HomeMy WebLinkAboutBLD94-0914 Mobile Home - BLD Permit / Conditions - 8/22/1994 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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BLD94-0914 P(ARCCL : 123174290010 PLAT !._ 0T
:'O^ (AnnRFS NE 1877 OLD BELFAIR HWY BELFAIR
OWNER :: CONNIE KUHN 275-5917
rrh!TRACTOR . 3 M CONSTRUCTION 426-4795
I ,�! TR A OF 5112 NY SE NWLT OF RIM TR A OF SP 11711 FS 15127.1 Of 063
7L.A nF (.WORK . . : N.FW RF0R : CATI1 TYPE AMOUNT BY DATE P,ECE=TYPEAMOUNT BY DATE RECEIPTTYPE OE USE , . .. MH ?TORTES . .. _ . - I
OCCUP . GR0LJP . . . . ? 0 L D G . 1111GHT . . 0 , 0 Ft. RLC $ 41.11 NJP /8122194 36936
TYPE OF CON ST. . . . FIREPL.ACf.S . . . . : 0 MNOF $ 111.80 NJP 18122194 36936
0CCU? . L0A0 . . . . . 0 W00DST0VES . . . . : 0 STFE = 4 .50 NJP /8122194 36936
0L-1F1_1. .. UN IT S . . . . . 0 PARKIN1 SPACES : 0
TNSPECTTON AREA : I SHORFI IN N TOTAL: 144.50 VALULATION: 1
SETBACKS.__ TOTI_FT S . . . . .. . . . . . : 0 FUEL TYPE.^ - - _ __ B0TLF"c/COMP _ M-IRT[ F ACNE
FRONT . . . S 340 . Oft BATH BASINS . . . . . . . 0 : ? 0 - 3 HP . : 0
RFAR . . N 5 . 0 f t BATH TUBS . . . . . . .. . .. 0 ' -1 ", 1•1P 0 mnr)f i r),.,r-F .0!!
S10C {1) . E 5 . Oft ^1-:OWE RS . . . . . . . . . . : 0 FURN :LOOK BTU : 0 15-30 HP . : 0 -MAKE _-
^ID {2 ) .W 5 . 0ft WATER 1ICATERS . . . .. . 0 FURN ` =:100K -,TU : 0 30 50 I1P . 0 401�101
SIARLINE . ? 0 . 0 f t CLOTHES WASIHE R5 . . : 0 FURN FLOOR . . . : 0 50+ lip : 0 YFn,n__
AREA ___ __.__._._ _ ---_- __ _ -- KITC14EN SINKS . . . . : 0 11LAT PUMP . 0
LOT SIZE . . . ? FLOOR DRAINS . . . . . . 0 VENT SYSTEMS . . . . 0 EVAP COOLERS ; 0 LIGI`F! : <J0
r,UIIDTNG . . . 10r7 f DRINKING FOUNT.. . .. , 0 VFhIT' FAI'J5 . . _ . 0 IiOODr; 0 t-DTP i ?"
BASEMENT. . . : 0sf LAUNDRY TRAYS . . . . : 0 DOMES . TNCTN : O - SE121ALm -•
OFCK!7 . . . . . : 0^`(' DI^IiWASHERS . . 0 AT" UNIT"- COMML TNCT11 : 0
GAR /CARP : ? 0r.f GARB DISPOSALS . . . . 0 1,0000 cfm. : 0 REI.00/REPATR : 0
AT/OT . : " URINALS . . . . . . . . . . , 0 O1I?F p (1NTTS . 0
MISC PLM FIXTURE: : 0 G-, OUTLETS . 0
PRCIECT DESCRIPTION:MOBILE HONE
PROJECT LOCATION:TWO MILES FROM BELFAIR OR LEFT. MOBILE HOItE WILL BE BEHIND NE 1875 OLD BELFAIR HWY.
aTHHEISgggPEpRMyyITT BBTTECOMyESTTMUUEELL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 181 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPEN^ED FOR A PERIOD
_IFPPjOVEDABEFDBEA�CII INGR�b RBC��I�gNMENGEO. EVIDENCE OF CONTINUATION OF WORK IS A PROGRESS TNsPc�'•^q !JYTUTU TUC !Rg DAY PERIOD. FINAL INSPECTION MUST EE
"OWNER OR AGENT.
EkO PRNT, rev: /3/31191 COMPLIANCE TO ATTACHED CONDITIO:<._ -- 1 EQUIRED
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
F-31 4'.11 1 1. I C N C4 I"',, J,] lf;� k" 1 1- kfk f 14'if'f- I f i ICI') f fit 1 421-9670
hNI) i0l 111 4 2 1—12 6
81.094-0914 1-1AP11.1 z I,,l -; I lii,-1900 10 f 1 A I Ifiv : H I It: fit
If1B A 0 1)61 f ME 1877 011-0 HFUFAIR HWY H F L F A Y R
CONNIE. KOHN 27S-6917
'1 0 . 4,)6
%It? IV sr wl Of Rim is A of st w#1 Its of Ohl
f- I I I If)1''i. fJ f I'l RI lip A1114141 fly D 0 ATf Rfff (Pf lvpf 40111 ov bAff
(T-y-p
fj 1 1) fit I (-i I 1 1 Vt . L fI f111C 40 06 HIP 081'%*144 464"4
1 V!,I or F I R I I AC f", 4119f t 11111 00 fl-IP #8j",N14 1�qlf,
t A 1 4) Ili 0 0 D"i 10 V F 1-;
j 1 0 �,Fff 4 UP 091.12/44 1i!44,
0 tJ I 1 1. t 114 1 i it V,A R K ! N 6 '--,PAC I
I N`-IJ 1' 1 H A VV A i H 1-t 1 1. 1"t
F 7 H A c K"i- f: I I I IF t I" f,f-I tv;p Milk I I f Lj,ftyt.
F R 0 N T HA I H 13 A S IN 6a h. Jill (A
A I? N 0 If t HA V 14 1 U F, 44 mWil I -
T 1)1. f 1 E 0 If I: H()W F p v3 f IIIk*N I 001K ti III 0 M 1 11.
Iflf Oft WA I F 0 1 ljt?14 1 0 0 K H T Ij 0 0 r,0 I-1 t. 0 it 0 1 0
I I t Nf- 0 0 f i- C 1 0 1 lit "i WA flk V 0 1, 1,1 RN F 1 ffffR 0 !,,0 if 0 1 lit?
ARIA I I c H F N NY, 0 111 A 1 11 11011*1 0
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I "V14 1 06!,;i t` 1)k I N t'-, A N 6 V 1)11 N 1 0 vt N 1 1:1114 1;
0 1 11 If I It
k A':,i:M 1 N 1 0 f 1 AUNDVY TRAYS I Ni: I N 0
D f 1-11 1 1 , . . - 0 1 D I .,;It i W A III f4 1; 0 All ,' I-IANIJ I I Nfj I N I I ) N C I N
6 Aft f.(I Ii F, 0 t 6 A Rr I i ff1 1•1 W;A 1 0 10000 1 (it : 0 14- 1 0cJFtf=RAiR 0
10000 1 m 0-1 Ht k, (IN I 1 0
10
fjWi fill I I I` I
P010V1' [OrAll1fUH40 qtlf4 fRON b[IFAIR 00 tiff, #4911-F mokf oil,( of 011111111 of tq)ri Oft Kllffl# Hitt
JHJS PFROIT llf(00ff NfIlt All VS)9 If 40fl. OR (01"TRO(TION A111111001710 IS NOT (011pill(UP 4110111 100 DAY'), fig if COPSIRRMOK 0 WOFf IS SOMIllitO IOR A VfVloli
#Emp, EVIDENCE Of, rONT11111111111111 Of WORY, IS A PROEM INSPFC1141 1411010 ikf 180 DAI PERIOD. FINAI, 111spulloo Am of
quorp OR AUNT. PAII G� ��
COMPtIANCF TO ATTACHED CONDITIONS IS RFQUYRFO
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date c by Gas Piping date (r)'
Foundation Walls date by Set Up i
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date J, / 9 by C __j
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date by S y
date by D.W.V. WALLBOARD NAILING
date b date by
Water Line
y FINAL INSPECTION
date by date by date by
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
Case N
I
I i q"ion 10 on, io "Or 11100"d "ilho"I rho appt ""al of thy mmoo" voitnyy
Vito mat , hil
X
/ I Propospd cir"t- Wre or m"y portion khoup" f qrqator tha" 40" iti hwohl li "m "rad" 11"p ,
mi " im"M of & I 9-thatch trom all Vrop"iVy li "on . "nn"mo"J " .end rjohl of
t I on(!G and virtlicol Arpay ; RIC )
X 1
4 ) 110F',QAN 1 10 1 qqt I F"RN HHJ 1 111 NH COOF . SFU I I ON 104 1 ANd NI- EIIHN hit . All NfFES NUSI
hAVV APVROVVD NOMU11- 145 OR ADDRF94fS PROVIOU0 IN k"c" A POqlltON A4 10 HU PIAMY VISIHIC
-
AND LFG1131-F FRON THE S1`REF1 OR PnAD FRANIINH THl- PRAVFRry MASON ' 0111,11Y H11 F I DINo
DI-PAWIMI-NI SEq"IMS VHAI THIS HI: rnNPIFIrD PRIOR FO VAIIINH KOH ANY q1lF IN911ECILONS A
REINSPECIION FFE . BASED ON RATFq IN FARIF 3A OF 111E 1 "o1 "NiFnitm H" 11DINH CODF 1,1111 BF
A",!41 lill(, D I K OWNER/CONI Rnf! I Ok I'Al I q 10 Pos r ADDRFqY ON q I I I ISO I OU V" 141`011FITEN6,
WSPICTI,nNS .
1,
0 ) All ( ONSTRUC-11ON MUql 14FFI OR PXCE110 All 1OCAl rOPUS nNO UHI
y.
61 RFOUIRLD INSINFIGUIONS ( FootincI . Inappetion-prior to pn"f , smt -"v 1 "npottioy-prior to
skirt t a d
tang. Final Jr-topeci ion yr-jor to occupa"vy ) f hAVp reueivwd a a py if th" Henprn)
InforAmIon and Gtilefinpw MobiJe/Man"fictured Hnoqinq l "viallati "ns Handout for
ciptalipci descriptionq of all rerl"irod ingpectio", on my whilut/ma""fact"red hnmteo
1 "9tallation I hereby aqunme all rospongibilli-V for 1-he arbod" li "q of thoap roqitirpti
inoppvtjo"s it thnqp requfi rod lnspervin"% are "of t-ecitimst "d . i "Op-ted O"d %ivi"Od
Afriapprovedl by the Inqpprtor in that prp6citbed ordQr , I "t-rderwhand Chat rmin4pmtton
fo"- arrd a" ho"rly in-psti Ation W" p"rk"nnI: Co Vhn 1441 HHU , lahip 3A will be assessod
in addition W my ni- irfift-n
pormit O,N to tasnIVeA"y tf" n pulinmbly ermutirps or'
probipmo 1.1-fat hava, hven tison-pd 1'"r-Chor "n,mraVa"A that = 4 InvosticlAvin" will
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 FRAMING by date by date by
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwcrk 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
hB Ct1!?!i11iF1d 'it' i..t.tii� .ai.iuf,4 1.1111. tr. I v 4. iii.ut. tvrt � I a n y ;.al I kIi; ir.:ttl:
lnc:pect.ion) w.i_1.1 t» grantmd for the rostrlenco
OWNER/CONJkAf'-TOR ( 1ndi.cAte which ) �Itgnat.tarp K
7 ) A1.1. rrlC/bi.Zp/M.41111fAC't.11r49d 11Ortl ! 1.iIIFi.tn(1E; Or d0?ck1�, 1ii(,J i t t,�A 1�..; t i tt l.,.r� tlis.l
Me lctr'taest .landinq or, Clark porrtlit:i.pd wi. t:hollt dr(iwim-ls+ or A trr.ritr.tin(I Iwo rm.1J. g o:," x
6 Any larldinq ov dock that is '30" or more in h,a'ight, from walkirlg �,tlrtmcc- 4-.0 f' irli -sh
grad@ rt�tlr.li. r9c, es elijAr- irai 1. : Arty Ic4ndinq or rletck theft hwF" .1 or more riwsec% rw(ilairas� �
handrraII - Arty I And iriq "'r oock hirgb>r t:tlara `•3(," x 'if;" 11111-At 1)*' which r� grlire�F
1;t:ritC,r,tlt a dr-AW111101; Arld a I'lli Idinq 1)(lrlrli.t AppI i (•rat.1on , I h i s 111 taI 1 .�t icm Nflrm.i r.. 1 oef
N0 inc1.lydt" atiy 1andJnq or der.k l.Argwr t, art t.hp 3r;" % 361+ C;i 701
t3) i ON-1+Tk0(' T T(tN FwR.0o `-S 10 rli" h TfJO CORK:C Tt D Ai iri (1li 1 itt 1) 11F P 01At;1!N rlllihl I fill t I D I N(i
DFPAkT M1- N1 A NO ON) FORM Hil l icrIN(i r'ililf w
r
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 FRAMING by date by date by
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
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(206) 427-9670.
CORRECTION NOTICE
Job Location 6,e- 1P' bLv
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found:
Items listed below must be corrected to gain code compliance
/, �o r-��c.� l't c.L.S '� � � �S-� f'-f- �c ..O�d✓' �- i n, `��..�� l c .� v,a�'
Jew r,J4.` �» ,�- f'L,,� 14 .
Z. l �OJ i c.J�� � � �,�✓ 4 l �XOc,J h S�lJ.s � � ` � � .,
Ole
�� D gc' tZ
You are hereby notified that the above corrections shall be made BEFORE
PROCEEDING WITH ANY FURTHER WORK
�d Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
Department G,
Date /D - —f y Inspector
■ so * NnT MnV THP1111111h TA& LOW
Page No. 1 CASE HISTORY FOR CASE NO.: BLD94-0914
CONNIE KUHN
NE1877 OLD BELFAIR HWY BELFAIR
09/21/94
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- ---
BLDA010 Application received / / / / 06/23/94 08/19/94 HLS
BLDA011 WARNING!! SEE PARCEL FLAG / / / / / / 06/23/94 KW
BLDA500 (F) Issue building permit / / / / 08/22/94 DONE NJP 08/22/94 NJP
BLDA920 Miscellaneous action / / / / 07/21/94 THE WELL IS BEING SHARED BY MOTHER AND DONE NJP 07/21/94 NJP
SON ON THE SAME PARCEL. THEY HAVE
DIFFERENT ADDRESSES BUT THE PARCEL
NUMBER FOR BOTH IS THE SAME.
BLDB110 Structural Plan Review 07/05/94 / / 07/13/94 DONE WLC 07/13/94 CKR
BLDB130 Planning Review 06/29/94 / / 07/05/94 DONE MMS 07/13/94 CKR
BLDB134 RLC Checklist Review / / / / 07/01/94 DONE AHB 07/05/94 TMJ
BLDB135 Addressing / / / / 06/30/94 DONE GMM 06/30/94 GMM
BLDB200 Environmental Health Review 07/05/94 / / 07/05/94 Needs septic design. HOLD BJW 07/05/94 MMS
RECEIVED VIA FAX COPY OF SHORT PLAT MAP
AND COPY OF RECEIPT FOR SEPTIC
APPLICATION. BJW 7/5/94
BLDB200 Environmental Health Review 07/13/94 / / 07/18/94 need septic design HOLD CAJ 07/18/94 CAJ
BLDB200 Environmental Health Review 08/19/94 / / 08/19/94 Based on new test holes, DeMiero PASS JGD O8/19/94 HLS
submitted a new design that was approved
08/19/94---new test hole inspection and
design review were done by JGD.
BLDB200 Environmental Health Review 08/19/94 / / / / Sons home and mothers on same parcel and DONE HLS 08/19/94 HLS
same well. Done
BLDB210 Water Adequacy 06/29/94 / / 06/29/94 This well must be brought into HOLD HLS O8/19/94 HLS
compliance as a two-party well because
the son house and well is on his
separate parcel.
BLDB210 Water Adequacy 07/18/94 / / 07/18/94 still need water source to come into HOLD CAJ 08/19/94 HLS
compliance as a 2-party water system
BLDB210 Water Adequacy 08/19/94 / / 08/19/94 Son and mothers homes are on the same DONE HLS 08/19/94 HLS
parcel as well as the well. Done HS
BLDC200 MH Setup inspection 09/20/94 09/21/94 09/21/94 CORRECTIONS: FAIL LW 09/21/94 LAW
1. HOOK UP POWER.
2. S.D. NEEDS TO BE WORKING.
3. VENT PRESSURE RELIEF LINE TO THE
EXTERIOR.
4. VENT DRYER DUCT TO THE EXTERIOR. USE
SMOOTH WALL PIPE.
OK TO SKIRT UNIT
CPh
^� 4 4
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as
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`�tr°� Permit No.
U MASON COUNTY ,,` k
�(IN 2 1 19% UILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 Q
PLEASE PRINT
#1 caner Connie Kuhn Phone # 275-5917
to Address NF 1 f�77 nl RP1 fa;r H;ghsaa Fire District#
City Belfair St WA Zip 98528
Directions to Job Site Two miles from Belfair on left Mobile home will be behind
NE 1875 Old Belfair Highway
Owner Mailing Address same
City St Zip
Lien/Title Holder 6-11J72 */L
Address
Clty St Zip
i
#2 Contractor Name Contractor Reg #
Address 17 dro Ex iration Date��/
City St_ Zip 3
#3 If septic is located on pro ct 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)
#44Le'galrDeos
. 12317 cription —�1! of h NW 1 /4 of 4F 1 /4 of Sep 1 7, T��N, R1G1, Gii�T
#5 Building Square Footage: (existing/proposed)
1st FI 1067 / 2nd FI / 3rd FI / Loft /
Basement / Deck / # bedrooms / # bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other sq. ft. /
#6 Use of building Describe work
#7 Type of Job: New x Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year 2s Make GUERDONModel 40510
Length 40 Width 28 Serial No.
# Bedrooms 3 # Bathrooms 2 Type of Heat Electric
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
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements• Easements Indicate Directional by (N, S, E, W)
Name of Flanking Streets in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW 39-F- �,^�-BELOW
�'r'a'fd�tt
15T:
APPLICANT TO DRAW T9P6ciflAf3HY PROFILE BELOW
30,
( ¢NT
-r wE1y, ra6,�
Sep
140
�i
C�
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
ath Basins Heatpump, Other
—Bath ubs No. Units Fees
Showers Furn BXZ
—Hot Water Ht — Heatpumps
Laundry Washer Vent S ems
Sinks of Vent Fans
_Floor Drains N Boilers/Compressors
_Laundry Basins HP
—Dishwasher No. 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 F 15.00 Auto Fire Sprink Sys 25.00
TOT LUMBING $ No. r
Gas O ets
Wood, Gas, Ilet 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 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 BUILDING DEPARTMENT. DEPARTMENT.
X OWNER / X BY
-T
DATE fo DATE
FOR OFFICIAL USE ONLY: Accepted by: y4w et.- Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: jT A- to (a>A GA ia,&X
Environm tal Health: 2 ?d 59^1
—J ' l
Building Plan Review IMF<_ �t� _ 5`� MIDI e-a 46 q
Occupancy Group:;1- '5 Type of Const: tJ
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee t�, Q'
Other
Other
Building Valuation: TOTAL FEE �-��
MASON COUNTY RESEARCH REQUEST FORM
426 WEST CEDAR STREET
SHELTON,WA 98584
PHONE # 427-9670
FAX # 427-7798
PLEASE ALLOW UP TO 72 HOURS FOR COMPLETION
DATE REQUESTED: �bsglf soleTIME:
REQUESTER NAME:
REQUESTER ADDRESS:
PHONE #: FAX #: AA
PLEASE RESEARCH THE FOLLOWING: Bw d-. PST o4
00 A� l
BUILDING RECORDS: oVl
SEPTIC RECORDS: Nor yer
AGE OF SYSTEM: STA l f m
WATER SAMPLE:
DATE SUBMITTED:
OWNER NAME: /t o f I M
ORIGINAL OWNER: T��` /
LEGAL DESCRIPTION: T*ioixr 44 oSO O//o o
PARCEL#:__ 12
RESEARCH TO BE:
MAILED: COUNTY STAFF PERSON:
ol
(WHO WITHIN THE CO. GETS THE INFO TION)
FAXED:
PICKED UP:
FOR COUNTY USE ONLY
RESEARCH COMPLETED BY:
DATE COMPLETED: "RESEARCI"
APPLICANT NAME'
DATE• /
BUILDING PERMIT CHECKLIST
RESOURCE LANDS & CRITICAL AREAS CHECKLIST.
All projects must complete the Resource Lands and Critical Areas Checklist before
a building or land modification permit is issued, or before final approval of a
septic system.
1. SITE ADDRESS
If site address is not listed, customer needs to be given a site address form.
DIRECTIONS TO JOB SITE
Needs to be as complete as possible (i.e. major roads, is house on left or right
side of road, etc. ) . Be sure to read for clarity (Landmarks, signage, owners name
on mailbox, etc. ?) .
LIEN/TITLE HOLDER
Who holds the mortgage (Bank or name of private owner holding contract)?
2. CONTRACTOR REGISTRATION # AND EXPIRATION DATE
This information needs to •be provided. The Building Department may be able to
research expiration information if customer does not know it. We must have a
signature in 1 of the/2 boxes, either the applicant or the contractor.
�(tom/
3. SEPTIC RECORDS ` he " aaQ //,'4
Septic records should be included. BERERE TO INFORM CUSTOMER OF $25 RECORD
RESEARCH FEE FOR ENVIRONMENTAL HEALTH. If no records are available, make a notation
on the form "No Records". If septic application is recent, mark "pending" in the
upper right hand corner.
EXISTING SEPTIC
Remind customer they need to have their tank pumped and determine whether their
system meets code (sanitary survey or parcel review?) . They will probably need to
show reserve for their septic.
d4. PARCEL #
Parcel # must be included or researched through Gateway.
lel 5. BUILDING SQUARE FOOTAGE
Verify that boxes are filled in. If there is a garage, verify whether it is
attached or detached. Include square footage information for mobile homes (you can
multiply length X width to determine number) .
6. USE OF BUILDING
Is it a residence, garage, greenhouse, etc. .?
dDESCRIBE WORK
(i.e. mobile home addition, addition to a house, etc. . . )
7. TYPE OF JOB
Verify appropriate boxes are marked.
8. MOBILE HOME INFORMATION
Verify appropriate boxes are marked. If factory order, please put factory order
# in mobile home serial #. If unit was assembled prior to June 15, 1976, refer to
procedures handout for "Obtaining Installation Permits for Mobiles Assembled Prior
to June 15, 1976."
9. SHOR M
If any ter is on or adjacent to property within 200 feet, #9 must be complete.
Once pe mi.t is entered into Tidemark, it will be routed to the Planning Department.
If pro erty is not on water, then put "none" or "n/a" .
1
, 10. SITE PLAN DRAWING
Must have setbacks from all property lines, easement lines and structures.
Drainfields septic tank location, outbuildings, etc. . .
11. TOPOGRAPHY DRAWING
If property is flat write "flat" on the topography section. If house or structure
is near a slope or hill, drawing must reflect this.
12. OWNER OR CONTRACTOR AFFIDAVIT
Owner or contractor must sign affidavit statement and date it.
13. ACCEPTED BY
Whoever is accepting permit information must sign your initials and date form on
the bottom of page 3 or use date stamp and initial on back of permit.
Q 14. PRI.
Need o sets of prints unless it is a stock plan. For stock plans, we only
requ a ne copy. n
15. WATER ADEQUACY r/!D`L-1 LJYI O � ��u
For new residences and mobiles�PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST
AND BACTERIAL TEST. If they are on a public water system, verify the water system
is in compliance with State requirements.
16. WSEC & V & IAQ CODE
Required re all residential, additions and commercial buildings. Energy Code
compliance needs to be COMPLETED. Verify heat source (no wood or pellet
stoves are a itted as primary system) . Window schedule must be filled out and
reflect what appears on submitted building plans. If applicant has decided to go
with the PUD in a Long Term Super Good Cents program, we require a copy of the
signed agreement with the utility.
17. PLUMBING/MKP�ICAL
This form; st be completed for any structure with plumbing and mechanical
1-11 excluding mobiles/modulars.
18. FIRE DISTRICTS
Please make sure the fire district is included in the application information.
Refer to map located at counter.
19. ROAD AC SS PPMIT
If you wi a accessing your driveway from a County road, contact the Public Works
DepartmeptNkn Mason County Building I, 427-9670 extension 450. Access from State
Highways re es Department of Transportation approval. Contact office (206)895-
4753 (Port Orchard) .
* ACCEPTED BY: > �"6 ,
** DO NOT ACCEPT P�RMIT AP CATION WITHOUT PRINTS AND REQUIRED DETAILED INFORMATION
(SETBACKS, ADDRESSES, PARCEL WATER) .
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