HomeMy WebLinkAboutBLD97-00830 Final SFR, Deck, Garage, Propane and Stove - BLD Permit / Conditions - 1/14/2000 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
S I-) 1 1 C- 1 r4 t 1 ` F Fl IUI 1 -r FOR INSPECTIONS CAt t 427-9670
BETWEFN °"pm AND Gam 427-7262
8I_097-0830 PARCEL t2?30477901 1 1 PLAT- 7 i V • Bt-K : LOT :
JOB ADDIRFS`. T131 NE TAH(IYA BLACKSMI CH RCS I;CLFAIR
OWNER s K IM 206-821 -01416
CONTRACTC.R s C:HAF RPORAT ION :360-698 9140
LEGAL - TA 11-1 Of Sd1Y 1314/ TO 8 Of SP 11791
CLASS OF WORK . . :NFW BFI)R : f3A1H : 2 TYPE ANOUN1 6f MATE AFCf!PT TfPf A111000' BY DITE RECEIp)
TYPF OF USE :SF ` TOR I FS , : 1
OCCUP , GROUP . , . A3111 Fitt DO . HE:F GHT t O .Of-t EH1P i 52.00 N,IF 11171197 45954 f 1RP t 33.00 NJP 11!2119? 45954
TYPF OF CONS r . . :5N 1= I RE P► ACES —, . . : 1 NR11 S 493,50 NJP 11121197 45954 "TEE 1 4.5N NJP 11!21197 45954
OCCUP . LOAD . . . . o wooDs-rows . . . ► 0 !PICK N 746.75 NJP 11121197 45954
F)WFi-t_ <UN I T,4 0 PARKING SPACES : 0 1PLN 1 63.65 NJP 11121197 45954
t NSPF'CT I ON ArIEA : 1 SHORFt.. I NE 7 . . . . :Y 011 € 75.15 NJP 111?119' 45954 10TAt: 964.15 YAI III.AT 10Nr 771a'3
TOILETS . . . . . . . . , , 2 17UEL TYPES----.--..__.___ BOII.FRSIC0MP- NOBILF HOM.F-.
FRONT . . . 0 .Of t BA TH B A S I N;; , r : / PRO/ ! ! 0-3 HP , : 0
hFAR . . . . 0 .Ofi BATH TUBS . . . . . , 1 3 1 5 HP . ; 0 MODFI. :
5 1 DF ( 1 ):, 0 .Oft `�HOWER-�: , , r .- 1:U IN 100K B-11) : 1 Is- 30 i1P . 0 MAKr>
SIDE(:?). 0 .0ft WATER HEATERS . . . . t 1 TURN 100K BTU - 0 :30_50 HP . : 0
SHRL i NF i O .Pf t CL 01liFS WASHERS . 1 FURN I I.00R . . . = 0 !;O-t" HI> 0 YFAR
AREA ___._- .._---_.__.__ - KITCHEN :SINKS . , . . : 3 HEAT PUMP , . , . . . : 0
1-01' SIZE' , t FI_oOR DRA INS 0 VF..NT `NYSTEMS _ 0 FVAP (,'OOL FR:., : 0 1 FNG111 : 0
BO I Lr)I NG 1 305sf DRINKING FOUNT , . , s 0 VENT FANS .. 5 1-4001) ti , - , . . . , . 0 WIDTH , 0
BASEMENT . . , ; 0-,f L AUNVAY FRAYS , . I . : 1 noMrS . I NC i N :O SFP I Al. Zt-
r'FCK3 . - . . , . . 5h5sf DISHWASHERS . . . . .. : 1 A 1 R I-IANVI- 1 NG UNITS--- COMMt. . 1 NC f N :0
GAR/CARP :G 630,:1 GARD DISPOSALS , 1 I �U 10000 of in . = 0 RLI Ot-;113FPAIR : . t3
AT/DT . aA LIRINAL., . . . . . . . . . .. : 0 .> 10000 cfm . : 0 OTHER UNITS . : 0
MI SC P(.MI F I XTI)f1F". : 0 3AS OII1't E-.TS 1
' ssas��^s�r�^a�:cac.:nz.rrx-na.:.xs«..:.exevc,=���.:r:..a-.r;�:smss�rr.�ssa�:-=«r+.:rra+ca..x+xri:aer�r:Orr:xcars�epy�ummatt:>:s-.x�^.':-r-�a.:xac:-.-ra--i,�-:�cr:.tas'/ :c-.s' -.saox>-a-s'�ea.t:r.:rs+-.:�v^,z:.zs�r_.�:s�.x:.-�:-.'or.t�.r.'s�•-s
PB)!JE(T =+FSC11lTION:NFS!DENCf, DEC> , OA11A6F.,P1OPANE TANA,STPYf.
PR6,IfC1 IUCAl14N:DO11N TFNtlYA BIACKSN1111 AD Off BEAN CRI19.. DFNA110 PD, III 1411T SIDF 01"10As1, fi401h NIS' CORNER Of TAKE
IRIS PERIif OcCONES 0611 AND 4'010 If NOR9 011 CONST111flION AUTNORNE1 ill NOT COIIENt1111141.1. IL# Dos, 0R if CONtiT 411ON ON low. IS SU"PEADED FOG A PEA;OD
of 186 DAYS AT ARY 1111:, A"19 R is CONNENCfo. FY om(f Of rONI!NUA1149 OF•1011Y IS'A Pf6CRE INSPfC11ON 111414 ill DAY PERIOD f INAi 1NSPECf!Op MUST s:f
APPROYER F,✓ FORE AUILOlNC CAN BO
�'vPIEO.
r11 O pill, Qv t 03131191 COMPLIANCE 1704TTACHUD CON�JT 1rVhS IS REO+U I RED;i
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date _ LG — by Gas Pipin date by t,
Foundation Walls _ date v — by Set Up
date /— 2 g- — 8' by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING FIRE DEPT.
date �> by �� Walls
by date by
��
PLUMBING OTHER
Groundwork Attic
date b date by Y/
vz
D.W.V. WALLBOARD NAILING
date a by date by 7��
Water Line FINAL INSPECTION
date by )�Z date _(nCj by_vz date by
-2
19-77" �1?
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
PF i"? M 1 -11" 0 ND 1 -I 1 CtiNE3
,Cad e: No . - BLD97 -0830
For : KIM RAIRD
Pages 1
1 ) this TappIIcatIon Is s4►hiec-t to But fer and Inndt=,capinq requirements as etstabiit_hpd under.
Mason County Ord i nanny- 1 .03 .036 ,
X
2 > Proponed struo.turo or any portion thereof (Ireater than '10" irr height from of ode ; iroe .
must maintain a minimum of 5 ' setback from all property i i ne> easements and 10 ' f rnm
all Ce:)unt y and States Road r i qht of way,, .
:i ) The uses, handl incl and atora�e3 of ha,,ardous materials or f lamptablo anti c ombus:;t ible
I i ctv i d,.• i n exne,as of 10 ga 1 ono is not allowed without the approval of the Ma:.aon County
Fire Marshal .
X
4 ) Appr oved per (:t l rrt�res I cons sand Setback s on subal l tted S I t o p I an . X
i Temporary erosion control measures must be Implemented to prevent water qua 1 i tv
degradation of rid i atom t waters or wet I Bands .
X x�
6 ) AppiIcan't aoknowled(j s tt+at <- tr► oture setback of ?!i feet from water i ., required to meei
Interim Resource Ordinance requ I red setback from critical area . x._
7 ) Ali approved plans are required to tie on- 6 1 te:► for I nspect i ur► r)tsr pole F- . t f i r{spet,t r on
1 s c;a I I ed for .and p i ars are riot on site, Approval WILL NOT be granted . In addition , r
Pe - Inspection fee in the amount of $32 .00 per tour (m i n l oaum 1 hour ) will be nharge*d and
must be coIieoted by thIs department prior, to any further Inspections being performed or
approval granted .
X
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
R0. Box 186 Shelton, Washington 98584
HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE
AND LEGIBLIF FROM THE STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY 1301LDINC,
DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A
HE I NSPFCT I ON FEE , BASED ON RATES IN TABt.E 3A OF THE 1994 UNIFORM 8111 L 111 NG CODE. WILL 8
,ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPFCTIONS .
9 ) The o-orroc.tIon I Ist , aionq with the Energy Comps iance Worksheet (whets a pl ioable ) IF;
part of the plans and must remain attached thereto . It i :4 the responsibility of the
applicant to make corrections ly dloatod on the pplans from tho correction I ists . Onoc
the plans are marked APPROVED, they may not be changed or altered without authorization
from the Building Official The permst holder is reponsIble to retain the oomplete
approved set of plans on s I to for the duration of the project . Failure to comply will
re uIt Its fiat lure cof required huff Idinq inspections . Fvery permit chaff I expire by
limitation and become null and void fit the building or worLc authorized by such permits
Is not commenced within 180 daVs from the date of issuance, or, It the t,u i l d i ng or work
authorized by such permits Is suspended or bandoned at any time after the work Is
commenced for a period of 180 days . X.____'
10) Any charges in -onstruc t i on shall be reviewed by e n i neser of record and submitted in
writing to the Mason Count.V Btfl iding Oepartmen prior t construction .
v
1 1 ) At i. CONSTRUCTION MUST MEET OR EXCFEQ At.[ l OCAL. CODES AND UB(-- HFOU I REMENTS .
12 ) Changes to approved 1hui Idinq purr,= that effect a Pmpi lance to the 1991 washin(jinn �:tale
Energy Code, 1991 Ventilation and Indoor Air G►ua I i t
Code, the Uniform But t d i nq Code and/or Ma=:on Couilty 400" I at i ons must
be approved by Mason County prior to corstructIonX
13 ) At L CONSTRUCT ION MUST MEFT OR t-"CFED i.00AL CODES , IF ANY OUFST IONS, PL EA`4
CAL.I. THIS OFFICE BEFORE CONSTRUCTION .
X_
1 4 ) CONSTRUCTION PROCESS Tn 13F FF I F L O CORRECTED_ AS REQUIRED PFR MASON COUNTY EAU I t P I NG
DEPARTMENT AND UNIFORM BU I t I)1 NG CODE ..x__ 4
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
15) This pro j ect Is approved to meet the 1994 Washington Mate Energy Code uei i n4) the
PrescripMe option, other fuels, number 7 , glazing 27% . Using this option all glazin,
including glazed doors and skyl lcihts , shall have fa a- value c}f .45 or less . Wall
Insulation R-- 19 or better , floor insulation minimum R-2.5, ceiling and vault Insulation
m i n i m itm R -30 .
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1e- 7690030 161
/ i Q 7690040 _ 7790 i� 150
77906 A P 1 795
SP 1639 10 7690050 151
7790 C /
4 I� 7690060 152
I 1 7790 A
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7690070
1 > 7790 141
� Sp 1794
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SP 16 1 iPJ 7690080 779
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1 7730 4 SP 1793
SP 16 2 �g 7690110
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1 7790 I20 A \
2304 3 00000 / d° 7690130
7790 121 SP 1792
Sp 16 laj 7690140
I 7790 122
' ' 1L 7690150
7790 110
7690140 q
I„ SP 1791
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1.�7690 111
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SP 16 1
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07/11/97 FRI 12:10 FAX 206 822 1508 CHAFFEY CORP ►i► HITSAP OFFICE 001
'"b CERTIFIES ----•. "1 VF LA O „ ---_ -
:i TyAT TyE FERN NAMED yE g,, R AND lNp�S�-RIES ",.
S REGfSTEREO AS PROVIDED
gECit 9Y LAW AS A
BTAA NUM9F�q14
s'
U 7• FF nroat� r
CHAFFEx CtlR�p STATE OF WASHlNGTON O $OX "56 ► A'T'ION i
KLAND W,A g$083
O T-V-u ,.
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
RESIDENTIAL REQUIREMENTS (NEW CONSTRUCTION, ADDITIONS, &REMODELS)
THE PROCESSING OF YOUR APPLICATION CAN BE EXPEDITED IF YOU PROVIDE
COMPLETE AND DETAILED INFORMATION.
YOU ARE ENCOURAGED TO COMPLY TO THE 1991 WSEC BY UTILIZING THE
APPROPRIATE PRESCRIPTIVE PATH FOR YOUlePROJECT. THIS WILL ALSO
HELP EXPEDITE MATTERS.
THE FOLLOWING INFORMATION MUST BE PROVIDED:
1) A complete window schedule must be submitted with your WSEC compliance
information, even if a window schedule is included on your building plans. Note that
sliding glass doors (patio), french doors,'and any door with 50% or more glass in it is
considered a window with the area (sq.ft.) being the entire units rough opening
dimensions. Any windows in doors (less than 50% of area) must be taken out of the
door area and put into the window area on the schedule.
This window schedule must minimally show the dimensions of the rough openings of
each window, the model (casement, horizontal slider, single hung, awning, picture,
etc...), and the units tested U-value.
2) If you are complying to the WSEC by prescriptive path and are using the area weighted
averaging method you must include your calculations (worksheet).
3) Indicate type of hot water heater, location of exhaust fans (bathrooms, laundry,
kitchen), the location of your whole house fan, and all insulation levels (walls, floors,
ceilings, and slab) on your building plans.
4) Indicate how you will comply with the requirement for introducing fresh air to each
habitable room on your building plans (window frame vents, through the wall ports, or
an integrated system with your furnace).
5) Using electric heat or a heat pump??? If so, you may be eligible for an incentive from,
from your local utility. For more information contact PUD #3 at 426-0777 or PUD #1
at 877-5249.
6) Questions? Call Debbera Coker at the Mason County Building Department at
(360) 427-9670 ext. 284.
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MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
OWNER D iGdL L M —f,4 t 2 D TELEPHONE 0l¢C�
COMPLIANCE INFORMATION
TYPE OF PROJECT: (INEW RESIDENCE O ADDITION O REMODEL O OTHER
AREA(SQ.FT.) 1ST FLOOR 3� b5- 2ND FLOOR — HEATED BASEMENT
Note: Heated basements must be insulated and finished to meet minimum energy code requirements.
TOTAL SQUARE FOOTAGE OF CONDITIONED (HEATED) AREA /Z O.S
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COMPLIANCE METHOD:
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( ) PRESCRIPTIVE PATH -- circle option — I II III IV V VI VII VIII
Glazing percentage (total glazing area divided by total conditioned area)
( ) COMPONENT PERFORMANCE — Chapter 5 — attach documentation and worksheets
( ) SYSTEMS ANALYSIS — WATTSUN 5.2 — attach documentation and worksheets
WATER HEATER
( ) Electric water heater 0-'Gas water heater
HEATING SYSTEM:
ELECTRIC RESISTANCE
( ) Electric Central Furnace ( ) Electric Wall Heaters ( ) Baseboard Units
( ) Radiant Panels ( ) Other
OTHER FUELS
( ) Heat Pump with electric furnace ( ) Heat pump with gas furnace ( ) Gas Furnace ( ) Oil Furnace
( ) Other _��s� � ( ) Boiler System (indicate type)
Make Model
Size rJEA, —AFUE HSPF
VENTILATION SYSTEM:
K'Spot and Whole House ( ) Central Ducted System ( ) Integrated with Furnace
( ) Heat Recovery System (air to air heat exchanger — heat recovery heat pump)
GENERAL NOTES:
Your building plans should indicate certain compliance measures: framing to be used (standard,
intermediate, advanced); type of vapor barriers being used; location of furnaces, hot water tanks and
other equipment; location of solid fuel burning appliances, fireplaces and their combustion air duct runs;
and termination points of exhaust ventilation fans.
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1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
PRESCRIPTIVE PATHS
OTHER FUELS (GAS, OIL, HEAT PUMP)
HVAC- Glazing wag Wag int' Wag ext' Slab'
Equip. %Floor Glaz N Doors Vaulted Above Below Below on
Opp UN-- Aroa U-Value U-Value Ce44ig2 Ceiling' Grads Grade Grade Floor Grade
I. Med. 10% 0.70 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
II. bled. 12% 0.65 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
III. High 21% 0.75 0.40 R-30 R-30 R-19 R49 R-10 R-19 R-10
ai M;oY Y".Y-L'fi.. ....N�l•�3 :.�:....f7-iV .::.::, Ii'f ,..:: ..�1--{V';� Reference case
V. low 21% 0.60 0.40 R-30 R-30 R-19 R49 R-10 R-19 R-10
VI.7 Mod. 25% 0.50 0.40 R-38 R-30 R-19 R-19 R-10 � R-25 R-10
V11.7 Mod. 30% 0.45 0.40 R-30 R-30 R49 R-19 R-10 R-25 R-10
1 ur""T""a r*q--rime for sash op0on Wed- For exwm a,it a proposed design has 5 Floors over orawl spao.a or*}posed to ambient air conditions.
is 9L"ratio to dw oonditoned Vlow area of I M it shag oomptr with all 01 VW
regrwrwrrrka d the 21%gia2 option(or hiker]. Proposed design which cwvnot 6 Required slab pwin»tat nsulation sh"be a water nsawd rnxtenal manutadured
� w n tln*Viicdic mguwwT ka of a listed option above.may calwlsts oonpiance for is iMendod use,and installed ao ..m.b manuradur*,,spec-h=ions. See
by Chapters 4 or 5 d this oods. section 602.4.
2 Regu rwrrer a alphas to am omtungs except single rattar of joist vaulted oelings. 7 Thesa options shall be appkable to bWdips less lhan ovo.stories.
A-Y 6-04s Advanosd Framed ceiling.
8 This wa8 mvtabon r.gw*nrrd denotes R-19 wall cavity ixuWion pies R'5 foam
R*quir*rnent applcabl*Only to single pryer or joist vaulted o«irnga. sheathing.
4 Below grade ovals it 10 is&&n lated sthw on tho exterior b a"ninrxrt level of R- g Miniraexn WAC Equpn+arrt efficiency requirwnent. 'Lowy denotes an AFUE of 0.74.
10,or on t1+s interior b the same level as walle above Veda. Extwo itr avwion 'feted danotse an AFUE of 47B- 'High'denotes an AFUE d 0.88.
^aW6d on beta+grade walle"be is water resi.tant material,"mmAactured for
io inbnd*d ii e,end instated t000rdig to the mw%Aacture(s specokatiom. See
seUion e022
ELECTRIC RESISTANCE HEAT
g Wag Wag int Wad ext' Slab'
%Floor Gazing Doors Vaulted Above Below Below on
Opdon Area U-Value U-Value Ceiling= CetGV Grade Grade Grade Floor Grade
1. 10% 0.46 0.40 R-38 R-30 R-21 R-21 R-10 R-30 R-10
I1. 12% 0.43 020 R-38 830 R-19 R-19 R-10 R-30 R-10
III. 12% 0.40 0.40 R-38 R-30 R-21 R-21 R-10 R-30_ R-10
' v...�vhi:::�;:., '� • v`..��N: .v:. :.wX�M!}S:v"f.!r^^:'�.'.N".•
:lawn-.:: \'!j'i-\i-• A:vn'..'..'?'..;- :.�i�:t... �wv�.v....�v..,�,��µ
Reference case
V. 18% 0.39 020 R38 R-30 R-21 R-21 R-10 R-30 R-10
Vl. 21% 0.36 020 R-38 R-30 R-21 R-21 R-10 R-30 R-10
Vll.' 25% 0.35 020 R-38 R-30 R-19+R-5' R-21 R-10 R-30 R-10
VI I I.' 30% 0.32 020 R-38 R-30 R-19+R-5' R-21 R-10 R-30 R-10
1 Mininerraa nOW"'enwnss for etch or lion 614" For eaanpla,d At proposed design has 6 floors over crawl species or opposed to anbient air oondiiorns.
At 94&"redo to tM oonditioned Woor area of I Y shale oonpy with ell of the
eeQuirem.nb of 0-21%96-V option(or higNett proposed design algid rartrnot ti Required slab perimeter insulation shah be a water resistant material,mwwfadur*d
na«t Ores OPeoifio r0*mfwnene9 of a Wed option above,may calotlaw oonpiarwc lot is irterndad w".and netai6d e000rditV to ma.dacturees spsaicationa. See
by Chapters 4 or 6 of this oode. section 6024.
2 Requirwnrw applies to ap oeiro"oxoapt"Vie niter or joist wired os7inga. 7 The**options tW be appiceble to btx'iSa"less than this*atorias.
Adv denores Advano.d Franwd Cogirg.
t This vnat mutation ngtrKerrient denotes R-19 w%A cavity i suiation plus R•5 loam
3 Roquirenwnt applicable ordy to single utter or joist vaulted owI gs. sheathing.
4 Below grads wak shell be insuiatsd either on itio exterior b is mininxn level of R-
M or on dins interior to""awns level as walls above grade. Exterior inw ion
installed on b*iow grade wads shall be a wwer Assistant material.menu siMred for
is intended use.and wtafed aooadirg to the mawfaottxer's sp*cricahons. See
s*aion 6022
WINDOW & DOOR SCHEDULE
1
WINDOWS
INCLUDE ALL WINDOWS, SKYLIGHTS, SLIDING GLASS DOORS, FRENCH DOORS AND
STORE DOORS. ANY WINDOWS IN DOORS(LESS THAN 50% OF AREA) MUST BE
TAKEN OUT OF THE DOOR AREA AND PUT INTO THE WINDOW AREA ON THE
SCHEDULE. rL!r L
BRAND FODEL U-V QUANTITY SIZE TOTAL SQ. FT.
-62
� � • s� -�. � ems° l�;
Lc) �.83
l 2�0� 2--�
^t,J� •Sa � Z�3� �P
TOTAL WINDOW AREA
DOORS
BRAND M U-VALUE LOCATION SIZE TOTAL SQ. FT.
3,o F( 20
�3c zil(-15�1 �-7
TOTAL DOOR AREA 37 2,S'
GARY YANDO,DIRECTOR
srgrFo
M DEPARTMENT OF COMMUNITY DEVELOPMENT
U
s N = PLANNING - SOLID WASTE - UTILITIES
�o N Y o~ BLDG. I - 411 N. 5T"ST. @ P.O. BOX 578
SHELTON, WA 98584 • (360) 427-9670
1864
DISCLAIl'4ER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created
by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's
willingness to proceed with processing of applications which might be affected by that Order, the undersigned property
owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of
Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting
actions'), which damages are attributable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
2 t57-?-? a-a 3C) L j - 7-1 - u I t t
Date (Parcel No. or Legal Description)
Q. V /l)T
Property owner's signature(Notarized)
(or the County may accept the signature of the owner's authorized agent upon proper proof of authorization)
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ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL)
STATE OF CA)ASig//� �
COUNTY OF "61-2s)
On this T— of , in the ye �, before me Notary Public,
persoc:aLy appeared__ l personally known to me to be the person whose name is
subscribed to thiL irtsirument, and acknowledged that he/she executed it.
W 1 NESS my haLd an6 official seal.
-For County use only-
Reviewed by applicant on
(Date)
otary's si ssio 1�� � ^dy—n
1 (� Staff Initial:
My Commission Expires:
Permit No.
l� MASON COUNTY
JUL 151997 BUILDING PERMIT APPLICATION \� ,13
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
b
#1 1�kc1e- ,t ,1,L �L Phone# Kz-0(") W
6TeAddress_ �� �U�{pl- l�JLa(IL /1f11�1b 1 Fire District# ,
City -Be k St L�>�_Zip �%
Directions to Job Site w T D
Owner Mailing Address 4sT14 eL4C-
City k C�>O I--- Fl-,)y I L,-.:�7 - St��_Zip Z
Lien/Title Holder -------
Address
Clty St Zip
#2 Contractor Name 2/O4-/L -77P-n Contractor Reg # 014F(--QK S-CSA(�
Address 3Y0'7 ---) y Expiration Date
City St_ Zip �Ir,5r.3 Phone# / 6"
#3 If septic is located on project site, include records.
Connect to Septic?Public Water Supply Well1�
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 rcel No. 7711 -7
gal Description T —12-4C- �� �oZ 3 ✓13
#5 Building Square Footage: (existing/proposed)
1st FI / 136S 2nd FI / 3rd FI / Loft /
Basement / — Deck l sss # bedrooms / 2 # bathrooms / 2_
Garage / C/''3 6 Carport / — (Circle ttache or Detached?)
Other SSS" peVC cw-rsq. ft. /
#6 Use of Puilding L L 1�/'2 iL i� Describe work
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#7 Type of Job: New J Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat
Purchase Price $
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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i
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
l
144P
f �S r
Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each)
No. Toilets & CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other �+�
40 Bath Tubs _ No. Units Fees
?Showers Furn BTU
Hot Water Htr S.3s Heatpumps
Laundry Washer 3.� Vent Systems
Sinks Io:C>� Spot Vent Fans 33 7
Floor Drains No. Boilers/Compressors
Laundry Basins 3.35 _ HP
Dishwasher 3.3s' No. Air Handling Units
Disposal -g•'3 cfm#
Urinals No. Fire Protection Systems
Other _ Auto. Fire Alarm Sys 50.00
14� 3.35 q0 _ Fixed Fire Supp. Sys 50.00
Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00
TOTAL PLUMBING $ 1 No. Other
�3 I Gas Outlets -7r
23- o0
Wood, Gas, Pellet Stove
PR-opf►-N� --arc G-� �
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION. -7 0
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APP OV FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT. 1
OWNER
XO XBY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: And, d I VIKL44 Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
CfMn G
Environmental Health:
Building Plan Review W�-�-
g_Z
Occupancy Group:Q 3 u t Type of ConstE;N
Fire Marshal:
Other:
Special Conditions: FEES
130ExgG = (cO, O30 Building Permit g93.'r�'
30 x 13-So $r SS 5— Plan Check Z r-
SsS 3e
g� x 8.-7S Plumbing Fee
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7.7 1 13 Mechanical Fee Q.- N(c jrvc.("^p o &WAK 70.7
Wood/ a's ellet Stove 33. 00
Radon Monitor
Violation Fee
Site Inspection
Building State Fee N. 3-0
Other &' f V t t4L394
Other
Building Valuation: 13 TOTAL FEE -