HomeMy WebLinkAboutBLD92-00680 Final SFR - BLD Permit / Conditions - 5/6/1993 COUNTY ��, �-MASON �
Mason County Bldg. III 426 W. Cedar
P.O, Box 186 Shelton, Washington 98584
3 13y-/3-90072
S4( 1
yy3 1'771ekle_5 c,7 ;d
rdki;ir ; ,r1
tt I 1k I N1 SY it 1A A AI Tih UJIS S1( SONVI I 1#116 1 stiff 11 i4 ." ✓!► ('INN
S t1 ! 1 }
1 AH++� �,lf s'i ��1+ ( + 4 1 1 ;
t Pf If �} +'�� ft
� 'ff 1 M1 +A1i ia_
i 'trl {t f I.t+{d'•• ! + LF' I' 1 r11 i �' �t,1'l.ft 1� 10 1't AaFtIP9, ,I is
+lt t il} } '!li1� b9 INIItt+ IJ}` t'Cf111 } " Nfl
111 tt ( It t `'r kf t'fiF[f { ti. } oti iZ IIM
i 1�I i. t I (... rti-?1 r§ 11+.t1 i 1 i'.^ii I? r7 f':.t # '� tS At tt t'. •t,- 1• ;) 111+IA1 r1'+ A sft11.A1i8N�r i .j ti
�[.xe+uY�r-ia,mlS...7�vY-:i.,:.a...i.Y•.-.'•r_.....w ,�'=ahS..:. ._sa�esa:`.�!`s_is:..�_-:-. _.... ;c�-^;,..,ra:. �—s�T.;..s^/IDsxzM�-��.Mpsr.-:._�
',1 Iwl+""} p ', _ ; �+ ils ; '. - ' � �-�i +'tt j, ;: i �i1 ' � a✓I!}�'Ia11 }r'„' t til'11' ltfitfilil k(l..t.
f f;t. �, ; { L'n. l ii ^S I i�t'1 "� `r;, itt• r9
f lrt }' i f t ;i}1111 t l 1 111t r 11 1; I {1 -t1ii:
it 1f1' 4'S
'1 t`1l
fit ( I t1itIf #Ij'iSLfy �. tdi � ( i11t`. # tttl
Itit I NI,' r4 I r}I(I-4 t
H+1',? ait t•! f ti!•. i 1 Ni}t'JI}!:' f 1 L:fi'ti"� b? � }tit,id} '. I tai # f>a 41 '�{. I' .1 tlf � _. .
1 '.Ii1a1€+<'<t1t 1t 11r1141}t i hdt: lilt + rlttl}`tt i iat ( Id 41
I itr11<.l1 t} ( `;1't}`,t1t 1 q+:ir..•}t) 1 tr
to i.1
1t► t ',{ 1.1 f�l 1 f .; 1 11 t- ; ., �q :, t„1-', t... ,
��_.: � . .,_-:-::��-_::.:�_�:�.:,::>.--.���.:-�.:.•.-:ems-�:.-,-
PNn�f+i i.t ',tftif'li M bt i181M#.E
i'fi+dfll i�lfFfi}}& It tf1 NA;0M YG _ It[itHl rtN MItf1i`I+id lit qft +tII it P1,1rgAI
fH15 P(f4II fit(f,01 . Out A0 V018 I( WOPI i1i IItN' t!U(�If�N AUiH1"Nl f! (", Nfl't } +iNMflltilr �IfNfr# i.,b I+At'e }a i rfi � �
P ?"}1t+it flc+H tl(+ 1lttkt i tl;p#Mkt0 Ifit A P111100
Al AN: liNi Milk wax IS f-0,01 _F E"VIA10,I;f if t'118IiNtIAfIh9 RI` 1,1101 1 A Pknbk-t i 'IN`;b'ltlfrill`ift11140 101- 180 bAt PtRtd;i_ fINAI 111IM(TION Nils 01
APPB(f.VIP ?ti})t1: 1111 It
a (All bt M(iItit
9NN1p f1k ntli N I .f ����`.-.�.,___�_. ✓d .,,�_._ GA t I � � .� / 2— ??��
k1I{ VP!t1 t s1141 1,UM111 1 ANC (0 A I ( AislIf'"11 CON -j.I 1 1.uN`, 1 ° ii1;_4111tt1 1)
q_3
CONCRETE MECHANICA MOBILE HOME
Footings- tback date / by -� Ribbons
date i Gas Piping date b
Foundation Wa t C! �- date b Set Up
date ` by t�� INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING FIRE DEPT.
/�`/��
date � � by /� 1���-� date Walls ( by ��� date by
PLUMBING OTHER
Groundwork Attic` ��
', date by
date `l � b � �� L � � 4 `
D.W.V. WALLBOARp NAIL NG
date by date " } J by
Water Line FINAL INSPECTION
date by date'' 3 by�,L�_ date by
t
I
MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
1991 WSEC AND V&IAQ CODE COMPLIANCE
PERMIT NUMBER 06 _) C) LEGAL > 0� a 21 (�
NAME ON PERMIT ISO)a 1 �d 1, C r� PHONE #
COMPLIANCE METHOD: ( ' Prescriptive O Component O Systems Analysis
Alec}r;L(1jeEi'stGn�� �l�f D�,�f�� ►a�8 h��
Insp. Rev. FOUNDATION Alajantundcr
Slab: R- (- ttXL foundation down to frontline/slab boom;or interior 24"top ofslab&horizon entire.)
( ) ( ) Below grade exterior wall insulation: R-
( ) ( � Crawlspace ventilation: -L.22&l = 87,;�112,e (I sq.ft.NF.v150 sq.f.floor area-cross vented)
/So
FRAMING
( ) ( - ' ( tandard ( ) Intermediate ( ) Advanced
( ) ( ) Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.)
Standard air seal: (Bottom plate/subtloor,rimjoist/mudsill,window/door frames,penetrations condition to non-condition-)
( ) ( ttic ventilation (I sq.ft.LT 00 sq.ft.ceiling area with 50/50 split UBC 3205-C) St7 1 :2.22y� /VF.4-
( ) ( Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm(0.25 WG;kitchen 100 cfm @.25 WG. Vented out with dampers.)
Fresh air ventilation: Available to all habitable rooms. Inst�alleedd and operational.
( ) (Whole house exhaust fan: cfm (I atermissysttm r' Sri nu,l auto rnntrols/sonoless than or=to I.s at.i WG)
( ) ( ) Integrated forced-air system. Outside air duct(with damper)allowing between 35&.5 ACM
'INSULATION
( ) (/Wall insulation (above grade) R- �_ (Batts face stapled)
( ) ( ) Wall insulation (below grade - interior) R- (Batt.:face stapled)
O ( Vapor retarders on walls (Faced bast.or 4 mil poly or perrrL paint.)
( ) ( ) Rim Joist (Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.)
( ) ( 4'__-Floor insulation R- (Substantial contact w/surface,supports less than or=to 23"OC*,not blocking vents.)
( ) ( Ceiling insulation R- — (Weatherstripped access/hatch insulatioa/and rigid access dam-no cardboard.)
( ) ( ) Vaulted ceiling insulation R- (Vapor retarder& I'air space)
( ) ( -Mechanical ventilation duets R-4 (Exhaust in unconditioned space&supply b conditioned space.)
( ) ( ) HVAC ducts in unconditioned areas R-8 (Joints sealed)
Pipe insulation R-3 Hot and cold lines in unconditioned areas(service or recirc.we Table 5-12).
( ) ( HW heaters: (NAECA label.separate power or gas shut-off,on R-10 pad if electric in unconditioned or on concrete.)
( ) (Heating system type: �t�riCc
Heat pump, list size, HSPF, and COP.
Indoor model # Outdoor model #
FINAL
( ) ( ) Radon monitor on site with instructions. (Sign&date.) � Ora
( ) ( ) Thermostat: (Heat ranee 55-75;AC 70.85;both 55-85. Backup heat cons ols(lockout)prevent simultaneous operation of
primary system.)
( ) ( ) Solid fuel applS.: (Glass/metal tight-fitting dcKws;dir.comb.air source,or 4'dia.dampened,indir.source for existing coast.)
( ) ( -r— Ground Cover: (6 mil black polyethylene or approved equal lapped 12'at joints.extending to foundation wall.)
( ) ( Penetrations (All exterior wall and ceiling penetrations sealed to drywall.)
* Less- than or equal to 2.3" on center is code. Twine is recommended or supports at 12" on center.
J
GLAZING
Plan Reviewer - Fill out this glazing section or attach a window schedule to is checklist. JMpector- Verify window
information during field inspections. Include skylights, glass doors and all other glazing on this form. Use rough opening
area for calculations.
Size Quantity Area Sq. Ft. U-Value Manufacturer rRev-77p1
S 1 oZC
L y o I S. yy
S c H r 8
10/
4X0
3 0 3Lr7
UJO
1P
e 4
37
OK �Q
Total glazing area: 0212
Total conditioned area: 12 s
Percentage glazing: D Veritted:
DOORS
Plan Reviewer-List opaque doors by type(solid core, insulated,etc.)quantity,U-value,and manufacturer. JMpeetor -
Verify door information during Field inspection.
Type/Quantity U-Value Manufacturer Rev. Insp.
go I ✓
r
Signature of Building Inspector: Date of Final Inspection:
II
I
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
PRESCRIPTIVE PATHS
OTHER FUELS (GAS, OIL, HEAT PUMP)
HVAC' Glazing Wall Wag int' Wall ext' Slab'
Equip. %Floor Cueing Doors Vaulted Above Below Below on
Option Effic. Area lJ-Value U-Value Cell N' Ceiling' Grade Grade Grade Floor Grade
I. Mod. 10% 0.70 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
II. Mod. 12% 0.65 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
Ill. High 21% 0.75 0.40 R-30 R-30 R-19 R-19 R-10 R-19 R-10
,.:RtO Reference case
V. Lnw 21% 0.60 0.40 R-36 R-30 R-19 R-19 R-10 R-19 R-10
VI.' Mod. 25% 0.50 0.40 R-38 R-30 R49 R-t9 R-10 R-25 R-10
VII.' toted. 30% 0.45 0.40 R-30 R-30 R-19 R-l9 R-10 R-25 R-10
1 Miwn rn requrerrrnts for each option listed. For example,f a proposed design has 5 Floors over crawl spaces or exposed to ambient air conditions.
a glazing radio to the oondAioned Yloor area of 19%,I shall oomply with all of the
requirenrnb of the 21%glazing option(or highfer). Proposed designs which cannot 6 Requird slab perimeter mulation shall be a water resistant raterial,manufactured
meet the specific requirertwib of a listed option above,may calculate oorrpLance for is intended use,and installed according to rronufacturefa specifications. See
by Chapter 4 or 5 of that code. ssaw 6024.
2 Requirements applies to all ceilings except single ratter or joist vacated caings. 7 These option shall be applicable to buildings Vass than three stones.
'Add denotes Advartoed Framed Ceiling.
8 The well mullion requirenrnt denotes R•12 wall cavity insulation plus R-5 foam
3 Requirement applicable only to single rafter or pat vaulted ceerGnga. sh eaNng.
4 Bobo grade walk @halt be insulated ether on the exienor to a mnimum level of R- 9 Wivrrsrn HVAC Equipnrrd efficiency requirerriont. tow'denotes an AFUE of 0.74.
10,or on the manor to the wine level as cells above grade. Exterior nsulatgn 'Mod denotes an AFUE of 0.78. }sigh'denotes an AFUE of 0.88.
nstaYed on below grade weft shah be a suer rammaint material,manufactured for
Is intended use,and netaiad amrial"to the nrrnrfacturefs specifications. See
section 8022
ELECTRIC RESISTANCE HEAT
Glazing wail wag int' Wall ext' Slab'
%Floor Glazing Doors Vaulted Above Below Below on
Option Area U-Value U-Value Cei4rlg2 Ceiling' Grade Grade Grade Floor Grade
I. 10% 0.46 0.40 R-38 R-30 R-21 R-21 R-10 R-30 R-10
11. 12% 0.43 020 R-38 R-30 R-19 R-19 R-10 R-30 R-10
III. 12% 0.40 0.40 R-38 R-30 R-21 R 21 R-10 R-30 R-10
Ilki& � ►s ,., »Q2Q ., . :>438 ::.:> Q:... wR iit...,.:..rwM ..Ell-1 ..�<> , 1�Y'.:<� R-3G —. iQ Reference case
V. 18% 0.39 0.20 R-38 R-3 R-21 R-21 R-10 R-30 R-10
A 21% 0.36 0.20 R-38 R- R-21 R-21 R-10 R-30 R-10
VII.' 25% 0.35 0.20 R-38 R-30 R-19+R-5' R-21 R-10 R-30 R-10
Vill! 30% 0.32 0.20 R-38 R-30 R-19+R-5' R-21 R-10 R-30 R-10
1 Af i+rrm requie.nenes for each option listed. For example,A a proposed dee.gn has 5 Floors over crawl spooee or exposed to ar bwo air conditions.
a planing rate to the Condit"ved Ybor area of 1 M if shop oompty with ail of the
requverrrnts of Cie 21%prang option(or hrghter). Proposed design witch cannot 6 Requred slab penneter mu4tion shall be a water resistant material manufactured
rttael Cie specdio rgwenssrMs of a listed option above,may calculate oonpGenee for b ntended use,and installed according to menu!ectu refs sped rations. See
by Chapter 4 or 5 of the code. section 6024.
2 Requrerrrrb applies to tilt ceilings except single ratter or joist vaulted ceilings. 7 These optorts shag be applicable to buAdings less than three stones.
'Adv'denotes Advanced Framed CeAr,g.
8 Tha wail mulshont requrerrrnt denotes R-19 wall cavity insulation plus R-5 foam
3 RewurerrrM applicable orly to single ratter or just vsuhed cerings, sheathing,
4 Below grade wail shall be rtsul.ted anther on the exteraor to a rnnirnum level of R-
10,or on the rnterar to the same lsrvet as wells above grade. Extenor insulation
mtalled on t- '- grade waft shall be a water rsW&m material,manulacturd for
is intended use,and walled according to the manufaaurels sped w ors See
section 6022
MASON COUNTY BUILDING DEPARTMENT
WINDOW SCHEDULE
WINDOWS (group same size windows on one line)
How
Brand Model U-Value Many Size Area (Sq. Ft.
q",X 4, 32.
�� K •�(v - "�(�-" 16
" " Z ,2'Px50 v
t b
S/_D 510 TGfAL WINDOW AREA (A)
SKYLIGHTS
How
Brand Model U-Value - Many Size Area (Sq. Ft.)
TOTAL SKYLIGHT AREA (g)
TOTAL GLAZING AREA (add A+B)
DOORS (from heated space to unheated space)
How
Brand Model U-Value Many Size Area (Sq. Ft.
TOTAL DOOR AREA .�lJ
4
ersc�aoe ' MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
�
1991 WSEC AND V&IAQ CODE COMPLIANCE r ' /w �G ,_ Y� e S C l� t° 1� V ' vc,1')&_J ?'
PERMIT NUMBER LEGAL
NAME ON PERMIT �111 N �of L jc�r j PHONE#
COMPLIANCE METHOD: Prescriptive ( ) Component ( ) Systems Analysis
a-a 6 hor'Fuels
7
Insp. Rev. FOUNDATION .S`� «
l i3��i 3 Pao n ?nits
( ) ( ) Slab: R- (Fact.foundation dowh to frosdine/slab bottom;or interior 24"top of slab&horizon adiant under entire.)
( ) ( ) Below grade exterior wall insulation: R-
( ) ( � Crawlspace ventilation: QA6 = (I sq.ft.N J/150 sq.ft.floor area-cross vented)
/S0 I.
FRAMING
-r— ( tandard ( ) Intermediate ( ) Advanced
Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.)
Standard air seal: (Bottom plate/subfloor,rim joist/mudsill,window/door frames,penetrations condition to non-condition.)
( /)� ttic ventilation (1 sq.ft.��00 sq.ft.ceiling area with 50/50 split UBC 3205-C) 1$,_D1160 -.;� 1:L 22_# NF+
( � pot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cfm @.25 WG. Vented out with dampers.)
F ( ) Fresh air ventilation: Available to all habitab)e rooms. Installed and operational.
Whole house exhaust fan:A01 cfm pntermitte'of sysWmTnual&auto controls/cone less than or=to 1.5 at.1 WG)
( ) ( ) ? Integrated forced-air system. outside air duct(with damper)allowing between.35&.5 ACH.
W JNSULA
(�=} ( Wall insulation (above grade) R �� face stapled)
( ) ( ) Wall insulation (below grade - interior) R- (Baru face stapled)
(( ) ( Vapor retarders on walls (Faced batt.or 4 mil poly or perm.paint.)
( ) ( ) Rim joist(Insulated with*vapor, &idam and caulked or 4 mil poly.)
-Floor insulation R- ial contact wi surface,supports less than or=to 24"OC' not blocking vents.)
Ceiling insulation Rerstripped access/hatch insulation/and rigid access dam-no cardboard.)
( ) ( ) Vaulted ceiling insulation R- (-V) (Vapor retarder&I"air space)
( ) ( )'—Mechanical ventilation ducts R-4 (Exhaust in unconditioned space&supply in conditioned space.)
( ) ( ) HVAC ducts in unconditioned areas R-8 (Joints sealed)
Pipe insulation R-3 Hot and cold lines in unconditioned areas(service or recirc.see Table 5-12).
HW heaters: (NAECA label.separate power or gas shut-off,o �RIO pad if electric in unconditioned or on concrete.)
( J__ (:;-_'Heating system type:
Heat pump, list size, HSPF, and COP.
Indoor model # Outdoor model#
FINAL
J�
Radon monitor on site with instructions. fsi n&date. Y
( ) ( ) Thermostat: (Heat ranee 55-75;AC 70-85;both 55-85. Backup heat controls(lockout)prevent simultaneous operation of
primary system.)
( ) ( ) Solid fuel appls.: (Glass/metal tight-fitting drx)rs;dir.comb.air source.or 4"dia.dampered,indir.source for existing Cont.)
( ( /� Ground cover: (6 mil black polyethylene or approved equal lapped 12"at joints,extending to foundation wall.)
Penetrations (All exterior wall and ceiling penetrations sealed to drywall.)
* Less than or equal to 24" on center is code. Twine is recommended or supports at 12"on center.
All U, V4 I deJ
GLAZING
Plan eviewer - Fill out this glazing section or attach a window schedule to This checklist. Impector- Verify window
information during field inspections. Include skylights, glass doors and all otherpglazing on this form. Use rough opening
area for calculations. oe WC3 j� OQ( CA -f-Ce a l9/�t2 �D) ► e
o Jl i d d .1� rn Y l` -�—.
Size Quantity Area Sq. Ft. U-Value Manufacturer Rev. Insp.
S N 1� �C� f'V\1 I cl
y 0 1 �
o- 6
o y
o s L ao a o
t_ •3�i
3 yp ILI
xG a,S ,
12
f2
Oe
32
OK �q
Total glazing area: 1`t I
Total conditioned area: 1:2IS
Percentage glazing: 1770 Verified:
DOORS
Plan Reviewer- List opaque doors by type (solid core, insulated,etc.)quantity, U-value,and manufacturer. Impgt2c-
Veiify door information during field inspection.
Type/Quantity U-Value Manufacturer Rev. Insp.
3 0 a t qcd ✓
Signature of Building Inspector: Date of Final Inspection:
IL -
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY
SINGLE FAMILY RESIDENTIAL APPLICATION
Site Address Parcel # ,Z13� 13 �DU�
Lot .6 Z Subdivision . 1&1
[✓fNew Residence [ ]Addition [ ]Remodel
Area (sq. ft.): 1 st Story 2nd Story Basement
Compliance Method
[ ]Prescriptive -- Indicate option (see attached sheet) ( ]I ( JII [ ]II [ ]VII [ JVIII
[ ]Component -- Attach documentation and calculations
[ ]Systems Analysis -- Attach documentation and calculations
Heat System
[ ]Electric (Electric Resistance)
[ ]Forced Air [ ]Wall Heater t4other 4:�Oa'I' (/gam
[ ]Baseboard [ ]Radiant
Make Model Size (KW)
[ ]Other
[ ]Gas Fumace [ ]Oil Furnace ( ]Heat Pump [ ]Other
Make Model
Size (BTU) AFUE HSPF
Ventilation System
[ ]Non-Heat Recovery Ventilation
[ISpot and Whole House [ ]Central Ducted [ ]Integrated with Furnace
Whole House Fan: .
Make &1'of4t4_�- Model S q0 Size (CFM) U
[ ]Heat Recovery Ventilation
[ ]Air to Air Heat Exchanger
[ ]Heat Recovery Heat Pump
Make Model Size
Attach 1) Window Schedule
2) Heat Loss Calculations
Radon
A three-month etched track radon monitor will be provided (by builder).
ACKNOWLEDGE:
(burd.r..yn tum)
J
-yam
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
RESIDENTIAL PLAN SUBMITTAL REQUIREMENTS
For processing of applications under the new Energy and IAQ Codes, it is imperative that
the submittals include certain basic information.
REQUIRED INFORMATION:
1. The application must be fully completed to determine compliance.
2. A window schedule must be attached. The schedule must show the make, model and
tested U-values. Glazing class alone is no longer adequate.
3. The building plans MUST show the following:
a) Framing to be used: standard, intermediate or advanced;
b) All insulation and R-values;
c) Type and location of vapor barriers;
d) Location of the whole house ventilation fan and controls;
e) Location and size of all other exhaust fans;
f All exhaust duct.runs and it h t e points of termination;
g) The type and location of all outside air inlets;
h) Termination point of appliance vents;
i) Location of all solid fuel appliances, fireplaces, and combustion air ducts;
j) Location of furnaces, hot water tanks and other equipment.
BUILDING PERMIT APPLICATION ��
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
2�y 22, DoBI
PARCEL �i I J/ -�1-7 D SLEICR. .ClT
NUMBER
NAME MAILADDRESS CITY&STATE ZIP PHCNE LICENSE NO.
CONTRACTOR =fS �j
USE OF �� G� ..r
BUILDING -{�
CLASS OF NEW V ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK �p ;� �<<•�� _.
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE/ (- ,SgFt STORIES_� SHORELINE Cl CONDITIONING.
BASEMENT SgFt BEDROOMS a PRIMARY RES.U--' THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS _ S Ft BATHROOMS - SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED UtIETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE B I ING DEPARTMENT. APPROVAL FROM THE BUILDIN jbEPAATMENT,
X OW DATE X BY DATE-4��
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
SHORELINE
7%^ WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION EPTE BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL
TliBY CASH CK MO
I _ �
PLUMBING & MECHANICAL PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
�!' Zzw Z'
DIRECTIONS
TO JOB SITE
LEGAL
DESCR.
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
_ c
USE OF
BUILDING
PLUMBING FIXTURES MECHANICAL FIXTURES
NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE
WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00
BASINS FLOOR/SUSPENDED FURNACE 6.00
Qi BATH TUBS BOILER/COMPRESSOR 6.00
SHOWERS REPAIR/ALTERATION 6.00
WATER HEATERS `Z . REFRIGERATION COMPRESSOR SYSTEM 6.00
AUTO.WASHER AIR HANDLING UNITS 7.50
SINKS HEAT-PUMPS 6.00
FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET
DRINKING FOUNTAINS 3 VENT.FAN SYS.3.00 PER UNIT
LAUNDRY TRAYS FIRE SUPPRESSION 5.00
CONNECT TO CITY SEWER WOOD FURNACE 5.00
DISHWASHER Z
DISPOSAL Z
URINALS
PERMIT BASIC FEE 3.00 IV PERMIT BASIC FEE 10.00
TOTAL TOTAL
SPECIAL CONDITIONS: _- NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED,
OWNERS AFFIDAVIT: I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF CONTRACTORS AFFIDAVIT: I CERTIFY THAT I AM A CURRENTLY REGISTERED
THE CONTRACT OR REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON CONTRACTOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE ORDINANCE
COUNTY ORDINAN EREQUIREMENT FO HICH THIS PERMIT IS ISSUED AND THAT ALL REQUIREMENTS REGULATING THE WORK FOR WHICH THIS PERMIT IS ISSUED AND ALL
WORK DONE W BE IN CONFO AN E T EREWITH. NO CHANGES SHALL BE MADE WORK DO WILL BE IN CONF ANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRS TA ING P A R THE BUILDING DEPARTMENT. WITHOU JIRST OBTAIN NGhO V L FROM THE BUILDING DEPARTMENT.
X OWNER DATE �7 , X 4111
B / 7 DATE �Z�
FOR OFFICE USE ONLY
APPLICATION ACCEPTED BY PLANS HECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION
BY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE
PARCEL LEGAL
NUMBER 3Z�ct_/3 DESCR.
Indicate below: Poppde y lines and dimensions.
Easements and roads.
/ Septic, drainfield and reserve area, or sewer.
q Septic tank and drainfield setback distances from foundations.
(6 Location of proposed construction on property.
Building & septic system setback distances from all property lines& easements.
Indicate North o/ Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system "as built' or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
71
d
ti
)o
a
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval.
r
SIGNATURE OF O ER(S)OK AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
1