HomeMy WebLinkAboutMIS97-00017 Cancelled Dock - MIS Permit / Conditions - 11/10/1999 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
M I a C U l_r. I__ A N V, CQ tJ y P IF FT M I -'I- f 01^t I NSPEC'T I ONC CAR. f_ 4?7--9570
MIS97--0017 PARCFL :223195000071 PLAT :WOPLO DIV : FSLK : LOT !
JOB ADDRFS : NF 264;0 TAHUYA BLACKSMITH RD TAHUYA
APPL. 1 CANT : JOHN BOYD 275--5029 PERMIT
OWNER : JOHN BOYU P75- 5029 NULL & VOID RYE PIRATION
LEGAL : ROQTEN LAKE TRACTS TR T1 Eft? if )15# TANBVA 81ACK811TM RI 1(
DATE I "�� � B
PROJFCT DESCRIPTION :
CONSTRUCT 400 SO . FT . DOCK AT WOOTEN I AKF , COMPOSED OF 40 FT . LONG AND 8 FT . W I DL SECTION
PERPENDICULAR FROM LAKE SHORE AND 8 FT . LONG AND 10 FT . WIDE SECTION PARALLEL TO LAKE SHORE , ANO
SUPPORTED ON 10 11NTHFATE D PILINGS
PROJECT LOCATION -
FROM BELFA I R DOWN NORTHSHORF RD, R I Gi11T ON BE'LFA I R TAHUYA RTy, GO ON HAVEN WAY, LEFT ON MNT V I FW
1 /4 MILE GO RIGHT ON TAHUYA BLACKSMITH RD, LOOT( FOR ADDRESS 1 /4 MILE ON "I GHT ,
PROJECT NOTES :
SFP97-001 7 PREPARED FOR P110POSAL ,
TYPE. AMOONT BY DATE RECF1PT�
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PRMT $ 62 .50 CPH 04/07/97 0000
`3 T FF. $ 4 ,50 C PH 04/07/97 0000
P[,CK 2t- .00 C.PH 04/07 197 0000 =
TOTAL.. . 92 ,00 ! 151iN OR AGENT `, DATF
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MIS PANT, rev Ili9i1P COMPLIANCE TO ATTACIWD CONDITIONS IS
REOU I RE'D
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date 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 by date by date by
PLUMBING
Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
I
i ti III
MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
11 M 1 -T" C. t:') N I-) I IF 1 C-)V14
Case No . ; I,II S97-001 7
For J()HN BOYD
Page - I
1 ) A I I approveri p I tins are reequ i red to be oti-. s I te: for i rrspecxt i on purpos.�s . IT Inspection
Is called for and plans are not on site , Approval W11..1- NOT he granted . In addition , a
Re- 1 aspect i on fee in the amot.ant of $32 .00 per hour (minimum 1 hour) will Eye charcied and
mast be co i e oe ed by this depat'tment pr i or to any further Inspections he i ng performed or
approval need ,
x.
2 i PURSUANT TO 1991 UN I FOW4 BUILDING t ODF , SECTION 305(C ) AND SFC T I ON b13, ALI- S 1 Tf S MUST
HAVE APPROVED NUMBERS OR AW? RESGES PROV I Chi 0 IN SUCH A POSITION AS TO BE PLAINLY VISIBLE
AND LEG I SI.E FROM THE STRErT OR ROAD FRONTING THE PROPERTY . MASON COUNTY S111 t.D I NC
OUPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS A
RE I NSPECT I ON FFE , BASED ON RATES IN TAB1 F 3A OF THE 1991 UNIFORM 110 i Ln i NG CODE W I L I_ ESE
ASSESSED IF OWNERICONIRACTOH FAILS `TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPECTIONS ,
i
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
X
3 ) ALL. CONSTRUCT :Oil MUST" MEFT OR EXCEED ALA t.00AI CODFS AND (U
REQUIREMENT
x
4 ) Chan(jes to approved bu l l d i ng plans th-it e4fect oomr) l lance to the 1991 Washington State
Energy Cede, 1991 Ventilation and Indoor Air Quality
Code, the tfn i form Building Cade and/or M•S swti County° Regulations must be appi oved by
Masora County pr i ��r to construct i onX��_��
5 > CONSTRUCT I ON PROOF~SS TO RE F I F t l) COP REC-I-C AS RkL1U_Lt�ES? PF R MA SON COUNTY BUILDING
DEPARTMENT AND UNIFORM CU I LD i NO CODE .x � 4`
6) The propose od pr lect mu,,,t oe cons i stent w i th a I 1 aPp i I oah-I e po I I C. i e:. and of her
prov I s i onp the Shores i i nA Management Act , its rules . and the MH9on County Sharel i rte
Master .P-f6o am .
7 ) A I 1 const rwit ll bri nd demo 1 i t i on debr i s must be removed from the shore I i ne after pr o sect
completion .
X._ _ ...-------
_.._
s'
GARY YANDO,DIRECTOR
.STgtFO
M o DEPARTMENT OF COMMUNITY DEVELOPMENT
A jJ us NT
o T i PLANNING-SOLID WASTE -UTILITIES
N Y y BLDG. I • 411 N. 5TH ST. • P.O. BOX 578
1864. SHELTON,WA 98584 • (360) 427-9670
DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created
by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's
willingness to proceed with processing of applications which might be affected by that Order,the undersigned property
owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of
Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting
actions'),which damages are attributable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
Date (Parcel No. or Legal Description)
J
Property owner's signature(Notarized
(or the County may accept the signature of the owner's authorized agent upon proper proof of authorization)
ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) _
STATE OF
COUNTY OF
On this day of th ,before me Notary Public,
personally appeared personally known to me to be the person whose name is
subscribed to this instrum a o7ledged that he/she executed it.
i J
WITNESS my hand and official seal.
-For County use only-
Reviewed by applicant on
(Date)
Notary's signature
My Commission Expires: Staff Initial:
1i•.'.'r�Lr.1
Permit No. XIA
MASON COUNTY p'a
BUILDING PERMIT APPLICATION , 'Co/
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT ` / C
#1 w r „�("� ►'1 '� Y Phone#d� �-
ite Address . Z m • Fire District#
City ��' St , Zip ki
Directions to Job Site /iliCge l
go Ao le 1W
if vn iH i L / At7 i � &o o u
Owner Mailin A Jr ss
City St Zip c—
Lien/Title Holder
Address
Clty St zip T
#2 Contracto ame I� x- Y j U� Contractor Reg 41-A�� SO--
Addre /dFJ Expiration Date /_ "�c 77
City St Zip Phone# V �
#3 If septic is located on project 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)
#4 \�'arcel No.��a 3 iG - -
Le al D crip ion E►� —C � �a p Ct n . 11C2" ling.
�0� O C; i✓�C tia - �r �' Cl�( 0
CA � �- � � �5e_ecc � v� �c 4
ACP
# Building Squ re ootage: existing! rose
1st FI / 2nd FI / 3rd FI / Loft /
Basement Deck / #bedrooms / #bathrooms /
Ga a /�Carport / (Circle:Attached or Detached?)
Other c.� sq.ft. b c)
#6 Use of building Describe work
#7 Type of Job: New Z _Add Alt Repair Othg— �^
�v
Z
#8 MOBILE/MANUFACTURED HOME INFORMATION O
Model Year MVel
Length idth S . Q
# Bedroo # Bat ms Type at
Purc se Price$ 0 4
#9 Indicate by circling the applicable source i ater is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake J,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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
r
i
Plumbing Fixtures ($3 eac!21 Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Units Fees
_Showers _ Furn BTU
_Hot Water Htr Heatpumps
_Laundry Washer _ Vent Systems
Sinks Spot Vent Fans
_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 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
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $
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 OF THE 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. DEPARTMEN �
X OWNER X BY
DATE DATE �/ 7
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planningli
Environmental Health:
Building Plan Review W
t-5 7
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
^fco/c '42- 31 700 Building Permit (oZ ro
Plan Check C"
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: 3, 760 TOTAL FEE a--