNER : RANDY L. CAURRE 275-2213 I..EGAI.. : TR 13 OF NE SE TR 8-1 OF SP 11681 NE 2/71 OLS RELFAIR NNY PROJECT DESCRiPT1ON : PROPANE TANK AND STOVE PROJECT I.-OCAT I ON e FROM BELFA 1 R ABOUT 4 M11-IFS DOWN OLT) BFL.FA I R 1IWY ACROSS FROM "APPL.F RUT TFR FARM" (L. I GH1 GRAY W 1 FH 91_ACK TRIM HOUSF ) PROJECT NOTFSs TYPE AMOUNT BY DATE RECEIPT MCFE T 37 .00 KS 10113/95 814 Mc13113 4 15 .O0 KS 10/ 13/95 814 TOTAL : 52 .00 OWNER OR AGE N ; DATE N1s—Pl11T, rev; 81!@ily CONCRETE MECHANICAL MOBILE HOME Footings-Setback date /p --2 y—5 S by I -� Ribbons date by Gas Piping date b Foundation Walls date -r- e-/aJ by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by L 7 k Cft[AD--FA LJA 98529- B ELF{q_52 i j NKI uNDEP, ffQus�� lIPPX'oX 19PUT 60' s G hp pro,REEN EF�- (E ZNE T P UND V-c uNR , FFORi/% /9PPROX. fro per GOMPA�uY - � - - tT-NEII_ Permit No. MASOM COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT /� #1 Owner '(�\cl Vl d� k, l_Gl Lk b f Phone# a7 s� ZZ- j 3 Site Address 20-71 OLD B EL F1+rfK 416 ff ly/ft Fire District# City gel+'a1r St 04 Zip �fs-f2k Directions to Job Site (from flelQt1'r QlooUaf y /Irs do Old DetP.ir wt,'V . sOco� v/e &ft-r Aat hr �� 4-�Zi!`4 t 4,-a Zu;-fA 9�4ck tri%� use ,7 Owner Mailing Address PO 60Y '17 3 City (fie/fitir 04--• St 04 Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name 110 m e 04U h e (- Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 Parcel No. Legal Description #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. #6 Use of buildin �6 �� l W�— ` S �� Describe work 9 #7 Type of Job: New Add Alt Repair Other #8 MOBILE/M UFACTURED HOME INFORMATION Model Year Make Model Length th Serial No. # Bedrooms Bathrooms Type of Heat Purchase Price$ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other /� Show following on the site plan r Lot Dimensions Flood Zones ` Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ( 3 each) Fee Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. Units Fees Showers Furn BTU _Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems _Sinks _ Spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins HP _Dishwasher No. Air Handlin- Units Disposal cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50-00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets �o Woo Gas Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL 0 MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDINGJ;EPARTMMENT. DEPARTMENT. X OWNER�C�/rL /l X BY DATWO?—/ r DATE FOR OFFICIAL USE ONLY: Accepted by: 2 Date: ( 2 G DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: FEES Special Conditions: Building Permit Plan Check Plumbing Fee Mechanical Fee �-1. 0-0— Wood/Gas/Pellet Stove c-© Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Lilding Valuation: TOTAL FEE 52 .0-0