HomeMy WebLinkAboutBLD2006-00925 Final SFR - BLD Permit / Conditions - 9/27/2007 ,
Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
irf Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2006-00925
OWNER: JUSTIN TRAVATTE
CONTRACTOR: LARSEN BUILDING LICENSE: LARSEB*214P6 EXP:4/17/2007 RECEIVED: 6/1/2006
SITE ADDRESS: 280 NE LARSON BLVD BELFAIR ISSUED: 8/25/2006
PARCEL NUMBER: 123305100083 EXPIRES: 2/25/2007
LEGAL DESCRIPTION: BEARDS COVE DIV 4 LOT: 83
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR, SET UP STOCK PLAN #2003-0131
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type o onstr.: V-B
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R-3, U Lot Size: Deck: 80
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:1,409 Garage-Attached 463
Valuation: Building Height: 24 Occ. Status: Unknown Basement: Cov. Porch 54
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: S 25.0 Ft. Shoreline: Ft. Water Body:
Rear: N 10.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Shoreline Desig.: Not Applicable Side 1: W 5.0 Ft. pp'cable
Year: Serial No.: Side 2: E 45.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee CMH 6/1/2006 $205.47 B12006000
Hosebibs 2 Gas Outlets 2 Planning Review Fee CMH 6/1/2006 $155.00 b12006000
Kitchen Sink 1 Propane Tank 1 Address Fee GMM 6/12/2006 $140.00 s22006000
Lavatories 3 Ventilation Fan 3 EH Plan Review CEW 6/14/2006 $75.00 s22oos000
Showers 1 Propane Stove 1 Building Permit Fee JRN 6/28/2006 $1,032.95 S22006000
Water Closets (Toilets) 3 Dryer Vent 1 Building State Fee JRN 6/28/2006 $4.50 S22006000
Water Heaters 1 Plumbing Base Fee JRN 6/28/2006 $20.00 s22006000
Bath Tubs 1 Plumbing Fee JRN 6/28/2006 $89.00 S22006000
Clothes Washer 1 Mechanical Base Fee JRN 6/28/2006 $23.50 S22006000
Mechanical Fee JRN 6/28/2006 $113.25 S22006000
ADJUST--Plan Check Fee JRN 6/28/2006 $465.95 s22006000
Total $2,324.62
BLD2006-00925 Please referto the following
pages for conditions of this permit. 1 of 6
CASE NOTES FOR
BLQ2006-M925
PLEASE INITIAL ALL CONDITIONS, SIGN,
r%•tr _
iw n
. CONDITIONS FOR OR MAIL TO MASON COUWTY D.C.D,
BLD2006-00925 PO BOX 186,SHELTON,WA 98584.
3M 427-9670 XW
1) A Road Access Permit or Approva4 must be granted by the Mason County Department of Public Works. For more information contact Public Works, at
(360)427-9670, ext. 450. The building permit will not be "finaled" until the permit holder can show proof that the access permit from Public Works has
been"fi I d" and approved,
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2) Water to be degraded to the detriment of the aquatic environment as a result of this project,
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3) Prior to final approval, all upland areas disturbed or neWAcreated by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (siEi fencing or straw matting), X—�
4) Appro per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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5) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
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6) Landings and stairs must meet the same setback Condit ons as any permitted structure; and,must be shown on your site plan. Please check your
"Appro Site Plan" to ensure these structures are shown and meet the setback conditions listed.
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7) 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
Depart cfarther inspections being performed or approvals granted.
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BLD2006-00925 Please refer to the following pages for conditions of this pemit -- ---- -- 2 of 6
8) In accordance with intemational codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus,access Koaas," an new 5uuuAucda L110L
require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the
street or road front
ing the roe and shall contrast with their background.
access road. The numbers shall also be plainly visible and legible from the s 9 property rty
r`0ason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted
by the jurisdiction and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
inspectio
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9) The plan review check list and corrections are part of the approved plans and must remain thereto, It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply andlor
removatQLIgpraved documents will result in failure of required building inspections.
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10) All stabs within the heated space shall be insulated imum R-10 for at least 24". Monolithic slabs shall be insulated around the perimeter from the
top of the slab to the bottom of the footing X
11) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X_�
12) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: IV, Window(Max U-Factor):0.40, Skylight(Max U-Factor):0.58,
Doors D;�!
U-Factor):0.40 or less,Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38,Vault Insulation R-30, Slab Insulation R-10.
X
13) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and (he*approved" site plan is not 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 shall be collected by the
Build[W g22gLtment prior to any further inspections being performed or approvals granted.
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14) Per 20031RC - SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WIN D (3-SECOND GUST)the wind speed for Mason County is 85 MPH.
MARI
15) Per 2003 IRC - SECTION R905- REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering a � AMU, in
accor the applicable provisions of this section and the manufacturer's installatlon instructions. TO 360-427-7798
OR MA,- TO MASON COUNTYO.C,D,
X PO BOX ff 88,SHELTON, WA 98584.
16) Stock Plan Identification number:2003-0131 36"27-9670X352
This project is approved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department,
original building plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building
Inspec !red inspection.
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BLD2006-00925 Please referto the following pages for oanditions of this perm. 3 of 6
1�7) Concrete used for basement walls, foundation walls, exterior walls, porches,carport slabs, steps exposed to the weather, garage floor slabs and other
verticall o
concrete worik exposed to the weather shall have a minimum compressive strength of 3000 psi(IRC Table R402.2).
XVy�a'"
18) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction, Al engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed,approval will not be granted, In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be
charge be collected by the Building Department prior to any further inspections being performed or approvals granted.
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19) All construction must meet or exceed all local ordinances and the international cozies requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit yevecation.
20) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. Far further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for The installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 25'of a Mason County road right of way, It is suggested to contact that office to review future planned work which may
affect your project.�—
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21) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinances Fggulation, must be reviewed and approved by Mason County prior to construction.
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22) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspecto made prior to requesting additional inspections.
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23) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks filled
on site must be located a minimum of 10'from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system
air intake (direct vent appliance, ventilation air intake, etc), andlor any weeds, grass, brush, trash or any other similar combustible materials. Propane
tanks less than 125 gallons must also be located a minimum of 5'from any building opening(foundation vents,windows, doors etc), property line or
easemen ne tank is exposed to probable vehicular damage, protective bollards must be instalIBUEASE INITIALAt�_ CQNC�IrinNS SIGN,
X DATE AND EETHE ! '60 4: -7i98
0n MAIL rn MA SObiPO BOX T
186,SHMON, WA 98584.
BLD2006-00925 Please referto the following pages for conditionsof this permit, 7 ('A7n X3Z 4 of 6
24) All propane tanks must be installed in accordance with the lnternationalFire Code and all applicable Mason County ordinances. All rropane gar n�
between 125 and 500 gallons must be located a minimum of 10' from any building, property line, public way, possible source of ignition (electrical outlets,
&ectrical fixtures, compressors, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. If a propane tank is exposed to
probab ehicular damage, protective bollards must be installed,
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25) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
meet installation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
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26) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not be tyk�— e final inspection has been performed and approved by a Mason County building inspector.
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27) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to
Planning Department regulations. Such regulations primarily consist of setbacks from shorelines and features considered to be critical areas (streams,
wetlands, slopes, etc.) If you think such fe to es exist on or nearby your property, please contact the Planning Department so that exact setback
requirements can be determined. X
28) All property lines shall be clearly identified at the time of foundation inspection. X�
29) 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 unt ordi ces and building regulations.
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30) All permits expire 1 BO 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
holder ented action from being taken. No more than one extension maybe granted.
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31) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
conn% ashing. Install metal connectors approved for contact with the new types of pressure treated material.
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32) �i5 ted in a smoke management zone, Please contact a fire warden at(360) 427-9670 ext. 459 for further information.
86, SWTON. WA 98584.
BLD2006-00925 PIlease referto fire follovrirrg pages for oord fionsof this permit 5 of 6
-This pen-nit bacomes null and void 0 workorconstruction 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 conbnuaticc of work is a progress inspection vAthin the t 80 day period. Final inspection must be approved before buibhg can be occupied.Proof of continuation of
work is by r%ansofa progress ins pecticn.The owner cc the agenton the owners behalf, represents that the information provided is accurate arid grants employees of Mason County access to
the above described prop ny and ucture for revie.v and it spection. p�
OWNER ORAGENT: DATE ^ D ��
PLEASE INITIAL All CONDITIONS,SIGN,
DATE AND EITHER FAX TO 360-427-7798
OR MAIL TO MASON CO NTY D,C.D,
PO BOX 186, SHELTON, WA 985U.
360-427-967O X352
BLD2006-00925 Please refer to the following pages for condifionsof this permk 6 of 6
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.This pennit bnoomes null and void if workorconstruction authorized is not corninencad within 160 days,or if oonstruct►on or work is suspended for a period of 180 days at any lime after vrork is
comrneno-?d. Evidence ofwnbnuationof work isa progress inspection vdthin the t80 day period. FinalinspecfionmustbeapprovedbeforebuiFding can be occupied.PrcoFofcontinuatbnof
work is by means of a progress inspection.The ownercc the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described prop iy and fracture for review and i spection. p�
OWNER OR AGENT:
DATE:
PLEASE IMTIAL ALL COMMONS,SIGN,
DATE AND WHER FAX TO 36"27-7798
0R MAIL TO MASON COUNTY D.C.D,
PO BOX 186, SHELTON, WA 985M.
360-427-9670 X352
BLD2006-00925 Pleasereferto the fonowing pages for conditionsof this pen-irk 6 of 6
`C 7,,12
o CONeD ?,
MECHANICAL MANUFACTURED HOME .X
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O Date By
Ribbons
0> Gar:Piping
aInterior -,L- By 771 Interior-Date By Date By
2� o
F_�terior Date IO- 2 By /� Exterior-Date B Set-up
rn
Point Load/Isolated Footings INSULATION - Date By �
BG}SLAB INSULATION C
Date BY Data Z y _oG sy /2. FIRE DEPARTMENT CA
Foundation W is Floors Date By Z
Date: �1��3�0e BY$2c Data 5'-tS "? BY DECKS
FRAMING Walls Date By
BY1?1d1 tsat By PROPANE TANKS
w.,...
PLUMBING Vault INN Dates By
Date By OTHER
Groundwork Attic
Gate �-v B y,%/-J Type_
Late g S� Data By
D.W.rr DRYWALL Type=
IntBraceWall pate gy, W
Date B t - Date By FINAL INSPECTION v
v Water tine Fire Separation CD- 2'v 7 yd✓r�t� Date By Date q-2`l cry BLiq l� CD
Pass or Request Inspect. c
Type of Insp. Fail state gate Done By Comments N
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TOPOGRAPHY PROFILE:
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Permit Assistance Center
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SHELTON (360) 427-9670 BECFAi' (360)275-4467 Elma (360)482-5269
FAx: (360) 427-7798 WEB SITE: www.co:mason.wa.us
P.O. BOX 186, SHELTON 98584
2004 Washington State Energy Code (WSEC) e'
2003 Ventilation and Indoor Air Quality Code (VIAQ)
effective July 1, 2004
Code Compliance Application Form ..
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/ Ventilation and Indoor Air Quality Code
(WSECNIAQ)application located on the reverse side.
2. Complete the window and door schedule on the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location arrd.fuel type of water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor gf ynsulation proposed for wWM!floors, ceilings pno
slabs, .: .t
4. Questions? Call Mason County Community Development at (360) 427-9Ej,70.ext. 352. Additional
WSEC and VIAO compliance information is availgki'(e on the internet at: • �•
http://Www.ene su.edulcod ( " ti• ..
Prescriptive Requirerinents'9,Vbr Group R Occupancy
Climate,,one 1,"Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Area %of U_ Ceiling Vaulted Above interior4 exterior Slab°
Option Floor „ s Ceiling s Grade below Below Floor on
10 Vertical overhead Factor 12 grade Grade Grade
I 121/6 .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
II 15%' .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
Unlimited
Single Family Res 40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
(R-3)Only
"Reference Case/Call (360)427-9670 ext. 352 for footnote information. Log&solid timber wall with a min. avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
WSEC/VIAQ Compliance Application
Owner: � ephone�,5-3 g$/S574 Parcel#: oa- _67—
Type of project New Residence ( )Addition ( ) Remodel
Total Sq. Ft. A � 1S Floor: 2"
of heated area:: floor: Hated Basement:
7�^
Heating System Type: 10 Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: Specify_
Glazing � Prescriptive Option see reverse side circle one: I P I
Percentage: Compliance
/ Method O Component Performance , Chapter 5— Calculation worksheets required
13s % Check one:
O Systems analysis, Chapter 4
Whole House Ventilation system O Whole House Ventilation usiKJfV
ng a dat7Ot76
Ventilation using exhaust fans&window or wall fresh air
System vents (VIAQ 303.4.1) Recovery Ventilation System (VIAQ 303.4.4A,,
Check one I��
O Whole House Ventilation Integrated O Whole House Ventilation using an inline
with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3)
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows:
�-
�, , �0
Gz 6 . 2�
J
Windows: Total Sq. ft. /
Doors:
Doors: Total Sq. Ft " �
Total window and door area
Total window & door area �� /(divided by) total sq. ft of heated area 4 q = 1% • %of glazing
YV
MASON COUNTY PERMIT N
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMPON CONTRACTOR FORMATI
Owner Company Name
Maili A ess Mailin ,Addy ss
City State Zip Code �� �— City State Zip Code
Phone - ther Ph. Phone Other Ph.'
Lien/Title Holder Contractor Reg. 2 Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# B
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic .._ Existing Septic
Connect to Water System Name of Water System _.
Well Sewer System Name of Sewer System
PARCEL INFORM TION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please in Jude stree name street numb r and city)
Dir ctions to site
Wi I timber be cut and sold in parcel preparation?Ye o
Is property within 200' of Saltwater Lake River/ Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluff 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of BuildingDescribe Work
No. of Bedroom No. of Bathroom Square Footage- 1st Floor 2nd Floor
3rd Floor Basement— Dec _Covered Deck Other Sq. ft.
Garage Attached Detached Carport,' Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative, or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties..lf permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for thi"ermit and conduct the wgr} proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work p @p iNtt�iction is
not commenced within 180 days or if construction wo is suspended for a period of 180 days. PROOF OF CON WORK IS BY
MEANS OF(\PROGRESS I ECTION.INACTIVITY F THIS P,-'[,FZMITAP ION OF 180 DAYS WILL INVALIDATE THE 12006 APPLICATION.
X �/ (/ Date: �UN
'Owner/O ne epresentatintr n¢f e which one)
FOR OFFICIAL USE BEYOND THI Pp Accepted by: Date
.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department t,
Planning Department
Environmental Health Department
Fire Marshal I i I
FEES
�S
BuildingPermit Fee Site Inspection
`� � _
Plan Review Fee EH Review Fee
Plumbing & Base Fee — Planning Review Fee
Mechanical & Base fee Other 60
Wood /Gas/ Pellet Stove Fee State Fee t. —
Violation Fee Pre-Paid at Submittal
Valuation $ L TOTAL FEES
I
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD PERMIT NO.: J
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186 Shelton,WA 98584
Shelton(360)427-9670 Belfair(360)A-4467 Elma(360)482-5269
APPLIC INFOR�ON CONTRACTOR IN ORMATI N
Owner Contractor Name
M ' ' ddr D Mailin ddr s
City I Sta Zip Code City D fate Zip Code
Phone �— t h e r Ph.0 Ph. f 5 ther Ph.(2,53 ) (0 3
Lien/Tit older Contractor Reg
Address Expiration_Z/ /
SEPTIC INFORMATION-Connect to New Septic X Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATI N - 12 di it Tax Parcel No. ( / / Fire District
Legal Description 3
Site Address (Please incl de street n m treet numb and city)
Directi s to site C.c/ 0
Is your property within 200'of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood 1
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&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-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance 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 will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No chang shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. Y first obtain g approval.
X / Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPART fViEN TA! REY[EVY AFp�tt7V D QENIEt3 GDNDITI:
Building Department Ls.
Occ Group Type Constr.Planning Department J N 0 12006
Other BELFAIR OFFICE
Other
-—— FEES
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES