HomeMy WebLinkAboutBLD97-00575 Cancelled - BLD Permit / Conditions - 7/24/1997 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
� 3 t t_ U 1 N CA P E R NI 1 T FOR I-NSPECT I ONS CALL 427-9670 �
RFTWEEN 5pm AND Bam 427•-'1262
Rt.1)97-0575 PARCF 1_ :32.1 347500020 PLAT .- 0 1 V : BL K : LOT , `
JOB At)URF SS : F 1 ES)1 rATF I :H LAKE fit) SHE I TON
OWNER : LAWRENC� 360-•A77-6603
;.:ON1 RACTOR : WASH 1 Nr F Cf N'1 EP 800-840 1 1 13
LEGAL : IN 2 OF SbAYf.Y 21411 �:,:�Y�: ,�-�;"��a:::,��.�a:�, '_:.,���z4•.�.,-..„��.:.T:e��.o--,x _-�.�..� ._. . _n-...�:-�� �
CI. AS',,: Or WORK , N W BFf)P : 3 -r BATH : ITYPF AMOUNT by pp.l RECT IPT TYPE A110114T FY DAIF tF''E IPTl
TYPE. OF USE : _ . ;M H STORIES , . ,.). . . c 1 !�$�::n �r � �a �x�i�...x,�:�:-: — �
OcclIP . GROUP .. . . :'. 131 DG . FIF 1 r-AM . ; 0 .0f t IADDR 1 5.00 V&. `@712419+7 44934 � I
TYPIE OF CON 'T . ; 2 F I REPL ACES .�, : 0 Isiff
NNOf ! 155.0#'•Jrs 01124i91 44960
OCCUP .• LOAD . . . . . A WOOD`'TOVE':; . .0 . a P ! 4.50 KS 07124197 44960
DWI` 6L .UNITS . . . . . 0 PARKING SPACES : 0 'EHCP ! \26.OP KS 01124197 44990 I j
INSPECTION ARf. A : 2 `MOREL INE7 . . ,�Y r~ �I,AAI : 19O.50 YPAY.A1l4N: 94000!
� � c�!as:^:aarsra.��•ssva�-acv:saz rc.x�•.-.s>=vam�.m�s-saaear�Wr_-.r:.�-�,�:ca.+-a-.::�cer-rro�s+-.t�zsan... -.a�7^_�xa�
TOILET: . . . UEL. -rYPC'S- -.-------•--_ BO i 1_ERSCCOMP -- MOBILE HOMF --
FRONT . , .N ri .Of t L3AT}I TEA:INS . . . . . 0 0•- HP . : 0REAR . . . .. S 5 ,Oft BATH TUBS . . . .. 0 3-15 HF 0 MOf)t i :REDMAN
'1 ,Oft SHOWFAs . . : 0 t URN r 10fdK . ExTIJr 01'> ?f� HI' , t 0 M74Kf•-
S I DE (2 ) .W 5 .Oft WATER HFATERS . . �` i 0 FURN >-100K BTU : 0 30-50 HP . : 0 A9"C:5
SHRL I NE . 0 ,01`1 CLOTHES WASHf. RS . . : 0 FtIRN - Ft OOR . . , : 0 r)04 11P . • 0 YEAR - _.-
AREA - -- _..:_...-__...____._-_ _ .. KITCHFN SINK:; . . . . 0 MEAT PUMP . . . . . . : 0 97
LOT SIZE . . FLOOR [)RAINS . . . . . . 0 VIE NT SYSTFT4S . . : N F VAP COOLERS - N I.ENG T-H :64
BUILDING — : P443sf DRINKING FOUNT . . . . 0 VFNT FANS . . . . . . i 0 HOODS) . . . . . . . . 0 WIDTH . r4
BASEMENT . . : Bs P LAUNDRY TRAYS . 0 COME S . I N(,' I N -0 --�,F'R I AL #- -
DECKS . . . ; . . : osf DISHWASHERS . . . . , . ; 0 AIR HANDLING UNITS- - COMML . INCIN :O 2.4-80
GAR/CARP :? 9)sf GARB DISPOSAtS . . . ; 0 10000 'e.fm , 0 RELOC/RFPAIR : 0
AT/DT . ,7 URINALS . . . . . . . . . . . 0 > 10000 cfm . : 0 OTHER UNITS . : 0
M I SC/t?1.14 F I XTURFr : 0 GAS OUTLETS . : 0
c:s^-��.:1sc:lr2L.�...-_TxGr.sZ:s':r_C s:: -:-,h-G:��r:::.::.�iay.'T�6.7ff-sz!' . �-ssS�riF`r-+�x:r.as_tlt.::.:ayev�aTscos-a;w+^-:�:1.a4.-ss?,s.sr�c�.2-•.•..:ns^'10':vKcrYiCs rr:Y7E�`.�`.'.aC'etas:xcr3^ccx�- axc::'�se1n^zssv`zre�srRts:sr^.:rx_.m,Cx
PROJECT DESCRIPTIAN;mvh 0i fe4 Nee
PROJECT LOCATION:Cstfiih Like R4 Aboet 112 11 in oq left
1014 PtANIT BECONfS NULL AND VOID IF WORK OA,CANSTRUC110N A►ITHORIIED IS NOT CONMrNCED WITHIN 160 DAYS, OR If CON TRUC110N OR WORK Ifi tiU�PENDFD fOR A PERIOD
Of BW BAYS AT ANY TINE AfTfR WORK IS CONNf.NfED. PVfOENCf dF :OIIIINVATIO" Of WORK .IS A PROGRESS INSPECTION WITHIN THE IAa nAY PfRIOU, FINAL INSPECTION NIf3T BE
AP VfD RffORf BUILDING CAN Rf OCC@PIFD.
OWNER ON -AGENT:
EiD poll, rev: 93131111 COMPLIANCE TO ATTACHED CONDITIONS IS REQUIRED
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date 7- O '97 b
Foundation Walls date by Set Up
date by INSULATION date � — by
BG/SLAB Insulation Final
Floors
date by date by date / '2C �/� by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D W WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
17 /��o�
�lv-97
I J
MASON COUNTY
T
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
P F- ft IVI I T" C', i -) IN 1.1 1 -11` 1 C7 fN
Casey No . c BLD97--0575
For . L AWRFN('F WOOD
Page ., 1
11 The, underslgned property owner Is aware of the uncertainty regarding Mason County 's
development regulations created by the Growth Managment Hearings Board 's Order of
October 2 , 159A, and in oonsideration of Mason County 's willingness to prooeed with
processing of app 1 i�aat i ons which might be affected try the Order , the undmrs i gned
pproperty owner hereby Agrees to W& i ve any I awse.., i t , action , or claim for damages -,3ga i n:st
Mason Countv which may arise out of Mason County 's actions in acceptance, processing
ants/or issuance of such permits or approva 1 s ( hereinafter, "porm i t t i nq actions " ) , wh I oh
damag+ys are attributable t the County 's decision t takre permitting actions despite
the risk that changes to the County 's development regulations might later make the
(bounty '` I prr-m i tt i ng actions I nva 1 1 d .
.? ) Th i s app 1 i cat i on 1 s ,iub loot to Mif f"r said Landscaping require-merits af. a4 t abl I shed under
Mason Co, my Ordinanoe 1 .03 ,036 .
3 ) The use, handling and storage of hazardous materials or flammable and oombeist i b l e?
I i qu i cis In Kxe.e!,,s of 10 (jai ions i riot allowed without the fapprovo I of the Masore County
Fire Marshal .
X
4 ) Proposed structure or any portion thereof greater than 30" in height crow grader lirie ,
must malnt in a minimum of 5 ' setback from all property lines , easements ind 10 ' from
all County 4nd Mate Road rie ht of ways .
X _.'.,A I
` ) PURSUANT TO 1904 UN 117013M BU i i Ce 1 N(� CODF , SECTION 30b(C ) AND SECT 1 ON 5133 AL I, S I `FE.S MtiST
NAVE_. APPROVED NOMBERS OR ADDRESSES PROV i bF..D IN SUCH A POSITION AS TO Bt PLA I Nt_Y VISIBLE
AND L FG I SL F FRO " THE STRFF-F OR ROAD FRONT I NS THE PROPFRTY . MASON COUNTY Still DING
DEPARTMENT REQUIRES THAT THIS BF COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A
RE I NSPECT 1 ON FFV , BASFD ON RATES IN TABI k : 3A OF THF 1994 IIN I FORM BU l I.h I NG CODU W 11.L [IF
ASSESSED IF OWNE.:R/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REOUkE-STING
INSPECTIONS .
,
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
X.
6) FIF00 1 RFD I NSP C T i M; ( 1-oot i tack i n q)evt t an Pr i or t o pour , .;ei up i n:ipec:1 i on pr l of to
sk i rt f ng Final I nspect i on-prior to Oncupanoy) . 1 have rece i v--cd a copy of the General
I nforma t i (in and Guide ! Ines. Mob i le/Ma ritifunturod Ilcus i nq Instal i at i or►s Firanciout rot
detailed description-, of all required inspections on my mob i l e/manufac..t ured hone
I nst a l I &t Ion . I her-eby assume a l l respons I b i f I t y for the sehedu 1 1 ng of these i i cqu i red
Inspections . It these required inspections are nr,)t requested, i nspeotced and signed
off ( approved ) by the i nEipec t car In the preso► i bed order , I understand that re i im;per. t ion
fees and an hourly Investigation fee pursuant to the 1991 UBC, Table 3A will be assessed
in add i t ion to nay or l q i n�a l perpa t t fees 'to rego l ve atay quept i onab l e pr-not Ices or
problomi that have heen discovered . I further linderstaand that this investigation wi l i
be scheduled as time a 1 1 ows . tort I I reso 1 ut l on of any/a l proh! terns no occupancy ( Final
! nspect i on) will be granted for the residence .
OWNER/C:ONTRAC TOR ( i ncf i ante wh i fatt ) S i cinat ure X
7 ) Al ! mobi home. landings or decks must be free�tanding ( self support inti ) .
l he l arge£.t landing or, de-ok perm i t t end without dt aw i net<. or a building perm i t i 36" x
36" . Any landing or deck that Is 30" or more In height from walking surface to finish
grade requ I res a quardra i ! ,Any i and i nc1 or deck t hat has 4 or more r t f.ei ca r oqu I res a
handraiI Any landing or, dock larger, than 36" x 36" must be permitted which requiren
.ctructurral drawings rand ae buf icfinu permit atppl icaatir.,n . This instHa lati «n P >rmit dhe�;
NOT I tic tlide any l and i nq or (leek larger than the 36" x 36" size .
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION an�c��
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
PLEASE PRINT
#1 Ow er Y �' �ti�d Phone# �' �
Site Address Caff 15h 1A�C Fire District#
city GY1�l�'OV1 ti '� St Zip gL7
Directions to Job Site Caf(15 h L-� P aba u4- Z VYI,t le, al fall I'M
Owner Mailing Address n �D 2��
City 1 5 L i k e St
/ Lien/Title Holder
Address
Clty \/Inn ' �,� 1 , St Zip
#2 Contractor Name a6 {j n tr Contractor Reg#
Address f06 i 4 V�1U)W Expiration Date
City St )A/A_Zi Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
4 'Parcel No.�Z 1,54 - 715 -
Legal Description 1—rad S 0f -; U yQ S
#5 Building Square Footage:
1 st FI (, 2 3 2nd FI 3rd FI Loft Basement
# Bedrooms -Mxv-, # bathrooms Deck (A5 Other
Garage Carport (Circle: Attached or Detached?)
#6 Us of b k w
building ��
r a
#7 Type of Job: New -\< Add Alt Repair Other MAY 211997
#8 MOBILE/MANUFACTURED HOME INFORMATION HEALTH SERVICES
Model Year C1 Make Model AQ2S
Length' _Width _Serial No. 8-
#Bedrooms -r"(t#Bathrooms _Type of Heat e) l - hLO4 pur)V .
Purchase Price$ WQVO)(.• �—
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Drainage Plan Wells
Septic Systems Easements
Proposed Improvements
Name of Side Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
w
NIX
�VP � l�
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3.35 eachl Fee Mechanical Fixtures ($6.75 eachl 01
No. T " ets CIRCLE FUEL TYPE: Gas, Electric,
Bath Ba 'ns Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
_Hot Water Htr _ Heatpumps
_-Laundry Washer _ Vent Systems
Sinks _ Spot Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins _ HP
Dishwasher No. Air Handling Units
_Disposal cfm#
_Urinals :NQ��ire Protection S stems
Other _ Auto.Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 16.75 _ Auto Fire Sprink 35.00
TOTAL PLUMBING $ No. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE_- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
X OWN X BY
DATE S —__2 DATE
ll
FOR OFFICIAL USE ONLY: Accepted by: % �~_. Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: Z q
Environmental Health:
41
Building Plan Review
vaj
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Violation Fee
Site Inspection
Building State Fee 12
Other
Other aja few 5.00
Other tI k 2 ,
Building Valuation: TOTAL FEE
GARY YANDO,DIRECPO'
�oN.STA
M N DEPARTMENT OF COMMUNITY DEVELOPMENT
u
o T z PLANNING -SOLID WASTE- UTILITIES
N Y y BLDG. I * 411 N. 5T"ST. • P.O. BOX 578
1864 SHELTON, WA 98584 * (360) 427-9670
DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created
by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's
willingness to proceed with processing of applications which might be affected by that Order, the undersigned property
owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of
Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting
actions'), which damages are attributable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
�)4 2-1 ;34-76-000ZD
Date (Parcel No. or Legal Description)
t-jc+-GIN 134(l
Property o 's signature(Notarized)
(or the Co may accept the signature of the owner's authorized agent upon proper proof of authorization)
ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL)
STATE OF Yti��� nC�►�'U�l
COUNTY OF
On this day of , in the year ,before me Notary Public,
personally appeared personally known to me to be the person whose name is
subscribed to this instrument, and acknowledged that he/she executed it.
WITNESS my hand and official seal.
-For County use only -
Reviewed b Ph on
(Date
Notary's signature
My Commission Expires: Staff Initial:
lip':.> �•,_1