HomeMy WebLinkAboutBLD93-00435 Cancelled SFR - BLD Application - 4/9/1993 Permit No.
MASON COMM
BUILDING PERMIT APPLICATION
-�ASE PRINT
#1 Owner dR, ' 1� Phone#
Site Address Fire District #
City St Zip 975 T-
Directions -to Job Site
J CIP,6��
,t fi a .,.�
Owner Mail ' g Address Z.
City St Zip
Lien/Title Holder
Address S;vN.L._
City St 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?_X Public Water Supply Well
(If residential, proof of potable water is required)
#4 Parcel No. 3 2! 30 - ?s- 00020 _
Legal Description T�hA.a 1 O f SM
#5 Building Square Footage:
1st Fl 2nd F1 3rd F1 Loft Basement
Deck #bedrooms 3 #bat Loms- Garage__.,__ Carport
Garage/Carport: Attached or Detache
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 Make Model
Leng h Width Serial No.
#Be #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland_ seasonal runoff
other
- l
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
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=APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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Plttbing Fixtures Fee Mechanical Fixtures
No. , Toilets 7 Primary Heat Source (circle type)
3 Bath Basins �— Elect/heatpump/ the o
Z Bath Tubs
,Showers NO. FEE
Hot Water Htr 3 Furn
Laundry Washer 3 Heat Pumps
Sinks la Vent Sys (Central)
I Floor Drains :3 Vent Fans (Spot/Whole)
Laundry Basins _ Boilers/Compressors
I Dishwasher 3 HP
Disposal Air Handling Unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee
TOTAL PLUMBING
Other
=Gas Outlets .Hookups _�.
Wood/Pellet/Gas Stove,9W
Other
Permit Basic Fee 15
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 RCN 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 OBT INING A PROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE
.eturn permit to: Department of General Services
26 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
.::.::..:::::::::::.:...:........ .:::.:::.:.: ::.::....::::::.::::.::.::..::.:.::...:::::::::..:::::......... :.:::.::.:..;,:::..::::...::
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E ONLY :. : eFO u5 ch 7ate -
DEPARTMENTAL REVIEW
F08 OFFICE US$ OILY
Approved Cond Hold
Approval
Planning:
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshal:
Other:
FEES
IlSpecial Conditions : II Ilsite Inspection I II
II II IlBuilding Permit I II
II II 11violation Fee I II
it II 1' 11
II 11 11Violation Investigation Fee I II
I( 11 IlPlan Check 13� 'q5 11
it II I( i
II 11 Il Plumbing Fee I a it
II 11 H
11 11 11Mechanical Fee
II 11 1' 11
II 11 II Woods tove Fee I
11 11 II
II - ` dal 'I
II 11 IlBuilding State Fee I y Sv II
IlBuilding Valuation: 6 1903qII 11 TOTAL I �--�i
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
OWNER TELEPHONE
OWNERS MAILING ADDRESS
COMPLIANCE INFORMATION
TYPE OF PROJECT: O NEW RESIDENCE O ADDITION O REMODEL O OTHER
AREA(SQ.FT.) 1ST FLOOR 2ND FLOOR HEATED BASEMENT
Note: Heated basements must be insulated and finished to meet minimum energy code requirements.
TOTAL SQUARE FOOTAGE OF CONDITIONED (HEATED) AREA 1?g"
COMPLIANCE METHOD:
( ) PRESCRIP'IZVE PATH — circle option— I II III IV V VI VII VIII
Glazing percentage (total glazing area divided by total conditioned area)
() COMPONENT PERFORMANCE — Chapter 5 — attach documentation and worksheets
() SYSTEMS ANALYSIS — WATTSUN 5.2 — attach documentation and worksheets
HEATING SYSTEM:
ELECTRIC RESISTANCE
()Electric Central Furnace () Electric Wall Heaters () Baseboard Units
() Radiant Panels () Other
OTHER FUELS
O Heat Pump O Gas Furnace O Oil Furnace O Other
O Boiler System (indicate type)
Make Model
Size AFUE HSPF
VENTILATION SYSTEM:
() Spot and Whole House () Central Ducted System () Integrated with Furnace
() Heat Recovery System (air to air heat exchanger — heat recovery heat pump)
GENERAL NOTES:
Your building plans should indicate certain compliance measures: framing to be used (standard,
intermediate, advanced); type of vapor barriers being used; location of furnaces, hot water tanks and
other equipment; location of solid fuel burning appliances, fireplaces and their combustion air duct runs;
and termination points of exhaust ventilation fans.
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OWNER'S NAME:- 1 `-� °t
WINDOW & DOOR SCHEDULE
WINDOWS
INCLUDE ALL WINDOWS, SKYLIGHTS, SLIDING GLASS DOORS, FRENCH DOORS AND
STORE DOORS. ANY WINDOWS IN DOORS (LESS THAN 50% OF AREA) MUST BE
TAKEN OUT OF THE DOOR AREA AND PUT INTO THE WINDOW AREA ON THE
SCHEDULE.
BRAND MODEL U-VALUE QUANTITY SIZE TOTAL SQ. FT.
TOTAL WINDOW AREA
DOORS
BRAND MODEL U-VALUE LOCATION SIZE TOTAL SQ. FT.
TOTAL DOOR AREA