HomeMy WebLinkAboutBLD2005-01524 Final SFR - BLD Permit / Conditions - 5/26/2006 Inspection Line(360)327-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W.Cedar P.O. Box 186
IP, Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2005-01524
OWNER: TIM RHOADES RECEIVED: 8/30/2005
CONTRACTOR: HILINE HOMES OF GRAYS HARBOR 360-482-7750 LICENSE: HILINH'981 BT EXP:2/10/2C ISSUED: 9/28/2005
SITE ADDRESS: 1550 E JENSEN RD SHELTON EXPIRES: 3/28/2006
PARCEL NUMBER: 321307590144
LEGAL DESCRIPTION: TR 14-D OF SURVEY 4/74 TR D OF SP#800 SURVEY 30/139
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR BROCKDALE RD TO JENSEN RD, FOLLOW PAST COUNTY ROAD ENDS
SIGN,TO TOP OF HILL AT 4 WAY INTERSECTON, TURN R, THERE IS
EXISTING HOUSE ON R, LOT IS NEXT TO IT(FIRST LOT FOR SALE)
General Information Construction &Occupancy Information Square Footage Information
No.of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp.Area: No.of Bathrooms: 2 Occ. Group: R-3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No.of Stories: 1 Occ. Load: Building:2,152 Garage-Attached 576
Valuation: Building Height: 17 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 115.0 Ft. Shoreline: Ft. Water Body: NONE
SEPA?: No
Model: Width: Ft. Rear: S 330.0 Ft. Slope: Ft. Shoreline Desi
Side 1: W 60.0 Ft. 9.: Not Applicable
Year: Serial No.: Side 2: E 5.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures FEES
Mechanical Fixtures
Type Qty. Type WLY. i,e By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KS 8/30/2005 $262.59 S12005
Hosebibs 3 Furnace<100K 1 Planning Review Fee KS 8/30/2005 $155.00 S12005
Kitchen Sink 1 Ventilation Fan 3 Building State Fee ARC 9/20/2005 $4.50 §12005
Lavatories 3 Heat Pump 1 Building Permit Fee ARC 9/20/2005$1,312.95 S12005
Showers 1 Dryer Vent 1 Mechanical Fee ARC 9/20/2005 $65.10 S12005
Water Closets (Toilets) 2 Mechanical Base Fee ARC 9/20/2005 $23.50 §12005
Water Heaters 1 Plumbing Fee ARC 9/20/2005 $89.00 512005
Bath Tubs 2 Plumbing Base Fee ARC 9/20/2005 $20.00 S12005
Clothes Washer 1 EH Plan Review CEW 9/28/2005 $75.00 S12005
Total $2,007.64
BLD2005-01524 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2005-01524
CONDITIONS FOR
BLD2005-01524
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 potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. 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 road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads connect 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) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X Tc-K-
4) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X °z_--
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5) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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6 The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. Structures
and/or land modifications (grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a seperate permit. The geotechincal
report/assessment shall remain attached to the approved building plans. X
7) The roof drainage should be conveyed into dry wells. X _FZ,—
8) The area of 40% slope shall be maintained as a vegetative area and that a 20-foot buffer be maintained on the north, west and east edges of the property
in order to manage the stormwater tending to leave the property. The south side of the property shall maintain a 30-foot buffer to manage stormwater.
These buffers should be maintained in vegetation and no culverts, pipes or other conveyances shall be allowed through the buffer area.
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9) 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
Department prior to any further inspections being performed or approvals granted.
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BLD2005-01524 Please referto the following pages for conditions of this permit. 2 of 5
10) 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 Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted
by the jurisdiction and 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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11) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal of approved documents will result in failure of required building inspections.
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12) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X ` I ,fZ
13) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved"site plan is not 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 shall be collected by the
Building Department prior to any further inspections being performed or approvals granted.
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14) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: IV, Window(Max U-Factor):0.40, Skylight (Max U-Factor):0.58,
Doors (Type/Max U-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.
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15) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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16) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be
charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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17) 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 Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
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BLD2005-01524 Please refer to the following pages for conditions of this permit. 3 of 5
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18) 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 ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 25'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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19) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
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20) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall be made prior to requesting additional inspections.
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21) All property lines shall be clearly identified at the time of foundation inspection. X wTF TZ_
22) 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 County ordinances and building regulations.
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23) 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 period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have prevented action from being taken. No more than one extension may be granted.
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24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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25) Stock Plan Identification number:2003-0022
This project is approved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department,
original building plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building
Inspector at each required inspection.
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BLD2005-01524 Please referto the following pages for conditions of this permit. 4 of 5
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 period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection 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 inspection.The owneror the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure for review spe
OWN ER OR AGENT: v DATE:
BLD2005-01524 Please referto the following pages for conditions of this permit. 5 of 5
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o ' C5NCRETE MECHANICAL MANUFACTURED HOME
Co F" that Ob By - Ribbons .
Date IZ/7/05 ByLj�W_- Gas Piping Date By
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� Foundatlon Walla Date 8y Set-up
Date I Z 7 AS By UOi— INSULATION Date By
BG 1 Slab Insulation Floors Z J �y FINAL I NSPECTION
Date By Date rj(L�IC" l� Date By
FRAMING Walla FIRE DEPARTMENT
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Groundwork pate1
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FINAL�NSPECTI?�.-
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APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPROVAL
By TS L — Date C? h y I d,
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11 i 28i 2005 17: 00 3605387157 P::GE 01
Nov. 25, 2005
Page 1 of 1
Morta Engineering & Testi;:g
To: Mason County Post-It' Fax Note 7671 Date`s e9�►
Building I11426 W. Cedar To �Q From
Shelton, WA 98584 Cc,/Dept co.
(360) 427-9670, (360) 427-7798 fax ~L !N5
Phone# Phone o
Attu: Mark, Building Inspector Fax O `�Z_j 7 Fax e
Subject: Geotechnical Engineering Site Inspection by Steven P. Mortis, P.E. of Morta
Engineering and Testing on Friday, November 25, 2005 at 1550 E. Jensen Rd,
Shelton, WA — Building Permit 002005-1524
On Friday, November 25, 2005 this geotechnical engineer inspected the above building site to
determine the adequacy of the subgrade for the footing foundation and the foundation in general.
A sharp pointed steel soil probe was used to check the compaction of the footing subgrade and
was not able to penetrate the surface of the glacial till material since a smooth blade on the
excavation bucket was used to minimize the amount of disturbance to the native soils. As a result,
the native glacial 6.11 soils were found to be essentially undisturbed and, therefore, adequate to
support the residence.
The 12" wide by 6" deep footings will be resting on very dense hardpan and, therefore, was
found to be adequate for the foundation of the building. Most of the footing will be at least 8"
deep since the 2 x 6" forms had at least a 2" gap underneath them.
It is recommended that the standing water observed on the site at the location of the
footings be removed prior to the concrete footing pour to ensure that the concrete does not get
mixed in with the water which could substantially reduce the compressive strength of the concrete
footings.
If you have any questions regarding this geotechnical engineering inspection do not hesitate to
contact me at(800) 590-095.
Best Regards,
(J/
Steven P. Morta, P.E.
P.O. Box 250,Ocean Shores,Washington 9SS69-0250
(360)2890959 Bus,(360)289.%82 Fat,(800)590-09M Toil Free
Smorta*AOL.com
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NAME ! Q Aba cA C NORTH VICINITY MAP
SITE ADDRESS
CITY
ZIP
MAILING ADDRESS 5 3 6, 14rX )OCI�
CITY 5 -1�
ZIP 9$5Fq
PARCEL NUMBER EEO-
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PHONE NUMBER H 5 �'cl
WM980
MILES FROM HILINE HOMES _
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Detach And Display Certificate --�
DEPARTMENT OF LABOR AND INDUSTRIES
REGISTERED AS PROVIDED BY LAW AS
CONST CONT GENERAL ; !
j REGIST. # EXP. DATE '
CCO1 HILINH*98113T 02/10/2006
EFFECTIVE DATE 01/30/2002
HILINE HOMES
11306 62ND AVE E
PUYALLUP WA 98373
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-- Detach And Display Certificate -- _ - --------- -- — ------ —
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ VIAQ Compliance Application
Owner: -�;,�,�o.} �� E. R no Telephone:(3,,,�A32_- Parcel#: 3Z1 30-7s— 9014,4..
Type of project V) New Residence ( )Addition ( ) Remodel
Total Sq. Ft. Z 1 S 1 s Floor : 2 floor: Heated Basement:
of heated area:: Z— A 5 Z
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: S ecif
Glazing Prescriptive Option see reverse side circle one: I II III
Percentage: Compliance -----
Method' O Component Performance , Chapter 5— Calculation worksheets required
Check one:
l Z % O Systems analysis, Chapter 4
Whole House Ventilation system Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air
Recovery Ventilation System (VIAQ 303.4.4)
System vents (VIAQ 303.4.1)
Check one
O Whole House Ventilation Integrated Whole House Ventilation using an inline
with a Forced Air System (VIAQ 303.4.2) supplyfan.an• VIAQ 303.4.3)
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows:
MrlGArm 0,mcr,o,1 Tc ► eye - .35 I r0 X s ' 0 O
geamyZ w& Z • 35 6,0 k 5 In 1 ZS
14
11 WA (,�',u 2.0 (✓�os k tr C3AT�k .3S 3� O x _3' 0 l 9
r
/�{6AtiZD (n�rN,b�,7s J;,c 6rZC-AT o— 35 7r 0 '� 5 ra 3 S
M/L INDW&IZ; ?)C'e'C KFAST 111c9►Z r 35 ? Zj X ra rD Z 20
RreakFAsr Aoo ,35 3 r 0 X 5 r is
5 a' O X 3' b 2 Z 1
'` ,►�ws� DN .r.� 'fZooM , 35 (G+ b X S b 30
D X 5 r O 3 0
Av0 -xPws E�+� , xSrL t 8 , 3
Windows: Total Sq. ft. 22-3 , 3
Doors:
� � 4
/1/ii�c',4A.n I,J,.Napws Ano53¢r 8zo1��o�.A � 35 t'D � � 1� �
Doors: Total Sq. Ft i
Total window and door area --Zo,Z. 3 f'
Total window & door area 2-(04• 3t) I (divided by) total sq. ft of heated area Z I S Z = Z %of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 Elma (360)482-5269
FAx: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2003 Washington State Energy Code (WSEC)
2003 Ventilation and Indoor Air Quality Code (VIAQ)
effective July 1, 2004
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
(WSEC/VIAQ)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
http.//www.energy.wsu.edu/code/
Prescriptive Requirements 0,1for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Option Area %of U- Ceiling Vaulted Above interior4 exterior Slab°
Floor Vertical Overheadil Factors 2 Ceiling3 Grade below a Below Floors on
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.
E WORK ORDER , PUBLIC WORKS 6EW BE KEPT IN THE
q_q
PERMIT P: Her
. Aulhottzpd by:
_R"ofted W. TCir�v"' �,(C �� _�..�' .' "
Type of Watt.. Date; s, '
CHARGE Tot
NAME # • y0�
ADENCY/OOMPANY /-j-�5_ y
BIUJNG ADORES
PHONE
Pub. Ihaom
MUM
e e: m-to •s "
• . pto��t ;.,,.,__....,� • l�OMB. •
hover EiTtMATEO TiOTAL M
- Von low- TOTAL i
r,n y� 1 F .
• EQIfi'MENTttSEd: .f '. � ' ��. � .
MATF.FULUSED; �•.:......
{�1 A*Ad Cost 3 MAM:
DATEMMUM
to Loa Hotin F MAl i
• tQVIPMENT UBEM,
MATERIAL,UBRD� ---••..r.., •
TOTAL ALL �-
3)' BILLED DATE. ___.,wI.- PAIDDATE
MASON COUNTY 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 i
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner"11na-,t%jd 6 • Khcoyke c Company Name WiLl vr. NnMES dt= elmA
Mailing Address 5 3 I-. IN-m lac rc Q4_ - Mailing Address 50 CLNT=F miy_E Ln Stc. "L5
City ►-& I+oON —State uA Zip Code g0sei} City M State Zip Code g
Phone 360 43Z- 29Zq Other Ph.(76A Z6'O--6S80 Phone - � 9 �
erPh.
Lien/Title Holder AkS E;A4y- Contractor Reg.# l,=l=NH 981QT':xp,O1 / 30 [�
E mail address E Mail Address
Drivers Lic.# R AtTE 23 b DOB 1 - 2.5 :1_1 1 Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic :*s Existing Septic
Connect to Water System VF-:!5 Name of Water System mklN SQz► ,je A
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 3Z.130 --7 S - 90 t a-d- Fire District
Legal DescriptionT,v.+ A' a n S6er+ R!j-1+ * RDU
Site Address (Please include street name, street number and city) I SSO I'=. -la.hs
Directions to siteTye'+n h. Ao A e 0s,e n, MA a .cc ow, grOLKSAa_A '4LtiIL0-- - v, ( . S
1145 A04 O I--A
Will timber be cut and sold in parcel preparation?Yes 2- o. .+ k�e r 'j i-i-.
Is property within 200'of Saltwater . 6 h_Lake M 1. River/Creek Pond N c
Wetland 1J= Seasonal Runoff�9_Stream N,., Slopes or Bluffs 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/ ;)
TYPE OF JOB - New_"Add Alt Repair Other PRIMARY RESIDENCE 0 SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms 2- Square Footage- 1st Floor Z 1526 2nd Floor
3rd Floor Basement 01Deck Covered Deck Other Sq. ft.
Garage Attached g Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit(evocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the crnractor. 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 obtained4be p&ftssiQn from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this applit°ation or the wgrk
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work propopd,. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason Qounty aeddd j Ia the above
described property and structure for review and inspection. This permit/application becomes null & void if wor thorized'&(61ruuction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CON � i® OF WORK IS BY
MEANS PROGRESS IN N.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE TH��C 4TION.
x.-.. 0AJ Date: 8-'21 -OS NTY
Owner/O ners Represen rac or (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department -'
Planning Department ! '
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee 1 317- . Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee (0 . 00 Planning Review Fee
Mechanical & Base fee 8$ d Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee r/lfr- Pre-Paid at Submittal
Valuation $ JS(o S0 TOTAL FEES
.r•,.,.. - ,.. .. r.;. ...,,, :' _..[ 1,:: ..1. a `,`;.-
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL 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 INFORMATION CONTRACTOR INFORMATION
Owner.T.Y+e-1 Vnj 4 E . 1460Q OL.O A Company Name
Mailing Address 63 E. 14*-/htec_K C_4- Mailing Address 50 Mv-% -trArsst Lo -As
Ci State WA Zip Code SIB of City sk 1 wt a- State--IsJ A Zip Code 9 8 s4l
Phone (1 +n-29 Other Ph.(36e) 280-6586 Phone 3` 1-7450 Other Ph.
Lien/Title Holders r A&T A& Contractor Reg.4 =00 111"'M 1 Ir Exp. 16
E mail address E Mail Address
Drivers Lic. 2ZOAC DOB 11 " 25 —Zj__ Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic4$6 Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 3Z13o —'IS— Otolt44- Fire District.I111" S
Legal Description T rcLQA- 4 PIa A0 `80a
Site Address (Please include street name, street number and city)_ISSO £ j ense.k-x Rd
Directions to site EP a Mn VbtAbALt VA. 4uAs Aa.-A 406r,
4c 1 %."t 1a iv% } a�L0 v 0 N
Is property within 200'of Saltwater k'o Lake Un River/Creek 010 Pond Ili
Wetland Seasonal Runoff uo Stream Ijp Slopes or Bluffs > 15% . S
TYPE OF JOB - New Add Alt Repair Other Use of Building e*
Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPC Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace 0
Bath Tubs Heatpumps
Showers Spot Vent Fan I
Water Heater ' Propane Tank
Clothes Washer i Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher 1 Kitchen Exhaust Hood
Hosebibs I Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PR0QF F CONTINUATION OF WOR $Y MEANS OF A PROGRESS INSPECTION.
Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES