HomeMy WebLinkAboutBLD2013-00725 Final SFR - BLD Permit / Conditions - 8/20/2014 * Inspection Line(3tiU)42/-/2(J2
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 279
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2013-00725
OWNER: TC ANDERSON INC. RECEIVED: 8/21/2013
CONTRACTOR: LICENSE: EXP: ISSUED: 10/28/2013
SITE ADDRESS: 381 NE BARBARA BLVD BELFAIR EXPIRES: 4/28/2014
PARCEL NUMBER: 223365300104
LEGAL DESCRIPTION: LYNCH COVE#3 TR 104
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE NORTHSHORE DR 2.2 MILE ON RIGHT ON LARSON LAKE RD LEFT ONTO
MATHEWS RIGHT ONTO BARBARA
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,492 Garage-Attached 517
Valuation: $ 188,641.40 Building Height: Occ. Status: Primary Basement: ob porch 115
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body:
Rear: Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Side 1: Ft. Shoreline Desig.:
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 2 Ventilation Fan 3 Plan Check Fee TW 8/21/2013 $944.42 S2201300000001
Lavatories 2 Propane Stove 1 Planning Review Fee TW 8/21/2013 $205.00 S2201300000001
Bath Tubs 2 Gas Outlets 2 EH Plan Review KKK 8/21/2013 $ 103.00 S6201300000001
Water Heaters 1 Fireplace 1 Water Adequacy Plan Revi KKK 8/21/2013 $ 103.00 S6201300000001
Clothes Washer 1 Exhaust Hood 1 Building State Fee DLC 9/20/2013 $4.50 S120130000000i
Kitchen Sink 1 Dryer Vent 1 Building Permit Fee DLC 9/20/2013 $ 1,492.15 S1201300000001
Dishwasher 1 Mechanical Permit Fee DLC 9/20/2013 $201.40 S1201300000001
Hosebibs 2 Mechanical Base Fee DLC 9/20/2013 $28.50 S1201300000001
Plumbing Permit Fee DLC 9/20/2013 $93.20 S1201300000001
Plumbing Base Fee DLC 9/20/2013 $24.70 S1201300000001
ADJUST--Plan Check Fee DLC 9/20/2013 $25.48 S1201300000001
Total $3,225.35
BLD2013-00725 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2013-00725
CONDITIONS FOR
BLD2013-00725
1) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at
(360) 427-9670, ext. 450. The building permit will not be"finaled" until the permit holder can show proof that the access permit from Public Works has
been "finaled"and approved.
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2) 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.
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3) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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4) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No foundation drains within 30ft, down gradient of drainfield/reserve area.
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5) 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
6) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X (.--
7) 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
8) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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BLD2013-00725 Please refer to the following pages for conditions of this permit. Page 2 of 6
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 Department prior to any further inspections being performed or approvals granted.
X
10) Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric not to exceed 6.8W or 6800 KW, Compliance Method: Prescriptive option 4C, Window(Max U-Factor):0.30, Skylight(Max
U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-49, Vault Insulation R-38, and
Slab Insulation R-10.
In addition the following credit from Table 9-1 shall be completed: Electric waters heater EF 0.93 or better
11) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel.
The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall
and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there
is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of
heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air
leakage results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA)
when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations
of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. The blower
door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required
for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate"and are available in %or'/z sheets. The
Mason County Permit Center will also have some available.
X
12) A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC
Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall
be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or
installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps).
Reference WSEC 505.
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13) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MPH.
X
BLD2013-00725 Please refer to the following pages for conditions of this permit. Page 3 of 6
T4) REQUIREMENTS FOR ROOF CUVEKINVS. Koot coverings snap De appiiea in accoraance wan ine appncaDie provisions or ine curreni cone anu ine
manufacturer's installation instructions.
15) A Mason County Stormwater 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/d ra infield 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 is acknowl g that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X ___'
16) The international 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.
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17) 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.
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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.
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19) 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.
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20) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENTAND 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 made prior to requesting additional inspections.
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BLD2013-00725 Please refer to the following pages for conditions of this permit. Page 4 of 6
1
21) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
meet the installation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
X
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22) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not be used until the final inspection has been performed and approved by a Mason County building inspector.
23) All property lines shall be clearly identified at the time of foundation inspection. X
24) 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
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 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.
26) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD
X
27) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
28) All construction and demolition debris must be removed from the site after project completion. Proper disposal of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
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29) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or properties. Silt fencing, straw, or
surface matting must be installed and maintained until upland vegetation has become established. X
30) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
31) 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 Plan"to ensure these structures are shown and meet the setback conditions listed.
X
BLD2013-00725 Please refer to the following pages for conditions of this permit. Page 5 of 6
�) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Nlease cneck your"Approved zjite Nlan" to ensure
these structures meet the setback conditions listed.
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33) Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. 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 any
time 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 owner or 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 OR AGENT: � .[)ATE:'/G��G..,_
BLD2013-00725 Please refer to the following pages for conditions of this permit. Page 6 of 6
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Pnit MASON COUNTY
BUILDING 111426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
0 Make corrections, items will be checked on next inspection regarding possible structural
'^ damage incurred b recent
® OK to ,�� ��� "natural/man made"
❑This is not a complete inspection disasters. This is_NOTa
Date 7 ,3l 17) /L-( Department VI?i L,4� _ CORRECTION NOTICE.
Inspector L6)c�
Dov NOT REMCOV ' THIS TAO-
Building Permit # /3 7 MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location -61 &/�rc%- B1ivd
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliant
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
C,Make corrections, items will be checked on next inspection
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MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location /Ut / r r4 f%J
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
fo n Items listed below must be corrected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
❑This is not a "natural/man made"
disasters.inspection disasters.This is NOTa
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Case Number:
Mason County Investigation Report Form
Parcel Number:C21W340 -12 -_06167
Violation Site Address:
� � T Phone#: ��'�4Y—,062 5�
Property Owner(s):
Mailing Address:
Tenant/Contractor/Operator on site: `T— , A(1t'4ee,66f) 75kC
Directions to Site:
Description of Concern: PALED lAP 6pp2oX. Jf)g69.vt`�" --ftei r k0o6t bye.,
-LD 1,2ee W OLILn
Under the provisions of the Pu lic Disclosure Law, RCW 42.56.240, the complainant may indicate a desire
for disclosure or non-disclosure of their identity. If non-disclosure is chosen, this portion of this form will
not be released to the public unless this case is filed in court. If filed,your name will be disclosed ifyou are
a witness in the case.
Mason County investigates possible violations on a complaint basis only. Therefore,the name of the person filing
the complaint should be provided.
Please check one of the following:
J Please do not disclose my identity. I understand that disclosure may be required by court order or if this
matter goes to court.
❑ You may disclose my identity.
Name(please print): 6A,0 1 kzM6/)S Phone: ( )
Address:
Street City Sty zip
Signature of Complainant: Date:
THIS SECTION FOR MASON COUNTY USE ONLY
Complaint Received by: Date:
Complaint Received by: YPhone ❑ Email ❑ Web Site ❑ In Person
Department of Concern: ❑ Building ❑ Planning ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other
Investigation Date and Findings: I f !7 "
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Date Closed: Reason Closed: Initials:
Case Activity Listing 6/6/2014
2:38:31PM
11 Case#: BLD2013-00725
VIO
Assigned Done
Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By
BLDC100 Inspection 1/22/2014 None DONE LAW 1/22/2014 LAW
Complaint received,erosion control not in place,concrete buried on site,the concrete were 8 in.thick 16 inch wide runners for an old MH on site,they were placed on the back bete ccn the properties,the
edge of the runners could be seen.they are acting as a retaining wall under 4 feet in hight,no permit required. I spoke to the owner Tom Anderson,I requested he install erision control measures,he agreed.
BLDA800 Documents Received 2/18/2014 None DONE DLC 2/18/2014 DLC
Received and approved uffer bar installation and repair request. See document attached.
BLDC125 Framing Inspection 3/19/2014 3/24/2014 None PASS LDK 3/25/2014 PIB
BLDC145 Insulation Inspection 3/19/2014 3/24/2014 None PASS LDK 3/25/2014 PIB
Wall Insulation-Pass.
BLDC135 Mechanical Inspection 3/19/2014 3/24/2014 None FAIL LDK 3/25/2014 PIB
Mechanical-Fail&Gas Piping-Fail:
1.) Item#7 from previous correction notice not completed. Seal tub/shower drain at floor penetration see from crawl.
ew-the county has received complaints of eros' oblems down to lower road on back of lot. will ll an approved erosion control fence or barrier. This must be complete ASAis.
3.) Items#4 from previous correction notice note also.
4.) Will need to install insulation dams between vaulted ceiling and flat so insulation is full depth. Ok to drywall. Make corrections,items will be checked on next inspection.
`r BLDA900 Telephone Call 3/25/2014 None DONE LDK 3/28/2014 PIB
Per phone conversation with TC Anderson-will be installing gutters on or before 3/26/2014 and install erosion control on back and side on 3/25/2014. LDK (3/25/2014
BLDC150 Wallboard Inspection 3/25/2014 Q
/26/201 None PASS LDK 3/28/2014 PIB
Int BWP-Pass.
Page 2 of 2 CaseActivity-rpt
Case Activity Listing 6/6/2014
2:38:31PM
Case #: BLD2013-00725
i
Assigned Done
Activity° Description Date I Mite 2 Date 3 1101d Disp 7o Bti Updated Updated By
BLDA010 Application Received 8/21/2013 8/21/2013 None DONE TW 8/21/2013 TW
BLDB200 Environmental Health Review 8/21/2013 8/28/2013 None DONE ALP 8/28/2013 ALP
Bedrooms match application and asbuilt. Site plan matches asbuilt. see condition 3020
BLDB210 Water Adequacy 8/26/2013 8/28/2013 None DONE ALP 8/28/2013 ALP
Lynch cove water system,49100. Letter submitted ok and status is green
BLDB110 Building Plan Review 8/21/2013 9/20/2013 None DONE DLC 9/20/2013 DLC
BLDB120 WSEC Compliance Review 9/20/2013 None DONE DLC 9/20/2013 DLC
Electric me 6.8 w/6800 KW,[recriptive option 4C,0.50 energy credit electric WH EF 0.93 or better.
BLDB130 Planning Review 8/21/2013 9/30/2013 None DONE AHB AHB 9/30/2013 AHB
Site visit to verify slope and potential debris on property. AHB
BLDA200 HOLD 9/20/2013 10/28/2013 Hold DONE JWH 10/28/2013 JWH
sign permit application
BLDA500 Issue Building Permit 10/28/2013 None DONE JWH 10/28/2013 JWH
BLDA540 Print Inspection Card 10/28/2013 None DONE JWH 10/28/2013 JWH
BLDC111 Footing/Foundation Wall Inspec 12/10/2013 12/11/2013 None PASS LAW 12/12/2013 PIB
Page 1 of 2 CaseActivity..rpt
Name Parcel
Mason County I
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code, T-rtle 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.
'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.
'Common 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.
Tom. arc lafe Imper�4ous`Sur aces: lease Comp go This Tab7Q_;:
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X
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/A`alks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X = _
X `if,the totallmpeivious area`of the proposed site
X = development is grater than.20DO square feet a
Small ParcaeLStorr r ater:Site.Pian;'►s Required.:.
Total'impi rvious.Surface Area(sum of atl areas)-. .
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwafer Site Plan IS NOT required for this development activity.
O-rmerBuilder/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,owners 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-
descnbed property for review and inspection as may be required.
Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER USquare Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
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:
httn//v,ww.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 sormwater 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 sormwater 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 sormwater 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 sormwater 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
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the sormwater 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.
Owner/Agent/Contractor(circle one)Date:_ EZZ/-j 3
Page 2 of 2
P'oN c MASON COUNTY PERMIT N 25
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
1854 PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
, ^_
NAME: , 1 (_ NAME: I e--
MAILING ADD SS: 'P7O fix. MARX4,G ADDRESS:
CITYJ�;R,KW ✓' STATE: /A ZIP: CITYEhL TE.Wk-. ZIP:
PHONE: CELL: PHONE: CELL:
EMAIL: EMAIL :
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) cJ' 3 no)6`� FIRE DISTRICT
LEGAL DESCRIPTI N(AB ATED) :
SITE ADDRESS 1 Nt, Za CITY w V'
DIRECTIONS TO SITE ADDRESS
IS PROPERTY WITHIN 200 FT:
SALTWATER ❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO ❑
TYPE OF JOB: NEW Nj� ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.)
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS —S�
DESCRIBE WORK
C
SQUARE FOOTAGE:
0
I ST FLOOR sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft. J
DECK sq. ft. COVERED DECK90sq. ft. STORAGE sq. ft. OTHER sq. ft. F
GARAGE sq. ft. ATTACHED ❑ DETACHED ❑ CARPORT sq. ft. ATTACHED ❑ DETACHED ❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN
m
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
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 contractor. I further
declare that I am ent� this permit and to do the work as proposed. I have obtained permission from all the necessary
parties, inclu ' any easement holder rties of interest regarding this project.The owner or authorized agent represents that the
informatio rovided is accurate and grants a loye on County access to the above described property and structure(s)for
review d inspection. This permit/application be es null&vo' if work or authorized construction is not commenced within 180
if construction work is suspended for a period of 180 days. OOF OF CONTINUATION OF WORK IS BY MEANS OF
INS,—d',y%6r
CTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 AYS WILL INVALIDATE THE APPLICATION.
X
Signature of Applicant Date
OWNER / REPRESENTATIVE /CONTRACTOR
Print Name (CIRCLE TO INDICATE)
DEPAR EN-T,kL-REVIEW ROVED A_ DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT — Q
PLANNING DEPARTMENT
FIRE MARSHAL
FEE'S TOTAL VALUATION:
BUILDING PERMIT FEE 1 4,1 .2 IRE ACCESS AND GRADE
PLAN REVIEW J l GEO- TECH REVIEW
PLUMBING &BASE FEE w STORMWATER REVIEW
MECHANICAL & BASE FEE p TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE VIOLATION FEE
co .moo r
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner 1 C /v>L Company Name fi LL
Mailing Address_e6 '/, of /, e yet✓ Mailing Address
City�iAr �/ State_Gv�--Zip Code 9f37� City State Zip Code
Pho Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address-L—IA&kc k d l zy-' -s t E Mail Address
Drivers Lic.# r LNV DOB / Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No --z_73_3 6 5'_3 KS C/� Fire District
Legal Description v -2-3/y, P_,o2_-t y S. 3,6 a lv;_:�
Site Address (Please include street name,street number and city) � LZ /V'tl/��-h�-L �!✓c� ZYe1 r m
Directions to site M AR 4ne' C-C^ 1ce-kc- Cd X-1— aC A A//iF-
l.�_- r
Is property within 200'of Saltwater_Ltl Lake n River/Creek Pond
Wetland --Ae-- Seasonal Runoff "tream Slopes or Bluffs J 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building 77-7797
Location of Fixtures/Units- 1st Floo 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG_Natural Gas_Heat Pump_
Toilets _Z- Type of Unit No. of Units Fees
Bathroom Sink — Furnace
Bath Tubs rz HeaSpot
Vent Ft
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
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 INSPECTION.
X 71r, i41 Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid 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
5oN U+l,
A -_coc�� MASON COUNTY PERMIT N820r2G—q)�25
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
_ WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
_ Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
184 PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: ( (_ 7 NAME: �L
MAILING ADD SS: T70 1 ALL MAIL �ADD�R�SS.-�,&� ip CITY:�,�} r' STATE: P,. ZIP: CTT�, TE\, la ZIP:
PHONE: CELL: PHONE: CELL:
EMAIL: EMAIL :
L&I REG 4 EXP.
PARCEL INFORMATION: t�
PARCEL NUMBER(12 DIGIT NUMBER) ��(p 53 00 1( T FIRE DISTRICT
LEGAL DESCRIPTION(AB eATED)
SITE ADDRESS a 1 _ �L CITY C-U V—
DIRECTIONS TO SITE ADDRESS
IS PROPERTY WITHIN 200 FT:
SALTWATER ❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[] NO ❑
TYPE OF JOB: NEW ' ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.)
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
DESCRIBE WORK
SQUARE FOOTAGE:
1ST FLOOR i I 5 sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq. ft. COVERED DECK 90 sq.ft. STORAGE sq.ft. OTHER sq. ft.
GARAGE 1520 sq. ft. ATTACHED ❑ DETACHED ❑ CARPORT sq. ft. ATTACHED ❑ DETACHED ❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
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 contractor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)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 OF
INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X
Signature of Applicant Date
X OWNER / REPRESENTATIVE /CONTRACTOR
Print Name (CIRCLE TO INDICATE)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
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 we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner 7-�C Company Name fi C
Mailing Address e67S ✓o a n/I./ Mailing Address
City 1",Ac State tak-Zip Code 1�3�� City State Zip Code
Phone��3 -7��'-7l1i� Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
Email address r�i�+e7�x�6P E Mail Address
Drivers Lic.#a DOB / Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No Fire District
Legal Description 7.' -2-3/,� R_'07-W S 36 Ca yJ[r
Site Address (Please include street name, street number and city) ';S-/ /Ve-17,h,
Directions to site /Z ('kwc, -z.--L A A_/y: ,rC-,r,.
-L�- r
Is property within 200'of Saltwater i� Lake n River/Creek Pond
Wetland ___A,=_- Seasonal Runoff t-Stream fl- Slopesor Bluffs > 15% ,
TYPE OF JOB - New Add Alt Repair Other Use of Building 12-
Location of Fixtures/Units- 1st Floo 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG—Natural Gas_Heat Pump_
Toilets Z- Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Z Heatpumps
Showers Spot Vent Fan 3 -
Water Heater Z Propane Tank '
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood 77
Hosebibs �— Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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 OFCONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X ,--,;.� ems.7C,_ - /;,, 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 a
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
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APPROVED PROJECTION OF THE BUILDING
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CWANGES SUBJECT TO APPROVAL
By —Date"' 30 C
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