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HomeMy WebLinkAboutBLD94-1488 Addition - BLD Permit / Conditions - 10/31/1994 MASON COUNTY Mason County Bldg. 111 426 W. Cedar oa 5 P.O. Box 186 Shelton, Washington 98584 I .,P 1- N CA 01,01'V Ut m U if 14',I'l I 1 0 N'i I Al 1 427-9670 141 i I'll' 1 N ANII H 427-7262 RLD94-l"S IIAHi- ft PI A Vj 10H ADDRES'.-J - SE 1346 ARCADTA RD SHELTON OWNFR : BRUCE SAEGER 426- 3702 LLGAIt 1 f 4i1 Sic Irr­ 'to ? fASIS' OF WORK ADD R CD R H A VH ! 0 'AN411of py 0A If Rf Q IPl ilYPI AN400"I'flY IiAlf Tj F_YPE OF 0-,F . . . . . .S I- 1-is R 1"I ;cup , (;trm I P H.L I(iH I- O - Otj PONT 1 211-S4 IS 11131114 w-q jypE Of- k ONS V , f1RFPLACES _ 0 RAP# I vif is 1#131194 37647 f)(I I."(I P . I I I A ) . 0 Wow"I b v r--S , 0 JI'M 1 94 Of fS 11/31/94 47647 OWE L 1. . UN I I f; 0 PARK1.96 SPACFS : 0 Siff 1 4 4 tS 10131/44 31647,, N6PECTION AREA ; 2 `iHORF I INE N IAIAI t 148,44 Srjtl�A,4KS­ 1 0 11, F. T•S 0 F OF I I YI>I L- R ('0 M P.- m 1)81 1 U Homf_ OR NT, N 0 f t RATH BASTNS . . . ' 0 3 lip 0 5 of t. KAI'H rUS 5 . 0 3 1.FS HI' 0 M0 D V: I F I U S . Of It tiNCIWt Rti 0 FlIRN ' I 061F H I IJ 0 If")— 10 141, . - 0 -An At,I 2 Y%'T3 F; 0"V WA-l'UR td-,AT`F R'i 0 1­11 k N �1­100f. 80 - 0 S H R 1,71 ME E . 0 0 f 1� Vi O'l H E- W A%14 F k S_ 0 V I I R N - F L 0 0 H 0 f-,)0+ H 1`1 0 'YEAR AREA K I T t,.H FE N SINKS . 0 HL-A I P1.1141f) - 0 - I (IT" ST7E FLOOR DRAINS , . 0 Vf N I `;Y -; I I- M 0 1 VAII 1':00 L F k"_ 0 .1 E NO T It 0 B01.1. D1 Nei 0SI ORINKING FOUNT 0 VENT f A N' HASEMFNF 0'r,"t LAUNDRY ) RAY" F k,c P4-0 1)F(:K 5 0%f 1)1:�')H W A",H F RS 0 AIO HANDI INO IMI 1 0 mm I I NV -11`4 - 0 GAR/(:,ARP Oqf 6 A R H [I V S11014 A 1 0 10000 c (.111 0 V E 4 Of-. RFFr h I k 0 A! /01 URINhl 10000 t im. 4) "1 fit R IJN I 1 0 M 1 13 1'-,1 M I I I 1r 1.S (i I4 oll f i s 0 10 1110.1if Homf fI-111ifo5 Pilo# 100 So F] Offiff 7R9 Q if PROJECT tOCATION!1 , 1 Nttf'i 0111 ARIFAIIIA RAAB 0 R1601' LAST HAIM ON 011014AY 09 RIM IRIS PERNIT MOOFS Noll AN04vole if IJORt Of 1405TROCTION AlITHOO171`11 1; 901 (09111fil't " 411411 180 DAYS' AR WORE IS SOM401`5 ffiF k PF#64 M.PFNCF Of CONTINVATION Of W 0 k,k. I I'MMSS INSPECTION L411010 lot to# 11AY PERIOD. fINAI, I#Syfrlfoo 10,;l RE fr 11-T iiz 91.0 PONT. revs 11131191! �. 10 H P I TANCE TO- A t'T AC14F D (*ONDI I 10HIS 1 '; 1?1 MITHUD CONCRETE MECHANICAL r MOBILE HOME Footings-Se , Setback date - by • L� Ribbons date /P f by Gas Piping date b Foundatiorf Wall date by Set Up date )-6--'' �VC �'v'~'L INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMINCL ,c �' Walls FIRE DEPT. date Cs' F - by .-/<7 date by date by PLUMBING Attic OTHER Groundwork date date b WALLBOARD NAILING D.W.V. dat -( ' /5� by date by Water Line FINA IN ECTIOy date by date ..�' by date by MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 Case No : HLU94­1486 rov , RRUCE SAECAR 7 PAqQ1 I I I The Ljfi:#? , handling land ;t ot a qe of hivtardotif,; mat ot i m] i, ot, f I imffimb I to rand off)h[I t.i h 1'$4 I. i �p�iicif, in exce�. ,� of 10 qa 1, 1 ow; it not-. A I ) ot,)'pd cii t I'10111t 1,11f, t ,;.jj(� Ma ,()Il Cotinty F1 h I X Pro 0 S 4P yj wt.ructure f?r any po I,t i on th,9 r eo f 9 1,,,A t e 1, UhAn <0 in Ilp i (111 t,, Irmn nrmdo tine MIA 11AN fn A miniml4m of f;etihack ft,om al. ] I;, (,A HFR s SP It And lAqvit-, of I r Y AV- X 3) • $)1 ] iU)prok.,,-d plans arip reqiiired to be lot, im;iprictAtin I,(i o s If Jwi4pq)ct*Jon i,t-'% fi.A1.10d fq�,and fplans a o? not on slte , Approval. Will. NOT be qt-AntipA , Ili mddi.tion , A e ' — nspec on Pe In tke amotint of $30 . 00 pQt hour� (mii1)immili ll hoom.' ') w I (I i I I , be chA n 0 must. be colleci-�;-d by thi,, PrAor tc'� any ftir-t- t>r pC -AA11(% boinq ppl-�_RIIMA oI Sappi-cil-,at granted . X 4 ) PORSU&N'T TO 1 99t ONI RM HUT I,OTNG CODE. . SECTION IW (C ) AN(i riFf TI ON F� 13 , AIA '', (TF!3 MUS-I IJAVF Al?.,PROVED NUMBERS' OR ADDRE`'wSUS PRoVJDT:IJ IN slICH A P01-01 .1oN W, It) HP PI AINt Y VI%THLE AND Ij ( 1811 FROM THE 13rREF F OR I?OA0 FRONTING THF- PP("IPFRI I'Y MAI_10N I'(111141Y HIJ I 1 11 1.NG I)EPARIAENT RFQUIRFS "THAT tHIS HE cOMP1 (" I'FI) PRIOR 'V(1 CAll VNI, FOR ANY I N"';P VC T 10 N A RF1N1.'iI­'VCTTON FFE . HASED ON kAIES 1N J'AH11 F 3A OF fI11 1991 ONI FORM 1:0111 DING CODF WI I I Elf A 0,1;F S, S F 1.) ,1'1 0 W N F R C 0 N T R A C 10 k VA I I S 10 POST A 0 D R E S 1; ON a I T F f,R-1 0 R I o 0 V.0 1)U I I N 0 1 H S P E(11 T'X(!' X A' Al I. C.0-N >I R 41 C I f ON Mill-; r IMFU l' OR E,X(:[,-.Ft') iiI i I it� r0fif ANO IIH(I G.) Changes .,, to apprco—d bui .1dinq plAns that of I—, r nlllp] ,�Artcp low I'hf; 1 <411i Wcit;hinqton `i'tate F n e r q j C.ci d ty . 1991 Vp n I J, I A t,i o 11 is n d r n d on t- 1% C od p the Untfot-cff Building Gode and/or, ma��kol (,Iln'ty Ft t.iow�'. am U t b,p a p p r o ve.d b y M A�o n County p rl t o r t-,o d n►titr i I ,irir- 7) CON91[POCI-TON PRO ;S TO Bf Fft I H ti(d?f f I fn W; 1111 1) 111 F f; it(I i tl',HfY fill I I It T N fl, 1)f 1)A R I M F N I A N 1) 11 N TFO 11 M BIB I 1 0 I'N(I 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 Building Permit # MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRE TION NOTICE Job Location 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 �//0 36 X3� �//Jic•� You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to Department Date �" �Q �s Inspector s ■ �� NUT MOV TH 1mv& T - ,� �= MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location S This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed beI mu t/be corrected to gain code compliance ; xee "tip � , xg �i� djz �'�� r�l �� y.0 l�C�•�° 5 ot wr You are hereby notified t at the above corrections sh9I be made BEFORE PROCEEDING WITH ANY FURTHER WORK IV07- iiia all for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OKto Department I /Ai Date 7�� yj�— Inspector u k 45i /i7 ■ �� � NOT Mo *V THI= Tmkol � Date Checklist Prepared O ZS MASON COUNTY BUILDING DEPARTMENT PLAN REVIEWER AND INSPECTOR CHECKLIST 1991 WSEC AND V&IAQ CODE COMPLIANCE Permit Number Address 1-SE . 134(, AYCAA t c,__,,, Sq. Ft. Name on Permit Contractor/Phone# 4ZC,- 3zoz Compliance Method: ( rescriptive�_(Option) ( ) Component ( ) Systems Analysis Date FOUNDATION Insp. Rev. ( ) ( ) Slab: R- (Ext.foundation down to frostline/slab bottom;or interior 24"top of slab&horizontal. Radiant under entire.) ( ) ( ) Below grade exterior wall insulation: R- ( ) ( ►K Crawlspace ventilation: 120"- 3-_'(I sq.&NFA/150 sq.ft.floor area-cross vented) FRAMING ( LK ( L41Standard ( ) Intermediate ( ) Advanced ( ) ( ) Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.) ( ( L)-' Standard air seal: (Bottom plate/subfloor,rim joist/mudsill,window/d7 frames,penetrations condition to non-condition.) ( � ( LK Attic ventilation(1 sq.ft. EA/150 sq.ft ceiling area) 3, ( ) ( ) Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 drn @.25 WG. Vented out with dampers.) ( _ Fresh air ventilation: Available to all habitable rooms. Installed and operational. (Integrated forced<windows ports.) ( ( �Whole house exhaust fan: Cfm(Intermittent system manual&auto controls/sone less than or=to 1.5 at.1 WG) I INSULATION Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extend 12"above loose fill or 6" above batt insulation) Mechanical ventilation ducts R-4(Exhaust in unconditioned space&supply in conditioned space.) VWn. ( ) ( bY Wall insulation(above grade) R- Z k (Batts face stapled) ( ) ( ) Wall insulation(below grade-interior) R- (Batts face stapled) Vapor retarders on walls (Faced batt,or 4 mil poly or perm.paint.-circle one) ( ) ( ) Rim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.) V-Aie) . 3 Vaulted ceiling insulation R- (Vapor retarder&1"airspace) n FINAL ( ) ( LY" Floor insulation R- aO (Substantial contact w/surface,supports less than or=to 24"OC,not blocking vents.) 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.) ( ) ( L-K Pipe insulation R-3 (Hot and cold lines in unconditioned areas-service or recirc.see Table 5-12). ( ) ( LK SHW heaters: (NAECA label,separate power or gas shut-off,on R 10 pad if electric in unconditioned or on concrete.) Heating system type: 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.) ( ) ( ) Solid fuel appls.: (Glass/metal tight-fitting doors;dir.comb.air source,or 4"dia.dampened,indir.source for existing const.) 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- (Insulate&weatherstrip access,baffle to prevent spillover-no cardboard) ( ) ( Lil �`Vapor retarder paint if a vapor retarder was not installed when insulation was installed. I GLAZING Plan Reviewer-Fill out this glazing section or attach a window schedule to this checklist. Lisp ce for- 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. U L 5 ll 3Co I► 'ao • LA Total glazing area: •S Total conditioned area: Percentage glazing: !L Verified: DOORS Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity,U-value,and manufacturer. Spector- Verify door information during field inspection. Date Type/Quantity U-Value Manufacturer Rev. Insp. ,`nS Signature of Building Inspector: Date of Final Inspection: e `., ASHINGTON STAM Attaclmelrt B ENERGY ENERGY Building Record WSEO Contract# ,-, - CODE PROGRAM 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: MN ❑Multifamily ❑Zero Lot Line Home ❑ Planned Unit /Development + please check one: ❑ City ounty Permit# G7 ` `7 1Ys, File ID# (if different from Permit#) + A. Site Information B. Owner Information Address Owner (ownerattimeof construction receives utility payment) city �e-/>` r, Zip Company — — Assessor's Property Tax# (or attach legal description) Address . / Q /ry c[ City /Yrr? StateO ,'/)Zip cicf`� Servicing Electric Utility Phone ( ) VIP el 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. Total#/Units <' `s 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 WSEC Compliance Method For Heat Pump Only: Prescriptive Path Built to the Electric Date of Permit Application ❑ Component Performance Requirements of WSEC? Date Building Permit Issued 1c9 ~ �� Date of Insulation Inspection ❑ System Analysis ❑ Yes ❑ No (If yes, 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 Me WSEC, and that WSEC checklist for this building is on file. Signature of Building Official or Authorized Representative Date ■ Building Department: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 MASON� � � ����� COUNTY ���U U ����� K 'K �K �U �� U �y " ° "" ^=~ ~~~ " ~ ,�~ ._~ ~= " ~ " " Mason CC}Unf« Bldg. U| 426W. Cedar P.O. Box 186 Shelton, Washington 98584 IE'11 FOR INSPECTIONS CALL 427-9670 BETWEEN 5pm AND 8am 427-7262 BLD94-1480 PARCEL ; 320282400020 PLAT : DIV: DLK : LOT - JOB ADDRESS : SE 1346 ARCADIA RO 3HELTON OWNER : BRU[E SAEGER 426-3202 CONTRACTOR : LEGAL ; T8 Z OF Wl/2 SEC [K- �� 10224 CLAS3 OF WORK ADD DEOR ; 0 ' BATH : 0 TYPE OF USE ' ' . , : SF STORIES ' ' ' ' ' ' . ; 0 0CCUP , GROUP , . . ; ? BLDG , HEIGHT , , ; 0 . 0ft- TYPE OF CONST . . ; ? FIREPLACES , , . , : 0 UCCUP . LOAD . ' . . : 0 WOOOST0VES . , . . : 0 DWELL , UNITS . . - . : 0 PARKING SPACES : 0 INSPECTION AREA ; 2 SHORELINE ?, , , ' : N SETDACKS-------------- TOILETS ' , ' , . , , . . ' . 0 FUEL TYPES---------- BOILERS/COMP---- MOBILE HOME-- FRONT , , , N 5 , 0ft BATH BASINS , , , . , . : 0 : : 0-3 HP . : 0 REAR . . . . S 6 ' 0ft BATH TUBS . , , , , , . , : 0 3-15 HP ' ; 0 MODEL : SIDE ( 1 ) . E 6 . 0ft SHOWERS . . . . . . . . . . : 0 FURN ( 100K BTU . 0 15-30 HP . ; 0 -MAKE------ SIDE ( 2) 'W 5 . Oft WATER HEATERS , ' . , : 0 punN >=100x BTU : m 30-50 HP ' : 0 SHRLINE . 0 , 0ft CLOTHES WASHERS . . : 0 FURN - FLOUR . . ' ; 0 50+ HP . ; 0 -YEAR------ 8RE0 ---------------- KITCHEN SINKS , ' , , ; 0 HEAT PUMP , , , ' . . : 0 LOT SIZE . , ; FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . ' , ; 0 EVAP COOLERS : 0 LENGTH ; 0 BUILDING . . . ; 0af DRINKING FOUNT . . . : 0 VENT FANS . , , ' ' . : 0 HOODS . . . . . . . ; 0 WIDTH ' : 0 BASEMENT , ' , ; 0ef LAUNDRY TRAYS . . . . : 0 DOMES . INCIN : 0 -SERIAL0---- DECKS . . . . . . ; 0ef DISHWASHERS . . . . . . ; 0 AIR HANDLING UNITS-- C0MML . INCIN ; 0 GAR/CARP : ? 0ef GARB DISPOSALS , , , : 0 (= 10000 ofm. ; 0 RELOC/REPAIR , 0 AT/DT ' : ? URINALS , ' . , . , ' . . ' ; 0 ) 10000 ofm. ; 0 OTHER UNITS . : 0 MISC PLM FIXTURES - 0 GAS OUTLETS . ; 0 yK0J[[T 0[SCKIyTI8N:AUDlTI0N TO N80iE HOME SITTING 800N 280 SV FT OFFICE 288 S0 FT PROJECT i00TI0N:1.3 MILES OUT &R[8DlA ROAD UM RIGHT LAST HOUSE ON DRIVEWAY ON RIGHT. THIS y[KN{T 8[C0NES NUii AN8 Y0U IF W08K 08 C0NSTKUCTIUN A0TH0RIZ0 lS N 0 T C0NN0C0 WIT8IN 180 DAYS, 8R I 0HST8UCTI0M 0K A08K I SUSPEN00 F0K A y000 0� 0N KkX� �I AKX 4AR I S IHSP[CTIUK WlTHIN TK[ 00 UkY P[V0U FlNAL lKSP[CT0K KUST 8E o,Pxov[u n�Fou� 'I Z 0ANE8 0K AG[MT� UATE80 yKNT. mv' 03/31/9 ' ` '�?nmP/ rAwcr rn urrurwFn rnmnrrrnmp `(Z n=nn`orn MASON COUNTY Mason.County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 Case No . : BLO94-1488 For : BRUCE SAEGER Page : 1 1) The use , handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fir a al . X 2 ) Pro s d tr.ucture Qr any portion thereof greater than 30" in height from grade line mus , i in a minimum of 5 ' setback from all property lines , easements and right of way X 3) All Uproved plans are required to be on—site for inspection purposes . If inspection is lled for .and plarJs a e not on site , Approval WILL NOT be granted . In addition , a e— nspection fee in tie amount of $30 . 00 per hour (mi imurp 1 hour) wi1l . be char ed nd must be collected by this department prior to any furtier inspections being perf�rme� or approv anted . X 4) PURSUA TO 1991 UNIFORM BUILDING CODE , SECTION 305 ( C) AND SECTION 513 , ALL SITES MUST HAVE A ROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO 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 ASSES D F OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INS C X 5) ALL ST TION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQU .RE X 6) Change to approved building plans that effect compl ' ce to the 1991 Washington State Energ Code , 1991 Ventilation and Indoor Air Quali . JR ..��tions Code , the Uniform Building Code and/or Mason Cou ty must be approved by Mason County prior to construction 7) CONSTRUCTION PROCESS 70 BE FIELD CORRECT A UI E PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE . x [8NO No Permit No. M t0S ;t UN Y ' SEP 2 5 94 BUILDING PERMIT APPLICATION �q`le 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 �A V Pt.lrm I #1 O er �'l�(Lf/ 45 �/t hone# ite Add r s Fire istnct# City StZip Directions to Job Site Owner Mail' g ddress ' City St 463q Zip `7 Lien/Title Holder 41)4r)-22 212 Address Clty St Zip #2 Contractor Name egl/)W 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 A�� el Nod-�/�- Legal Description #5 Building Square Footage: (existing/proposed) Z40_ T 1 st FI / 2nd FI / 3rd FI / Loft / Basement / Deck /-Orbe rooms / # bathrooms / Garage / Carport / Circle: Attached or Detached?) Other q• L � ( 1 c #6 Use of building e Describe work #7 Type of Job: New Add Alt Repair other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year ake Model Length Wi 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 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 Street Name of Fronting Street in relation to lot Ian p p APPLICANT TO DRAW SITE PLAN BELOW 1 V v APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW l �� Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. uaita 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 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 $ 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 TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- 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 APP VAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDIN E ARTMENT. DEPARTMENT. X OWNER X BY DATE DATE - — — Z4 FOR OFFICIAL USE ONLY. Accepted by: ' Dater_ DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. }iold + Approval hy�n Planning: II ►,ih,YV11i111/1 � CC►S Environmental Health: Building Plan Review w L� Occupancy Group: Q-3 Type of Const: Syj Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check y. ©C., Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor e_ Violation Fee Site Inspection Building State Fee cf. S 0 Other Other Building Valuation: 3 7 Z TOTAL FEE r ' f I DATE: s6 APPLICANT NAME' BUILDING PERMIT CHECKLIST RESOURCE LANDS &CA ICAL AREAS CHECKLIST. All projects musplete the Resource Lands and Critical Areas Checklist before a building or 1dification per is issued, or before final approval of a septic system. 1. SITE ADDRESS form. If site address is not listed, customer needs to be given a site address DIRECTIONS TO JOB SITE Needs to be as complete as possible (i.e. major roads, is house on eft or owners night ame side of road, etc. ) . Be sure to read for clarity (Landmarks, signage, 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 informationeitherif custome customer does t know it.the contractor.emust have a signature in 1 of the 2 boxes, 3. SEPTIC RECORDS OF Septic records should be included. •$f SURE o records arINFORM avlabe CUSTOMER make a notation RESEARCH FEE FOR ENVIRONMENTAL "pending" in the on the form "No Records". If septic application is recent, mark "pe g upper right hand corner. EXISTING SEP IC p ed and determine whether their u Remind cs mer they need to have their tank ump system m is code (sanitary survey or parcel review?) . They will probably need to show r erve for their septic. 4. PARCEL # Parcel #° must be included or researched through Gateway. 5. BUILDING SQUARE FOOTAGE whether it is Verify that boxes are filled in. If there is a garage, verify ou can attached or detached. Include square footage information for mobile homes (y multiply length X width to determine number) . 6. USE OF BUILDING .? Is it a residence, garage, greenhouse, etc. . DESCRIBE WORK ) (i.e. mobile home addition, addition to a house, etc. . . 7. TYPE OF JOB Verify appropriate boxes are marked. 8. MOBILE HOME INFO TIO order, please put factory order Verify appropriate es are marked. If factory # in mobile home se #�. If unit was assembled prior to June 15, 1976, refer to procedures handout or "Obtaining Installation Permits for Mobiles Assembled Prior to June 15, 1976. 9. SHORELINES property lete. If any water is on or /'�' acent towithin 200 feet, #9 must be cartment. Once permit is entere o Tidemark, it will be routed to the planningDep If property is not 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 iVflat write "flat" on the topography section. If house or structure is near a s pe 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. 14. PRINTS Need two sets of prints unless it is a stock plan. For stock plans, we only require one copy. 15. WATER ADEQUACY For new re idences and mobiles. PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST AND BACTJMIAL 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 for all residential, additions and commercial buildings. Energy Code compliance fo needs to be COMPLETED. Verify heat source (no wood or pellet stoves are p�&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/MEDICAL This form ust be completed for any structure with plumbing and mechanical excluding obiles/modulars. 18.; FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to map located at counter. [� 19. ROAD ACCESS PERMIT If you will be accessing your driveway from a County road, contact the Public Works Department in Mason County Building I, 427-9670 extension 450. . Access from State Highways requires Department of Transportation approval. Contact office (206)895- 4753 (Port Orchard) . * ACCEPTED BY: ** DO NOT ACCEPT PERMIT APPLICATION WITHOUT PRINTS AND REQUIRED DETAILED INFORMATION (SETBACKS, ADDRESSES, PARCEL I AND WA R) . "checklst.blg" 10/05/93 checklst.blg 2 9120/93