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Home My WebLink AboutCOM2023-00057 Fuel Piping and System Upgrades - COM Application - 4/24/2003 MASON COUNTY COMMUNITY SERVICES Permit No: YY) — 005 > PERMIT ASSISTANCE CENTER: a •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,%VA 98584 Phone She#on:(360)427-9670 ext.352.Fax:(360)427.7798 Phone i Belfaic(360)2754467.Phone Elma:(360)482-5269 - BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: I NAME:ACAN trrveaT«ENra LLc NAME:toe N.c caweome A. MAILING ADDRESS:5312PncrrrcNwrE MAIL&O ADDRESS:tatTeemA.eE CITY:F12 STATE:wA ZIP:0°4z' CITY: STATE.wA ZIP:t 8s 4 sr PHONE#1:_. - - PHONE:� 616 CELL: 204mym 3 PHONE 42: EMAIL:" i r EMAIL - - LBrI REG#oc,to ew-m r I". j PRIMARY CONTACT: OWNER❑ CONTRACTOR E] OTHER❑ 3 NAME we"•""'• EMAIL FhffA0'h"— j MAILING ADDRESS 's17i"A ie CITY"' STATE wA zIP PHONE CELL useer rru PARCEL DWORMATION: PARCEL NUMBER(12 Digit Number) +.zszsetamrs ZONING uoA LEGAL DESCRIPTION(Abbreviated) TR Z-S OF NE SE LOT:!OF aP Mn FIRE DISTRICT tL Moon Repiwul SITE ADDRESS NE aiFTON w CITY e.a.: DIRECTIONS TO SITE ADDRESS I IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO O SNOW L 3AD:_psf IS PROPERTY WTIMN 200 FT OF THE FOLLOWING: (Chock ati rkm appy): j SALTWATER❑ LAKE❑ RNERICREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION I] REPAIR❑ OTHER n. j USE OF STRUCTURE(Raidmce,Garage,Caamerctat Bldg E,)Comeww .Mp srticn 6 Rea IS USE: PRIMARY +❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(nae 6idg)❑ YES(Parr(rl al'Bidg)❑ NO❑ DESCRIBE WORK Fuel POng eed Syo-Up9mdn j SODA,RE FOOTAGE:(propoxaq j 1ST FLOOR sq.iL 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.R DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.It GARAGE 4 IL Attacked❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER .......... I ENVIRONMENTAL HEALTH: SEWAGEISEWER SOURCE: SEPTIC❑ SEWER❑ I NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YES❑ NO❑ Ijym attach completed Water Adequacy Form 1PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO❑ EXISTING SQ.FT. i EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS _._-...---._._.-....-- .-�r_..._.........._.._ - OWNER acknowledges that submission of Inaccurate information may result n a stop work order or permit revocation.Acknowledgement of such is by i signature below.I declare that I am the owner and i further declare that I am entitled to receive this permit and to do the work as proposed.1 have I obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason Canty access to the above described property and structure(s)for review and inspection.This parnittapplication becomes null 8 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APP TION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) j X S• ` r ofOWNER(Must be signed by the OWNER) Llate'' DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH ----.1 i 'ECOLOGY Underground Storage Tank System Summary UST ID: 586153 li Site Name: SAFEWAY FUEL 1571 Glossary UST ID: 586153 Facility/Site ID: 83271142 Latitude: 47.45356 Active Tag(s): A8850 Address: 23961 NE STATE ROUTE 3 STE A Longitude: -122.82436 Responsible Unit: Southwest BELFAIR,WA 98528 County: Mason Tank Summary Tank Name Tank Status Tank Install Date REG/UNL Operational 101212001 PRE/SUP/UNL Operational 10/2/2001 I Tank Name: REG/UNL Tank Status: Operational Tank Installation: 101212001 Tank Upgrade: 1 01212 00 1 Business License Endorsement Expiration: 10/31/2023 Tank Status Date: 11/8/2001 Piping Installation: Tank Permanently Closed Date: Tank Information Piping Information Material: Steel Clad with Corrosion Resistant Composite Material: Flexible Piping Construction: Double Wall Tank Construction: Double Wall Pipe Corrosion Protection: Corrosion Resistant Corrosion Protection: Corrosion Resistant Manifolded Tank: SFC'at Tank: Single Wall Sump Release Detection: Interstitial Monitoring SFC'at Dispenser/Pump: Single Wall Sump Tank Manufacturer: Primary Release Detection: Automatic Line Leak Detector(ALLD) Spill Prevention: Single Wall Spill Bucket Secondary Release Detection: Annual Line Tightness Test(LTT) Overfill Prevention: Overfill Alarm Pumping System: Pressurized System Actual Capacity: 20,000 Gallons Piping Manufacturer: Capacity Range: 20,000 to 29,999 Gallons 'SFC=Steel Flex Connector Compartment Substance Stored Substance Used Capacity 1 Unleaded Gasoline Motor Fuel for Vehicles 20,000 Gallons Toxics Cleanup Program Report Generated:4/13/2023 Page 1 of 2 EC0L0G,Y Underground Storage Tank System Summary UST ID: 586153 Tank Name: PRE/SUP/UNL Tank Status: Operational Tank Installation: 10/2/2001 Tank Upgrade: 10/2/2001 Business License Endorsement Expiration: 10/31/2023 Tank Status Date: 11/8/2001 Piping Installation: Tank Permanently Closed Date: Tank Information Piping Information Material: Steel Clad with Corrosion Resistant Composite Material: Flexible Piping Construction: Double Wall Tank Construction: Double Wall Pipe Corrosion Protection: Corrosion Resistant Corrosion Protection: Corrosion Resistant Manifolded Tank: SFC'at Tank: Single Wall Sump Release Detection: Interstitial Monitoring SFC'at Dispenser/Pump: Single Wall Sump :Tank Manufacturer: Primary Release Detection: Automatic Line Leak Detector(ALLD) Spill Prevention: Single Wall Spill Bucket Secondary Release Detection: Annual Line Tightness Test(LTT) Overfill Prevention: Overfill Alarm Pumping System: Pressurized System Actual Capacity: 20,000 Gallons Piping Manufacturer: Capacity Range: 20,000 to 29,999 Gallons 'SFC=Steel Flex Connector Compartment Substance Stored Substance Used Capacity 1 Diesel Motor Fuel for Vehicles 10,000 Gallons 2 Unleaded Gasoline Motor Fuel for Vehicles 10,000 Gallons Toxics Cleanup Program Report Generated:4/13/2023 Page 2 of 2