HomeMy WebLinkAboutBLD2005-00172 Final SFR - BLD Permit / Conditions - 8/15/2005 Inspection Line(360)127-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. 3 426 W. Cedar P.O. Box 186
goo Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2005-00172
OWNER: DONALD INZUNZA RECEIVED: 2/3/2005
CONTRACTOR: ADAIR HOMES INC (360)352-8571 LICENSE:ADAIRH"262RZ EXP: 1/9/2009 ISSUED: 2/23/2005
SITE ADDRESS: 11 E MIKKELSEN RD SHELTON EXPIRES: 8/23/2005
PARCEL NUMBER: 321343400020
LEGAL DESCRIPTION: TR 2 OF SE SW
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR 101 TO HWY 3, TURN LEFT ON MASON LAKE RD,R ON MIKKELSEN RD,
STOCK 2003-0032 #1920 SITE LOCATED ON LEFT SIDE.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type ofConstr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:1,920 Garage-Attached 440
Valuation: Building Height: 16 Occ. Status: Primary Basement: COV DECK 24
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 79.0 Ft. Shoreline: Ft. Water Body:
SEPA?: No
Rear: IN 45.0 Ft. Slope: Ft.
Model: Width: Ft. Side 1: IN15858.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: S 105.0 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 KS 2/3/2005 $242.43 S12005
Hosebibs 3 Ventilation Fan 3 Planning Review Fee KS 2/3/2005 $155.00 S12005
Kitchen Sink 1 Dryer Vent 1 Building Permit Fee KS 2/3/2005 $153.88 S12005
Lavatories 2 Building State Fee ARC 2/4/2005 $4.50 S12005
Water Closets (Toilets) 2 Building Permit Fee ARC 2/4/2005 $1,212,15 S12005
Water Heaters 1 Mechanical Fee ARC 2/4/2005 $39.65 S12005
Bath Tubs 2 Mechanical Base Fee ARC 2/4/2005 $23.50 S12005
Clothes Washer 1 Plumbing Fee ARC 2/4/2005 $75.00 S12005
Plumbing Base Fee ARC 2/4/2005 $20.00 S12005
EH Plan Review CEW 2/8/2005 $75.00 S12005
Total $2,001.11
BLD2005-00172 Please refer to the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2005-00172
CONDITIONS FOR
B LD 2005-00172
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-C4 '0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
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 Count Fire Marshal standards q y for Fire Apparatus Access Roads u to the point where
PP P
such r ods connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
—r-�-
3) 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 gra ted. 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 A�f
to any further inspections being performed or approvals granted.
X
4) 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
in
X
5) 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 pr ed documents will result in failure of required building inspections.
X
6) 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 De t nt prior to any further inspections being performed or approvals granted.
X
BLD2005-00172 Please referto the following pages for conditions of this permit. 2 of 4
7) - 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 (Typ tMa> -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
��1JJJ '_
8) Stock Plan Identification number:
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 atieach equired inspection.
X
9) 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
10) 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 Washin ton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocati
X
11) 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 withi 5' 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
12) All changes to " pr ved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or r I ion, must be reviewed and approved by Mason County prior to construction.
X
13) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the inter atonal codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shIt
ade prior to requesting additional inspections.
X
14) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2005-00172 Please referto the following pages for conditions of this permit. 3 of 4
15) 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 fin I inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason C tt ordinances and building regulations.
X
16) 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 fora pKiod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder hav nted action from being taken. No more than one extension may be granted.
X
17) Pressure tre d wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, lashing. Install metal connectors approved for contact with the new types of pressure treated material.
X
18) Records on file indicate this parcel contains fill material. Applicant is advised that all foundation/footings must be placed on native, undisturbed soils or fill
compactio rr
s reports must be submitted prior to requesting inspection.
X //
19) Prior to final approval, all upland areas disturbed or newly cr #e �yconstruction activities shall be seeded,vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
20) Approve er mensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
This permit becomes null and void if work orconstructio uthorized 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 w s a pr ess 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 ins pecti .T ow or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above describe p o erty and str c r or re w and inspection.
OWNER O NT: 2i"ZYJ
�
LD2005-00172 Please referto the following pages for conditions of this permit. 4 of 4
2/4/2005
Conditions Associated With 3:11:14PM
Case#: BLD2005-00172
Perinit Condition Status t'p(fated
item# Code Title Status Changed By Tag Date By
1) 700 RCW 18.27 NOT MET 2/3/2005 KS
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. X
2) 4998 FIRE APPARATUS ACCESS ROADS NOT MET 2/3/2005 KS
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.
X
3) 1001 PLANS REQUIRED ON SITE NOT MET 2/4/2005 ARC
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
4) 1002 POST ADDRESS NOT MET 2/4/2005 ARC
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.
X
5) 1003 PLAN REVIEW CORRECTIONS NOT MET 2/4/2005 ARC
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
6) 1012 SITE PLAN REQUIRED ON SITE NOT MET 2/4/2005 ARC
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
Page 1 of 3 CaseConditions..rpt
2/4/2005
Conditions Associated With 3:11:14PM
Case#: BLD2005-00172
Permit Condition Status I pdated
item# Code Title Status Changed By Tag Date B%
7) 1020 WA STATE ENERGY CODE NOT MET 2/4/2005 AKC
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
8) 4000 STOCK PLAN NOT MET 2/4/2005 ARC
Stock Plan Identification number:
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.
X
9) 4500 MIN. COMPR. STRENGTH FOR CONCRE' NOT MET 2/4/2005 ARC
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
10) 5003 ALL CONSTRUCTION NOT MET 2/4/2005 ARC
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.
X
11) 5019 MCPW Development Requirements NOT MET 2/4/2005 ARC
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
12) 5030 CHANGES TO APPROVED PLANS NOT MET 2/4/2005 ARC
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.
X
13) 5045 FIELD CORRECT NOT MET 2/4/2005 ARC
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
Page 2 of 3 CaseConditions..rpt
2/4/2005 .
Conditions Associated With 3:11:14PM
Case#: BLD2005-00172
Permit Condition Status Updated
item# Code Title Status Changed By Tag Date By
14) 5510 Property Lines NOT MET 2/4/2005 ARC
All property lines shall be clearly identified at the time of foundation inspection.
X
15) 5600 FINAL INSPECTION REQUIRED NOT MET 2/4/2005 ARC
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.
X
16) 5610 PERMIT EXPIRATION NOT MET 2/4/2005 ARC
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.
X
17) 5700 PRESSURE TREATED LUMBER NOT MET 2/4/2005 ARC
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.X
18) 1000 *SITE CONDITIONS NOT MET 2/4/2005 ARC
Records on file indicate this parcel contains fill material. Applicant is advised that all foundation/footings must
be placed on native,undisturbed soils or fill compaction tests and soils reports must be submitted prior to
requesting inspection.
X
Page 3 of 3 CaseConditions..rpt
r A
C:
o CONCRETE ME CH NICAL MANUFACTURED HOME
Y, Footings / Setbacks Date 0 Oq OS— By Ribbons
0
Dat /7 p� Gas Piping Date By
i —
N Foundation Walls Date B y Set-up
Date By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date j(C5 �,W Date �► O� Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAUJNG
D.W.V. Date% cf) < B A��
Date ®S Lm `O�- By F CS FINAL INSPECTION
Water Line Date 64 1$ t S By (Z C
Date By Date By
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PA56FD $ � � las g ,S 0S
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PLOT PLAN
RECEIVED
Name porn ALl7 IN zunzA
Mailing Address F0 tg>Ya35 S k al
Home #300- 'I a-071-1 Work # 3(0Q-'4a(o-3 7 Cell #
Property Location �I kh Mikl<eL sets T0,I Ske_l-bQ
Legal Address T5 al,,j R 3W Sec Tax Lot # 3a 134 2) 4CO0aU
,,4 Ga5oA) County, State of
THE WFORMATION ON THIS PLOT PLAN HAS BEEN MOVIUEL•AI III PEVIEWEU BY IIIEIPnPEBTY
OWNER WHO BY SIGNING BELOW:1)ACKNOWLEDGES A.':U ACCEPI5 FULL BESPOI rABILI IV
FOR ITS ACCURACY AND COMPLETENESS.2)IS RESP0115I BLE T(III I13UI1E I I IAT 711E
IMPROVEMENTS TO THE SI TE TAKE MACE IN CONFORMANCE W 1111 11 II5 PLAN 3)IVI I I.
4 ESTABLISH ALL THE CORNER IRONS.LOT LINES A140 CODE-REnUIRFO SEIRACK5 PFC)UIPE[)OF
5Cn LE: i = 1 THIS PROPERTY.ANY CHANGE(S)TO THIS MAN MUST BE PRE APPBOVEU BY TI IE
fi0yfift1QVTAL AGENCIESWj�IEEEETH JURISDICTION. THE MORTGAGE LF-PIDER AM)n IF
C TRACYANMZO
�D.
OWNER SIGNATURE
DA1
PL G _ -
OWNER SIGNATURE DATE
REVISED:
DATE: /2-27--ol
a
s APPROVED
� POVED
f MASON COUNTY DCO PLANNING
a M �• J
SITE PLAN REQUI''ED TO SE ON SITE
CHANGES SUD1 {;t TO APPROVAL
T
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Date /7
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TAOKS
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/ VIAQ Compliance Application
Owner: Uno Telephone: _ Parcelk
Type of project New Residence ( )Addition ( ) Remodel
Total Sq. Ft. 1 S Floor : ,� j` 251floor: Heated Basement:
of heated area:: �1
Heating System: Electric wall heater O Electric Central Furnace OLPG Furnace
O Heat Pump with Electric Furnace O Heat Pu p with Gas Furnace O Boiler, specify fuel type
O Other: Specify:
Glazing Prescri tive Option see reverse side circle one: 1 II IV
Percentage: Compliance _
Method O Component Performance , Chapter 5— Calculation worksheets required
o/ Check one::
O Systems analysis, Chapter 4
Whole House Ventilation system O 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 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:
426 W. CEDAR
E- ; '�a:.
Ak l'
426 W.
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 SEATTLE (206)464-6968
ELMA (360)482-5269 FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2001 Washington State Energy Code (WSEC)
effective July 1, 2002
2000 Ventilation and Indoor Air Quality Code (VIAQ)
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:
www.energy.wsu.edu/buildings/
Prescriptive Requirements "for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Area %of Ceiling Vaulted Above interior4 exterior Slab'
Option Floor „ U s 2 Ceilin 3 Grade below ' Below Floors on
10 Vertical Over Factor g 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.
MASON CUUN I Y PERMIT N0--n, 00t5 —�X)/:J 2
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
APPLI T INFQR l0N CONTRACTOR IN ORMATI N
Owner lnzA— Company Name V TV YA'a- �F
Maili Address Mailing Address r
City State�_Zip Code City ; State 1119 Zip Cod
Phone(- Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. ZfZZExp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect 1pftater System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION - 12 Di it Parcel No. Fire District
Legal Description
Site Address (Plea a 'nclu a stre t name, street number a d city) knn
Dir c i s t Site r t ( i.L
I 1
Will timber be cut and sod in parc I preparation?Yes/ o
Is property within 200"of Saltwater Lake River/Creek Pond
Wetland Seasonal Run ff Stream Slopes or Bluffs > 15%
Is this permit submittal th9vtesult of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - e Add Alt Repair Other PRIMARY RESIDENCE [El SEASONAL ❑
Use of Building Describe Oork �
No.of Bedrooms No.of BathroomsSquare Footage- 1 st Floor 1j 1,LL2nd Floor.
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage L!/ Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Ma 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 CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPEMO
X Dated
Owner/Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department _ a f Of
Planning Department
Environmental Health Department C
Public Works Department [ c G G t - oO� ,
Fire Marshal
FEES
Building Permit Fee 21Z I t5- Site Inspection
Plan Review Fee EH Review Fee
Plumbina & Base Fee 9S. 00 Planning Review Fee
Mechanical & Base fee 3 • f Sr Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ �j 3 Z fp . �O TOTAL FEES
PERMIT NO.:
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 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR I RMATI N
Owne '2N J-rQ11'TYA Contractor Name --j
Mailino Address Mailing Address } Al
City 7 State Zip Code 1 City 1. 1 State Zip Code
Phone( 41 Other Ph.( Ph.( - )3 - Other Ph.
Lien/Title Holder Contractor Req.# r
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION-12 digit Tax Parcel No.'= 4 UXL2
L / Fire District
Legal Description 1 t` r7' 2
Site Address(Please inclttde street name, street number and city 1
Directions to site 4, Qvi r r USion
Is your property within 200' of the following: Body of W. (game)
a r me) Saltwater
Lake River/Creek Pond Wetland easonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt— -./Repair Other Use of Building
Location of Fixtures/Units 1st Floor ul 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump
Toilets /i Type of Unit No. of Units Fees
Bath Basins Furnace
Bath Tubs Heatpumps
Showers Vent Fans
Water Heater i Propane Tank
Laundry Wsher Gas Outlets
Sinks Wood/Gas/Pellet Stove
Dishwasher Direct Vent?
Other Other _
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt frorn the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
X Date X D,
Date "r
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
IJFPARTM I3RI EsfiF -�kP 751#wEf" VE ED3. OONDMOf�GOD)E5:
Building Department
Occ Grou T e Constr.
Planning Department
Other
Other
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Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES