HomeMy WebLinkAboutBLD2012-00237 Addition - BLD Permit / Conditions - 5/30/2012 Inspection Line(3(j0)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
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RESIDENTIAL BUILDING PERMIT BLD2012-00237
OWNER: KEN FRANCKOWIAK RECEIVED: 4/16/2012
CONTRACTOR: LICENSE: EXP: ISSUED: 5/30/2012
SITE ADDRESS: NE SABER DR B FAIR PARCEL NUMBER: EXPIRES: 11/30/2012
LEGAL DESCRIPTION: BEARDS COVE DIV 8 LOT: 84
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
ADDITION OVER EXISTING GARAGE NO NEW FOOTPRINT (NO NEW STATE ROUTE 300 TO SANDHILL. LEFT ON LARSON BLVD RIGHT ON
PLUMBING OR MECH) CAPTAIN HOOK LEFT ON SABER TO ADDRESS
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: R-3 Lot Size: Deck:
Type of Work: ADD Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:480
Valuation: $ 49,396.80 Building Height: 16 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body:
SEPA?:
Model: Width: Ft. Rear: Ft. Slope: Ft. Shoreline Desi
Side 1: Ft. g..
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee GMM 4/16/2012 $418.44 S1201200000001
EH Plan Review MRB 4/30/2012 $ 103.00 S5201200000001
Building State Fee LDK 5/10/2012 $4.50 S1201200000001
Building Permit Fee LDK 5/10/2012 $643.75 S1201200000001
Total $1,169.69
BLD2012-00237 Please refer to the following pages for conditions of this permit. Page 1 of 4
CASE NOTES FOR
BLD2012-00237
CONDITIONS FOR
BLD2012-00237
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.
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2) 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
De pa t prior to any further inspections being performed or approvals granted.
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3) Own nt is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
4) 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
X mov�l;e.�)approved documents will result in failure of required building inspections.
5) Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option III, Window(Max U-Factor):0.30, Skylight(Max U-Factor):0.50, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38 advanced or R-49 standard, Vault Insulation R-38,
and Slab Insulation R-10.
In addition the following credit from Table 9-1 shall be completed: 6
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6) A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC
Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall
be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or
installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps).
Refer - SEC 505.
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BLD2012-00237 Please refer to the following pages for conditions of this permit. Page 2 of 4
7) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
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8) 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 a[w shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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9) 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 Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit rev on.
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10) 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. For 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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11) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinan regulation, must be reviewed and approved by Mason County prior to construction.
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12) 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
Inspect hall be made prior to requesting additional inspections.
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13) 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
Maso unty ordinances and building regulations.
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14) 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 vented action from being taken. No more than one extension may be granted.
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BLD2012-00237 Please refer to the following pages for conditions of this permit. Page 3 of 4
15) , Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
conn s, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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16) Retaining walls needed to support a surchar ch as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X�-
17) 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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18) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approv e Plan"to ensure these structures are shown and meet the setback conditions listed.
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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 progress inspection within the 180 day period. Final inspection must be approved before building can be
occupied. Proof of continuation of ork is by means o arve
ress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate
and grants employees of Mason/Co ty ac s tot described property and structure for review and inspection.
OWNER OR AGENT: , DATE:. fit ���
BLD2012-00237 Please refer to the following pages for conditions of this permit. Page 4 of 4
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
Irflo Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2012-00237
OWNER: KEN FRANCKOWIAK RECEIVED: 4/16/2012
CONTRACTOR: LICENSE: EXP: ISSUED: 5/30/2012
SITE ADDRESS: 201 NE SABER DR BELFAIR _ EXPIRES: 1/11/2013
PARCEL NUMBER: 123315100084
LEGAL DESCRIPTION: BEARDS COVE DIV 8 LOT: 84 "
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
ADDITION OVER EXISTING GARAGE NO NEW FOOTPRINT(NO NEW STATE ROUTE 300 TO SANDHILL. LEFT ON LARSON BLVD RIGHT ON
PLUMBING OR MECH) CAPTAIN HOOK LEFT ON SABER TO ADDRESS
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use: SF Insp. Area: No. of Bathrooms: Occ. Group: R-3 Lot Size: Deck:
Type of Work: ADD Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:480
Valuation: $ 49,396.80 Building Height: 16 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body:
SEPA?:
Model: Width: Ft. Rear. Ft. Slope: Ft. Shoreline Desi
Side 1: Ft. 9..
Year: Serial No.: I Side 2: Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type City. Type By Date Amount Receipt
Gas Outlets 2 Plan Check Fee GMM 4/16/2012 $418.44 S120120000000(
Propane Tank 1 EH Plan Review MRB 4/30/2012 $ 103.00 S5201200000001
Propane Stove 1 Building State Fee LDK 5/10/2012 $4.50 S120120000000(
Building Permit Fee LDK 5/10/2012 $643.75 S120120000000(
Mechanical Permit Fee TW 10/16/201 $ 152.20 S220120000000t
Mechanical Base Fee TW 10/16/201 $ 28.50 S2 2 01 2 0 00 00001
Total $ 1,350.39
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BLD2012-00237 Please refer to the following pages for conditions of this permit. Page 1 of 4
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CONCRETE MECHANICAL MANUFACTURED HOME
O Date By� D
N Footings/Setbacks Gas Piping Ribbons n
o Interior Date By Interior-Date f(-7r-f L By }� Date By
o , 1 N
J Exterior Date By Exterior-Date `V B Set-upC0
Point Load l Isolated Footings INSULATION Date By c
Date By Data SLAB INSULATION By FIRE DEPARTMENT __ D
Foundation Walls Floors Date By m
Date By Data IZ Z By Wq DECKS Z
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Dale By OTHER
_ w.._
Groundwwork Attic
Type
1 ,'c-y Date By Date By Date By
f
D.W.v DRYWALL Type.
Int.Brace Wall Date By IA
Date By pate By r
v FINAL INSPECTION 0
N Water Line Fire Separation C
m
m Date By Date By Date J B
m N
s Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments N
CD C4
v �v.
CD
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From: „Chuck Williams" <chuck@cwaconsultants.net>
To: Debbera Coker"' <Dlc@co.mason.wa.us>
Date: 6/27/2012 1:31 PM
Subject: RE: Franckowiak Garage Field Question
Attachments: Frankckowiak Garage Addition Holes in Beam .doc
See attached
CW
-----Original Message-----
From: Debbera Coker[mai Ito:Dlc@co.mason.wa.us]
Sent: Wednesday, June 27, 2012 10:43 AM
To: Chuck Williams
Subject: Re: Franckowiak Garage Field Question
Would you send me the statement with your seal and signature?
Debbera Coker
Mason County Building Department
Building Inspector IV/Code Enforcement
Phone: (360)427-9670 ext 510
FAX (360) 427-7798
e-Mail: DLC@co.mason.wa.us
PO Box 186
426 West Cedar Street
Shelton, WA 98584
>>> "Chuck Williams" <chuck@cwaconsultants.net> 6/27/2012 10:38 AM >>>
Debbera
This is on a different house (Franckowiak Garage). It is acceptable to
drill a maximum 2" diameter hole in the 3-1/2"x9" LVL beam over the garage.
The holes can be located anywhere between the garage header and the Glu-Lam
near the center of the garage and the centerline of the hole should be a
minimum of 2" from the top or bot of the beam. The only purpose of the
beams on either side of the garage door is to support the end reactions of
the roof girder truss above at the cantilever. They support no other
vertical loads. The stresses on the interior of the beam are minimal.
If you have any questions please call or e-mail me.]
Thanks
Chuck
CWA CONSULTANTS, P.S.
STRUCTURAL ENGINEERING
BUILDING CODE CONSULTANTS
8675 E.Caraway Road,Port Orchard, WA 98366 (360)871-5433 FAX: (360)871-5633 E-Mail:chuck@cwaconsuhants.net
June 27, 2012
To: To Whom It May Concern
Subject: Franckowiak Garage
It is acceptable to drill a maximum 2" diameter hole in the 3-1/2"x9" LVL beam
over the garage. The holes can be located anywhere between the garage header
and the Glu-Lam near the center of the garage and the centerline of the hole
should be a minimum of 2" from the top or bot of the beam. The only purpose of
the beams on either side of the garage door is to support the end reactions of the
roof girder truss above at the cantilever. They support no other vertical loads.
The stresses on the interior of the beam are minimal.
I trust this alleviates your area of concern. If you should have any further
questions, please don't hesitate to contact me.
Sincerely,
Chuck Williams SE
CWA Consultants, P.S.
C:\Documents and Settings\Dlc\Desktop\Frankckowiak Garage Addition Holes in Beam_1.doc
Perrnit# 13i MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
OK to 1,<W6 Ere- I`��%/� �—� /�(,�✓/�' damage incurred by recent
This is not a complete inspection isastersman made"
❑ p p disasters.This is NOT a
CORRECTION NOTICE.
Date � - -� � � Department C- �
Inspector7`��
-V k ,, *T i ' 'r1k ' THI T,_"
Permit# MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTiON NOTICE
Job Location 2-L t
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
foil Items I'sted,below mus be c rected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
Cell for re-inspection when corrections are made before continuing ❑ please contact our office
Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
❑ This is not a complete inspection "natural/man made"
R 1 disasters.This is NOTa
Date Department CORRECTION NOTICE.
Inspector L
■ 11 N� iff x* -�T - ' THI T ,
k
MASON COUNTY RESIDENTIAL P .ANS SUBMITTAL CHECKLIST
}wner's Name._
�("(',tr�(' a 1 Date � � Reviewed By.
)oczanents:
Building Permit Application Completed I�l Stogywater Checklist
planning Intake Checklist Completed,
�( Site plan includes:Allowable building area,roof overliangs,decks,etc.
W�Q Fire Apparatus Access Road info required? Yes/No
_Energy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace
O Heat pump with electric Rmlace O Heat pump with LPG furnace O Boiler(heat type )
O Other. Specify.
OQechanical/Plumbing Application-WATER HEATER FUEL TYPE/LOCATION
Engineering? Yes/No Snow load:_ Seismic: _
Stock Plan—approved snow load: Seismic:
✓tanufactured Homes—4 FLOOR PLANS
Foundation Type: ANSMvlanufacture method Engineered footing/foundation Basement
Decks: Covered? Uncovered over 4 x 6 and over 30"? Construction plans required.
;onstruction Plans:_3 COMPLETE SETS
—Plans Legible _Recognized Scale _Elevation Views _Cross Section
_Foundation Plan _Roof Framing Plan _Floor Plan-Use of rooms noted(all floors)
_Floor Framing Plan-all floor levels including loft,crawlspace,etc. (<'100 S.F. ??—stairs?)
—Dock Framing Plan,incl cov.porch framing
'tan Details: r
Roof framing details,truss lay-out may be needed a-lip and girder location shown) ��nt t-� ►'use
Wall Framing-Does bearing-wall height ex 10'?(Engineerm maybe required) Z.XL& e
�Floor framing: Floor joists(size&spacing) ����p �� Floor beams:
Window headers. Typical header. rCT e header:
Foundation:footing size,reinforcement
Concrete Walls-Does Concrete Wall Height Exceed 8' ngine ng may be required, see details)
v Landings at all exits?Less than 30"above grade?Y/N
�. Heated By Furnace-Location of furnace Fuel type:
Fireplace/Stove Information Shown-Fuel Type? Location(s):
Window Sizes Marked on Plans
Braced wall panels(shear walls)marked on plans or lateral engineering?
2-story garage? (Engineering may be required) 1d story of two story Dl—450/6,D2—55%
COMMENTS:
ENGINEERING REQUIRED
_ Braced wall panels/brace wall limes are not marked on plans(R602.10)
Amount and location of bracing does not meet minimum required in Table R602.10.1
DESIGN CRITERIA— All notes and details required as a result of the engineered analysis shall be transferred onto proposed
building plans. Wind 85 MPH, Exposure B(unless proven otherwise). Seismic Zone: ,Snow-__psf
IRREGULAR BUILDINGS R301-222-2
Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be
considered to be irregular when one or more of the following conditions occur
1)Exterior braced wall line or BWP cantilevered or offset by more than 4'
2)Roof or floor is not laterally supported on all edges
2A)Portion of roof or floor extend more than 6 fL beyond the braced wall line.
3)End of BWP extends more than 11 over an opening more than 8 ft in width below.
4)Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension.
5)Portions of floor level are offset vertically
6)Shear wall lines do not occur in two perpendicular directions.
7)When a story above grade is includes masonry or concrete construction(exc:fireplaces, chimneys,and veneer).
When this applies the entire story shall be designed.In accordance with accepted engineering practice.
I- hermit tech building checklistdoc Revised 11-29-2007
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/Ventilation Code Compliance Application
Owner: Parcel#: Type of project:
Total Sq. Ft. 4t& 15 Floor: 2 nd floor: Heated Basement:
of heated area::
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other: Specify:
Glazing Compliance ® Prescriptive Option (see reverse side) circle one: I II III
Percentage: Method O Component Performance , Chapter 5— Calculation worksheets required
I 1_7 % Check one::
O Other (specify):
Check one O Whole House Ventilation system O Whole House Ventilation O Other,
Ventilation using exhaust fans&window or Integrated with a Forced Air describe:
System wall fresh air vents(M1508.4) System (M1508.5)
Referencing WSEC Section 901, "Additional Residential Energy Efficiency Requirements," all
NEW residential units must develop 1 credit from Table 9-1. Identify and describe which option(s)will be used
ENERGY to cc If the table is not attached to this form you can access the table on our website at.
CREDITS ://www.c .mason.wa.us/forms/Communft Dev/index. h .
ption: escription:
Table 9-1 L-4 Lo tficvais 4-p LKYJ i 9!� wi Id La4v�
indow & Door Schedule (If needed, a tach an additi nal sheet)
Total
Manufacturer Room/location• U-Factor Size Quantity —Square Feet
Windows:
S 4t 0 JL 40
r a41
Windows: Total Sq. ft. 5D
Doors:
Doors: Total Sq. Ft
Total window and door area
Total window&door area I(divided by)total sq. ft of heated area Bo 1Lo -7 %of glazing
9,1
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION ��2
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 =kT
On the web www.co.mason.wa.us
APPLICANT INF MATION CONTRACTOR INFORMATION
owner �i4n1C6��s %� [� Company Name d6�ti�'z
MailinciAddress ACI NE 5AtWO 012, Mailing Address
City t State WA Zip Code g S7 Z V City State Zip Code
Phone Other Other Ph. Phone Other Ph.
Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to-New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
r
PARCEL INFORMATION - 12 Digit Parcel No, f Z33 i- 51- Fire District
Legal Description b ' > t le)L I)i y !& Lc7 gy
Site Address(Please include street name, street number and city) N F,Sr46e,? Z)e_ G,,!z l :Cat
Directions to site Iw`� 3c:: .Z S,+L,c i+,ll ► 41 i 4-2-, 9i,k) - ��� CA0+,art l+r%-it �- c;v s�C3e�
Will timber be cut and sold in parcel preparation?Yes N
Is property within 200' of Saltwater tiv Lake vv River/Creek MJ Pond
Wetland k�.) Seasonal Runoff—,6�rLStream 6LC 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 PRIMAR)' ESIDEN E K SEASONAL ❑
Use of Building i ti n1,�2uT Describe Work�L"' a" .,,QQ� C (� - 7r -�\
No. of Bedrooms No. of Bathrooms Square Foot ge 1st Floor_ - 2nd Floor
1 - -lj:t�t
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage_. - Attached Detached Carport Attached Detached
MANU ED HOME IN FORMAT - Mod Yea
��L��h Wi Serial No. No. of Be ms of Bathrooms
ype of Heat Purc se Price�7$ Re cement Unit? Yes/Nstaller Name ertification 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 othe/ct
interest regarding this application or the work proposed in the application,I have obtained
permission from the to apply for this permit a the work proposed. The owner or agent on owners behalf,represents that the information
provided is accuratand nts em ees ounty access to the above described property and structure for review and inspection.
PROOF OF t� I WORK BS OF A PROGRESS INSPECTION.
X / . Date G 2,aeg,Z. .Z6/Z
ner/Own Re resentative NContractor indicate which one
FOR FFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department p �,
Planning Department -
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Buildinq Permit Fee Site Inspection
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 I Pre-Paid at Submittal
Valuation $ 1 TOTAL FEES