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Home My WebLink AboutGRD2013-00007 Baseball Fields - GRD Permit / Conditions - 9/13/2013 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County Bldg. 3 426 W. Cedar P.O. Box 279 Shelton, WA 98584 i� LAND MODIFICATION BUILDING PERMIT GRD2013-00007 OWNER: MASON COUNTY PARKS RECEIVED: 7/18/2013 CONTRACTOR: LICENSE: EXP: ISSUED: 9/13/2013 ENGINEER: LICENSE: EXP: EXPIRES: SITE ADDRESS: 1000 NE SAND HILL RD BELFAIR PARCEL NUMBER: 123301460000 LEGAL DESCRIPTION: N 3/4 OF NE EX PROJECT DESCRIPTION: DIRECTIONS TO SITE: ESTIMATED AMOUNT OF CY 400..PROJECT INCLUDES CONVERTING ST RT 3 TO BELFAIR, L ON ST RT 300/ NORTH SHORE RD, R ON 2 EXISTING BASEBALL FIELDS AND RENDERING FACILITIES ADA SAND HILL RD ACROSS FROM SCHOOLAT TOP OF HILL ACCESSIBLE.. WORK INCLUDES DEMOLITION OF BACKSTOPS,TIMBER STEPS, CHAIN LINK FENCING, Inspection Area: Fill?: Comp. Plan Desig.: Rural Grading?: Yes IRO Desig.: Cutting?: Shoreline Desig.: Not Applicable Area Graded: Acres SEPA?: Yes Cubic Yards: 400.00 FEES Type By Date Amount Receipt Total GRD2013-00007 Please refer to the following page(s)for conditions of this permit. Page 1 of 4 CONDITIONS FOR GRD2013-00007 1) All upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given some other equivalent type of protection against erosion. X 2) After completion of the project, it is recommended that stormwwater treatment devices be installed. 3) Properties adjacent to the site should be protected from sediment deposition through the use of buffers or other perimeter controls, such as filter fence or sediment basins. 4) This permit is approved to renovate 2 baseball fields including the addition of accessible compliant walkways, parking stalls, irrigation system. Lawn sprinklers and irrigation systems shall be protected from backflow in accordance with the 2012 Uniform Plumbing Code, WAC Section 603.5.6, see code section attached to approved plan, sheet L2.0. 5) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building D�eRtment prior to any further inspections being performed or approvals granted. 6) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinqDce or regulation, must be reviewed and approved by Mason County prior to construction. 7) The accessible parking space shall constructed in accordance with ICC/ANSI A117.1-2003, Section 502. A copy of the specifications are attached to the approved construction plans. The accessible parking space shall be marked, not less than 96-inches wide and shall extend the full length of the parking space. The accessible space shall be identified by approved signage that display the international symbol of accessibility not less than 60-inches above the floor of the parking space, measured from the bottom of the sign. 8) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. X 9) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holdeL have prevented action from being taken. No more than one extension may be granted. GRD2013-00007 Please refer to the following page(s)for conditions of this permit. Page 2 of 4 10) A COMPACTION REPORT PREPARED AND SIGNED LICENSED DESIGN PROFESSIONAL SHALL BE REQUIRED. THE REPORT SHALL VERIFY THAT FILL MATERIAL HAS BEEN COMPACTED TO NOT LESS THAN NINETY-PERCENT OF MAXIMUM DRY DENSITY. SUBMIT COMPACTION REPORT(S)TO THE MASON COUNTY BUILDING DEPT., PO BOX 279, SHELTON, WA 98584 PRIOR TO THE FINAL INSPECTION. X 11) ALL CLEARING,CUTTING, GRADING, EXCAVATING, TERRACING, FILLING AND SIMILIAR WORK WILL BE REGULATED BY THE REQUIREMENTS PURSUANT TO THE MASON COUNTY GRADING PERMIT STANDARDS ADOPTED BY RESOLUTION 141-96 and MASON COIJ�CODE, TITLE 14, CHAPTER 14.44. 12) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X—+W__L_� 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 180 days at any time after work is commenced. Evidence of continuation of w rogress inspection within the 180 day period. Final inspection must be approved before building can be occupied. OWNER OR AGENT: DATE: R GRD2013-00007 Please refer to the following page(s)for conditions of this permit. Page 3 of 4 Case Activity Listing 3/27/2017 3:01:28PM Case #: GRD2013-00007 Parcel #: 123301460000 IF; Description: ESTIMATED AMOUNT OF CY 400..PROJECT INCLUDES CONVERTING 2 EXISTING BASEBALL FIELDS AND RENDERING FACILITIES ADAACCESSIBLE.. WORK INCLUDES DEMOLITION OF BACKSTOPS,TIMBER STEPS, CHAIN LINK FENCING, INFIELD/OUTFIELDS AND INSTALLING NEW BACKSTOPS,DUGOUTS, ADA COMPLIANT CONCRETE WALKS, ADA COMPLIANT PARKING STALLS, ALSO CHAIN LINK FENCING, INFIELD/OUTFIELD MIX Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By updated Updated 13y GRDA010 Application Received 7/18/2013 None DONE GMM 7/18/2013 Gti1ti1 GRDA9209 Miscellaneous Action 7/18/2013 7/18/2013 None DONE GMM 7/18/2013 GMM NO EH REVIEW GRDA110 Planning Review 7/18/2013 8/21/2013 None DONE GBM GBM 8/21/2013 GBM Grace took from Allan on 8/1 to assist with SEPA review.SEPA comment period ends on 8/15/13.Stormwater and SYPA sent inter-office to Loretta in PW on 8/l/13.SEPA comments were received from DOE and added as conditions of approval. GRDA100 Building Review 7/18/2013 8/29/2013 None DONE DLC 8/29/2013 DLC GRDM500 HOLD 7/22/2 Vb/2013 Hold TW 9/13/2013 GMM GRDA500 Issue Grading Permit 9/13/2013 None GMM 9/13/2013 GMM (AA gyp GRDA520 Print Inspection Card 9/13/2013 None DONE TW 9/13/2013 GMM 0 w�_t ,oH!>rt PLLt-7� .bid {t,�e a -�-AUt JCa� -1iroupw dt 3�3 — U m ►��-+ �---_ a COSH�j YL i�' Off a14�W 7 � 4�t�JaQlub, ;M 7� 44;u { � qrSt,TA a of 1 l ®wt 0 S C case 3 4 OV Grace Miller- Re:Fwd:GRD2013-00007 Grading Permit for Sandhill County Park From: Trish Woolettsk(lSe To: d2@rwdroll.com Date: 3/25/2016 2:1S PM ` Subject: Re:Fwd:GRD2013-00007 Grading Permit for Sandhill County Park8 CC: Genie McFarland; Grace Miller, Jahanel Neal . Attachments: Trish Woolett.vcf Don, If you wish to reinstate the permit you can pay half the original permit fees.At the time you reinstate tl er�rpit Qu II have 180 days to have an inspection to keep the permit active.If necessary you can do one extension of 180 days in w'r"i h` Ir cAo expirat on. That amount for reinstatement would be$150.88.You also need to have the approved plans and permit card on site at time of inspections. 7ricia WWoohett BuifQurg Inspector II 9dason County Community'Dev 615'W AOerStreet Shelton WW,4 98584 360.427.9670 eia.281 fad 360.427.7798 tw@co.mason.wa.us CountyWe6-Site:unm co.mason.wa.us >>> Grace Miller 3/14/2016 1:10 PM >>> Please read the question from Don, below,and let me know what to tell him ASAP. Can I just refer him to one of you? I dont know the answers.I dont have any issues with approving it.Thanks. 615 West Alder Street Shelton,WA 98584 >>> Don Campbell <d2@rwdroll.com> 3/10/2016 8:47 AM >>> Grace: Back in 2013 Mason County Parks received a Grading Permit for the improvements to two Little League ballfields at Sandhill County Park(see screen shot from the Mason County website below). That permit has obviously expired, but Jeff Vrabel, Parks Director, has notified us that the project is now funded and he would like to proceed with bidding and construction this coming summer. Can you please tell me what we need to do to either reactivate that permit or apply for a new one? If we have to apply for a new permit, can we use the information submitted previously? Will Parks have to pay the fees a second time? I appreciate your help and direction. Don Campbell, PLA Project Manager Robert W. Droll, Landscape Architect, PS 360-456-3813 1 file:///C:/Llsers/gbm/AppData/Local/Temp/XPgrpwise/56F547EAMasonmail100167376E1373C01/GW 00001... 3/28/2016 3 � a CaseGRD2013-00007 Number MASON COUNTY PARKS ATTN JOHN C3seISS' Status �' Applicant KEATES 411 NORTH 5TH STREET SHELTON Parcel123301460000 1NA 98584 Number Project1000 NE SAND HILL RD BELFAIR Address Valuations 0-00 Description ESTIMATED AtMOU14T OF CY 400 PROJECT INCLUDES CONVERTING 2 EXISTING BASEBALL FIELDS AND RENDERING FACILITIES ADA ACCESSIBLE. WORK INCLUDES DEMOLITION! OF BACKSTOPS31MBER STEPS, CHAIN LINK FENCING, INFIELD/OUTFIELDS AND INSTALLING NEW BACKSTOPS,DUGOUTS, ADA COMPLIA14T CONCRETE WALKS. ADA COMPLIANT PARKING STALLS, ALSO CHAIN LINK FENCING, INFIELD/OUTFIELD MIX I Activities Description Date Assigned Date Done Status Assigned To Done By HOLD 07/22/2013 09/13/2013 DONE TW Off°PEWT 6 RWY TO PaCK WV w TO PO AA M%GOLWTY a+r+tKS Issue Grading Permit 09/13/2013 GMM Print Inspection Card 0911312013 DONE TW Building Review 07118/2013 08/2912013 DONE DLC Planning Review 07/18/2013 08/2112013 DONE GBM GBM Ggce�:e«OTsAF3�SG`st 8a '«Itix Str"�4rpf�H'S` tti?^12&3s'W,eci of,a1S'Iz Z* a ' SC 6 Yt ? , SebL fdaM PaYGfS1,ti �►os+rne�r art rues*:�+ a-�a ae c a' asp Application Received 07/1812013 DONE GkiM Miscellaneous Action 07/1812013 07/18/2013 DONE GMM file:WC:/Users/gbm/AppData/Local/Temp/XPgrpwise/56F547EAMasonmai1100167376E1373C01/GW 00001... 3/28/2016 I 3 IN Donald Campbell,PLA WA Reg. No. 1243 Cell:253.970.7027 d2(o)rwdroll.com Landscape Architecture-Site Planning-Recreation Facility Design Robert W.Droll,Landscape Architect PS 4405 7th Avenue,SE,Lacey,WA 98503(mao) tel:360.456.3813-fax:360.493.2063 www.rwdroll.com AME.RICAN WORTS K"LUMS MF3►iRWt ASSOCIATION • • file:///C:/Users/gbm/AppData/Local/Temp/XPgrpwise/56F547EAMasonmai1100167376E1373COI/GW 0000I... 3/28/2016 MASON COUNTY DEPARTMENT of PUBLIC WORKS 100 W PUBLIC WORKS DRIVE SHELTON, WASHINGTON 98584 MEMORANDUM DATE: August 6,2013 TO: Grace Miller, Planner III Cc: Mr. Robert W. Droll John Keates, Facilities, Parks and Trails Director FROM: Brian K. Matthews, P.E., Director Y*-' SUBJECT: GRD2013-00007,SEP2013-00062 Thank you for the opportunity to review and comment on the grading permit application and SEPA for proposed improvements to Sandhill Park. Mason County Public Works reviewed the following information submitted by Robert Droll, Landscape Architect, PS and DNS dated 8/1/2013: ■ Memo dated July 12, 2013 requesting submittal of abbreviated plans prepared by the Project Landscape Architect; and ■ Permit Plan Set dated July 16,2013. Mason County Public Works will accept the submittal of an abbreviated stormwater control plan prepared by the Project Landscape Architect based on the following findings: 1.' MCC 14.48.150 states that projects exceeding five thousand square feet of impermeable surfacing must have a large parcel ESC and permanent stormwater quality control plans(if required) prepared and stamped by a licensed civil engineer. The Director has the authority to determine submittal requirements. 2. This project will create more than five thousand square feet of new impervious, but the net increase of impervious surfaces is less than 1%and generally linear in nature. Runoff from new impervious area will be dispersed in highly permeable soils. We have no comment on the SEPA determination. We have the following comments can the submitted plans and GRD2013-00007.. 1. Please provide trench detail and pipe schedule for the storm line. Are cleanouts planned along line A or C? 2:. Provide a detail for the outfall level spreader. 3. Provide an inspection schedule and maintenance plan for the storm system (drywell, porous pavement, outfall level spreader, etc.) prior to final grading permit approval. Thank you for the opportunity to comment. Please contact Loretta Swanson at ext. 769 if you have questions or need additional information. Page 1 of 1 Grace Miller - GRD2013-00007 Grading Permit App from Mason County parks for Sandhill Fields work From: Grace Miller To: Loretta Swanson Subject: GRD2013-00007 Grading Permit App from Mason County parks for Sandhill Fields work CC: bob@rwdroll.com; d2@rwdroll.com Hi Loretta I have an application from Parks (Bob Droll is their representative) to improve the baseball fields at Sand Hill Park.You had copied me on your communications with Donald Campbell, RLA and Bob Droll on 5/24/13. I am forwarding the drawings and the SEPA for this project to you today.The SEPA comment period ends on Aug 15th. Please let me know if you have any comments or conditions to add to the permit by that date.Thank you. Grace Miller - 0 0 0 0 7 �-vc ��1�� '' r&v` � �rard /Z' s I ahnnt hlanlr R/10011 Page 1 of 1 Grace Miller - Sandhill stormwater requirements From: Loretta Swanson 1 To: bob@rwdroll.com Date: 7/11/2013 2:21 PM > Subject: Sandhill stormwater requirements CC: Keates, John; Miller, Grace Attachments: Sandhill Ballfield Renovations.docx Hello Bob Thanks for sharing information regarding the proposed Sandhill improvements and inquiring about stormwater submittal requirements. After reviewing the project, I believe the best approach is to request that abbreviated stormwater control plans be accepted, and that we allow the plans to be prepared by a landscape architect. Please cite the reasons for justifying this request. (You are not requesting an exception to the minimum requirements; this requires a hearing per 14.48.260.) Let me know if you have any questions on how to proceed or on the abbreviated submittal. Regards, Loretta Swanson Stormwater Program Coordinator 100 W Public Works Drive Shelton, WA 98584 (360)427-9670 Ext. 769 file:///C:/Users/gbm/AppData/Local/Temp/XPgrpwise/51 DEBF63Masonmail l 00167376E... 7/16/2013 1 Sandhill Ballfield Renovations Stormwater requirements Basic design parameters ■ >5000 sq ft of new impervious area ■ >7000 sq ft of disturbed area ■ Highly permeable soils ■ New impervious is mostly linear and tributary to ballfield 14.48.080 Applicability Nonresidential activity creating more than 5000 sq ft required to submit an ESC and PSQC prepared by licensed civil engineer. 14.48.090 Regulated Activities Considered (2)(A) Redevelopment and under Ecology Manual 14.48.100 Exemptions Does not qualify(nor qualifies under Ecology Manual) 14.48.150 New development and redevelopment—Minimum requirements "Nonresidential development exceeding five thousand square feet of impermeable surfacing and/or land disturbing activities of one acre or more must have the large parcel ESC plan (if required) and the permanent stormwater quality control (PSQC) plan (if required) prepared and stamped by a licensed civil engineer." Request of the Public Works Director that an abbreviated large parcel ESC and PSWQC plans be submitted, and that preparation by the project landscape architect is acceptable. Please do not follow the minimum requirements as outlined in our code—they follow the 1992 Manual format and we now use the 2005 Manual. Page 1 of 1 Grace Miller - Ra.c Sand Hill County Park Renovations - Permitting Questions rr From: L To: Miller, Grace Date: 5/24/2013 2:12 PM Subject: Re: Sand Hill County Park Renovations - Permitting Questions Grace, Just to let you know I talked with Don right after your email. They will be submitting a �sPs all 1 n iaiw--wa -_Q,;its, but it should be a fairly simple plan. Let me know if you need help with review when it comes in. Loretta >>> Grace Miller 5/21/2013 1:07 PM >>> Hello Donald, Ow !plan a Swanson in the Public Works Dept may be able to assist you with any questions regarding the stormwater equirements. Loretta's a-mail address is: LorettaS@co.mason.wa.us. Please let me know if you need a Land cation Application. Thank you. Miller >>> "Don Campbell" <d2@rwdroll.com> 5/21/2013 11:50 AM >>> Grace: I left a phone message for you and am following that up with an email if that is okay. renovation AR-4 for the two cma I h^^�l^1� ^IdS of,* Sand Hill Rom Most of the work is improving spectator areas and renovating the existing play fields:` We will be keeping the existing field material in place and not importing than a couple of hundred yards of material, plus installing a subsurface drainage system. New backstops, dugouts, and sideline fences, as well as a new irrigation system wig# be constructed, as will porous asphalt paving in the spectator areas. I had a couple of questions regarding the permitting needs and what we can expect to submit for. We were thinking only a grading permit, but would like to know for sure. Approximately 2 acres of disturbance, approx. 300 cy of import common fill, and approx. 450 cy of specialty infield mix for the playfield infields. I would appreciate a call to discuss what we need to submit. Thank you in advance. Don Donald Campbell, RLA WA Reg. No. 1243 Robert W. Droll Landscape Architect, PS 4405 7th Avenue SE Suite 203 Lacey, WA 98503 phone: 360.456.3813 facsimile: 360.493.2063 email: d2@rwdroll.com file:///C:/Users/gbm/AppData/Local/Temp/XPgrpwise/519F7543 Masonmai11001673 76E 1... 5/28/2013 Planner: Grace Allan Rebecca MASON COUNTY PLANNING INTAKE CHECKLIST Owners Name: m 4-50 n v LLS Date: -7- I q— � Project — Commercial .: yes no Site Plan: ❑ North Arrow ❑ Property Dimensions: x Irregular Shape ? yes no ❑ Streets and Driveways shown ❑ Road Frontage Name: ❑ All Existing Structures Shown with setbacks and use. ❑ Identified Surface water(streams,ponds, shoreline,wetlands,natural/historic drainage,defined drainage) ❑ Topography (slopes) ❑ Minimum Structure Setbacks (direction/setback): f l Cott-c v`. ❑ Utility and Drainage Easements: yes no (if yes enter condition#5022) ❑ Other Easements ❑ Accessory Appurtenances: propane tank Heat pump ❑ Does site plan show landings at all exits ? ❑ Variance applied for: yes no Parking spaces allotted: yes no ❑ County Access Permit Needed (add condition #0010) ❑ State Access Permit needed (add condition #0020) ❑ Standard Planning conditions: #5019 and #700 ❑ Are there any impediments (dogs/gates) that may restrict access to your site? yes no ❑ If yes, do we need appointment? yes no ❑ Is site clearly marked? Address Name Other ZONING UGA'S ALLYNBELFAIR/SHELTON Rural LAND DESIGN ONS GC PF R-1 R-1P RC 1 RR 2.5 AGRICUL POS FR R-2 R 1R RC 2 RR 5 LTCFL BI GC-CI R-3 RI RC 3 RR 10 IN-H ING HC LTA R-5 RT RMF RR 20 AL T MU R-10 RT/RTC RNR MAP BP vC RAC NR Critical Areas: (streams,ponds,shoreline ands&steep slopes) Shoreline Designation: ❑ N/ ❑ Urban ❑ Rural ❑ Conservancy ❑ Natural Water Body: SEPA: yes no own Flood Plain: yes no unknown Map # Aquifer Rechar yes no unknown Map# Ta s/Cas RLC/SP : 6 year Reforestation: yes no Eagle Nest Tag: yes no Other/North Bay Sewer: yes no BUILDING Robert W. Droll, Landscape Memo I Job No. 13010 To: Loretta Swanson,Mason County Stormwater Program Coordinator Program Manager Date: July 12,2013 Re: Sand Hill County Park Renovation On the behalf of Mason County Parks& Recreation Department Parks is requesting a waiver of preparing a full report documenting how this project complies with the Department of Ecology Stormwater Management Manual for Western Washington's(SMMWW)minimum requirements. Parks requests that an abbreviated large parcel ESC and PSWQC submitted herewith and prepared by the Project Landscape Architect be acceptable. The project consists of renovating 2 youth baseball fields with the goals of improving the quality of the field and therefore the level of play, improving the quality of the spectator experience, and rendering the facilities ADA compliant. Improvements consists of new backstops, new ADA compliant routes/walks, 2 ADA compliant parking stalls,new irrigation,and new infield and outfield mixes. The project site is located within Parcel 123301460000 and totals 1,306,800 square feet(sf)or 30.00 acres. The project site represents 8%of the total parcel area. Presently there is 7330 square feet(sf)of impervious surfaces and 97,400 sf of pervious surfaces within the project site. When the project is complete,there will be 14,850 sfnf impervious surfaces and 89,900 square feet of pervious surfaces. Net increase of impervious surfaces for the parcel by the proposed improvements is 0.6%. Site Soils consists of Indianola Loamy Sands. Local observation of the two fields and cutbanks of the area indicate the sand is deep and drains well. The Park and area I appropriately named. The proposed linear concrete accessible walk is 6' wide at it's narrowest point and 20' wide at it's widest point. The entire walk will drain towards the field where it will be dispersed and infiltrated. The concrete walk will not be a pollution generating impervious surface for no vehicles can access the walk. The area where the new ADA parking stalls are located is presently a gravel-packed hard surface. Asphalt paving for the ADA parking stalls will harden the asset and assure ADA compliance. Stormwater from this asphalt will be treated the same way it treated now,via a vegetated swale. The gravel access and area north of Field #1 is existing, the work includes the gravel intregity and installing a drywell. Maintenance vehicles only will use this area on a 2-3 times-a-week basis. After review of the plans and consideration of the minor scope of this project,we hopeful you will conclude this project fulfills the spirit and intent of the SMMWW and will result in no impact. Thank you. RECEIVED 4405 7t'Avenue, Lacey,WA 98503,360.456.3813, FAX: 360.4932063,email:bob@rwdroll.com JUL 19 2013 426 W. CEDAR ST FORM MUST BE COMPLETED IN INK PERMIT NO.: GRD D vV V� PLEASE PRESS HARD MASON COUNTY LAND MODIFICATION PERMIT APPLICATION f ljgt�. 426 W.Cedar/P.O.Box 186,Shelton,WA 98634 Shelton 360 27-9670 Belfair 360 276J467 Elms 60 82-6269 Seattle 206 464-6968 APPLICANT INFORMA ION 11� � CONTRACTOR INFQQRM9TIION Owner �i�iC'1lrSr Contractor Name Kd !� GLP�Y.Pflhtr 1� Mailing Address I -siT-623 P,EX I Mailing Address City State_ Zip Code City State Zip Code Phone) Other Ph.(_ Ph.( Other Ph.( JJ Lien/Title Holder Contractor Reg.# Address Expiration ENGINEK INFOR ATIO Name 1 Phone( D ) t ll J Address O State Zip Code 3 PARCEL INFORMATION-12 digit Tax Parcel No. IfIllf,O / 1 Fire District Legal Description Site Address(include street na a al Directions to site: �Ctr d l F..-� Will timber be cut and sold in parcel preparation?(Yes/No) ID Is your property within 200'of the following:Body of Water(Name) 1`1D Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Soft compressible soils TYPE OF JOB-Excavation Filling Grading Total size of area Size of area to be leaved on opes over 10% Estimated amount of cubic yards Describe Work�t LAND MODIFICATION INFORMATION YES NO Will fill be brought on site? If yes,source I.P%Az kill ve. 011 ❑ Will excavated materials be taken off site? If yes,destination tY ❑ Does fill contain potential hazardous materials? Er Has a soils report been completed on site? If yes,include copy. ❑ Xr Will proposal result in redirection of any surface water runoff onto adjacent properties? ❑ Will proposed work alter where storm water or ground water enters or exits the site? ❑ B� Will quality,quantity or velocity of storm/ground water be altered? ❑ Will runoff be collected/controlled by interceptors,curtain drains or other collection devices? ❑ Will the land be replanted upon completion? �IQLd ❑ Will the proposal result in slopes steeper than those currently on site? ❑ ❑Is the site within 200'of a designated shoreline? NOTICE: THIS PERMIT BECOMES NULL 3 VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-]certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval: X Date X Date ` FOR OFFICIAL USE BEYOND THIS POINT Accepted b -I-- Receipt St mittal Amount Due�.0 Receipt No. D PAR ENTAIL REVIEW MPROVED DENIM CONDITION CODES Building -p! ent a �4 Planning Department Public Works Department Fire Marshal FEES Grading Permit Fee t3 Site Inspection Plan Review Fee Other Public Works Fee Pre-Paid at Submittal RMW ( T Violation Fee TOTAL FEES L JUL 19 2013 4426 W. CEDAR 91 I V 2 FORM MUST BE COMPLETED IN INK PERMIT NO.: GIRD4 J- ponc i+ PLEASE PRESS HARD MASON COUNTY LAND MODIFICATION PERMIT APPLICATION -7`'Y�� 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 SheRon 36D l2796T0 Belfair 360 276J467 Elma 60 925269 Seattle 206 461-6968w1kCEIVED APPLICANT INFORMA ION/I CONTRACTOR INFQQRM TION r/ I/'� , Owner B464fd �llf�t•.l fGS Contractor Name �f'd t�i*v.P�4tee Mailing Address —� Mailing Address JUL 19 2013 City State_ Zip Code City State Zip Code Phone(^ Other Ph.( Ph.( Other Ph.(Lien/Title Holder Contractor Reg.# A W. CEDAR ST Address Expiration / / r. I It ENGINE INFOR ATIO lit Name W12 4 at, g$c a Phone( D ) 1J Address 6LO10 State Zip Code 3 k PARCEL INFORMATION-12 digit Tax Parcel No. JEW ! 14160040 ire District Legal Description Site Address(include street name aIrid clt Directions to site: SQ�t! fly F,�L Will timber be cut and sold in parcel preparation?(Yes/No) Is your property within 200'of the following:Body of Water(Name) 1"m Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Soft compressible soils TYPE OF JOB-Excavation Filling Grading Total size of area Size of area to bi I�topes over 10%_ t - Estimated amount of cubic yards 0 Describe Work. •� LAND MODIFICATION INFORMATION ,_(/,;� YES NO Will fill be brought on site? If yes,source 1% 1 i ET-' 0 Will excavated materials be taken off site? If yes,destination Q- 0 Does fill contain potential hazardous materials? O .W Has a soils report been completed on site? If yes,include copy. 0 Will proposal result in redirection of any surface water runoff onto adjacent properties? 0 Will proposed work alter where storm water or ground water enters or exits the site? 0 , Will quality,quantity or velocity of storm/ground water be altered? 43- Will runoff be collected/controlled by interceptors,curtain drain or other collection devices? 0 '� Will the land be replanted upon completion? l Ls{ Ar 0 Will the proposal result in slopes steeper than those currently on site? 0 Is the site within 200'of a designated shoreline? NOTICE: THIS PERMIT BECOMES NULL 3 VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project.Acknowledgment of such is by signature below: OWNER AFFIDAVIT-]certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-)certify that I am Currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes she first obtaining approval, be made without first obtaining approval.- IX Date X Dale ` FOR OFFICIAL USE BEYOND THIS POINT Accepted b Date t St mittal Amount Due?.J) Receipt No, D PARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Depa ent Planning Department ; Public Works Department Fire Marshal FEES Grading Permit Fee Site Inspection Plan Review Fee Other Public Works Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES