HomeMy WebLinkAboutBLD95-0773 SFR - BLD Permit / Conditions - 6/29/1995 MASON COUNTY
Mason County Bldg. III 426 W, Cedar
P.O. Box 186 Shelton, Washington 98584
S U i l_. d I N 0 P F- R M I T FOR INSPECTIONS CALL 427-9670
BETWEEN 5pm AND Sam 421-7262
OL.D95--0773 PARCEL. 023315100092 PLAT :BEPLO DIV : BLKv LOT : 92
.JOB ADDRESS : NF 131 EZR I GOADUN DR BFL_FA I R
OWNER : LEONARD SCHMIDT 275-4477
CONTRACTOR :
LEGAL, % BEARDS COVE DIY 6 BiKv IOTv 92
CLASS OF WORK . . :NE:W BEDR : 3 ,BATH : 2 TYPE AMOUNT BY DATE RECEIPT TYPE AMOUNT BY DATE RECEIPT
TYPE OF USE . . , . :SF STORIES . . . . . . . :1
OCCUP . GROUP . , . a 7 BL.DG . HE I GHT . . : O .Oft ENCP 1 11.11 CPA #6129195 54513 NCR 1 33.06 CPR 06129195 59513
TYPE OF CONST . . :7 FIREPLACES . . . . a 0 Pic 1 42.00 CPA /6129195 59513 Siff 1 4.50 CPA 0612919S 59513
OC.CUP . LOAD . . . . : 0 WOODSTOVES . . . . : 0 PRMT 1 3S6.11 CPR 06129195 59513
DWELL, .UNITS . . . . a 0 PARKING SPACES : 0 PICK $ 168.11 CPA 06129195 5951a
INSPECTION AREA : 1 SHOREI., I NE? . . . . :N Pit 1 45.90 CPN 16129195 59513 TOTAL: 638.51 VALOLATIIN: 61168
SETBACKS--------------- TO(-LETS , . , . : 2 FUEL TYPES----- ----- S01 L.EFIS/COMP- --- MOBILE: HOME-- -
F'RON"T _V4 10 10f t BATH BASINS . . . . . , : 2 : 0-3 HP- : 0
REAR . . . .E 10 .01t BATH TUBS . . . . . . . . : 2 3-15 HP . a 0 MODELv
S i DE t 1 > .N 10 .0f t SHOWERS . . . . . . . . . . a 0 FURN < 1 fi 0K BTU a 0 1 5•-:30 HP , v 0 --MAKF___.......
SIDE: (2) .S i 0 .0f t WATER HEATERS . . . . a 1 FURN }-100K BTU : 0 30-50 HP . 2 0
SHRL I NE . 0 .Oft CLOTHES WASHERS . . : 1 FURN _. FLOUR . . . : 0 Ci04 HP . : 0 -•YEAR-- -
AREA ---------•-------- K F TC14EN S 1 NKS . . . , t 1 HEAT PUMP . . . . . . : 0
LOT SIZE: . . : FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH ,- 0
BUILDING . . . : 1284st DRINKING FOUNT . . . : 0 VENT FANS . . . . . . : 0 HOODS . . . . . . . 1 0 WIDTH . : 0
BASEMENT . . . : Oaf LAUNDRY TPAY ; . . . < : 0 DOMES . i NC I N c O -SERIAL#--.--•.
DECKS . . . . . . a Ost DISHWASHE:RS . . . . . . v 1 AIR HANDLING UNITS-- COMML . INCIN :O
GARICARP :G 520st GARB DISPOSALS . . . a 0 <= 10000 (,-fm . : 0 REnLOC/REPAIR : 0
ATIDT . :A URINALS . . . . . . . . . , a 0 > 10000 cFn+ . v 0 OTHER UNITS . : 0
MISC PLM FIXTURES : 0 GAS OUTLETS . : 0
PROJECT OESCRIRTIONrRESI1ENCr
PROJECT [OCA110111:RAY '111 RIGA1 SA.NDHILI , LEFT LARSON BIVD, LEFT LARSON 2N0 RU RIGHT SANTA MARIE R16RT RRiGGADUN ?NO IOT ON RIGHT.
THIS PERMIT BECOMES Nutt, AND VOID IF WORK 09 CONSIOUCTI®N AUTHORIZED 13 NOT COMMENCED WITHIN 180 DAYS OR If CONSTRUCTION OR WORK IS SUSPfM0E6 r01 A PERIOD
Of 181 DAYS AT ANY TIME AFTER WORK IS CONYFNCED. FVIDENCE Of CONTINUATION Of WORK IS A PROGRESS INSW 1 101 WITHIN THE IS1 DAY PERIOD. fINAt INSPECTION MUST B
APPROVEI BEFORE 8U1101NG.CAM Of 1CCPIED.
011011 OR AGENT:
fA# PINT, SON: 111/li COii1PLi>~MOi 7e ATTACHFD CONDITIONS IS REOUIPIED �
CONCRETE C.x 'T ' S; MECHANICAL _ MOBILE HOME
Footings-Setback —5 date iv 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 9— — by L date by date by
FRAMING Walls FIRE DEPT.
date ,z>• 2 /— S f by / date by l date by
PLUMBING OTHER
Ground rk Attic
date I— '� - by L date by
D.W.V. WALLBOARD NAILING ` ,4'
date 1 y- i Y by e i date 1 O-aX-' C'S by 1
Water Line FINAL INSPECTION
date / ,2 — 5 by e date 11-02 a_ 5 by L date by
rCC.Lc
�� d� C f l�l..y'� 17�G-M b e n y � ✓/!� ��S '"I �?�1 � L� t��G� '�'l_5
--1 ��e- ir\ c �� b�c✓�c� ��n�s L-J 9- -SS
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
Case No . i 131, 095-0773
For : LEONARD SCHMIDT
Paget I
1 ) The use , handling and sturago of hazardous mpt.Arlals or 'flammable and combustible
liquids In excess of 10 gallons is not allowed without the approval of the Mason County
Flr+�7rr 1 ,
X
2 ) Struoture must be setback 5 ' from all utllitV and dr,ainaqe ea'saments ' total of 10 '
from each property line , or a variance must be obtained from the BulldIng Department .
X
3 ) Proposed structure or any portion thereof greater- than 30" in height from trade line
must mpint, In a minimum of 5 ' setback from all property lines , easements and right of
X
wav%__-/.
4 ) ,
All approved plans are required to be on.-,site for Inspection purposes . . 11 inspection Is
called for, and plans are not on site Approval WILL NOT be granted . In addition, a
Re- In6pection fee In the amount of iiO .t O per hour- (minimum I hour ) will be oharg"d find
must be collected by this department prior to any further inspections beltig performed of,
approv arated .or,I -
5 ) PURSUANT 10 1991 UNIFORM BUILDING CODE SFcTION 305(C ) AND SECTION 1513 , ALI. 814ES MUST
HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS To BE PLAINLY VISIBI-E
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
REINSPECTION FEE , BASED ON RATES IN TABI.E 3A OF THE 1991 UNIFORM RUItDING CODE WILL BE
ASSESSED IF OWNFR/CONTRACTOn FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPECTION .
-
X C-17 7
6) The correction list , slong with the Energy Compliance Worknheet (when applicable) is
part of the plans and must remain attached thereto . It Is the responsibility of the
applicant to make corrections Indicated on the plans 'from the correction lists . Once the
plans are marked APPROVED, they may not be changed or altered without authorization from
the Building Official . The permit holder, Is reponsible to retain the complete approved
set of plans on site for the duration of the project . Failure to comply will result In
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
I I t,(4 U I I u,"s 1,f u I 10 1 i I q in e%., i I o I i I- I y P(�,1 01 1 t ',it ci I I e X I., I i v t.�)y iiPgi4tiCton 4 ri J
benome null and void It the building or work authorized by such permits Is not commenood
withln 180 days: from the date of Issuance, or if the building or work authorized by such
permits Is sus or, abandoned at any time after the work Is commenced for a period of
180 day s ,
7 ) No 0companci , This structure Is limited to Al-1-1 us o ix ya An e othr "36 will be in
• violation o the 11niform Bui Irtin Code and Mason CqAjntRequ t i Otis
tonless a "Change of Use permit 75 approved . X
8 ALI., CONS "UCTION MUST MEET OR EXCEED ALL LDCAL CODES AND UBC
REQU�AEWT
X
9) This In a non-heatod addition ( seperated from the existing home by exterior doors or
windows or both ) and by being designated as such Is exempt from and will not be
oonstructed to meet minimum Washinrlton State Energy Code requirements .
10) Changes to approved building plans that atfoot oompliance to the 1991 WaFhinqton State
Energy Code 1991 Ventilation and Indoor Air Ouality
Code, the 6niform Bul Idinq Code and/or Mason County "(jut tions must
be approved by Mason County prior to constructionX
11 ) ALL CQNST*]UCTI0N MUST MEED OR EXCEED LOCAI. CODES . IF ANY QUESTIONS, PLEAS&
L..rTHIVOFFICE BEFORE CONSTRUCTION .
12) CONSTRUCTION PROCESS TO BE FIELD CORRECT
�S6, 10,�4UIRED PER MASON COUNTY BUILDING
DEPARTMENT AND UNIFORM BUIIDING CODE .x---Z-
CONCRETE MECHANICAL MOBILE HOME
Fo®tings-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 Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
Date Checklist Prepared <g• a(.o • q.S
MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
1991 WSEC AND V&IAQ CODE COMPLIANCE
Permit Number ' 03 Address V)L 13
Sq. Ft. II Za4
Name on Permit d-�, Lto�a� . ontractor/Phone # 44-1-7
Compliance Method: escriptive -,T-70 (Option) ( ) Component ( ) Systems Analysis
Date FOUNDATION
Insp. Rev.
( ) (�Slab:R- i xt.foundation down to frostline/slab bottom;or interior 24" of p of slab&horizontal. Radiant under entire.)
( ) ( ) Below grade exterior wall insulation: R-
( ) ( ) Crawlspace ventilation: __ (I sq.ft.NFA1150 sq.ft.floor area-cress vented)
FRAMING
standard Intermediate ( ) Advanced
( ) ( ) Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.)
Standard air seal: (Bottom plate/subfloor,rim joist/mudsill,window/door frames,penetrations condition to non-condition.)
( ) ( ✓� Attic ventilation (1 sq.ft.NFA/150 sq.ft.ceiling area) kZ.8q }-rjZ0% J804/1 57:) �- `Z 0
( ) ( ✓� Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cfm @.25 WG. Vented out with dampers.)
Fresh air ventilation: Available to all habitable rooms. Installed and operational. (Integrated forced air,windows,wall ports.)
Whole house exhaust fan'&L cfm(Intermittent system manual&auto controls/sone less than or=to 1.5 at.1 WG)
1,w
INSULATION
Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extend 12"above loose fill or 6"
above batt insulation)
Mechanical ventilation ducts R4(Exhaust in unconditioned space&supply in conditioned space.)
( ) ( ✓Y Wall insulation(above grade) R- M M1A'
g (Batts face stapled)
( ) ( ) Wall insulation(below grade-interior) R- (Batts face stapled)
( ) ( ✓� Vapor retarders on walls (Faced bast,or 4 mil poly or perm.paint.-circle one)
( ) ( ) Rim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.)
( ) ( ) Vaulted ceiling insulation R- (Vapor retarder&1"air space)
FINAL
Floor insulation R- (Substantial contact w/surface,supports less than or=to 24"OC,not blocking vents.)
( ) ( Ventilation system is operational(spot,whole house,fresh air to all habitable rooms. If integrated system,certification by installer is
required.)
( ) ( ) HVAC ducts in unconditioned areas R-8 (Joints sealed;mechanically fastened with a minimum of 3 fasteners.)
( ) ( ✓� Pipe insulation R-3 (Hot and cold lines in unconditioned areas-service or recirc.see Table 5-12).
( ) ( SHW heaters: (NAECA label,separate power or gas shut-off,on R-10 pad if electric in unconditioned or on concrete.)
Heating system type: F-AX t. -1g00
( ) ( ✓� Radon monitor on site with instructions.No. Supplied by MCBD
( ) ( ) Thermostat: (Heat range 55-75;AC 70-85;both 55-85. Backup heat controls(lockout)prevent simultaneous operation of primary system.)
( ) ( ) Solid fuel appls.: (Glass/metal tight-fitting doors;dir.comb.air source,or 4"dia.dampered,indir.source for existing coast.)
( ) ( ) Ground cover: (6 mil black polyethylene or approved equal lapped 12"at joints,extending to foundation wall.)
Penetrations(All exterior wall and ceiling penetrations sealed to drywall-plumbing,exposed beams,wall receptacles,fans,recessed lights.)
VWtl-
( ) ( %4 Ceiling Insulation R- (Insulate&weatherstrip access,baffle to prevent spillover-no cardboard)
( ) ( Vapor retarder paint if a vapor retarder was not installed when insulation was installed.
GLAZING
Plan Reviewer-Fill out this glazing section or attach a window schedule to this checklist. Inspector- Verify window
information during field inspections. Include skylights, glass doors and all other glazing on this form. Use rough opening
area for calculations.
Date
Size Quantity Area S . Ft. U-Value Manufacturer Rev. Insp.
Z GD 1 1 d (-)-
5C'40 iI 40 f 40
ay-
5DZ� 1 I zD
,?S OLta I 32
50(_0 to 1 33
3C130 1
Total glazing area:
Total conditioned area: 1
Percentage glazing: l �O Verified:
DOORS
Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity,U-value,and manufacturer. Inspector-
Verify door information during field inspection.
Date
Type/Quantity U-Value Manufacturer Rev. Insp.
3"Co 8310 0�- LCS
3 �� a�- Less
Signature of Building Inspector: Date of Final Inspection:
NASHINGTON
Attac
EN� Building Record WSEO Contract# 91-19-hment B
CODE
PROGRAM For Site-Built Residential Buildings Heated by Electric Resistance or Heat Pumps
:::...::: C ... ..
------------
(p ase check one) (please check one)
New Building ❑Addition over 500 sq.ft. NSlingle Family ❑Duplex
Jurisdiction: A4.4 2��t ❑Multifamily ❑Zero Lot Line Home
❑ Planned Unit Development +
please check one: ❑ City ounty Permit# —
�s .Fi le ID# if different from Permit +
A. Site Information B. Owner Information
Address AA� 1\3/ c,_dUi'1 Owner ownerat time of construction receives util' ment
OtJcz"a
City Zip i3s,5:g Company _
Assessor's Property Tax# or attach legal description): Address 3\35
Pa_,' _s ✓cam D k L- Cit Stat /9 Zip a�
Servicing Electric Utility ULZ3 Phone 7--5--
C. If Single Family,Zero Lot Line or D. Duplex E.If Multifamily(R-1)
Planned Unit Development First Duplex Unit s .ft. Total #/Bld s.
Total Conditioned Floor Area s . ft. Second Duplex Unit s .ft. Total#/Units
............. ...:::.:::. .:.iiiiiiiiiiii:�.......-......vi:iiiii:viii:�iiiiiii •• v..x4ti •:::::::::._::::::::::::::::::::::::::.:::::n:�::::::::.:�::::::v............•. :::::::::.
.....:.................................................................................................................. .. -.rx v::•::::v. :::::.�:::::::::::::::::::::::::::::.:::::::::::::::::::::::::•.:gin;w::::::::::::_:............
yyy��s. #11�� ...:.:-:::••::::::..�:::::::::.�::::::::::::::::Ui:iiiii:^iiiiii:^iiii:-ii::::?:':•iiiiii:?iiiiii i::ii':i::ii:-is-ii:-::::?•:.i:?•iiiii:_i::?Ci:?^iiiiii:?iiiiii::J::i:::::::::::::::::::v:: iiiiiiiiiiiiiii:��i:MIF�� ...
A. Primary Space Heat Type 9. Secondary Space Heat Type C. Water Heat Type
(check one) (check all that apply) (check one)
❑ Electric Baseboard None Electric
Electric Wall Heater ❑ Wood ❑ Gas
❑ Electric Furnace ❑ Electric Baseboard ❑ Other (specify below)
❑ Electric Heat Pump ❑ Other (specify below)
❑ Other
WSEC Compliance Method For Heat Pump Only:
Xrescriptive Path Built to the Electric Date of Permit Application
clomponent Performance Requirements of WSEC? Date Building Permit Issued —a
Date of Insulation Inspection 95.
❑ System Analysis ❑ Yes ❑ No (If yes,
Date of Final Inspection
utility may offer incentive.)
I hereby certify that this building or addition has been inspected for the measures required
by the 1991 Washington State Energy Code(WSEC), that it is in substantial compliance with
MkheWS), C, and that the yt�SEC checklist for this building is on file.
Signature icial or Authorized Representative Date
■ Building Department: Return white copy to Gail Burris,Washington State Energy Office, P.O.Box 43165,Olympia,WA 98504-3165.
■ Owner or Building Deparment: Forward canary copy to the servicing electric utility to trigger WSEC compliance payment.
■ Building Department: Retain pink copy for jurisdiction's building file.
WSE0194-015 5-95
MASON COUNTY
BUILDING III 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 code/compliance/
l c. i n t •'r c crck( G.J t
e, r- 221-L 1-e r- 494, -A, r.
4 nse..LX le—
You are hereby notified that the above corrections shall be made BEFORE
PROCEEDING WITH ANY FURTHER WORK
6 Call for re-inspection when corrections are made before continuing
Q. Make corrections, it will be checked on next inspection
OK to
Department
Date / /7 Inspector r
0 00 0 NnT l, MnV TH14Mk T
" ,�
MASON COUNTY V
BUILDING III -426 W. CEDAR .
SHELTON', WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location -A . P. 1--to Q. �
V�(.D�S- -o-7 -;)--:�
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
You are hereby notified th tthe above corrections shall be made BEFORE
PROCEEDING WITH ANY FURTHER WORK
Call for re-inspection when corrections are made before continuing
D1 ke corrections, items will be checked on next inspection
:1OKto
Department
Date �-5 S Inspector
044 nT MOOV THlqq-m,
,��
MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, Wd►SHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location i31 L nr
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
`d 6-
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
❑ OK to
Department
Date 2. 7 5- Inspector
Do * [_UT R MOOV THI TA* qi
Permit No.
MASON COUNTY fmiS Ck p3`�
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 ow r .Z__1= ll�C�l�,(7 SC�/]N zD7" Phone#_�` S '/�/ 7 7
ite Addreac: /_�� I 8p 1 n c> J4 y U 0 L21? L Fire District#
6 it
y 8ZLFAl k UM• QP ��g St Zip
Directions to Job Site 3
IR
"
Owner Mailing Address
City � St 1V9. Zip
Lien/Title Holder d�
Addres . 0'.
Clty StV Zip
#2 Contractor Name Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project 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) Pit f4 GoIV G c3u+1 fJ 0,X7- �N'►h�u h�'f-�l
114' ceI No.
6 egal Description O�C2Q Otom? V i J• C� -C'�f -All /9/ &S0'*7 (ou4c1y
#5 Building Square Footage: (existing/pro osed)
1 st FI ' / 2nd FI / 3rd FI / Loft /
Basement / Deck_ / #bedrooms / #bathrooms_/
Garage / Carport_ / (Circle 49iicDr De4oftd?)
Other sq. ft. /
#6 Use of building ji—h I L Y Describe work
S �'v tit.. t -
#7 Type of Job: New, Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width ' No.
# Bedrooms # athr o Type of Heat
Purchase 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 b N, S, E, W)
Name of Flanking Street y
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
D TO
Vv
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
N �,4?.
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets _ CIRCLE FUEL TYPE: ��Iectric�)
Bath Basins Heatpump, Other
,gtBath Tubs No. Units Fees
_Showers Furn BTU
A—Hot Water Htr y Heatpumps
]Laundry Washer _ Vent Systems
J-Sinks 3 Spot Vent Fans
Floor Drains - No. Boilers/Compressors
Laundry Basins �^ 4 HP
Dishwasher 3 No. Air Handling
,&, Disposal C) cfm#
Urinals No. Fire Protection Systems
Other _ Auto. Fire Alarm Sys 50�00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 D _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ � . 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 Od
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $33.
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 OFTHE 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 FQV FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING EPARTMEN DEPARTMENT.
L
X OWNE X BY
DATE "r '� DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: �6, 4 �i��C� �I t�
Environmental Health:
Building Plan Review `
Occupancy Group H, Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other&-c C ECI�L[S1 Fes, W. JZ
Other ACW AZAA,- f EYle&
Building Valuation. TOTAL FEE
--it1IASON COUNTY
DEPARTMENT'OF COMMUNITY DEVELOPMENT
RESOURCE'LANDS AND CRITICAL AREAS CHECKLIS
t �imit. I�icnt,er I ?/W
-----------
Parcel Number
❑_ 1. Saltwater shoreline or lake 20 acres or larger?
-----------------
Name of Water Body
❑ 2 Rivers, streams- or creeks with year round flow? AA
Type of Other Water
❑ 3. Rivers, steams or creek with intermittent flow but are within a clearly defined channel? A)o
❑ 4. Lakes or ponds less than 20 acres in size? /1r�
❑ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal
circumstances support vegetation adapted for life in such conditions;such as marshes,bogs,
and swamps_ //0
❑ 6_ Slopes greater than 15'% (8.5 degrees)? On Landstide Hazard Map? ✓0
7_ Floodplains?
'.6 of Slopes
❑ ��11
❑ 8- Seismic Hazard Areas? ry V
❑ 9. Agricultural Open Space Taxation.Program? 411�
❑ 10. Open Space Timber Taxation Program, or Designated forest or Classified Forest?A�J
X11. Site has no Resource Lands or real.
Comments: � /„�/' / el S'7 6F
V��✓✓/'� ri � llli� �/e CGZ 6Til'L e /l2tJGGl �'C
�qu 5
Bale
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