HomeMy WebLinkAboutBLD2005-00239 Final SFR - BLD Permit / Conditions - 8/17/2005 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. 3 426 W. Cedar P.O. Box 186
IP14 Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2005-00239
OWNER: WILLIAM SNYDER RECEIVED: 2/17/2005
CONTRACTOR: ADAIR HOMES INC. 360-352-8571 LICENSE:ADAIRH"262RZ EXP: 1/9/2007 ISSUED: 3/25/2005
SITE ADDRESS: 1600 E JENSEN RD SHELTON EXPIRES: 9/25/2005
PARCEL NUMBER: _321307590134
LEGAL DESCRIPTION: 13-D OF SURV 4/74 TR D OF SP#796
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR, STOCK PLAN#2003-0050 101 North exit off Wallace Kneeland turn right. Left on Brockdale Rd. Right on
Jansen Rd. 4th driveway on right.
General Information Construction&Occupancy Information Square Footage Information
No.of Bedrooms: 3 Type of Constr.: V-B
Type of Use: SF Insp.Area: No.of Bathrooms: 3 Occ.Group: R-3, U Lot Size: Deck: 120
Type of Work: NEW Fire Dist.: No.of Stories: 2 Occ. Load: Building:2,080 Garage-Attached 400
Valuation: Building Height: 23 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 75.0 Ft. Shoreline: Ft. Water Body:
Rear: S 2 SEPA?: No
Model: Width: Ft. .0 Ft. Slope: Ft. Shoreline Desi
Side 1: W 25.0 Ft. 9•: Not Applicable
Year: Serial No.: Side 2: E 20.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 2/17/2005 $846.14 S22005
Hosebibs 2 Ventilation Fan 4 Planning Review Fee KKK 2/17/2005 $155.00 S22005
Kitchen Sink 1 Dryer Vent 1 Building Permit Fee KKK 2/17/2005 $133.16 S22005
Lavatories 3 EH Plan Review CEW 2/19/2005 $75.00 S22005
Showers 1 Adjust Plan Check Fee JRN 2/25/2005 -$7.28 S22005
Water Closets (Toilets) 3 Building State Fee JRN 2/25/2005 $4.50 522005
Water Heaters 1 Building Permit Fee JRN 2/25/2005$1,112.59 S22005
Bath Tubs 1 Mechanical Fee JRN 2/25/2005 $46.90 S22005
Clothes Washer 1 Mechanical Base Fee JRN 2/25/2005 $23.50 S22005
Plumbing Fee JRN 2/25/2005 $89.00 S22005
Plumbing Base Fee JRN 2/25/2005 $20.00 S22005
Public Works Review AT 3/23/2005 $39.22 S22005
Total $2,537.73
BLD2005-00239 Please referto the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2005-00239
CONDITIONS FOR
BLD2005-00239
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 pgtential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647 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) The internatioanl code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved
access roa gads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such road ,gads
with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
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3) 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
Departme t ny further inspections being performed or approvals granted.
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4) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that
require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the
access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background.
Mason County Buj ding Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted
by the jurisdicti nd the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
inspections.
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5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X r' t
6) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Ele or other fuels, Compliance Method: IV, Window (Max U-Factor):0.40, Skylight (Max U-Factor):0.58,
Doors (Type 'Factor):0.40 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38,Vault Insulation R-30, Slab Insulation R-10.
BLD2005-00239 Please refer to the following pages for conditions of this permit. 2 of 4
7), Stock Plan Identification number: 2003-0050
M This project i proved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department,
original buil n plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building
Inspector a required inspection.
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8) Concrete use for basement walls,foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical con to work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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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 hington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit ion.
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10) All changes "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinanc lation, must be reviewed and approved by Mason County prior to construction.
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11) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the ingbe
tional codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector ma rior to requesting additional inspections.
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12) All property lines shall be clearly identified at the time of foundation inspection. X
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
Mason Co dinance 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 p i d not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have ted action from being taken. No more than one extension may be granted.
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15) Pressure d wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connect d fla ing. Install metal connectors approved for contact with the new types of pressure treated material.
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BLD2005-00239 Please referto the following pages for conditions of this permit. 3 of 4
16.) 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 ordi n.ce and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason C nt "Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located thin 5'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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17) Prior to final approval, all upland areas disturbed or new4yred by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
18) Temporary erosion control measures must be implemented to prevent water quality deg r 6 of adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X `
19) Approved �mensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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20) The approval of this project is subject to the recommendations and specifications outli ed in the attached geotechnical report or assessment. Structures
and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical rep s ssment, may require a seperate permit. The geotechincal
report/assessment shall remain attached to the approved building plans. X
21) The side cast clearing debris that has been placed over the top area ravine slope consists of unstable soil masses that are prone to failure and
rapid erosion. This material must be pulled back off the slope and di e d of he area of low relief. The disturbed areas of the slope will need to be
stablilized with pl ntings to restore the slope protection. X
22) Collected wat II be carried to the south and discharged into the flow line of the ravine in an approved manner.
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This permit becomes null and void if w 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 continuati of work is a pro +�specti n within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress ins c' The ow r he ge on the owners behalf,reWthatation provided is accurate and grants employees of Mason County access to
the above described property and e for r ie nd�p tion.
OWNER OR AGENT: DATE:
BLD2005-00239 Please referto the following pages for conditions of this permit. 4 of 4
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PLUMBING Attic _ (4�k)
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oN'srATF MASON COUNTY
o Py A o N DEPARTMENT OF COMMUNITY DEVELOPMENT
> s U = Planning Division
2 o T Z
N P O Box 279, Shelton,WA 98584
n
Y Doti (360)427-9670
1864
NOTIFICATION OF INCOMPLETE APPLICATION
March 10, 2005
WILLIAM SNYDER
P O BOX 1334
SHELTON WA 98584
Parcel No.: 321307590134
Project Description: SFR, STOCK PLAN #2003-0050
Dear Applicant:
You have submitted a permit application (case no. BLD2005-00239) for proposed
construction or development in the county. Upon review of your application, I have
determined that the contents of the application are incomplete or do not provide
enough detail for review.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 295 if you have questions.
Sincefely,
Tammi Clark
Land Use Planner
Mason County Planning Department
3/10/2005 1 of 2 BLD2005-00239
M
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NOTIFICATION OF INCOMPLETE APPLICATIO
N
Case No.: _
3/10/2005 BLD2005 00239
Comments: A site inspection was conducted on 2/25/05 to assess critical areas
relevant to future residential construction. The proposed project is
adjacent to or within 300 feet of a steep slope. This area meets the
criteria for a landslide Hazard Area per the provisions of the Mason
County Resource Ordinance NO. 77-93. Applications for development
within 300 feet of a Landslide Hazard Area require a geological
assessment/geotechnical report to assess slope stability and address
specific efforts to remediate the hazard. Enclosed is a copy of the
Landslide Hazard Areas chapter of the Resource Ordinance. Please
note the distinction between a geological assessment (Section EA)
and a geotechnical report (Section E.5). A geological assessment is
required for slopes between 15% and 40%, and a geotechnical report
is required for slopes greater than 40%.
Please provide the enclosed ordinance to your licensed engineer or
geologist so that they are aware of all the requirements per Chapter
17.01.100, Section E.1-7. Missing information will result in further
delay in the processing of your building permit.
The report must state that the hazards of the landslide are can be
overcome in such a manner as to prevent harm to property and public
health and safety, and must also assure the project will cause no
significant environmental impact (Section E.7).
There will be a geological assessment/geotechnical report review fee
of$175.00.
3/10/2005 2 of 2 BLD2005-00239
OLYMPIA BRANCH ADAIR BUSINESS CENTER
2303 93rd Ave SW , ,; ° .' 1111 SW 170th Ave.
Olympia,WA 98512 Beaverton,OR 97006
Const.360-352-7641 •" Phone:503-645-4730
Sales 360-352-8571 Fax:503-645-9715
Fax 360-943-0701 It's a Smart Move.
February 14, 2005
Mason County Building Dept
PO Box 186
Shelton WA 98584
Dear Official,
Please find enclosed a building permit application for William & Tina
Snyder. They will be building a 2080 Sqft home at 1600 E, Jensen Road,
Shelton, WA 98584.
Enclosed are three sets of blueprints, plan check fee of$1134.30, strip
map to site, approved septic design, well drillers log, bacteria test, plot
plan and energy form.
If I have forgotten anything or if your requirements have changed, please
notify me at (360) 352-8571.
RECEIVED Thank you
,FEB 16 2005 &"nu�p
426 W• CEDAR S7.
Sarah Reining
Administrative Assistant
Adair Homes Inc.
OR CCB#593
WA#ADAIRH*262RZ
ADAIR HOMES,INC. AURORA BEND CALDWELL CRESWELL MEDFORD OLYMPIA WOODLAND
' adair homes.com
I
PLOT PLAN
Name 7i n h
Mailing AddressF.-() . j3C2.-,e t3!,3q 5F d 9$5V
Nome #6360),— 41-32--0522 Work # Cell #
Property Location I LOO C Jeens e rL Dr. S hO n , IA-Jd 9 8 5gT___
Legal Address T5 ZI N R 3 VSec 3 Tax Lot # ,321_30 -]55 j ,34
t"Q-50 n County, State of 1Ab,,5 W i qq"Il O r1
THE INFORMATION ON TIB5 PLOT PLAN HAS BEEN Pr1OVI UF.D Al IU PC V IF\Ylib By IIIEIPr IPETITY
OWNER WHO BY SIGNING BELOW:I)ACKNOWLEDGES a(-'CH'I,,FUI I.fir.SPI II I91RII.1 I Y
FOR ITS ACCURACY AND COMPLFTEHESS.2)11,hE5O1t11 RLE 1 n GI I'd1RF I I IA T fill!
/ IMPROVEMENTS TO THE SITE TAKE PLACE IN COIJTORMAI-ICE IVI 111 11115 PLAN 1)IVII I.
ESTABLISH ALL THE CORNER IRONS.LOT LIMES AVID COhE.RE(jIlluCh 517 IRAC.1:5 hF(.1111hED OF
SCALE:: 1 rr = THIS TIROPERTY.ANY CIIAHGF.(S)TO THIS PLAN MUST BE FRE.AI'I'110VED RY 111E
���(J GOVERNM AL AG CIES TH JURISDICTIOIJ. TI IE MORTCACE:I.FIdUEh A1JU II II'
/ COV1113 O AIJD ONIA TED.
R SIG URE bATC
1
/ OWNER 5IGNAT RE UA I E
PLANNING
1 p 1 )r �0 1
C�°�o-
F d
ay �� irk go �se.
3
I gyp, 20
No We l Innc�S
3f APPROV D
ASON COUNTY DCD PLANNING
SITE PLAN REQUI ?E7 TO BE ON SITE
CHANGES SUB.lECT TO APPROVAL
Date 3 a
1
1
REVISED�, Z - 11
�ATE
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MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 SEATTLE (206)464-6968
ELMA (360)482-5269 FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2001 Washington State Energy Code (WSEC)
effective July 1, 2002
2000 Ventilation and Indoor Air Quality Code (VIAQ)
Code Compliance Application Form
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/ Ventilation and Indoor Air Quality Code
(WSECNIAQ)application located on the reverse side.
2. Complete the window and door schedule on the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location and fuel type of water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and
slabs,
4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 284. Additional
WSEC and VIAQ compliance information is available on the internet at:
www.energy.wsu.edu/buildings/
Prescriptive Requirements 0,1for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Area /o of U Ceiling Vaulted Above interior4 exterior Sl2b4
Option Floor Vertical Overhead Fa - 9 2 Ceiling3 Grade below 4 Below Floors on
10 12 grade Grade Grade
I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
II* 15%" .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
IV Unlimited
Single
Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
(R-3)Only
`Reference Case/Call (360)427-9670 ext. 284 for footnote information. Log&solid timber wall with a min. avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ VIAQ Compliance Application
Owner: elephone:14-3Z OL . Parcel#:•�o��-J O
Type of project ( New Residence ( ) Addition ( ) Remodel
Total Sq. Ft. 1S Flo 2n, floor: Heated Basement:
of heated area:: L 4 C'
Heating System: Electric wall heater O Electric Central Furnace OLPG Furnace
O Heat Pump with Electric Furnace O Hea Pump with.}—Ga urnace O B iler, specify fuel type
O Other: Specify: 1
Glazing Prescriptive Option see reverse side circle one: 1 II IV
Percentage: Compliance
Method O Component Performance , Chapter 5— Calculation worksheets required
% Check one::
O Systems analysis, Chapter 4
O Whole House Ventilation system O Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air
Recovery Ventilation System (VIA(?303.4.4)
System vents (VIAQ 303.4.1)
Check one
O Whole House Ventilation Integrated O Whole House Ventilation using an inline
with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3)
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows:
Windows: Total Sq. ft.
Doors:
Doors: Total Sq. Ft
Total window and door area
Total window &door area /(divided by) total sq. ft of heated area = %of glazing
�/h►I ((() S` ot'v- 19 `lT'1 ► ptwv—- Prepared by:
MASON COUNTY RESIDENTIAL PLANS UBMITTAL CHECKLIST
Owner's Name: n Date: Reviewed By:
Documentsi
`Site
Permit Application Completed
lanning Intake Checklist Completed,
Site plan includes:Allowable building area,roof overhangs,decks,etc.
_ pparatus Access Road info required? Yes/No
nergy Code Application Form-HEAT FUEL TYPES(� _
echanical/Plumbing Application-WATER HEATER FUEL TYPE 1
Engineering Included&info transferred onto building plans:Design criteria:Code referr�ce: ,snow to ,
Seismic Zone(circle one): 1 r D2 ; Calculation incl(circle): Vertical Yes / /'Vo),Lateral Yes /
Construction Plans:_V3'COMPLETE SETS
P ns Legible �jecognized Scale _Elevation Views ✓ Cross Section _Foundation Plan
oof Framing Plan Floor Plan-Use of Rooms Noted _Deck Framing Plan,incl cov.porch framing
Floor Framing Plan-all floor levels including loft,crawlspace,etc.
Plan Details:
USSe�
_/Roof framing details,truss lay-out may be needed v
_/Wall Framing-Does bearing-�11 heig4t exceed 10'?(Engineering may be q fired) '
Floor framing: Floor joists: ,Floor beams:
mdow headers. Typical head
_Foundation:footing size,reinforcement
_Concrete Walls-Does Concrete Wall Height Exceed 8'?(Engineering may be required,see details)
Non-Conventional Framing-Foam Core,Logs,etc.?(Engineering is required)
7 Point loads trace to footings below?
Slab insulation shown
►�Landings at all exits?
HcMiMy Furnace-Location of Furnace
_ ce/Stove Information Shown-Fuel Type?
Window Sizes Marked on Plans
Braced Wall Panels(BWP)[also referred to as shear walls]Reference 2003 IRC Section 602.10: no z
C
Braco Wall Panels(BWP)Marked on Plans? YES(continue below) NO(lateral analysis included?)
_4'Exterior BWP's located at comer,OR check option below: D I1
v�4'panel within 8'of comer with 1800#holdown ,or
_jAL2'comer panel and 4'BWP located within 8'or comer R602.10.5(see detail),or
2'8"Alternate BWP(ABP)
4'Interior Braced Wall Panel(IBWP),within 8'of comer,not to exceed 25'o.c.
EXCEPTION:spacing may be 35'o.c.in order to accommodate one single room not exceeding 900 SF,length of wall shall be
required length multiplied adj.Factor from Table R602.10.11 (25'-30'use factor of 1.2,30+'to 35'use factor of 1.4)
Continuous footing required under 2-story structures in D2 or see exception in 602.10.9.
IRREGULAR BUILDINGS R301.2.2.2.2
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 ft.beyond the braced wall line.
3)End of BWP extends more than 1 ft.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.
COMMENTS:
MASON COUN I Y PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar • P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT I FORMATIO CONTRACTOR INFQRMATIQN
Owner I Company Name
Maili, Address Maili Address Y
7 Cit State Zip Cod
City tate Zip Code y P
Phone 2' Other Ph. Phone Other .
Lien/Title Holder Contractor Reg.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# ,= DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Oter System Name of Water System
Well Z Water System Name of Water System
PARCEL INFO TI N - 12 Dice Parcel No. Fire District
Legal Description
Site Address (Pie a in de s reet a stre t um er a d i y
D' ctio s to it t Qn
t
Will timber be cut and sold injArcelfep a ' �Y / o
Is property within 200'of Saltwater River/Creek Pond
Wetland Seasonal Runoff Slopes or Bluffs > 15%
Is this permit submittal th esult of a Stop Work Notice,Correction Notice or other enforcement action?Yb o
TYPE OF JOB - NevAdd Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑
Use of Building Descr' e o
No.of Bedrooms No.of Bathrooms quare Footage- 1 st Floor 2nd Floor. fah
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORM TI - M I Model Year
Length Width Serial No No.of Bedrooms No.of Bathrooms
Type of Heat Purchas c Replacement Unit? Yes/No
Installer Name Certification 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 other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provideoAs accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
X D
RO(JlrflF�C N /NON Q,F'JI'y(��I�-I,S;B�ItA�ANS OF A PROGRESS INa eECTIpN.
Owner/Owners Re resentative/Contractor indicate which one !9
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department 0i- no D IV E
Planning Department 01 w-
Environmental Health Department
Public Works Department
Fire Marshal J(i (
FEES
Building Permit Fee 9 L Site Inspection
Plan Review Fee 8� EH Review Fee
Plumbing & Base Fee — Planning Review Fee
Mechanical & Base fee `1-`o Other 60
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ - TOTAL FEES
FORM MUST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair(360)2754467 Elma 360 482-5269 Seattle 206 464-6968
APPLIQANT
� I NF ORM ALO CONTRACTOR INFORMATION
�/Owner I Y_.l Contractor Name
Maili Address C. Mailing Address.` z
City. State Zip Code xi! LLf City I i State JAa Zip Code
Phone( Other Ph.0 Ph.( - Other Ph.
Lien/Title Holder Contractor Reg. # &TJ I t'14 A2-UTZ
Address Expiration I / /
=SEPTICORMATION-Connect to New Septic Existing Septic Connect to Sewer System Nameof
m
PARCEL INFORMATION-12 igit Tax Parcel No. Fire District
Legal Description : 2l L
Site Address(Pleqs� rcJydestreet name, st e�number and city)
r cti ns to site //�Vf —
� 1
Is your property within 200' of the following: Body of Water (Nay Saltwater
Lake River/Creek Pond Wetland S off Stream Slopes or
Bluffs
TYPE OF JOB New_V Add Alt epair Ot r Use of Building
Location of Fixtures/Units 1st Floor 2nd Floor�Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No. f Fixtures Fees LPG Natural Gas Heatpump
Toilets Type of Unit No. of Units Fees
Bath Basins Furnace
Bath Tubs I Heatpumps
Showers _ Vent Fans
Water Heater �_ Propane Tank
Laundry Wsher Gas Outlets
Sinks Wood/Gas/Pellet Stove
Dishwasher Direct Vent?
Other Other
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
X Date X f Date ( �
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
At 'WMMALI2EWEW: A?PROVED DENIED flNDiTICTVL'it)CJ 51
IE
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
FEES
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing& Base Fee Other
Mechanical& Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES