HomeMy WebLinkAboutBLD2013-00502 Final SFR - BLD Permit / Conditions - 4/11/2014 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 279
� Shelton, WA 98584 �r""4T'� C��'L P'5�1� �
RESIDENTIAL BUILDING PERMIT BLD2013-00502
OWNER: MIKE SECHREST RECEIVED: 6/28/2013
CONTRACTOR: MORGAN BUILT HOMES 1.360.830-5065 LICENSE: MORGABH876LC EXP.- 6/3/2015 ISSUED: 8/9/2013
SITEADDRESS: 270 NE LAKE DR TAHUYA EXPIRES: 2/9/2014
PARCEL NUMBER: 223305000188
LEGAL DESCRIPTION: HAVEN LAKE TR. 188
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR- 1 bedroom + full loft open to below, unfinished basement ST RT 3 TO BELFAIR, L ON ST RT 300/NORTH SHORE RD, R ON BELFAIR
TAHUYA RD, R ON TAHUYA BLACKSMITH, R ON LAKE DR TO SITE
ADDRESS ON THE RIGHT SIDE
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 1 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Group: R3 Lot Size: Deck: 400
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:1,040
Valuation: $ 122,409.28 Building Height: Occ. Status: Seasonal Basement:412 cov entry 16
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: W 133.0 Ft. Shoreline: 63.0 Ft. Water Body: HAVEN LAKE
Rear: E 63.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: N 5.6 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 2: S 9.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 1 Heat Pump 1 Plan Check Fee GMM 6/28/2013 $766.06 S120130000000i
Lavatories 1 Ventilation Fan 2 EH Plan Review GMM 6/28/2013 $ 103.00 S1201300000001
Bath Tubs 1 Propane Tank 1 Water Adequacy Plan Revi GMM 6/28/2013 $ 103.00 S1201300000001
Water Heaters 1 Gas Outlets 3 Planning Review Fee GMM 6/28/2013 $205.00 S1201300000001
Kitchen Sink 1 Fireplace 1 Building State Fee DLC 7/31/2013 $4.50 S2201300000001
Clothes Washer 1 Exhaust Hood 1 Building Permit Fee DLC 7/31/2013 $ 1,122.55 S2201300000001
Dishwasher 1 Dryer Vent 1 Mechanical Permit Fee DLC 7/31/2013 $210.60 S2201300000001
Hosebibs 2 Mechanical Base Fee DLC 7/31/2013 $28.50 S2201300000001
Plumbing Permit Fee DLC 7/31/2013 $67.10 S2201300000001
Plumbing Base Fee DLC 7/31/2013 $24.70 S2201300000001
ADJUST--Plan Check Fee DLC 7/31/2013 $-36.40 S2201300000001
Total $ 2,598.61
BLD2013-00502 Please refer to the following pages for conditions of this permit. Page 1 of 6
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CASE NOTES FOR
BLD2013-00502
CONDITIONS FOR
BLD2013-00502
1) 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. The building permit will not be "finaled" until the permit holder can show proof that the access permit from Public Works has
been "fin led"and approved.
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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
1-800-647 0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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3) Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric wall mount heat with duct less heat pump, Compliance Method: Prescriptive option III, Window(Max U-Factor):0.30, Skylight (Max
U-Factor):0.50, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38 advanced or R-49 standard,
Vault Insulation R-38, and Slab Insulation R-10.
In addition the following credit from Table 9-1 shall be completed: Option 1 C, ductless heat pump
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4) 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
Xepart�negt prior to any further inspections being performed or approvals granted.
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5) 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.
6) 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 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 ap roved documents will result in failure of required building inspections.
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7) THE. OUTATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
�LL^�I-
BLD2013-00502 Please refer to the following pages for conditions of this permit. Page 2 of 6
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` 8) The"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, then
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
Build in De artnj nt prior to any further inspections being performed or approvals granted.
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9) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel.
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 Section 503.10.2, 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 0.00030 Specific Leakage Area (SLA)
when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations
of the building envelope, including penetrations for utilities, plumbing, electrical, ventilation, and combustion appliances and sealing thereof. 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 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate" and are available in %or%sheets. The
Mason County Permit Center will also have some available.
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10) A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC
Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall
be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or
installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps).
Referencg WSE,t 505.
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11) 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.
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12) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer' installation instructions.
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BLD2013-00502 Please refer to the following pages for conditions of this permit. Page 3 of 6
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13) 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 to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contrac orris agnowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X L —
14) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
ch rged a d s all be collected by the Building Department prior to any further inspections being performed or approvals granted.
15) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
perrr�it reywatio .
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16) 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 prof ct..
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17) All changes to"appr ved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinartce.or rer�ula on, must be reviewed and approved by Mason County prior to construction.
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18) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENTAND 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 ade prior to requesting additional inspections.
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19) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
m4 the,inst Ilation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
BLD2013-00502 Please refer to the following pages for conditions of this permit. Page 4 of 6
20) All property lines shall be clearly identified at the time of foundation inspection. X /1 -
21) 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 County ordin nces and building regulations.
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22) 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 n t exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holderhave 9r ven ed action from being taken. No more than one extension may be granted.
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23) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. All
applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the
registered design professional responsible for the report/assessment, and may require special inspection by same. Structures and/or land modifications
(grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a separate permit. The geotechnical report/assessment shall
remam_attachefl to the approved building plans.
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24) Retaining walls needed to support a surcl`arge�uch s structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X /1�l6
25) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD.W��Y.
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26) An inspection performed by a representative of N.L. Olson and Associates shall be completed on-site prior to placement of concrete formwork
or rebar, in accordance with the geotechnical assessment, to verify the footing's foundation subgrade area are consistent with the
Geotechnical assessment findings and specify additional recommendations as needed.
A written report(s)shall be submitted to the Mason County Building Dept., PO Box 279, Shelton, WA 98584,prior to the footing inspection and
available fort spec on.
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27) This permit is approved for a dwelling with a loft and unfinished/unheated basement.
To finish the basement in the future compliance to the energy code in effect at the time of change shall be required. Currently R-10 slab
insulation is required in heated spaces with slabs. It recommended that R-10 insulation be installed and inspected as part of this propject to
prepare for,future changes.
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BLD2013-00502 Please refer to the following pages for conditions of this permit. Page 5 of 6
28) Approved per dimensions and setbacks on submitted site plan. Shoreline setback is measured from the furthest projection of the structure (the second
floor degk).
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29) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason
County Shorelin Master Program.
30) All construction and demolition debris must be removed from the site after project completion. Proper-;dispbsal of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
31) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or properties. Silt fencing, straw, or
matting must be installed and maintained until upland vegetation has become established. X — 1 L
32) Prior to final approval, all upland areas disturbed or newly cr ated by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
33) 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 PI n" to ensure these structures are shown and meet the setback conditions listed.
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34) 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.
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35) Retaining walls needed to support a surchar" sup as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X ti
36) SATSIFACTORY MAINTENANCE REPORT PRIOR TO TEMPORARY/FINAL OCCUPANCY.
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 any
time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be
occupied. Proof of continuation of work is by means of a progress inspection.The owner or the agent pn the owners behalf, represents that the information provided is accurate
and grants employees of Mason County access to the ab ve described property and structure for reytew d inspection.
OWNER OR AGENT: �Z ti v �� k /L i��' DATE:
BLD2013-00502 Please refer to the following pages for conditions of this permit. Page 6 of 6
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Permit#_, MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 2270 1,ake- Dj-
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gai'nypompliance
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You are hereby notified that the above corrections shall be m!qe
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
"natural/man made"
❑This is not a complete inspection disasters.This is NOT a
Date le. / 3 Department CORRECTION NOTICE.
Inspector l
Permit# MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 2 7 0 L-4 Le- ()r,
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
fo nd' Items listed below ust be corrected to gai compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
M Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
❑.OK to
damage incurred by recent
"natural/man made"
❑This is not a complete inspection disasters.This is NOT
Date (2°-2 3 _ �7 Department CORRECTION NOTICE.
Inspector
� * N Llmh, wNk T , � � 4 T T-,
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Permit# 13 0"
MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
f.% Ap 1 T11
1W 0. .&REC ON No wRwE
Job Location P70 AJE—� l-�;�� L/--
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
fo n Items listed below must be corrected to gain compliance
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xf c ,w� JA,�s hl,ff
Imo.,,�I�l L�� ''{�✓� S'i►�� � •
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
Make corrections, items will be checked /on next ins ecti n regarding possible structural
OK to �� � � ✓ �'��� / .�- � '"� damage incurred by recent
"natural/man made"
❑This is not a c mplete inspection disasters.This is_Nola
Date Department �) CORRECTION NOTICE.
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Inspectorl�-
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Page
L°AN.L. OLSON&ASSOCIATES, INC. Daily Field Reportof 1
Report
Number:
Engineering,Planning and Surveying
2453 BETHEL AVENUE Date: Job Number: Location:
P.O.BOX 637 9117/2013 8156-13 270 NE Lake Drive
PORT ORCHARD,WASHINGTON 98366-0637 Temperature and Weather Conditions:
Phone 1-800-755-1282 FAX(360)876 2284 Cloudy 60 s
Field Representative: Contractor: Project Manager: Permit Number: Project Name:
Wes Johnson WRJ Seacrest Residence
At the request of the client, NLO was on-site to observed the newly excavated building area.
The building's subgrade area was T-probed with a 21 inch diameter steel probe. dense silty sand, glacial
till, was encountered. In areas T-probed, NLO's representative observed soil penetration of less than
one inch in the native undisturbed subgrade. In NLO's opinion, the foundation subgrade appeared to
have been prepared per the guidelines presented in our Slope Assessment Report, Proposed Single
Family Residence, 270 NE lake Drive, Tahuya, WA, NLO Job number; 8156-13; dated June 24, 2013.
In our opinion, the observed subgrade area should provide adequate support for the new building.
NLO observed that the building foundation has also been adequately setback from the step slope area
overlooking Haven Lake.
north edge of excavation
NLO will return at the client's request.
\� SCALE:NONE
Al
step down.
south edge of excavatio
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l3 PROBED BUILDING AREA
II
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top of slope
Wesley R. Johnson, P.E. O
NLO Field Representative f o
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Contractors or Tradespeople Printer Friendly Page Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with L&I to perform construction work within the scope of
its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name MORGAN BUILT HOMES UBI No. 600572930
Phone 3608305065 Status Active
Address 10233 Yates Ln Nw License No. MORGABH876LC
Suite/Apt. License Type Construction Contractor
City Bremerton Effective Date 6/3/2013
State WA Expiration Date 6/3/2015
Zip 98312 Suspend Date
County Kitsap Specialty 1 General
Business Type Individual Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Effective Expiration
License Name Type Specialty 1 2 Date Date Status
ME Construction
MECONI"101JWCONSTRUCTION Contractor General Unused 4/16/1990 12/10/2000 Archived
INC
ME Construction
!MECON""159JN General Unused 4/15/1985 4/15/1990 Archived
__ CONSTRUCTION Contractor
MECON"171JN M&E Construction Carpentry/Framing Accoustical 4/15/1983 4/15/1985 Archived
CONSTRUCTION Contractor
Business Owner Information
Name Role Effective Date Expiration Date
MORGAN, GREGORY REID jOwner 06/03/2013
Bond Information
Bond Bond Company Name Bond Account Number Effective Datel Expiration Date Cancel Date Impaired Date Bond Amount Received Date
Wesco Insurance Co 146wbO27300 05/30/2013 jUntil Cancelled 1 1 $12,000.00 06/03/2013
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Datell Amount lReceived Date
1 Nevada Capital ncic003402 05/30/2013 05/30/2014 $1,000,000.00 06/03/2013
Ins Co
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 7/1/2013
11,11 ! L D i N G
Name Sethr<s4- Parcel# 2233 G 5600 1055 BLD#20 1 3 OOrj� a
�r g t,
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 surfacez.
'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 £afcr late Impe .JDUs Sur aces:�lease ort plefe This .T6614e_
Surface Type Length X Width = Area *All dimensions in feet
Buildings '3 b X _ 9 XU
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
Driveways 60 X o = 6 act
X = Length of drive begins at the right of way
X =
Parking Areas 10 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
X =
Others X
X tf..the total impervious area bf the proposed site
X = 6 development is.greater than.2DD0,square fW a
Small Parcel Stormwater.Site Plan is Required .
Td&i Impay oils surface Area(sum ofiall areas)
If the Total Impervious Surface is LESS THAN 2000 Square Feet, ease read,acknowledge and sign below.
Based Upon the information you have provided a mw rfe 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 /l/ "z Owner/Agen ontracto circle one)Date: —.2
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 I of 2
Name S Pc he-S '- Parcel# 2 Z 3 3 G 5-°Oo I ✓ 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 this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
htto//www.co.mason.wa—us/code/commissioners/index htm
Please follow the Iinks to "Title 14,Chapter 14.48 Stormwater Management".
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 Sma11 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:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850, Shelton WA 98584
Physical: 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 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 prop! y for review and inspe . n as may be required.
X Owner/Agen ontractor(circle one)Date 6 - 6
Page 2 of 2
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION ( (A n
,. 426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269____�� a j
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Vy%i Ke- ►'J e b b i c. S e c k y e_f t Company Name Pork..)
Mailing Address C H 110 Iry to. Mailing Address /v)-3 3 V 4 f r S L4 n c
Citydr.N.r.I State ia-,4.Zip Coe 9 e3 j2 City State t..,+ Zip Code 9e 3 1 2-
Phone340 -696 +3316 Other Ph. Phone-Ica - col - Y/tQ OtherPh.34c, �3a-so6
Lien/Title Holder Contractor Reg. # Mo a ci w a H V6 << Exp. 4- 3 •? �y
E mail address E Mail Address r r j i0 ho f m„l • c v—
Drivers Lic.# DOB Drivers Lic.# rA r L1 y( c'L DOB /c1 /b v
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existin+ptic
Connect to Water System Name of Water System f'r-•S�K l/c
Well _Water System Name of Water System to o i' V 4 4t
PARCEL INFORMATION - 12 Digit Parcel N� -o a o 1 8 P, A Or Fire District rY
Legal Description Ave l
Site Address (Please include street name, street number and city) 2 r7D N' = L 4 1 -e YDr'. 71,4 L4 u
Directions to site Leak w—sfi T,v...•. 6o1 off w.,rhh c 140, It A4. an TA h H uq r d K+ ov,
N e-� tv C P&% 144 V P k 5►H.4 h u h (.A )C
Will timber be cut an6 sold in parcel preparation? Yes/ o
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 - New—)(,-Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building S F R Describe Work (���1 C A -4
No. of Bedrooms No. s Square Footage- 1 st Floor Zo 7 2nd Floor
3rd Floor --' Basem tun-kn"• f ck_4DU Covered Deck 1 6 Other Sq. ft. ----
Garage_AL)_h_-@- Attached I etachec Carport ry 14 Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason Coun cess to the above described property and structure for review and inspection.
PROOF OF CONTI ATIO OF WORK IS BY 7N"F A PROGRESS INSPECTION.
x Date:
Owner/ ers Repr ntative/2Kractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by, ( 2-2n I
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department g•Jc. " Xi �(�
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee S Site Inspection
Plan Review Fee ;.3(o7,R 9.
EH Review Fee
Plumbing & Base Fee !o 4 �4-7a Planninq Review Fee
Mechanical & Base fee 'i Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ ICK TOTAL FEES
� y xa as
a
i D e GIB, a8 jc i p v� F�lj
� 7a0
a � flv
------------
tti�� ��f x 1�J-) �S�
PERMIT NO.�b I ze 13- 00 562_
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360)427-9670•Belb (360)275-4467•Elma(360)482-5269
On the we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner l t e 06"c- 5 e C h r-.5 Company Name►W 6 n 9 ur.
Mailing Address 6 12 1 L '(v lw 4 1/ Yu Mailing Address I °2 3 3
City 19 r-- a r L--: State_A Zip Code q 43 ?12 City 11veni f f+D'^ State —d Zip Code �� 3 Z
Phone 6 9 _3 3 3 v Other Ph. Phone 3 6 0 - Sul - L11 °1 u Other Ph.7 4° -8 3°F0 6
Lien/Title Holder Contractor Reg. # ►nu r;a.13 H I174 L C Exp 6 -3- )5 _
E mail address E Mail Addresses 4—^ ;+1 �� h vtr""l . C-14,
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic— — Existing Septic ok Connect to Sewer System
Name of Sewer System je.e4. c 10,A c v,I o 4 1/e�P (3
PARCEL INFORMATION - 12 Digit Parcel No o u d o Fire District
Legal Description :
Site Address (Please include street name, street number and city) 2nL ej- -e ?
Directions to siteLott S 14or-e2 t, on t r. 4 wA
Is property within 200'of Saltwater Lake )�5 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- 1 st Roo 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
ape of Fixture No. of Fixtures Fees Fuel Type:Electric_LPG✓Natural Gas_Heat Pump-4-
Toilets Type of Unit No. of Units Fees
Bathroom Sink 1 Furnace
Bath Tubs �' 1 \ re v HeaSpotp Vent
Fan tf
Showers � Spot Vent Fan
Water Heater Propane Tank 3 Clothes Washer I Gas 0 s
Kithen Sinks I Wood/ ellet Stove
Dishwasher Krtche aust Hood 1
Hosebibs Dryer Vent 1
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 CONTINU N OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
Owner/Owner epresentative/ ntractor (indicate which one)
FOR OFFICIAL USE BEY ND T S P INT
Accepted b Planning Pd Ck# Date I Bid Pd Receipt No.
DEPARTM NTAL 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