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Home My WebLink AboutCOM2024-00027 FLD2024-00038 Mechanical - COM Permit / Conditions - 10/1/2024 615 W.Alder St.Bldg 8,SHELTON,WA 98584 MASON COUNTY COMMUNITY SERVICES SHELTON:360�27-9670,EXT 352 1 BELFAIR:360-275-4467,EXT 352 / Building,Plm-mg.ErnitonmentalHe Itf%Community H"Ith i ELMA:360-482-5269,EXT 352 www.co.mason.wa.us INSPECTION CARD AND CERTIFICATE OF OCCUPANCY** To schedule an inspection call or visit http:/hvww.co.mason.wa.us/community-services/bid-inspection.php Permit Number COM2024-00027 Date Issued 05/21/2024 Issued By ��V i,p Project NEW WALK-IN COOLER ��I \\\ V l' Site Address 5101 ESTATE ROUTE 106 Applicant UNION CITY MARKET/HOOK 8t FORK Contractor Contractor Phone Primary Code UPC IBC,IRC,IFC,IEC,IMC,& Type Permit Type MECH/PLUMB-COMMERCIAL Occupancy -APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS. -DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED. -THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION,FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY. -ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION. -OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION. **THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED.** PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET Public Works Access/Driveway Other Health Septic Well Deptartment Planning Site Inspection Department Fire Marshall Fire Apparatus Access Fire Sprinkler Auto Fire Alarm Hood and Duct Other Final Building Building Official: Community Services Designee Department Concrete Setbacks Slab Footing Perimeter Point load Footing Footing Interior Footing Decks/Porches Foundation Stem Walls Other Rough-In Groundwork Plumbing Framing Groundwork Mechanical Plumbing Groundwork Gas Pipe Mechanical Gas Piping Shear Wall Nailing Underfloor Other Insulation Slab Ceiling Floor Vaulted Ceiling Walls Vapor Barrier Other Wallboard Interior Wall Brace Panels Fire Walls Nailing Other Final Building r / - •Z D Manufactured Setbacks Setup Home Concrete Foot/Runners Final Other 9-I Z-Z q a EG INSPECTION RESULTS Page MASON COUNTY INSPECTION of Community Development COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584 Permit Assistance center,Building,PEannmg (360) 427-9670 ext. 352 Application # COM2024-00027 Application Type MECH/PLUMB- Owner UNION CITY COMMERCIAL MARKET/HOOK & FORK Parcel # 322325001001 Site Address 5101 E STATE ROUTE 106 UNION, WA 98592 Inspector Inspection'Type Date Status Comments 9-12-24 DEC EMAIL A PICTURE OF THE L&I STICKER Drew Carlson M/P FINAL INSPECTION 09/12/2024 FAIL INCLUDE WITH EMAIL PERMIT#, NAME OF PERMIT AND ADDRESS DREWC@MASONCOUNTYWA.GOV PROJECT WILL FINAL WHEN I CONFIRM RECEIPT OF EMAIL A^ Washington State Department of iLlLabor & Industries Your jobsite for permit number 4310872E was inspected 9/27/2024 by Electrical Inspector Percy Martinez. The results of inspection are listed below: Inspections: ecti n Restilt ection Comment 77 27/2024 iscellaneous,Other Approved Complete70MPLETE - RECEPTACLE PUMP AND LER OK. RECTIONS The following corrections were written on this inspection today. The following corrections were marked completed on this inspection today. WAC -296 .46B Listing and labeling vei -provide listing for condensing unit and for green tc cable .010(7) required hat comes pre wired-In order to meet the minimum electrical afety standards for installations, all materials,devices, ppliances, and equipment,not exempted in chapter 19.28 CW, must conform to applicable electrical product standards recognized by the department,be listed,or field evaluated. Other than as authorized by the chief electrical inspector, quipment must not be energized until such standards are met. ote 1: Request to energize-Permission to energize will be ased on the preliminary field evaluation report findings of an ccredited testing laboratory. Include the preliminary field valuation report with the equipment owner's request to nergize when permission to energize is sought from the chief lectrical inspector.Note 2: Unlisted industrial utilization quipment may be field evaluated by an approved product esting laboratory OR evaluated by an approved engineer. ndustrial utilization equipment must comply with WAC 296- 613-903. Here is the link: ttp://apps.leg.wa.gov/WAC/default.aspx?cite=296-46B-903. More information and a complete list of accredited electrical product testing laboratories and engineers can be found at: ttps:Hlni.wa.gov/l icensing-permits/electrical/electrical- instal lation-information/ NEC-440 .14 . Location vei provided disconnection means at ac. refer condenser- Disconnecting means shall be located within sight from, and readily accessible from,the air-conditioning or refrigerating quipment.The disconnecting means shall be permitted to be installed on or within the air-conditioning or refrigerating quipment. Disconnecting means shall meet the working space requirements of I I0.26(A).The disconnecting means shall not Washington State Department of labor & Industries ' Mrre4y e located on panels that are designed to allow access to the ir-conditioning or refrigeration equipment or where it bscures the equipment nameplate(s). You can view all inspection information on this permit online at Labor and Industries,electronic permit and inspection system.Additional fees may be assessed and will not appear until they are processed by our support team. If you do not have any correction(s),no further action is needed at this time. You may have one or more correction items needing attention: The results of your inspection request are attached. Your installation did not meet minimum safe-wiring standards required by Washington state law. [National Electrical Code,RCW 19.28, and/or WAC 296- 4613] Please note that per RCW 19.28.101(3); all corrections must be made within 15 days of the date issued. For correction items notated"Reinspect on Final";you must complete the corrections within 15 days of the date issued and request a progress inspection or final inspection within 45 days of the date of this letter. Unit RunTesting Report Run Tester: Unit Passed on TST123 Heatcraft Refrigeration Products LLC 420 Southwell Blvd,Tifton,GA 31794 Serial Number T23C04540 Model-Number PT0068MBNAMSA Date _ 3/8/2023 11:54:00 AM Unit Voltage 230 V Unit Phase 1 Unit Current 4.699706 A Run Test Records Ohms Test: Passed HIPOT Test: Passed Discharge Temprature: Passed Condensor Fan Test: Passed EVAP Fan Test: Passed Compressor Test: Passed Suction Pressure Test: Passed Discharge Pressure Test: Passed Defrost Test: Passed Inspect By: Fleming, Lamonda PRIMARY SINGLE PHASE PROTECTION PROVIDED USE COPPER CONDUCTORS ONLY GND � FACTORY WIRING CC FIELD WIRING (WHEN PLUG PLUG IN CONNECTOR NOT BLUE T1 L1 BLACK PROVIDED) T2 L2 WHITEMED RED 208-230V/10/60 HZ REFRIGERATION CONTROLLER by Caret 1 2 131415 6 7 8 9 1011 BLACK • • Y o 3 w 3 w 'WHITE CFM m a m w w w } O > 10 YELLOW BLUE DEFROST TEMP YELLOW ROOM TEMP Tet 1 2 3 FELLOW REDS 1 BLACK 0 0 RELAY R7 EFM I RED WIRE NOT USED ON AIR BLUE BLACK DEFROST MODELS SW BLACK BLUE BLACK BLACK CC HPS BROWN RANGE A R1 B 1 2 C 3 BLUE R S YELLOW Model: PT0068MBNAMSA RC Serial: ST23CO4540 COMPRESSOR LEGEND Customer: CC-COMPRESSOR CONTACTOR DLH-DRAIN LINE HEATER HL-HEATER LIMIT THERMOSTAT RT-ROOM THERMOSTAT TFC-TEMPERATURE FAN CYCLE SWITCH CCH-CRANKCASE HEATER OLT-DRAIN LINE THERMOSTAT HPS-HIGH PRESSURE SWITCH SC-START CAPACITOR WN-WIRE NUT R e V 3.93 CFM-CONDENSER FAN MOTOR EFM-EVAPORATOR FAN MOTOR PFC-PRESSURE FAN CYCLE SWITCH SR-START RELAY DH-DEFROST HEATER GND-GROUND RC-RUN CAPACITOR SW-SWITCH PT0068MBNAMSA - SUBMITTAL Project Name: Project Location: ,�,/ Quote ID: Item A, 1000 CLIMATE Submitted For., Submitted On: Submitted By: Submitted From: CONTROL Identity Tag: LlFor Record ❑ For Approval By. Date: ProductGeneral • • Product Family: PTN Voltage:(VoIWPh/Hz) 208-23011160 Application: Indoor Refrigerant Type: R446A Temperature Range: Medium Temp Unit Cooler Motor Type. VSEC Defrost Type: Air Compressor Model: Z806KAE Technical Information Atrrbiitnt Lairrp Roa111'Ternp Application Cap, J ) , (T) {BTi)INJ 95 35 550 0 5.61 21n1fRmps 15 a :NE'tif,4 F'iug Supprled? Recepta�te Approx Net.Weight ;Jost Number YES 6-15r' 215 ACFNF Y_€STMS -289116—� 9 AZIN� 99 P 99 PM 18 ip M 20 Itf6 =_--z a 4 ul6 -- ---------�..._......._ 24 314 j ------24 314 51 3t8 �---ELECTRICAL CONNECTION l AIR FLOW 11014 inches Page 1 of 2 PT0068MBNAMSA - SUBMITTAL Project Name: Project Location: ' Quote ID: Item#: 1000 CLIMATE _ submitted For: Submitted On: Submitted By. Submitted From: �•"'��— COL Identity#: Tag: Standard Features AESTHETICS PERFORMANCE • STUCCO-ALUMINUM FINISH MAXIUM VERTICAL STORAGE CAPACITY • IDEAL FOR HOLDING TEMPERATURE • MEDIUM-TEMP AIR AND ELECTRIC DEFROST • LOW-TEMP ELECTRIC DEFROST ENVIRONMENTALLY FRIENDLY RELIABLE&DURABLE • PRE-CHARGED WITH R448A REFRIGERANT TO MEET CARB&US CLIMATE LIQUID-LINE FILTER DRIER(MEDIUM AND LARGE CABINET ONLY) ALLIANCE REQUIREMENTS TWO-YEAR PARTS WARRANTY ENERGY EFFICIENCY EASE OF INSTALLATION • P1 UNITS USE SINGLE SPEED EC MOTORS(EVAPORATORS) PRE-CHARGED WITH REFRIGERANT • P2&P3 UNITS USE 2 SPEED EC MOTORS(EVAPORATORS) NO REFRIGERANT PIPING REQUIRED • P2&P3 UNITS USE SINGLE SPEED EC MOTORS(CONDENSERS,PT0046M USES EVAPORATIVE CONDENSATE PAN(INDOOR UNITS ONLY) PSC) ALL UNITS GET A REMOVABLE TOP PANEL WITH LATCHES • P2&P3 UNITS USE A MICROCHANNEL CONDENSER FOR HIGHER EFFCIENCY& ALL P1&SELECT P2&P3 UNITS COME WITH A POWER CORD CORROSION PROTECTION i CONTROLS • MICROPROCESSOR CONTROL Minimum Unit Clearances Top View Side View Allow 2 feet clearance above unit to remove top panel y� and to allow service access. Complessw Compressq[ , � Sea on Section Mounting rails may be used to attach unit to ceiling. Through-bolts should be Evapnracor Evaporator� Minimum 2"dearari insulated or non-conductive AirFlow `;o>v to prevent sweating. Capacities shown are Application Capacities reflecting nominal operation at 10'F TD.For models within the scope of the DOE AWEF(Annual Walk-in Energy Factor)standard,the Net Capacity is determined by the AHRI 1250 test method.DOE will publish this compliance data at www.regulations.doe.gov Page 2 of 2 INSPECTION CARD Mason County H 615 W. Alder St. Building 8, Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov PERMIT# COM2024-00027 PROJECT ADDRESS 5101 E STATE ROUTE 106 UNION, WA 98592 PARCEL# 322325001001 PROJECT DESCRIPTION NEW WALK- IN COOLER OWNER UNION CITY MARKET/HOOK& FORK ADDRESS PO BOX 609 PHONE 1.407.271.5274 CONTRACTOR ADDRESS PHONE CONTRACTOR LICENSE LENDER INSPECTION INSP DATE Comments INSPECTION INSP DATE Comments Rough-Plumbing Inspection Mechanical/Plumbing Final Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov F 4-00027 MECH/PLUMB - COMMERCIAL ESCRIPTION: NEW WALK- IN COOLER ISSUED: 05/21/2024 ESS: 5101 E STATE ROUTE 106 UNION EXPIRES: 11/17/2024 PARCEL: 322325001001 APPLICANT: UNION CITY MARKET/HOOK&FORK OWNER: UNION CITY MARKET/HOOK&FORK PO BOX 609 PO BOX 609 UNION,WA 98592 UNION,WA 98592 1.407.271.5274 FEES: Paid Due Mechanical Fees $46.00 $0.00 Technology Surcharge $3.12 $0.00 Mechanical Base Fee $30.00 $0.00 Final Inspection $80.00 $0.00 State Fee-Commercial $25.00 $0.00 Technology Flat Convenience $5.00 $0.00 Fee Totals : $189.12 $0.00 FIXTURES Qty Mechanical Fixtures 1.0000 For the installation or relocation of each boiler or compressor over 30 horsepower(52.7 kW)to and Including 30 horsepower(105.5 kW), or each absorption system over 500,000 Btu/h (146.6 kW) to and Including 1,000,000 Btu/h (293.1 kW) REQUIRED INSPECTIONS Rough- Plumbing Inspection Mechanical/Plumbing Final Inspection Printed by:Annie Wilson on:05/21/2024 08:30 AM Page 1 of 3 VA Mason County Mason County - Division of Community Development 615 W.Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov MECH/PLUMB - COMMERCIAL COM2024-00027 CONDITIONS * The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency (ORCAA). It is unlawful for any person to cause or allow the demolition (or major renovation)of any structure unless all asbestos containing materials have been identified and removed from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or operator has obtained written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 www.orcaa.org * 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. * 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 made prior to requesting additional inspections. * 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 UNLESS OTHERWISE APPROVED. * All building permits shall have a final inspection performed and approved by 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. * Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Code 14.28 and 14.17. * All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may grant one or more extension of 180 days, upon the receipt of a written extension request prior to permit expiration. Letter must indicate that circumstances beyond the control of the permit holder prevented action from being taken. * All furnace installations shall meet the minimum efficiencies set forth in the current edition of the Washington state energy code (WSEC). any portion of the mechanical system that is altered or replaced shall meet the minimum standards set forth in the WSEC and international mechanical code. * All construction must meet or exceed all local and state ordinances in addition to 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. Printed by:Annie Wilson on:05/21/2024 08:30 AM Page 2 of 3 c Mason County Mason County - Division of Community Development 615 W.Alder St. t�N`G Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov MECH/PLUMB - COMMERCIAL COM2024-00027 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued By: �-46I P Contractor or Authorized Agen Date: Z�x( I 1r?-4 Printed by:Annie Wilson on:05/21/2024 08:30 AM Page 3 of 3 DM1624 - 66024 � S Phone onotiBelfai n:taoulv5-4467 exc eat• Pax:tuoula2-5269 � Phone Belfair.(360)275-4467• Phone Elms:(360)482-5269 PLUMBING &MECHANICAL PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: a� ► �roa NAME: MAILING ADDRESS: TO 3.. C° MAILING ADDRESS: CITY: IJ STATE: ',J ZIP: -01 CITY: STATE: ZIP: 1"PHONE: jt 0 7 L T 1-1 z 7 1'_L..z.,, e. PHONE: CELL: 2°d PHONE:t'3 6 o) i r✓- �, .� 0-4 EMAIL: EMAIL:tA&r k,1 :L !`' urt,c,,.L ju^ L f•CCi• L&I REG# —W PARCEL INFORMATION: PARCEL NUMBER(12D1gitNumber): '1'22;2-`at' -C 1[k t Zoning- LEGAL C O:r►,.era;al DESCRIPTION(Abbreviated):�A,, W,.,t i.. l L,..j f iMV C z VLk:i LQtS`i-'I i<7VA Z1<'%..77LB SITE ADDRESS: 5`10 I -I b` • eiC Z CITY: L4.n to n DIRECTIONS TO SITE AD SS: t-k I( LA m WA TYPE OF JOB: NEW V ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FDCPURES/UNITS—1 sT FLOOR_j<_2ND FLOOR BASEMENT GARAGE_OTHER PLUMBING FIInTMS(SHOW NUMBER OF EACH) MECHANICAL UNITS Tvoe of Fixture No.of Fixtures Fees Fuel Type:Electxic 'K LPG Natural Gas Ductless_ Toilets Tie of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heat Pump Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/GasTellet Stove Dishwasher Kitchen Exhaust Hood Hose bibs Dryer Veto Other Solar Panel Other _J— Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER acknowledge submission of inaccurate Information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that 1 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 panties of interest regarding this projecL 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 pernitlapplication becom es null&void if work or author zed construction is not commenced within 180 days or If construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Sti j—'— Apr 25,2024 Signature of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTFS/CONDTTIONS Plumbing & Mechanical Permit Application H&F 4-25-24 Final Audit Report 2024-04-25 Created: 2024-04-25 By: Cathy Berg(cathy.berg@alderbrookresort.com) Status: Signed Transaction ID: CBJCHBCAABAARec5uInGGNTC8oTysoJyZyvMtUWx80Lg "Plumbing & Mechanical Permit Application H&F 4-25-24" Histor Y Document created by Cathy Berg(cathy.berg@alderbrookresort.com) 2024-04-25-3:03:00 PM GMT Document emailed to shaun.tucker@alderbrookresort.com for signature 2024-04-25-3:03:36 PM GMT Email viewed by shaun.tucker@alderbrookresort.com 2024-04-25-3:06:42 PM GMT o Signer shaun.tucker@alderbrookresort.com entered name at signing as Shaun Tucker 2024-04-25-4:15:07 PM GMT CYO Document e-signed by Shaun Tucker(shaun.tucker@alderbrookresort.com) Signature Date:2024-04-25-4:15:09 PM GMT-Time Source:server Agreement completed. 2024-04-25-4:15:09 PM GMT Q Adobe Acrobat Sign MASON COUNTY Mason County Permit Center Use: • COMMUNITY SERVICES FLD 2 6k l - G16191 ) Building,Planning,Environmental Health,Community Health 615 W.Alder Street—Bldg.8,Shelton,WA 98584 Date Rcvd I.D Phone:(360)427-9670 Ext.352♦Fax:(360)427-7798 Flood Development Permit A lication Owner's Name: Contractor: ' L r1 i o nN)eVLLJM eEA' Mailing Address: Mailing Address: City, State,Zip City, State,Zip A Phone: Jul _.),i I — 52 14 Phone: Email:i , IL 1 VI It Email: Tax Parcel Number. .Mffl Site Address: - - r� .} t ' n , K,- I {.(1tF Ito I�lt'11G'�'V I understand I am making application for a permit to develop in a designated flood hazard area.The undersigned agrees that all such work shall be done in accordance with the requirements of the County Flood Damage Prevention Ordinance,building codes and all other applicable Local, State and Federal regulations. This application does not create liability on the part of the County or any officer or employee thereof for any flood damage that results from reliance on this application, or any administrative decision made lawfully there under. Owners Signature (required): �ti t'� Date: May 8,2024 Scope work for review: A. Description of Work (complete for all work): Assoc. Permit(s): 1'Ya -Cr - 1. Proposed Development Description: ❑ New Residence ❑ New Manufactured home ❑ Bridge/Culvert/Stabilization -Von-Residential ❑ Fill/grade ❑ Bulkhead (new, repair, replace) ❑ Addition/Remodel/Repair to an existing structure (includes mechanical, plumbing, and work such as a re-roof). 2. The parcel has been identified in the following Flood Hazard Area: ❑ A 'Q�AE ❑ AO ❑ VE 5s {{ FIRM Panel/Map 1 0,4.5 6, � Base Flood Elevation (BFE): I`T Official Use 3. Habitat Assessment required: ❑ Yes ❑ No, exempt per If NO, must state what exemption qualifies, if YES attach Habitat Management plan, Biological Evaluation, or JARPA Application. 4. Are any other Federal, State, or local permits required? Must attach copies of permits. ❑ Yes ❑ No If yes, list type: 5. Is the proposed development in an identified floodway? ❑ Yes ❑ No If yes, a No Rise Certification must be attached. B. Complete for Historic Structures (must be on historic registry). 1. Provide documentation of historic registry from Federal or State. 2. Provide a detailed letter requesting a variance. Letter must include parcel number, address of site, scope of work and mitigation items regarding wetproofing or floodproofing that are available. No work can affect or result in increase flood heights or additional threats to public safety. All mechanical and plumbing must be flood or wetproofed. No variances will be granted in a Floodway. C. Complete for NEW or Substantial Improvements Structures and Building Sites: ''* 1. A FEMA Elevation Certificate is required, must be completed by a Washington State licensed Surveyor. Elevation Certificate must be attached. 2. Base Flood Elevation at the building site: feet NAVD 88 3. Required lowest floor elevation (including basement floor): feet NAVD88 4. In flood hazard areas without a base flood elevation (BFE), what is the highest adjacent. Grade? (HAG) Structure must be a minimum of two (2)feet above the HAG. The required finish floor height is D. Complete for Alterations, Additions, or Improvements to Existing Structures:` 1. What is the estimated market value of the existing structure? $ Attached: Assessor's Parcel Detail Report OR Appraisal from a Washington State Licensed Appraiser 2. What is the cost/valuation of the proposed construction? $ Percentage Attached: Contractors Bid (FEMA Criteria) OR County Valuation per Mason County Ordinance When the cost or valuation of the proposed construction equals or exceeds 50 percent of the market value of the structure, then the substantial improvement/repair provisions shall apply. Is the proposed work a substantial repair/improvement ❑ Yes ❑ No If yes, complete section C above. E. Complete for Non-Residential Floodproofed Construction:*** 1. Type of floodproofing method: 2. The required floodproofing elevation is: feet NAVD88 3. Floodproofing certification by a registered engineer is attached: ❑ Yes ❑ No F. Complete for Subdivisions and Planned Unit Developments: 1. Will the subdivision or other development contain 50 lots or 5 acres? ❑ Yes ❑ No 2. If yes, does the plat or proposal clearly identify base flood elevations? ❑ Yes ❑ No 3. Are the 100 Year Floodplain and Floodway delineated on the site plan? ❑ Yes ❑ No Administrative Planning Staff Signature: Date: Approved: Denied: Building Staff Signature: Date: Approve Denied: Environmental Health Staff Signature: Date: Approved: Denied: Comments/Conditions: i �S n+ o-n i O�SVA l d Gr�ta%y�, , °�- r iS � - ***A final completed FEMA Elevation Certificate must provide prior to final inspection. Mason County Flood Damage Prevention Ordinance #41-17 & International Building Codes