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HomeMy WebLinkAboutBLD2006-00819 Final SFR - BLD Permit / Conditions - 6/18/2007 Inspection Line(360)427-7262 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 BLD2006-00819 OWNER: JEREMY DEEMER RECEIVED: 5/17/2006 CONTRACTOR: LICENSE: EXP: ISSUED: 6/6/2006 SITE ADDRESS: 131 E JENSEN RD SHELTON EXPIRES: 12/6/2006 PARCEL NUMBER: 321314100020 LEGAL DESCRIPTION: NE SE LYING ELY OF BROCKDALE RD TR 2 OF L.L.S. #03-04 - S 28/247 PROJECT DESCRIPTION: DIRECTIONS TO SITE: New SFR North on Brockdale Rd. to east on Jansen approx. 1000 ft. property on left. 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: 3 Occ. Group: R-3U Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No.of Stories: 2 Occ. Load: Building:3,877 Garage-Attached 739 Valuation: Building Height: 27 Occ. Status: Primary Basement: COVPORCH 677 Manufactured Home Information Setback Information Shoreline&Planning Information Water Body: Make: Length: Ft. Front: S 370.0 Ft. Shoreline: Ft. SEPA?: No Model: Width: Ft. Rear: N 188.0 Ft. Slope: Ft. Shoreline Desi Side 1: W 132.0 Ft. 9• Not Applicable Year: Serial No.: Side 2: E 176.0 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 5/17/2006 $1,308.42 S22006000 Hosebibs 3 Furnace<100K 1 Planning Review Fee KKK 5/17/2006 $155.00 S22006000 Kitchen Sink 2 Gas Outlets 6 Building State Fee ARC 5/31/2006 $4.50 S22006000 Laundry Tray 2 Propane Tank 1 Building Permit Fee ARC 5/31/2006 $2,040.95 S2200600o Lavatories 5 Ventilation Fan 4 Mechanical Fee ARC 5/31/2006 $251.55 §22006000 Showers 2 Heat Pump 1 Mechanical Base Fee ARC 5/31/2006 $23.50 322006000 Water Closets (Toilets) 3 Propane Stove 3 Plumbing Fee ARC 5/31/2006 $145.00 S22006000 Water Heaters 2 Dryer Vent 1 Plumbing Base Fee ARC 5/31/2006 $20.00 S22006000 Bath Tubs 2 ADJUST--Plan Check Fee ARC 5/31/2006 $18.20 S22006000 Clothes Washer 1 EH Plan Review TW 6/1/2006 $75.00 S22006000 Total $4,042.12 BLD2006-00819 Please referto the following pages for conditions of this permit. 1 of 5 I ` CASE NOTES FOR BLD2006-W819 CONDITIONS FOR BLD2006-00819 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-gQ0-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X" V O 2) 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 such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. x `Y 3) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at (360)427-9670, ext. 450. The building permit will not be"finaled" until the permit holder can show proof that the access permit from Public Works has been' "finaled" and approved. X,_,'1 r 4) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X 5) Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is RR5. 6) Approved er dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. 7) 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. x -ti�V� BLD2006-00819 Please referto the following pages for conditions of this permit. 2 of 5 i 8) 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.�n,� X "_-'I r+ 9 9) 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. X ,Y.,r, 10) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 11) 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. X _V` \, ) 12) 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. X 13) Per 2003 IRC -SECTION 1609 -WIND LOADS- 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609 BASIC WIND SPEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH. X 14) Per 2003 IRC - SECTION R905- REQUIREMENTS FOR ROOF COVERINGS- R905.1 Roof covering application. Roof coverings shall be applied in a ordaannce with the applicable provisions of this section and the manufacturer's installation instructions. --T 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). X 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 char eg d and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. BLD2006-00819 Please referto the following pages for oonditions of this permit. 3 of 5 1'7) 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 re ocation. X_ '` 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 x '�V;x� 19) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance of�regulation, must be reviewed and approved by Mason County prior to construction. X 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 In pe to r hall be made prior to requesting additional inspections. 21) All property lines shall be clearly identified at the time of foundation inspection. X 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. 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 revented action from being taken. No more than one extension may be granted. X �(` U 24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, c nn ctors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. xn n BLD2006-00819 Please referto the following pages for conditions of this permit. 4 of 5 25 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. 26) 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 Site Plan"to ensure these structures are shown and meet the setback conditions listed. x - V_/ 27) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. 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 anytime 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 descri d prop° and structure f r review and inspection. OWN ER OR AGENT: Z)`,�.1. �� �� � 1! z DATE: 0(� b BLD2006-00819 Please refer to the following pages for conditions of this permit. 5 of 5 o ' CONCRETE MECHANICAL MANUFACTURED HOME rn n Date 3144'01 By LMNA, _._ M m Footings I Set bac Gas Piping Ribbons ITI o Interior Date 2s(Xo ,�d� Interior-Date �VV' By 1.$ Date By � n Ulu l� Exterior Date o Exterior-Date �.0r, B (0 S' C- ITI Point Load I Isolated Footings INSULATION By X Date By BG t SLAB INSULATION nl Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS FRAMING Waft 3 f Date By Data z a�o� � r�� Date 3 �f J� By"N( y A- PROPANE TANKS PLUMBING vault R� 2w �.�t-ij�s/a'Z �, Date By Date By OTHER Groundwork Attic � 3 Data By Date By Type: � bate By D.W.V DRYWALL Type: Date By L�1�' Int Brace Wall Date By W Gate Byn FINAL INSPECTION v Water L' Fire Separation C Date B Data By Date 0t dz By I O Pass or Request Inspect. c Type of Insp. Fail Date date Done By Comments _ co zr m 5to s >�5 aeti4c lCS (uC �f1S" `� Ti:' 1�'� 7 ob �� � i tc.;1,2 i d✓ta(� i/t$�P.tX'i'o�'rS. c � ' k Fl � Fi Qz Wb -S 0 a 0 m � �% l'''t �uss � � o? 3 � 07 L�►t✓ VAu 4 CEO ►Ay _o Check hqA 3 70 0 / c %AVA 010 4 , �7 CAutk T-e, b `k -e—S 0 -o,..,A.a _wt -- '�s..:a,....,-n.,r,�-.•�_...r.,...•,.._.,.,,.a.,,,......r..:.ssal�tiM4w.-+.+IF.S......:......_:.....'..p._r r N MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTO►v(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 2004 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. 352. Additional WSEC and VIAQ compliance information is available on the internet at: http://www.energy.wsu.edu/code/ Prescriptive Requirements °,'for Group R Occupancy Climate Zone 1, Table 6-1 Glazing Glazing U-factor door Wall Wall Wall Area%of Vaulted Above interior° exterior Slab° Option Floor „ U s Ceiling Ceiling3 Grade below °Below Floors on 10 Vertical Overhead Factor 2 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.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. q<= 2. � h PLANNING ff 93. s 7 �s , t= JVED �� K a. COUNTY DCD PLANNING yaX 6o r W y SITE PLAN REQUIRED TO BE ON SITE •� /� ::: '' CHANGES SUBJECT TO APPROVAL E TMv. By Date t^ /.�NCpN�� ` .4 i 1 V Gy, o-i S 1., R We fi �tl 'f4 `o A a If .� D- .� 60 a...�tW...A!Naa•w-�WYYr+'N g._•fw+i.+�ltii.,. tw.s,.» a ...w - - MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/VIAQ Compliance Application Owner �rYLer' Telephone: 432q330 Parcel#: 13 I 41 Type of project (✓f New Residence ( )Addition ( ) Remodel Total Sq. Ft. 15 Floor: 2"d floor: Heated Basement: of heated area:: Heating System Type: O El, wall heater O Electric Central Furnace O LPG Furnace O Heat Pump with electric furnac H at pump with gas furnace O Boiler, specify fuel type: O Other: Specify Glazing O Prescriptive Option see reverse side circle one: 1 II g V Percenta e: Compliance Method O Component Performance , Chapter 5— Calculation worksheets required r 4+J . % Check one:: , 011 Systems analysis, Chapter 4 O Whole House Ventilation system 0 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 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 I(divided by)total sq.ft of heated area = %of glazing ©2/14/,EVWt7 15:33 FAX 360 753 V%2!t� THE IVAILBO% Z 001/002 Robert G. Turpin, P.E. Structural Engineer 2747 Pacific Awww e, Suite&Z1 Olympia, WA 98501 (360) 481-2078 February 14, 2007 Mason County Building Inspector Jeremy & Monica Deemer a1 E. Rockwood Dr. 'Shelton, WA 98584 e: Deemer Residence 131 E. Jensen Road, Shelton, WA 98584 Gen',-men, `O-A.-ve�nspecte ct the ,rm emt were questioned. 19-142,10Q8 ha'idown in the master bedroom installed on a 3' long cripple below the-windc me sill will be satisfactory if the cripple is screwed to the adjacent double wrch an additional 24 (each) SDS '/4 X 4 '/z" Simpson screws_ The screws skbcjuld be spaced to prevent splitting_ l'fNe holdowns on the rear garage wall and in the bedroom # 3 exterior wall �gar to he installed as intended. Sihocerely, O of WASh ' bert G. Turpin, P. �p 12082 c�9FGIsMS Ss��NAL ECG 03/05/2007 16:08 3602493475 KDS ENVIRONMENTAL PAGE 02 itNC Z W z 0 oe 5 P.O. BOX 312 (360) 249-5540 1-600-339-9546 WMontesano,wA 98563 Fax(360)249.347E www.kdsonvironmental.com March 5,2007 Jeremy Dean 131 E. Jensen Rd., Shelton, WA Dear Mr. Dean., 'Phis is to inform you that as of today,March 5, 2007 that all moisture readings are well below the 19%wpm. If you have any questions concerning the inspection process,please call. The full report will follow this confirmation letter. Thank you, Brad Wilson Certified Mold Remediator(CMR 03617) Building Inspector PD/R-MAI-07-02 03/05/2007 16:08 3602493475 KDS ENVIRONMENTAL PAGE 03 y \ I I RIM,, yT?y ji f h ♦ y 1 '�e+i�.Aar 3 Ji n+d yam?)I t Ey3,�i _^':�J �- �: •�'A+�+�i��)'"�,' •Q..r� .i6"_ - �y�f�l'���:1}, :EZ` �1 �..Fl 1i :ja��*vll,y li�' y �Ij�i+'°`Y P��r. 'i.�\ �� r i+''�• Y4'h • 1 vr FIN INC . A OCIAIFN Certified Mold Hemedistor , The Indoor Air Quality Association has awarded the credential 1 �h Certified Mold Remediator (CMR) to the individual named below In v � order to obtain CMR status, an individual must achieve a passing score y. I.'I of 70 percent.or greater on a rigorous, 3-hour examination. CMR status is only awarded to individuals who meet experience requirements that } assure field knowledge of mold remediation and related indoor .•SyY.^+rF�Jw� environmental issues. Bradfee D. Wifson CMR 03617 12/11/2007 l - Certification Number Expiration Date yy �q4�f �r .�Q-• 'OJT 'Rt= Signed on behalf of the Indoor Air Quality,Assoczacinrr I •4 S�� N,.\�� 111 Glenn I•"ellman,E"recuti»e Director r � e V V• V ���� Y !`}+ '���^tom, •{ t V . 'j1Y ! ! - ?�' .'.;- k `,-�t w. :2 I 1".sue 56lir'ii'^; tf- 1% CD CD J r`i ■51�7 OD CP �. m LO �. IA I Building inspector � A CERTIFICATE REFRESHER . . � This is to certify that D. WilsonBradlee has attended and satisfactoriiy completed all requirements to y. maintain accreditation as an Ai---iERA Building Inspector in r accordance with the Toxic Substance Control = •• ` =: z Act Titie (Section 206) and 40 CFR 763. c�5 O 1 Accreditation No. PDIR-NAi-07-02 -' January 17, 2007 ;_ . -,r:.✓�.. Course Date-. J y 1 . (J< 1 Valid through-. January 17, 2008 Donna McNea Nowicki & Associates, Inc. 35516 9th Avenue South, Bidg. #6 r " Federal Way, Washington 98003 tt - -52333 (253) 927 �- .lsri". ��� Yi'K Rv SY �Y JVYy'r}% _ ACCESS & GRADE WORKSHEET DATE: ACT ADDRESS c3 ,��jpn INSPECTOR ���2'-1� DRIVEWAY ACCESS Len the Width; �Surtac Size of turn-around: Condition of shoulders• ,�U,Ss� Vertical clearance• need ost at end of drivewa with reflective address numbers. GRADErOF DRIVEWAY L , r_ % OF ROAD !U ROAD ACCESS Length: Width• Surtace }�A-` � Condition: Vertical clearance: : io (_) BURN PERMIT REQUIRED FOR LAND CLEARING FIRE. ( ) LOT INSIDE SMZr 4X4 FIRES ONLY. ( ) LOT INSIDE UGAr NO OUTDOOR BURNING PERMITTED. LOT TOO SMALL FOR: BURN PERMITS — 4X4 FIRES. REMARKS 7-0 tl4itT continue remarks on back 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 kXC_ APPLIC NT INFORMATION CONTRACTOR INFORM&N a Owner' r (Vl u rI' C C . ot.e Company Name_ f_ Mailing Address C4 I r` Mailing Address City-S to-l.- r, StateldLiL Zip Code 'IR City State Zip Code Phone +IL - `1'1�Y Other Ph. 6C 1-DG A_ Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address ('�M E Mail Address Drivers Lic.# r DOB 3 c . `7S� Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect tp Water System Name of Water System Well ✓ Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No 2, co,O'.._, Fire District Legal DescriptionNL- SF L'Ly o►= i'*UCKQot.c IZ0 FA z CNr I_L1 Grl Site Address(Please include street name,street number and city) t5I f- .Trri i Pj1 R'A ,Ski j (l Directions to site Pv,_��"tn, )v+ �t'�CaCilQ.tr- R: LL L fan J,IAIell rt.�,,v, ,C �UIsC� fF} — ✓t ( o 1-f Will timber be cut and sold in parcel preparation?Yes o Is property within 200' of Saltwater iyo Lake .yn River/Creek No Pond A,-o Wetland V v Seasonal Runoff __AL2__Stream__4Li-' Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o TYPE OF JOB-New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building I Zt>icJslfl(d Describe Work 44U-" No. of Bedrooms No. of Bathrooms *�,3/tj Square Footage- 1 s''t Fllo�oo�rr 3547 2nd Floor 3 Z D 3rd Floor Basement Deck Covered `s�_Other Sq. ft. 'i Garage +�g Attached Detached Carport Attached Detached li 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 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 t i e9 P e ed o receive this permit and to do h� p 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 an other in interest regarding this application or the work proposed in the application, Y PAY ca on I have e9 9 aPP obtained permission f P epP pe 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 F CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X l Date: S-1A- O 6 Kwn-Qrl 6wners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: A. 11k Date. I ) DEPARTMENTAL REVIEW AP ROVED DENIED NOTES Building Department ),YWO C ' 1 ; Planning Department 1. ) Cl "1;(. C">L okAY 1)0 Environmental Health Department Public Works Department Fire Marshal I ` FEES Buildinq Permit Fee O Site Inspection Plan Review Fee 18 • zo EH Review Fee Plumbing & Base Fee •00 PlanningReview Fee Mechanical& Base fee Z-� O Other Wood/Gas/Pellet Stove Fee State Fee S Violation Fee AID Cam, Pre-Paid at Submittal Valuation$ 2 0 g , TOTAL FEES -TOT ra L. CbJ , io o r CA, Kea-) UkL . 2v", (off(. S?"� �.tom � 1 „�-►•� ��,. Z(p , � Z- ', 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 `Jt't-Q y)W DA c'inel. Company Name ?i3 Q Mailin Address ?" E RucKv goo el "106- Mailing Address City 1 rL C State L" Zip Code City State Zip Code Phone 432 "`93�L- Other Ph. - CL; IS Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail addressiJN(1_)L;:1MC-9 L'1'4S'4.cc M E Mail Address Drivers Lic.# L)EEk JA2�C�F DOB 3- i�, ?S_ 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, I'>l y i L"C,( ',!G Fire District Legal Description NE SE LI1111 , Ll-,j or 3i<oCKo'L1CF tzi> Tk. 2 Cyr' C_L_S- 44 O '3 __C;LI Site Address(Please include street name,street number and city) 131 E TCAS-en Rd Directions to site r Or 1�' rec_Kci�Ir EciS1 cr , . Rd c '1e-u v �o + r o rt LCP Is property within 200'of Saltwater &D Lake V —River/Creek Pond Wetland __dLlLSeasonal Runoff A10 Stream Slopes or Bluffs > 15% A/o TYPE OF JOB- New ✓ Add Alt Repair Other Use of Building es idcn fl0.I Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric '!LPG �!Natural Gas_Heat Pump Toilets Type of Unit No.of Units Fees Bathroom Sink ' Furnace I Bath Tubs Heatpumps i Showers 2 Spot Vent Fan Water Heater sl Propane Tank Clothes Washer I Gas Outlets —� Kithen Sinks Wooellet Stover Dishwasher Kitchen-Exhaust Hood Hosebibs Dryer Vent I Other LIFv Z— Other qyLAq 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: �67'/G " v 6 wne /O ers Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: -,_- 1I5lanning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group Type Constr. Planning De artment 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