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HomeMy WebLinkAboutBLD2024-01360 MFG Home - BLD Application - 11/14/2024 (2) MASON COUNTY Permit No:$U7�t7��f-Q13tv0 COMMUNITY DEVELOPMENT RECEIVED Permit Assistance Center, Building,Planning NOV 14 2024 BUILDING PERMIT APPLICATION 615 W, Alder StreMa PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:,,�hf � �r�C� 1j(u ( C. NAME: I - r-CtV1.S ,/1 (�I hPSovo MAILING ADDRESS:�I i f r MAILING ADDRESS: -D 3aX I I I�0 CITY:A nd re.LOS STATE: ZIP:`7 cj"7 I CITY:01 uYv`Ai o, STATE: W n ZIP:G�S C S) PHONE#i: PHONE: 1365CELL: ,Sc le- PHONE#2: EMAIL: V i 1 1 IMPS Di rl EMMONS EMAIL: L&1 REG#CC.i)rLl.=C(`y 33P� J PRIMARY CONTACT: OWNER❑ CONTRACTORS OTHE$[INAME TY'CQV ', r Ines EMAIL V1WneS rllrt'wn'qCcrk K"� I COh, MAILING ADDRESS Fb lark 11'190 CITY STATE_ZIP 99 GbA- PHONE CELL 'Slag-"7$at -i$ n _ PARCEL INFORMATION:PARCEL NUMBER(12 Digit Number) 4 0oZ 0 0000 5` ZONING LEGAL DESCRIPTION(Abbreviated) L-al& txAS 5 FIRE DISTRICT 1QO SITEADDRESS 01b r) Si -LF5 i1� C r• r> CITY rkvOC)1Seei-+ DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[] NU SNOW LOAD: psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW x ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commerc of a*Eu.) f�.esir�pn 0— IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS HEATED STRUCTURE? YES(whaleStd4' YES(Farr[s1 of Bldg)❑ NO❑ DESCRIBE WORK_hft,S'I•A,l l N,{AU MF:.(a 14DyYL(, SQUARE FOOTAGE:(proposed) 1ST FLOOR_k2,5,t sq.ft. 2ND FLOOR sq.fL 3RD FLOOR sq.& BASEMENT sq.ft. DECK__5D sq.ft. COVERED DECK sq.ft. STORAGE sq.fL OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: f *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE �r l p�L� 60d MODEL�C4 c�5 3 G YEAR1z20a LENGTH 4- WIDT Ce• n BEDROOMS =Q BATHS lz49 SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING PLUMBING IN STRUCTUREI YES NO❑ Ifyes,attach completed Water Adequacy Form PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NON EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS S- TOTAL BEDROOMS_,2 OWNER 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 ft owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all ft necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,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 pennitlapplication 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X Signature of OWNER(Must be signed by tho OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT L FIRE MARSHAL PUBLIC HEALTH 529W_012)(00 PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RECEIVIM NAME:Si-k-\t0`, Cl rA,_ R Ll.t I L NOV 14 2024 I G�,Qt'S (,(.G NAME: (r' V I.$ I 1 hP MAILI G ADDRESS:R1 MAILING ADDRESS:PQ AID{ CITY:_ xis STATE: ZIP:" 1 CITY: 01 ;� STATE: fl?M* S # PHONE#l: PHONE p•- -1 lir CELL:,3Ub PHONE##2: EMAIL : Vi 11 jriy,:t r}wvtk I. fA,% EMAIL: L&I REG# CC V.;l i.T e(_M PW EXP. I I /2 /Z5- PRIMARY CONTACT: OWNER❑ CONTRACTOR OTHER❑ NAME V I I hE'S EMAI 'L ( A('n na i •�`� MAILING ADDRESS�gQ)( 1119 D CITY STATE TAA, ZIPC PHONE • CELLAb Q-'i j LE'l T PARCEL INFORMATION: j{ '' /����, PARCEL NUMBER(12 Digit Number) `-toga '"0 U5 `Sa 1WO 5D ZONING LEGAL DESCRIPTION(Abbreviated) Lul'o CU_�brvu #/of L04 • a FIRE DISTRICT SITE ADDRESS 90 n S+0LV JS+t I I 1br CITY DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOW SNOW LOAD:yLpsf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑ TYPE OF WORK: NEWO ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc) ;�I J ex IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS cQ NUMBER OF BATHROOMS_ HEATED STRUCTURE? YES(Whole Bldg) W YES(Part[s]g1 Bldg)❑ NO❑ DESCRIBE WORK I._ D SQUARE FOOTAGE: (p,00posed) I ST FLOOR 17 0_sq.ft. 2ND FLOOR sq. ft. 3RD FLOOR sq.ft. BASEMENT sq. ft. DECK S (7 sq.ft. COVERED DECK sq.ft. STORAGE sq. ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* n-e MAKE r) f()ac tt MODEL aY4f/3 C, YEAR : Ov`� LENGTH 4k WIDTH o BEDROOMS a BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER ❑ / NEW ❑ EXISTING PLUMBING IN STRUCTURE? YESX NO ❑ I/'yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOX EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS 02 _ TOTAL BEDROOMS _ Z52__ OWNER 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 and 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 legal representative,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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X _,_ff� 11/t3/ ?-1 Signature of OWNER (Must be signed by the OWNER) Date PLANNING 13C.Da.o,?4-b l 3&C) IXIT wow. Qnsu ._.... . . _._.�_ Y ...... ,� D)WO aV a p -- • 1 AREA lL 1 a xk � Y 135.4`X1 =.fir'` ---- C b� LLr,�t.•�tr,F.� d • Site Name: Location:N STANDSTILL DR NORTH Service Company: p Y: HOODSPORT Tax ID:422055200005 AAA Septic LLC UBe:Residential,Single Family PO Box 1460 Shelton,WA 98584 360-427-6110 Serviced:08/3012024 by:Jeremy Hayek Submitted 09/06/2024 by:Brett Taylor Dump Location:Bio-Recycling Jurisdiction ID:422055200005 COMMENTS Compartment Tank Pumped: YES Tank Size(Gal lons)(Number only, no text): 1000 Effluent level within operational limits(if NO explain in comments). YES Total Gallons pumped from tank(Number only, no text): 1000 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): Access Risers installed to grade(N/A if not present): NO Tank Construction Material: Concrete Tank Condition Good: YES Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: NO Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches, if other specify): 2 Compartment 1 Sludge accumulation(Inches,if other specify): 1 10 Compartment 2 Scum accumulation(Inches, if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 6 This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportlD:751256 View pump reports online at www.onlinerme.com Page 1 of 1 SWG MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. cn� CD 426 W.CEDAR/P.O.BOX 1666/SHELTON,WA 98584 Date r s. N PHONE(206)427.9670 Reoeipt No. _ o' Amount$ Z PROP r,Q /11 n�� p�—o 7—_9f2. � CHECK APPLICABLE ITEMS ✓ MAILIN RESS: DAYTIME PHONE: INSTALLING NEW SYSTEM q l: � 3 5,�;/(0 9 ?L �� S REPAIRING OLD SYSTEM EXPANDING SYSTEM w CITY: �QN STAG Y ZIP' SINGLE FAMILY _ T. PROPE :, S a/ ulA OTHER z Laj7/CL JAR u. SPECIFY: SPECIFIC DIRECTIONS FOR LOCATING TE: PRIVATE WELL g �•- �_ 7yit1 G PUBLIC SYSTEM s-lli SYSTEM ID NUMBEZI^� ST LC %Du,AnD z14su T�i4 lac R 7- +r SYSTEM NAME ' � j2,9" APPLICANT _ C. S(Tp7'ia.,) 1. 7— s L.,7S ! wf NAMELK a4w&V �N Installer of �� Ca�3 Sep?i C s Lot _ft.x�_ft. MAILING ADDRESS s r� Size: acres �{ O I v Name of Lt C v s t,, $epTtC-� Number o l�7 SIGNATO E 3 N. I� Designer 'coBedms X 0 PLOT PLAN .! Draw a dimensional plot plan, f t� including: w ❑hole cf st 'ryl g Io holes iq�`'JJ L5 L! � Do IQ meas istances to property bound 3 O Entry road;other roads, �D 1 ©to drive NOTE: DO NOT DRAWIN Dr SYSTEM DESIGN ��I OFFICIAL USE ONLY.D i RITE BE DOUBLE LINE. ' SOIL LOGS 544' t� )�� ��"�QJv'tikxzc�- tQ -+0 n -f& bd([� Depth from On�jin31'^^~dvj� Grade to Restrictive Layer or Water Table: In. DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS Finding Score Designer Level: U One AeTw'o Soil Type �- p+�� Vertical Separation n. Septic Tank Daily Capacity: D Gal. Flow: p?�� GPD Slope Appl s Infilt. Parcel Size nc. `rt Rate GPD/FT Area F-T- Distance to Shoreline� ft / Total Ipeqior Date) y Nalgs_ S i& OMmI NT ICON ONS FORAPPROVAL F`` J 1 ► c e(; t1 —AA) I&-(,noG�Z aw yCu. Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit. This Permit expireQyears from date of site inspection.Denial of this permit may be appealed to the Health Oyleer within 10 days of denial date. .❑ Design Re*red U Not �ed� DESI N: Approved U Not Approved INST N. roved Q Not Approved DATE:$ ��1`5 BY: DATE:_ By L( DATE: Q �j TOP:Health Dept.Copy MIDDLE:Designer's CoDV BOTTOM:Annlinant's Cnnv r 1 I I �.�;cvcv Yz >>Eini — VA GE, O F, - to j ! I C4r(p Of. r,nr"lt t)1 I:tlr rollowirttl it. mn ttre �uLml1.Lad I A dnai4 n wi]1.1. 1{t) ryV l - t tj(�,� lyzs fo + t, +,zt ictzlr'c3 ailtl Clr1t",C'ri `j t nehed I' , �t ;,l Rtts CF,rL}:liAL ( eau d Ft'j tour e' aiemn on cltel:kl.iEtt; :,�F,L•+l.J!:.�h.lr� .t . �:'`'fi 1 ;� ;,t�• 1 ucl .1J ! al>l.,I irahlc? it'_enzs tin Checkli C ! �r.rc :•c,:e tTk .t.ca , z�'! :ti 1 %i1)h1 i iahl.c i gems MI c:lteckli tt. -, - (. _ i 1';� ,pt,n<:LI' T 1�!-:tr•rt,r•r.cr,')•:LcrN i LAKE USHMAN $EPTICSit ; it Hoc, ispo,r't,WA 0 548 it ( 06) 877.5 5 ItCW6., _{ V.J``� It,••r:icjucz r., IJlnm __ . —_ -.._.. II I 'r+,op. 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I ;Irs a►ld ca1r of I I , Critical AreaAIChecklipt. iI Ii dr.�tJinry t�lu) tl� Culit.sat ; II --r— .. _ .. .: _:� �.._-._ . .i _--�_ - _�... .__ - __. ......_.-_ .. ...... `_gym.-r•r_r.�i".. :-s:-e--..� ,t + i i DJ-XTcM APPRO VA.L 1 t µ '1'11c urtd' t i!�11Er)rl •tivignor i I �e I, I clra•!I 11.0t''7 witi.v the ro.r;irement to be not.if.ted by h. II II iltnta.11c l (if t lte ,iiin a .iv,�l, fl w le , /�• Porno R f .nal Tispect'.i( tl pr1ol- C0 I) II (:elve),. . II I •r U8HMAW8IEftId6 I If N -31 Canvasbi0 Pf. Ir The url0$:r.(sigl od }Zits iPvaIt led aid kj)Jlrhvr!d t:l,ilt: clniiign <ill bobalf of Mr(2 Wr g1 , Bern .11 � (; li i 1.1 z t F)i�i:t c���� . r. ' �)�[:r'• ;, � I I f i1 l'.114TTYON' ULST�GN 1APPR�?VAL S V I ONLY MIDI TL TPE FOI+T,Ot TN<; CONUITIOlt t: �t' J II �TFJE I)EPIG'�J J6 T p ApPRUVRfl^ RYA �SA;iON COUNTY I)RPTARTM trr OF I} Ji,,, J SRRV (i , ,TFIF ON-SI '9 0 I AGA sg IT HAS 110T FXPTREDY XXPXRATTOII OF AID PE iT 1' SAS p F x TTI U SITE I NISTFr'TTON, NOT ON TGIF DATF OF DRSlc-P APPROV T111': I;YPTE TG HST i,LS BY A C'T-:QTTr'TFD INSTALLER, fTNLRS.S RIOR AUT IfORIZATT01 I 'OATA .NF:n ROM A3;, N C0111:•T1Y 11t 4'Mz,t'MF.17r 6F 11PATITFt SFRV (11iS I: b J V(iceH �t"7"Y f OD 9VES-148 (90C} 90996 VM `OdSPOOH ! "Id�4gsenuea TE-N /oil Acrtu IL C* a�e4 'c�—��f►»rj �fF� Qt e9 Sa���yas Ott Q� h�i11*,/n �a�s�s ";,74.A SSt�&d6,� r„1ra� poi s9oAe— � �� •,�S_fX�,�,� 1,/oo�sov000y 0,6 N SoQOQ 2-siC��'Z�a ' �s {{ - ----L-K CUSHMANSEM-C S - -N I Chu pL -Hu77 U _. ._---• -------- �;---------— — ------ � /1O\ �!'t w�A-tZ.y rem�-ci t e L� Mason County Ce:t:aeatA44swises—....Aa -Date "•. �.• -`.:=-�;�_.._.:_ Z� tt -.t-• u��.0 �-TVs... `emu C.IL' � 7 1.of 1-31 CjwL • - )D�f --- - ( P--_ -�` `' pu t -_-_ - eo�ooec P /r , -- -.. ----- - ---- -- - -St�e_Y"tr... •--•-UaTQ--Set. - - - - --- -- _ - e►T..c�s.+ .D�aT,a;.es+ t oak ry f � t•o c ON-SITE SEWAGE INSTALLATION r FINAL INSPECTION �I.�ItICAI �1�P DATE CALLED IN: TIME: 1� ,�d INSTALLER: APPLICANVOWNER: CALLER: PHONE#OF CALLER: SWG#: PARCEL NUMBER: �� SUBDIVISION: Div: Lot: SYSTEM TYPE(CHECK ONE): PRESSURE GRAVITY INSPECTION SCHEDULE(CHECK ONE): APPOINTMENT PLUG IN AS-BUILT ON-SITE(CHECK ONE): '10. YES NO STAFF INITIALS: APPOINTMENT DATE: TIME: COMMENTS: ON-SITE SEWAGE INSTALLATION STAFF INSPECTION REPORT s > Yes Comments I. SEPTIC TANK A) >5 ft.from foundation? W 1� o B) >50 ft from wells and surface water? . C) Bldg stub-out to septic tank:clean-out if not 1-20/o? D) Baffles intact and clean? E) Dividing wall intact? F) Risers installed for access? 11. D-Box beveled with water and/or speed leveler(circle)? M. DRAMIELD A) >10 ft from foundation and>5 ft from perceived property lines? �- B) >100 ft from wells and surface water? C) >10 ft from potable water lines? D) Laterals level to±I inch&end caps present if not looped? v E) Gravelless chambers utilized? L F) System dimensions the same as shown on the design? y G) Gravel clean,properly sized,and proper depth? H) PRESSURE SYSTEMS 1) Sand quality ASTM C-33? 1� 2) Head height uniform and a24 inches? 3) Clean-outs and observation ports present? 4) Mound: Side Slope 3:I? - 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I? IV. PUW/PUW CHAMBER A) Screen basket or effluent filter(circle one)installed? B) Riser installed for access? C) Alarm installed? D) Pump on timer or demand(circle)? V. AS-BUILT REQUIRED? VI. OTHER COM'UMS/OBSERVATIONS The undersigned has reviewed this installation and verifies these findings on behalf of n ounty D ent of H`e>alth Services tanan Date Revised 9126/97 AS-BUILT FORM Revised 8/28/97 trot Rn�cEr.TD�Iax a�iorl Applicant's Name 2 Assessor's Parcel No. ^� L&DO b.� yr ugit Number) Permit Number W D _6 Subdivision Installer's Name Designer's Name S I sS FAL1 Elf CtGI§T N/A Yes I. SEPTIC TANK om Prior to Cpletion A)) >5 ft.From foundation? k B) >50 RAF wells and surface water? C)) Bldg stub-out to septic tank:clean-out ifnot 1-2%? T D) Bathes intact and clean? E} Dividing wall intact? F Risers installed for access? II. D-Box Leveled with water and/or speed leveler(circle)? III. DRA iFIELD A >10 R from foundation and>5 ft from property lines? B >100 ft from wells and surface wateo _� C >10 ft from potable water lines? D Laterals level to-t I inch&end caps present if not looped? E Gravelless chambers utilized? F System dimensions the same as shown on Uie design? G) Gravel clean,properly sized,and proper depth? H) PREssURE SYSTEMS 1 Sand qquality ASTM C-337 2 Head height uniform and z24 inches? Actual head height 3 Clean-outsand observation ports present? Mound: 4 Mound:d: Side Slcpe 3:17 S Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&17 IV. PUW/PUW CHAMSPR A Pump make Pump model B Screen basket or a uent ter circle one)insta EIRiser rinstalled for access? Al arm installed? Pump gallons per minute Pump on timer or demon circ e 1 If timer.Timer On Timer Off -- C;NECKLIST ❑ Dts bud&manifold oricmation &!eyout ❑ Tren*'be dimcmionsand critical diaunce,within layout ❑ Sep iehump tank placemrnt ❑ Loeatioaofbuildings. ❑ Observation port&clean-out location. ❑ Location of wells&roads. ❑ Undisturbed native soil between trenches / ❑ North arrow G4i ner,bk M/nor ihcerments to septic tank locah'an and dram eld orientation made in lheJield by the inrtaller are genera!!y acceptable ro both the departnuntand the designer,bur routd tnccrtain coi-compromise the viab/lt ,19,aYstem.Jt ie the Iniraller t reapontfbigry to obtain prtor written opproval f�rom¢Rees the health deportment or the deetgner before making any devloh'ons om tea dealgn lhat 0 f^et the ayrtem wobtlity.Any devian'one from the approved design mwt be shown above. CgRr1 IcA xzoN o)z1 xal 1 axtox I nstaller,, eck a box from Row"A"and"B";sign and date the certification certiinstalled the system without any deviation I cerd[fy,that all deviations from the desi stain d rom tesign stamped"APPROVED"byMCDHS `APPROVED"by MCDHS are shown above, Ccrtiffy that I contacted the designer and left the system ❑ I did not contact the de-si er riPert pection up to 48 hrs prior to cover. gn P or to final cover becausethe designer waived the notification requirement.that all information contained on this form isaccu ate. I understan iffee' se for immediate suspension ofmy installei certification. rein is not aeourate,there approves this installation on behalf of Mason County Dep o H th S ee/Q�$� $ _ l� YW t, i0-_ an e