HomeMy WebLinkAboutBLD2011-00035 Final Addition and Remodel - BLD Permit / Conditions - 12/14/2011 Y Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2011-00035
OWNER: JANA FAHMY RECEIVED: 1/14/2011
CONTRACTOR: LICENSE: EXP: ISSUED: 2/7/2011
SITE ADDRESS: 2700 NE TAHUYA BLACKSMITH RD TAHUYA EXPIRES: 8/7/2011
PARCEL NUMBER: 223195000068
LEGAL DESCRIPTION: WOOTEN LAKE TRACTS TR 68
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Remodel and addition to existing structure. ST RT 3 TO BELFAIR, L ON ST RT 300/ NORTH SHORE RD, R ON
BELFAIR TAHUYA RD, R ON TAHUYA BLACKSMITH RD TO SITE ADDRESS
ON THE RIGHT
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R31_1 Lot Size: Deck: 196
Type of Work: REM Fire Dist.: 2 No.of Stories: 2 Occ. Load: Building:2,739 Garage-Attached 644
Valuation: Building Height: Occ. Status: Seasonal Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: Ft. Shoreline: 45.0 Ft. Water Body: WOOTEN LAKE
Rear: S 45.0 Ft. Slope: Ft. SEPA?: Unkn
Model: Width: Ft. Side 1: Ft. Shoreline Desig.: r ll t6lan
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee GMM 1/14/2011 $747.86 S12011000
Kitchen Sink 1 Fireplace Planning Review Fee GMM 1/14/2011 $205.00 S12011000
Lavatories 3 Furnace<100K 1 EH Plan Review SJC 1/14/2011 $103.00 s b2—1bob
Showers 3 Gas Outlets 6 Building State Fee DLC 1/27/2011 $4.50 si2oi-1 bob
Water Closets (Toilets) 3 Propane Tank 1 Building Permit Fee DLC 1/27/2011 $1,391.35 sizbi i000
Water Heaters 1 Ventilation Fan 3 Mechanical Permit Fee DLC 1/27/2011 $166.10 si2oii000
Bath Tubs 1 Heat Pump 1 Mechanical Base Fee DLC 1/27/2011 $28.50 S12011000
Clothes Washer 1 Dryer Vent 1 Plumbing Permit Fee DLC 1/27/2011 $121.80 siz6i000
Plumbing Base Fee DLC 1/27/2011 $24.70 S12011000
ADJUST--Plan Check Fee DLC 1/27/2011 $156.52 512011000
Total $2,949.33
BLD2011-00035 Please refer to the following pages for conditions of this permit. 1 of 7
CASE NOTES FOR
BLD2011-00035
CONDITIONS FOR
BLD2011-00035
1) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
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2) All cKaYiges to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordina cj or regulation, must be reviewed and approved by Mason County prior to construction.
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3) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency(ORCAA).
It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been
identified and removed from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or
op ator has obtained written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 www.orcaa.org
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4) Auc� )
kanges in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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5) Epoxy grout required and specified on the approved building plans shall require a special inspection. The special inspector shall be the engineer of record
or their authorized representative, a WABO Certified special inspector, or certified testing laboratory. In addition a Mason County Building Inspector may
perform the inspection provided holes are prepared in accordance to manufacturer specifications that are available on-site during inspection.
Special inspectors shall inspect the installation of grouted construction anchors as stated in the manufacturers specifications. An inspection report shall
be pr ared and submitted to the Mason County Building Department prior to the framing inspection of the project.
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BLD2011-00035 Please refer to the following pages for conditions of this permit. 2 of 7
` 6t ' CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDINU UEPAK I MLN I ANU I Ht Huur I tU
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.
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7) All Jillng permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason County ordinances and building regulations.
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8) Fuel bing 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 pressure 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, a sed until the final inspection has been performed and approved by a Mason County building inspector.
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9) All t1lavities serving as exterior walls, exposed during construction or remodeling work shall be insulated to the full depth of the wall cavity and
inspected prior to covering. Insulation R-values shall be as follows: 2x4 wall cavities min. R-15 and 2x6 wall cavities min. R-21.
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10) A mini um of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC
• Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall
be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or
installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps).
Reference WSEC 505.
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11) Pro Visionsr surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your proje
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BLD2011-00035 Please referto the following pages for conditions of this permit. 3 of 7
121 ' A permanen certificate, completed by the builder or registered design professional, shall be posted within three teet of the electrical aistnoution panel.
The certificate all list the predominant values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall and/or
t floor), and ducts ou the conditi sp es; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there is
more than one value for a omp a certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of
heating, cooling, and service wa eatiequipm nt, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air
leakage results if a blower door test wa ndu r
• Building envelope air leakage control shal n / eptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA)
when tested with a blower door at a press o ascals O.g.). Testing shall occur at any time after rough in and after installation of penetrations
of the building envelope, including penetration for sties, p electrical, ventilation, and combustion appliances and sealing thereof. The blower
door test results shall be recorded on the per n& ificate re located near the electrical distribution panel. Air leakage testing is not required
for additions less than 750 square feet. Reference 1 5.4 Certi to and 502.4.5 Building Air Leakage Testing.
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Compliance certificates are available online at the LU Ene webs) d, "WSEC 2009 Certificate" and are available in '/4 or%2 sheets. The
Mason County Permit Center will also have some available
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13) Alp ''its expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
hold have prevented action from being taken. No more than one extension may be granted.
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14) Th I 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
corr ctions indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal of approved documents will result in failure of required building inspections.
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15) All appr ed plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Depart ent prior to any further inspections being performed or approvals granted.
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16) All pr a e tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
meet t e installation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation-of Propane Tanks.
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17) All o erty lines shall be clearly identified at the time of foundation inspection. X
18) Contractor registration laws are governed under RCW 18.27 and enforced by the�Atate Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-8007 47-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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BLD2011-00035 Please referto the following pages for conditions of this permit. 4 of 7
All replacement windows shall be installed per manufacturer's specifications and be flashed per IK(; section KIW.b. All Installations snail meet
requirements for guards per R613 and safety glazing per R308.4. WSEC requires a U-factor of.32 or less in all heated spaces. Existing,
non-conforming, egress window openings are not required to be enlarged, but it is highly recommended. Egress windows replaced in an existing opening
shall be brought into compliance with current codes if a product is available for this application. Building plans/permit are required for windows in new,
enlarged or relocated openings these installations must meet all current codes.
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20) R+EQUIEMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
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21) WIN L ADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MPH.
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22) A or4i County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor is cknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
23) ALL SURFACE WATER AND POTENTIAL R FF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR RO D WAY.
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24) Wa n on State Energy Code Compliance has been approved as follows:
Heat Type: LP Furnace with Heat pump, Compliance Method: Prescriptive option ll, Window(Max U-Factor):0.32, 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 Existing Slab.
In addition the following credit from Table 9-1 shall be completed: R
Option 1A, 95% is __ urnace with heat pump. �� Q.o,�' �� " • �
.o`er
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BLD2011-00035 Please referto the following pages for conditions of this permit. 5 Of 7
27j Installation of heating equipment in a single-family residence shall meet the requirements of the current Washington State Energy Code, applicable
sections of the IRC and IMC.
Heating equipment shall be sized in accordance to IRC, Section M1401. Heating and design load calculations for the purpose of sizing HVAC systems are
required and shall be calculated in accordance with accepted practice, including infiltration and ventilation. Design calculations shall be available for
inspection during inspection.1.0 rL� L
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Referencing IRC M401.4, all ducts, air handlers, filter boxes, and building cavities shall be sealed. All joints of duct systems and seams shall be made
substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Closure systems used with rigid fibrous
glass ducts shall comply with UL181A and shall be marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape.
Closure systems used with flexible air ducts and flexible air connectors shall comply with UL181 B and shall be marked 181 B-FX for pressure-sensitive
tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings shall be mechanically fastened.
Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181 B and shall be marked 181 B-C. Crimp joints for round metal
ducts shall have a contact lap of at least 1-1/2 inches (38 mm) and shall be mechanically fastened by means of at least three sheet-metal screws or rivets
equally spaced around the joint. Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation
instructions.
Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be insulated to R-8
DUCT TIGHTNESS ING shal con c eeson(s)trained to perform such testing. A signed affidavit documenting test results in accordance
to WSEC Section 503.10.3 e p to a so Co t B ilding Department prior to the final occupancy inspection. Affidavit forms are
available on at the WSU- ergy we to tit u aarage Affidavit"or"Duct Leakage Testing Results (Existing Construction)." Duct
tightness testing i required if the 'r h r d I located within the heated space.
All heating equipment shall meet the requir ments of the National Appliance Energy Conservation Act(NAECA) and be so labeled. (WSEC503.4) or in
accordance to WSEC Section 1411.
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26) Owne Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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27) Thef,.
pr posed project and land use must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the
Mason ounty Shoreline Master Program.
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28) All Jns�truction and demolition debris must be removed from the shore area after project completion. Proper disposal of construction debris must be on
land i such a manner that debris cannot enter or cause water quality degradation of State waters.
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29) By Inition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan" to ensure
these structures meet the setback conditions listed.
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BLD2011-00035 Please referto the following pages for conditions of this permit. 6 of 7
Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approve, ite Plan"to ensure these structures are shown and meet the setback conditions listed.
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property nd structure for review and inspection.
OWN ER OR AGE T: j� �'L, DATE: 2_� l a D C
BLD2011-00035 Please referto the following pages for conditions of this permit. 7 Of 7
o CONCRETE MECHANICAL C:o.�� / MANUFACTURED HOME n
l,jo DateS� �/Z -// By
Footings !3etbac Gas Piping Ribbons
a Interior Date By Interior-Date By Date By <
Exier�cw Date By exterior-Date cn D
INSULATION
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Point Load/Isolated Footings Date By D
BG P SLAB INSULATION
Date ?_ sy Data By FIRE DEPARTMENT
Foundation Walls Floors date By
Date By Data By DECKS
FRAMING Walls Date By
Date S` - By j- Data - - ! By PROPANE TANKS
PLUMBING vault Date By
Date By EITHER
Groundwork Attic _...,.0
Cate By Type
Date BY __..�. _, ,_,- Data By
D.W.v DRYWALL Type.
Int Brace Wall Date By W
Dale By Date By FINAL INSPECTION 0
v Water Line Fire Separation N
Date '_ j` By Date By Date L _/ y ~� By, o
io 73,
Pass or Request Inspect. c
s Type of Insp. Fail Date Date done By Comments o
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Permit# , MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location
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.musl ae corrected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
all 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 ' ' l,/_`Z Department CORRECTION NOTICE.
Inspector
■ NnT , �-�l��4 ' THI 'mb, T,
Jk
MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION .NOTICE
Job Location 2�6 l�,�ySrc5s�iT�
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
nd: Items listed below must be corrected to gain compliance
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l ou are hereb o e ache above rections shall be made
EF�'Ukt ' CtEl rWIT4A Y FI I T IEwd®ftk
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Call for re-insP ctt n when co ections a made before continw
❑ Please contact our office
❑ Ma or cti n,ire will be check ��n A,xt insp ion � regarding possible structural
❑ OK to damage incurred by recent
"natural/man made"
❑This is not a complete inspection disasters.This is NOT a
Date L.T-./���/ Department c5��- CORRECTION NOTICE.
Inspector Ti
� �� J�`IT THImak T , -kmff
Permit#
MASON COUNTY
BUILDING Ill 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
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Job Location 77 / y�� G
2- F ��
This structure has been inspected by Mason County Building Department
and the following VIO�LATI✓ON of County Laws and Ordinances has been
found: Items listed elow mu At be corr ct t ai lance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
OK to Clf-%�' /-X C-A--/0 7 -0 #���0 vie' damage incurred by recent
^ oK � �.�� ��i "natural/man made"
❑This is not a complete inspection W�y�, ��
disasters.This is NOT a
��- ,��/ CORRECTION NOTICE.
Date �J� _� Department
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Inspector
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Permit#1 �
-- MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found- Items iste below must be corrected to gain compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
OK to �r�l/ �/ t �G(� c�SJT � /� �-. damage incurred by recent
� —�— •�— ���' "natural/man made"
❑This is not a complete inspection . Z— f/x�/�U>u disasters.This is NOT a
\e d"����c CORRECTION NOTICE.
Date `� - Department �
Inspector
NCIT , r 10 w ' THIqx T , _omw,
Building Permit # MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 2-,7cq? LZ 6'Z1'2 i"75� eZ2
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
f und: Items Listed below must be corrected to gain code compliance
ofe2ex
.�T ,ems i
" c�.. ' '' ►�✓��,� �,-� c� arse-" �'�-.+�
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are hereby notified that the above corrections shall be m de
BEFORE PROCEEDING WITH ANY FURTHER YVOR
❑ Call for re-inspection when corrections are made before continuing7\ L ebecAla5
❑ Make corrections, i ems will be checked on next inspection
14 OK to � � � Sfl� �� v�T/C � `-
❑ This is not a complete inspection Department -�
Date & `Z 7/1 Inspector i
■ �� NnT Mo AV T H I most,, T M L* qi
Planner: Grace la Rebecca
MASON COUNTY PLANNING INTAKE CHECKLIST
Owners Name: / Date: I I I VW
Project::I�emm - nn Qniwpu Commercial . : yes no
Site Plan:
❑ North Arrow
❑ Property Dimensions: Irregular Shape ? yes no
❑ Streets and Driveways sho '
❑ Road Frontage Name: 'a -2 — —
❑ All Existing Structures it a s use.
❑ Well Location, Septic a ain-fie sho setbfcks
❑ Identified Surface wa reams, ponds, sh , wetlands, nat istori , defined nage)
❑ Topography (slo Ue
❑ Minimum Stru tbac it etback):
F: /- 1�: S I- S2 /
❑ Utility an g ntsyes 0 if es enter con 'tion #502 )
❑ Other Easem s
❑ Access ppu nc rop nk at pu
❑ Doe a di at al s ?
❑ Varian - r: arkin aces al no
❑ County A es a edl c d 00 )
❑ State Access Pe rrl nee d conditio 02
❑ Standard Pla ndit 5019 d #
❑ Are there any i diments gs/ at ma is ac o ur si ? yes no
❑ If yes, do we need appointment? no
❑ Is site clearly marked? Address Name Other
Ilk
. .
UGA'S
ALLYNBELFAIR/SHELTON Rural LAND DESIGNATIONS
❑ GC ❑PF ❑R-1 ❑R-1P ❑RC 1 ❑FA 2.5 ❑ AGRICULTURAL
❑POS ❑FR ❑R-2 ❑R-1R ❑RC 2 VIRR 5 ❑ LTCFL
❑BI ❑ GC-CI ❑R-3 ❑RI ❑RC 3 ❑RR 10 ❑ IN-HOLDING
❑HC ❑LTA ❑R-5 ❑RT ❑RMF ❑RR 20 ❑ TRIBAL
❑T ❑MU ❑R-10 ❑RT/RTC ❑RNR
❑ MHP ❑BP ❑VC ❑RAC
Critical Areas: (streams, ponds, shoreli e, wetlands & steep slopes)
Shoreline Designati n• ❑ N/A Urban ❑ Rural ❑ Conservancy ❑ Natural
Water Body:
SEPA: yes no u o n Flood Plain: yes no un o Map #
Aquifer Recharge: es no On Map#
Taes/Cases:
RLC/SPI: 6 year Reforestation: yes
Eagle Nest Tag: yes (io)
Other/North Bay Sewer: yes n
Nam r �� Parcel# �IYi�J 1 q SOt'XX' C BLD#201 ( —O'DO 3
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings �j t X r" _
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X j _
X = Length of drive begins at the right of way
X =
Parking Areas D X QQ Any paved, gravel or packed area per definition
X - above table
X =
Patios/Walks X IV 06
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas)
If the Total Impervious S ac r . is LESS 2000 S ua ee , ase r nowledge and sign below.
Based Upon the inform do you have provided'a Stormwater Site Plan IS PT required for t'h� elopment activity.
Owner/Builder/Agent Ack w ed�es'tTfa s�i of inx urat�e info ma ' n may result in s)l Wary.order r permit revocation.
Acknowledgement of such i by signature below I declare that I am the o n r,owner's legal epresentat' the contractor.I
further acknowledge that the in ation . e is accurate a mploye of Mason County a ted access to the above-
described property for review and inspection as ma .
L-� Owner/Agent/Contractor(circle one)Date:
If t e otal Impervious Surface Are is GREATER THAN 2000 S uare Feet,please read, acknowledge and sign
the�ormation provided on page 2 f 2
Page I of 2
MASON COUNTY PERMIT NO. 000 35
BUILDING PERMIT APPLICATION +
426 W. Cedar• P.O. Box 186 Shelton WA 98584 LA
Shelton (360) 427-9670 • Belfair(360) 275-4467• Elma (360) 482-5269 _5
On the web w w.co.mason.wa.us
APPLICANT INFORMATION CONTACTOR INFORMATION
Owner ! Comp7Address
Mailing Address q':aQ SZ rO Mailing
Cit State-�Zip Code gl7a CityState <Codde
Phone a5 -FSSl-1�190ther Ph. ( air,`J'Q.3� Phone tContra
E Mail
DOB Drivers Li DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect t Septic Existing Septic
Connect toVVater System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No Fire District
Legal Description `
Site Address (Please include street name, street number and city) T ?SaP
Directions to site
Will timber be cut and sold in parcel preparation? Yes
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 Wp Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt V Repair,Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building .5"nl; .�k4e Describe Work DCA r • ti
No. of Bedrooms ��� No. of Bathrooms Square Footage- 1 st Floor 2nd Floor i 6 6
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.
PRO¢ CONTINUATIO OF ORK IS BY MEANS OF A PROGRESS INSPECTION.
Xr Date;
L— tjer/Owners Re resentative/C n actor (indicate which oneFO CIAL USE BEYOND IS POINT Accepted by Date 1 l4 2A1�
DEP RTMENTAL REVIEW PROVED DENIED NOTES
Building Department _ _ /� gr r2JYloRr � 5 d
Planning Department / a atJd Y06 O✓e/ ,�
Environmental Health Departmen �.
Public Works Department
Fire Marshal .
FEES
Building Permit Fee / Site inspection
Plan Review Fee q l5 .b F'O V. 5F EH Review Fee
Plumbing & Base Fee 2 70 r / f Planning Review Fee
Mechanical & Base fee cn,Y""b -L d Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ��
Valuation$ TOTAL FEES
L)FpPY Neh o%/roof S f a i�'r✓�-�f reel Wa/lS
over ! £ adcl n eLL)
New o✓e r ex)
`7 xap ---Ai9�
&(5eMkx-,�- P5 en?cd e J 50
�G No chi J aye, A4/a elA n � wqj
.�/ter .� �►'�
x X ?2
a q�
q�
.FOP
Lower
o`j 3
� 7 � 9