HomeMy WebLinkAboutBLD2008-00279 Final SFR - BLD Permit / Conditions - 11/5/2009 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 BLD2008-00279
OWNER: KEVIN SHEARER
CONTRACTOR: ALLEN SHEARER TRUCKING (360)275-3465 LICENSE:ALLENST074PA EXP: 2/6/2009 RECEIVED: 3/13/2008
SITE ADDRESS: 582 NE HAVEN LAKE DR TAHUYA ISSUED: 4/15/2008
PARCEL NUMBER: 223304290002 EXPIRES: 10/15/2008
LEGAL DESCRIPTION: LOT: 2 OF SP#2597
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New SFR Down North Shore right on Belfair Tahuya Road right on Haven Way left on
Haven Lake Dr. 1/4 mile on left 584- big entry way.
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: R-3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: No. of Stories: 2 Occ. Load: Building:4,000 Garage-Attached 676
Valuation: Building Height: Occ. Status: Primary Basement: COVPORCH 791
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: W 175.0 Ft. Shoreline: 150.0 Ft. Water Body: wetland
Rear: E 50.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: N 385.0 Ft. Shoreline Desig.: Unknown
Year: Serial No.: Side 2: S 200.0 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 CMH 3/13/2008 $486.69 B12008000
Hosebibs 5 Fireplace 1 Planning Review Fee CMH 3/13/2008 $190.00 612008000
Kitchen Sink 1 Furnace<100K 1 Fire Warden Review CMH 3/13/2008 $68.00 612008000
Lavatories 5 Ventilation Fan 5 Address Fee BLF 3/17/2008 $162.00 512008000
Showers 1 Heat Pump 1 ADJUST—Plan Check Fee ARC 3/17/2008 $1,036.49 S12008000
Water Closets (Toilets) 3 Dryer Vent 1 Building State Fee ARC 3/17/2008 $4.50 S12008000
Water Heaters 1 Building Permit Fee ARC 3/17/2008 $2,343.35 S12008000
Bath Tubs 2 Mechanical Fee ARC 3/17/2008 $164.85 S12008000
Clothes Washer 1 Mechanical Base Fee ARC 3/17/2008 $26.60 S12008000
Plumbing Fee ARC 3/17/2008 $128.11 S12008000
Plumbing Base Fee ARC 3/17/2008 $23.10 S12008000
EH Plan Review ADR 4/15/2008 $100.00 S12008000
Water Adequacy Plan Review ADR 4/15/2008 $50.00 S12008000
Total $4,783.69
BLD2008-00279 Please refer to the following pages for conditions of this permit. 1 of 5
t CASE NOTES FOR
BLD2008-00279
CONDITIONS FOR
B LD2008-00279
1) Approv4nfsionDspd setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
2) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There ar, pgte risl, and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-6 9 erson signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
3) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be gr n d. n ddition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Departm pri any further inspections being performed or approvals granted.
X
4) Owner/ erit' o' ible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
5) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicate plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. T r is responsible to retain the complete approved set of plans on site for the durati the project. Failure to comply and/or
removal appr ocu nts will result in failure of required building inspections.
X
6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X `
l
7) The"approved"site plan quired to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then
approval will n t r n addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Building De t ri any f rther inspections being performed or approvals granted.
X
BLD2008-00279 Please referto the following pages for conditions of this permit. 2 of 5
8) , Washington State Energy Code Compliance has been approved using the following:
0, Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation R-10.
Exception: - 0 ins ay be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
underside in is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
9) Per 2003 IRC -_;SEC 609-WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum i loa sc bed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WI P OND GUST) the wind speed for Mason County is 85 MPH.
X
10) Per 2003 10iith
*Ie
05- REQUIREMENTS FOR ROOF COVERINGS- R905.1 Roof covering application. Roof coverings shall be applied in
accordan provisions of this section and the manufacturer's installation instructions.
X
11) 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/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 tKnow
4egg ;at
septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor is all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
12) Concrete used for baseme 4"s, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concr rk dtib the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
13) Any changes in ropos construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Departmen to str tic All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. ocu a �s a oved, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged an sh a collecte by the Building Department prior to any further inspections being performed or approvals granted.
X
14) 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 Wpship gt Oo� ncy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit rev on.
X
BLD2008-00279 Please referto the following pages for conditions of this permit. 3 of 5
15) 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 t REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Ma County a , Cont ct the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be locate in 2 f a n County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.
X
16) All chang s�regup"Nn,
p ov d" b ilding plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance be reviewed and approved by Mason County prior to construction.
X
17) CONSTR CTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The constr ctio o p rmitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the int io a co s amended and adopted by Mason County. Any corrections, changes or al r equired by a Mason County Building
Inspector a e ri to requesting additional inspections.
X
18) All property lines shall be clearly identified at the time of foundation inspection. X
19) All building p its shall a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to reques final in p tion r to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason my o i an nd building regulations.
X
20) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a perio not xc dig 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder hav rven d a rom being taken. No more than one extension may be granted.
X
21) Pressure treat woo m nu red after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, all m al connectors approved for contact with the new types of pressure treated material.
X
22) Landings and m m he same setback conditions as any permitted structure, and, must be shown on your site plan. Please check your
"Approve Ian a ese structures are shown and meet the setback conditions listed.
X
23) Water quality' of o e aded to the detriment of the aquatic environment as a result of this project.
X
24) Prior to final JL, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
BLD2008-00279 Please refer to the following pages for conditions of this permit. 4 of 5
25) All construction and demolition debris must be removed from the beach after project completion. Proper disL,,;alf tr �tion debris must be on land
in such a manner that debris cannot enter or cause water quality degredation of State waters. X
26) Temporary erosion control measures must be implemented to prevent water quality de dati f ent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X
27) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are re ed`fo is osed development and
construction must be obtained PRIOR T ;SACMEVELOPMENT AND CONSTRUCTION. X
28) Due to the amount of wetland are in prroposed building area all construction best management practices must be strictly adhered to during
the construction phaseX
29) By definition, prop ne tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these struct s et a tback conditions listed.
X
This permit becomes null and void if work or construction th rized 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 co nuation of work is a pro es 'nspection 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 ro r s inspectio . wner r t agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described prop and str ure r r4vie a inspection. I
OWNER OR AGENT: DATE: ��l
BLD2008-00279 Please referto the following pages for conditions of this permit. 5 of 5
AV
NW to
CONCRETE MECHANICAL MANUFACTURED HOME _
o Date/,,,� .,l�t7 B '�iyf -- m
CD rn Footings !Setbacks Ribbons D
Gas Piping
o Interior Date By Interior-Date By Data By M
Exterior Date — By Exterior-Date Bt-
up
Point Load!Isolated Footings INSULATION Hate By m
Date y- )g-o� By Tn BG 1 SLAB INSULATION -------- �
I Date By FIRE DEPARTMENT Z
Foundation Wall Go r0 Floors Date By
Date By Data ? _3 -4>K By DECKS
FRAMING walls Date By
Date Bv. Data By PROPANE TANKS
PLUMBING' vault Date By
Dale By LOTHER
Groundwork Attic
Dale By Date By Type-
Dato e�
D.w.V DRYWALL Type:
Int.Brace Wail Date 5y W
Date - /— By Date By FINAL INSPECTION r—
w Water Line r� Fire Separation � o1V
m Dale -7- [.-/.OV By Date By Date I �` By /
00
`° Pass or Request Inspect. c
Type of Insp. Fail Date Date Dane By Comments N
m V
0
6elvCD � ti_r
N / Go.,.T/�+'i oct s �9/� —
a i7 lv.9c L. 4iiL.C
0
CD
�j-Ls; -LSo9
FW - ,ram' �
vq"r- t"g oL. F t ►
/
ct` 1
a;7 a-7-/-or ,ova s.�reeff,� 3 72_7�
.25
�7L
L
RECEIVED
MAR
LoTt
W4D
\ 4
- \ z 7 ,
��\
�l � 8
21:-31 \
Te�o 5(bo �,A
APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUI;'ED TO BE ON SITE `1V0�A— g
C ANG S �BJECT TJ APPROVAL
By 4m� Date
Afeax, Yq
Mason County Map Output Page Page 1 of 1
Mason Count Ma MAR 13
z
D BELFA R OFFICE
l _
n
1 * J
NE FAFORD WAY
w
NE HAVEN WAY ¢
3 J�2 m
- � 4� i
w
J
z �t0
0
N&ventu
�S fi
v p
m y
�a
i
4Y
a
QY f I
J s
z x
O m
A
ti �
m x
z r�
z Z
Uj a
m �
NE WINDFLOWER WAY _...... w
z
X
tsasrt
DISCLAIMER AND LIMITATION OF LIABILITY:
The data used to make this map have been tested for accuracy,and every effort has been
made to ensure that these data are timely,accurate and reliable.However,Mason County LEGEND
makes no guarantee or warranty to its accuracy as to labeling,dimensions,or placement or
location of any map features contained herein.The boundaries depicted by these data are Goads Federal Landis
approximate,and are not necessarily accurate to surveying or engineering standards,and are
intended for informational purposes only.Mason County does not assume any legal liability ✓�`✓Hignways 4 City of Shelton
or responsibility arising from the use of this map in a manner not intended by Mason County.
In no event shall Mason County be liable for direct,indirect,incidental,consequential, Rivers S[reem County Boundary IC}htR)
special,or tort damages of any kind,including,but not limited to,loss of anticipated profits P 9tt?eI5 CQhtittr8510t�91 Districts
benefits arising from use of or refiance on the information contained herein
Sections ' Lakes
0 2006-Mason County
415 N.Sixth Street Townships Rupet Sound&Major Lakes
Shelton,WA 98584
http://mapmason.co.mason.wa.us/servlet/com.esri.esrimap.Esrimap?ServiceName=amason... 3/13/2008
ACCESS & GRADE INSPECTION OLD
--, ]
ADDRESS ✓ c_ ' l (,� P �. L/� De
INSPECTOR ` �'' ' DATE: . g
DRIVEWAY ACCESS
Length:h: Width: Surface:
e
Size of turn-around:
Condition of shoulders:
Vertical clearance:
( ) need post at end of driveway with reflective address numbers.
GRADE,OF DRIVEWAY %, OF ROAD %
ROAD ACCESS
Length: Width: Surface:
Condition of shoulders:
Vertical clearance:
( ) BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
( ) LOT INSIDE _ FIRES ONLY.
( ) LOT INSIDE UGA, NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS 4X4 FIRES 2x3 FIRES.
PASSED ( ) FAILED ( ) ON HOLD ( )
REMARKS � ��� `'. _ � 1 c
(continue remarks on back)
Name_ '�✓� Parcel# "�2U Z BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in tkis jurisdiction. A complete copy of the ordinance can be found on the Mason County w �: t
http//www.co.mason.w'a—us/code/commissioners/index.htm 'q
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management". l-Aik UtflCE
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist you
in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public
Works this document will constitute an approved plan if all of the relevant details* are to be installed in their
entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A).. — The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
TO BE KEPT IIg f ` w: (360)-427-9670 EXT.450
a 1. Box 1850, Shelton WA 98584
PARCEL FttcE 415 N 6th St, Shelton WA 98584
If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the Stormwater system will not adversely affect the septic system of this,or
any other,parcel. You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT. 352
Mail.P 0 Box 1666, Shelton WA 98584
Physical: 426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of s h is by signature below. I declare that I am the owner,owner's legal representative,or the contractor.I further
acknowledge that the ' ation provided is accurate and employees of Mason County are granted access to the above-described
prope evie d in ection as may be required.
X Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
Name Parcel# BLD#
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 X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections (example:
eaves/gutters)
X =
Driveways 11X =
Length of drive begins at the right of way
X =
Parking Areas X
X __ Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
Others - X =
X = If the total impervious area:of the proposed site
X = development is.gre6ter than 2000 square feet a
Small Parcel Stormwater-Site Plan is Required
Total Impervious Surface Area (sum of all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owner's legal representative,or the contractor.I further
acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-described
property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:_
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR IN OR N
Owner N " = Company Name . - �V L m
MailingAddress
X I Mailing Address O 761
City _ A��- Sta ek_Zip Code City A State L Zip Code 2
Phone 3 _ Other Ph. 36, 2.1 S� J�7 Phone y� Other Ph.
Lien/Title Holder �� ✓f Contractor Reg. A� Exp. 20
E mail address E Mail Address
Drivers Lic. #_`�}ac:.'It'- r�2L`�� DOB -I - Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well_ Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. — - Fire District
Legal Description
Site Address (Please include stfeet name, street number and city V AN A
Directions to si -iA Ac V -I"�
Will timber be cut and sold in parcel preparation?Yes No
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland�_Seasonal Runoff '! Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - NewA_Add Alt Repair Other PRIMARY RESIDENCE F SEASONAL ❑
Use of Building ADMt- Describe Work 1&2 L.p ►�E{�UMcz
No. of Bedrooms— No. of Bathrooms 2 L Square Footage- 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage ?�. Attached X Detached f 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 informaticn provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or au �o� tr tion is
not commenced with' 0 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUPNfl-1ryIvY
MEANS.QFAPR I ON.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE IHAR 13 20f fOpO08
Date:
Owner/Owners epresentative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: a AIR OFFICE
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Fire Marshal
FEES
Buildinq Permit Fee Site Ins ection
Plan Review Fee 44J S«a 0 316 EH Review Fee
Plumbing & Base Fee 1 5 • 'Z� • Planning Review Fee
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee a E F Bu re-Paid at Submittal
Valuation $ 31-01 3 6 .74 TOTAL FEES
.. .?..,..,..,.:.. r.;.-n-,�..g7'.J'Ro�vtowtnTR",^'E�7d7,+^..1�['}..'�.v-e+,nrs,+-r.-•..�ywrrgsrTTRr..n.q...-r.--�'."P`-+�;�s�'1n-vF:r�.n.7}. .. .�//y ..
0Ve
Fr
Fi r 5 F 4o a R.
77 ( -
U 7-
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.Co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name _f i;� / Llti(-7
Mailing Address Mailing Address
City State Zip Code City State Zip Code Z
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. #;', i; ! Exp. 7 � 'V
E mail address E Mail Address
Drivers Lic. # DOB Drivers Lic. # DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic 1%'` Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to sile `` t
4
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/ Creek Pond
Wetland ',' Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New ,� Add Alt Repair Other PRIMARY RESIDENCE F SEASONAL ❑
Use of Building Il -It Describe Work
No. of Bedrooms -�5 No. of Bathrooms ''%-'_ Square Footage- 1 st Floor 2nd Floor
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 informaticn provided is accurate and grants employees of Mason County access to the
described property and structure for review and inspection. This permit/application becomes null & void if work or au��X 4 rou t is
not commenced withip-180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUA�'4V41b-W IS BY
MEANS OFAPRQGRESSINSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF180 DAYS WILL INVALIDATE THEAPPLI A
MAR1
X�-,��,; � (.,�. . _ Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department iU
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planninq Review Fee
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
d PERMIT NO.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar• P.O. Box 186, Shelton,WA 98584
Shelton (360) 427-9670•Belfair(360) 275-4467• Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR I ORMA ION
Owner !` �� ;r_" � t.A Company Name
Mailing Addres w FAX I > Mailing Address p
City RE412-11 kz- State I JA ZipCodecJA62b City A. fate — Zip Code
Phone 5W -;WO 3/ye Other Ph.�/<027Sr39?7 Phone '�S her Ph.
Lien/Title Holder Contractor Reg.4 Lex Exp. -
E mail address E Mail Address
Drivers Lic.#S146?4CXfA?_.UI 0 DOB 3 - J' Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic: Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city) Y WA
Directions to site �' - Y1AjAt(QNAutZkJ
Eq nj T T Y h
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland._Seasonal Runoff__)_-�__Stream Slopes or Bluffs > 15%
TYPE OF JOB - New-)(--Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1st Floor 2nd Floor ''Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_X I_PQ_ Natural Gas— Heat Pump__
Toilets Type of Unit No. of Units Fees
Bathroom Sink A" Furnace Z
Bath Tubs � Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks �— oo as/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent l
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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,re =i swtmation
provided is accurate and grants-employees of-Mason County access to the above described property and structure for r��i i s
PROOF ONTINU WORK IS MEANS OF A PROGRESS INSPECTION.
X --yam, _ Date:
MAR 13 2008
Owner/Owners epresentative/Contractor (indicate which one)
aELFAIR OFFICE
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES