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Home My WebLink AboutBLD2009-00341 SFR - BLD Application - 5/4/2009 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO PLEASE PRESS HARD BUILDING PERMIT APPLICATION 1 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 I Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATIO R Owner fhw IAt E 13LOO_ Company Name Mailing Address `O 5 �• Mailing Address City T ORCI State LJR Zip Code City State Zip Code Phona.M O, S b' % Other Ph. Z/i!li 9 S7 Phone Other Ph. Lien/Title Holder ^- Contractor Reg. # Exp. E mail address c Jr �`�SN • «'= 1 E Mail Address Drivers Lic. �' DOB ` ( Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic( Connec to Water System Name of Water System (2 P14 ►V �"�°1 � % '• XiSTJC Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. — 7-de"- R Fire District Legal Description I IVI NWV P 2 Site Address (Please include street name, street number and city) f, fit= F1- Sr. F,f a Directions to site AU `,W � Y. Al 49" oLA '"L tQ ' 4 " t,AJ XEAFISR L.Al 4E4k lC T T 4&&Z Jtrtt J-SP r Will timber be cut and sold in arcel preparation?Yes Is property within 200'of Saltwater Lake River/Creek Pond /VOW Af4AF- 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 PL `-C PRIMARY RESIDENCE 4 SEASONAL �] Use of Building Describe Work�i L ti'�� A ' /ftrc( SIC No. of Bedrooms —No. of Bathroom Square Footage- 1st Floor AC(a 2, 2nd Floor 72 9- 3rd Floor—Basement Deck VVCovered Deck AIATIA L Other Sq. ft. ara _ Attached --X, Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. 4114 No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ f F 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 informaticn 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 O�1FA PROGRESS INSPECTION.INAC IVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X �c'cc.: � /: Date: -5Z /o 9 Owner/ (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted ti : Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES 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 INFORMATION CONTRACTOR INFORMATION Owner erki-) E Company Name Mailin Address 0 T -s Mailing Address City tate WA Zip Code 346 City State Zip Code Phone318-oIZS`r&2'&- Other Ph. 710-77S'7 Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address ed•SS'395 @ N,5.4j, C'5- l E Mail Address Drivers Lic.# �4RX F_'•tt Yf NP DOB k'-17 ` (. Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic t — Connect to Sewer System Name of Sewer System PARCEL INFORMAT ON - 12 Digit Parcel No. Fire District Legal Description A114 i5t EX TR a O f P kS2 A Site Address (Please include stre t name, street number and city) _1 S IEEE" / Directions to site F t� W4 7 L4jFT a REb N L I. X AC't t9'""ry D 24 R1G.Hr ' 7-bTE C46kh (SErA., J�fw Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New__,)( Alt Repair Other EP1,AcE Use of Building c Location of Fixtures/Units - 1st 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 Propane Tank Clothes Washer LGe&Qutlets Kithen Sinks W s/Pellet-Steve Dishwasher en Exhaust Hood Hosebibs .— Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTIN TIl�4 ON OF WORK IS MEANS OF A PROGRESS INSPECTION. X Date:T�O g Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES / MASON APPROVED , ✓ SITE PLAN RE OUY DCD PLgNNING T QUIRED TO BE ON SITE G S SUBJECT TO APPROVAL 330.22' By N87-52-23W t@ C' 5EA50NALRUNOFF \ EXI5TING 36'X 40' 1 POLE DARN o LOT 2 EXI5TING 24'X 24' ui z GARAGE Q z NCA Lu a zj �N s' u of IOU/ I I— o --I ty tz p 15NG 12'X 12 w o J AZEDO l 141.04' 46 r \ r�Y� PON D / Zmn�� Uj EXISTING DRIVEWAY LL I ep Epp \ / N I / LOT 1 I 330.17 Name_jEA&3412b Parcel# I-A 3 f 7— Y,2— 9/60�2, 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 Ac X (= r = X = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: eaves/gutters) X = Driveways C 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 inlC 1, 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) r 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 Name 9 AbW"b F 244 Parcel# /RS) 1 2/6e Z BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website: http//www.co.mason.wa—us/code/commissioners/index.htm Please follow the links to"Title 14, Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A)�The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in 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 Owner/Agent/Contractor(circle one)Date: .3 V o Page 2 of 2 ACCESS & GRADE INSPECTION BLD ADDRESS: /66 1k6?-FY,59 INSPECTOR: E / DRIVEWAY ACCESS 04� need post at access of driveway with reflective address numbers ? 1,9 C S Length: Width: Surface: Size of turn-around: Condition of shoulders: Vertical clearance: GRADE OF DRIVEWAY %, OF ROAD % ROAD ACCESS Length: Width: Surface: Condition of Shoulders: 1� Vertical clearance: BURN PERMIT REQUIRED FOR LAND CLEARING FIRE. L� LOT INSIDE UGA—NO OUTDOOR BURNING PERMITTED. LOT TOO SMALL FOR: BURN PERMITS 4 X 4 FIRES 2 X 3 FIRES PASSED ( ) FAILED ( ) ON HOLD ( ) REMARKS: