HomeMy WebLinkAboutBLD2014-00987 Final Remove Window - BLD Permit / Conditions - 3/17/2015 IIIZIPUI IIVII LII IC tODU)-f/I-/4k)4
��eo" °pUvrF MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III
426 W. Cedar
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT
BLD2014-00987
OWNER: LARRY KLUBE RECEIVED: 10/30/2014
CONTRACTOR: LICENSE: EXP: ISSUED: 10/30/2014
SITE ADDRESS: 400 E JENSEN RD SHELTON
EXPIRES: 4/30/2015
PARCEL NUMBER: 321323290041
LEGAL DESCRIPTION: LOT: 1 OF SP#2272
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
REMOVE AND REPLACE 1 WINDOW FOLLOW BROCKDALE RD, R ON JENSEN RD TO SITE ADDRESS ON THE
RIGHT SIDE
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.:
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: Lot Size: Deck:
Type of Work: REP Fire Dist.: 11 No. of Stories: Occ. Load: Building:
Valuation: Building Height: Occ. Status: Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft.
Water Body:
Rear: Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Side 1: Ft. Shoreline Desig.:
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Building State Fee GMM 10/30/201 $4.50 S1201400000001
Building Permit Fee GMM 10/30/201 $ 117.50 S1201400000001
Total $ 122.00
BLD2014-00987 Please refer to the following pages for conditions of this permit. Page 1 of 3
o CONCRETE MECHANICAL MANUFACTURED HOME r
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-!I, Footings /Setbacks GatePiping By Ribbons m
o Intenor Date By interior-Date BY Date By
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4 _. _ Set'UP >
INSULATION
Point Load/isolated Footings Date By X
BG!SLAB INSULATION <
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By
Date By Data By DECKS
FRAMING Walls Date By
Date Ry, Data By PROPANE TANKS
PLUMBING Vault Date 11.y
Date By OTHER
Groundwork Attic
Date By Type
Date By Date By
D.w.v DRYWALL Type-
Int Brace Wail Date By W
Date BY Date By r
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Dale By Date By Datd5 By
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o Pass or Request Inspect. c
Type of insp. Fail Date Date Dane By Comments CID
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MASON,COUNTY PERMIT NO 8,4Qd
BUILDING PEFfMIT 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 Larry Klube Company Name Home Depot At Home Services
Mailing Address 400 E Jensen Rd Mailing Address140 County Line Road,#101
City Shelton State WA Zip Code 98584 City Pacific State Wa Zip Code98047
Phone 360-427-7291 Other Ph. Phone 800-381-5699 Other Ph.
Lien/Title Holder Contractor Reg. #HOMED"972RQ Exp. 2/1/2015
E mail address E Mail Address naida@nwpermit.com
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No.32132.32-90041 Fire District _
Legal Description
Site Address(Please include street name, street number and city)400 E Jensen Rd Shelton Wa 98584
Directions to site Head west on W Cedar St toward N 5th St,Take the 3rd right onto N 7th St,Take the 2nd left onto W Alder St,
Continue onto Olvmoic Hwv N,Turn riqht onto E B St,Sliqht left onto N 13th St,Continue onto E Brockdale Rd,Turn riqht onto E Jensen Rd
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 ] 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair X Other PRIMARY RESIDENCE ❑✓ SEASONAL ❑
Use of Building residence Describe Work remove and replace 1 window:no size/structural changes
No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached 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 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 CO UA OF W RK IS BY MEANS OF A PROGRESS INSPECTION. /
X Date: . O
Owner/Owners Representative/Contr for indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: 410, Datejn• 'Z.�i�}
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Public Works Department
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