HomeMy WebLinkAboutBLD2009-00980 Final Garage with Residence - BLD Permit / Conditions - 8/10/2010 t
Inspection Line(360)427-7262
to MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2009-00980
OWNER: RICHARD HUTCHINS RECEIVED: 11/6/2009
CONTRACTOR: LICENSE: EXP: ISSUED: 12/7/2009
SITE ADDRESS: 3231 E BROCKDALE RD SHELTON EXPIRES: 6/7/2010
PARCEL NUMBER: 321314100001
LEGAL DESCRIPTION: NE SE LYING WLY OF BROCKDALE RD
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Garage with residence and living area. BROCKDALE RD TO SITE ADDRESS ON THE LEFT SIDE
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 1 Type of Constr.: VB
Type of Use: SF Insp.Area: No.of Bathrooms: 1 Occ. Group: R-3/U Lot Size: Deck:
Type of Work: NEW Fire Dist.: No. of Stories: 1 Occ. Load: Building: Garage-Attached 1,080
Valuation: Building Height: 18 Occ. Status: Primary Basement:836
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 120.0 Ft. Shoreline: Ft. Water Body:
SEPA?: No
Model: Width: Ft. Rear: W 210.0 Ft. Slope: Ft. Shoreline Desi
Side 1: N 170.0 Ft. 9.: Not Applicable
Year: Serial No.: Side 2: S Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 2 Exhaust Hood 1 Plan Check Fee GMM 11/6/2009 $675.06 S12009000
Kitchen Sink 1 Ventilation Fan 2 Planning Review Fee GMM 11/6/2009 $205.00 Si2009000
Lavatories 1 Dryer Vent 1 EH Plan Review GMM 11/6/2009 $103.00 S12009000
Water Closets (Toilets) 1 Water Adequacy Plan Review GMM 11/6/2009 $41.00 S12009000
Water Heaters 1 Building State Fee LDK 11/24/200 $4.50 S12009000
Bath Tubs 1 Building Permit Fee LDK 11/24/200 $1,128.15 S12009000
Clothes Washer 1 Mechanical Permit Fee LDK 11/24/200 $40.20 S120o9000
Mechanical Base Fee LDK 11/24/200 $28.50 S12009000
Plumbing Permit Fee LDK 11/24/200 $58.40 S12009000
Plumbing Base Fee LDK 11/24/200 $24.70 S12009000
Total $2,308.51
BLD2009-00980 Please refer to the following pages for conditions of this permit. 1 of 5
- CASE NOTES FOR
BLD2009-00980
CONDITIONS FOR
BLD2009-00980
1) 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
Depart t prior to any further inspections being performed or approvals granted.
X
2) OwnerMent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
3) 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
rr(emoval of pproved documents will result in failure of required building inspections.
4) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X VLd
5) 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
Build in D artment prior to any further inspections.being performed or approvals granted.
x �-1/ .,
6) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation R-10.
Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
unders� f the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
7) Per IRC -SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS- R905.1 Roof covering application. Roof coverings shall be applied in
accord�pce h the applicable provisions of this section and the manufacturer's installation instructions.
X
BLD2009-00980 Please refer to the following pages for conditions of this permit. 2 of 5
r
8), A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
' inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. "NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor isa knowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
9) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/Reserve requires a 10ft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
X. No,f tion drains within 30ft, down gradient of drainfield/reserve area.
10) 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).
x \2 W
11) The international 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
X such roads fonnect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
—T
12) 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
perms yopPtion.
X
13) Installation of heating equipment in single family residences shall meet the requirements of the current Washington State Energy Code.
The furnace to be installed shall not exceed 150% of the heating and cooling design load. Heating and design load calculations for the purpose of sizing
HVAC systems are required and shall be calculated in accordance with accepted engineering practice, including infiltration and ventilation. Design
calculations shall be available for inspection during the framing inspection.
Warm-air furnaces shall have a minimum efficiency of 78%AFUE or higher or 80% combustion efficiency. All ducts shall be securely fastened and
sealed with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric systems or tapes installed in accordance with manufacturers installation
instruc iqn Duct tape is NOT permitted as a sealant on any ducts. Ducts in unheated spaces shall be insulated to R-8.
X 'd` ��
BLD2009-00980 Please refer to the following pages for conditions of this permit. 3 of 5
.1211 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.)
15) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinan c r regulation, must be reviewed and approved by Mason County prior to construction.
X
16) 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.
X 4 j 1,
17) All property lines shall be clearly identified at the time of foundation inspection. X 'Y LA
18) 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 o ty ordinances and building regulations.
X
19) 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 ha v r ented action from being taken. No more than one extension may be granted.
X �
20) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, nd flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X -
21) Retaining walls needed to support a surcharge s i h as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
22) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
BLD2009-00980 Please referto the following pages for conditions of this permit. 4 of 5
23) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
' "Approved Si1i Plan"to ensure these structures are shown and meet the setback conditions listed.
24) 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
X 800-647-0 8 The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
25) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X—�1%:��,
26) No residence was on site at the time of this permit. This structure has NOT been reviewed or approved as an Accessory Dwelling Unit(ADU): A second
dwelling unit detached from an existing single-family dwelling for use as a completely independent or semi-independent unit with provisions for cooking,
eating, sanitation and sleeping. ADUs are required to meet the requirements under Mason County Development Regulations 17.03.029. When a
separate res1d n is proposed in the future, the planned structure must meet these regulations.
X - 1
27) Prior to final approval, all upland areas disturbed or newnM
ed by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
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 owner or 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 r r ie and inspection.
C
OWN ER OR AGENT: DATE:
BLD2009-00980 Please referto the following pages for oonditionsofthis permit. 5 of 5
F
CONCRETE MECHANICAL MANUFACTURED HOME _
C
0
__ _. _ -- Date By - •--1
Footings 1 Setbacks Gas Piping Ribbons =
o � Interior Date By nterior Date By Date [3•
o Exter.ar Dale IV By 1,iDX- - --- ' Z
J Exterior-Date B+�_, -- fit• , (A
__ __..__.^ INSULATION
Point Load!Isolated Footings -- Date By �
BG/SLAB INSULATION - n
Date By Data By FIRE DEPARTMENT =
Foundation Walls Floors Date By >
Date t t, to By Data S-y-� By DECKS C
FRAMING Walls Date By
Date By 114
Data By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic
Date By Date _ By Type �O �� L
Date /' By
D.w.V DRYWALL .Type v
Int.Brace Wall �-n Date ay W
v Date — By Date _ Byl /� FINAL INSPECTION -- 0
Water Line Fire Separation
Date By Date By V Date O''�D 8� O
�p tp
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments W
00
' o , �� �u't 1H D JG1PL Att c
� ZOO,
ZA
8 Ulm f I--, Z A t!v Z !o p L ov— 4, K.2� " 1^d Glevt✓di�� Pwt•»�O N��irl
a
� LJID
o _.. WJt 61ac - �ul� GcM L/�/7u� vv►s�T°2-
,plvv
Q
f ��
o 7C 6 t-,y ,S=/G,/� //-/o /
1�
Name Parcel# BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment', with more than 2,000 square feet of impervious surface'.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area * All dimensions in feet
Buildings X =
C X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
(� X = eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas) zq
I
If the Total Impervious Surface Area is L S THAN 2000 ScitkrejMeet, please read,acknowledge and sign below.
Based Upon the information you have provided a Storm a to Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.1
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page I of 2
i
i
Name Parcel# 32,13 `—A l — OQOO L BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
http//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stonnwater Site Plan".This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail: P 0 Box 1850, Shelton WA 98584
Physical: 415 N 6th St, Shelton WA 98584
If this development has, or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other, parcel. You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT. 352
Mail: P 0 Box 1666, Shelton WA 98584
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X` /G Owner/Agent/Contractor(circle one)Date:��Cp Q
Page 2 of 2
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/VIAQ Compliance Application
o Owner: 0,,Ovd y lci c, �c6iy7s •Telephone I) gg6,b � Parcel#: 3Z 13 _ - O 066
'Type of projectV) New Residence ( )Addition ( ) Remodel
Total Sq. Ft. 2� 1S Floor : 8— --1 2" floor: Heated Basement:
of heated area:: 82-i
Heating System Type: & Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: Specify
Glazing O 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 (VIAQ 3o3.4.a)
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
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
2006 Washington State Energy Code (WSEC)
2006 Ventilation and Indoor Air Quality Code (VIAQ)
Effective July 1, 2007
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. The window and door schedule should include all windows, skylights, sliding glass doors, french doors and
any other door with 50% glass or more. Use rough opening dimensions of windows and doors to calculate
size. It is always helpful to list the u-factors of windows and doors, if known. If you do not know u-factors,
the plan reviewer will assume all window & door glazing will have a u-factor of .35 or less. When using the
area weighted average method to comply with the prescriptive path include calculations with submittal
documents.
3. On your building plans note the location and fuel type of heating system, water heater, location of exhaust
fans (bathroom, laundry, kitchen, etc.) and R-factor of proposed insulation for walls, floors, ceilings, and
slabs. Outdoor lighting, permanently mounted to a residential building or to other buildings on the
same lot shall be high efficacy luminaires or motion sensor with integral photocontrol photosensor.
All linear fluorescent fixtures must be fitted with T-8 or smaller lamps, but not T-10 or T-12 lamps.
To verify compliance, provide lighting information on plans.
4. Questions? Call Mason County Community Development at (360)427-9670 ext. 352. Additional WSEC
and VIAQ compliance information is also available on the WSU-Energy Program website at:
http://www.energy.wsu.edu/code/
Prescriptive Requirements " for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Vaulted Wall Wall Wall
Area%of Door Ceiling Ceiling3 Above interior exterior Slab s
Option Floor U s 2 See note Grade 4 below 4 Below Floor 5 on
10 Vertical Overhead Factor below 12 grade Grade Grade
I 10% .32 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
II* 15%* .35 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
IV Unlimited
Single
Family Res .35 .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. 352 for footnote information. Log&solid timber wall with a min. avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.Vaulted ceilings shall be limited to 500 sq.ft. of ceiling area for any
one dwelling unit.
_Ql'OGe53
I der
�►�� 'Nf-A� 1
7
way
�p
a
APPROVED
MASON COUNTY DCD PLANNING '
SITE PLAN' REQUIRED TO BE ON SITE
CHAN E -----�
SUBJECT TO APP OVA ` - • �- `.
�l7 By Date
o
----_..A-- -___.__.____.__._..._.._--.�._.__._. _..�..._._ _..__�__
i
i
i
I
�� �
1
l
� I
i
}
�' ``
�� I
� i
,:��
�`
��� �'�
r�
!�
r'�� � r
�'
,,;
�%
. �I
,��' �
�'
r' �
.g''
' �,
� ' ��
,�':
�.
PERMIT NO. _ lC_iJ
MASON COUNTY
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 INFO�MAJI N CONTRACTOR INFORMATION
Owner t ! chti r V �O—C�1 1 n-`� Company Name
Mailing Addre 0 0 0 Mailing Address
City {( o �Stateh A Zip Code $ City State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 1 i ')O Fire District
Legal Description
Site Address (Please include street name, street number and city) E• P G if.
Directions to site oil nr t
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other_ Use of Building
Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
lype of Fixture No. of Fixtures Fees Fuel Type:Electric LPC�_ Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs 1 Heatpumps
Showers = Spot Vent Fan �)c Z
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
Dishwasher Kitchen Exhaust Hood —�—
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OVVNER/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.
PROOF OFXCOINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building De �arment ({ L�
' J I-
Occ Group T ��
e Constr.v'�
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
F
Gas/Pellet Stove Fee Other
n Fee TOTAL FEES
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.
PLEASE PRESS HARD 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 INFO ATION CONTRACTOR INFORMATION
40 Owner ") r w i i Ui"C 1�1 r Company Name
Mailing Addre s aL 1-Upn Mailing Address
City x i r Stat' V% Zip Code `rL City Zip Code
Phon4 LP( 0 '`AID• O! 1 Other Ph. Phone er Ph.
Lien,�Tkie•Hotder Contractor Reg. # Exp.
EMai_ad&ess E Mail Address
Driuer-s,-Lie.,#,.,_ -f)00_ Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connec Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. ' i 04;:'> t Fire District
Legal Description
Site Address(Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs /o
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?YestNp,"
TYPE OF JOB - New^ Add Alt Repair_Other PRIMARY RESIDENCE Ig SEASONAL ❑
Use of Building Describe Work E. " t f
No. of Bedrooms No. of Bathrooms Square Fooi6ge 1FS1 Floo 4821 2nd Floor
3rd FIoQ,r Baseraent Deck Covered Dec Other Sq. ft.
1`1Garage ` -Attached 'x Detached Carport Attached Detached
MANUFACTURED HO-NPE INFORMATION, --1t14F ce Model Year
Length L Width See ll No. ", s . of ooms 'No: of Bathrooms
Type of Heat a Pur6ha 6 Price$ `.../ Replacem 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 provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OFff 180 DAYS W((IIL�LLLIIINVALIDATE THEAPPLICATION.
X Date]
Owner/'Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT. Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department N 4 w Q+1-0W y o 4 I f,
Planning Department
Environmental Health Department 1 M
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbinq & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES