HomeMy WebLinkAboutMIS99-0716 Pre-Inspection - MIS Permit / Conditions - 10/28/1999 ------------
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
M 1 AGE Lt._AIVEcoUS i UnRM 1 -U rt INSPECTION;
MI S99--071-6 PARCEL % 123306400044 PLAT :BFPLO U 1 V : BLK : LOT : 44
JOB ADDRESS : 260 NF SANTA MARIA LN BELFAIR
APPLICANT : ROSE LUEBKE 360-277-3281
OWNER : ROSE VUEBKE 360--277-3281
LEGAL - BFP.ROS COVE DIV 7 BLK: LOT: 44 NE 281 SANTA NARIA DA
PROJECT DESCP 1 P1" t ON :
PREINSPECTION FOR A HOME DAY CARE
PROJECT LOCATION :
GO DOWN NORTH SHORE RD, TURN RIGHT ONTO SANDH 1 LL , TLIAN LEFT ONTO L.ARSON t A.KE BL Via. GO TO L.ARSON
F LAKE VAIVE TURN LEFT GO TO SABRE , TURN RIGHT THEN IMMEDIATE RIGHT ONTO SANTA MA111A THE LOT 1S THE
SECOND) ONE ON LEFT .
PROJECT NOTES :
TYPE AMOUNT BY DATE RECE: t PT
I'S I N .1 42 .00 KS 10128/99 1691
i
I�TOTAI : 12 .00 OWNER OR AGENT DATE
NIS PANT, revs /4111192 COMPLIANCE TO ATTACHED C014DITIONS IS
REQUIRED
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 b date by
FRAMING Walls y FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING i
date by date by
Water Line FINAL INSPECTION
date by date by date by
i
II
— II
I
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
PI~ F11+4 1 `T' 0 0 N 0 1 T 1 0N !Zl
Case No . : M I S99--0716
For : ROSE LUEBKE
P.agea 1
1 > PURSUANT TO 1997 UNIFORM BUILDING CODE , ALL SITE MUST BE MARKED WITH APPROVED 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 ADOPTED FEE SCHEDUI. rS AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF
OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS .
X
(, �� �' t -_v
°�- MASON COUNTY MIS
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 •427 9670
�{�.'� Fee Required prior to inspection
PLEASE PRINT
#1 Owner Jp n Phone#
Site Address City &' Cd"P'
Mail Address
City I St Zip
Applicant n ��u�e-1-,��, Phone#Applicant Address
Address
City St Zip
#2 Parcel No. 3�
Legal Description o
#3 Purpose of Pre-Inspection Ck. d C w—
#4 Use of building o me_� r q C ,,� �1-e,
#5 Indicate by circling the applicable source if any water is on or adjacent to subject property:
saltwater lake creek stream marsh river pond wetland seasonal runoff other
Directions to Site:
W41 AA
Gl
Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
Applicant Signature ' Date��- Z7- z
FOR OFFICIAL USE ONLY: Accepted by: Date,;
Receipt No. Referred To
DEPARTMENTAL REVIEW
OFFICIAL U FOR O E ON
LY
C S
Proposal Proposal
Approved Denied
Planning:
Building: _
Fire Marshal:
Special Conditions
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
` No. Z Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
_,2 B.aibzlis Ccmklo,; No. Unk Fees
_Showers 2, Furn BTU
I Hot Water Htr / _ Heatpumps
I Laundry Washer �l Vent Systems
3—Sinks ( Spot Vent Fans
Floor Drains No. Boilers/Compressors
Laundry Basins 2 _ HP
Dishwasher J 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 15.001 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ �J\ 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
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 APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
- p)X OWNER'-_ � r h X BY F � --�--
DATE DATE
FOR OFFICIAL i USE ONLY:accepted by: Date
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: G 30' ► vp i
O{u r V f U'M a2YC,04v'A 1, �1+�Q S � G,� (^J IIJ��.!�n S VC.V)all Gam." if
JSCA,Wf�$
i
dr
Environmental Health:
i
Building Plan Review (�i j)C,
Occupancy Group: Type of Const:
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
Other
Other Building Valuation: TOTAL FEE S 7 3,5-/,,