HomeMy WebLinkAboutBLD2012-00655 Final Addition with Covered Deck - BLD Permit / Conditions - 2/22/2013 Inspection Line 27- 262
' MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427(967004ext7352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
L�
RESIDENTIAL BUILDING PERMIT BLD2012-00655
OWNER: STEVEN FREY
CONTRACTOR: STEPHEN JOHNSON, INC 1.360.275.6734 LICENSE: STEPHJ*199LW EXP: 6/1/2014 RECEIVED: 8/29/2012
SITE ADDRESS: 140 NE LAKEWAY DR NORTH BELFAIR ISSUED: 10/3/2012
PARCEL NUMBER: 223107900700 EXPIRES: 4/3/2013
LEGAL DESCRIPTION: TR 70 OF SURVEY 11/17
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
ADDITION WITH COVERED DECK Bear Creek Dewatto Rd to Blacksmith to Lakeway North to end.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use: SF Insp. Area: No. of Bathrooms: Occ. Group: R-3 Lot Size: Deck:
Type of Work: ADD Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:400
Valuation: $ 45,647.60 Building Height: 17 Occ. Status: Primary Basement: COV PORCH 220
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: W 190.0 Ft. Shoreline: 300.0 Ft. Water Body: Blacksmith Lake
Model: Width: Ft. Rear: E 30.0 Ft. Slope: Ft. SEPA?: No
Side 1: N 210.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: S 350.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Propane Stove 1 Plan Check Fee TW 8/29/2012 $392.18 S2201200000001
Gas Outlets 2 Planning Review Fee TW 8/29/2012 $205.00 S2201200000001
EH Plan Review KKK 8/29/2012 $ 103.00 S6201200000001
Building State Fee LDK 9/27/2012 $4.50 S2201200000001
Building Permit Fee LDK 9/27/2012 $603.35 S2201200000001
Mechanical Permit Fee LDK 9/27/2012 $79.20 S2201200000001
Mechanical Base Fee LDK 9/27/2012 $28.50 S2201200000001
Total $ 1,415.73
BLD2012-00655 Please refer to the following pages for conditions of this permit. Page 1 of 5
F CASE NOTES FOR
BLD2012-00655
CONDITIONS FOR
BLD2012-00655
1) 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 a,0 monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. Thep on this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
2) Owner/Agent is responsiblp4ckpost the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
3) Owner/builder assumes a responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No foundation drains wi � 30ft, down gradient of drainfield/reserve area.
X
4) Approved per di ons and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
5) All construction and demolition debris must be removed from the site after project completion. Proper dis of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
6) Temporary erosion control measures must be implemented to prevent water quality degradation djacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X
7) Prior to final approval, all upland areas disturbed or newly created by co u i activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing, straw, or jute matting). X
8) Landings and stairs meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site Pla to a ure these structures are shown and meet the setback conditions listed.
X
9) By definition, prop tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures mee etback conditions listed.
X
BLD2012-00655 Please refer to the following pages for conditions of this permit. Page 2 of 5
10) 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 add i ' re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and must be collected by the Building
Department prior to r inspections being performed or approvals granted.
X
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 hol 's 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 d cu wi I result in failure of required building inspections.
X
12) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
13) 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 prio y further inspections being performed or approvals granted.
X
14) 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 the following credit fr able 9-1 shall be completed: 6
X
15) A minimum of 50 percent o-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 swi g 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
X
16) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installaCtio ructions.
X C
6,1111
17) In buildings of unusually tight construction, fuel-burning appliances (excluding cooking appliances and domestic clothes dryers) shall obtain combustion
air from outside in accordance a international codes.
X
BLD2012-00655 Please refer to the following pages for conditions of this permit. Page 3 of 5
18) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather sha ve a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
19) All construction must meet or exceed all to a ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is 1' a approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
X
LIZ
20) 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' o Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.
X
CIZ
21) Placement of structure mus Py
with standards set forth per the international codes regarding descending and/or ascending slopes.
X
22) 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, be eviewed and approved by Mason County prior to construction.
X
23) 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 no to requesting additional inspections.
X
24) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test sure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not be used until the�a i ection has been performed and approved by a Mason County building inspector.
X
25) All property lines shaVbelearly identified at the time of foundation inspection. X
26) All building permits shall have a final inspection performed and approved by the Ma �buntyilding Department prior to permit expiration. The failure
to request a final inspecti r to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason County ordina s a uilding regulations.
X
BLD2012-00655 Please refer to the following pages for conditions of this permit. Page 4 of 5
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 ex g 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have prevente ctio being taken. No more than one extension may be granted.
X
28) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and flashing. tall metal connectors approved for contact with the new types of pressure treated material.
X
29) Retaining walls needed to support a surcharge such as structrKes, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
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 of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate
and grants emplo s of M unty ac ss to th above described property and structure for review and inspection.
OWNER R AGENT: DATE: O
BLD2012-00655 Please refer to the following pages for conditions of this permit. Page 5 of 5
{
c
b CONCRETE MECHANICAL MANUFACTURED HOME
t j Footings /Setbacks Date /� By Gas Piping Ribbons ---_- <
o Intenof Date By Inferior-Date 2 20,-12By 77? cat, By N
CD
CnExtefw Date . By Exterior-pate B _ set-up M
INSULATION c
Point Load J Isolated Footings Date By M
BG}SLAB INSULATION Z
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors, Date By
Date p B Data By DECKS
FRAMING Walls Date By
Date /1-L-/L By J` Data gy PROPANETANKS
PLUMBING Vault Date ByDate sy, OTHER
Groundwork Attic
Date By Type:
Data By Data By.
D.W.V :1 DRYWALL Data
//t Int.Brace Wail Date By W
m Date By 1 yT
Date r �J $ / FINAL INSPECTION 0
N Water Lane Fire Soperation N
m
Date By Date By Date By O
p N
s Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By CommentsCD o
SS le-2 z
l lr y j z, Leo/(.._ -z'v
GD'�I�^'l t'�►• t IS Z
0
a door
i�-c FU- >� d G >✓
N nx0__1}GL /vs,/G9 T
-14
(_
O o c� 4rY ti
4�. o--7f�l� cv yF�r wifr',;
oy �p
�rJlt l ��� '� o LG<S � • c&_
W.q-I-C. V14 vc.
7—
1
ro aS3 1-2/- ?•-lz- c�
O
J
Permit MASON COUNTY
BUILDING /ll 426 W. CEDAR
SHELTON, WASHINGTON 98584
360 427-9670
CORRECTION NOTICE
Job Location ,�f��-/y� L�,��' Gr,14Z 41 y
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
1 1 /d ?�n-e s� t���✓�ou/
Sojci>
//.l L T Oy —1oGtJ — S/ /1'di
/ D,� /Lc. � C..
a � _
� !�L = � �✓ �. ^- " Sv mom/ L C. -
trJy/ k/ ,f`x4,,
,S'' v o. C.cv .s'. G
40
You ale I 1iAe6y notified that the move corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
"natural/man made"
❑ This is not a complete inspection disasters.This is NOTa
Date / Department CORRECTION NOTICE,
Inspector T it
Dt N* *T 0114 ' ' T Im4b, T,,rm * mw
�Nh
PLANNING
.� PLANNING:
ALL SETBACKS ARE MEASURED
FROM THE FURTHEST
1030
may' PROJECTION OF THE BUILDING
- 9.89"
( I
'io
�A
I APPROVED SON COUNTY
MA
DCD PLANNii',JCa
SITE PLAN REQUIRED TO BE ON SITE
t d CHAN ES SUBJECT TO APPROVAL
BY e,
% Date
Iv� CO UQ�LcI pa.-r;p 11 k Z�
- 2.1
� I � Z�'� (rRP•i� grJR�
Zd �
/bD; G� 1 1 I -f 12-
I
I Stephen Johnson, Inc.
I P.O. Box 488
i Belfair, WA 98528
(JLXdjA a-+ Fit
I 1 cl o ,-J'a 4#W'CA'—"i^ at. /v.
8&Z~ , i t),q y8s 28
FAR-0-2 z a/07 9oe 700
I I 360
I
I 1
2_
/v &DG-
:y��� ]l 1nPrM
Name ��� Parcel# *7 7.3( 0 ` I 10111(0 ilLD#
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.
'Redevel^pment 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
art of a routine maintenance activi and land disturbing activities associated with structural or impervious redevelopment.
P tY, g
'Common 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.
T>7 Calculate lmperv�ois Surfaces:�{ease Goiriplefe_T�is Table ,
Surface Type Length X Width = Area *All dimensions in feet '
Buildings
s
X =
X = Measurements for buildings are taken at the
farthest projections(example:
X = perimeter of the ( p 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 = Ifahe total impervious area-of the proposed site
X = developrmentis greater than.20DO-square feet a
Small Parcel:Stormwater.S-te.Plan:is Required .
Total`Impervious.Surface Area(sum of.all-areas).. _
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 such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge the information provided is accurate and employees of Mason County are granted access to the above-
des ed ro e for re w d inspection as may be required. /
X Owner/Age Contractor(c' cle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2 quare Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page I of 2
Name Parcel 4 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:
http//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 SM
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 design 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 inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/Ventilation Code Compliance Application
Owner: Y, Parcel#:'�ZTZ
Total Sq. Ft. 1 F oor: floor: Heated Bas ment:
of heated area:: Q®
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace 0 Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other: Specify:
Glazing Compliance 4D Prescriptive Option see reverse side circle one: 1 II III
Percentage: Method O Component Performance., Chapter 5— Calculation worksheets required
3(-AD % Check one::
O Other (Specify):
Check one O Whole House Ventilation system o Whole House Ventilation O Other,
Ventilation using exhaust fans&window or Integrated with a Forced Air describe:
System wall fresh air vents (M1508.4) System (M1508.5)
Referencing WSEC Section 901, "Additional Residential Energy Efficiency Requirements,"all
NEW residential units must develop Icredit from Table 9-1. Identify and describe which option(s)will be used
ENERGY to comply. If the table is not attached to this form you can access the table on our website at:
CREDITS hftp://www.co mason.wa.u s/forms/Comm u n it Dev/index. h .
Option: Description:
Table 9-1 to vIf C� ' b,+I�
Window & Door JSchedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows:
4 Sf. � xL l 33
26
3ts S m Z 30
Windows: Total Sq. ft.
Doors:
Doors: Total Sq. Ft
Total window and door area
0
Total window&door area 123 /(divided by)total sq.ft of heated area Lf 0�) = 36 %of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 Elma (360)482-5269
FAx: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2009 Washington State Energy Code (WSEC)
Effective January 1, 2011.
Ventilation & Indoor Quality
Ventilation code provisions are now located in the 2009 International Residential Code (IRC), 2009
International Mechanical Code (IMC), & 2009 International Building Code
The following information will be required for the WSEC and ventilation code plan review:
1. Complete the Washington State Energy Code/Ventilation code application located on the reverse side
including information about the project, proposed compliance methods and proposed energy credit(s) listed
in Table 9-1 attached to this form. All dwelling units are required to develop at least one credit from Table
9-1.
2. Include all windows, skylights, sliding glass doors, french doors and any other door with 50% glass or more
on the window and door schedule. Use rough opening dimensions to calculate size. It is always helpful to
list the u-factors of windows and doors, if known. If you do not know u-factors, the plan reviewer will
assume that all window & door glazing will have the required u-factor of the compliance option. When
using the area weighted average methods to comply with prescriptive-path include calculations with
submittal documents.
3. Identify the location and fuel type of the heating system, water heater, location of exhaust fans (bathroom,
laundry, kitchen, etc.) and R-factor of proposed insulation for walls, floors, ceilings, and slabs on the
building plans. Indoor and outdoor lighting shall be high efficacy luminaires that comply with WSEC section
505. To verify compliance, provide lighting information on plans.
4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. WSEC compliance
information and code text is also available on the WSU-Energy Program website at:
http://www.energy.wsu.edu/code/
Prescriptive Requirements " for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor " Wall Wall 6
Area % Vaulted Wall inta exta Slab
Option of Floor Door s z 3 Above below Below a on
P 10 Vertical Overhead Factor Ceiling Ceiling Grade Floor Grade
grade Grade
R-49 or R-21 R-21
I 13% .34 .50 .20 R-38 R-38 int' TB R-10 R-30 R-10
adv
R-49 or
II* 25% .32 .50 .20 R-38 R-38 R t� TB1 R-10 R-30 R-10
adv
R-49 or
III Unlimited .30 .50 .20 R-38 R-38 R t� TB1 R-10 R-30 R-10
adv
*Reference Case/Call (360)427-9670 ext. 352 for footnote information. Log&solid timber wall with a min. avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
� r
FORM MUST BE COMPLETED IN INK MASON
COUNTY
PERMIT NO ! �
PLEASE PRESS HARD BUILDING 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 INFORMATION
Owner -Pre 4 Company Name pw— 1.,►'+50 _L��'
Mmilinn Addr s r- IV Mail' Add ess - D ox
SL Ci e/ State Zip Code763
City State Zip Code �'
Phone 3 Z77 Other Ph. Phone36 a Z'7��7 3 5/ Other Ph.
Lien/Title Holder Contractor Reg. Exp.
E mail address E Mail Address S ue S )I�rrc •
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 Sewer System Name of Sewer System
PARCEL INFORMA I Fire District it Parce
Legal Description IVAS— 76 / Cp e Z- N
Site Address (Please include street name, street number and city) l IV17 tiE 2
Directions to site
Will timber be cut and sold in parcel preparation?Yek/Rv
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/
TYPE OF JOB;-7New Add Alt Repair Other PRIM RY RESIDENCE ❑ SEASONAL ❑
Use of Building St�-P�« -Describe Work +
No. of Bedrooms--No. of Bathrooms Sq are Footage- 1st Floor
3rd Floor Basement Deck Covered Z
� Z =ther Sq. ft.
Garage-- Attached //Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make A Model Year
Length Width Serial No. 1 o. 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. This permit/application becomes null & void if work or authorized construction is
not commenc thin 1 or if const4ntracTo—r
rk is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS OF P RES INSP CTIO .INOF THIS PERMIT APPLICATION OF 180 SAYS WILL INVALIDATE THEAPPLICATION.
XDate:
Owner/Owners resentativ / (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department 4/2711Z 1 col
Planning Department
Environmental Health Department
Fire Marshal
FEES
BuildingPermit Fee Site Inspection
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
PERMIT NO.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton(360)427-On t0;B iair
eb ww3w 0)275 on67-Elma(360)482-5269
us
APPLIC T,INFORMATION CONTRACTOR INFORMATION
Own er � Company Name
Mailing Address Mailing Address
City State Zip Code city-- State Zip Code
Phone Other Ph Phone Other Ph.
Lien/Title Holder Contractor Reg. # 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 Fire District
Legal Description
Site Address(Please include street name,street number and city)
Directions to site
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
Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_LPG—Natural Gas_Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gee
ets
Kithen Sinks W ellet Stove
Dishwasher Kiaunt Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
O✓VNER/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 Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr. 1,81111, Wt-
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