HomeMy WebLinkAboutBLD2003-00926 Final SFR - BLD Permit / Conditions - 1/14/2004 Inspection Line(360)127-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
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Mason County Bldg. 3 426 W. Cedar P.O. Box 186
Shelton, WA 98584
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RESIDENTIAL BUILDING PERMIT BLD2003-00926
OWNER: CHRIS COX
CONTRACTOR: ADAIR HOMES INC LICENSE: ADAIRH*262RZ EXP: 1/9/2005 RECEIVED: 7/9/2003
SITE ADDRESS: 1051 NE BELFAIR MANOR DR BELFAIR ISSUED: 8/19/2003EXPIRES: 2/19/2004
PARCEL NUMBER: 123307590264
LEGAL DESCRIPTION: TR 26 OF SURVEY 2/149
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE 101 TOWARDS SHETON EXIT OFF OF 1 ST SHELTON EXIT TURN RIGHT
ON HWY 3 23MILES TURN LEFT ON 300 TURN RIGHT ON SANDHILL RD
LEFT ON BELFAIR MANOR DRIVE
General Information Construction &Occupancy Information Square Footage Information
No.of Bedrooms: 3 Type of Constr.: V-N
Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No.of Stories: 1 Occ. Load: Building:1,702
Valuation: Building Height: 14 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline & Planning Information
Make: Length: Ft. Front: S 50.0 Ft. Shoreline: Ft. Water Body: wetland?
Rear: N 40.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: W 60.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: E 190.0 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 NJP 7/9/2003 $56.80 S22003
Hosebibs 2 Ventilation Fan 3 Building State Fee NJP 7/9/2003 $4.50 S22003
Kitchen Sink 1 Dryer Vent 1 Building State Fee NJP 7/9/2003 $4.50 S22003
Lavatories 2 Planning Review Fee NJP 7/9/2003 $150.00 S22003
Showers 1 Building Permit Fee MRG 7/22/2003$1,060.95 S22003
Water Closets (Toilets) 2 Mechanical Fee MRG 7/22/2003 $39.65 S22003
Water Heaters 1 Mechanical Base Fee MRG 7/22/2003 $23.50 S22003
Bath Tubs 2 Plumbing Fee MRG 7/22/2003 $77.00 S22003
Clothes Washer 1 Plumbing Base Fee MRG 7/22/2003 $20.00 S22003
EH Plan Review ADR 7/24/2003 $75.00 S22003
EH Permit Revision CEW 8/8/2003 $35.00 S22003
Total $1,546.90
BLD2003-00926 Please referto the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2003-00926
CONDITIONS FOR
BLD2003-00926
1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X _YS
2) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located 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 re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or
contractol fail to post the address on site prior to requesting inspections.
X Tt— '
3) 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 Fire Marshal. X
4) Any f use development or vegetation removal in the SE corner will require additional review and may require wetland categorization and delineation.
_
X �
5) All upland areas disturbed or newt created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt
fencing or straw matting). X Ms
6) Approved per dimensions and setbacks on submitted site plan. X 7�5
7) Proposeucture(s) must maintain a minimum setback from all property lines, easements and 25'from all County and State Road right of ways.
X
8) 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
Departmior to any further inspections being performed or approvals granted.
X
9) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located 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 re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or
contractor faiL to post the address on site prior to requesting inspections.
X
BLD2003-00926 Please referto the following pages for conditions of this permit. 2 of 4
10) The plan review check list and corrections, along with the Energy Compliance Worksheet(when applicable)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 sib for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections.
X
11) The"approved" plot plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" plot 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
Buildin De artment prior to an further in i� p p yinspections being performed or approvals granted.
X _ TS
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 (Type/Max 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 -112S
13) In buildings of unusually tight construction, fuel-burning appliances (excluding cooking appliances and domestic clothes dryers) shall obtain combustion
air from outside in accordance with the Uniform Mechanical Code.
X
14) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code 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 revocation.
X
15) All changes to"approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance
or regulation, must be reviewed and approved by Mason County prior to construction.
X
16) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector be made prior to requesting additional inspections.
17) All property lines shall be clearly identified at the time of foundation inspection. X
18) 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
19) 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
holder have prevented action from being taken. No more than one extension may be granted.
X 7
BLD2003-00926 Please referto the following pages for conditions of this permit. 3 of 4
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 anytime after work is
commenced. Evidence tinuation of work is as plrogr s i pection within the 180 day period. Final inspection must be approved before building can be occupied.
OWN ER OR AGE C DATE: C IJQZ2�5
BLD2003-00926 Please referto the following pages for conditions of this permit. 4 of 4
o 'CONCRETE MECHANICAL MANUFACTURED HOME'
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Footings / Setbacks Date B y Ribbons
Date � By Gas Piping Date B y
N Foundation Walls Date B y Set-up
rn
Date `V By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date � NCO By Date // - 2. -cO By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.W.U. Date
Date % By FINAL INSPECTION
Water Line_ Date �'�`f�% By
Date By .;. ,. 2 ,"_ Date By
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APPROVED
MASON COUNTY CO PLA NING
SITE PLAN REQUIRE TO BE 0 SITE
C NGES SUBJEt� TO ANNR` AL
By
_ Date
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t
30' VT , DR1VE Fu{ INGf1:SS -�GR�3
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RECEIVED
��0� C3�Aty �rotz
CF-\R1S TT—=RESA COX hL 2 8 2003
N E (c� ► 0�, t4ow OAn t3q , 426 W. CEDAR ST.-
2:1 5 — LA U 1 Tire information on this plot plan has been provided and
reviewed by the property owner who,by signing below: 1.)
5i j E acknowledges and accepts full responsibility for its accuracy
Intl completeness: 2.) Is responsible to ensure that the
S N E i3ELFAtR tV1L�,tJ�JR improvements to the site take place in conformance with tills
plan:3.)Will establish all the corner irons,lot lines and code-
'25 VA R I WN r 0 Q,5 2'3 required setbacks required of this property.Any change(s) to
tills plan must be pre-approved by the governmental
rj (o\.A agencies with jurisdiction,the mortgage lender Ind the
�1 W contractor Ind documented.
1 ►� MA`s0t\) C O . 1 11JA r x rrf (; �
—Owner Date
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�wner U
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r
ADAIR HOMES , INC .
SINCE 1969
BEAVERTON
July 2, 2003
1111 SW 170T" AVE.
BEAVERTON, OR 97006-4220
SALES (503) 645-3547 Mason County Building Dept
CONST (503) 645-1156 PO Box 186
FAX (503) 645-5986 Shelton WA 98584
BEND
63309 NELS ANDERSON RD. Dear Official,
BEND, OR 97701-5743
SALES (541) 382-4068 Please find enclosed a building permit application for Chris &Teresa Cox.
(541) 382-6924 FAX (541) 382-8989 y g a q
The will be building 1702 S ft home at 1051 NE Belfair Manor Drive,
FAX
Belfair, WA 98528.
OLYMPIA
2303 93RD AVE. SW Enclosed are three sets of blueprints, plan check fee of$ 207.00 , strip
OLYMPSALES A, 60 98512-1028 ma to site, approved septic design, and lot plan. The water is still
SALES (360) 352-8571 P PP P � g� P P i
CONST (360) 352-7641 waiting for approval but I will send you the information once I receive it.
FAX (360) 943-0701
MEDFORD If I have forgotten anything or if your requirements have changed, please
notify me at (360) 352-7641.
541 BUSINESS PARK DR.
SUITE A
MEDFORD. OR 97504-4191 Thank you very much for your time and assistance.
SALES (541) 732-1560
(541) 774-8 FAX /
FAX (541) 774-8847847
�ut n�a~
CALDWELL Sarah Marshall
1904 E. CHICAGO ST. Administrative Assistant
SUITE C Adair Homes Inc. f
CALDWELL, ID 83605 n
BUS (208) 459-8274 \\A
FAX (208) 459-8289 O v To�1
BUSINESS CENTER $ J
1111 SW 170T" AVE. `
BEAVERTON, OR 97006-4220 S0
PHONE (503) 645-4730 "( A
FAX (503) 645-9715 1 kP-
OR CCB#593 r
WA#ADAIR H#262RZ
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FIOfIIf Builders Assodation
of wt.o'i 'a Rx d
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CH��S TmssA COX
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` MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
P.O. Box 186 ♦ 426 W Cedar Street ♦ Shelton, WA 98584
www.co.mason.wa.us
Phone (360)427-9670 ext . 352
Irf • Building Belfair: (360) 275-4467
• Planning Elma: (360) 482-6968
to
• Environmental Health Seattle: (206)464-6968
Fax: (360)427-7798
SITE PLAN INSTRUCTIONS
A complete, accurate, and detailed site plan is important to avoid delays in the review and approval of your proj-
ect. A sample site plan and topography are located on the inside of this form. An easy to use grid, which can
be used to draw your site plan on, is also located inside. The following items will be required, if applicable, to
complete the building permit application package. Additional information may be needed depending upon indi-
vidual site conditions. For more information see submittal standards and instructions on the back of this form.
Dcn = c_n = � X K X > o c) g � cno o � cnX -an
-om o — oQ, my coG- m >vo 0C m m co o
0 -0 3 m B -p P 3 o- (� � _ � o c 3 T �
Submittal CD
o m m y 0 2 Q o � � m 3 o
_ 0 oo m o � � v mo' 07 CD
Requirements �' C m 3 — 0 � 00 • a 0 v �.
Ca_ ? o 0
Building Permit Application Form
Site Plan 4 4 4 4 4 4 4 4 5
Septic Records
Septic Permit Application 3
&Septic Design
Water Adequacy Form
Construction Plans 3 3 3 3 3 5
Energy Code ,, ,f V
Application Form Healed
Septic Pumpers Report X X X X X X
Existing systems older than 3 years.
Property Lines Flagged v v
Geotechnical Study" 3 3 3 3 3 3 3 3
See instructions on back
Plumbing/Mechanical VO ,, VO VO
Application Form
Engineered Calculations" 2 2 2 2 2 2
Floor Plan VO
S.E.P.A. VO
The number in the table indicates the number of copies required if applicable.
Required for submittal of a complete application.
X A pumpers report may be required when a septic system is existing and has been installed for three or more
years. The pumpers report, dated within the last three years, shall include the size and condition of the tank and
the condition of the baffles.
• Additional information and permits may be required by the Planning Dept. call extension 281 for information.
* If applicable, needed when site conditions require the additional information. Rev: 3/1/02
SITE PLAN REQUIREMENTS:
A complete, accurate and detailed site plan is important to avoid delays in the review and approval of
your project. Use the checklist below as a tool to help you complete the site plan.
❑ 1. Scale: A scale of 1"=20', is typical but other scales such as 1"=10' or 1"-40' are also
acceptable. Do not exceed 1"=60.
❑ 2. North arrow
❑ 3. Property line location and dimensions.
❑ 4. Label abutting streets
❑ 5. Shoreline/Surface water: Indicate creeks, streams, lakes, ponds, wetlands and other
bodies of water within 300 ft of the proposed project.
❑ 6. Wetlands and Seasonal Drainage: Show setback distances from wetlands or
seasonal drainage.
❑ 7. Easements: Indicate location and size of road, utility, and private easements.
❑ 8. Show All Existing Development: Identify existing and proposed structures. Include
porches, decks, roof overhangs, cantilevers, and structures that will be demolished.
❑ 9. Proposed Building Footprint: Use scale to show distances to property lines, existing
structures, septic tank and drainfield. Stake or flag footprint of proposed structure.
❑ 10. Sewage Disposal System: Identify septic tank location and drainfield.
❑ 11. Existing and proposed Buffers: Include open space, fences, sidewalks and parking
areas.
❑ 12. Retaining walls: Proposed and existing.
❑ 13. Slopes/Site contours (Topography): Identify any slopes greater than 15%, fills or
cuts greater than 4ft. that are located within 300ft. of the proposed project. Use Contour
lines or arrows to show the direction of the slope.
❑ 14. Wells: Show existing and proposed, need to include all wells located within 100 ft
of property.
❑ 15. Waterfront projects: Show all structures on adjacent property.
❑ 16. Driveway/ Site Access
❑ 17. Stormwater Run-off Path: Identify stormwater run-off path and direction of flow.
❑ 18. Land modification/Grading permits: Site applications for land modification permits
must show topography before and after the proposed work.
o . ake sore�lem es.
te PI,
Sample Site Plan and Topography
i all C o
Be dentirted r�U�e�eekljst
rare 04Y0 inlb to
Scale: 1"=40' stes rr`denf. urs�tep a4.t'oo
_.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.,_.._.._.._.._.._. s sir es
Main. Street se `��� rief4re f° ro
a
_.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._ ._.._.._.._.._.._.._.._1 a
Pr �k4� e�tsf` e
1 PO
ay tru�tu reed
1 shore th ere ams,re 10�a
-4110
WableB10a eet wo ld�o f
Reserve Drainfield agA�eah�e
1
1 p �
104' Io
' Draii afield
c:C
Stormwater in
1 -- —I ---------I 225, run-off path
1 - - P
---I-- 6'
56' 40'
1 ', .CD
114' Existing iCD
1 r Garage
! Wetland 1 ` I
i Buffer Zone 11 D 171'
1 m 125'
............ .............
1 '
i 1 c i 100
l
11 ', Allowable Building �i� {
Area % € I
1 l 80'
� I
Well i
�* 300'
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< _.._.._..,.._.._.._.._.._.._.._.._. ..............._.._.._.._.._.._ ._.._.._.._.._.._.._.._..
North
+45'
+51
0'
68' 55' 1 40' 25' 1 36' 36' 35'
IIL 11
TOPOGRAPHY PROFILE:
Direction: Scale: Approval: for office use
Building Permit number: Building:
Owner/Applicant: Date of Planning:
application: Env. Health:
Parcel Number:
JUL-23-2003 12: 16 ADAIR HOMES-OLYMPIA 360 943 0701 P.01i02
' HOMES3 INCm
ADAIF� 1
BEAVERTON
TO: AMANDA REYNOLDS
1111 SW 170711 AVE.
BEAVERTON, OR 970064220
SALES (503) 645-3547 FROM: SARAH MARSHALL
CONST (503) 645-1156 ADAIR HOMES, INC
FAX (503) 645-5986
BEND DATE: 7/23/03
63309 NELS ANDERSON RD.
BEND, OR 97701-5743 RF: CHRIS &TERESA COX
SALES (541) 382-4068
CONST (541) 382-6924
FAX (541) 382.8989
OLYMPIA PARCEL: 123307500260
2303 93A" AVE. SW TOWNSHIP: 23 N
OLYMPIA, WA 98512.1028 LOT: D
SALES (360) 352-8571 RANGE: I
CONST (360) 352-7641
FAX (350) 943-0701 SECTION: 30
ADDRESS: 1051 NE BELFAI R MANOR DR
MEDFORD BELFAIR, WA 98528
541 BUSINESS PARK DR.
SUITE A D. OR 97504-a191 I HAVE INCLUDED THE CHANGES FOR CI-iRIS & TERESA
MEDFOSALES (541) 732-1560 COX'S PLOT MAP. THE SEPTIC TANK AND DRATNIELD
CONST (541) 774-8996 SHOULD BE ACCURATE ON THE MAP. IF YOU HAVE ANY
FAX (541) 774.8847 QUESTIONS OR,CHANGES TfIAT ARE NEEDED, PLEASE
CALDWELL CONTACT ME AT (360) 352-7641.
1904 E. CHICAGO ST.
SUITE C THANK YOU,
CALDWELL, ID 83605
BUS (208) 459-8274 I
FAX (208) 459.8289 1 �
BUSINESS CENTER J'�r
Jill SW 1707u AVE.
BEAVERTON, OR 97006-4220 SARAH MARSHALL
PHONE (503) 645-4730
FAX (503) 645-9715
OR CCB#i 593
WA#ADAIR H#262RZ
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Listings as of 03/18/03 at 1:50o Vacant Land Agent Detail Report
m
LN:23037658 1-0 Lot NE Belfair Manor Or Belfair 98528 Maso ST:Active LP:24,950
'T LT: D ELK: COM: Belfair PRJ: Short Plat 2104
AR: 171 TAX- 12330-75-00260 OPLS: 24,950
MAP:9 GIRD: C-3 NIA: Yes FIN: SPS:
t' DO: From Belfair,North Shore Rd to rt on Sandhill Rd to left on Belfair Manor OMD:
Dr.to last driveway on rt to 1st lot on left. LD: 03/18/03
XD: 09/30/03
^ SLDT:00/00/00
LO: Reid Real Estate(ID:4013)Phone:360-275-2868 SOC: 4.0
LAG: Roy E Boad(ID:735)Phone:360-275-2868
CLO:
GZC: Residential CLA: PTO:No F17: Not Provided
OTVP: OCC: OWN:JESFIELD
OPH: (360)275-7462 OAD:Belfair,WA PHO:
POS: Closing
TXY: TX: SNR: ATF:
E TRM: C
20%dwn 3 yr term 8.5% STY: 41-Res-1 Acre+ J
�o0P '—'-' `RR,Mobiles Not OK SKS:N CTR: SEC:30 23 01
ZNR: WRJ: t�'
ACR: 1.200 LSF: 52272 LSZ: 169x329 WFG:
DOC: Road Agreement,Well Agreement
WFT. LDE: Dead End Street
VEW:
RD: RDI: Gravel,Privately Maintained,Recorded Maint.Agrm
IMP:
FTR: Partially Cleared
TPO: Level, Rolling SLP: LVL:
WTR: On Property,Community Well SFA: ESM:
GAS: Not Available STD: 00/00/00 SUR:
ELE: On Property SEP: SDA: SST:
SWR: Not Available SAP: SOD: 00/00/00 SDX: 00/00/00
SD: North Mason#403 EL: Sand Hill JH: Hawkins SH: North Mason
Legal Description:Lot D Short Plat 2104
Marketing Remarks: 1 1/4 acre only 3 miles from Belfair has frontage on Dept. of Natural Resources forest land.Power,water&phone to
property with ideal soil for septic,building and garden.No manufactured housing.
Presented By:Roy E Boad/Reid Real Estate
Lot Sizes And Square Footage Are Estimates.
Information From Reliable Sources, But Not Guaranteed.
V�
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http://Iocator.nwmis.com/scripts/mgrgispi.dll 3/18/03
..--�--. 529702
529702
Short "a' of a portion •
of Che Southeast quariCer Short pis No. Q�l�
(SE}) of the NorchNest Is
row d:
qquarter (NWT) of Section Z-
�.(30), Township (23) NQrth-
Range (1) West. W.M, ctor of er+er
ervices
Parcel No. 12330 75 00260
Short Platfor: James Jesfield
P. 0. Box 159
Belfair, WA 98528
(206) 275-6684
SOUTHEAST QUARTER OF THE NORTIIWEST QUARTER
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"DIT011'1 Fl(o O`ASEMCAJT AS WARNING - Meson County has no
39a7:7P SNOW uIN VOL 2 responsibility to build,
8FE URVPYS- improve, maintain, or otherwise
JAMw A, N're 1q9, service the private roads
7PSFIeLO contained within or providing
aervice to the Property des-
rTI tALSFwCz DIRECTOR cribed in the short plat.
n�k
I
Request To Revise An Approved Plan
Permit Number: BLD200 2(o Name C._4(z ks e 1 ezes-4 C
Parcel Number 1aS!2,b - 7S Phone Number daytime (3(D o ) �2-7 5 -7 cf o �-
Project Address DS Mailing Address NE G SII��C P (�
Please provide a complete, detailed description of the proposed revisions to the approved plans:
Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No
Are the approved site plans included? ❑ Yes ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No
Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No
If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural changes to a"designed„plan will be approved without the written consent of the engineer and/or architect of record.)
Does the proposed revision modify the footprint or location of the structure? ❑ Yes ❑ No
If Yes, Is a revised site plan,with all new setback dimensions included with this request?
❑ Yes ❑ No
Additional Information:
426 W: CEDAR 512
Applicant's signature Date:
Office Use Only Received by:
Forward to declartments indicated below: Apapw6tpate
❑ fl' ing Original Valuation: $
Additional Valuation: $
Planning w U Z Sq.Ft. x$ $
Sq.Ft. x$ $
Environmental Health 13Total New Valuation $
❑ Public Works Additional Fees:
Additional Planning Dept. $
New Setbacks: Front / Rear / Additional Plan Review $
Additional Building Permit $
Side1 / Side2 / Additional Plumbing $
Additional Mechanical $
Additional Conditions/Comments: Additional E. H.Dept. $ 3
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
7ah initial
Revised SRO 7/2003
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION OQU4
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 INFORMATION CONTRACTOR INF RMATI N
Owner 5 � _T�0r_e_C;0_ N)k Contractor Name
Mailin ddress IY Mailin Address
City. U t%, State VA Zip Coe City I State 1�QIZip Code
Phone ( ) 4Mther Ph. ( ) Phone ( Z~ 0+1 Other Ph. ( )
Lien /Title Holder '�Ll. Contractor Reg. # 1 ( wzxp�/ zj
Email Address Email Add r ss
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic
Connect to Sewer System Name of Sewer System
Well Water System 7- Name of Water System
PARCEL INFORM 1 digit lax Pa el No. I Z3 3C Fire District
Legal Description N
Site Address (Please incl de street na e, street nu er and city) X /(I tnor pr. IY'
Directions to site 1 ac vc� -tm 1 k e Yi
2 3lf InAliton Q it; Man
Will ti ber be cut and sold in parcel preparation? (Yes o mt7
Is property located within 200' of saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
PERMANENT RESIDENCE SEASONAL RESIDENCE ❑
TYPE OF JOB - New V Add Alt Repair Other Use of Building
Is this permit sub ittaI t ere t of Stop Work Notice, Correction Notice or other enforcement action? (Yes/No)
Describe Work
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE - 1st Floor D 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INF R A I Model Model Year
Length Width riaa No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit? (Yes/No)
Installer Name Certification No.
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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY
RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW:
OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis-
ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware
of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this
that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there-
shall be made without first obtaining approval. with. q changes shall be made without first obtaining approval.
I
X Date X at 7
.. FOR OFFICIAL US B YO.ND THIS POINT 0
Accepted by Planning Pd Ck#
Date 4�J/0-7Bld Pd. `.7-i Reciept No.
DEPARTMENTAL REVIEW AP OVED DENIED CON ITION CODES
Building D g ment
Occ Group . .Type Constr.
Planning De artment
Environmental Health Department
Public Works Department
Fire Marshal
s
Valuation$ w
FEES 3
Building Permit Fee Site Inspection
U
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES
i
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner WC4 , L hy Contractor Name
Mailin Address Mailing Address
City State Zip Code City State( lr_ Zip Code-
Phone y - I Other Ph.( Ph. -•t - Other Phl
Lien/Title Holderlt�'�tf?�_ Contractor Reg. # A-- 2,
Address Expiration _/ /
SEPTIC INFORMATION-Connect to New Septic_ �Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION- 12 digit Tax Parcel No. !% l0�-�- / Fire District
Legal Description
Site Address (Plea a ricl de street name street number and city)
Directions to site 4 }
Aa,
Is your property within 200'of the following: Body of Water(Name) ,(m�_ Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
TYPE OF JOB New V 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
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 lon FI NIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Vgy VDI rH
18 .DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS A ORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The eMton owner's beef,represents that the
information provided is accurate and grants employees of Mason County access to the abo cribed property gn�® tures for review and
inspection of this project. Acknowledgment of such is by signature below: O ��j
OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I aPermit
O as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington d h of the ordinance
requirements for which this permit is issued and that all work will be.4pne in requirements regulating the r Ithi issued and all work
conformance therewith. No changes shall be made without i tko t shall be done in conform No changes shall be made without
approval. A- first obtaining approval.
r
X Date X_q h�h n0"'Or-Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
_.. .......... _
DEPARTMENTAL R1wVtEW APPROVED...........DENIED CONDITION:CQDES
Building Department
Occ Group Type Constr.
Planning Department
Other
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