HomeMy WebLinkAboutBLD2006-00049 Final SFR - BLD Permit / Conditions - 10/9/2006 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
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2006-00049
OWNER: CRAIG CAMM RECEIVED: 1/12/2006
CONTRACTOR: HILINE HOMES 360-807-1849 360-807-1722 LICENSE: HILINH*981BT EXP: 2/10/2008 ISSUED: 2/9/2006
SITE ADDRESS: 41 NE BLACKSMITH DR BELFAIR EXPIRES: 8/9/2006
PARCEL NUMBER: 223037500120
LEGAL DESCRIPTION: TR 12 OF SURVEY 6/151
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR, STOCK PLAN #2003-0059 Old Belfair Hwy to Bear Creek Dewatto Rd to Blacksmith Lake Rd. site on
corner of Bear Creek dewatto Rd. and Blacksmith Lk. Rd.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: V-B
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R-3, U Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:2,318 Garage-Attached 624
Valuation: Building Height: 17 Occ. Status: Primary Basement: Cov. Porch 108
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: W 285.0 Ft. Shoreline: Ft. Water Body: NONE
Rear: E 190.0 Ft. Slope: Ft. SEPA?: Unkn
Model: Width: Ft. Side 1: N 115.0 Ft. Shoreline Desig.: hWtiApplicable
Year: Serial No.: Side 2: S 70.0 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 1/12/2006 $278.27 S12006000
Hosebibs 2 Ventilation Fan 4 Planning Review Fee KS 1/12/2006 $155.00 S12006000
Kitchen Sink 1 Dryer Vent 1 Address Fee KS 1/12/2006 $140.00 si2bbsbbo
Laundry Tray 1 Building State Fee JRN 1/18/2006 $4.50 B12006000
Lavatories 3 Building Permit Fee JRN 1/18/2006 $1,391.35 612006000
Showers 1 Plumbing Base Fee JRN 1/18/2006 $20.00 B12006000
Water Closets (Toilets) 3 Plumbing Fee JRN 1/18/2006 $103.00 612006000
Mechanical Base Fee JRN 1/18/2006 $23.50 612006000
Mechanical Fee JRN 1/18/2006 $46.90 612006000
EH Plan Review TW 1/26/2006 $75.00 B12006000
Total $2,237.52
BLD2006-00049 Please referto the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2006-00049
CONDITIONS FOR
BLD2006-00049
1) 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
X such1r`his connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
2) 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
Depirtprient prior to any further inspections being performed or approvals granted.
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3) 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
inspft'ns.
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4) 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
rem ya�of approved documents will result in failure of required building inspections.
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5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
6) 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,
Do s 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.
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BLD2006-00049 Please referto the following pages for conditions of this permit. 2 of 4
7) 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).
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8) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
jhharlg� and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
9) 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
perttrocation.
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10) 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 prof ct„
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11) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
Xrdi��r�Ce or regulation, must be reviewed and approved by Mason County prior to construction.
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12) 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
X sp�clr shall be made prior to requesting additional inspections.
13) All property lines shall be clearly identified at the time of foundation inspection. X JVG
14) 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
Ma 4qn ounty ordinances and building regulations.
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BLD2006-00049 Please referto the following pages for conditions of this permit. 3 of 4
15) 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
` (old.T I h ve prevented action from being taken. No more than one extension may be granted.
16) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
con ec ors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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17) 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
1-8 0-�47-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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18) )Water ua►ity is not to be degraded to the detriment of the aquatic environment as a result of this project.
19) Prior to final approval, all upland areas disturbed or new�Y created by construction activities shall be seeded,vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X l.�Lt.
20) Xpp�gvld per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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 progress inspection.The owneror 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 and^ structure for review
and inspection.
OWNER RAG ENT: Q�� C l_ � DATE:
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BLD2006-00049 Please refer to the following pages for conditions of this permit. 4 of 4
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Point Load!Isolated Footings INSULATION Date By
BG 1 SLAB INSULATION
Date _ By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By
Date By Datag _ 1-2-:xs— By DECKS
FRAMING Walls r Date By
Date 8/7-aC By Data �j By PROPANE TANKS
PLUMBING Vault Date By
Date By OTHER
Groundwork Attic
Date By Date By Type:
Date By
D.W.V DRYWALL Type_
I B Int.Brace Wall Date By W
Date l 1 01v y �L L43'G�tv' By r
Date g. FINAL INSPECTION 0
n`Di Water Line /1 Fire Seperation _ NC
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/VIAQ Compliance Application
Owner: Telephone: 3 Parcel#:
a ?�b 3 7 TO
Type of project ew Residence ( )Addition ( ) Remodel
Total Sq. Ft. 1S Floor: ?�oor: Heated Basement:
of heated area:: l - �j I ?---
Heating System Type: Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric fur ace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: Specify__
Glazing O Prescriptive Option see reverse side circle one: 1 II IV
Percentage: Compliance
Method O Component Performance , Chapter 5— Calculation worksheets required
Check one:: O Systems analysis, Chapter 4
O 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:
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 Elma (360)482-5269
FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2004 Washington State Energy Code (WSEC)
2003 Ventilation and Indoor Air Quality Code (VIAQ)
effective July 1, 2004
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
(WSECNIAQ)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. 352. Additional
WSEC and VIAQ compliance information is available on the internet at:
h ttp://www.energy.wsu.edu/code/
Prescriptive Requirements 0,1for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall Wall
Area % of Ceiling Vaulted Above interior° exterior Slab
4
Option Floor „ U s 2 Ceiling3 Grade below 4 Below Floors on
t0 Vertical Overhead Factor 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. 352 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 County Permit Assistance Center
Planning Intake Checklist
Owners Name: �Q Date: V 1 d- 0(r
Project: CW2 Reviewe By:
Commercial Development: YES qO, Comments:
Planner: GBM TS CM114J KJM SNG PBC
Site Plan:
❑ rth Arrow
Property Dimensions: :33o X C)\�_ Q❑ 51reets and Driveways Shown. Road name:
Wl Existing Structures shown with setbacks
ell Location, Septic and Drain-field Shown with setbacks
p- Identify all surface water(streams,ponds, shoreline,wetlands, etc.)
"Topography(slopes)
❑�`roposed Structure Setba (Dire�on/Setback):
v F: / a R:_ l l�1 .1: / S2: � /
tility and Drainage Ease ents: Yes&o-(if yes enter condition#5022)
Other Easements
u—accessory Appurtenances-
0—County Access Permit Needed(add condition#0010)
o._rate Access Permit Needed(add condition#0020)
Standard Conditions to be added to all Building permits that planning reviews:#5019 and#0700
Are there any impediments that may restrict access to your site? (dogs/gates)
Shoreline and Planning Info
Setbacks: Shoreline: Q 0�U- Slope: Imo' i
_)Shoreline Designation: Comprehensive Plan: Rural Zonin
0 20
g:
Not Applicable ❑ Agricultural RR 2.5 5 '
❑ Urban ❑ In-holdingA RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ ConservancyRural ❑ RI
❑ Natural ❑ RAC ❑ RNR
❑ Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban Growth Area ❑ MPR
❑ Unkno ❑ Unknown
Water Body(type of water if unnamed): 'y �
SEPA: Yes No
Flood Plain: YES N U own Map#
Aquifer Recharge: YES NO Unknown Map#
Tags/Cases:
RLC/SPI Case: �� i 6-Year Dev. Moratorium: YES
Eagle Nest Tag: YES NO Other YES N
Addressing: Check box if needed QY Reviewed by: /C
Revised:11-01-2005 I:\PLANNING\PAC\PLANNING INTAKE
HiL 1\E - Building Permit Information Form - 2318 Plai
This form contains the information you'll need to complete your building permit packet. We've included information for all counties,
some of it may not apply to yours. If you have any questions, please give us a call at 360-807-1849.
Applicant/Owner/Contact Information: Your name, address phone number
Contractor Information: Name: HiLine Homes
Address: 1213 Lona Rd
Centralia Wa 98531
Phone: (360)807-1849
License# HILINH'981BT
Expiration: 01/30/04
Tax Parcel#/Assessor's Acct.#: This will be with your property information.
Job Site Address: Your new home address(example: xxx Filmore St.)
Legal Description: This will be with your property information. (example:Lot xx Large Lot Sub Division xxx in Lewis County etc.)
This will be a New Single Family Residence
Describe work/Type of Job: New Home construction
Home information: Floor Area: (sq. footage)
Main/1st: 2318 #of stories: 1 Carports: 0
Second: 0 Bedrooms: 3 Decks: 0
Basement: 0 Bathrooms: 21/4 Porches: 96
Total: 2318
Garage: 598 (Attached)
Construction Method. Wood frame
Heating System:
Be sure to choose the information below that correlates with the heat system you have ordered.
HVAC/Mechanical Contractor is the company installing your heat system.
Cadet/Wall Mount/Zone Heaters: Standard heats stem
nstaller: North Pacific Electric Contact: Bernie/Kim
icense#: NORTHPE994JB Phone: 360-943-6020
xpiration: 04/01/04 Location: Olympia
anuf: Brand:
odule#: KW: 13.5
HF: AMPS: 20
n permits,for the#of wall heaters,put 1,or you'll be charged extra for every one.
Heat Pump w/furnace w/HWH:
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staller: Chehalis Sheet Metal Contact: Dave Pyles
cense#: CHEHASM252MH Phone: 360-748-9921
xpiration: 07/02/04 Location: Chehalis
anuf: Trane Module: 2TWR1030A1000A KW: 10
onnaqe: 21/2 HSPF: 7.75 Seer: 10
RA: 73 Efficiency: 100°%
Natural Gas or Propane furnace w/H E
Installer: Chehalis Sheet Metal Contact: Dave Pyles
icense#: CHEHASM252MH Phone: 360-748-9921
xpiration: 07/02/04 Location: Chehalis
anuf: Trane Module: TDE060A936 Watts: 977
TU: 60,000 Efficiency: 80%
Spot Vent Fan: 1 Kitchen Exhaust Fan: 1 Dryer Vent: 1 Wood/Gas/Pellet Stoves: 0 Gas Outlets: 0
Plumbing System: Installer: Dee Dubs Plumbing Contact: Darren
License#: DEEDU7PL1990KQ Phone: 360-456-7469
Expiration: 05/31/04 Location: Olympia
Toilets: 3 Bathroom Sinks: 3 Bath Tubs: 1 Showers: 2 Kitchen Sinks: 1 Water Heater.. 1
Clothes Washer: 1 Dishwasher: 1 Hose Bibs: 1 (fast 4 enter quantity of 1, every home has 2)
Energy Compliance Information:
Compliance Method/Path: Always#3 (Per Washington State Energy Code)
License#: DEEDUPLI990KQ Phone: 360-456-7469
Expiration: 05/31/04 Location: Olympia
Toilets: 3 Bathroom Sinks: 3 Bath Tubs: 1 Showers: 2 Kitchen Sinks: 1 Water Heater. 1
Clothes Washer: 1 Dishwasher: 1 Hose Bibs: 1 (first 4 enter quantity of 1, every home has 2)
Energy Compliance Information:
Compliance Method/Path: Always#3 (Per Washington State Energy Code)
Total sq. ft of glazing (glass): Standard home: 265.5. w/sliding glass door option: 282.5 divided by_
total sq. ft. of heated area: 2318 equals a glazing percentage of 11% standard or 12% w/sliding glass door option.
Swinging doors and skylights are not counted in this configuration because they meet all requirement minimums.
Window Schedule: See attached form.
Ventilation System:
Intermittently operating Whole House Ventilation System using exhaust fans&window fresh air vents. (VIAQ 303.4.1)
tlfouse Fan Specifications: Whole house fan: Qty: 1 Manuf: QuieTTest Module#: QT130 CFM: 130
Bathroom One-Bulb Heater/Fans: Qty 3 Manuf: Solitaire Ultra Silent Model#: 162 CFM:70
Copyright 2003 HiLine Homes of Centralia
NAME �I -/ci>i le'c' ( is /r� NORTH VICINITY MAP
SITE ADDRESS �aC r
CITY
ZIP
MAILING ADDRESS 12-'k�7- . �
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PARCEL NUMBER L)i2---
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MASON COUNTY PERMIT NO.
T -.
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
APPLIC T I O TI CONTRACTOR I R ATION
Owner Company Name
Maili Addres Mailing*ddr s
City t Zip C e City S Zip Code
Phone Oth r P - Phone Othe Ph.
Lien/Title Holder Contractor Reg. {p�
E mail addres 49
E Mail Address /RT
Drivers Lic.# DOB Drivers Lic. # DOB
SEPTIC /WATER SYSTEQII INFORMATION - Connect to N w Septi Existing Septic
li Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
' PARCEL INFORMAj�Q�I I2 Di it P cel No. Fire District
Legal Description ,t KK
Site Address(Please in 1111de stre name, s reet nuter a d city)
Directions t si I
Will timber bLscut and sold in parcel preparation?Yes/No 4- C( 5 1(
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 1.53%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - Add Alt Repair Other R IM S DEN E SEAS NAL E]
Use of Building escnbe W rk
No. of Bedroom No. of Bathroom 7-1/4Square Footage- 1st ,0 2nd Flo r
3rd Floor Basement Deck Covered Deck-ML- Other Sq. ft.
Garage- Attached ---9-Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or p
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or tt X a t are
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have o6t�ifT�d a permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this,E Iigat1 vie work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work prop ''ff1144ee��77wwner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to th
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described property and structure for review and inspection.This permit/application becomes null & void if work��oo,,��� dQ s
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONl'1NOMOF WORK IS BY
MEAAS OFAPROGRESS 1 SPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
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1 ,(1,IIMIIMj AUTY- Date: I1T_
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department IJO
Planning Department _
wto
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee \ Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planninq Review Fee
Mechanical & Base fee "-� Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ `O TOTAL FEES
I
MASON COUNTY PERMIT NO.
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
On the web www.co.mason.wa.us
APPLIC T1 F RM TI; N CONTRACTOR I F R TION
Owner .Company Name
Maili A d e Mail'! s
City t Zip C e City e Zip Code
Phone Other P Phone r Ph.
Lien/Title Holdgr Contractor Reg. WON? Exp.
Email address E Mail Address
Drivers Lic.# OB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORTE
IO - lf Dj it P rcel11 Fire District i°e
Legal Description
Site Address (Ple a 'n ud reet n e trokt tuber a ci
.00
Di tions Q% it
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1 st Floor_ 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNJTS
Type of Fixture No of Fixtures Fees Fuel Type:Electric--E- LPG__ Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs = Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING--- TOTAL MECHANICAL
O'VVNER/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.
PRQQF�OF CONTINU TIO OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X( )11M1 L CAMMi W tt — Date:.
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES