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HomeMy WebLinkAboutBLD2009-00932 Final MFG Home DDR2009-00117 - BLD Permit / Conditions - 6/27/2010 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 11010 Shelton,WA 98584 RESIDENTIAL BUILDING PERMIT BLD2009-00932 OWNER: SANDY GAVER RECEIVED: 10/21/2009 CONTRACTOR: LICENSE: EXP: �u I ISSUED: 10/21/200 SITE ADDRESS: 500 E DEER CREEK RD SHELTON —Co EXPIRES: /22/2010 PARCEL NUMBER: 321362100000 2/2010 LEGAL DESCRIPTION: N1/4 NE NE NW ELY OF CO RD#5623 PROJECT DESCRIPTION: DIRECTIONS TO SITE: PERMIT FOR NEW MFG HOME 5.21.10 covered porch added to the ST RT 3, L ON DEER CREEK RD TO SITE ON THE RIGHT SIDE permit. -- -- General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: VB Type of Use: MH 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: Valuation: Building Height: 16 Occ. Status: Primary Basement: COV PORCH 160 Manufactured Home Information Setback Information Shoreline & Planning Information Make CMH Length: 44 Ft. Front: E 10.0 Ft. Shoreline: Ft. Water Body: na SEPA?: No 92 Model:OAKWOOD Width: 27 Ft. Rear: W .0 Ft. Slope: Ft. Shoreline Desi Side 1: N .0 Ft. 9 Not Applicable Year:2009 Serial No.: ALB031220 Side 2: S 27.0 Ft. I Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Mobile Home Submittal Fee GMM 10/21/200 $264.25 S12009000 EH Plan Review GMM 10/21/200 $103.00 S12009000 Water Adequacy Plan Review GMM 1 012 112 00 $41.00 S12009000 Address Fee GMM 10/21/200 $173.50 S12009000 Planning Review Fee GBM 10/23/200 $205.00 s12009000 Mobile Home Issuance Fee LDK 10/29/200 $264.25 S12009000 Building State Fee TW 12/2/2009 $4.50 S12009000 Plan Check Fee TW 5/21/2010 $73.00 S12010000 Planning Dept. Permit TW 5/21/2010 $60.00 S12010000 Building State Fee LDK 6/7/2010 $4.50 S12010000 Building Permit Fee LDK 6/7/2010 $141.00 S12010000 Total $1,334.00 BLD2009-00932 Please refer to the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD2009-00932 CONDITIONS FOR BLD2009-00932 1) Prior to final approval, all upland areas disturbed or n created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X !ILI 2) Approved per dOensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 3) 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. X �. 4) 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 Sit Plan" to ensure these structures are shown and meet the setback conditions listed. X 5) 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 1-800-647-09pq. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 6) 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,�rior to any further inspections being performed or approvals granted. X 7) Owner/Ag4 EsTrisponsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 8) THE FOUNDATIO SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X _(a, 9) 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 rtment prior to any further inspections being performed or approvals granted. X BLD2009-00932 Please referto the following pages for conditions of this permit. 2 of 5 10) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each part art of the installation. RCW43-63B.090 J An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed or inst certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X 11) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute To order the ANSI instructions(ANSI). you may ether get an order form from the Mason County Building Department or you can contact the O ice of Manufacturing Housing (360) 725-2800. X , Vtormwater 12) A Mason County Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan"constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor i cknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 13) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations. B. Septic tank(s) requires 5ft setback from all footing/foundations. C. No foundati drains within 30ft, down gradient of drainfield/reserve area. X 14) Concrete used f6r basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete ork exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X 15) 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 S BLD2009-00932 Please referto the following pages for conditions of this permit. 3 of 5 16) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be schedu d as time allows. Until resolution of any/all problems no occupancy (Final Inspection)will be granted for the residence. OWNER/CONTRACTOR(indicate which) Signature X 17) This permit is for the placement Z stallation of the manufactured home only and does not imply approval or review for any other items indidcated on the plot plan. 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 19) All changes to"approved" builds plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulati 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 Inspector shall be maoeSrior to requesting additional inspections. X 21) The installation per i(Aall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearly marked in the • stallation instructions. X 22) Owner/applicant mus tain a seperate perm or the placement of any size propane tank serving a fixed appliance within a dwelling structure or unit prior to the placement of the tank. X 23) All property lines shall be clearly identified at t time of foundation inspection. X 24) All building permits shall have a final inspection performed and approved by the M o ounty Building Department prior to permit expiration. The failure to request a final ins ection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordii94ncRs and building regulations. X BLD2009-00932 Please referto the following pages for conditions of this permit. 4 of 5 25) 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 per d not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have v ted action from being taken. No more than one extension may be granted. X 26) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and f hing. Install metal connectors approved for contact with the new types of pressure treated material. X 27) Retaining walls ded to support a su rge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall.X 28) 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. X 29) 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 Pla 'to ensure these structures are shown and meet the setback conditions listed. 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 progr inspection.The owner yr the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property structure for review d inspection. 'YkOWNER OR AGENT: DATE: BLD2009-00932 Please refer to the following pages for conditions of this permit. 5 of 5 ar o CONCRETE MECHANICAL MANUFACTURED HOME y Date By � C Footings/Setbacks Ribbons m 1P Gas Piping oInterior Date By Interior-Date By date By ior N Exter Date By Exterior•pate B y Set-up n Point Load l Isolated Footings INSULATION Date © By Z BG!SLAB INSULATION Date I, - //Z Data By FIRE DEPARTMENT Foundation Wails Floors Date By Date BY Data �''' DECKS F RAM I NG_T walls Date By Date By Date By PROPANE TANKS PLUMBING Vault Date By Date By OTHER Groundwork Attic Date By Type Date BY Date By D.W.v DRYWALL _.__.._. Type. Int Brace Wall Date By Date By oat. 13 � � r Y FINAL. INSPECTION 0 v Water Line Fire Seperation C Date By Date E3y Gate �- L7-/�� By o CD Pass or Request Inspect. CD Type of Insp. Fail Date Date Diane By Comments w CD EP s�T 1 t -tv zy-Iraof N 52y4c G CD tiV11 0 i o- 3 o 7Lao� l' 4 s�Lkts /t CdCac�� APPROVED MASON COUNTY DCD PLANNING SITE PLAN REQUIRED TO BE ON SITE CHANGES SUBJET TO n? APPROVAL fi � � �--> of PLAN PPLOREVISION VED c._.f N c - s qol PLANNING 6 119 6- q J� 9�, 003 MAr2- lp La iAkEt2 J r PLANNING: ALL SETBACKS ARE MEASURED o^ FROM THE FURTHEST 3, p? PROJECTION OF THE BUILDING PLANNING 2 7 1 1l cl APPROVED ftT MASON COUNTY DCD PANNING X SITE PLAN ROU I 'EO TO BE ON SITE CHANGES 5Uf" "f TO APPROVAL By Date o 3 0 K 5 qo� 27' 6 YD - _ 99. o3 FhdAk Nam Parcel y&)d3(p „al-^oxo BLD# aODq_ boC1 3 a Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 1 of 2) Per Mason County Code,Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development, or redevelopment', with more than 2,000 square feet of impervious surface 2. 'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width = Area *All dimensions in feet Buildings 0q X lL� _ X = Measurements for buildings are taken at the _ perimeter of the farthest projections(example: X eaves/gutters) X = Driveways X = ZO X = Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition above table X = Patios/Walks X = X = Any paved, gravel or packed area per definition above table X Others X = X If the total impervious area of the proposed site X evelopment is greater than 2000 square feet a all Parcel Stormwater Site Plan is Required -Total Impervr0uS dace Ares sum`bf all arias r If the Total Impervious Surface Area is LESS LA&200.0 S are et, please read,acknowledge and sign below. ____ _.BasedlJpon.the_info n,atiom-y-au.have_prow.ided_aStormwaler Site Plan.JYNDT required for this_develDpment activity, _. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. AcknowI d ent of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor. I further ack ow edge that the information provided is accurate and employees of Mason County are granted access to the above- described p p rty for review and i 10pection as may be required. ' Owner/Agent/Contractor(circle one)Date: to— If the a pervio sVurface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign k, the information provided on page 2 of 2. Page 1 of 2 J Name Parcel# BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website: http//www.co.mason.wa—us/code/commissioners/index.htm Please follow the links to"Title 14,Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. If you have further questions pertaining to parcel drainage and Stormwater management Mason County's Public Works Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at: Phone: (360)-427-9670 EXT.450 Mail: P 0 Box 1850, Shelton WA 98584 Physical:415 N 6th St, Shelton WA 98584 If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or any other,parcel. You may also wish to consult with the septic design professional involved with the project.Mason County Division of Environmental Health can be reached at: Phone: (360)-427-9670 EXT.352 Mail:P 0 Box 1666, Shelton WA 98584 A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met prior to a request for final inspection of the building permit. Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- described property for review and inspection as may be required. X Owner/Agent/Contractor(circle one)Date: Page 2 of 2 I ` ILITY PERMIT MASON COUNTV NBLIe W6AkS Road Numb r (03 cD 100 W Public Works Road Name Shelton,WA 98584 11 �,r pG271']lt.L`X 11'es fin: � Department Use Only Admin. Fee= $125, Lineal Ft. Work: Q' x $0.25=$ Paid by: ❑Charge Charge Card Fee$ Total Fee$ IqD ❑Cash)p Check('1 3� ❑ Bond Attached ❑N/A ❑ Ins. Cert. Attached ❑ N/A Receipt No. 13 Subject to general and special permit co ditior"nd provisions written,printed or referenced on any part of this permit, and conditioned upon payment of all fees($125.00+25 cents per lineal footage of installation)and, submission of required bond and insurance certificates,PERMISSION IS HEREBY GRANTED TO PERFORM UTILITY WORK IN THE MANNER,AT THE LOCATION AND FOR THE PURPOSES DESCRIBED HERE TO BE COM LETED BY PERMITTEE: (APPLICATION IS NOT COMPLETE UNLESS ALL INFORMATION IS PROVIDED) Operator 100— C OInS KL c etL rL Job Number Zs' ADD( Address. Telephone [ gj Lic.Bonded Contractor Address: Telephone ; `. Contractor License No. y- f,{.4 Expiration: Location of Proposed Work. (Legal Description/parcel number when applicable) Purpose:'%Jnstallation❑Adjustment❑Relocation❑Maintenance ❑Other Facility: Y}pe, size, class, etc.: 2 `� 14b,-a- 016`l t AAAE .24®f?JC� Nature oflnstallation: ❑Longitudinal(Parallel) ❑Transverse(Crossing) ❑Fixed Object ®® ❑Miscl. Surface Disturbance❑ Open Cut P�Boring/Push ❑Aerial/Ground Mounted 9 laar ❑ Miscl.Non-surface Disturbance ❑ Other ROW Authorization: ❑Franchise No. ❑Master Road Use Permit No. ❑Private Line Permit No. ❑ Contingent on Issuance of ROW Authorization Approx Start Date: 12. 2— 0 Approx. Completion Date: //:- & ❑Attach Exhibit Showing character, location, &detail of Proposed Work(MCC 12.24.060.13.4) Mason County must be notified one to three days before work begins. Failure to do so will result in shutdown of operations. Notifications can be made on Mason County's web site, Public Works homepage. Project Spec Performance/Payment Bond/Cash Deposit: Amount$ ( Term ❑ Blanket Performance and Payment Bond filed or Exempt Operator ❑ Private Line operator with Licensed/Bonded Contractor ❑No Bond Required ❑ Other PERMITTEE HAS READ,UNDERSTANDS,AND AGREES TO COMPLY WITH AND BE BOUND BY ALL TERMS AND CONDITIONS OF THIS PERMIT AS WRITTEN OR REFERENCED HEREIN AND SIGNATORY BEL,W WARRANTS WHAT HE/SHE HAS FULL AUTHORITY TO ACCEPT THIS PERMIT ON BEH ,J (F)AXD A§A BINDING AGENT FOR PERMITTEE. Agreed to bye Ei � � r _ � �� Title: Date: l 2f Print Name [Released pproved by:` �'�`` i = Date:/�%-/ FN Title: 4s E= 0 day Renewal y: Date: Title: by: Date: Title: 1 CMH BEST VALUE 2MANUFACTURING WH oS��_= Corner T Ub DNOJC UTRITY p EN D I f=w, M. BATH _ 60'Tub/sbwr KITCHEN apt..ql cab Post DbI.5IL 6 P A welx;la W rdroba ® Relrlp. naox Bar 5 FAU Wardrobe — SofRf./ h Recessed Lgnts '� r \ ROOM _ Stdl Gable`.\LJVNO E \ BEDROOM #2 S f MASTER BEDROOM w BVC442F 1188 SCE . FT. ALL OF THESE UPGRADED FEATURES ARE INCLUDED • Deluxe exterior design including16 gable with columns . 16" eave over front door sidewall • Picture frame style oak cabinets through out • Ceramic tile accent edge and splash in kitchen • General Electric dishwasher . Glamour style master bathroom . Rounded drywall corners • Fiberglass tub/shower combo guest bath FI LE Sc COPY j1A APPROVED MASON BUILDING INSPECTOR CHANGES SUBJECT 1`0 APPROVAL DATE ►Of DocOrnenis attached toaFi e', Jl,, Site plan: Plan review checklist: —jvj S I'aG Engineering: Y l�Lateral Vertical Number of pages THESE PLANS MUST BE ON THE JOB SITE FOR INSPECTION MUST MEET ALL CURPT"'~' WASHINGTON STAi E, " HANGES SUBMIT'tFkNGES FOR APPROVAL PwoR,T'O.PERFORMING WOF'K VENT AT1Sg FtPer1::,'-' Sri Ft i Request To,Revise An'Approved Plan Permit Number: BLD2009 - COq3)�— Name(yWk t�:(GLtG_ka_V_ Parcel Number - a2,I - CCOcYJPhone Number daytime X-SiQ) Project Address O Mailing Address Please provide a complete, detailed description of/the�proposed revisions to the approv d plans: Are two sets of the revised plans or addendum indicating the changes included? )<Yes ❑ No Are the approved site plans included? ❑ Yes )<No Are the revisions clearly and accurately identified on the plans or addendum? -!R( Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes N No If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.) Does the proposed revision modify the footprint or location of the structure? Yes ❑ No If Yes, Is a revised site plan, with all new setback dimensions included with this request? Yes ❑ No Additional Information: Applicant's signature Date:f 21 - Office Use Only Received by: Date Sent Assigned To Approved By Date B ''// Original Valuation: $ U L�1�. �rG Additional Valuation: $ P. ��! Sq.Ft. x$ $Sq.Ft. x$ $ ❑ E.H. Total New Valuation $ ❑ P.W. Additional Fees: Additional Planning Dept. $ Additional Plan Review $ Additional Conditions/Comments: Additional Building Permit $ fail, Additional Plumbing $ Additional Mechanical $ Additional E.H. Dept. $ Other51. felt" $ N.S0 Total Amount Due: $ Amount To Be Paid Up-Front$ .. .. .r..-gq..��^yree[r.k z,..,.::--;w+a�:.-,-,...,�..,�'f"�°:'¢�3F'�'� •jSa'?m*,ry�rn�".�a. _ FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. • r PLEASE PRESS HARD BUILDING PERMIT APPLICATION 11i• 5 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Sb,elt n (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 (Y IM %4 r nlj. On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFQRMATION Owner '1 Company Name {� �rrn. ( y1[".r�y4.• Mailing Address j Mailing Address City - StateLO Zip Code City AState Zip Code Phone '41 1 g Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address 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 Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. r) 1)0 1)10 Fire District Legal Description Site Address (Please include street name, street number Ind city) r+� Directigns4,site - 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 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 Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor ? ,1,j__ 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make jCJM4 Model Year Length Width Serial No. ' a 8 1k No. of Bedrooms. No. of Bathrooms Type of Heat Purchase Price $ 171 1 ` 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. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X j t I Date: Il U— {, —Q'j Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: gf, Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department I La i Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & 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 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 411 N. Fifth Street/ P.O. Box 186, Shelton WA 98584 360.427.9670 ext. 352 DDR 2001 Rec'd by Request for Administrative Variance for Reduction in the Required Setbacks ($115.00) For administrative review, the minimum variance on a setback request is 5 feet from the side yard lot lines and 10 feet for front and rear lot lines or any access easement. Request for further reduction requires a standard variance. Setbacks are measured from the furthest proiection of the structure, including roof eaves. __ II _ ,/- - Applicant/Owners: nk' . tou- �C�GL Mailing Address: ( PO �� �� LAC Rol l/V/"` s1 561 Telephone : City: Vice- State: LA�)t�-" Zip: l If this reduction is tied to a building permit,p1lease give permit case number. BLD a�L)9 OU 3c-.� Parcel Number(s): Zoning JC' Site Address: 66e- .. CJyl , Requested varianc : Fro Rear Side Yard (please circle all that apply) Requested setback variance: '645'd" 10I ��u'�ft. I An illustrated site plan is required. Your site plan must show the following: north arrow, abutting street or easements, set backs to all property lines and existing buildings, slopes, surface water, wetlands, critical areas, septic, well and driveway. Show all proposed new development. The following circumstances must apply: '--FRONT AND OR REAR YARD REQUIREMENTS: 1) Existing lots of record as of March 5, 2002; You must meet one of the following: (Please circle all that apply) 2) One of the following exists on the lot: a) steep slopes, wetlands, or streams present; b) soils that restrict building or septic development; c lot width at the front yard line of no more than 50 feet; lot size of no more than one-fourth acre; \\CLUSTER I_HOME_SERVER\HOME\COMMON\COMMUNITY DEVELOPMENT\PAC\VARIANCES\2009 Adminstrative.van doc Updated: 12-15-2008 e) existing improvements of buildings, septic systems, and well areas. SIDE YARD REQUIREMENTS: 1) Existing lots of record as of March 5, 2002; You must meet one of the following. (Please circle all that apply) 2) One of the following exists on the lot: a) steep slopes, wetlands, or streams present; b) soils that restrict building or septic development; c) lot width at the front yard line of no more than 50 feet; d) lot size of no more than one-half acre, e) existing improvements of buildings, septic systems, and well areas. Explain how these circumstances preclude a reasonable development proposal from meeting the setback standard for Rural Residential 2.5, 5, 10, or 20 zones. LDf s Owne gent (please indicate) Signature and date Official Use Only Approved Date ceL_-L3�o9 Denied Date Reason for denial: \\CLUSTERI_HOME_SERVER\HOME\COMMON\COMMUNITY DEVELOPMENTIPAC\VARIANCES\2009 Adminstrative.var.doc Updated: 12-15-2008 MASON COUNTY PUBLIC HEALTH 426 W CEDAR ST.,PO BOX 1666,SHELTON,WA 98584 SHELTON(360)427-9670,Ext:352, ELMA(360)482-5269, BELFAIR(360)275-4467 WEB: http://www.co.mason.wa.us FAX:(360)427-8442 Application for +W'aivveer/^Appeal Amount Paid: 11-0 00 Receipt Number: I)0n 9 — 1 y LI �. Instructions teev- up- I. Complete Parts 1 and 2.No determination can be made until these parts are fully completed. 2. Fees may be billed for waivers and appeals,based on the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Public Health for review. PART 1. APPLICANT/PARCEL IDENTIFICATION cAfl+ �n Name of Applicant mortj 3r21� Telephone 1 -3UO -, 259- L4118 .xnd.� pia u Mailing Address of Applicant — O , o x S 1 113 City I-A0 State WA Zip gE60 1 12-digit Tax Parcel No. L a 3 � -- a)- I -- 00 00 0 �I Site Address BA) E �12. atx-�---RO&J- - �4t4c/ — . Subdivision Name and Lot PART 2: Nature of Waiver/Appeal ❑ Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Onsite Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(include justification,additional material may be attached.): 1 f 4 c*. 1 n on r Applicant Signature• 6 Date: iD_al"C)� Page 1 of 2 Updated 8/10/07 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal W Waiver ❑None required ❑ Class A ❑Class B ❑Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/Standard revision) -� y6 - 3. Nature of Appeal: o uS L ` .�, �L,.�jLA DF � o 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Health Services Director ❑ Certified Contractor Review Board ;14 Environmental Health Manager 5. Mitigating Factors: 6. I have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has been submitted. Staff Signature: (_ / �^' �L/ Date: PART 4: Determination of the Hearing Official The hearing official has determined that approval of this request will not adversely affect public health and is hereby granted. This decision is based on the following findings and conditions: e Me The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied. This decision is based on the following findings and conditions: 7 ) Hearing Official Signature: W Date: �� � Cf Page 2 of 2 Updated 8/10/07 .�► � � /YI��� Law -�'Ca i,q k�Y� 3 z�36-Z/— oaoag 3. oz -r p<-TFN n r BInc, r7� � � d�Q M X 161 i 44 q cp K m t 6 99, g3 i o FROM (THU)OCT 22 2009 8 :34/ST. 8 : 33/No. 6820026937 P 2 iAkEle ^3. o7 �A4 r 1Y \.. b24)vu FrEL F` 71� � �ou,ns `F S�Cpsl� BLO4IG,S 27 ��► Ll ff 17' X q W K � qo� r0 Ito' S ' 99.