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Home My WebLink AboutBLD93-1852 SFR - BLD Permit / Conditions - 1/29/1994 MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 11-� It.0 :0 U ID I[ M C:::i U,* I-? M I I UOR 1 1 t i I I p hl 1, 427 -46/0 H V T!-I F t N f.pfii it N I ai,atn 4?7—/2 6 2 OLD93-1862 PARC L I , 1, 233.1 '-it 0008t), PI AT : H L P 1 0 1 Vc f1i l( 'S � NE 31 BRIGGAIDUH OR HFATR QLJNrk - 001) Sift f4+ to mir. Ne.u3mar <E- Ke-wrnan CONTRACTOR .- OWNER IS CONTRACTOR LF(iAk . IF111.0% COVIF PIV 1 111,11- tot! 86 f S 14131 111 161-- CLA%S OF IJORV aNI,W BF DR. IIYWt 64111INT NY "Alt RfUlf"I IVP(' A001191 8f DA f REtWl 'TYPE OF S,F TOR I 0 cf:tjp . GROOP , 10,06 . lit- Ildi I cy kf I I RAI)# 4,1111 fW 4114104 341135 TYPE' OF CONSI FIRKPLACES , Lh P 1,0, 1 0,.40 14 IINII/94 34136 OCCI)P - 1.0Af) . 0 WOODS I OVE S 34m 1114E 1 1, . I.)N I i 0 P AR I N N 5 P A C 17Siff TU 01128/44 3441F, L 1N*sPk'-C1 YON AHI` h I H 0 R F t- 1,N U N T A� V8 AC KS',—- — - ---- - ,- 01LF I 1. m I- - - -. k 1)m t Mtm I I I FRONT', < 4C,J 3 0 0 f t., HAT14 HASIN!� , lip 0 RUAR . . . . E 10 Of t, HA I'll rtlb,. 1.1> 1411 0 M(Mf I 11AF f i N 11 0 f t '.:fluwl K!1 f-(JRN (4 ic, is I 1) 0 fit) 0 M it I- s T cIF I 1 0 t I, W AIX R H f- A I F 14 r 1 F 0 R N 10 0 k I 1 11 0 HF (j SHRI INE 0 0 r. C L.0 Iff f. fit E k .1 P 0 k m f t tittle 14 P A R V A K I I is it I`_N 1 H 1, S 1 fi E A T pkjml' 1.0'r SIZE +I Qot� DRAI.Hs 0 VFNIT f VIII, 0.00t EPS , 0 1 FN(j 1 i1 0 8U.f I f) [146 14 00s f DRINKIN6 1011NI 0 VFNI F 4-,N 0 U I 0'r H 0 0sf LAUNIMY IPAYS _ 0 I.N t)v.c v 0 f 0 1 S 1H W A ci H E R I A R 1 1 N 1,� ljtq t i INCIN - 0 GAP/CARP . (! 484i`i f GiARH DTSPO Al.`,i 0 0-"_ .j000O C- t-11) vl Pt I (W I,If PA I f? 0 AT /D'I A UR INA I 0 4_4_:ptj00 ("fin 0 0111fli UNI 0 MIS(: 1_1 I m 11 X T 1i R F S 0. 6 A', 0 1.) 1 1 PROAM LOMM"NORTH CHopf ROAD RIAHI ON SAND Hill ifft 00 SAORF DRIVF, Mot, 0`04.11,196AP114 01110, INTS PERNI-I BUMS MI. AND VOID if Vogl OT ((INSTRUCTION 40THORIZED is NOT ceivicto :0,111114 1811 DAVS.. 09 'IF (611SIRMION OR WOU IS SUMNO[b FOR A FIRM Of 180 DAYS At ANY 1111 AHFR.� IS (ONNENf�,I). fVMIACE Of CONTINUATION Of WORt fS A 1`9049fic� INSPIC1140 U111119 [Of 180 !JAY PE1100 H M NAt 10I) IDN ADS1 of AFPOQvfo effolE 0(11(9111�fi ( A* 0(typice. OWNER 04 ANENT: 441E: CONCRETE - ��'� 1 ,�f x} MECHANICAL MOBILE HOME Footings-Setback d date by L Ribbons dates _ 4--- by. Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date '7- ! - 5 y by PL,r date by date by FRAMING Walls FIRE DEPT. dateCy-3 b — c( by date cq —a by date by PLUMBING OTHER Groundwork Attic date � -/1-1�l b G_-J date 3^2 3- 5'�" by D.W.V. WALLBOARD NAILING ►�r �ir'�roe-)e,c date !JLC. - - 5 c by t date (�?�. 10 �(�yy by L c 1 aL J Water Line FINAL INSPECTION date crV- &3 � -y cj by [ date 3 by date by �4-� e- r CD Cc� 1( tJ�1 ll s � MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 C. 14 M 1. 1 t-, (.3 Ili 11 ,111- 1 '1 0 r4 IF; a ra*? No . t HL,D93-185? Fol . HOH GotTIS Page : I 1 ) All approved plan% arve r-equil-tpid to bo oil -s it P for- i tmpec 1.! oll p I 11,1)o'."(a s. i.s c.i4lled for and VlAn� aro riot. on 0t (4 , Appcok/at 41111- Nil [ ho v a it L v(i n A d d i a ri . it PIR-1 rlsper;tf oil fope in the Amos.int of $-,10 , 00 per how- (mi,titnitim I gotit' ) t-ltll b;p chAcciod and MUSt: be r0IAC,-CtRd by thiS OC4f)AI-t-01011t. prtot- to Arty fitri-JifAr verformod oi- Appt-ova.1 ?A cl X PUR St AN F TO 1ti91 (IN I FORM HU I L 01 NG CODE: , SEC I I ON 305( C, ) AND .�'F C f I ON t) I A t 1, S f'f FIS MOST HAVE AP -KOVED NUMHERS ON AljDRFSsF:i PROVIOLD IN '01CH A POSII ION AS 10 Fit PLAINLY VUSIHIF AND Lffitlht f FROM THE STRfET OR ROAD FRONTING I HE PR011f:P I'Y , MASON C011N I Y 6 if 1.L()I NG OLPARTMEN"I REQUIRES' '[ HAI' THIS BE cOmpt FTED PRIOR 11) CAI ( ING f-OR ANY �; ftf` TNI,'P CTIONS , A REINSPECtJON FEE . HASff) ON RATES IN TAHtf: 3A OF THE 1991 IINIFoRM H11111ITNO (:Of)f, WTI I. HE ASSESSEO IF OWNEO/CONT-RACIOR FAILS to PPS ADDRE ;!1 ON 1�114_ PIR1011 11.) T N S,P U.C, T V. -YVI 3) The wke , haiicllinq and 6tovacIft of hAZAI'dow, iyfmtot i .11c, ot, and coffobti" tibip 11.4111.1d" in ex 'P.6% of 10 qmljoll.:: it; riot. allm.lold Ihe Ma!�;on Cotirity F i r cz M h .A 4 AI E. U1- ION M"'i I MEEI OR f=Xf.Ffl) All Litt Al C011f,'.; ANO iftli, f<f. ipt I N to approved buil.dinq plAng t4lmt' p f f*I c I (,omp '4 n c o I Uw hlviqt..on y.Fi-ifirg Code , 1991 Vent.il e� l_-.ion and Indool, Ait, QiiAlitv C o d 0 , th v Uni- for-in Hijilding codv and/ou Masion Comity bo appr ()vc!(l by Mahon Count.V pvlor- to 6 ) 'flwi PRO "JEC f wil_t. MEET THE 1, 0mc, -fFRM supER cloot) ct,-N 1 14 E Q I I t R f M I N T!� A 1�; AGRFt D OPON W1 III 1 14F E L VC TH J f, 1)1 1 L I TY SERVI C I NO Itif PROPE'RIY . 1N1;PFC1T0W; FOR fNII?(1_1Y (' 00f COMT11 IANCff ( INSIAI-ATION & INDOOR VENI It-AfToN) Witi. HE PERFORMFO HY A (11- 11 1 rY 1-0:PR( f N I A 1 *1 Vf If C.ha%p o,c c,w r a n 41 you dec, ldo not to q(,) with ih tll;fif! jjf*6(j1: to Art-antle pner (ly (.:ode Camp IiAtl,m CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date by . Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 r o 11 1 i o c t,tj r p )r an 1:j MA10 �f ,1 � VI1Mg Ni Den will he.lvo t1f) h •f?"orded J.J; I h iJit-, doRd af-i W'll- 01-cfipaflr�y td P,d i F7,p c, "1 .1 11 ff)(.1 L a t. CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls -date by Set*LJp date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98534 (206) 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 code compliance �_�� l G��3Y� ��•� � �r�VO(l��ll, �1�=5 y-� 1 �'!� �---�:� d� Zy/lrr�(' 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 ❑ Make corrections, items will be checked on next inspection XOK to Department /9 Date �- 2 3- i'S� Inspector L -� ■ ioks NnT MOOV THI — TA ,olm , \ \ r * WATTSUN 5.3 LONG TERM SUPER GOOD CENT3/1091 MCS COMPLIANCE REPORT 12/07' ' rLE: 4:LT0496 -WS HOUSE ID: lt93-03`' 3ite: NE 31 BRIG9ADUN Anal/at: TONI HERMANSEN BELFAIR, WA 08508 Jurisdiction: MASON COUNTY { 206 }275-3997 Utility: MASON COUNTY PUD #3 Homeowner: 808 3OLTIS House Type: Single Family NE 31 BRIGSA[X]N Floor Area: 1400 ft2 ( 206 )275-3997 Builder: BOB SOLTIS Weather Data: Olympia, WA P.O. BOX 767 Climate Zone: 1 | | The PROPOSED design QUALIFIES for SGC( 01 MCS ) Tier 1' . . � REFERENCE PROPOSED � | COMPONENT PERFORMANCE 296 294 Btu/hr-F � } ENERGY BUDGET 2.89 3'11 kWh/ft2-yr � | � REFERENCE DESIGN Reference lomponent Description Value X Area - UA ______________________________________________________________________________ On Grade Slab R15 2 ' horizontal w/TB F-0.520 156ft 81 '1 Glazing @15% 0'35 U-value U-0'350 210.0 73'5 Doors- Metal R5 base case U-0,190 21.0 4'� A8 Wall R21+R5 ADV U-0.041 078 40'1 Ceiling, Attic R40 blown Attic ADV U-0.020 1400 28 '� Infiltration Standard air sealing ACH-0'350 10850ft3 69'5 ____________________________ Reference UA 296 _______________________________________________________________________________ PROPOSB} DESIGN COMPONENTS . ^ Component Description Value X Area = UA ______________________________________________________________________________ On Grade Slab R10 2' vertical F-0'540 ' 156ft 84.2 Glazing @10N ""NW XO W/LOWE U-0'320 95.0 29.51 =NNW PATIO W/LOWE U-0.360 41'0 14 '3` Doora �::K' EACHTREE AVANTI A300 OR EQUAL U-0.000 21.0 1 '9x A8 Wall R21 INT T1-11 U-0.056 1052 58'1--) Ceiling R49 blown Attic STD baffled U-0.027 1002 29.5 ________________________________________________________________________________ ~ Itema in parentheses not included in COMPONENT PERFORMANCE twteLa, Denotes non-standard values - check calculation of thermal value. * Denotes adjusted UA to reflect 7-1/2 mph wind speed. Page 1 WATT UN 5.3 LONG TERM SUPER GOOD CENTS/1991 MCS COMPLIANCE REPORT 12/07/'- -TLE: R:LT0496.WS HOUSE ID: 1t%-04�- R49 blown Attic ADV U-0.020 30:3 Infiltration Standard Air Sealip.;j ACH-0.350 1005oft3 64 -------------------------- Proposed UA Struc Mass Slab w/carpet w/pad, Sheetrock wall M- 5.000 1400 7nQ ------------------------------------------------------------------------------ - HEATING/COOLING/VENTILATING SYSTEMS PROPOSED Heating System Type : Electric: Zoned System Efficiency: i()() % Modified Efficiency: 100 % Design ACH: 0.60 Heating Load{ at 53F dt ): 18212 Btu/hr, System Size: 5.3 kW Maximum Size 0150%: 8.0 kW Average Annual Heat: 6313 kWh Annual Cost: $ 204 Ventilation System: Integrated Spot Whole House Cooling System: SEER: 0.0 Cooling Load( at 5F cat ): 13214 Btu/hr Recommended Size @125%: 1.5 tons Annual cool requirement: *Am kWh/yr Solar Access: Partially Shade(-.1 GLAZING ORIENTATION PROPOSED PROPOSED , 3ok-Ith 3-4.Of North 34 .Oft2 Southeast Northwest East 34.,() West 34 .0 Northeast Southwest - ---------------------------------------------------------------------------------- Economic and energy consumption estimates are designed for comparative purposes only- Actual cost for heating will vary depending on weather conditions, occupant lifestyle and other factors. Page 2 Road No: Road Name: MASON COUNTY ROAD DEPARTMENT 411 North Fifth Shelton, WA 98584 PERMIT Subject to all terms, conditions and provisions written or printed below or on any part of this form, PERMISSION IS HEREBY GRANTED TO: �`LVM� tJ 'U�`L�/A4 v I A,/ 0-- Address: 42C Q 3 1061171ffAy -Ac A 10 ��"Phoe: 27.s- ss zLr To install a c � S Location: Rt 6- Legal Description: eSM fx� (Z-(/es;7— K� REMARKS: Culvert Specifications: Culvert to be metal, concrete or polyethylene. Culvert to be minalm of 11' diameter by 2V length. Culvert wiz lay in ine of ditch. Access to be graveled to property line with 3' of clean gravel. A Bond in the amo of S �-� _accompanies this permit. (Rct. 4 1 _tiunt 2' Check 0 . ) Contractor: Address: Phone: License No: Expires: * Access will be staked and flagged by Permittee for pre-inspection. * Access will be pre-inspected by this office prior to installation. * Access installation shall be in accordance with county specifications. * Commercial/multi use access shall require STOP sign, installed in conformance to the MUTCD manual, at intersection with county road. No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with, and received instructions from the Road Supervisor , Phone: 427-9670 extension 450. This permit shall be void and bond forfeited to Mason County unless the work herein contemplated shall have been completed on or before: , 19 DATED at Shelton, Washington, this day of 19 Issued by: CONTACT OFFICE WHEN ACCESS IS COMPLETE FOR FINAL INSPECTION Title: r N. SCALE: 1"=20' Bob Soltis, Inc. Beards Cove Div. 8, Lot 86 NE Briggadun Q 2 --------_---- ----- w �en�h S v type �' .v 5 2 6 0 yo' ,•,pOVJec r, l.4e o Pe5 1� CP �y 22 •o a � -', �O G2 O� N. SCALE: 1"=20' Bob Soltis, Inc. Beards Cove Div. 8, Lot 86 NE Briggadun p°• o 3°• EXtS�,NGa ta ------- ----------� o ty pe a 5' Z 6 �O 1 i 26• Jta�nt�e`a g W e[ r', _ ater �eSetJe S` 13Z 2 2 � 30 90 G2 O� Q. �9 dsv! zmeo ZZ OZ O� Z , Z - $ O 9 Z ' 4F as�� o ---------- ------- P�a�}U`Q�N�ls,X� cr, ��uaa1 to _ r ZZ ,O r unpe66ia8 3N 99 10-1 69 'Ala OAOO SPJeOG '3ul `S!lIoS qo8 ,OZ=,.I =31vos 'N l BEARD'S COVE COMMUNITY ORGANIZATI PC p; T. � D E �1 � P.O. BOX 338 BELFAIR, WA 98528 FL� 1 t LC December 27, 1993 _ u c u u u J GENERAL SER1ilC=S Mr. Mike Burns Building Department Mason County Shelton, WA, 98584 Dear Mr. Burns As per our conversations on December 14th and December 23 regarding the building lots owned by Mr. Robert Soltis, I have discussed the situation with our Attorney, Mrs. Carrene Woods with the following results. Mrs. Woods recommended that we let Mason County know that we understand the situation and give our approval for the normal setbacks on each lot as per county specifications. . In regards to Beards Cove Community Organization giving a variance on adjacent properties,Mrs. Woods advised us that it would have to be up to that adjacent property owner not Beards Cove Board Members to give the variance. Therefore,according to Mrs. Woods, the document which Mr. Soltis had me sign as Board President on December 13, is invalid and must therefore be resubmitted with each adjacent lot owner giving his or her approval for a variance on each of the setbacks. I will be gone until the 3rd of January,and will contact you upon my return. Again I would like to thank you for your help in this matter. If Beards Cove Community Organization can help alleviate this matter please advise us how you would like or us to proceed. Sin rely Dennis . Bilow, President Beards Cove Community Organization BUILDER\HOMEOWNER AGREEMENT LTSGC# g3_C'4q (, Super Good Cents HOMEOWNER: BOB SOLTIS PHONE: 275-2997 SITE ADDRESS : 31 3r1G9a�Ll�1 ACCT: MAILING ADDRESS : P.O. BOX 767 BELFAIR, WA. 98528 BUILDER: BOB SOLTIS PHONE: 275-2997 MAILING ADDRESS: P.O. BOX 767 BELFAIR, WA. 98528 I understand that in order for the electrically heated home located at the above address to be certified and in addition qualify for "Long Term Super Good Cents" . Home must be constructed in compliance with the Washington State Energy Code, attached Wattsun heat loss and Long Term Super Good Cents addendum\specifications . I understand that inspection by District staff is required at each of the following stages : Prior to pouring of concrete slab, if required. Prior to installing exterior insulation and damp proofing the below grade basement walls, if required. X Prior to installing insulation (structure is framed, roof is on, roughed-in plumbing, heating, wiring, telephone and TV cable are installed, and all penetrations are sealed) . X Following installation of insulation and vapor retarder but prior to covering. X Final inspection - all components installed. X Other AS NEEDED. NOTE: Final inspection by our Super Good Cents Department must be 6ompleted prior to the final inspection of the appropriate Building Department. It is understood that the Super Good Cents Department is to be notified at 426-0777 or 426-8255 Ext. 777, not less than 48 hours prior to required inspections . I understand the "Long Term" Super Good Cents certification by Mason County Public Utility District No. 3 only verifies compliance with the Long Term Super Good Cents program standards and only in respect to energy efficiency. Neither the District nor any employees make any warranty, exPgpssed or implied, in regard to the general workmanship and structural integrity of the residence or the future electrical consumption. I, the undersigned, understand that if the home is built according to this agreement, the attached specifications, detailed checklists, and addendum, and is certified by the District representative that I will be eligible to receive Long Term Super Good Cents incentive payment(s) in the amount shown on the attached worksheet. I further understand that it is my responsibility to be aware and adhere to the Long Term Super Good Cents specifications . Only upon verified completion by the on-site inspections listed in the agreement of all the attached criteria by the Mason County Public Utility District No. 3 Long Term Super Good Cents representative, will the house be certified as a Super Good Cents home. Signed: H eowner Builder Date Date Federal ID¢# or ocia ec . ## Federal ID## or Social Sec. ## — jvq_� Nt'und'tLL, U i i y Represen a ive TONI HERMANSEN Utility epresen a ive (prin ) DECEMBER 6, 1993 Date Homeowner conservation incentives may be paid directly to homeowner, or applied as a credit on your utility account. Permit No. MASON COUNTY BUILDING PERMIT APPLICATION giN� �- PLEASE PRINT / �J 3 w #1 Owner aOJ9 �� L , �-r Phone# ��1`/ 7 Site Address AJe 31 A.A Fire District # city— zz-PAgc St Zip Directions t Job Site 14 a}• 4A J Owner Mailing Addre Ali City St Zip Lien/Title Holder A� Address City St Zip #2 Contractor Name Contractor Reg#.S'l{///'1/P 9e_ 6--) Address/oc 70/ r Expiration date G City Stt&LZip Phone #3 If septic is located o project site, include reco ds . Connect to Septic? Public Water Supply Well (If residential, proof of potable water is required) #4 Parcel No. � - - Legal Description #5 Building Square Footage: 1st Fl-5Zff 2nd F1 13rd Fl_ _ Loft Basement) Deck G�� #bed #bathrooms o2- Garage Carport Garage/Carport. Attache or Detached Other #6 Use of building— Describe work #7 Type of Job: New- Add Alt Repair Demolition Re-Roof Bulkhead Other #8 MOBILE HOME INFORMATION Model Year Ma Model Length Wi th Serial No. #Bedrooms # o s Type of Heat #9 Any water on or adjacent to property: saltwater lake river pond wetland seasonal runoff other r Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Scale: Name of Fronting Street Date: =APPLICANT TO DRAW SITE PLAN BELOW =APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No.v2Toilets CIRCLE FUEL TYPE: Ga , Electri c;4ath Basins Heatpump, Other GJ,411 4.17 Bath Tubs No Units Fees _Showers Furn BTU Hot Water Htr Heatpumps Laundry Washer _ Vent Systems Sinks __3 Spot Vent Fans C� ' _Floor Drains No. Boilers/Compressors _Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPR FROM THE BUILDING THE BUILDING DEPARTMENT. DEPA T. X OWNER X BY -� DATE DATE 7 FOR OFFICIAL USE ONLY: Accepted b : f 1—/ ram p Y Date: `�'�_�'�f�_f��'--'�- DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Zk) L(- 1yoT, A AO r-o V e— t�l/1/t-i(- S+o e \1 jq(2-b 1/q-a1AN(! )(1 1c Cyr NU P Occupancy Group-_ -3 01-.IType of Const: S N Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check 1-7 Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor SOD- Violation Fee Site Inspection Building State Fee Other �? Other [Building Valuation: C v TOTAL FEE Plumbing Fixtures Feed Mechanical Fixtures No.�Toilets �_ Primary Heat Source (circle type) ath Basins ��B I� Elect/heatpump/other Bath Tubs L 0� Showers NO. FEE _Hot Water Htr 3 0tj Furn Laundry Washer Heat Pumps Sinks Vent Sys (Central) Floor Drains Vent Fans (Spot/Whole) Laundry Basins Boilers/Compressors Dishwasher _ HP Disposal Air Handling Unit Urinals cfm. Other Fire Protection Systems Permit Basic Fee 1S o TOTAL PLUMBING $ O O Other Gas Outlets .Hookups Wood/Pellet/Gas Stove Other Permit Basic Fee TOTAL MECHANICAL $ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAININ VAL FROM THE BUILDING DEPARTMENT. DEPART X OWNER X BY DATE DATE Return permit to: Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562 -5628 ... .......... _....._. ......_._ FOR OFF IC St :!ONLY': Accepted by: Date:>' DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond Hold Approval Planning: S Environmental Health: Building Plan Review: CAI V Occupancy Group: 3 m - S" Fire Marshal: Other: FEES 11Special Conditions : II IlSite Inspection II II IlBuilding Permit I II ii II I� 'I II II Ilviolation Fee I II II 11 I II 11 11violation Investigation Fee I II II 11 it 11 II Plan Check II II II 11 11Plumbing Fee II 11 I' 'I 1l 11 11Mechanical Fee C)11 II II I i I � II 11 11Woodstove Fee I II 11 11 1' 'I II 11 IlBuilding State Fee I II I' 'I I' i � s� 'I IlBuilding Valuation: 7"7, �3 i 0 11 11 TOTAL I �/, OU 11 I� 'I 11 �I 4y Permit No. MASON COUNTY p��-� �� k -If63/.2— BUILDING PERMIT APPLICATION, /'';;' 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT / #1 Owner �b �r-.f _ Phone# 02 ' Site Address Q Fire District# City St k'J4- Zip Directions Job Site o�— Lem aQ Dz n Owner Mailing Address City St Zip l Lien/Title Holder /UIJYLQ_ Address Clty St Zip #2 Contractor Name i Contractor Reg #ST£P f Z 1 ij L L Address Expiration Date 6P / / / 934 City St Zip��3� Phone # o-77s=67:2 V #3 If septic is located on pro' site, include records. / Connect to Septic? Public Water Supply%— Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 Parcel No. a 3v - L- Legal Description 2 •?� J #5 Building Square Footage: (existing/proposed) 1st FI / / 00 2nd FI 3rd FI / Loft Basement / Deck / # bedroo / _#bathrooms. /oZ. Garage /` Carport / ( 'Attache r Detached?) / Other sq. ft. / (/ X' #6 Use of building J / G Describe work #7 Type of J b: New)— Add Alt Repair Othe #8 MOBILE/MANUFACII IREID HOME INFORMATION ear Mal, Model 7ngt Serial No. _::_— # o # Bathroom Type of Heatase Price $ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Indicate Directional by (N, S, E, W) Name of Flanking Street in relation to plot plan Name of Fronting Street APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW See