HomeMy WebLinkAboutBLD2022-01304 SFR - BLD Inspections - 4/1/2025 INSPECTION CARD
Mason County
615 "'. Alder St.
Building 8, Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
PERMIT# BLD2022-01304 PROJECT ADDRESS 13310 W Shelton Matlock Rd Shelton, WA 98584
PARCEL# 520081390100 PROJECT DESCRIPTION DEMO EXISTING CABIN & BUILD NEW SFR W/ATTACHED
GARAGE
OWNER BOGDANOVICH GREGORY A ADDRESS 500 W MARKET ST PHONE 360-580-6511
CONTRACTOR ADDRESS PHONE
CONTRACTOR LICENSE LENDER
INSPECTION INSP DATE Comments INSPECTION INSP DATE Comments
Setback Inspection Rough-Plumbing Inspection DEO -G
Footing Inspection Mechanical Inspection Tw -(L
Foundation Wall-Pre-Pour 7 31 D Gas Piping Inspection
su a Insulation Inspection
Underfloor Inspection -0-2 Connection has been verified by
Shearwall Inspection -�r� BLD-Final Inspection -(-a
Framing Inspection -6'1`{ t Foundation Wall Inspection
�o��•�`�:o�-FAIc,. L-(-Z3 I�flS�' A"�' �yw�Il SASS ��1-�'t �E lJ
Cw.,rx A-3 Ss aL^nuc�
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MASON COUNTY 360-427-9670 Shelton ext.352
7 Belfair ext.352
COMMUNITY SERVICES 36 60-40-275 82-269 Elma ext.352
Building,Planning,Environmental Health,Community Health
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.masoncountywa.gov
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: IBLL7;0.?:?-Abbi
ADDRESS/LOCATION: J-U Q W .S Ej-jo J 141A--ttof,,& er)
FINDINGS:
Reber w4s rzhovcol g-R-.- w4;-r ►llc2ce,4001 r h"Y's.
Provt f- en -^cN l Nc u►.f
t o"O'44 -W., r-
Bnv
Items listed above must be corrected to lain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
Call for re-inspection when corrections are made before proceeding with any further work.
Make corrections, items will be checked on the next inspection.
OK to
Date: Please contact our office regarding possible
Department: 'BI-P structural damage incurred by recent
Inspector: pep "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
t
MASON COUNTY 360-427-9670 Shelton ext. 352
360-275-4467 Belfair ext.352
COMMUNITY DEVELOPMENT 360-482-5269 Elma ext.352
Building,Planning,Fire Marshal
615 W. Alder St.Bldg.8 - Shelton,WA 98584 www.masoncountywa.gov
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: St D26 z 2-013 o 9
ADDRESS/LOCATION: 13310 W SNELZOA) 141A?(OCk ?B
FINDINGS:
-- eX-I L c�1 7�'ov rS�� �� RCCejT wllf*et V,
-/ br Jw,l
OK+-1 7n
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
Call for re-inspection when corrections are made before proceeding with any further work.
Make corrections, items will be checked on the next inspection.
❑ OK to
Date: 2-6-�y ❑ Please contact our office regarding possible
Department: $LD structural damage incurred by recent
"natural/man made"disasters.This is NOT a
Inspector: CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
INSPECTION RESULTS Pagel
MASON COUNTY INSPECTION
of Community Development
COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584
pogo„dt AssistdaLo,Urltet,BuddinV,Plano,ng (360)427-9670 ext. 352
Application # BLD2022-01304 Application Type NEW SINGLE FAMILY Owner BOGDANOVICH GREGORY
RESIDENCE A
Parcel# 520081390100 Site Address 13310 W Shelton Matlock Rd Shelton, WA
98584
Inspector Inspection Type Date Status Comments"
11-19-24 DED
1' 11FEMA final certificate required
2)planning mitigation condition on permit. Contact Planning Department to get this
resolved
Mechanical Inspection was never passed. Main trunk line blocks off access to half
of the crawlspace. Please reroute duct or provide alternate means of access to the
Dave Dobson BLD-FINAL INSPECTION 11/19/2024 FAIL entire crawlspace
bollards required in garage for appliance protection
anti-tip bracket required on kitchen stove
tom steps on concrete porches exceed the maximum height allowed of 7-3/4".
graspable handrails required on concrete stairways with 4 or more steps
fill in planter area in order to avoid guard requirement on back porch
address numbers to be posted on home
1 '
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
B DD2022-01304 NEW SINGLE FAMILY RESIDENCE
PROJECT DESCRIPTION: DEMO EXISTING CABIN & BUILD NEW SFR ISSUED: 03/15/2023
W/ATTACHED GARAGE
SITE ADDRESS: 13310 W SHELTON MATLOCK RD SHELTON EXPIRES: 09/11/2023
PARCEL: 520081390100
APPLICANT: BOGDANOVICH GREGORY A OWNER: BOGDANOVICH GREGORY A
500 W MARKET ST 500 W MARKET ST
ABERDEEN,WA 98520 ABERDEEN,WA 98520
360-580-6511
VALUATIONS: FEES: Paid Due
Covered Deck/Carport 433.00 $9,526.00 Mechanical Fees $269.00 $0.00
R-3 VB Residential, one- 2330.00 $351,527.10 State Fee-Residential $6.50 $0.00
and two-family Plumbing Fees $156.00 $0.00
U VB Utility, miscellaneous 572.00 $34,565.96 Building Permit Fee $2,910.32 $0.00
Planning Review Fee $240.00 $0.00
Mechanical Base Fee $30.00 $0.00
Building Plan Review/Change of $125.00 $0.00
Use-Onsite Sewage
Plumbing Base Fee $25.00 $0.00
Plan Check Fee $1,891.71 $0.00
Technology Surcharge $105.64 $0.00
Total: $395,619.06 Totals : $5,759.17 $0.00
FIXTURES
(Q,ty Mechanical Fixtures (sty Plumbing Fixtures
1.0000 Gas Outlet(s) (1-5) 1.0000 Number of Clothes Washers
1.0000 Dryer Vent(s) 1.0000 Number of Dishwashers
1.0000 Kitchen Exhaust Hood(s) 1.0000 Number of Kitchen Sinks
1.0000 Furnace(s) 1.0000 Number of Water Heaters and or Vent
1.0000 Heat Pump(s) 2.0000 Number of Bath Tubs
Printed by:Ariane Paysse on:03/15/2023 03:08 PM
Page 1 of 7
Mason County
Mason County - Division of Community Development
615 W.Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2022-01304
(Qty Mechanical Fixtures City, Plumbing Fixtures
1.0000 Propane Tank(s) 2.0000 Number of Showers
1.0000 Wood/Gas/Pellet Stove(s) 3.0000 Number of Hose Bibs
4.0000 Spot Vent Fan(s) 3.0000 Number of Toilets
4.0000 Bathroom Sink
REQUIRED INSPECTIONS
Setback Inspection Rough- Plumbing Inspection
Footing Inspection Mechanical Inspection
Foundation Wall-Pre-Pour Inspection Gas Piping Inspection
Slab Insulation Insulation Inspection
Underfloor Inspection Connection has been verified by Health or Utilities
Shearwall Inspection BLD-Final Inspection
Framing Inspection Foundation Wall Inspection
CONDITIONS
" The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not
allowed without the approval of the Mason County Fire Marshal.
* 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 shall have a minimum compressive strength of
3000 psi (IRC Table R402.2).
* Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate
building permit and approval prior to construction of the retaining wall.
* 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 and monetary liabilities to the homeowner for using an
unregistered contractor. Further information can be obtained at 1-800-647-0982. The person signing this condition is either
the homeowner, agent for the owner or a registered contractor according to WA state law.
* 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, must be reviewed and approved by Mason County prior to construction.
* 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
contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained
permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County
access to the above described property and structure(s)for review and inspection. This permit/application becomes null &
void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
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Page 2 of 7
Mason County
Mason County - Division of Community Development
615 W.Alder St.
Building 8
Shelton,WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2022-01304
A minimum of 90 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance
with IECC/WSEC Section R404.1.
* Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer
specifications and in accordance with IRC Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level
of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of
fuel burning appliances), repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or
created.
* When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by
the Mason County Department of Public Works. For more information contact Public Works, at(360)427-9670, ext. 450 or
100 W Public Works Dr. Shelton. The building permit will not be finaled until the permit holder can show proof that the
access permit from Public Works has been finaled and approved.
* All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor
increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way.
* Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance
with Mason County Title 14.28 and 14.17.
* Installation of heating equipment in a single-family residence shall meet the requirements of the current WSEC R403,
applicable sections of the IRC, and IMC.
Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.7. 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.
Referencing IRC M1601.4, 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 TESTING shall be conducted by person(s)trained to perform such testing. A signed affidavit
documenting test results in accordance to IECC/WSEC Section R403.3.3 shall be provided to the Mason County Building
Department prior to the final occupancy inspection. Affidavit forms are available on at the WSU-Energy Program website
titles, "Duct Leakage Affidavit"or"Duct Leakage Testing Results (Existing Construction)." Duct tightness testing is not
required if the air handler and all ducts are located within the heated space.
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Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2O22-01304
" Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a
permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor
& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-
4000.
Adopted Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window(Max U-
Factor):0.30, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation
R-30, Ceiling Insulation min. R-49, Vault Insulation R-38, and Slab Insulation R-10.
2 Heat pump
1.3 Prescriptive compliance is based on Table R402.1.1 with the following modifications:
Vertical fenestration U =0.28, Floor R-38, Slab on grade R-10 perimeter and under entire slab below grade slab R-10
perimeter and under entire slab or Compliance based on Section R402.1.4: Reduce the Total conductive UA by 5%
2.1 Compliance based on R402.4.1.2: Reduce the tested air leakage to 3.0 air changes per hour.
maximum at 50 Pascals or For R-2 Occupancies, optional compliance based on Section R402.4.1.2: Reduce the tested air
leakage to 0.3 cfm/sf maximum at 50 Pascals and All whole house ventilation requirements as determined by Section
M1507.3 of the International Residential Code or Section 403.8 of the International Mechanical Code shall be met with a
high efficiency fan(s) (maximum 0.35 watts/cfm), not interlocked with the furnace fan (if present). Ventilation systems using a
furnace including an ECM motor are allowed if they are controlled to operate at low speed in ventilation only mode.
3.2 Air-source centrally ducted heat pump with minimum HSPF of 9.5. 3
4.2 HVAC equipment and associated duct system(s)installation shall comply with the requirements of Section R403.3.7.
Locating system components in conditioned crawl spaces is not permitted under this option. Electric resistance heat and
ductless heat pumps are not permitted under this option. Direct combustion heating equipment with AFUE less than 80% is
not permitted under this option.
5.5 Water heating system shall include one of the following: Electric heat pump water heater meeting the standards for Tier
III of NEEA's advanced water heating specification or For R-2 Occupancy, electric heat pump water heater(s), meeting the
standards for Tier III of NEEA's advanced water heating specification, shall supply domestic hot water to all units. If one
water heater is serving more than one dwelling unit, all hot water supply and recirculation piping shall be insulated with R-8
minimum pipe insulation. 5
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Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2O22-01304
* A permanent certificate, completed by the builder or registered design professional, shall be posted on a wall in the space
where the furnace is located, a utility room, or an approved location inside the building. When located on the elctrical panel,
the certificate shall not cover or obstruct the visibility of the circuit directory label, service disconnect labek, or toher reqyired
Iabels.The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab,
basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the
solar heat gain coefficient(SHGC)of fenestration. Where there is more than one value for each component, the certificate
shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service
water heating equipment, duct leakage rates including test conditions as specified in WSEC Chapter 4, and air leakage
results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 5 air
changes per hour when tested with a blower door in accordanve with WSEC Section R402.4.1.2.
The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution
panel. Air leakage testing is not required for additions less than 500 square feet. Reference WSEC R402.4.1.2.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2015 Certificate" and are
available in '/<or'/z sheets.
* All property lines shall be clearly identified at the time of foundation inspection.
* The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more
than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards
for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to
another fire apparatus access road which connects to a county maintained public road.
* All building permits shall have a final inspection performed and approved by 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.
* Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly
corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of
pressure treated material.
* Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site
plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
* All RED stamped 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 addition, a re-inspection fee (refer to current fee
schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections
being performed or approvals granted.
* The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility
of the applicant, owner or contractor to make the required 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 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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Page 5 of 7
Mason County
Mason County - Division of Community Development
615 W.Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2022-01304
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'of a Mason County road right of way, it is suggested to contact that
office to review future planned work which may affect your project.
The stamped 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, 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.
CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING
DEPARTMENT AND THE ADOPTED BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All
construction must be in conformance with the international codes as amended and adopted by Mason County. Any
corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting
additional inspections.
" WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind
speed for Mason County is 85 MPH.
Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building
Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration.
Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No
more than one extension may be granted.
The foundation/footing must be placed on undisturbed, firm-native soil. Proper frost depth shall be observed below grade
in undisturbed soils.
A Mason 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/age nt/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 acknowledging that all components of the stormwater
management system have been installed as approved on the stormwater site plan.
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' of a Mason County road right of way, it is suggested to contact that
office to review future planned work which may affect your project.
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Page 6 of 7
1
Mason County
Mason County - Division of Community Development
615 W.Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2022-01304
All construction must meet or exceed all local and state ordinances in addition to 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.
By definition, 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.
" REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable
provisions of the current code and the manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs.
On-site Septic System final installation approval required prior to temporary/final occupancy of the residence.
" Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained
* Applicant/Owner assumes all responsibility if On-site Sewage Components are 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/Perimeter Drains within 30ft, down gradient of Drainfield/Reserve area.
D.) No Cut Bank(s) (greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/ Reserve area.
All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County
ordinances. All propane tanks must meet the installation requirements and minimum setbacks as listed in the Mason County
Fire Marshal's Standards for the Installation of Propane Tanks.
Flood Venting must be maintained in perpetuity for the life of the structure.
The surveyor of record on the preliminary FEMA Elevation Certificate must inspect the foundation forms prior to Mason
County Building Department to verify the forms will be adequate to support the installation of the finished floor at the required
height of 461.5 (two feet above the HAG listed on FEMA Elevation Certificate). A stamped letter of verification from the
surveyor must be provided at the time of Mason County Inspection.
" Prior to scheduling the final inspection from Mason County Building Department the surveyor must complete the final
FEMA Elevation Certificate and provide a copy at time of inspection.This document must be filled with FEMA for record.
• Existing residence must be demoed prior to permit closure.
• Must adhere to HMP/CLMP
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of wor will be complied with whether
specified herein or not. The granting of a permit does not presuml to give authority to violate or cancel
the provisions of any other state/loll law regu con uctio o e performance of construction.
Issued By:
Contractor or Authorized Agent: Date:
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f
MASON COUNTY
i
COMMUNITY SERVICES
SuMing.Pksnnin%Envk4onmentaf Health,Comrnunity Health
These requirements apply to all IRC building types, including detached one-and two-family dwellings and multiple
single-family dwellings (townhouses).
Contact Information Project Information
Owners Nam (o /&�. CW4Site Address:31Z) W.
SW�AAA��
Mailing Address: �t�'�'v
0 W. M ArKV321- s ek 6*1 V1/1t
Parcel Number:
5 a� Ob�g-I3 Q�10 U
Square Feet(total):
Ventilations Compliance:
❑Whole House Ventilation system El Whole House Ventilation
using exhaust fans&window or wall Integrated with a Forced Air
fresh air vents(M1507.3.4) System(M1507.3.5)
Other,describe:
Instructions:This single-family project will use the requirements of the Prescriptive Path below and
incorporate the minimum values listed. Based on the size of the structure,the appropriate number of
40L additional credits are checked as chosen by the permit applicant.
Provide all information from the following tables as building permit drawings:Table R402.1- Insulation and
Fenestration Requirements by Component,Table R406.2- Fuel Normalization Credits and 406.3- Energy Credits.
All Climate Zones(Table R402.1.1)
R-Value a U-Factor a
Fenestration U-Factor b n/a 0.30
Skylight U-Factor b n/a 0.50
Glazed Fenestration SHGC b,e n/a n/a
Ceiling 2 49 i 0.026
Wood Frame Wall g,h 21 int 0.056
Floor 30 0.029
Below Grade Wall ,h 10/15/21 int+TB 0.042
Slab 0 R-Value& Depth 10, 2 ft n/a
R-values are minimums. U-factors and SHGC are maximums.When insulation is installed in a cavity that is less
a than the label or design thickness of the insulation,the compressed R-value of the insulation from Appendix
Table A101.4 shall not be less than the R-value specified in the table.
b The fenestration U-factor column excludes skylights.
"10/15/21+5TB" means R-10 continuous insulation on the exterior of the wall, or R-15 continuous insulation on
the interior of the wall,or R-21 cavity insulation plus a thermal break between the slab and the basement wall at
c the interior of the basement wall. "10/15/21+5TB"shall be permitted to be met with R-13 cavity insulation on
the interior of the basement wall plus R-5 continuous insulation on the interior or exterior of the wall. "5TB"
means R-5 thermal break between floor slab and basement wall.
d R-10 continuous insulation is required under heated slab on grade floors.See Section R402.2.9.1.
Prescriptive Path—Single Family 2018 Washington State Energy Code-R
For single rafter-or joist-vaulted ceilings,the insulation may be reduced to R-38 if the full insulation depth
e extends over the top plate of the exterior wall.
R-7.5 continuous insulation installed over an existing slab is deemed to be equivalent to the required perimeter
f slab insulation when applied to existing slabs complying with Section R503.1.1. If foam plastic is used, it shall
meet the requirements for thermal barriers protecting foam plastics.
For log structures developed in compliance with Standard ICC 400, log walls shall meet the requirements for
g climate zone 5 of ICC 400.
Int. (intermediate framing)denotes framing and insulation as described in Section A103.2.2 including standard
h framing 16 inches on center,78%of the wall cavity insulated and headers insulated with a minimum of R-10
insulation.
Each dwelling unit in a residential building shall comply with sufficient options from Table R406.2 (fuel
normalization credits) and Table 406.3 (energy credits) to achieve the following minimum number of
credits.To claim this credit,the building permit drawings shall specify the option selected and the
maximum tested building air leakage and show the qualifying ventilation system and its control sequence
of operation.
1. Small Dwelling Unit:3 credits
Dwelling units less than 1,500 sf in conditioned floor area with less than 300 sf of fenestration area.
Additions to existing building that are greater than 500 sf of heated floor area but less than 1,500 sf.
2. Medium Dwelling Unit:6 credits
All dwelling units that are not included in#1 or#3
3. Large Dwelling Unit: 7 credits
Dwelling units exceeding 5,000 sf of conditioned floor area
4. Additions less than 500 square feet: 1.5 credits
All other additions shall meet 1-3 above
Before selecting your credits on this Summary table, review the details in Table 406.3 (Single Family),on page 4.
Summary of Table R406.2
....... .....
8 .
�-
Heating Credits-select ONE
Options Fuel Normalization Descriptions heating option User Notes
_. ..._._ _.._..1_....__
1 Combustion heating minimum NAECAb ; 0.0 ❑
2 Heat pump` 1.0
j 3 Electric resistance heat only-furnace or zonal -1.0 ❑
4 DHP with zonal electric resistance per option 3.4 . 0.5- - ---...._..,-
5 All o..... - ----- -- --------
Energy Credits-select ONE
O tions Energy Credit Option Descriptions energy option from each ! ;
p category
._._.__ ..___..... i._. __.._. .____. .......__. ._._._...._._._-__._._...__-.______. _...... �... _.___ _._ .._..........
__.-_._.._...___-_.___.____._..___._
1.1 Efficient Building Envelope 0.5 ❑
1.2 Efficient Building Envelope 1.0 ❑
._ _........ _----- _.-.........._..... -._
1.3 Efficient Building Envelope 0 5 ! +❑
.._ g _.. _ ,. _
1.4 !Efficient Building Envelope 1.0 ❑
1.5 'Efficient Building Envelope 2.0 ❑
........-- - --- ......- ;
1.6 Efficient Building Envelope 3 0 ❑ -
_ ._ _ _ _. ..-- ...---... ----._.... _ _ _..
1.7 Efficient Building Envelope 0.5 ❑
_._.....
2.1 Air Leakage Control and Efficient Ventilation 0.5 ❑
2.2 Air Leakage Control and Efficient Ventilation 1.0 IN
2.3 Air Leakage Control and Efficient Ventilation 1.5 ❑
2.4 Air Leakage Control and Efficient Ventilation 2 0 ❑
r _--- -- - -_ __._._.._._... ...-... _.......
3.11 High Efficiency HVAC 1.0 ! ❑
j 3.2 High Efficiency HVAC 1.0 ❑
3.3a High Efficiency HVAC 1.5 ❑
. --- .. _._ ..__ ---- ---
3.4 High Efficiency HVAC 1.5 i ❑ I
- - - _......_......
- --------------
3.5 !Hi h Efficiency HVAC 1.5 DO
! 3.61 j High Efficiency HVAC 2.0 ! ❑
Prescriptive Path-Single Family 2018 Washington State Energy Code-R
............................... ......................._. ........ ........__ .......... .....__ ....................... _.................. ._ . ....... .................
4.1 High Efficiency HVAC Distribution System 0.5
i 4.2 High Efficiency HVAC Distribution System 10 ❑ j - __ _
-.......
5 1' Efficient Water Heating 0.5 ❑
5.2 Efficient Water Heating0.5 ❑
—_ _.— -- — — -- — ..
! 5.3 Efficient Water Heating 1.0 ❑ __ _ __
i
5.4 Efficient Water Heating 1.5 ❑
5.5 Efficient Water Heating
2 0
_.._... g- ........._........_. ...__... - ---_ — _._._ --- ----...-----...._.—_..__._...:
5.6 Efficient Water Heating ! 2.5 ❑
_— ...--- .-....--- .... .__.....--- - ......--- ----- — . .
__-
6.1e Renewable Electric Energy(3 credits max) 1.0 ❑
-— --- --
7.1 Appliance Package 0.5 El
.. _._ ....._...... ___.. ---- —
i Total
L__Credits
a. An alternative heating source sized at a maximum of 0.5 W/sf(equivalent)of heated floor area or 500 W,
whichever is bigger, may be installed in the dwelling unit.
b. Equipment listed in Table C403.3.2(4)orC403.3.2(5)
c. Equipment listed in Table C403.3.2(1)or C403.3.2(2)
d. You cannot select more than one option from any category EXCEPT in category S.Option 5.1 may be combined
with options 5.2 through 5.6.See Table 406.3.
e. 1.0 credit for each 1,200 kWh of electrical generation provided annually, up to 3 credits max.
See the complete Table R406.2 for all requirements and option descriptions.
Please print only pages 1 through 3 of this worksheet for submission to your building official.
Prescriptive Path—Single Family 2018 Washington State Energy Code-R
ti
Page 1 of 2 Date: May 23,2023 Case No.: 23-10-0453A LOMA
Federal Emergency Management Agency
o�cyl� Washington, D.C. 20472
'I:VI>SV
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION
MASON COUNTY, Lot 1, Short Plat No. 1916, as described in the Statutory Warranty Deed
WASHINGTON recorded as Document No. 2081788, in the Office of the Auditor, Mason
(Unincorporated Areas) County, Washington
COMMUNITY
The portion of property is more particularly described by the following
metes and bounds:
COMMUNITY NO.: 530115
AFFECTED NUMBER: 53045CO575E
MAP PANEL
DATE: 6/20/2019
FLOODING SOURCE:NAHWATZEL LAKE APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:47.236183,-123.334298
SOURCE OF LAT&LONG: LOMA LOGIC DATUM:NAD 83
DETERMINATION
OUTCOME 1%ANNUAL LOWEST LOWEST
HAT IS REMOVED CHANCE_ ADJACENT LOT
LOT BLOCK/ SUBDIVISION STREET FROM THE SFHA FLOOD FLOOD GRADE ELEVATION
SECTION ZONE ELEVATION ELEVATION (NAVD 88)
(NAVD 88) (NAVD 88)
1 -- Short Plat 1916 13310 West Shelton Portion of Property X -- - 458.0 feet
Matlock Road (unshaded)
Special Flood Hazard Area (SFHA) -The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or
exceeded in any given year(base flood).
ADDITIONAL CONSIDERATIONS(Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.)
LEGAL PROPERTY DESCRIPTION STATE LOCAL CONSIDERATIONS
PORTIONS REMAIN IN THE SFHA
ZONE A
s document provides the Federal Emergency Management Agencys determination regarding a request or a Letter o. Map Amendment :or the
property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined
that the described portion(s) of the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of
being equaled or exceeded in any given year(base flood). This document amends the effective NFIP map to remove the subject property from
the SFHA located on the effective NFIP map, therefore,the Federal mandatory flood insurance requirement does not apply. However, the lender
has the option to continue the flood insurance requirement to protect its financial risk on the loan.
This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this
detormination. If you have any questions about this dorumont, please contact the FEMA Mapping and Insurance oXchnnge (FMIX) toll froc nt
(877) 336-4---627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC Clearinghouse, 3601
Eisenhower Avenue, Suite 500,Alexandria,VA22304-6426.
Patrick"Rick"F.Sacbibit,P.E.,Branch Chief
Engineering Services Branch
Federal Insurance and Mitigation Administration
Page 2 of 2 Date: May 23,2023 Case No.: 23-10-0453A LOMA
orcnRlti�
J � Federal Emergency Management Agency
x ' Washington, D.C. 20472
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS)
LEGAL PROPERTY DESCRIPTION (CONTINUED)
BEGINNING AT THE SOUTHWESTERLY CORNER OF LOT 1 OF SAID SHORT PLAT SUBDIVISION;
THENCE NORTH 38°23'08"WEST, ALONG THE WESTERLY LINE THEREOF, A DISTANCE OF 189.23 FEET;
THENCE NORTH 50°57'00" EAST, FOR A DISTANCE OF 100.01 FEET, MORE OR LESS, TO THE EASTERLY
LINE OF SAID LOT; THENCE SOUTH 38°23'08" EAST.ALONG SAID EASTERLY LINE, FORA DISTANCE OF
190.86 FEET, MORE OR LESS, TO THE SOUTHWESTERLY CORNER OF SAID LOT AND THE NORTHERLY
MARGIN OF SHELTON-MATLOCK ROAD; THENCE SOUTH 51°52'43"WEST, ALONG SAID MARGIN, FORA
DISTANCE OF 100 FEET TO THE TRUE POINT OF BEGINNING
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA(This Additional Consideration applies to the
preceding 1 Property.)
Portions of this property, but not the subject of the Determination/Comment document, may remain in the
Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property
remains subject to Federal, State/Commonwealth, and local regulations for floodplain management.
ZONE A (This Additional Consideration applies to the preceding 1 Property.)
The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that
was determined using the best flood hazard data available to FEMA, but without performing a detailed
engineering analysis. The flood elevation used to make this determination is based on approximate methods
and has not been formalized through the standard process for establishing base flood elevations published in
the Flood Insurance Study. This flood elevation is subject to change.
STATE AND LOCAL CONSIDERATIONS (This Additional Consideration applies to all properties in the
LOMA DETERMINATION DOCUMENT (REMOVAL))
Please note that this document does not override or supersede any State or local procedural or substantive
provisions which may apply to floodplain management requirements associated with amendments to State or
local floodplain zoning ordinances, maps, or State or local procedures adopted under the National Flood
Insurance Program.
This attachment provides additional information regarding this request. If you have any questions about this attachmont, pleaso contact tho FEMA
Mapping and Insurance eXchange (FMIX) toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency
Management Agency, LOMC Clearinghouse, 3601 Eisenhower Avenue, Suite 500,Alexandria, VA 22304-642.6.
Patrick"Rick"F.Sacbibit,P.E.,Branch Chief
Engineering Services Branch
Federal Insurance and Mitigation AdminI strntlon
TX R
� Federal Emergency Management Agency
Washington, D.C. 20472
�qND 5"�
ADDITIONAL INFORMATION REGARDING
LETTERS OF MAP AMENDMENT
When making determinations on requests for Letters of Map Amendment (LOMAs), the Department of
Homeland Security's Federal Emergency Management Agency (FEMA) bases its determination on the
flood hazard information available at the time of the determination. Requesters should be aware that flood
conditions may change or new information may be generated that would supersede FEMA's determination.
In such cases,the community will be informed by letter.
Requesters also should be aware that removal of a property(parcel of land or structure) from the Special
Flood Hazard Area(SFHA)means FEMA has determined the property is not subject to inundation by the
flood having a 1-percent chance of being equaled or exceeded in any given year(base flood).This does not
mean the property is not subject to other flood hazards. The property could be inundated by a flood with a
magnitude greater than the base flood or by localized flooding not shown on the effective National Flood
Insurance Program(NFIP)map.
The effect of a LOMA is it removes the Federal requirement for the lender to require flood insurance
coverage for the property described. The LOMA is not a waiver of the condition that the property owner
maintain flood insurance coverage for the property. Only the lender can waive the flood insurance purchase
requirement because the lender imposed the requirement. The property owner roust request and receive a
written waiver from the lender before canceling the policy. The lender may determine, on its own as a
business decision, that it wishes to continue the flood insurance requirement to protect its financial risk on
the loan.
The LOMA provides FEMA's comment on the mandatory flood insurance requirements of the NFIP as they
apply to a particular property. A LOMA is not a building permit, nor should it be construed as such. Any
development, new construction, or substantial improvement of a property impacted by a LOMA must
comply with all applicable State and local criteria and other Federal criteria.
If a lender releases a property owner from the flood insurance requirement,and the property owner decides
to cancel the policy and seek a refund, the NFIP will refund the premium paid for the current policy year,
provided that no claim is pending or has been paid on the policy during the current policy year. The
property owner must provide a written waiver of the insurance requirement from the lender to the property
insurance agent or company servicing his or her policy. The agent or company will then process the refund
request.
Even though structures are not located in an SFHA,as mentioned above,they could be flooded by a flooding
event with a greater magnitude than the base flood. In fact, more than 25 percent of all claims paid by the
NFIP are for policies for structures located outside the SFHA in Zones B,C,X (shaded),or X (unshaded).
More than one-fourth of all policies purchased under the NFIP protect structures located in these zones.
The risk to structures located outside SFHAs is just not as great as the risk to structures located in SFHAs.
Finally,approximately 90 percent of all federally declared disasters are caused by flooding,and homeowners
insurance does not provide financial protection from this flooding. Therefore, FEMA encourages the
widest possible coverage under the NFIP.
LOMAENC-I (LOMA Removal)
LOMAs are based on minimum criteria established by the NFIP. State, county, and community officials,
based on knowledge of local conditions and in the interest of safety, may set higher standards for
constriction in the SFHA. If a State,county, or community has adopted more restrictive and comprehensive
floodplain management criteria, these criteria take precedence over the minimum Federal criteria.
In accordance with regulations adopted by the community when it made application to join the NFIP,
letters issued to amend an NFIP map must be attached to the community's official record copy of the map.
That map is available for public inspection at the community's official map repository. Therefore, FEMA
sends copies of all such letters to the affected community's official map repository.
When a restudy is undertaken, or when a sufficient number of revisions or amendments occur on particular
map panels, FEMA initiates the printing and distribution process for the affected panels. FEMA notifies
community officials in writing when affected map panels are being physically revised and distributed. In
such cases, FEMA attempts to reflect the results of the LOMA on the new map panel. If the results of
particular LOMAs cannot be reflected on the new map panel because of scale limitations, FEMA notifies
the community in writing and revalidates the LOMAs in that letter. LOMAs revalidated in this way usually
will become effective 1 day after the effective date of the revised map.
LI,pRTtijF
Federal Emergency Management Agency
' Washinbton, D.C. 20472
MIND SCG
May 23, 2023
MR. JAMES TURNBOW CASE NO.: 23-10-0453A
TURNBOW LAND SURVhYING, PLLC COMMUNITY: MASON COUNTY, WASHINGTON
P.O. BOX 834 (UNINCORPORATED AREAS)
SFILUI.ON, WA 98584 COMMUNITY NO.: 530115
DEAR MR. TURNBOW:
This is in reference to a request that the Federal Emergency Management Agency (FEMA)
determine if the property described in the enclosed document is located within an identified Special
Flood Hazard Area, the area that would be inundated by the flood having a I-percent chance of
being equaled or exceeded in any given year (base flood), on the effective National Flood Insurance
Program (NFIP) map. Using the information submitted and the effective NFIP map, our
determination is shown on the attached Letter of Map Amendment (LOMA) Determination
Document. This determination document provides additional information regarding the effective
NFIP map, the legal description of the property and our determination.
Additional documents are enclosed which provide information regarding the subject property and
LOMAs. Please see the List of Enclosures below to determine which documents are enclosed.
Other attachments specific to this request may be included as referenced in the
Determination/Comment document. If you have any questions about this letter or any of the
enclosures, please contact the FI3MA Map Insurance eXchange (FMIX) troll free at (877) 336-2627
(877-FIMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC
Clearinghouse, 3601 Eisenhower Avenue, Suite 500, Alexandria, VA 223 04-6426.
Sincerely,
Patrick "Rick" F. Sacbibit, P.E., Branch Chief
Engineering Services Branch
Federal Insurance and Mitigation Administration
LIST OF ENCLOSURES:
LOMA DETERMINATION DOCUMENT(REMOVAL)
cc: State/Commonwealth NFIP Coordinator
Community Map Repository
Region
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
City State ZIP Code Company NAIC Number
S H E_L-7FO f-i w /�4 0 9 b e y
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones Al—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,ARIA,AR/AE,AR/A1—A30,AR/AH,AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: WSRN Vertical Datum: NAVD-88
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 ❑X NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement, crawlspace,or enclosure floor) 458.5 ❑X feet ❑ meters
b) Top of the next higher floor 462.5 ❑X feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑ meters
d) Attached garage(top of slab) ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) 458.3 ❑X feet ❑ meters
f) Lowest adjacent(finished)grade next to building (LAG) 458.3 ❑X feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 459.5 [X] feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including
structural support 458.3 [A feet ❑ meters
SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑No ❑Check here if attachments.
Certifier's Name License Number s_. .A v
JAMES D TURNBOW 42679
Title
PROFESSIONAL LAND SURVEYOR
Company Name
TURNBOW LAND SURVEYING, PLLC `
Address S % !ti �0
PO BOX 834
L
City State ZIP Code
SHELTON / Washington Q 98584 S —�
Signature Date Telephone Ext.
06/14/2023 360-432-2753
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments (including type of equipment and location, per C2(e),if applicable)
B10-PORTION OF PARCEL REMOVED(ABOVE ELEVATION 458)PER LOMA CASE NUMBER 23-10-0453A
C2(b) ELEVATION REPRESENT TOP FORM AS CONSTRUCTED. BUILDING CURRENTLY BEING CONSTRUCTED.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company, and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owners Name Policy Number:
GREGORY A. BOGDANOVICH
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O.Route and Company NAIC Number:
Box No.
13310 W. SHELTON-MATLOCK ROAD
City State ZIP Code
SHELTON Washington 98584
A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
LOT 1,SHORT PLAT 1916,AFN 500261,TAX PARCEL 52008-13-90100, DEED AFN 2081788
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 47°14'1125"N Long. 123°20'0376"W Horizontal Datum: ❑ NAD 1927 ❑X NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 2534 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
B1.NFIP Community Name&Community Number B2. County Name B3. State
MASON COUNTY UNINCORPORATED MASON Washington
B4. Map/Panel B5, Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
53045CO575E E 06/20/2019 06/20/2019 x UNSHADED 458
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 139:
❑ FIS Profile ❑ FIRM ❑ Community Determined 0 Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 ❑X NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ❑ No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6