HomeMy WebLinkAboutBLD2011-00570 Final SFR - BLD Permit / Conditions - 3/9/2012 Inspection Line(360)427-7262
t 1rfMASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
4
RESIDENTIAL BUILDING PERMIT BLD2011-00570
OWNER: JOSEPH HOESCHE RECEIVED: 7/11/2011
CONTRACTOR: LEXAR HOMES 1.360.807.1849 LICENSE: LEXARH*909QT EXP: 2/10/2012 ISSUED: 8/8/2011
SITE ADDRESS: 2040 NE BLACKSMITH DR BELFAIR EXPIRES: 2/8/2012
PARCEL NUMBER: 223097500330
LEGAL DESCRIPTION: TR 33 OF SURVEY 7/17 SEE SURVEY 4/121
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR ST RT 3 TO BELFAIR, L ON ST RT 300! NORTH SHORE RD, R ON BELFAIR
TAHUYA RD, L ON BLACKSMITH DR TO SITE ADDRESS ON THE RIGHT
SIDE
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:1,940 Carport-Detached 528
Valuation: $ 217,559.80 Building Height: Occ. Status: Primary Basement: cov porch 64
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 484.0 Ft. Shoreline: Ft. Water Body:
Rear: W 20.0 Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Shoreline Desig.: Not Applicable
Side 1: N 186.0 Ft. j
Year: Serial No.: Side 2: S 90.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 2 Furnace>100K 1 Plan Check Fee GMM 7/11/2011 $1,071.82 S 120110001
Lavatories 3 Heat Pump 1 Planning Review Fee GMM 7/11/2011 $205.00 S120110001
Bath Tubs 2 Ventilation Fan 3 Fire Warden Review GMM 7/11/2011 $73.00 S120110001
Showers 1 Pellet Stove 1 EH Plan Review KKK 7/11/2011 $103.00 S620110001
Water Heaters 1 Exhaust Hood 1 Water Adequacy Plan Review KKK 7/11/2011 $103.00 S62011000i
Clothes Washer 1 Dryer Vent 1 Building State Fee DLC 8/2/2011 $4.50 S120110001
Kitchen Sink 1 Building Permit Fee DLC 8/2/2011 $1,654.55 S 120110001
Dishwasher 1 Mechanical Permit Fee DLC 8/2/2011 $173.90 S12011000i
Hosebibs 2 Mechanical Base Fee DLC 8/2/2011 $28.50 S120110001
Plumbing Permit Fee DLC 8/2/2011 $110.60 S 120110001
Plumbing Base Fee DLC 8/2/2011 $24.70 S 120110001
ADJUST--Plan Check Fee DLC 8/2/2011 $3.64 S 120110001
Total $3,556.21
BLD2011-00570 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2011-00570
CONDITIONS FOR
BLD2011-00570
1) Approve,' per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
2) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands to the east and north. Silt
ffen`ciin straw, or jute matting must be installed during site development and maintained until upland vegetation has become established.
3) Prior to final approval, all upland areas disturbed or new created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X .girl
4) 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 j j.
5) 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.
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6) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meet the setback conditions listed.
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7) 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/drainfield 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/contractglr is acknowledging that all components of the stormwater management system have been
installed as approved on the stormwater site plan. X J1
BLD2011-00570 Please refer to the following pages for conditions of this permit. Page 2 of 6
8) 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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9) 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
Xepa; nt prior to any further inspections being performed or approvals granted.
10) Owner/Kent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
11) 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 J1
12) 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.
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13) Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option III, Window(Max U-Factor):0.30, Skylight(Max U-Factor):0.50, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38 advanced or R-49 standard, Vault Insulation R-38,
and Slab Insulation R-10.
In addition
si the following credit from Table 9-1 shall be completed: Option 1A, Air-source heat pump efficency HSPF 8.5 or better
X
BLD2011-00570 Please refer to the following pages for conditions of this permit. Page 3 of 6
IL
14) 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'/sheets. The
Mason County Permit Center will also have some available.
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15) 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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16) 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.
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17) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
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18) 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 road 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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19) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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BLD2011-00570 Please refer to the following pages for conditions of this permit. Page 4 of 6
20) 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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21) 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
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22) 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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23) 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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24) 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 shill be made prior to requesting additional inspections.
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25) All property lines shall be clearly identified at the time of foundation inspection. X
26) 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.
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27) 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
(older haveeppprevented action from being taken. No more than one extension may be granted.
BLD2011-00570 Please refer to the following pages for conditions of this permit. Page 5 of 6
28) 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 WAY.
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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: DATE:
BLD2011-00570 Please refer to the following pages for conditions of this permit. Page 6 of 6
4 i
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Date By Data SLAB INSULATION By
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Foundation Wails Floors , ^ Date By =
Date By Data 1 2 By L�-'��"" DECKS
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Date I/ Bow Data By PROPANE TANKS
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Groundwork Attic Type
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Permit# // -C s`17C MASON COUNTY
BUILDING Ill 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
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CORRECTION NOTICE
Job Location 2 0 �Z e. l*'
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
ound: Items listed below must be corrected to gain compliance
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You are`fierebv notified that�he above orrections shall be made
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Call for fe-inspection when correcj§s4r-e-rfia�before continuing ❑ please contact our office
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❑ Make cori! �fibns, items wifT be checked on next inspection 4 ` regarding possible structural
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This is not a complete inspection
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,.Date �1 .i Z - // Department
Inspector 7/?
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E(uilding Permit # ��-CY�'.5� MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 2 e9 96 ,r3C_A� ��I � &4
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 complian e
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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
❑ Make corrections, items will be checked on next inspection
OK to v, -�_ --
❑ This is not a complete inspection Department
Date Inspector I A
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Permit#� MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location a)LfrJ �J L
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
M Make corrections, items will be checked on next' spection regarding possible structural
0 OK to -rc. ou, I�� r y - ci # <- - damage incurred by recent
�� "natural/man made"
❑This is not a complete inspection disasters.This is NOT
CORRECTION NOTICE.
Date zT�I Z Department
Inspector W
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FLAG FOR
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SE �� 4g� SITE PLAN REQUIRED TO BE ORSITE
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PLAT NING:
ALL SETBACK ARE MEASURED
FROM TH FURTHEST
PROJECTION 0 THE BUILDING
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PLA NING
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RECEIVED
- JUL 13 2011
426 W. CEDAR ST.
Name b46ch , Parcel# -75 • 6CP30 BLD# c2161 1 - W J V
If
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 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 2.
'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.
ZCommon 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.
To Calculate Impervious Surfaces Please Complete This Table'
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/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas) Z
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 Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of s ch is by signature below. I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge th t the information provided is accurate and employees of Mason County are granted access to the above-
described property for eview and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Su ace Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided page 2 of 2. RECEIVED
Page I of 2 JUL 13 2011
426 W. CEDAR ST,
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:
h=//www.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 stormwater 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 stormwater 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 stormwater 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 stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic deign 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 stormwater 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 inspect' as may be required. /
X Owner/Agent/Contractor(circle one)Date: '7 " Zo�l
Page 2 of 2
ACCESS & GRADE INSPECTION BLD
ADDRESS: r-) U /-3�— �liy
INSPECTOR:
DRIVEWAY ACCESS
( ) need post at access of driveway with reflective address numbers
Length: Width: Surface:
Size of turn-around:
Condition of shoulders:
Vertical clearance:
GRADE OF DRIVEWAY %, OF ROAD %
ROAD ACCESS
Length: Width: Surface:
Condition of Shoulders:
Vertical clearance:
BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
( ) LOT INSIDE UGA—NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS 4 X 4 FIRES
2 X 3 FIRES
PASSED ( ) FAILED ( ) ON HOLD ( )
REMARKS:
RECEIVED B U I LD I N G ' O AP I l - CI05rl b
JUL 13 2011 BUI�LDeNG PERMIT g6APPLICATION426 , Shelton, WA 98584 AI1;4n
426 W. CEC ShItn (360) 427-9670• Betfair(360)275-4467• Elma (360) 482-5269 ,
On the web www.co.mason.wa.us I
APPLICANT INFORMATIO CONTRACTOR INFORMATION
Owner.1' ,-T-1 64 H D 5 [ Company Name L�'Xtt r l +o
Mailing Address # �n p:-y-o Ile q7 r , AJ�C-- Mailin Address /2) 2 Lcnj f
City StateU.L�Zip Code !��9'r3 .t. City State u-'d Zip Code 2 ' 3/
Phone 3L'p-32Q--214 7 Other PhI ;'? Phone 10- R01—PH I Other Ph. 3LO-S-1. VT571
Lien/Title Holder Rah Il �-z Contractor Reg. # eXA %Q`Exp. 2 zc_t 2s-
E mail address-1 Lj nK'A n-P � Y<eE i» t' rr* E Mail Address
Drivers Lie.#� O lrC. i33C1 DOB 7 - '--1---- Drivers Lie.# r� DOB CC
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic � Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION-12 Digit Parcel No;aQ 3G I---7 5' -C>0 3,'s o Fire District c3,_
Legal Description 3• • : % If t
Site Address(Please include street am ,stree number and city)� i7'q ---N
Directions to site 0- o - 1 ,1 r ej Lr4 It.,
Will timber be cut and sold in parcel preparation?Yes -No
. Is propertyy within 200'of Saltwater Lake River/Creek Pond
Wetland "� Seasonal Runoff Stream Slopes or Bluffs ] 151/0
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCEA SEASONAL ❑
Use of Building •S Describe Work
No. of Bedrooms_ 3 No.of Bathrooms. 2-- Square Footage- 1 st Floor 11 W. 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage- Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION -Make Model Year
Length Width Serial No. No. of Bedrooms No.of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result it 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
pen-nit 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 NU ON OF W RFC IS B MEANS OF A PROGRESS INSPECTION.
X + Date'
Own r/Owners Representative/Contractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date �- I I •ZL I..I..
DEPARTMENTAL REVIEW 4PPROVED DENIED NOTES
Building Department `'1U3
Planning Department
Environmental Health Department 58X 3 /97A
Public Works Department gX43�
Fire Marshal ,.
FEES Gar aaxq-
Building Permit Fee 1 4 Site Inspection
Plan Review Fee .t � /0 7 5. EH Review Fee
Plumbing&Base Fee //D • 6e D f AI "' Planning Review Fee
Mechanical& Base fee 173 ,11, t Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal D
Valuation$ / gli9 TOTAL FEES
RECEIVED 2
JUL 13 2011 MASON COUNTY
_,) tV�ILBING/MECHANICAL PERMIT APPLICATIGNBU I LDI N
426 W. t:l=U I 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
Ownerjo3 Company Name Z r M-15
Mail' Addres 0 % '^ ^ Ad Mailin
City State 16LI]lZip Code I AS - City I State—CL�f—Zip Code
PhonedL�2--37:2_ - Zy�i 7 Other PQ(co-lzn C>7,C=D Phone 9uC" ' -7/,Wq Other Ph. ' �I 11.
Lien!Title Holder Contractor Reg. # (�I Exp- e-201 L
E mail address,� E Mail Address
Drivers Lic.# C3 _S5j_6 DOB_Z _7_ 6-7 Drivers I ic.it (3a�tia) Cc� izc DOB e .a
SEPTIC INFORMATION-Connect to New Septic 4 Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel N 0 F, -OCD 3 Q Fire District
Legal Description 0 r - -;(3 "
Site Address(Please include street name,str t number and city)
Directions to site ' rKg-
T O
Is property�vithin 200'of Saltwater Lake River/Creek Pond
Wetland �`rr Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB- New K Add Alt Repair Other Use of Building Si-fL
Location of Fixtures/Units- 1st Floor X 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Elect6c-kLPG_Natural Gas_Heat Pump X
Toilets Z Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs _ �_ Heatpumps !
Showers 1 Spot Vent Fan 3
Water Heater Propane Tank
Clothes Washer , Gas Outlets
Kithen Sinks / MAW-Gas/Pellet Stove
Dishwasher K'� en Exhaust H
Hosebibs a Dryer Vent 7
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.1 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 O NTIN TION OF WDRK fS B EANS OF A PROGRESS INSPECTION.
X /[�''/c Date:_
C!rw-ner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOt40 THIS POINT
Accepted b C-OILPtanning Pd Ck# _ Date -I •Z.D I Bld Pd Receipt No.
DEPARTM NTAL 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