HomeMy WebLinkAboutBLD2007-01405 Final Log SFR with Deck - BLD Permit / Conditions - 12/3/2009 Li l� " Inspection Line(360)427-7262
MASON COUNTY DEPT. OF �OMM6(�fl Y DEVELOPMENT Phone: 360 427-9670 ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
lip; Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2007-01405
OWNER: KEN TAKEGAMI RECEIVED: 8/6/2007
CONTRACTOR: MICHAELS CUSTOM WOODWORKS INC. 360.709.0258 LICENSE: MICHACW977DL EXP: ISSUED: 8/27/2008
SITE ADDRESS: 181 E BERGESON RD SHELTON EXPIRES: 2/27/2009
PARCEL NUMBER: 220031290120
LEGAL DESCRIPTION: TR 12 OF NE1/4 &TAX 1303 EX SEE SURVEY 6/13 & 30/216 TR 2 OF SP#469
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New LOG SFR/deck Harstene Island
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 1 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Group: R-3 Lot Size: Deck: 221
Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:400
Valuation: Building Height: 20 Occ. Status: Seasonal Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 364.0 Ft. Shoreline: Ft. Water Body: Peale Passage
SEPA?: No
Model: Width: Ft. Rear: W 5 Ft. Slope: Ft. Shoreline Desi
Side 1: IN31.0.0 Ft. 9.: Rural
Year: Serial No.: Side 2: S 62.0 Ft. Comp. Plan Desig.: Rural
BLD2007-01405 Please refer to the following pages for conditions of this permit. 1 of 6
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 3 Exhaust Hood 1 Plan Check Fee KKK 8/6/2007 $287.14 S22007000
Kitchen Sink 1 Ventilation Fan 1 Planning Review Fee KKK 8/6/2007 $170.00 s2zbb�bbb
Lavatories 1 WoodStove 1 Address Fee BLF 8/13/2007 $154.00 S12008000
Showers 1 Dryer Vent 1 Fire Warden Review DHS 8/21/2007 $64.00 S120b8bb0
Water Closets (Toilets) 1 EH Plan Review TW 8/27/2007 $75.00 S12008000
Building State Fee ARC 9/4/2007 $4.50 S12008000
Building Permit Fee ARC 9/4/2007 $441.75 S12008000
Mechanical Fee ARC 9/4/2007 $87.75 S12008000
Mechanical Base Fee ARC 9/4/2007 $25.30 S12008000
Plumbing Fee ARC 9/4/2007 $36.30 S12008000
Plumbing Base Fee ARC 9/4/2007 $22.00 S12008000
Geotechnical Asses.Report BKD 10/4/2007 $368.25 S12008000
Geotechnical Asses.Report BKD 3/17/2008 $180.00 S12008000
Geotechnical Asses.Report BKD 3/19/2008 $240.00 S12008000
EH Permit Revision CEW 8/18/2008 $40.00 s12008000
ADJUST--Building Permit Fee ARC 8/21/2008 $30.30 S12008000
Additional Plan Check Fee ARC 8/21/2008 $68.00 S12008000
Total $2,294.29
CASE NOTES FOR
B LD 2007-01405
CONDITIONS FOR
B LD 2007-01405
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
X 800-647-0f T;i on signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
2) Approved per d io setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
3) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X
4) 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
Department prior further inspections being performed or approvals granted.
X
BLD2007-01405 Please referto the following pages for conditions of this permit. 2 of 6
r
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
Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2007-01405
OWNER: KEN TAKEGAMI
CONTRACTOR: MICHAELS CUSTOM WOODWORKS INC. 360.709.0258 LICENSE: MICHACW977DL EXP: RECEIVED: 8/6/2007
SITE ADDRESS: 181 E BERGESON RD SHELTON ISSUED: 4/1/2008
PARCEL NUMBER: 220031290120 EXPIRES: 10/1/2008
LEGAL DESCRIPTION: TR 12 OF NE1/4 &TAX 1303 EX SEE SURVEY 6/13 TR 2 OF SP#469
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New LOG SFR Harstene Island
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 1 Type of Constr.: VB
Type of Use: SF Insp.Area: No.of Bathrooms: 1 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No.of Stories: 1 Occ. Load: Building:400
Valuation: Building Height: 20 Occ. Status: Seasonal Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 364.0 Ft. Shoreline: Ft. Water Body: Peale Passage
Rear: W 517.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: N 3 1.0 Ft. Shoreline Desig.: Rural
Year: Serial No.: Side 2: S 62.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 3 Exhaust Hood 1 Plan Check Fee KKK 8/6/2007 $287.14 S22007000
Kitchen Sink 1 Ventilation Fan 1 Planning Review Fee KKK 8/6/2007 $170.00 s22oo7000
Lavatories 1 Woodstove 1 Address Fee BLF 8/13/2007 $154.00 S12008000
Showers 1 Dryer Vent 1 Fire Warden Review DHS 8/21/2007 $64.00 S12008000
Water Closets (Toilets) 1 EH Plan Review TW 8/27/2007 $75.00 S12008000
Building State Fee ARC 9/4/2007 $4.50 S12008000
Building Permit Fee ARC 9/4/2007 $441.75 S12008000
Mechanical Fee ARC 9/4/2007 $87.75 S12008000
Mechanical Base Fee ARC 9/4/2007 $25.30 S12008000
Plumbing Fee ARC 9/4/2007 $36.30 S12008000
Plumbing Base Fee ARC 9/4/2007 $22.00 S12008000
Geotechnical Asses.Report BKD 10/4/2007 $368.25 S12008000
Geotechnical Asses. Report BKD 3/17/2008 $180.00 S12008000
Geotechnical Asses. Report BKD 3/19/2008 $240.00 S12008000
Total $2,155.99
BLD2007-01405 Please refer to the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2007-01405
CONDITIONS FOR
BLD2007-01405
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 monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-09 T e rson signing this condition is either the homeowner, agent for the bwner or a registered contractor according to WA state law.
X
2) Approved p Ji�and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
3) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X 6'
4) 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
Department prior t y irth inspections being performed or approvals granted.
5) Owner/Agent is resp bl to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
6) 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 and/or
removal of approv� will result in failure of required building inspections.
X
7) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
8) The"approved"site plan is required to be on-site for inspection purposes. If an inspection is requested and the "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
Building Department prior n her inspections being performed or approvals granted.
X
BLD2007-01405 Please referto the following pages for conditions of this permit. 2 of 5
9) Washington State Energy Code Compliance has been approved using the following:
' Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation•R-10.
Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
underside of t�f she ing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
10) Per 2003 IRC-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 EED 3-SECOND GUST) the wind speed for Mason County is 85 MPH.
X
11) Per 2003 IRC- SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordance with the applicable provisions of this section and the manufacturer's installation instructions.
X
12) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
13) 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. All 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
charged and We
collected by the Building Department prior to any further inspections being performed or approvals granted.
X
14) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washin ton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocatio
X
15) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulatiq b reviewed and approved by Mason County prior to construction.
X_ / --
16) 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
X Inspector shall b prior to requesting additional inspections.
BLD2007-01405 Please referto the following pages for conditions of this permit. 3 of 5
17) ,Alf 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 i ordinan lding regulations.
X j�
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 ra being taken. No more than one extension may be granted.
X
20) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, an flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X
21) Stress grading of structural log members of non-rectangular shape, typically used in log buildings, shall be in accordance with ASTM D 3957. Such log
members shall be identified by the grade mark of an approved lumber grading or inspection agency. In lieu of a grade mark on the material, a certificate
of inspection as to species and grade issued by a lumber grading or inspection agency, meeting the requirements of the applicable code, shall be
permitted. (IBC 2303.1.10)
X �
22) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site PI "toe ure these structures are shown and meet the setback conditions listed.
X
23) Prior to final approval, all upland areas disturbed or newly crea� y construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X ® /
24) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved
access road. oads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads c v c wit ounty maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
25) This site does not comply with Chapter 14. Access and Grades shall be improved to meet code or a residential sprinkler system installed-- requiring a
seperate building permit. Now complies 9/24/2007
This site does not comply with Chapter 14. Access and Grades shall be improved to meet code or a residential sprinkler system installed-- requiring a
seperate building permit.
Note;Re-inspected and found turn -around and driveway grade and surface material now complies with Chapter 14 .
BLD2007-01405 Please referto the following pages for conditions of this permit. 4 of 5
26) Site is located within an unstable Landslide Hazard Area. Adequate drainage/siltation control/stormwater plan must be implemented as part of
development, clearing, grading, or construction on the site.Development should be designed to preserve the natural drainage courses in the area.
Surface drainage, including downspouts, shall not be directed onto or within 50 feet above or onto the face of a Landslide Hazard Area or it's associated
buffer. If drainage must be discharged from the top of a Landslide Hazard Area to below it's toe, it shall be collected above the top and directed to below
the toe by tigh - drain and provided with an energy dissipating device at the toe.
X
27) The Mason County Resource Lands and Critical Areas Ordinance requires vegetative management of the site. There shall be a minimum disturbance of
trees and vegetation in order to minimize erosion and stabilize Landslide Hazard Areas. Limbing trees for view purposes is preferred over tree removal.
Vegetation removal on th
erosion.X pes nks between the ordinary high water mark and the top of the bank shall be minimized due to the potential for
28) Regulations which apply for GRADING of the site (per Mason County Resource Lands and Critical Areas Resource Ordinance):
A. No grading shall be performed in Landslide Hazard Areas or slide prone areas prior to obtaining a grading permit subject to approval by the Director
and based on recommendations contained in the geotechnical report with slope stability analysis and grading recommendations.
B. Clearing, grading, and other construction activities shall not aggravate or result in slope instability or surface sloughing.
C. Undergrowth shall be retained to the extent feasible.
D. Clearing methods which minimize soil disturbance shall be used.
E. No fill, dead vegetation (slash/stumps), or other foreign material shall be placed within a Landslide Hazard Area.
X
29) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report, it's addendums and
approval letter. If structures and/or land modifications (grading, cuts, fills, etc.) requir a geotechnical report may require a seperate permit. The
geotechincal report shall remain attached to the approved building plans. X
30) By definition, ropane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structur eet t setback conditions listed.
X +
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 work is a progre ction within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress insp he owner gent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described poop y ;;rrefor re and inspection.
OWNER OR AGENT: DATE:
BLD2007-01405 Please referto the following pages for conditions of this permit. 5 of 5
o CONCRETE MECHANICAL MANUFACTURED HOMEDate
oC) Footings!Setbacks GasPi ping
BY Ribbons
interior Date By interior-Date BY Date By D
C) Fxter+or Date 6-&C-Ir By,;72 Exterior-Date By Sot-up 3
Point Load/isolated footings INSULATION Dates By T
Date - gy /�2 Date By
INSULATION By -- — -
FIRE DEPARTMENT Z
Foundation Wads floors Date By
Dates By Data /— 2 6--c- i By DECK
FRAMING Walls r Date
Date • "� c' B Date � '
By b� PROPANE TANKS
PLUMBING vault Date By
Date / _ L By � OTHER
Groundwork AtticTYpa./��J/OIC
�In4°�lT•�- "�
Date By Dated By Date J�!�/ v r- B.Vw
D.W.v DRYWALL type.
Int.Brace Wall Date By (a
Date -2 9 ey Date By .._ r
FINAL INSPECTION
Water Li na fire Seperation o
Date By Daum By Data `'� -3 By� p
m V
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments P.
o S� 40
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COUNTY "CD PLANNING
CHAT i , TO APPROVAL
E
+ --_----��-.— Date
144
Nv �� �/� "� \ ,,' �Qi ver✓n_y__, 37�f" 3 Loy �►
PLANNING 91c', yy -
PLANNING:
ALL SETBACKS ARE MEASURED
FROM THE FURTHEST
PROJECTION OF THE BUILDING
oN_STATE MASON COUNTY
�P5 c DEPARTMENT OF COMMUNITY DEVELOPMENT
o s u y= Planning Division
o Y P 0 Box 279,Shelton,WA 98584
IP of �' (360)427-9670
1864
REQUEST FOR ADDITIONAL INFORMATION
October 02, 2007
KEN TAKEGAMI
TO BE KEPT IN THE 110 AUTUMN LN PARCEL FILE
TULLAHOMA WA 37388
Parcel No.: 220031290120
Project Description: New LOG SFR
Dear Applicant:
You have submitted a permit application (case no. BLD2007-01405) for proposed
construction or development in the county. Upon review of your application, I require
additional information to complete the permit review process.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 360 if you have questions.
Sincerely,
Grace Miller
Land Use Planner
Mason County Planning Department
Comments: Staff has received comments regarding your geotechnical report from
our consultant, Jerome Morissette and Associates. Please see their
attached letter. Once we receive the requested information and
clarifications, we will forward them for further review. Thank you.
10/2/2007 1 of 1 BLD2007-01405
Request To Revise AnApproved Plan
Permit Number BLD200-7 NameKPL ► .
Parcel Number 6 Phone Number daytime
Project Address Mailing Address
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 O No
Is a stamped and signed approval included with this request? ❑ Yes ❑ No
(Note:No structural chanees to a"deli "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:
Applicant's signature Date:
Office Use Only Received by:
Date Sent Assigned To Approved By D to
. VB. 1 .Original Valuation: �C� $2 Additional Valuation:Sq.Ft. '�Z I x$ $
Sq.Ft. x$Total New Valuation $ 3 2 a
C�p f a
Additional Fees:
Additional Planning Dept. $
Additional Plan Review $ .
Additional Conditions[Comments: Additional Building Permit $ 30 30
l�• 7S Additional Plumbing $
L f 7 7- p$' . Additional Mechanical $
Additional E.H.Dept.
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
Op"
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ VIAQ Compliance Application
Owner: tZy Telephone: ?a Parcel#: o d
Type of project ( ) New Residence ( ) Addition ( ) Remodel
T1 ---T
otal Sq. Ft. `7� 15 Floor : �a 2" floor: Heated Basement:
of heated area::
Heating System Type: XEiectric 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: 1 II IV
Percentage: Compliance
Method O Component Performance , Chapter 5— Calculation worksheets required
Check one::
% O Systems analysis, Chapter 4
Whole House Ventilation system O Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air
Recovery Ventilation System (VIAQ 303.4.4)
System vents (VIAQ 303.4.1)
Check one
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:
A-lI'I A2 s `jam CvB�U f ��
« �t {
11 tt t 03�0 �S
Windows: Total Sq. ft. 1661 , 06
Doors:
104v
Doors:Total Sq. Ft f D
Total window and door area 1 p, D $
Total window&door area 9 0l(divided by)total sq.ft of heated area zt-ev 0 = e a 5 %of glazing
7 P 77,77.1117"
MASON COUNTY PERMIT NO,
BUILDING PERMIT APPLICATION
426 W. Cedar - P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 e Belfair (360) 275-4467 o Elima (360) 482-5269
On the web www.co.mason.wa.us
APPLICAVT INFORMATION CONTRACTOR INFORMATIft
Owner MCA 'rAk:jffAM; �Q�JAA j4 'Company Name
A A Mail' Add
Mailin d es In 01 4 41 -1 4A89
- City
ess
City.�_9=a__WA__-sta e Zip Code -2-7_M6B /:13213 State LdOr- Zip Code"5&_
Phone �01 Other Ph. PhoneJ6 Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address 4J61 E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic �- Existing Septic
Conn to Zjater System —Name of Water System
Well-1--lo'01 Water System—Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street nNne, street nu ber and city)
DirAtions to sij�zm !Am, MQA
A�li i-
49 46r44 - 12 1
Will timber be cut and sold in Parcel preparation?Yes n
Is property within 200'of Saltwater !165 Lake River/Creek—Pond
Wetland SeasonalRunoff Stream Slopes or Bluffs > 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 PESIDENCE 0 SEASONAL
rt)A Use of Building Describe Worksly�z -J'fAi CA,fj A I_S-f- .0ekL^r= vir 77_ ',❑
__
No.of Bedrooms— No. of Bathrooms I Square Footage - 1st Floor *0& 2nd Floor C'_-)
3rd Floor Basement— Deck—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 th&work as proposed in the application.I declare that I have obtained the permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica-
tion or the work ed in the plica I have obtained permission from them to apply for this permit and conduct the work proposed.
-7
X Date: 7n?!9
Owner/Owners RepresenAive t2ont'r1cl6jr (indicate which one)
FOR OFFICIAL USE BEYOOD THIS RPINT
Accepted b Llin=Planning Pd Ck# Date E5-OU-0 LBId Pd Receipt No.
DEPARTMtNTAL REVIEW APPR VED DENIED NOTES
Building Department
Planning Department
Environmental Health Department (1 F_�"pt� - in�y).s'q
Public Works Department U
Fire Marshal
ben W(I - Loot)I I M 2- f
FEES
Building Permit Fee !JAI . 7V Site Inspection
Ili Plan Review Fee EH Review Fee
Plumbing & Base Fee 58 Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee A,-.0 a'f/'0-- Pre-Paid at Submittal
Valuation $ 21?, 700 . 0-0 TOTAL FEES
1
MASON COUNTY PERMIT NO.
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 2
On the web www.co.mason.wa.us � -
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner.I" TAYfZAaa 1 .X u7-A► ,0 10rAgmti N&K Company Name M'k !!cwyAttl Ce.s»— Al&oAvj,.eiCk t
Mailing Address f 1 D 4"T_Q .n N 114-"P Mailing Address 141 S'F Ai9a t C y V LA dt F
City rR t L A N are 44 State 7-Al Zip Code :1 A 3 CL fr City SUFL L oV State�A Zip Cod �e, �f�y
Phone :r j 3� y?v2 Other Ph. Phone 7 `O I-y f aZ SM Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address w lei k-r,2 C-42t 0140L.6 dr„ E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No.-7 SV od'I iz go 12 (J Fire District
Legal Description `fi /1/Z 19 F WE %y t 1`Air t 3 y 3 Ex,
Site Address (Please include street name, street number and city)
D' ctions to site w TO -7tKf T #AQ n'a * s t AA C-94
c f F HI-[( . AR Pf 00 LIEFT F e1tjq&,,f avf IAO
Is property within 200'of Saltwater V E—T Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric,_ LPC Natural Gas,_ Heat Pump_
Toilets 1 Type of Unit No. of Units Fees
Bathroom Sink 1 Furnace
Bath Tubs Heatpumps
Showers 1 Spot Vent Fan
Water Heater 1 Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs 1 Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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.If permission is
required from any easement holder or any other parry in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work 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.
PROOF OF CONTI11911.11ATION WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: ?- /-* —0 7
Owner/ wners Representa' Contra t dicate which one)
FOR OFFICIAL USE BEYO D THIS POINT
Accepted b . anning Pd Ck# Date 0 Bid Pd Receipt No.
DEPARTM TAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr.-
Planning Constr.-
Planning Department q- , 7
Environmental Health Department
FEES
Plumbing & Base Fee ° Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES