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Home My WebLink AboutCOM2005-00104 Remove 2 Underground Storage Tanks - COM Permit / Conditions - 9/13/2005 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)t27-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext. 352 Shelton, WA 98584 i� COMMERCIAL BUILDING PERMIT COM2005-00104 OWNER: NORTH MASON SCHOOL DIST RECEIVED: 9/13/2005 CONTRACTOR: LICENSE: EXP.- ISSUED: 9/13/2005 SITE ADDRESS: EXPIRES: 3/13/2006 PARCEL NUMBER: 123325000058 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TR 25-B PROJECT DESCRIPTION: DIRECTIONS TO SITE: Removal of 2 underground storage tanks See attached map General Information Construction &Occupancy Information Type of Use: Insp.Area: No. of Units: Type of Constr.: Type of Work: OTH Fire Dist.: 2 No. of Bathrooms: Occ. Group: No.of Stories: Occ. Load: Valuation: Building Height: Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: Model: Width: Building: Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline& Planning Information Front: Ft. Shoreline: Ft. Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Side 1: Ft. SEPA?: Comp.Plan Desig.: Side 2: Ft. Fire Protection System Information Auto Fire Alarm System?: Emergency Key Box?: Standpipe?: Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2005-00104 Please refer to the following pages for conditions of this permit. 1 of 3 Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt f Building Permit Fee KKK Qri 3r9nn5 ear,sin 999nnrnn Building State Fee KKK wi�ignne U en g99nnRnn Total $100.00 CASE NOTES FOR COM2005-00104 CONDITIONS FOR C 005-W104 1) Comply with DOE standards for UST remov 2) Proper erosion and sediment control practices must be used on the construction site and adjacent areas to prevent upland sediments from entering shoreline waters. Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be effective to prevent soil from being carried into surface water by stormwater runoff. Sand, silt, and soil will damage aquatic habitat and are considered pollutants. Any discharge of sediment-laden runoff or other pollutapollutants to waters of the state is in violation of Chapter 90.48 RCW, Water Pollution Control, and WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington, and is subject to enforcement action. Any work in or adjacent to waterways that will adversely affect water quality must receive specific prior authorization from the Department of Ecology pursuant to WAC 173-201 A-1 10. A short-term water quality standards modification may be issued if the proponent agrees to a number of specific construction practices and techniques designed to minimize water quality impacts. All areas disturbed or newly created by construction activities must be revegetated using bioengineering techniques, clean durable riprap, or some other equivalent type of protection again t roSion when of r 'r a not practical. This permit becomes null and void if work orconstruction 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 progress inspection 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 inspection.The owneror the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above desc ' property ructure for re w a inspection. _ OWNER R AGEN ✓ i DATE: COM2005-00104 2 of 3 MASON COUNTY PERMIT NO. CDm d,.W S BUILDING PERMIT APPLICATION OU I D 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 FC ONTRACTOR INFORMATIO Owner NaQ T4 M'ALOV-210 D r + ompany Name �- Mailing Addr s ailing Address t Q A zo City tate Zip Co ty A—'4-eDA- -f-State_w,Zip Code -3 Phone Phone Gca- 4 / - Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# S ? le(v3,C BF DOB 1 - 3 7 SEPTIC /,WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Conn Water System Name of Water System Vueff ewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 1. 3 Z 5 3 o d o 4 T1:2 3 Fire District 2- Legal Description S'g7 %Ajr f4,! d:�eA Say Site Address (Please include street name, street.number an city Directions to site 4-1 �- Will timber be cut and sold in parcel pre aration. Ye / Is property wit Nn 200'of Saltwater Ali Lake 79 a River/Creek �-0 Pond Wetland Seasonal Runoff�Stream--,&Z lulls 15% 4 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 FESIPENCE ❑ SEASONAL_ Use of Building Describe Work n.!:CCo%.� `f GCS/crxl 6fle 4.K,W L a'r No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor2nd Floor 3rd Floor Basement Deck Covered Deck Other 1'r-Gf b Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACrTURED HOME INFORMATION - Make Model Year Length,,e_'- Width Serial No. No. of Bedrooms No. of Bathrooms Type of.�-leat Purchase Price$ Replacement Unit? Yes/ No Installer Warne 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. If 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 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. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS O A OGRESS INSPEti TO INA OF T I PERMIT APPLICATION OF 118,0DAXS WILijNVALIDATE THE APPLICATION. Date: r Q Own ri,�ners Representati / (i ate which one) FOR OFFICIALASE'S POND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPRO ED JDENIED NOTES Building Department 11 Tr PlanningDepartment S(k ?-mhbLio lot, Environmental Health Department i Fire Marshal FEES Building Permit Fee ns ection Plan Review Fee EH Review Fee Plumbinq & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES