HomeMy WebLinkAboutCOM2005-00072 Final Post Office - COM Permit / Conditions - 5/19/2006 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352
Shelton, WA 98584
L�
COMMERCIAL BUILDING PERMIT COM2005-00072
OWNER: JOHN STRAATMAN RECEIVED: 6/21/2005
CONTRACTOR: ASHBY HOMES LICENSE: ASHBYH1036RW EXP: 4/10/2006 ISSUED: 11/16/200E
SITE ADDRESS: 28611 N U S HIGHWAY 101 LILLIWAUP EXPIRES: 5/16/2006
PARCEL NUMBER: 323305156013
LEGAL DESCRIPTION: LILLIWAUP BILK 56 & LOT:13-18& T.L.& 1/2 VAC CABLE BLK: 26 LOT: 4 & WILY 1/2 VAC CABLE
PROJECTDESCRIPTION: DIRECTIONS TO SITE:
Post Off ice 101 North to Lilliwaup, site on left before Lilliwaup Motel and Store.
General Information Construction &Occupancy Information
Type cf Use: Insp.Area: No. of Units: Type of Constr.: V-B
Type of Work: NEW Fire Dist.: 17 No. of Bathrooms: Occ. Group: B
yp Valuation: $ 129511.00 No. of Stories. Occ. Load:
1 9
BuildingHeight:g 14
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building: 1,456
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline & Planning Information
Front: N 77.00 Ft. Shoreline: 112.00 Ft.
Rear: S 29.00 Ft. Slope: Ft. Water Body:Hood Canal Shoreline Desig.:
Side 1: E 45.00 Ft. SEPA?:Yes Comp.Plan Desig.: Rural
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Emergency Key Box?: Standpipe?:
Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?:
fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?:
COM2005- 0072 Please refer to the following pages for conditions of this permit. 1 of 5
5) T e approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment.
St uctures and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a seperate permit.
T e geotechincal report/assessment shall remain attached to the approved building plans. X
E All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be
granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and collected by the Mason County
B ilding Department prior to any further inspections being performed or approvals granted. X
7FP RSUANT TO INTERNATIONAL CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A
POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY
BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION
FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE INTERNATIONAL CODE WILL BE ASSESSED IF
OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
8 All property lines shall be clearly identified at the time of foundation inspection. X
9) T e approved site plan is required to be on-site for inspection purposes. If inspection is called for and the site plan is not on site, Approval WILL
NOT be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and collected by the Mason
County Building Department prior to any further inspections being performed or approvals granted.
X
10)��The mechanical system for which energy consumption, performance, or mode of operation are regulated by the 2001 Washington State Energy
(}� Cc de (WSEC) and Ventilation And Indoor Air Quality Code (VIAQ) shall be tested to ensure that control devices, equipment and systems are
ca ibrated, adjusted and operate in accordance with approved plans and specifications. Drawings and notes shall require commissioning in
ac ordance with WSEC section 1416.4. --
r Lighting controls shall be tested to ensure that control devices, components, equipment and systems are calibrated, adjusted and operate in
ac ordance with the approved plans and specifications. A complete report of test procedures and results shall be prepared and filed with the
owner. Drawing notes shall require commissioning in accordance with WSEC 1513.7.
' X -
11) R cyclable materials & Solid Waste Storage: Space shall be provided for the storage of recycled materials and solid waste. The storage area
s hall be designed to meet the needs of the occupancy, efficiency of pick-up, and shall be available to occupants and
haulers.X
12) Fie apparatus access roads standards chapter 14.17 of the Mason County Building Code shall be adhered to. X
Mi imum 2A10BC rated fire extinguishers are required to be within 75 feet travel distance in approved locations and mounted no more than 48
in hes from the finished floor to the top of the extinguisher. X
13 WA ter quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
X
14) Pr or to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type
of erosion protection (silt fencing or straw matting). X
15) T e proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the
son County Shoreline Master Program.X
COM2005- 0072 3 of 5
Plumbing Fixtures Mechanical Fixtures FEES
Type; Qty. Type Qty. Type By Date Amount Receipt
Hosebib' 1 Furnace<100K 1 Plan Check Fee KKK aiw9nnR 14 R99nnrnn
Laur)dry Tray 1 Ventilation Fan 1 Planning Review Fee KKK Frw9nns nn RggnnFnn
Lavatories 1 Heat Pump 1 Building State Fee KART, F1?a19nnr1 ra rin q?gnnr,nn
Water CIO ets (Toilets) 1 Building Permit Fee NARr Fi?ai?nns 01 1Rl 7F S?9nnrnn
Water Heaters 1 Mechanical Fee KARrr FnaignnF 07 9r, ,,gvnn,,nn
Mechanical Base Fee NARrr, Fnai?nnF nn g9?nnrnn
Plumbing Fee NA ( R19a19nnR ass nn S??nnsnn
Plumbing Base Fee NAR(1 Fi?argnnr, ,Zgn nn S99on5nn
Non-Res. Energy Code nl r. F/77/9nnF R5R nn Cg?nn5nn
EH Plan Review r.FXni 71?R19nnF R75 nn S?9nn mn
Total $2,393.14
CASE NOTES FOR
COM2005-00072
CONDITIONS FOR
COM2005-00072
1) C anges to approved building plans that affect compliance to the current Washington State Energy Code (WSEC), ventilation and Indoor Air
QL ality Code (VIAQ), Building/Plumbing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction.
X
2) Any changes in construction shall be reviewed by engineer of record and submitted in writing to the Mason County Building Department prior to
construction. All engineering documents are a part of the approved set of plans and must remain attached thereto. If engineering documents are
removed, approval will not be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and
collected by the Mason County Building Department prior to any further inspections being performed or approvals granted.
X
3'& CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE
A OPTED BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in
co formance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a
M son County Building Inspector shall be made prior to requesting additional inspections.
X
4)y
All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The
fai ure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being
non-compliant with Mason County ordinances and building regulations.
X
COM2005-0 072 2 of 5
16) e porary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing must
be installed and maintained until upland vegetation has become established. X
17) proved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
18) bject work shall be consistent with conditions of Mason Environmental Permit No. MEP2004-00088. X
19) other necessary permits from Mason County, Washington State and/or Federal Agencies that are required for this proposed development and
co struction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X
This permit tecomes 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 rnDans of a progress inspection.The owneror the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above dE scribed property structu r uiew and ins on. _
OWNER OR AGENT: DATE: /43� J
II
COM2005-C 0072 4 of 5
11/28/2006
Conditions Associated With 2:46:09PM
Case #: COM2005-00072 P64 O-Q�
ermit Condition Status
Updated
## Code Title' Status Changed sy� Tag Date By
1) 5030 Changes to Approved Plans NOT MET 6/24/2005 MRG
Changes to approved building plans that affect compliance to the current Washington State Energy Code
(WSEC),ventilation and Indoor Air Quality Code(VIAQ),Building/Plumbing/Mechanical Codes and/or
Mason County Regulations shall be approved prior to construction.
X
2) 5002 ENGINEERING NOT MET 6/24/2005 MRG
Any changes in construction shall be reviewed by engineer of record and submitted in writing to the Mason
County Building Department prior to construction. All engineering documents are a part of the approved set of
plans and must remain attached thereto. If engineering documents are removed,approval will not be granted.
In addition,a reinspection fee,based on the current fee schedule,minimum one-hour will be charged and
collected by the Mason County Building Department prior to any father inspections being performed or
approvals granted.
X
3) 5045 FIELD CORRECT NOT MET 6/24/2005 MRG
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.
X
4) 5600 FINAL INSPECTION REQUIRED NOT MET 6/24/2005 MRG
All building permits shall have a final inspection performed and approved by the Mason County Building ---
Department prior to permit expiration.The failure to request a final inspection or to obtain approval will be
documented in the legal property records on file with Mason County as being non-compliant with Mason
County ordinances and building regulations.
X
5) 5620 GEOTECHNICAL ASSESSMENT/REPOR NOT MET 6/24/2005 MRG
The approval of this project is subject to the recommendations and specifications outlined in the attached
geotechnical report or assessment.Structures and/or land modifications(grading,cuts,fills,etc.)required in
the geotechnical report/assessment,may require a seperate permit.The geotechincal report/assessment shall
remain attached to the approved building plans. X
6) 1001 PLANS REQUIRED ON SITE NOT MET 6/24/2005 MRG
All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are
not on site,Approval WILL NOT be granted. In addition,a reinspection fee,based on the current fee schedule,
minimum one-hour will be charged and collected by the Mason County Building Department prior to any
further inspections being performed or approvals granted.X
7) 1002 POST ADDRESS NOT MET 6/24/2005 MRG
PURSUANT TO INTERNATIONAL CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR
ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM
THE STREET OR ROAD FRONTING THE PROPERTY.MASON COUNTY BUILDING DEPARTMENT
REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A
REINSPECTION FEE,BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE
INTERNATIONAL CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS
ON SITE PRIOR TO REQUESTING INSPECTIONS.X
Page 1 of 3 CaseConditions..rpt
11/28/2006
Conditions Associated With 2:46:09PM
Case #: COM2005-00072
ermit Condition Status Updated
# Code Title Status Changed By Tag Date 13;y
8) 5510 Property Lines NOT MET 6/24/2005 MRG
All property lines shall be clearly identified at the time of foundation inspection.
X
9) 1012 SITE PLAN REQUIRED ON SITE NOT MET 6/24/2005 MRG
The approved site plan is required to be on-site for inspection purposes. If inspection is called for and the site
plan is not on site,Approval WILL NOT be granted. In addition,a reinspection fee,based on the current fee
schedule,minimum one-hour will be charged and collected by the Mason County Building Department prior to
any further inspections being performed or approvals granted. X
10) 6000 WSEC-Commissioning Reports NOT MET 6/27/2005 DLC
The mechanical system for which energy consumption,performance,or mode of operation are regulated by the
2001 Washington State Energy Code(WSEC)and Ventilation And Indoor Air Quality Code(VIAQ)shall be
tested to ensure that control devices,equipment and systems are calibrated,adjusted and operate in accordance
with approved plans and specifications.Drawings and notes shall require commissioning in accordance with
WSEC section 1416.4.
Lighting controls shall be tested to ensure that control devices,components,equipment and systems are
calibrated,adjusted and operate in accordance with the approved plans and specifications. A complete report
of test procedures and results shall be prepared and filed with the owner. Drawing notes shall require
commissioning in accordance with WSEC 1513.7.
X
11) 5710 SOLID WASTE STORAGE NOT MET 6/27/2005 DLC
Recyclable materials&Solid Waste Storage: Space shall be provided for the storage of recycled materials and
solid waste. The storage area shall be designed to meet the needs of the occupancy,efficiency of pick-up,and
shall be available to occupants and haulers.X
12) 270 Fire Marshal Comments NOT MET 10/19/2005 CJH 10/19/2005 CJH
Fire apparatus access roads standards chapter 14.17 of the Mason County Building Code shall be adhered to.
X
Minimum 2AlOBC rated fire extinguishers are required to be within 75 feet travel distance in approved
locations and mounted no more than 48 inches from the finished floor to the top of the extinguisher.
X
13) 34 No Degradation of Water Quality NOT MET 11/16/2005 TSC
Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
X
14) 60 Erosion Protection NOT MET 11/16/2005 TSC
Prior to final approval,all upland areas disturbed or newly created by construction activities shall be seeded,
vegetated or given an equivalent type of erosion protection(silt fencing or straw matting).
X
15) 70 Shoreline Management Act NOT MET 11/16/2005 TSC
The proposed project must be consistent with all applicable policies and other provisions of the Shoreline
Management Act,its rules,and the Mason County Shoreline Master Program.X
16) 170 Temporary Erosion Control NOT MET 11/16/2005 TSC
Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent
waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become
established. X
Page 2 of 3 CaseConditions..rpt
11/28/2006
Conditions Associated With 2:46:09PM
Case #: COM2005-00072
1�
� .
Status Updated
to°� Changed By Tag Date By
17) 200 SITE PLAN NOT MET 11/16/2005 TSC
Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest
projection of the structure.
X
18) 1 MEP2004-00088 NOT MET 11/16/2005 TSC
Project work shall be consistent with conditions of Mason Environmental Permit No.MEP2004-00088.
X
19) 320 All Necessary Permits Required NOT MET 11/16/2005 TSC
All other necessary permits from Mason County,Washington State and/or Federal Agencies that are required
for this proposed development and construction must be obtained PRIOR TO SAME DEVELOPMENT AND
CONSTRUCTION.X
Page 3 of 3 CaseConditions..rpt
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Date By Date BY Date By
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3
MAPON COUNTY
Departments Community Development
INSPECTION CARD and
CERTIFICATE OF OCCUPANCY'S
fitPO BOX 186, 426 W Cedar ST, Shelton WA 98584
General Questions: (360) 427-9670 ext 352 Inspection Requests: (360) 427-7262
Permit Number COM2005-00072 Date 11/16/2005 Issued By
Project Post Office
Site Address 28611 N U S HIGHWAY 101 LILLIWAUP
Applicant JOHN STRAATMAN
Contractor ASHBY HOMES License Number ASHBYH1036RW
Con.Phone Expiration Date 0 4/1 012 0 0 6
Primary Code 20031BC Occupancy B Division
Use Type of Construction V-B Occ. Load 9.00
Public Works Access/Driveway Other
Health Dept Septic Well
Planning Dept Site Inspection
Fire Marshal _Fire Apparatus Access Fire Sprinkler
Auto Fire Alarm Hood and Duct
Other Final 11INK Lv S" I r- DA(
Building Dept Building Official Emmett Dobey
Concrete Setbacks :z Slab
Footing Perimeter _ Ret_Wall/Bulkhead
Footing Interior Footing Decks/Porches
Foundation Stem OK L L" 3 _d Other
Rough-In
Groundwork Plumbing nie Plumbing
Groundwork Mechanical Other
Groundwork Gas Pipe
Gas Piping
Framin �'
Mechanical %— ae F if
Insulation Slab Ceiling
Floor Vaulted Ceiling
Walls 2,q/o(. t' Vapor Barrier
Other
Wallboard Nailing Interior Wall Brace Panels Fire walls
Other
Final Building
Mamif.Home _Setbacks
Concrete Foot/Runners Final
Other
APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS
*THIS STRUCTURE MAY NOT BE USED FOR OCCUPANCY UNITL ALL APPLICABLE FINAL INSPECTIONS ARE COMPLETED
DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVALS ARE GIVEN.
POST THIS CARD IN A CONSPICUOUS PLACE ON THE FRONT OF THE PREMISES CONVENIENT FOR MAI9NG REQUIRED
'TRIES.
..-.L PERMITS EXPIRE 180 DAYS AFTER PERMIT ISSUANCE OR 180 DAYS AFTER LAST INSPECTION ACTI)4TY IS PERFQRJJED.
OWNER/AGENT IS RESPONSW E FOR CALU14G Ff3R ALL INSPECTIONS
PRIOR TO CALLING FOR FINAL INSPECTION;%Li�CONDrnoNs OF THE PERMIT MUST BE MET.
1
oN-STAIF MASON COUNTY
o P� A o N DEPARTMENT OF COMMUNITY DEVELOPMENT
o N Z Planning Division
7 N y y P O Box 279, Shelton, WA 98584
1864 (360)427-9670
NOTIFICATION OF INCOMPLETE APPLICATION
June 29, 2005
Parcel No.: 323305156013
Project Description: Post Office
Dear Applicant:
You have submitted a permit application (case no. COM2005-00072) for proposed
construction or development in the county. Upon review of your application, I have
determined that the contents of the application are incomplete or do not provide
enough detail for review.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 295 if you have questions.
Since ly,
C6"t&l
C�
Tammi Clark
Land Use Planner
Mason County Planning Department
6/29/2005 Page 1 of 2 COM2005-00072
NOTIFICATION OF INCOMPLETE APPLICATION
6/29/2005 Case No.: COM2005-00072
Comments: Your building permit application and Habitat Management Plan have
been received. The Habitat Management Plan will be reviewed in
conjunction with MEP2004-00088. As indicated in earlier meetings,
construction cannot occur across property lines. In a letter dated May
25, 2005 (enclosed) from Michael MacSems, a Boundary Line
Adjustment (BLA) will be required. Issuance of a building permit cannot
be done until the BLA process is completed. Please contact Michael
MacSems at ext. 571 if you have any questions regarding this process.
A BLA application is enclosed for your convenience.
6/29/2005 Page 2 of 2 COM2005-00072
I
Case Activity Listing 11/28/2U06
1:55:23PM
Case #: COM2005-00072
Assigned Done
Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By
COMB225 Public Works Review 7/10/2005 7/131/2005 None DONE AAT AAT 11/16/2005 PMC
DATE: July 13th, 2005
INTER-DEPARTMENTAL COMMUNICATIONS
TO: Tammi Clark,DCD-Planner
FROM: Alan A.Tahja,P/W-Co.Hydr.Engr.
SUBJ: Stormwater Plan&Geo Rvw NAME: Straatman-Lilliwaup Post Office .
COM2005-00072&COM2005-00073
Tammi,
The Geotechnical assessment and the Stormwater and erosion/sediment Control plan prepared for the Lilliwaup Post Office located at Lilliwaup has been received and reviewed by Public Works.
The report appears to satisfactorily fulfill County requirement(s).Requirements contained in the Geotechnical Report by Bradley Noble Geotechnical Services should be adhered to and incorporated into the
site's development and made as part of the conditions for permit issuance.The Stormwater Control Plan and the Erosion and Sediment Control Plan prepared for the Lilliwaup Post Office appears acceptable
and should also be made a requirement for the permit issuance.I recommend accepting the report as satisfying the Countyrs requirement(s).
Adequate Erosion and Sediment(E&S)control features need to be implemented during land disturbing activities to protect neighboring properties and State waters from adverse stormwater runoff impacts.
The migration or release of silty water or mud from the applicant's property will be considered a violation of County and State water quality protection regulations.
Please feel free to contact me at County extension 461 if you have any questions regarding these comments,or if you feel any features need further discussion or attention.
Sincerely,
Alan A.Tahja
COMB200 Environmental Health Review 6/21/2005 7/26/2005 None DONE CEW 7/26/2005 CEW
will need a recorded easment since drainfield is on a different parcel.7/26/05rec recorded easement
COMB009 Fire Marshal Review 10/19/2005 10/19/2005 None DONE CJH CJH 10/19/2005 CJH
See conditions:Fire apparatus access,fire extinguishers.Building is less than 2000 square feet.
COMB009 Fire Marshal Review 6/24/2005 10/19/2005 None DONE CJH CJH 10/19/2005 BJR
See conditions of approval for Post Office construction
Page 3 of 5 CaseActivity..rpt
�06
Case Activity Listing 111/281/28/2/2 O6
1014 Case #: COM2005-00072
Assigned Done
Activity Description Date I Date 2 Date Hold Disp To By Updated Updated By
COMB225 Public Works Review 7/5/2005 7/13/2005 None DONE AAT AAT 11/16/2005 PMC
DATE: July 13th, 2005
INTER-DEPARTMENTAL COMMUNICATIONS
TO: Tammi Clark,DCD-Planner
FROM: Alan A.Tahja,P/W-Co.Hydr.Engr.
SUBJ: Stormwater Plan&Geo Rvw NAME:Straatman-Lilliwaup Post Office .
COM2005-00072&COM2005-00073
Tammi,
The Geotechnical assessment and the Stormwater and erosion/sediment Control plan prepared for the Lilliwaup Post Office located at Lilliwaup has been received and reviewed by Public Works.
The report appears to satisfactorily fulfill County requirement(s).Requirements contained in the Geotechnical Report by Bradley Noble Geotechnical Services should be adhered to and incorporated into the
site's development and made as part of the conditions for permit issuance.The Stormwater Control Plan and the Erosion and Sediment Control Plan prepared for the Lilliwaup Post Office appears acceptable
and should also be made a requirement for the permit issuance.I recommend accepting the report as satisfying the County's requirement(s).
Adequate Erosion and Sediment(E&S)control features need to be implemented during land disturbing activities to protect neighboring properties and State waters from adverse stormwater runoff impacts.
The migration or release of silty water or mud from the applicant's property will be considered a violation of County and State water quality protection regulations.
Please feel free to contact me at County extension 461 if you have any questions regarding these comments,or if you feel any features need further discussion or attention.
Sincerely,
Alan A.Tahja
Page 2 of 5 CaseActivity-pt
06
5
MASON COUNTY PERMIT NO. n �Oo
BUILDING PERMIT APPLICATION
426 W. Cedar • P O. Box 186, Shelton, WA 98584 G
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner-J&11V '-d' Company Name
Mailing Address �>< I. Mailing Address
City States Zip Code City State Zip Code
Phone jl L8 Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.# =k 'Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
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. ZI 6drire District
Legal Description " "P
Site Address (Please include street name, street number and city)
Directions to site :t✓I Iti uv t %
\ o
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
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 RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No.of Bathrooms Square Footage - 1 st Floor 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 in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X c�_n ,��. >� , Date: ,; .. �, �C Cad
Owner/Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW A ED D D NOTES
Building Department
Planning Department
Environmental Health Departmen
Public Works Department44
Fire Marshal
FEES
Buildinq Permit Fee Site Ins ection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood /Gas /Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
FORM MUST BE COMPLETED IN INK PERMIT NO.
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR I MAT.IQN
Owner Jchr) r,�d i r e 5trc�a� t'�G.x Company Name t v i--1 m ES
Mailing Address O• oX LF Mailing Address R 2 ox 219 2
City I—i I I I WCIAI,n ' tate W N Zip Code 5 5 City r State 0 I'c Zip Code9858 q-
Phone -g-11- 518$ Other Ph. Phone '621-9'-f-g7 Other Ph.
Lien/Title Holder Contractor Reg. 4 Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic ✓ Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. ce &cJ--� Fire District 7-0
Legal Description SCle GQ+6,5 3
Site Address (Please include street name, street number and city) 861) 1 ti a O( L; I I Wa
Directions to site I0I �J o�r+ti +c, L i I I. tJG.0 0. S'l� i ors I be re- Li I I%wauo
Kci ea V_e.
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% ✓
TYPE OF JOB - New Add Alt Repair Other Use of Building Fi c e
Location of Fixtures/Units 1st Floord Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric y LPG Natural Gas_ Heat Pump
Toilets l Type of Unit No. of Units Fees
Bathroom Sink I Furnace
Bath Tubs Heatpumps I
Showers Spot Vent Fan I
Water Heater I Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs 2 Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
P OF CO I UATION O ORK IS BY MEANS OF A PROGRESS INSPE TION.
d.^.�_ Date:7 ion
caner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr.
Planning Department
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