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HomeMy WebLinkAboutBLD95-00344 Final SFR - BLD Permit / Conditions - 6/6/2001 MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 B LJ I L_ 0 1 N 01 PFFAM I _r FOR INSPECTIONS CAL I. 427-9670 BETWEEN 5pm AND Sam 427-7262 81-095-0344 PARCELj223195000074 PLAT :WOPL.0 D[ Vi BLKg LOT - tJOB ADDRESS : NE 2590 TAHUYA BLACKSMITH RD TAHUYA PERMIT OWNER : DON HEDMAN 405-1553 CONTPACTOR : TIMBURLINE CONST 275-8127 NULL & VOID BY EXPIRATION LEGAL . VOOTFI LAKE. TRACTS TO 74 A 1112 73 DATE L4 BY CLASS OF WORK . ,;NEW BEI)Ri 2 SATHs 2 TYPE AMOUNT BY bAlf RECEIPT TYPE AMOUNT By DAZE AF Ct I PT TYPE OF USE . . . . :SF STORIES . . . . . . . 0 — dw., OCCUP . GROUP . . . v? BIDG . HEIGHT . - i O .Oft SOIR 11 42.86 KS 06127195 39492 OCR 1 45.00 kS 06127195 34492 TYPE OF CON ST . . :7 FIREPLACES . . . . 1 0 PONT $ 384.06 KS 06127195 39492 FIRP $ 25.00 KS 06127195 39492 OCCOP . LOAD . . . . 0 WOODSTOVES . . . . 1 0 PADN S 9.10 ts 06127195 39492 Off $ 4.50 KS 0601195 39492 DWELL .UNITS . . . 0 PARKING SPACFSt 0 PICK 11 192.10 KS #6127196 39497 IFHCP $ 11.00 KS 06127195 39492 INSPECTION AREAt 1 SHORULINE? . . . . :Y P1.0 t 48.96 KS 06121195 39492 ITOTAL. 759.50 VALULA11011t 161741 SETBACKS-------------- TOILETS . . . . . . . . . . t 0 FUEL TYPES---_--_---- BOILERS/GO1AP- --- MOBILE HOME_ FRONT —S 2310ft BATH BASINS . . . . . . 1 0 0­3 tip . - 0 REAR . . . .N 10 .0ft BATH TUBS . . . . . . . . : 0 3-15 HP . s 0 MODEL : SIDE ( 1 ) >E 5 .0ft SHOWFRS _ _ . . . . . . 0 FURN < 100K BTU : 0 15-30 HP , : 0 -MAKE-­­­ SIDE (2 ) .W 5 .0ft WATER HEATERS . . . . 0 FURN >-100K STU : 0 30-50 HP . : 0 SHRLINE ,S 23 ,Oft CLOTHES WASHERS . . : 0 FURN - FLOOR — z 0 504- HP . : 0 AnEA ----------------- KITCHEN SINKS . . . . 0 HEAT PUMP . . . . . . t 0 LOT SIZE — : FLOOR DRAINS . . . — t 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 IENGTHt 0 FUILDING . . . i 1608sf DRINKING FOUNT . . . : 0 VENT FANS . . . . . . : 0 HOODS . . . . . . . i 0 WIDTH . : 0 BASEMENT . . . : Ost LAUNDRY 'TRAYS . . . . 0 DOMES . INCIN ;0 -SERIA14 DECKS _ . . . . Osf DISHWASHERS . . . . . . 0 AIR HANDLING UNITS-- COMML . I NC'INtO GAP/CARPtG 720st GAPS DISPOSALS . . . : 0 <- 10000 ofm . t 0 RELOC/REPAIRt 0 AT/DT . tA URINALS . . . . . . . . . . t 0 > 10000 ofm . : 0 OTHER UNITS . i 0 MI SC PIM FIXTURES . 0 GAS OUTLETS - t 0 PROJECT PROJECT LOCA11011ti.01 14 7ARUYA BLACKS11111 RO TON VOOTfl LAKE, VIA HAVEN RAY. 1411- FEINIf BECOMES 4411 AND VOID IF *019 02 CONSTRUCTION AUTHORIZED IS NOT COMMENCED 1ITNI# I$# DAYS, 01 If CONSTRUCIIIIII 00 101K IS SUSPENDED FOR A PERIOD OF 180 DAYS AT ANY 11MF AFTER 1OA9 IS CONVENCF0. [VIafNCE Of CONTINUATION OF #OAK IS A PROORISS INSPECTION 111HIN 101 106 DAY PERIOD. (IRAI INSPECTION VU,0 Of APPROVED BEFOlf FU11[9114 CAN 81 OCCOahlED, OftER oil AGENT; RATE$ oil, COMPLIANCE TO ATTACHED CONDITIONS IS RfO411*14t, L CONCRETE �c7 _ _ MECHANICAL MOBILE HOME Footings-Setback �J —20 date Z_ r by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date /n by date to_ J 'S S by a--J date by PLUMBING �`�j ✓ Groundwork mLy � �� Attic OTHER date by date /D—/0— 7 S by t � D.W.V. WALLBOARD NAI IN date '1 -ZZ J S by date by Water Line FINAL INSPECTION date by G date by date by 1 r�V/S �U-�7�15' MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location 25--fo This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed belowmust be corrected to gain code compliance / 3. N o 1 G cti T e-� C.�I SC7 !/tSc I G� t9-r► i S L�-r+ s !O/� �S 4r--G ez f TOo 1-e- (n e,, dot mc=r LILL f C-EC-- ( S T b, r►i L You are hereby)notified that the above corrections shall be made BEFORE PROP EEII DING WITH ANY FURTHER WORK 5 5 5 rcj4rr5. ,�� Je,+ I �-�c Y.? ❑ Call for re-inspection when corrections are made before continuing / ❑ Make corrections, items will be checked on next inspection I �— C l r M C- ❑ OKto Department Date /O .SS— 7S Inspector G--� r �r ■ �� NOT Mo *V THI T Page No. 2 CASE HISTORY FOR CASE NO.: BLD95-0344 DON HEDMAN NE2590 TAHUYA BLACKSMITH RD'TAHUYA 09/22/95 Action Description Req/ Schd/ End/ Action Notes ' Disp By Update U pd Code Sent Done Done Date By ------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDC140 Fr/PL/Mc/Pen Inspection 09/19/95 09/21/95 09/21/95 CORRECTIONS: FAIL LW 09/22/95 LAW 1. THE INSTALLATION MANUAL FOR THE FURNACE DID NOT SHOW THAT IT'S REQUIREMENT WAS FOR CLEARANCE'S TO COMBUSTIBLES. (LPG UNIT 3 INCHES REQUIRED BY THE MECH. CODE). 2. CUT THE SHEETROCK BACK 1 INCH AWAY FROM THE B VENT IN MECH. ROOM AND PROVIDE A INSULATION DAM AROUND IT. 3. CAULK AROUND FLOOR BOOTS. 4. FINISH INSTALLING WINDOWS AND SEAL AROUND. 5. MAINTAIN 2 INCHES OF CLEARANCE BETWEEN THE FIREPLACE AND COMBUSTIBLE MATERIAL. 6. PROVIDE HANGERS AT DORMER ON DOUBLED UP MEMBER AND RAFTERS. 7. IN THE CRAWL AREA WERE THE JOISTS ARE HEADERED OFF AROUND THE FIREPLACE, PROVIDE JOIST HANGERS. 8. SHEAR NAIL THE FRONT WALLS OF THE GARAGE AS PER PLANS. 9. PROVIDE FRESH AIR 801S IN HABITABLE ROOMS. 10. PROVIDE ROOF VENTILATION AT DORMERS. OK TO INSULATED EXCEPT OVER CORRECTIONS. Page No. 1 CASE HISTORY FOR CASE NO.: BLD95-0344 DON HEDMAN ' NE2590 TAHUYA BLACKSMITH RD TAHUYA 09/22/95 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By ------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDA010 Application received / / / / 03/20/95 03/20/95 KW BLDA100 Approved For Issuance / / / / 05/17/95 DONE KS 05/19/95 KS BLDA500 (F) Issue building permit / / / / 06/27/95 DONE KS 06/27/95 KS BLDB110 Structural Plan Review 04/04/95 / / 04/20/95 I talked with Mrs Hedman on 4\20\95.I HOLD DPB 05/08/95 PSD explaned to her that we needed structural details of the garage portion of the project before we could complete reviemw.DPB 5/8/95 Put in building hold bin. psd BLDB110 Structural Plan Review 05/05/95 / / 05/17/95 DONE DPB 05/17/95 DPB BLDB120 WSEC Compliance Review 04/20/95 / / 04/26/95 DONE DC 04/26/95 DLC BLDB130 Planning Review 03/20/95 / / 03/31/95 DONE AHB 04/05/95 MMS BLD8134 RLC Checklist Review / / / / 03/31/95 N/A AHB 04/04/95 AHB BLDB135 Addressing / / / / 03/23/95 DONE GMM 03/23/95 GMM BLDB200 Environmental Health Review 04/26/95 / / 05/08/95 Approved septic system 12/93, plot plans DONE PSD 05/08/95 PSD and bedrooms match, put in building Hold bin. psd BLDB210 Water Adequacy 04/26/95 / / 05/08/95 As per conversation with Mrs. headman, DONE PSD 05/08/95 PSD there was cabin on the lot, the as-built also shows a residence. psd BLDC110 Footing inspection 07/19/95 07/20/95 07/20/95 FOOTING FOR THE GARAGE. DONE LW 07/20/95 LAW BLDC120 Underground plumbing insp. 07/19/95 07/20/95 07/20/95 IN GARAGE, (DWV) DONE LW 07/20/95 LAW MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 Pr_ PUA i _U C-1C3N0 1 _f 1 C:) N Case No . : BL.095--0344 For .. DON HEDMAN Page : 1 1 ) They proposed project must be Consistent with all app I i r•ab I e po i i c t es and o f her• provi4lons of the Shoreline Management Act , Its rules , and the Mason County Shore+ l ine Mast ProgramX a 2 ) The 'ppl (cant noknowiedges that this de3velopment was sited such that further she>re.• Prot ,tion measures will not be requiredfor protection of the facility . 3 ) Approved per site--plan . X - 4 ) Proposed structure or any portion thereof greater than 30" In height from grade: line, must ftaintain a minimum of 5 ' setback from all property lines, easements and right of WAYS x 5 ) All Opland areas disturbed or newly created by construction activities shall be seeded, veg� t*-d or given some other equivalent type of proteotion against erosion . X 6 ) As shown on the gite plan , the f000ndation -Footprint of the proposed structure :hall be setback 23 feet from the ordinary high water mark on the shoreline of the lake to meet the proper, shoreline setback . 7 ) All approved plans are required to be on-site for, Inspeotion purposes . If inspection is called for and plans are not on site, Approval WILL NOT be granted . In addition , a Re- bnspect I on flies In the amount. of $30 .00 per hotir (m i r► i mum 1 hour ) will be charged and must Pe collected by this department prior to any further Inspections being performed or appr va l orantesd . X H ) PURSUANT TO 1991 UNIFORM BUILDING CODE , SECTION 305(C ) AND SECTION 513, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND I..EGIBt..F-' FROM THE STREET Oil ROAD FRONTING THE PROPERTY . MASON COUNTY Bull-DING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A REINSPFCTiON FEE BASED ON RATES IN TABLE 3A OF THE 1991 UNIFORM RU1LL)ING CODE WII. I- BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR To REQUESTING INSPECTIONS . MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 X F 93 ALL. ONSTRUCTION MUST MEET OR EXCEED ALL. LOCAL. CODES AND UBC L' L'RE7 IREMENTS X effect complianoe to the 1991 Washington State 10) ch noes to apprcived building plans that e Energy Code, 1991 Ventilation and Indoor Air, Quality I Code, the Uniform Building Code arid/or Mason County a ulations must be approved by Mason County prior to constr otionx 11 ) CONSTRUCTION PROCFSS CO BE FIELD CORRECTED 'S REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE -x Date Checklist Prepared 6- MASON COUNTY BUILDING DEI'AIZTMENT PLAN REVIEWER AND INSPECTOR CHECKLIST 1991 WSEC AND V&IAQCODE COMPLIANCE Permit Number 75 o�4r7f Address IVE A� O - a '�(J CtSml7�h Sq. Ft r�OD� Name on Permit 14Er_)AMn1, DO Contractor/Phone#Ti'mbe� /-h¢ ends S h Compliance Method: �-) Prescriptive (Option) ( ) Component ( ) Systems nalysis ez j /-bme - of'her"fve_Xs Date FOUNDATION Insp. Rev. ( ) ( ) Slab: R- (Exc foundation down to frontline/slab bo(tom;or interior 24"top or slab&horizontal. Radiant under entire.) ( ) ( ) Below grade exterior wall insulation: R- ( ) (a) Crawlspace ventilation: /o•��_(I sq.ft.NEA/150 sq.ft-floor area-cross vented) /Go8/�Sv = FRAMING Standard ( ) Intermediate ( ) Advanced "� LOCI�ljh'1 Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.) Standard air seal: (Bottom pla(e/subfloor,rim joist/mudsi%window/door frames,penetrations condition to non-condition.) Attic ventilation (1 sq.fL LT A/150 sq.ft.«fling area) C0/7f1A.Ze0 CCto Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cfm @.25 WG. Vented out with dampers.) Fresh air ventilation: Available to all habitable rooms. Installed and opc adoaal. ace tcd forced air,windows,wall Potts.) ( ) ��-'(-A) Whole house exhaust fan: ) �� 6c cfm(Intermittent system manual auto controls/sone less than or=to IS at.1 WG) INSULATION or 3 he e ( ) (r ) Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extead 12"above loose fill or 6" above batt insulation) ( ) ► ) Mechanical ventilation ducts R-4 03xhaust in unconditioned space do ly'a conditioned space.) Wall insulation(above grade) R- (Batts face staplcdh`�¢ r c�z//s �e �✓ ec( .; �h ( ) ( ) Wall insulation(below grade-interior R- (Sams face stapled) �J Vapor retarders on walls (Faced batt,or 4 tail poly or perm.paint.-circle one) ( ) ( ) Rim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.) Vaulted ceiling insulation R-�_(Vapor retarder&1-air:Pace) FINAL Floor insulation R-T(Substantial contact w/surface,supports less than or=to 24"OC.cot blocking vents.) Ventilation system is operational(spot,whole home fresh air to all habitable roots. If integrated system certification by install-is required) HVAC ducts in unconditioned areas R-,8 points sealed;medwaically fastened with a minimum of 3 fasteners.) Pipe insulation R-3 (Hot and told Bats in untovAtioned areas-service or oecirc.see Table 5-12). SHW heaters: (NAECA label,separate power or gas shut-o(f,on R-10 pad if electric in unconditioned or on concrete-) ( ) (v) Heating system type: C_K-2 - Pro A:U�� Radon monitor on site with instructions.No. - Supplied by MCBD ( ) ( ) Thermostat: (Hea(range 55-75;AC 70-95;both 55-85. Backup heat controls(lockout)Prevent simulttuseoas operation of primary system.) Solid fuel appls.: (Glass/metal tight-fitting doors;die comb.air source,or 4"dice.dampened,indir.source for existing Coast.) Ground cover: (6 mil black polyethykne or approved equal lapped 12"at joints,extending to foundation wall.) Penetrations(All exterior wall and ceiling penetrations sealed to drywall-plumbing,exposed beans,watt receptacles,fans,recessed lights.) ( ) ( ) Ceiling Insulation R- (Insulate do weatherstrip access,baffle to prevent spillover-no caedbout!) Vapor retarder paint if a vapor retarder was not installed when insulation was installed. GLAZING Fill out this glazingsection or attach a window schedule to this checklist. In�peCtor- Verify window Plan eviewer information during field inspections. Include skylights,glass doors and all other glazing on this form. Use rough opening area for calculations. Date Size Quantity Area S . Ft. U-Value Manufacturer Rev. Insp. o G r 17,5 u5 SP t �� c�r� a to sc�/, ss t C) I esS 4710 7-�e l,4A.)Cr-t E �/ I 5- Lk i 0 0 /J t 3n Total glazing area: — — Total conditioned area: aP O F) Percentage glazing. ':7q( r Verified: DOORS Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity,U-value,and manufacturer. Inspector- Verify door information during field inspection. Date Type/Quantity U-Value Manufacturer Rev. Insp. b B E . 40 3°Co8 �s oo� ND Signature of Building Inspector: Date of Final Inspection:_--- J -i ACV NOR17ONTAL(In Attie,Alcove`or CrowlepeCe) DOWNFLOW(in Aic.',f•at ClOset) ------ 1 ,; Bidet' — Sides--Single-WOO Vert _- -- D 0 Type B•1 Double.Well Vent 0 0 Back _ _ 0 Top-Sinp_Io•W_su1 V_vnt 1 1 Back 1 Type B-1 Double-Wall Vent 1 1 Top 1 ----- ..-et 8fi '^`�--- fit FrontlF Single-Well Vent Front-3ingle Wa11 Vqn: f4t TV"a-1 Doutde•WaU Vent 3t 3t Type 6-1 Double-Wall Vent 3t 3t --^ 5 8 F! Vent-Single•Wali Vent - Vent---Single•Wad Yent � 1 type B•1 Gownle-Wed Vent + t Type 8 1 Double-Wall Vent i ►tORIZONTAL(in C108e0 .^--�- ~�` •IndicateS supply or return sides when furhaCe Is in the horiZontsl p051_ Sides' T � 3 -Ion 3 t Clearance showr,is for outlet end.The inlet end must malntaie o-rr,.m+rl- 2 2 imum clearance frorr the vent tU Combusticie matena. vh@rl :3""q Top-S+ng1s Vent 2 Z single wa0 +on Type C•1 Douala-Wall Vent _ _. t Minimum 13•,r front.Clearar-Ce required to ato+�ve. Front•-Single•Wall Vent a f! NCTLS. ,r;r, B 1 Ocuble-Wall Vent 3 3 1 PrOvlde 30-+n,front cletrance for ser Acing An Open COUP frU: F TYF� 8 9 e furnBCC Gan ntee' this requirement. vent-single-W==11 1 2. A mtror,um clearance of 3 m,rrust be prevllried In front of the tulnacr Type B.yent 1 for r`umbu4,ricn air enu proper oPerat,on. _ k •I t e,A. 1 h '--^ i1NP w,.�'AT WryIE 9W At j 'i �; i� �� •GCE980�` T;e o!,+ hQt,E ; Il .OWjik ENTAN I !;; I►� Sf mil+: � 0.N 0A8 ENTAN i .yA C� u.Q t4v� II' 'wGCE98CA' F-:- 3AB N -��I pyre ICE C" r 4+ •._..�T�-�yyMr r+e ��fT�''� y116't!w—' +:tB ..-.I�4rB TTi it 'J'MpLj'$'O CAI.,NC'19.b a-�t. arJrnGNw�•r8 oM K O Apc Alpo-60n cnF wMOEF Go..t$I.PtALE31 {N.;ED 11^Ht�OP PU T4 1.HogZON1%PO&'T1ON it DIMENSIONS ;in.) _ A D E VENT CONN' id-3'16 128f16 12.1111fi 4 s-3;1 fi 12.9116 12.11116 r 4 14-3r1 A 12.9116 12.11%15 4 +4-3,16 12.9M6 12-11r18 4 17.1r2 15.7l9 16 4 17•1 r2 is-7/8 '8 4 _ 17-1;2 15 7%g 16 4_ 2; 19 31 t9-1%2 a 24-1'2 22.7;6 23 5 •Refer to the fuMa0e InSMIIISWv Instr=101`15 for props►venting procedures. MIS MASON COUNTY PRE-INSPECTION APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670 L41.oo Fee Required prior to inspection PLEASE PRINT #1 Owner 0 -7/4-y Phone# Site Address 2 S°I U /L'-�F 7-41"'At jj+ 4?c: City Mail Address city —St St Zip Applicant Phone# Applicant Address City St Zip #2 Parcel No. Z Z 3/ 97Z Legal Description &1Up7Esu L.Ak-e- 7-eAC7- - `IeAC7 - �41 #3 Purpose of Pre-Inspection #4 Use of building ;e �e a o /-60 #5 Indicate by circling the applicable source if any water is on or adjacent to subject property: saltwater lake creek stream marsh river pond wetland seasonal runoff other Directions to Site: Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems, Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc. I pplicant Signature Date FOR OFFICIAL USE ONLY: Accepted by: � m R Date: f Receipt No, � —Referred To DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Proposal Proposal Approved Denied Planning: Building: Fire Marshal: Special Conditions - •cc) File. Edit Options 'vVlndot-) Help Exit � Nc-, Ilon To Do � QBE ELL Cic•se Edit Project Groop Add r l•ane Parcel A'tivity F'ecpie Fees 'Jaluotiob conditions Ga_..N•atcs OL095-00344 Status ISS ❑ 0 11 Name: DON HEDMAN Updated: 1/20199 KW ener�I Address: 2590 NE TAHUYA BLACKSMITH RD TAHUYA fdtaster # BLD95-00344 Project: ionstr. Descri:ttion: - f C,cc. RE:-,IElEP'JI: E Axea u Mobile Directions to Site: Plumbing LOT 74 TAHU)A BLACK'SPVIITH F'D TON "/OOTEN LAKE, VIA HAVEN WAY. T+ e of Use: I-rriigIIe, F-Irnil; Mechanical Ty 1-� a - Type of 1,r'',`ork: Stti,reline c: Inspection Area: 11 �=�etr:�ack:� � Finaled: Issued: '2171'53 Fire District: Expiration: 11f2'imi Received: /20,"3-+ Total Valuation: Printing Ca:_e'-�i_fn-imary Report for 9LD95-00344 tik Ott "PERMIT'PLAN fl•ilcfosolt Excel - _ Niail VL Copyright©1997-1999 Tidemark Computer Systems Inc. 6/1/01 All Rights Reserved. i MASON COUNTY - PERMIT ASSISTANCE CENTER P.O.Box 186 Shelton,WA 98584 (360)427 9670 O PERMIT# DATE _ Permit Name / $ D Received From • PROJECT , J PLAN CHECK PLUMBING MECHANICAL WOOD/GAS/PELL ET STOVE RLC m Q ADDRESS E H REVIEW 3 Z OTHER W mr 41 STATE FEE ❑CASH ECK MONEY ORDER • $ 0 Deputy `— rnt���� - DA6 Permit No. MASON COUNTY -U BUILDING PERMIT APPLICATION y, / 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 q `` PLEASE PRINT f 61 #1 ,eite r 'Do" �'DYh�4-rV Phone# �.S— l S.S3 ddress k,c. MQ TR h4AV A.l�-C� rilTit i2.1> = Fire District#I- TA-H-t. yd: St WA! zip 985,Z$ Directions to Job Site _ 40 T-" ?4 T A H� b 0J, Woo 7-e7u 14- W-A-i +v LA� Owner Mailing Address r 0. RCIA /qb/ City t et F-,+/R- wr4 St VA'. Zip 16 S`2_--ti6 Lien/Title Holder OW A Address Clty St Zip #2 Contractor Name e6^,s7= (�oU �Cz-hr� Contractor Reg# Ti;" Se-e /Z¢Kea Address �?v - pA 77 Z Expiration Date d S'/ Z-7 / g3� City &Z F-A- e— St W Zip Phone# 'Z7 r' 9/ Z 7 Lc�wTA c.T N o #3 If septic is located on pr ject site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) E1(Sr�Trr� u'�-zL #4 el No. 'ZZ31 g - 5d - boa `14 Legal Description G.a i -7 4 W cv'1-ew #5 Building Square Footage: (existing/proposed) 1st FI / /608 2nd FI / 0 3rd FI / a Loft / O Basement / U Deck / e #bedrooms / Z #bathrooms / Z Garage /Zo Carport / o (Circl .Attache or Detached?) Other sq. ft. / #6 Use of building (2- j o y c--Lr- Describe work NCB #7 Type of Job: New ✓ Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION [ENM � DTNM Model Year Make Model Length Width Serial No. MAR 17 IJ #Bedrooms #Bathrooms Type of Heat Purchase Price$ HEALTH SERVICES #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW btu. F , ?(WPos c { I -74- r sin i Z. Z APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 eachj Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYP . Gas Electric, Bath Basins Heatpump, Other Bath Tubs No. UniLs Fees Showers Furn BTU 6 I Hot Water Htr Heatpumps Laundry Washer 3 _ Vent Systems Sinks Spot Vent Fans 2� Floor Drains No. Boilers/Compressors Laundry Basins HP _Dishwasher No. Air Handling Units Disposal cfm# Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50�00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 a Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ -- No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15/.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE DATE — - FOR OFFICIAL USE ONLY:Accepted by: Date: 5 DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: U ! •-ea K� Environmental Health: 9 Building Plaq Review ',�_q Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES D Building Permit g Yam_ Plan Check Plumbing Fee Mechanical Fee ood as/Pellet Stove V e— PtQS-e Radon Monitor 8` Violation Fee Site Inspection Building State Fee q- Other Other Building Valuation: 1 TOTAL FEE �g^�