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HomeMy WebLinkAboutBLD2002-00713 Final SFR and Deck - BLD Permit / Conditions - 11/21/2007 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 P10 RESIDENTIAL BUILDING PERMIT BLD2002-00713 OWNER: RODNEY POLSON RECEIVED: 6/5/2002 CONTRACTOR: LICENSE: EXP: ISSUED: 7/19/2002 SITE ADDRESS: 170 NE LAKE DR TAHUYA EXPIRES: 5/17/2007 PARCEL NUMBER: 223305000174 LEGAL DESCRIPTION: HAVEN LAKE TR. 174 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE AND DECK TAKE NORTH SHORE ROAD WEST OUT OF BELFAIR, TURN RIGHT ON BELFAIR TAHUYA RD., TURN LEFT ON HAVEN LAKE RD., TURN RIGHT ON TAHUYA BLACKSMITH RD., TURN RIGHT ON NE LAKE RD., HALFWAY nnwN TH RnAn nN THE RI General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: V-N Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: 404 Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:952 Valuation: Building Height: 27 Occ. Status: Seasonal Basement:952 Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: W 136.0 Ft. Shoreline: 42.0 Ft. Water Body: HAVEN LAKE g SEPA?: No 10 Model: Width: Ft. Rear: E .0 Ft. Slope: Ft. Shoreline Desi Side 1: N .0 Ft. 9.: Urban Year: Serial No.: Side 2: S 7.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Kitchen Sink 1 Furnace<100K 1 Plan Check Fee KLW 6/5/2002 $541.29 59494 Lavatories 2 Gas Outlets 3 Planning Review Fee RAM 6/6/2002 $38.00 59978 Showers 1 Propane Tank 1 EH Plan Review CEW 6/12/2002 $75.00 59978 Water Closets (Toilets) 2 Ventilation Fan 4 Building State Fee RLS 7/17/2002 $4.50 59978 Water Heaters 1 Propane Stove 1 Building Permit Fee RLS 7/17/2002 $832.75 59978 Bath Tubs 2 Mechanical Base Fee RLS 7/17/2002 $23.50 59978 Clothes Washer 1 Mechanical Fee RLS 7/17/2002 $65.10 59978 Plumbing Base Fee RLS 7/17/2002 $20.00 59978 Plumbing Fee RLS 7/17/2002 $70.00 59978 Tank install/remove RLS 7/17/2002 $52.30 59978 Additional Plan Check Fee RLS 5/8/2003 $56.80 S12003000 Building Permit Fee RLS 5/8/2003 $7.00 S12003000 Mechanical Base Fee GMM 5/10/2007 $8.00 612007000 Mechanical Fee GMM 5/10/2007 $60.00 B12007000 Total $1,854.24 BLD2002-00713 Please referto the following pages for conditions of this permit. 1 of 4 t ' r MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone:Inspection Line (96700,ext7262 352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 L� RESIDENTIAL BUILDING PERMIT BLD2002-00713 OWNER: RODNEY POLSON 253-941-6275 CONTRACTOR: LICENSE: EXP: RECEIVED: 6/5/2002 SITE ADDRESS: 170 NE LAKE DR TAHUYA ISSUED: 7/19/2002 PARCEL NUMBER: 223305000174 EXPIRES: 1/19/2003 LEGAL DESCRIPTION: HAVEN LAKE TR. 174 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE AND DECK TAKE NORTH SHORE ROAD WEST OUT OF BELFAIR, TURN RIGHT ON BELFAIR TAHUYA RD., TURN LEFT ON HAVEN LAKE RD., TURN RIGHT ON TAHUYA BLACKSMITH RD., TURN RIGHT ON NE LAKE RD., HALFWAY DOWN TH ROAD ON THE RIGHT SIDE LOT 174 General Information Construction &Occupancy Information Square Footage Information No.of Bedrooms: 2 Type of Constr.: V-N Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: 404 Type of Work: NEW Fire Dist.: 2 No.of Stories: 2 Occ. Load: Building:952 Valuation: $76,042 Building Height: 27 Occ. Status: Seasonal Basement:952 Manufactured Home Information Setback Information Shoreline & Planning Information Make: Length: Ft. Front: W 136.0 Ft. Shoreline: 42.0 Ft. Water Body: HAVEN LAKE Rear: E 42.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 10.0 Ft. Shoreline Desig.: Urban Year: Serial No.: Side 2: S 7.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Water Closets (Toilets) 2 Furnace<100K 1 Plan Check Fee KLW 6/5/2002 $541.29 59494 Lavatories 2 Gas Outlets 3 Planning Review Fee RAM 6/6/2002 $38.00 59978 Bath Tubs 2 Propane Tank 1 EH Plan Review CEW 6/12/2002 $75.00 59978 Showers 1 Ventilation Fan 4 Building State Fee RLS 7/17/2002 $4.50 59978 Water Heaters 1 Building Permit Fee RLS 7/17/2002 $832.75 59978 Clothes Washer 1 Mechanical Base Fee RLS 7/17/2002 $23.50 59978 Kitchen Sink 1 Mechanical Fee RLS 7/17/2002 $65.10 59978 Plumbing Base Fee RLS 7/17/2002 $20.00 59978 Plumbing Fee RLS 7/17/2002 $70.00 59978 Tank install/remove RLS 7/17/2002 $52.30 59978 Total $1,722.44 BLD2002-00713 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2002-00713 CONDITIONS FOR BLD2002-00713 1) This application is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036.X �(2 ,O 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 are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-.j547-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X ,2/l , 3) The use, handling and storage of hazardotis materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. X 4) 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 X 5) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Charell Holcomb, at (206)427-9670, ext. 450. X 6) 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 7) The proposed project must be consiste t Vh all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program.X 8) X atex quality is not to be degraded to the detriment of the aquatic environment as a result of this project. 9) All construction and demolition debris must be removed from the beach after project completion. Pop r disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degredation of State waters. X BLD2002-00713 Please refer to the following pages for conditions of this permit. 2 of 4 10) Approved per dimensions and setbacks on submitted site plan. XA�Z 11) 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 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 De X p m nt prior to any further inspections being performed or approvals granted. 12) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located in such a position as to be plainly visible and legible from the street or road fronting the property. Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspections. X ,42,-­' 13) The plan review check list and corrections, along with the Energy Compliance Worksheet(when applicable) are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the 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 plan site for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. X 14) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X_,rQ/-`� 15) The"approved" plot plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" plot plan is not on site, then approval will not be grarited. 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. X 16) Washington State Energy Code Compliance has been approved using the following: Heat Type:LPG Compliance Method: IV Window(Max U-Factor): .65 Skylight(Max U-Factor): .68 Doors (Type/Max U-Factor):.40 foam core ,Wall insulation R- 19, Floor insulation R- 19, Ceiling Insulation R-30 , Vault Insulation R-30 , Slab Insulation R- 10X 17) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code 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 i p mit revocation. X a�l 18) All changes to "approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance or re ti n, must be reviewed and approved by Mason County prior to construction. X 19) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspec r all be made prior to requesting additional inspections. X BLD2002-00713 Please referto the following pages for conditions of this permit. 3 of 4 20) All propane tanks must be installed in accordance with the Uniform 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. X ,!:`� 21) Fuel piping shall be inspected after the installation of gas 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 be_usgd until the final inspection has been performed and approved by a Mason County building inspector. X 22) Owner/applicant must obtain a seperate perlpit for the placement of any size propane tank serving a fixed appliance within a dwelling structure or unit prior to the placement of the tank. X rQ- 23) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to Planning Department regulations. Such regulations primarily consist of setbacks from shorelines and features considered to be critical areas (streams, wetlands, slopes, etc.) If you think such features exist on or nearby your property, please contact the Planning Department so that exact setback requirements can be determined. X 24) All property lines shall be clearly identified at the time of foundation inspection. X XO�� 25) All building 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 Cal ordinances and building regulations. X 26) 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 period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have prevented action from being taken. No more than one extension may be granted. X 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 anytime 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. OWN ER OR AGENT: DATE:-7- va- -- I BLD2002-00713 Please referto the following pages for conditions of this permit. 4 of 4 ' 7�4 G �� Z`'� 35SnJSl �;l L ►) I l Q 0.� ', F-z,S - 1 Z7- ssg' t/ --7/Gr7 b � '�. ! f� �3^1 �.; 2i 1 SDI97aO -T► nip ci� —z;r Q Aq elep ..-C�-J-Aq L 1 elep I V' i �q . elep N01103dSNIIIIVNId our �eleM elep Aq9 amp i9 .l JNIIIV V ellVM /�M'0 Aq £ t elep elep q '�`� o J E13HIO O 18Wflld Aq slap -)(t+i Aq C! £ I elep �q elm '1d3U 3HId SIfeM � NIYIIVlid Aq elep Aq elep Aq slap ie"W uo4elnsul OVISADO Aq elep NOLLV1f1SNl Z _ e mp do leS --7 Q"Aq ( � . elep SIMM UWA" g eleP 0 00 01 V 4 Bu seO Aq e- SuogglU j�j Aq _, 42 j 7 elep 40Val'AS-'5m41do=l 3WOH 31180W IVOINVH33W 3� 4 Y From: "Debbera Coker" <Dlc.PAC.MASON> To: pib.INSPECTORS.PAC.MASON Date sent: Tue, 24 Sep 2002 09:39:34 -0700 Subject: 131-132002-00713, Poison Phyllis would you make a note on the inspection card for me? R-0 slab ok provided: R-5 (exterior) + R-19 interior Where R-5 exterior is not installed, minimum R-21 wall insulation. Thank you! PyoN-S T,gr Fo� MASON COUNTY Mc .� DEPARTMENT OF COMMUNITY DEVELOPMENT o s"°u '= Planning Division z o T = P O Box 279, Shelton,WA 98684 N .0 Y o~ (360)427-9670 1864 NOTIFICATION OF INCOMPLETE APPLICATION June 06, 2002 RODNEY POLSON 4625 S 289TH PL AUBURN WA 98001 Parcel No.: 223305000174 Project Description: RESIDENCE AND DECK Dear Applicant: You have submitted a permit application (case no. BLD20 02-00 71 3) for proposed construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. Please contact me at (360)427-9670, ext. 577 if you have questions. Sincerely, Rick Mraz Land Use Planner Mason County Planning Department 6/6/2002 1 of 2 BLD2002-00713 NOTIFICATION OF INCOMPLETE APPLICATION 6/6/2002 Case No.: BLD2002-00713 Comments: Per the comments from a previous site inspection by Scott Longanecker, the proposal will require a geological assessment to support the construction. Scott's letter, dated 9/11/01, included a copy of the Landslide Hazard Areas chapter of the Mason County Resource Ordinance. This document details the specific contents of a geological assessment. Since the building permit application is incomplete, the proposal does not vest to old shoreline regulations but, instead, must comply with those rules that came into effect on June 1, 2002. However, based upon the RLC letter, it appears the proposal still complies with current shoreline setback requirements. If you have questions or require clarification on these issues, please contact me. 6/6/2002 2 of 2 BLD2002-00713 .x-;.ux dra!-. ...:.:.+r.. "'s' � _ - - �� �,��� �I -r:� ,y�tl-.. �v- .•j / �,t h•.r' ��. .. MASON COUNTY, WASHINGTON � M SCALE ! s 100', t JA Q 277 ,tT� 30 gap IN ? � .ram � "�i►'�� � ��o ���-v�`�-%�- 0� o o ��, .tom. �3 '' �.r�Q "'�'p v'•>� x�� �► � MASON COUNTY PERMIT ASSISTANCE CENTER PLANS SUBMITTAL CHECKLIST Owners name: P<3 1 Date�6-r`31-Uwe Project: Y6"�' G Reviewed by: Documents: Accurate site plan attached to each set of plans (road setback /sideyards < 10? ► Topography attached to each set of plans Energy Code application (heat fuel type 1-9 urrr_Cn 1 Mechanical/Plumbing application complete (water heater fuel pe &location: (_ ) Contractor registration#OR provide written notice "Hiring a Contractor or Remodeler Engineering/design criteria: snow load, 80 mph wind/exp, seismic zone 3 (Scope? ) Construction Plans: (3 sets) js Plans legible Recognized scale Cross Section Elevation K Roof framing ' Deck framing Foundation plan )< Floor framing,all levels Floor plan (use of rooms) DETAIL: (Include wood species and grade, i.e. DF#2, HF#2, PT, etc.) >C Roof framing detail (species, size, &spacing)}rob6 Wall framing detail (size, species, &spacinAAAAPIo P-GGv 1(0"o • c- Bearing wall ht exceeding 10 ft requires engineering Floor beams(size, species, &spacing) Floor joists (size, spacing, species) \-7[q j cb s)(vv Header and beam (size &species for openings over 4 ft) 6ee P\c c,- OC-1 Foundation (size, steel, anchoring)1 Concrete walls (Reinforcement detail, >8 ft requires engineering) Non-conventional framing (steel structures, foam core, log, etc. requires full engineering) Fire separation walls shown on plans Point loads identified, calculations provided if needed. Slab insulation shown Stairs/Handrails on stairs with more than 3 risers ;C Guardrails on landings greater than 30" above grade Location of furnace identified on plan, where?��<nyw.eA'Jk OV NJ c Propane appliances in basement (3" screened floor drain to o/s,2 combus 'on vents) Fireplace/Stove information shown Window sizes marked Covered porch detail (Use ICBO Chapter detail? 1 �d Braced wall lines clearly marked on plans (Within 8 ft of corner, n.t.e. 25 ft o.c., table 23-IV-C-1) Interior braced wall lines required for boxes greater than 34 ft 5 Do plans meet UBC prescriptive braced wall line requirements? UNUSUAL SHAPES: Roof or floor extend more than 6 feet beyond brace wall line or ICBO detail. (2320.5.4.2) Openings greater than 12 feet or 50% of the least floor area. (2320.5.4.4) Braced wall lines do not meet in a perpendicular direction. (2320.5.4.6) Braced wall lines offset the vertical plane from the foundation (2xl 2 NTE 48", 2xl0 NTE 40", no offset in 2x8 or smaller) (2320.5.4.1) Floor and roof is laterally supported by braced wall lines on all edges (2326.5.4.4) The end of a braced wall panel extends more than 1 ft over an opening in the floor below (BWP may extend over an opening 8 ft or less in width when the header is 4xl2 or more, U.B.C. section 2320.5.4.3) Engineered documents (Engineering required/included? ► Design criteria-snow load , wind 80 mph, exposure C, seismic zone 3 Engineered data transferred onto the plans Structural general notes& calculations, 2 sets (Specify scope of work, project location, design criteria, etc) Washington State licensed engineers or architect signature and eng. expiration date COMMENTS: 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 Seattle 206 464-6968 APPLICANT INFORMATION (� CONTRACTOR INFORMATION Owner k-Ansy S �ini•�w 1"OL-SOAJ Contractor Name Mailing�1 Address y61S S. 1R /PL . Mailing Address City /'Tabu,n State 41.4 Zip Code OY9001 City State Zip Code Phone(Z<'t )9W-G 17SOther Ph.U Ph.C__ Other Ph.0 Lien/Title Holder 5,4~ Contractor Reg. #_ Address Expiration / / SEPTIC INFORMATION-Connect to New Septic.X_Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. 2. 33 0 / 0 00 175/ Fire Distric Legal Description Site Address(Please include street name, street number and city) _ Directions to site ie. am' •r - a A Al. .•.1A 14 ca r,4 A I gign o claw.. T f-h4,1 ewd V n a AI A* s e.-Lar/74/ Is your property within 200' of the following: Body of Water(Name)_U.4ae,y 4r4ke Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building f ecrea .arf Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets _ - Type of Unit No. of Units Fees Bath Basins 7- Furnace Bath Tubs Z Heatpumps Showers _1_ Vent Fans Water Heater �_ Propane Tank 1 Laundry Wsher_� Gas Outlets Sinks �_ Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date s Zg O z► X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AEPARTMENTA[ RW.ENl>; RRPFt(]VEi . DEMIEt3......;> CONDITION 4DES' Building Department Occ Group Type Constr. Planning Department Other Other . .. �$ ....... ..... .. Permit Fee Site Ins..ection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES MASON COUNTY PROJECT SITE INFORMATION N Case No. I Name lCodne $ A i / `LSoN PARCEL NUMBER Z2330"SO —001 �1J Date .27 O Z SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property lined .I I Fadjacent property line I I I I I I I I I I I I I I I I I I � I I I I I I I 1 I I I I I f/w I I 1 � I I I I I I I I I I I I I � I I I I adjacent property line- I I <--adjacent property line SAMPLE SITE PLAN adja ent property line-� f-adjacent property line D 30' rR�SCRvE 3o+I Sf1L_S�w!AL I H J. I Hone b I GnaEN c�k I I HOu.s f� i I j P0.oPCaLb smpt:c �I I. 1 I r4— 60' --/30 C �I VAAfuT I I CrARA[.4 I % I o I Ili P.0PmCD \ / I -'\\ T A&R=iA.LrLLAA L 50 i K---40"� \ yo• I I I I I eo• —91 I I I \ I /00" I I L--e-LL I I { I I i I � 0' I adjacent ro ert line-� i af- \i Fad'acent ro ert' line I TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) i SAMPLE TOPOGRAPHY PROFILE E7 sec r� di Star.cQ +,0 f nrJ//I�G ►' "1.a.1�L ' 7a Sf rwrlw t Rna� d iS't'�►'�LG +a S�opa 'f-o¢ IG2'oN So„Ta Noust de+ter,` yQdNl�ur�� roff I N ON ZWr IN AJVe44, S,rle Signature Date N - �S'I o J q O-J �2 r No 1 I v�oj I S \� I d b �n s D d d MASON COUNTY PERMIT NO. _ 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 INFORMATIQU . CONTRACTOR INFORMATION Owner !� Company Name Mailing Address _Izz ?'Q 4 yh/JI Mailing Address cityh - State ' Zip Code�A/X-21 City State Zip Code Phone,?4�3 yc I- (z�-j Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB 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. 7 7 1 nt-I-) �7,14 Fire District Legal Description _ Site Address (Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPC�_ Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove (e[ Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent 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 parry 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X .� 1,r-w & y4 Date: caner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted bye , Planning Pd Ck# Date 4 Bld 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 OU UFC Plan Review Fee Wood /Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES MASON COUNTY PERMIT NO.: BL 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Ro hpjc v � Dbm JrA PQLSnn/ Contractor Name �(/v�✓Q Mailing Address &.2 s S 292 0 )OL, Mailing Address City State fitZ& Zip Code gg_&-ij City ate Zip Code Phone( ffjj 9y//_1,275-Other Ph.(_____) Ph.( Other Ph.( Lien/Title Holder lame— Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic_X_Existing Septic Connect to Sewer System Name of Sewer System Well__X_Water System Name of Water System i PARCEL INFORMATION-12 digit Tax Parcel No. 2 2. 3 f 7 / -0 D© 1:jam Fire District Legal Description 'r Site Address(Please include street name, street number and city) — Directions to site-7—AK o P r de r, La Will timber be cut and sold in par el preparatio ? (Yes/No)4im raw ..+ the r."k+ s,JL - to-?-1 A/ Is your property within 200' of the following: Body of Water (Name) 4AUe,y Lake Saltwater Lake)_ River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE TYPE OF JOB Newer_Add Alt Repair Other Use of Buildingrecti-fo-T171 Describe Work No. of Bedrooms_Z__No. of Bathrooms QUARE FOOTAGE-1st Floor2nd Floor 3rd Floor Loft Basement 95'7. Deck Y1�41 _Other sq. ft. Garap _Attached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approv first obtaining approval. X Date 5' Z X Date FOR OFFICIA USE BEYOND THIS POINT c� Accepted byP Date 51J11J&ubmittal Amount Due Receipt No.5 1 D�RARTNIE EVIW APP ov€a DENIED CONDITION Cop[w5 Building Dep IT� t Occ Group Constr. V-14 Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical& Base Fee Other a;5 OU Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES