HomeMy WebLinkAboutBLD93-00982 Final SFR - BLD Permit / Conditions - 3/9/1994 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
f;.^ C'01I :_ 4 2 7—9 6 7 0
1 �.I I t%! ANSI ) , 427-7262
BLD93-0982 PARCEL : 3213075°000/1 I 1 fti 1) IV BIKE 1.0T °
JOB ADDRF, S :: E 119 CAPITAL PEAK RD SHELTON
01111FR ; RAMO NOTAR 427-6709
C-ONTRACTOR- S&K BUILDERS 275-8186 CHRS 426-9056
LF' G AI : TR 9-0 OF SURV 4174 TR 0 OF SP 1799 FS 11266:90
C L A S S 0 F, WORK . . . NEW BLDR : 3 . BATH : 3 TYPE AMOUNT BY DATE RECEIPT TYPE AMOUNT BY DATE RECEIPT
TYPE OF USF . . . . : SF STORIES . . . . . . . : 1
OCCUP . GROUP . . . : ? BLDG . HEIGHT. . : 0 ., 0ft RADN j 8.01 CPH 11119/93 34429 PLCK j 320.45 CPR 11/09/93 34429
TYPE OF CONST . . : ? FIREPLACES . .. . : 0 P L M j 66.00 CPH. 11/09/93 34429 EHFE j 0.00 CPH 11/09/93 34429
OCCLIP . LOAD 0 WOODSTOVES . . . . : 0 MCH j 63.01 CPH 11/09/93 34429
DWELL . UNITS . . . . . 0 PARKING SPACES : 0 S T F E j 4.50 CPH 11/19/93 34429
INSPECTION. AREA : 2 SHORELINE?. . . . : N P R N T j 493.00 CPH 11/19/93 34429 TOTAL : 954.95 VALULATION: 115866
" TBFICKS----- ---- --- - TOILET" . . . . . . : 3 FUEL TY;'F'`; FD:CI R:: /r,OMP— - MDL' 1I f L1OMF:
FRONT. . . ? 0 . 0 f t BATH BASINS . . . . . . : 3 :: / / f / : 0- 3 HP . : 0
REAR . . . . ? 0 , 0 f t BATH TUBS . . . . . . . . : 3 '3 -15 Ili, : 0 M011FI" - ?
SIDE ( 1 ) . ? 0 . Oft: SHOWERS . . . . . . . . . . : 3 FURN < 100K BTU : 0 15-30 lip . : 0 --MAKE-------
SI.OE (2) . ? 0 . 0ft_; WATER HEATERS . . . . : 1 FURN )=100K BTU - 0 30-50 HP . : 0
SHRLINE . ? 0 . 0 f t CLOTHES WASHERS . . : 1 FURN — FLOOR . . . : 0 504 lip . : 0 YEAR-------
ARFA — -- _— -------- KITCHEN SINKS . . . . ; 0 HEAT PUMP . . . - 0 ?
LOT SIZE. . : ? FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 0
BUILDING . . . : 2101.sf DRINKING FOUNT . . , : 0 VENT FANS . . . 4 HOOD") . _ _ _ 0 WIOTII . : 0
BASEMENT . . . : 956sf ,LAUNDRY TRAYS : . . . : 1 DOMES . INCIN : O -SERIAL#-----
DECKS . . . . . . . Osf DISHWASHERS . . . . . . . 1 AIR HAND LTNG UN.T1S-- COMML . TNCIN : O ?
GAR/CARP : G 800sf GARB DISPOSALS . . . : 1 <= 10000 cfm. : 0 RELOC /REPAIR : 0
AT/OT . : D URINALS . . . . . . . . . 0 ) 1.0000 cfm ° 0 0,111FR HNI1 ''i • 0
MISC PLM FIXTURES : 0 0A" OUT LE:TS . : 0
PRO'FCT DESCRIPTION:RESIDENCE
PROJECT LOCATION:TAKE JENSEN ROAD OFF OF BROCKOALE. PROCEED PAST "ADOPT A PET" TO TOP OF HILL. TAKE 1ST DRIVEWAY PAST RIGHT TURN (STREET SIGN) . J08 SITE IS
!.AST LCT ON THE RIGHT,
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 PER 00
OF 181 DAYS AT ANY TIME AFTER WORK IS COMMENCED. EVIDENCE OF CONTINUATION OF WORK .IS A PROGRESS INSPECTION WITHIN THE 180 DAY PERIOD. FINAL INSPECTION M9T BE
APPROVED BEFORE BUILDING CAN BE OCCUPIED.
OWNER OR AGENT: � &4je_ DATE:
8LO—PRNT, rev: 03/3119, COMPLIANCE TO ATTACHED CONDITIONS IS REQUIRED
I
CONCRETE MECHANICAL (� MOBILE HOME
Footings-Setback date '� '- "J by j ` Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation . '? �C�-`3 ^� Final
Moors �?-��(s, 1
date by dais S by FIRE DEPT.date by
FRAMING
n� Walls
date 1"2--I3 - by `��— date -Pe-r'�' � by date by
PLUMBING OTHER
Groundwork ,i�� Attic ���� - Li
date i '.`'��,`s/�� b �- � date by
WALLBOARD NAILING
D.W.V.
date
date
Water Line FINAL INSPECTION by
date by date �, �L date by
-Y,?l ja L Par PUD
OT r} 3a I q�} e —
/gRq, -,j -,4 �
MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
A MN
Case No . : BLD93-0982
For : RAMO NOTAR
Page : 1
1 ) A11_ upland areas dijturbed or newly created by construction activities shall be seeded ,
.,e.getated or given some other equivalent type of protection against erosion .
2) PURSUANT TO 1991 UNIFORM BUILDING CODE , SECTION 305 (C,) AND SECTION 513 , ALL SITES MUST
HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE
AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING
DEPARTMENT REQUIRES THAT THTS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS , A
"REINSPECTION FEE , BASED ON RATES IN TABLE 3A OF THE 1.991 UNIFORM BUILDING CODE WILL BE
ASSESSED IF OWNER/CON'TRACTOR FAILS `t`0 POST ADDRESS ON ".I-1 E P?TOR TO REQUESTING
" hl r)7 rT7g1 ,! 7
3) . ALL ; ;'LiION MUST MEET OR EXCEED ALL. LOCAL CODES AND UBC
X E Q,U Z""ITS
4 ) builder changed 91wall to 8 ' concrete wall that is max height without being
engineered
5 ) THIS PROJECT WILL MEET THE LONG TERM SUPER GOOD CENTS REQUIREMENTS AS AGREED UPON WITH
'Fill' ELECTRIC UTILITY SER` TCTNG THE PROPERTY . INSPECTIONS FOR ENERGY CODE COMPLTANCF
t( zzNSULATION & INDOOR VENTILATION) WILL BE PERFORMED BY A UTILITY REPRESENTATIVE .
1f changes occur and you decide not to go with the I_TSGC program contact the M('Bn at
extensio 4 to arrange energy code compliance .
x
6,) OWNER MUST SHOW PROOF OF SATISFACTORY WATER SAMPLE PRIOR TO TEMPORARY /PERMANENT
OCCUPANCY OF THE RESIDENCE .
MA
d
MASON COUNTY
Mason County Bldg, 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
W093-41982 PAki I I
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MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
Case My K ,
Fort RAHU NhfAR
A I i howdar vaq d I g I urhad op "Y" 1 y ct am I Gd by u9nn vi "v v ion
111I1?SUAN 1 . 10 1941 UNIF"kM h" ! L " IN6 cool , ANH 41111 "N n1k mil III ! ",I
1IAVf AVPk= D N"NHvkb Ott nonts! n4i n PHDVIDI " IN K"I' l-I A VFI� 1 1 I "M A4 I " "I I I hINI Y V141 t
AND IhGIHIF 1-100M fHt n1kif ! "If NOAO IVONI ! No I "! VROPIHIT HH"N f ""I'lly 11011111HO
DFIARRIKLMI: ktro" IRP4 INAI IHI Hv vompiffulc pbl "t; I " uAl1lHK Jok ANI 4fly INKVIC11 "NS. A
NIINSPECIIUN FEE , HA41-0 ON KAIF4 IN IAHII TH Of I Hf ! "" I "Hilown h" I IHINA 11MI: will HV-
It
IN%PFCTIONA .
A ACI n N S 10 0 C I I ON N U S I H F v I u V i An! 1 w At I I ±±t At cool nNH "Hi
41 hclille: cha"q"d I ' voli to m , conri - km wail MaL t4 mov h- iqhi
"nylinopred
nj FHIS PROJECI Will MVInt 11-11; IbMut 1IlQM hOnD ill,lf" rf "JIMIN11414 04 nhvufh UPON Wilil
lilt FIvcvklc oil ! ITY Q kvIvINh 1 "I 1-hovvilly , Ilvinvil 1 ION4 v"v iml G"! I "HI I "MVI IANVI.
( INS"IACION b INPOOP VtN1 HAI VON ) Wil I Ht. PI 1:10NMI b kv A 01 if I I VIFUMNIAIM
It "hanqow ovv"r and yq" det id- not in qn with ih- il "ni proqlam t "" ( Anl Ih- HI "H At
.'tlil to ""Orqy Cody cwplimmn-
III OWNER MUsl 5110101 PROOK Ol- 4A1141M I VIP Y WAftk AAMPir PRIOR in lIMV"P AI- 1QIPHnHIHI
Mc"PA CAtiF 1l Hf 101: 4 =NCF .
•
Page No. 1 CASE HISTORY'FOkuAS- Nb.: MIS93-0519
RAMO NOTAR
E119 CAPITAL PEAK DR SHELTON
09/16/93
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- ---
MISA010 Application received / / / / 09/07/93 09/07/93 KS
MISA050 Approved For Issuance / / / / 09/07/93 DONE KS 09/07/93 KS
MISA100 Staff review / / / / / / 09/07/93 KS
MISA500 (F) Issue permit / / / / 09/07/93 DONE KS 09/07/93 KS
MISC100 Inspection 09/16/93 / / 09/16/93 Walls OK (steel in place most of the PASS DLF 09/16/93 DF
forms were set).Rough in plumbing being
installed - looked good - I approved
cover it is to be under test for next
inspection. Next is R/O Plumb - Slab
Insul. - Mono Forms for the basement
walls. 9-16-93 DLF
MISC110 Footing inspection 09/07/93 09/14/93 09/14/93 PASS WK 09/15/93 DWH
<FPO
I
MASON COUNTY ,
_ BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(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
134C O A,( S i —C _ 1 a�
�osr,6j
fwlo!
� 1 EC 7-1D�
jG2 Q S/T� I O7- �Or�c�yL E T.y /�D 7—
You are hereby notified that the above corrections shall be made BEFORE
PROCEEDING WITH ANY FURTHER WORK
4 Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
Department ,)(S
Date Inspector Gam_ O 4 C--S
■ Pto "
s� sT 'MOV ' T 1, _
,�
• MAS COUNTY s
BUILDING 6 W. CEDAR
SHELTON, WASHINGTON 98584
(206) 427-9670
CORRECTION NOTICE
Job Location z57
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 r!�O�,yL��� ���-/be✓�-G� sT�p �r� w'�/l ,5�,,9s���
You are hereby notified that the above corrections shall be mi_?a; EFORE
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 /1.-37 --0T7 9i` Inspector
■ �� 4 NOT MK SHill -w
T,V
A U 6 0 4 1993 �uI:.DE Z�rcr�CwZTc3 AGRE -�rr C'
Super Good Cants LTSGC # 3-
HFA►L E�j PHaNZ
SITE ADDRESS : �� t " IAA J� l• D j i �' /�
MAILI-NG ADDRESS:
BUILDER: B ANT) K BUTT.nVRG C
- - PHONE: �a -
MAZLZ-NG ADDRESS: '
I understand that in or--zer fcr the electrica_'jy heated home located at
the above address to be certi=ied and in addition qualify for "LONG
TERM SUPER GOOD C�VTS" . Hcme must be constructed is comp__==
Washington State Eaergy Code, attached Wattsun heat loss aadcLoagth the
Super Good Cents addend•�:m/specifications .
I understand that inspection by District sta-ff is required at each of
the following stages :
Prior to pcuring of ccnc_ete slab ; f d.
Prier to i=stalling ex_erior insulation and damp p_oc-z.; L
below gradei - _g the
bas emen t walls ; = Tz�;
X PriOr to _=stalling ins• l y
roughed-ing, 1ta��onw(s!-1 ct =9Qis framed, r oef is on
Ile , -lumbin hen ; _ g, phone aid � T cable are
installed, and a_1 penetrations are sealed) -
x _ Fol lcwing i=stallat_on of insulatioa and vapor retarder but
Prior to covering.
X Final inspection - all components installed.
Other
AS NEEDED.
NOTE: Final inspection by our Super Good Cents Depa_tment'must be
completed prior t;, the final inspecti
Deparon of the appropriate Building
It is understood that the Supe= Good Cents Depar t-nent is to be notified
re 426ed im or 42c=s . Ext. ;; not less than 48 hours price to
required i:spectic=s .
I understand the "long Te=" Super Good Cents c,._L `i ;County Put! ic u-" ' ty _""mil cat_on by Mason
Districp :to. 3 only veri_;
Long Te� Su-e: Gocd Cents program standards andeoncomp irzsoect tothe
energy eff_clency. Neither the District nor any employees mace any
warranty, ex-ressed or implied, in re5ard to the ever
structu_al Zegri�-, of the in
or the future electral ic=?anship and
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 Te^t SGC incentive payments) in the amount
shown on the attached worlds^-et.
i
Z 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 this 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:
graeowner
ui-1 er
ate S 4 %' `3
ate
ecerai ID# or oc1a1 secur-ty r# r eeera, ID# or soda 5ec•:r_ty
,T
Utz—
_ity Representative
i-ityRepresentat-ve print
ate
Homeowner conservation incentives may be paid directly ' to homeonwer
or applied as a credit on your' utiliI_-y account.
WATTSUN 5.3 LONG TERM SUPER GOOD CENTS/1991 MCS COMPLIANCE REPORT 07/16/93
FILE: B:S&K.WS HOUSE ID :
Site: Analyst: TONI HERMANSEN
jurisdiction: MASON COUNTY
400, Ut i I i ty : MASON COUNTY PUD 03
Homeowner: House Type: Single Family
Floor Area: 3019 ft2
Builder". Weather Data: Olympia, WA
Climate Zone: 1.
1 The PROPOSED design QUALIFIES for SGC( 91 MCS ) Tier I..
REFERENCE PROPOSE[)
1 COMPONENT PERFORMANCE 599 597 Btu/hr-F
ENERGY BUDGET 5.317 5 .40 kWh/ft2-y'r,
REFERENCE DESIGN
Reference
Component Description Value X Area UA
---------------------------------------- ----------------------------------------
80 Wall 3 .5 ' R21 batt 3.5 ' w/TE: t.) 0 1.1.
BG Slab 3.5 F-0.556 12ft 6 . 17
BG Wall 7 ' R21 bait 7 ' w/TB U-0.035 378
80 Slab 7 ' F-0.503 76ft 3B.L.
On Grade Slab R15 2 ' horizontal w/TB F-0.520 62ft 32......
Floor R30 vented joist U-0.029 1115 3 2.
Glazing @15% 0.35 U-value U-0.350 452.9 158.
Do o r!_'-, Metal R5 base case U-0.190 92.0
AG Wall R21+R5 ADS) U-0.041 2396
Ceiling, Attic R49 blown Atlic ADV U-0.020 2067 41 .":'';
Infiltration Standard air sealin.,
ACH-0.350 24866f t3
--------------------------- -
Reference
-------------------------------------------------------------------------------------
PROPOSED DESIGN COMPONENTS
Component Descriotio)i Value X Area UA
---------------------------------------------------------------------------------
BG Wall R21 Batt w/TB 3.5' deptl--i U-0.040 38 1 .5
-
--------------------------------------------------------------------------------
Items in parentheses not included in COMPONENT PERFORMANCE totals.
Denotes non-standard values - check calculation of thermal value..
Denotes adjusted UA to refiect 7-1/2 mpo wind speeo.,
Page I
WATTSUN -TERM SUPER GOOD CENTS/1991 MCS COMPLIANCE REPORT
FILE: B:S&I-c, HOUSE ID:
BG Slab 12ft 6.7
BG Wall R21 Batt w/TB 7 ' dept[--, U-0.035 378 13.
BG Slab F-0.503 76ft 38.2
On Grade Slab RIO 2 ' vertical F-0.540 62ft 33.!-..;
F I oor R30 vented Joist 16oc U-0.029 1115
Glazing @14Z ""NW XO W/LOWI*_H.": U-0.320 39.5 12.2.;K
wANW P I C; W/LOWE U-0.290 127.0
xwNW SH W/LOWE]: U-0.330 205.0
wxNW PATIO W/LOWE:� U-0.360 41 .0 14.a
AwDEFAULI- DOOR GLASS U-0.750 11 .0 7.&:
Doors "INSULATED DOOI: U-0.140 92.0 12. 9 ":
AG Wall R21 + R3.7 INT Lap Wood U-0.044 2291
R21 TNT Lap Wood U-0.054 134 7.
Skylights @ x"CRYSTALITE LOWE/AR U-0.370 6�0 2 .2::;::
Ceiling R49 blown Attie STD bafflec-I U-0.027 1739 A 7.()
R49 blown Attic ADV U-0.020 322 6.4
Infiltration Standard Air Sealing ACH-0. 350 24866ft3 159.�,
-------------------------------
Proposed UA 5917
Struc Mass Light Frame, Sheetrock walls M_ 3.000 2067 620:1.
Slab w/carpet w/pad, Sheetrock wall M- 5,000 952 476(l
--------------------------------------------------------------------------------
HEATING/COOLING/VENTILATING SYSTEMS
PROPOSE[-,
Heating Oystem Type: Electric: Central Furnace
System Efficiency: 100
Modified Efficiency: 7P
Design ACHz 0,6(j
Heating LoadCat 53F dt ): 56419 Btu/hr
Oystem Size: 11.5 kw
Maximum Size 01500: 17.2 kW
Average Annual Heat: 23639 =-I
Annual Cost: $ 1064
Ventilation System: Integrated Spot
I Whole Houst�
Cooling System.,
SEER" 0.0 ( Ducted )
Cooling Load( at 5F dt ): 32114 Btu/hi-,
Recommended Size @125%., 3.7 tons
Annual cool requirement: XXX kWh/yr
Solar Access: Part iolly Shaded
---------------------------------------------------------------------------- ----
Page 2
WATT::,1.-N 5.::3 LONG TERM SUPER GOOD CFNTOi1.991 MCS COMPLIANCE REPORT
FILE: B:S&K.WS HOUSE ID:
-----------------------------------------------------------------------------------
PROPOSED DUCT SYSTEM
Location Avg Rva l ue Surface e Area
--------------------------------------------------
UPPLY Vented c;:rawl:=pace R-11.0 603. ; ftom:
RETURN Attic or garage R-11.0 120.8
--------------------------------------------------------------------------------
GLAZING ORIENTATION
PROPOSED PROPOSED
South 105.t:3f t2 North . 105.t'tf t2
Southeast : Northwest :
�' i 5 o
�.e3'ci:'t :a..i..1._>. tlJe :t 1C?.... .
Northeast . Southwest .
_--.__.....-------_.--•-•--.......-_-_....--------.---.-_.------.-.-....-..-..-...-----__...------...-.._.._.---_-....._..---_..----..-.-_.-..._......_..._.._..._....-............
=:.t'.t?1'ic_rm i <_ and energy consumption estimates 't �E < i _led for Ccrpr _ati vi..
purposes only . Actual !::o•iii:.t for heating will vary depending on wea ti•'ey,
conditions , occupant lifestyle and other r factors.
L _
N2 SE NE
SW NE E //739' 189.33, 204.07 212.9/, 118./1 285 91
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SHELTON
NOTES
We'
01.
.o mAL NOTE SYMBOLOGY EXAMPLE Gorr
Permit No.azz
MASON COUNTY
BUILDING PERMIT APPLICATION kJ ?3-05/
PLEM PRINT
441
Tr Owner Z4alno Al,f,
0 - -
Site Addr6s 7-l& 7777
City. St
Directions to Job Site 7_4 . "/ e" —zip
A'zy. _`6 6'(
4 h 4
Owner mailing Address- !F-
city 6/,Lle,I St 14'4 zip .5)r
Lien/Title Holder
Address
City St —Zip
#2 Contractor Name 5<gt)Z�*oqjq1
—Contractor Reg-.,"
Address 711 Expiration date
City 0 Phone9'z,( e
#3 If septic is located n ject site, include records'.
Connect to Septic?!� Public Water Supply_ Well
(If residential, proof of potable water may be required)
4#4 Parcel No. 2-13 61 _ 75- �'oOqy
legal Description
Building Square Footage: (existing/proposed)
1st F1 2nd Fl 3 rd Fl Lof t
Basement Deck-------L 4,1j hroom
._ #bedrooms
Garage Carport ftat.
__ (Circle: Attached or Detached?)
Other —sq ft
#6 Use of building
Describe work 104 t
am 7 Type of Job: New Add Alt Repair_ Demolition
Woodscove Re-Roof- Bulkhead_ other
a"
tr MOSTLE-ROME r_ZTFQR1-%Tj0N 11111q-
Model Year Make — Model
Length Width Serial No .
,rBedrooms "Sac.hrooms_ Type of Reac
"9
Any water an or adjacent cc proper:y:A/4a1cwacar Lake
r,-v e r nand wA=r I n r-t4 I -agda
L; t-reG (SZ each) Fee 17oo
va . Toilets G'� vent Systems"X 3 . 00
Bath Bas irs 6"b
--/:--- (o vent Fans X 3 . 00 �
y r No. Boil.ers/Cressor s
Oo
Showers 0- 3 H 0
/ Hat Water Htr 3 -15 HP
..Laund.- washer Z tT �J
.�"S i-.ss_ 15-3 0 3P
30-50 HP 6 . 00
F1oa� Doi na 50 + � �-
,00
Has ins Z_ / NO. Air Haadlinq IIni t v o
Dishwasher _� <� 10000 c 1. �--
`�
isposal Z _3 > 10000 cft. �y
._Urinals Other
� �Qther
--van Coolers _
Hoods _
Pertlit Basic Feed Fire Suppression _
TOTAL PLma=a $ Domes. Incin.
Cr_=1 . Incin.
Mechanical F{ Reloc/Repair 6 . 00
Xt�''-A4 Gas Outlets X 2 .00
No Ptzel was Woadstove seyarate'
Fu--n < 10 O K BTU 6. 00 —Other
Fu= >. 1.001 BTU 6. 00
Furs Floor - 5 . 0.0 Permit Basic Fee 10 . 00_
Heat Pumps 6. 00 TOTAL MESCAL $-
=0 A THLS PERT BE N,L AND VOID IF ;CPK OR CQNSTRIICTION .
II'IZ30RIZID IS NOT COM*jj�IiC= WITHIN ISO DAYS, OR IF CONSTRUCTION OR WORK
IS SUSP=OEM OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTTMiE AFTER WORK
IS C:OMMENC=
OWNM S AFF=Av= - C;12MACTORS AFFLIIAV=
I CERTIFY THAT I AM EXEWT FR01 ME M-CUIREIIEIITS OF THE I CERTIFY THAT I AN A CURREIRLT REGISTERED CXTRAcToR
CO"rUCTORS REGISTRATION LAY Rt31 13.27 Ara All AWARE
OF THE MASON COUNTY ORatNA HAT REOUIRE?1E)ITS FOR WHICH IN THE STATE OF WAsMIMGTON Ara I AM AWARE OF THE
MOINAMa REQUIREMENTS REGULATING THE WRK FOR WHICH
THIS REKNIT IS ISSUED AMO TAT ALL WORK Od1E WILL BE IN THE PERMIT IS ISSUED AM
AW ALL WORK DE WILL BE IN
CZ3fIFUKNAMCF THEREWITH. MO OUIMGES SHALL BE MCE CONFORPANCE THEREWITH. NO CIlAMGES SHALL BE +AoE
WITHOUT FIRST OBTAINING AP►RpyA� fRQ1 THE BUILDING OEPARTMEIIT. WITHQIT FIRST 02TAINING AP"MAL FRO4 THE BUILDING
DEPARTMENT.
X OWNER
OATn X BY
IIATS r.
Ret z-3 perit ta : oepartmeat of General Serrices
426 w. Ceda=./p 0 . 80, 186, Sheltoa, ??A 98584 427 -9670/1-800-562 -5628
POR OFFIC=A.L IISz ONLY: Accented ty=�Y� l5 _ Date: -CZ "-L
Show fcllowinq on the site plan i
Lac~Dimensions Flood Zones I
Existing Structures Fences
St~scture Setbacks Driveways
Water Lines Shorelines
Drainage Plan Tomography
Septic Systems Wells
Proposed Z=rovements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT To DRAW SITS' PLAN HELD
°a
NNI
_Zy oNu
L9
w
V
-,�V44
i
A ,
i
APPLICANT TO DRAW TOPCGRAPfly PROFILE HELC
i
� 1 ioa
w
I
DEPARTMMAL REyIEtiy
FOR OFFmcz U= MmIr '
Apprav*d Cand Hald
Appre"t
Planning:
%3
i -
Eaviroameatal 8ealth: r _ p-
Wag
Building Plan 8aview:
L
�L
0 c cupancy Group: R m
Fire Marshall:
Other:
II Special Conditi=s: Ru«0 e 2 II IjSite Inspection I Il
II II IlBuilding Pe=it
Il II Ilviolation Fee
II I II
li C -;I
II II lviolation Investigation
II gation Pee II II I II
II 11 Plan Check 13`a° y II
II II If '� A
II II II Plumbing• Fee I
II II Il - 166 ,60
II II IlMecbanical Fee �00 I II
II II if l
II II IlWaadstove Fee ( II
II II U I
I` II IlHuil-ding State Fee
II Buildi a I I I
S Valuac_cn: II