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HomeMy WebLinkAboutBLD93-1494 SFR - BLD Permit / Conditions - 11/2/1993 MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 1 011" 42/--9670 H.1111 Ht.093-1494 NE ?073 OLD 6f­LFAkR HWY HEIFAIR OWNLR MILES BRAINARD 276--34/# 1-014tfiA(' fOR . H I LFS C0N;'rRt11C I ION 27S--3470 I I IiAl. -, 11 14 Of It St It 1-2 If St 11600 FS 16#11:11!2 t. 1 01,111) 01 W(114 NI IA 14 1.:1.4 1 1 fi A I I I ItPI A01,041 NY #Alf RMIPI JIM, A101101 Wf IJAI I pfcflpll "'T,0 14 4 t I I . I I 1 -1 -�_ . �q�_ �;.1 I y 1,1, OF A)`,1-, .. �;I OC(Alp , 614011p . 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IPO DAIS, AN It ("A"Iflifilov oiiI WOPI 11,; sospfolifo too 4 PF01411 of too NAYS At ANY TIN[ AFTER wolif 11 01111fActo (VIDINU Of- (41111011ATION of wopt fl, A PR(14H ")" lqqpfs,l 11AR RI IN)# 1111' 1114 hf;,i pfirf"ll fANAl. INSPIMON ANSI III kpppovfo offillif 0#11.0116 (AN 8F 0041,1W 0401`11; OR AhINT: PAO rev! $31011,41 COMPt,JANC(i 10 AI I ACHLI) C011401 I IONS Is ttt-,()jjjjjf,t) CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date ((-t by Gas Piping date b Foundation Was date 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 OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 Ease No . v HL09 1-- 1-40i tor: M i l t K V BRAINAP, Pagel I '1 I Fhw now . handl.inq mrid wtt)i otl" Ut titii.ai' lttttl';., moil i- i ,i14 vt i i. ,illiliooty rirlcl rlllllail4; l. 9il1 �i liquids in ew6Ct5's , of IA gallons is not, rillownd uit:hf)ii1 lho .' ppro-ni of 1_ilr, M,9'r4e_1ii County F i rc_ RbrskiA I .. 3 i Qjopctw"d v't r"cture or any portion t.F't<,,r,.,r) F cir -m l Mr t 1i.' n 10" , r1 h . i Uh l i r om quad, t i ng mu6t maintain a minY.t'titrm of h ' not.back from all ptr.,p+rl y 1 7i -n ,ah"iti-rivy ,-"4 r igh1 of Xi'1y+ 7t • Al 1 • pi't5�/»`l1 plane are requ i.r ed to he ori- b i t H I nr 111 .1+%°+ i, t r,ri F,lit`(t+,;,.= It i tR•,i,s;�c. l t oO lta t;l3. eod fcir rind plant RrP not:. on wif,Q AI'tt')►'i1vAl Will N011 h- gia"iwd I " a4divinrl ,. A Ry- t"spikut i on lea l p the amount: o $ 30 . 00 par ho"r ( mi n i nr"m 1 hoiit t "i 1 l bo olim 'i`Ied and rrtrii':t Fib` inflected nin eif?pni"f'.ment,' prior to m"y trlrihet iuvbpt' -tin"i I+e+ 1rtq pp ior'rlod nr. 41 r'UkSUAN1 10 i191 UNIFORM loll1 t 11IN" ODE ; .` 1 1 ioN 1041C ) hMV 411il "t 1 nit 4i 1vs MUSI HAVE Ai'PROVEU NUNt11Fk'i OR AUi.ihl='SVo PNOV.iULU iN KOLH k "'. 1 1 11 H h% 11 01 FI Ar_N1 T V141E111` AN" At IHI C FROM VHw' SIREF 1 OR ROAD URON1 1146 1Hf: 1110" l i 1 MASON 1 1111N1 T FiUt i i'► tMt 1ii 1'Ai; CMFNI Ftlt}tllHt:L, IifAT FH1 `> OF t"rlMi'i V 11.F) F°'K.t:t7k 10 i:F11 i tNi, t=ri13 ANy' tS11'r iN`:t'1"1' 11rlNK : A HvINSPECI LON FEE. HASLO ON RAI'Lo IN FAHFt sA OF 1101t 1991 UNIFORM N" 1111iNi i"tttrt: .I,.li:l t HF A`;gESSED IF nwwcK jcom1"RA( Ft1k ( AII S 10 1 OSI ADDWFSS ON `I K PR IOU to R 0"I-`,1 .I.Nr1 h1 CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date 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 OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 TH I: 11.11 ::E IL... IF.::U _lE II''d! 1I"cii; R::> il:::': If 2' 11,11,11 IL. 11 11 R P L C t1 L I 4 s o 7 0 BETWEEN 5pm AND Sam 427-7262 BLD93-1494 PARCEI_ : 123174190102 PLAT : DIV ": PI_K ° IOT .1OB ADDRESS : NE 2073 OLD BELFAIR HWY BELFAIR OWNER : MILES BRAINARD 275-3470 'ONTRACTOR : MILES CONSTRUCTION 275-3470 L E G A L : TA 14 OF NE SE TR B-2 OF SP 11681 FS 15118:19:2 CLASS OF WORK NEW BEDR : 3 . BATH : 3 ITYPE AMOUNT BY DATE RECEIPT (TYPE AMOUNT BY DATE RECEIPT TYPE OF USE . . . . : SF STORIES . . . . . . . : 1 OCCUP . GROUP . . . : ? BLDG . HEIGHT . . : O . Oft, R A D N $ 8.00 CPH 11/02/93 34369 PLCK $ 213.00 CPH 11/02/93 34369 TYPE OF CONST . , : ? FIREPLACES . . . . : 0 P L M $ 60.00 CPH 11J02J93 34369 OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . : 0 M C H $ 45.00 CPH 11/02/93 34 36 9 DWELL . UNITS . . . . : 0 PARKING SPACES : 0 STFE $ 4.50 CPH 11102/93 34 36 9 INSPECTION AREA : 1 SHORELINE? . . . . : N PRMT $ 426.11 CPR 11102/93 34369 TOTAL: 756.50 VALULATION: 90409 SETBACKS------- —____._"-- TOILETS . . . . . . . . . . : 3 FUEL TYPES---_------------ BOILERS /COMP------ MOBILE HOMF FRONT— S, 50 . Oft BATH BASINS . . . . . . : 5 : /ELE/ / / : 0-3 HP . : 0 REAR . . . . N 66 . Oft BATH TUBS. . . . . . . . : 1 3"-15 HP , o 0 MODFL : ? SIDE (1) .W 5 . Oft SHOWERS . . . . . . . . . . : 2 FURN < 100K BTU : 0 15--30 HP . : 0 —MAKE------ STDE ( 2 ) .E 5 . 0ft WATER HFATERS . . . . : 1 FFURN ?=100K BTU : 0 :=30-50 HP . : 0 ? SHRLINE . ? @ . Oft CLOTHES WASHERS . . : 1 FIJRN — FLOOR . . . : 0 50+ HP . : 0 —YEAR------ AREA ------ -- -------- KITCHFN SINKS . . . . : 1 HEAT PUMP . . . . . . : 0 LOT SIZE . . : ? FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 FVAP COOLERS : 0 LENGTH : 0 BUILDING . . . : 1650sf DRINKING FOUNT 0 VENT FANS . . . . . . : 4 HOODS . _ _ : 0 WIDTH . : 0 BASEMENT. . . : 0sf LAUNDRY TRAYS . . .. : 0 DOMES . INCIN : O —SERIAL#---- DECKS . . . . . . . 0sf DISHWASHERS . . . . . . . 1 AIR HANDLING; UNITS-- COMML. . INCTN : O ? GAR/CARP : G 690sf GARB DISPOSALS . . . : 0 <= 10000 cfm. : 0 RELOC/REPAIR : 0 AT/D'T . : A URINALS . . . . . . . . . . : 0 ) 1.0000 rfm _ : 0 OTHFR UNITS . : 0 MISC PLM FIXTURES : 0 GAS 0UTLETS . : 0 PROJECT OESCRIPTION:RESIDENCE PROJECT LOCATION:APROX 2.3 MILES FROM BELFAIR OUT THE OLD BELFAIR HWY ON LEFT, ADDRESS SIGN ON HWY, ACROSS ROAD FROM APPLE BUTTER FARM SIGN. 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 184 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 APP?^"r" BEFORE BUILDING CAN BE OCCUPIED. Ol'. ;GENT:_ v, O DATE: 2 rev: 03/31/9, COMPLIANCE TO ATTACHED CONDITIONS IS REQUIRED MASON� ����� COUNTY ��U U ����� U��U��L~�K �U^� K 'K �K 8U�� U �� " ° "^ ^~~ .�� " ~ ~_, .�� =~ " ~ " " \` , Mason CC)iJnfv p\|r1CJ. U| 426 \�/. Cedar— P.O. n� l�� �� Hn Washington. �� ^'^/^^ ..�.� Shelton, \&���0yl��.^^[l 98584 Case No . ; BL093-1494 For : MILES V 8RAINARO Page : 1 1) The use , handling and etorage of hazardous materials or flammable and combustible liquide in excess of 10 qallons is not allowed without the approval of �hc Manon County Fire Marshal . ^ 2) Pro� poy� d structure or any portion thereof greater than 30" in height from grade line 'muat maintain a minimum of 5 ' setback from all property lines , easements and right n� ways X__ /v ~_ 3) ' All . ,ved plans are required to be on—site for inspection purpoeee . If inspection is ca\led for and plane are not on site , Approval WILL NOT be granted . In addition , a Re—Inspection fee in the amount of $30 . 00 per hour (minlmum 1 hour) will be charged and must be collected by this department prior, to any fur �hor 1nspectionm hp1nq performed or approval granted . X �- 4 ) PURSU"°*�n . TO 1991 UNIFORM BUILDING CODE , SECTION 305 (C ) AND SECTION 513 , ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS T0 BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS ' A REINSPECTION FEE , BASED ON RATES IN TABLE 3A OF THE 1991 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER /CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIn'' ' X *_ / ' ' Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 t51.� PLEASE PRINT #1 Owner AAIL6S V, 8lLi41AJ4ti0 Phone# 2 '75_ - 5 ,17C Site Address,y. F , 2 o7 3 ad QEc- 4co9//L l,Gwy, Fire District# City 9ELFA! 2 St (a.r,�=l - Zip 9 8 S Z 19 Directions to Job Site A PR o 2, 2 /z) O N L F',c 7—, n D(2GC S' C', G n, o ,v 11 c✓-� 'acaoss- 'Qr7.Q17) G/�om Q�PLE Rc.rr�2 �Ft2m 1'lGitL Owner Mailing Address /L(i LE S V 8&A 4 ,k,,4 2 n ►J ,6 Z r zr o,-c> B-'[..FA r2 fi c,24 City 8�eL r­Ri I St u,A . Zip Ci &S Z e Lien/Title Holder Address Clty St Zip #2 Contractor Name Ik IL S GmN Sm 2i-,cl-i v Al Contractor Reg #MicEscit o9-aXoV Address N.E% 2i z j ©iD Expiration Date 2- City ��F-L F.q�2 St (."1 Zip fig, _ Phone # 2 7 S -- 3 y7 0 #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. /2 3 ! "1 Legal Description i �-f #5 Building Square Footage- (existing/proposed) 1st FIB/ 2nd FI 3rd FI / Loft / Basement Jic)Aj F_7 Deck '�`? _# bedrooms / # bathrooms / Garage / (o�{U Carport / (Circl Attache or Detached?) Other /'?�� Sto�ft. / #6 Use of building Q S,, DX- ,,TAB 44 c)m 'P Describe work #7 Type of Job: New !/ Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME,INFQATION Model Year Make Length Width ri o. # Bedrooms # Bathroo Type of Heat Purchase Price $ #9 Indicate by circling the applicable source s on or adjacent to subject property: River Pond Creek Stream Wetland L ke Zrsh Saltwater Seasonal Runoff Other Show following on the site plan 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 ciao a O n S Evric 0 o � � rV De�io�4 a 0� � (A ° w Q G O 3 �y• 3 `� �E�FSlSruG L"A4TG2 t/uF APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW HOME � 7 F % Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. .3 Toilets l CIRCLE FUEL TYPE: Gas, Electric, 5 Bath Basins 1 5 Heatpump, Other FL6'c_rlRtc aF 15ruNcE I Bath Tubs 3 No. UaL Fees Showers Furn BTU Hot Water Htr 'J Heatpumps i Laundry Washer Vent Systems Sinks / Spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins HP (Dishwasher _ . Air Handling 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 $ lU� No.. Other Gas Outlets Wood, 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 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 I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE 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 BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Reviewddda,A , s A A *t Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee O Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor D Violation Fee Site Inspection Building State Fee 5 Other Other Building Valuation: TOTAL FEE LP Date Checklist Prepared IO—30- MASON COUNTY BUILDING DEPARTMENT PLAN REVIEWER AND INSPECTOR CHECKLIST 1991 WSEC AND V&IAQ CODE COMPLIANCE Permit Number q3- I LQ4 Address Scl. Ft. �So� Name on Permit BR A i AJAiQ J. M" I E6 V. Contractor/Phone# cA 75. 3 4 76) Compliance Method: ( ) Prescriptive (Option) '(v) Component ( ) Systems Analysis 31`1 iaoq Date FOUNDATION Insp. Rev. ( ) ( ) Slab: R- (Ext.foundation down to frontline/slab bottom;or interior 24"top of slab&horizontal. Radiant under entire.) ( ) ( ) Below grade exterior wall insulation: R- ( ) �) Crawispace ventilation: 1A (I sq.ft.NE&/150 sq.ft.floor area-cross vented) 1819 � 156 FRAMING ( ) (v) (v) Standard ( ) Intermediate ( ) Advanced Woodstoves and/or fireplaces: (6 sq.inches combustion air supply dud with damper direct to firebox.) Standard air seal: (Bottom plate/subfloor,rim joist/mudsitl,window/door frames,penetrations condition to non-condition.) ( ) (v) Attic ventilation (1 sq.ft.NFA/I50 sq.ft.ceiling area) l fAL4 &`/1O 150 10a Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cffm,@.25 WG. Vented out with dampers.) Fresh air ventilation: Available to all habitable rooms. Installed and operational. (Integrated forced air,windows,wall ports.) Whole house exhaust fan: cfm (Intermittent system manual&auto controls/sone less than or=to 1.5 at.1 WG) INSULATION Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extend 12"above loose fill or 6" above bait insulation) ( ) (r) Mechanical ventilation ducts R-4(Exhaust in unconditioned space&supply in conditioned space.) ( ) (v) Wall insulation(above grade) R- C2I (Batts face stapled) ( ) ( ) Wall insulation(below grade-interior) R- (Bats face stapled) Vapor retarders on walls (Faced bat(,or 4 mil poly or perm.paint.-circle one) ( ) ( ) Rim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.) Vaulted ceiling insulation R- t`?7� (Vapor retarder&1"air space) Se t•.- FINAL Floor insulation R-�—(substantial contact w/surface,supports less than or=to 24"OC,not blocking vents.) ( ) (r ) Ventilation system is Operational(spot,whole house,fresh air to all habitable rooms. If integrated system,certification by installer is required.) ( ) ( ) HVAC ducts in unconditioned areas R-8 (Joints sealed;mechanically fastened with a minimum of 3 fasteners.) Pipe insulation R-3 (Hot and cold lines in unconditioned areas-service or recirc.see Table 5-12). SHW heaters: (NAECA label,separate power or gas shut-off,on R-10 pad if electric in unconditioned or on concrete.) ( ) (r ) Heating system type: r=l e_C*rl'C_ ; O50ri e0c ( ) (—►) Radon monitor on site with instructions.No. - supplied by MCBD ( ) ( ) Thermostat: (Heat range 55-75;AC 70-85;both 55-85. Backup heat controls(lockout)prevent simultaneous operation of primary system.) ( ) ►kon Solid fuel appls.: (Glass/metal tight-fitting doors;dir.comb.air source,or 4"dia.dampered,indir.source for existing coast.) Ground cover: (6 mil black polyethylene or approved equal lapped 12"at joints,extending to foundation wall.) ( ) �► ) Penetrations(All exterior wall and ceiling penetrations sealed to drywall-plumbing,exposed beams,wall receptacles,fans,recessed lights.) Ceiling Insulation R- LP (Insulate&weatherstrip access,baffle to prevent spillover-no cardboard) ( ) ( ?) Vapor retarder paint if a vapor retarder was not installed when insulation was installed. GLAZING Plan Reviewer-Fill out this glazing section or attach a window schedule to this checklist. Jmpector- Verify window information during field inspections. Include skylights,glass doors and all other glazing on this form. Use rough opening area for calculations. Date Size Quantity Area S . Ft. U-Value Manufacturer Rev. Insp. 501-tw >e/v / ad a v 2.8&6 a og 0 o s ,, l / / a .37 4010 X/D / 8 Loma �/C) 07 t�n/es fheru�; nd�- a,t� ,'fh 'w /I I � O Total glazing area: J Total conditioned area: /�oZ Percentage glazing: �' �• Verified: DOORS Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity,U-value,and manufacturer. hapector- Verify door information during Field inspection. Date Type/Quantity U-Value Manufacturer Rev. Insp. 28 6 Signature of Building Inspector: Date of Final Inspection: BUILDING DEPARTMENT INSPECTION SCHEDULING INFORMATION REQUEST TAKEN BY TODAY' S DATE DATE OF INSPECTION Date inspection requested NAME ON PERMIT �y�1 ��5 R rac lkl y- STREET ADDRESS_ �� 207 3 0(d R�LTur PERMIT NUMBER BLDG3`jgW TYPE OF PERMIT ,TELEPHONE CONTACT # AND NAME 5 V -7() ` INSPECTION AREA v) TYPE OF INSPECTION: \� _FOOTING B NAILING _HOLES _FOUNDATION/STEM WALL FIN _OTHER (DETAIL) _SLAB INSULATION _ FOOTING _SLAB ROUGH-IN PLUMBING _MH SET-UP _FRAM/PLUMB/MECH/PEN _MH FINAL _INSULATION _WOODSTOVE CONFIRMATION CALL BACK BY DATE CONTACTED: , ► TIME: V Tt vASHINGTON Sim 0IFRGY Building Record WSE©Contract# 9 ttachmeCB CODE FROGFAM For Site-Built Residential Buildings Heated by Electric Resistance or Heat Pumps (please check one) (please check one) "New Building ❑Addition over 500 sq. ft. "" Single Family ❑Duplex Jurisdiction: M 4 SUnI ❑Multifamily ❑Zero Lot Line Home ❑ Planned Unit Development + please check one: ❑ City NCounty Permit# —/ 9 ��## File I D# (if different from Permit#) + A. Site Information B. Owner Information Address /Vc �2p d Owner owner at Vme of construction receives utilitypayment) city i zip M,:5-A Company Assessor's Pfopprty Tax# orattach legal descri tion Address /milLY i �a ,21 T CityState ,4 Zi Servicing Electric Utility Phone ( ) ) 7S _ , C. If Single Family, Zero Lot Line or D. Duplex E.If Multifamily(R-1) Planned Unit Development First Duplex Unit s .ft. Total #/Bld s. Total Conditioned Floor Area s . ft. Second Duplex Unit s .ft. ITotal#/Units ._. . .......................................................................-................................................................................................................................................................................................................ ..................................................................................................... .........................................-..................................................................................................................... ........................................................................................................................................................................................................ ............................. ....................................................................................................................................................................... A. Primary Space Heat Type B. Secondary Space Heat Type C. Water Heat Type (check one) (check all that apply) (check one) ❑ Electric Baseboard None Electric Electric Wall Heater ❑ Wood ❑ Gas ❑ Electric Furnace ❑ Electric Baseboard ❑ Other (specify below) ❑ Electric Heat Pump ❑ Other (specify below) ❑ Other ::...... AIC ..................... .. . WSEC Compliance Method For Heat Pump Only: Date of Permit Application ❑ Prescriptive Path Built to the Electric Component Performance Requirements of WSEC? Date Building Permit Issued //_ a. — Q" es, Date of Insulation Inspection y "9.s ❑ System Analysis El Yes El No (If Y Date of Final Inspection utility may offer incentive.) I hereby certify that this building or addition has been inspected for the measures required by the 1991 Washington State Energy Code (WSEC), that it is in substantial compliance with �;egSEC, and th t the WSEC checklist for this building is on file. Signature B Iding Official or Authorized Representative Date ■ Buildi �partment: Return white copy to Gail Burris,Washington State Energy Office, P.O.Box 43165,Olympia,WA 98504-3165. ■ Owner or Building Deparment:Forward canary copy to the servicing electric utility to trigger WSEC compliance payment. ■ Building Department: Retain pink copy for jurisdiction's building file. wsEo'94-015 5 95