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Home My WebLink AboutBLD94-1734 Mobiule Home - BLD Permit / Conditions - 1/29/1995 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 E L) I L I) I N CG PERM I .T FOR INSPECTIONS CALL 427- 9670 BETWEEN 5pm AND 8am 427-7262 BLD94--1734 PARCEL :221224100040 PLAT : D I V : BLK : LOT : JOB ADDRESS : E 1661 THOMAS RV GRAPEVIEW EW OWNER : STEVE COBLE 4,26-4433 CONTRACTOR : VANDFP POOL CONSTRUCTION 862•-1213 LEGAL ; W 331 Of GOVT 1.01 2 MU Of I11 FS 18112 CLASS OF WORK . . ,NEW BEDR s 3 .BATH s 2 TYPE AMOUNT 661 DATE RECEIPT TYPE AMOUWI BY DATE RECEIPT TYPE OF USE . . . . :MH STORIES . . . . . . . :1 OCCUP . GROUP . . :7 BLDG . HEIGHT . . 0 .Oft MHOF 1 10/.98 II 01131195 38777 TYPE OF CONST . . s? F I REPLACES . . . . c 0 STfE 1 4.50 TN /1H1/95 38277 OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . t 0 DWELL .UNITS . . . . : 0 PARKING SPACES , 0 INSPECTION AREA : 4 SHORFL INE? . . . . :N TOTAL: 104.51 VAIHLATION: 122513 SETBACKS-- _----.-------.- TOILETS . . . . . . . . . . s 0 FUEL. TYPES- .------ BOILERS/COMP----• MOBILE HOME--_— FRONT . . .E 5 .Oft. BATH BASINS . . . . . . s 0 : 0- 3 HP . ; 0 REAR . . . .W 5 .Oft BATH TRUBS . . . . . . . . . 0 3-15 HP . . 0 MODEL :SILVERCRE SIDE( 1 ) .N 5 .Oft SHOWERS . . . . . . . . . . . 0 FURN < 1O0K BTU : 0 15-30 HP . ; 0 -MAKE-------- S $DE± (2 ) .S 5 ,Oft WATER HEATERS . . . . 0 FURN > 100K STI) ; 0 30-50 HP . 0 SHRL E NE . O .Oft CLOTHES WASHERS . . : 0 FURN F1 OOR . . . , 0 504 HP . : 0 - YEAR------- AREA ------...a- ------_- - KITCHEN SINKS . . , 0 HEAT PUMP . . . . . , . 0 94 LOT S I ZE . . :AC FLOOR DRAINS . . . . . 0 VENT SYSTEMS . . . 0 EVAP COOLERS ; 0 I ENGTH ;64 BUILDING . . . : 24OOsf DRINKING FOUNT . . . : 0 VENT FANS . . . . . , : 0 HOODS . . . . . . . : 0 WIDTH . :40 BASEMENT . . . : os'r LAUNDRY TRAYS . . . . : 0 DOMES . INCIN :O SERIAL4t- DECKS . . . . . . : Osf DISHWASHERS . . . . . . . 0 AIR HANDLING UNITS---'- COMME_. . I NC I N :0 GAR/CARP :? Osf GARB DISPOSALS . . . : 0 <— 10000 r,ftn . : 0 RELOC/REPAIR : 0 AT/DT . :? URINALS . . . . . . . . . . : 0 > 10000 ofm . s 0 OTHER UNITS . ; 0 MISC PLM FIXTURES : 0 GAS OUTLETS . : 0 PROJECT 9ESCRIPTION;MOBILE HONE PROJECT ROGATION;HWY 3 TI! ISIARD VIER DRIVE TO SITE THIS PERMIT BECOMES NULL AND VOID If WORK 0R CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 18Q DAYS, OR If CONSTRUCTION OR WORK IS SUSPENDED FOR A PFR O0 Of 180 DAYS AT AN TIME AFTER WORK IS COMMENCED, EVIDENCE OF CONTINUATION Of WORK IS A PIOOIIESS INSPECTION 011810 THE 180 DAY PERIOD, FINAL INSPECTION MUST B APPROVER BEFORE BUILOINS CAN BE OCCUPIED. OWNER OR AGIN IL1_PRMT, rev: 03131191 COMPLIANCE TO ATTACHED CONDITIONS IS REQUIRED CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date by Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D W v WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 PERM I T" 0ONL..0 $ I I (i) N ...; Case No . , RLD94-1734 Fore STEVE COBLE Page , 1 1 ) The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons Is not allowed without the approval of the Mason County F..Ire Marshal . 2 ) Subject to conditions of Resource Lands and Critical Areas (RL.C ) Checklist RI 94--16(27 3 ) Proposed structure or, any portion thereof greater than 30" ► n height from grade line must maintain a minimum of 5 ' setback from all property lines , easements and right o+ wvs 4 ) All approved plans are required t oo be on-site for inspection purposes . It inspection is called for and plans are not on site, Approval WILL NOT be granted . In addition, a Re- Inspection fee In the amount of $30 .00 per hour (minimum 1 hour ) will be charged and must be collected by this department prior to any further inspections being performed or approval granted . 5 ) PURSUANT TO 1991 UNIFORM BUILDING CODE , SECTION 305(C) AND SECTION 513 ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED 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 REINSPECTION FEE , BASED ON RATES IN TABLE 3A OF THE 1991 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PPIOR TO REQUESTING INSPECTIONS , 6) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC E U REMENTS 7 ) REQUIRED INSPECTIONS ( Footing inspection-prior to pour, Set- up Inspection-prior to skirting. Final Inspection -prior to occupancy) . I have received a copy of the Genern t CONCRETE MECHANICAL HOME Footings-Setback date by ibbons date by Gas Piping date by Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Attic Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by LI MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 Information and Guidelines-Mobi ie/Manu1'aatured Housing Installationy ilandout fur detailed descriptions of all required Inspections on my mobile/manufactured home Installation . I hereby assume all responsibility for the scheduling of these required inspections . If these required Inspections are not requested, Inspected and signed oft (approved) by the inspector in the prescribed order, I understand that reinspect ion fees and an hour Iv investigation fee pursuant to the 1991 UBC, Table 3A will he assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered . I further understand that this investigation will be scheduled as time allows . Until resolution of any/s i I problems no occupancy ( F i na l inspection ) will be granted for the residence . OWNER/CONTRACTOR( indicate which ) 8) All mobile/manufactured home landings or decks must be freestanding (self su orting) . The largest landing or dock permitted without drawings or a building permit its 36" x 36" . Any landing or dock that is 30" or more In height from walking surface to finish grade requires a guardrail , Any landing or deck that has 4 or more risers requires a handrail Any landing or deck larger than 36" x 36" must be permitted which requires structural drawings and a building permit application . This installation Permit does NOT include ny landing deck larger than the 36" x 36" size . 9) Changes to approved building plans that effect compliance to the 1991 Wiishington State Energy Code, 1991 Ventilation and Indoor Air Quality Code, the Uniform Building Code and/or Mason Co y Regu ations must be approved by Ma3on County prior to construct i o __ . t 10) CONSTRUCT ION PROCESS TO BE FIELD COR CTED AS REIJIRED PER MASON COUNTY BU I L.D I NC DEPARTMENT AND UNIFORM BUILDING CODE _� _ . ____�_. CONCRETE MECHANICAL MOBILE HOME � �e " 7 Footings-Setback date by Ribbons date by Gas Piping date /v2/' / b Foundation Walls date by Set Up date by INSULATION date /-3/ by BG/SLAB Insulation Floors Final �� date by date by date 12- 5 by W FRAMING Walls FIRE DEPT. date by date by PLUMBING date by OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by l2-ZI-Au 62�G$a�.D .�c l3 T l6 t& k& 2d ( cLd /) (jb w 4 nyy�G` ,Mp �i 4. /► "'1- 12- 9 jo i.c wLC - 7� -,,J r1 L_ S O c cI6 ' Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT / #1 Own � ,,,b�� . Phone # 126- tiy3.3 e Address 0 Fire District#________ � yYl � , City (�Nr,ni V,e,v✓ Stl(L.Zip 9?S'/C Directions to Job Site ls►--/4/eJ L/ _w Ov S' __- Owner Mailing Address 206/0 /O8 ,q7` F City IkL f.,t./ . St LJ Zipcj3 90 Lien/Title Holder Address City St Zip #2 Contractor Name k/ (. / tL sfr'� 7' Contractor Reg # y74/j G /070/7 Address )Oh/0 /O jTk S? t Expiration Date / ? / 95 City io q t, ✓ /a/C St Zip 9'x-3 97 Phone # /21 3 #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well_ Connect to Sewer System? Name of System C (If residential, proof of potable water is required) #4 Parcel No. 221�?z�11 - OOn - Cl) �y E Legal Description AJ O m w o #5 Building Square Footage: (existing/proposed) 1st Fl 2nd Fl / 3rd Fl / Loft Basement / Deck / # bedrooms / # ftDrooms Garage A x32/. Carport / (Circle: Attached or Detached?) ri-i Other_____________________ sq. ft. /OO / #6 se of building � Describe work LI i r 56 L ll ilir,6 C JJa��s ��n, d /. a Of — #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFLf1.RMATION �rtJ Model Year 9Gl Make S;Lt,- Model_1( Length Width Lb Serial No. # Bedrooms 3 # Bathrooms . Type of Heat Eh c- Purchase Price $ ) /) / ff/3. 0 y #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other /�f , Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW �Pcww 1 LJt ?l Gaff^y I'I�MNS Mo . fl, , 6 k/e.L1- %��N i v ✓ Jo2�� APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW s,-7c� DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: c( 2)ec 4- -4o R l.C- q - /(,Z7 Environmental Health: Building Plan Review Occupancy Group: Type of Const: s Fire Marshal: Other: Special Conditions: FEES Building Permit /OO ' Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee -�— Other Other Building Valuation: TOTAL FEE 10 1 Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) Toilets CIRCLE FUEL TYPE: Gas, Electric, ��,,aBasins Heatpump, Other t,h 1bs No. Units Fees Showers \ Y Furn ' v BTU Hot Water Htr atpumps Laundry Washer f Vent Systems Sinks ,2 Spot Vent Fans &Floor Drains No.. Boilers/Compressors 'Laundry Basins HP Dishwasher No.. Air Handling Units Disposal cfm# —Urinals No.. Fire Protection Systems Other Auto. Fire Alarm Sys 50,00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 -t9- to Fire Sprink Sys 25.00 TOTAL PLUMBIN $ No. Othe Jam- Gas Outle Wood, Gas, P et Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AMAWAREOFTHEORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNE C. C X BY DATE / / (Z g DATE FOR OFFICIAL USE ONLY: Accepted by: Date: CHANGES APPROVE[) SUBMIT CHANGES FOR APPROVAL ( PRIOR TO PERFORMING WORK MASON BUILDING INSPECTOR CHANGES SUBJECT TO APPROVAL MUST MEET ALL CURRENT WASHINGTON STATE CODES -'� VANDERPOOL CONSTRUCTION 20610 108TH ST, EAST BONNEY LAKE, UA 98390 Z• h ( (v<<Ss'S THESE PLANS MUST BE 206 862-1213 C /)c (/ht!) !rj, ON THE JOB SITE FOR INSPECTION. 7/16" 058 �c�tf aKs "11 1X6 TKT i v l FtPgt 2344 3-TAB C OVER -frtt55 �" f FACIA ! P�J sg" P.OOFELT 12 R U Sa 50 Ft C 3 N r1 CONT A UM �UFACTED GUTTER ter.- TRUSSES _e'( HURRICANE CLIPS D.S. 2X4 STD & BTR HF PLATES 96 1/2 ALUM ' 7/16" LP PANEL U/7" BUILFING PAPER AAGh=I' 1�e//s ^•�� 2X4 STD & BTR HF STUDS d i2te i2„lam,(2f'"• 4 ,S 16' 0.C. 2X4 PRESSURE TREATED SPLASH BLK ; MUDSTILL W/ 1/2" OXIO" AB B S O.C. 70,. x- 5/1ab -- '' h �/ 4° CONCRETE SLF CL$ �� a TTG�lA ecl ¶2" • 24 4 REBAR 6 EACH MI. FLUSH GRADE k12"X12" FOOTING UNDISTURBED SOIL CINC FTG. � (2) 44 REBAR BEARING VALVE 2,000 F rtL A / CITY OF TUMWATER �x ru3(.� �,Ct.v. MUST MEET ALL CURRENT D^� ✓ WASHINGTON STATE CODES CHANGES THESE PLANS MUST BE APPROVED SUBMIT CHANGES FOR APPROVAL ON THE JOB SITE MASON BUILDING INSPECTOR PRIOR TO PERFORMING WORK FOR INSPECTION. CHANGES SUBJECT TO APPROVAL L--' nATF IZ7/99/ Q d & L,oq q C" C( Lk/fflCLI MUST MEET ALL CURRENT THESE PLANS MUST BE WASHINGTON STATE CODES ON THE JOB SIRE �•�� FOR INSPECTION• I ,.PC SUBMI- RANGES FOR PPROVAL one t,:'e R TO PERFORRMI WORK —--� al -- ---- ruo- ,pus �.�� APPROVED N P4 }� 22 sfi PS _ i MASON BUILDING INSPECTOR o I See q•I{ 'tied stiee- �, L ., /PR CHANGESJ�UBIECT TO AP VA c� 7 \ x v L VENT � AT I Sq Ft P r 150 Sq 5 �\a N v �_ �-o• FRONT EL VF ATION Or�t, (feacjc✓S 4L FK. Fart ro SME G'o r r'✓5 PLAN xL M-no THESE PLANS IVIJS i ON THE JOB SITE FOR INSPECTION 1f PAIb 22 5N''-PS REAR ELEVATION SID ELEVATION / PP ��ED No w Suet • SEE Slw_+oo Sv-20=arc aR� ilttd Jute 111 1 2O3n GMAGE R Dom 9r JGES SUBJE T L Tc • MASON COUNTY BUILDING DEPARTMENT MINIMUM LATERAL RESTRAINT PANEL I)E'I'AII S The details shown on both sides of Ibis sheet may be used when it is impossible to meet the 48 inch panel requirement of UBC 2517(g).APPROVAL FOR USE OP THESE DETAILS MUST BE OBTAINED FROM 371E MASON COUNTY BUILDING DEPARTMENT PRIOR TO INSTALLATION. The details in this handout are grouped into 3 general types. TC-1 and TC-2 are to be used as top of wall connections in combination with the details on the reverse side of this sheet. Details TC-3 and TC-5 can each be considered as a direct replacement for a single 48 inch bracing panel.Details TC-4 and TC-6 are for use on BO331 sides of a wall opening(i.e..a window or door opening). These details are to be used in the construction of ONE AND TWO STORY,SINGLE FAMILY AND DUPLEX UNITS ONLY.All other projects not meeting the conventional construction requirements of UBC Sc-_tion 2517(g) shall be subject to review and/or design (at the discretion of the Mason County Building Department) by a Washington State licensed engineer. TOP CONNECTIONS _ n* - > Qs- - J=�� O --IurLAOp_R /l EA"iTND IiPADCR elf �. TO CORNER f� 1i(' SIMPSOt4 ST22 1 -STMP TIE OR EO. • /, MIN. EXT. • I ExT. •• MIN.3/8' • / " PLYWOOD W/8d •y i� NAILS @ l'O.C • / PLYWOOD w/8d f I _�—KnIISQJ"O.C I• ' I - I• .I 4XPOS7SoR I •I /(2)2X STUDS ••� .I 4X POSTS OR • �(2)2X STUDS • ! ' (• @ PLYW O N O •'I I / 3X BLOCKING � I. JOIfrP I / -. ,j @ PLYWOOD .�� \ • � • . ��2oINr I TC-I I• TC-2 THESE PLANS MUST BE ON THE JOB SITE FOR INSPECTION. 1 IonoliL S'cb ns�la lov\ �� y 1983 ( ;l �nSUti-�ed Y A4 her Yer 4a n-r II I W�¢a 8p.,2(tl�t S�a,n5 \ sip r�ttw� 1lPwLA $:11 Th.k. YO�� of Hold U.jj,• o6 ns�l,1 on �rolecf o, �ntul�l r.. 70 76.t A.uti«Colt (o' Q cr I Q" �4AM'd tl� 1"i h1A1 H.oJW e.d„.A Pr sal Pis1e j� 3.5'.,,, Goncrel Slab `r '' s11XD�y �J 1 - - f- \ F��1\.ZnfVl.l.c�Slati, Two sTn� y 241 . 7R-S 4. R !o 1 �t/ �elJaf`�o ��wuug aao. Gc.de.Use I I eier.t i&-10 I Iiff is' - / THESE PLANS MUST BE , ON THE JOB SITE ./l FOR INSPECTI JON. THESE PLANS MUST BE ��. ON THE JOB SITE VANDERPOOL CONSTRUCTION FOR INSPECTION. 20610 108TH ST. EAST APPROVED BONNEY LAKE, UA 98390 x.- 206 862-1213 MASON BUILDING INSPECTOR CHANGES SYBJECT-TO APPROVAL V `� l� L� DATE Jul ?/16 OSB 2341 ;-TAB C 1X6 TKT -f 4 ROOF/OVER ,.--•' e, FELT _/' CONT A UI4 "1FACTURED J GUTTER TRUSSES / HURRICANE CLIPS II 2X4 STD & BTR HF PLATES ALUM D.S. _____ 7/16" LP PANEL U/7" BUILFING PAPER 2X4 5Th & DTR HF STUDS @ 16" O.C. 2X4 PRESSURE TREATED SPLASH BLK - / MUDSTILL U/ 1/2" OX1O" AB @ S' O.C. 4 4" CONCRETC SLF \2 M 2# 4 REBAR 5 EACH MI FLUSH GRADE I 12"X12" FOOTING UNDISTURBED SOIL CINC FIG. � � (2) #4 REBAR BEARING VALVE 2,006 F L%1A % ; _ CITY OF TUMWATER vii./IJr...� ��C,ru� (� /�.G(�►'� S ECTEU BY . C L APPLICANT NAME: a �� lJ DATE: BUILDING PERMIT CHECKLIST ❑ RESOURCE LANDS & CRITICAL AREAS CHECKLIST. All projects must complete the Resource Lands and Critical Areas Checklist before a building or land modification permit is issued, or before final approval of a septic system. 1. SITE ADDRESS If site address is not listed, customer needs to be given a site address form. DIRECTIONS TO JOB SITE Needs to be as complete as possible (i.e. major roads, is house on left or right side of road, etc. ) . Be sure to read for clarity (Landmarks, signage, owners name on mailbox, etc.?) . LIEN/TITLE HOLDER Who holds the mortgage (Bank or name of private owner holding contract)? 2. CONTRACTOR REGISTRATION # AND EXPIRATION DATE This information needs to be provided. The Building Department may be able to research expiration information if customer not know it. We must have a signature in 1 of the 2 boxes, either the app ' tNQr the contractor. 3. SEPTIC RECORDS /1 Septic records should be included. BE SURE TO I USTOMER OF $25 RECORD RESEARCH FEE FOR ENVIRONMENTAL HEALTH. If no recorLis ar ble, make a notation on the form "No Records". If septic a cation ,rec 'k "pending" in the upper right hand corner. EXISTING SEPTIC Remind customer they need to have their tank p� d an ter whether their system meets code (sanitary survey or parcel revim , They wil obably need to show reserve for their septic. 4. PARCEL # Parcel # must be included or researched through Gateway. u_ 5. BUILDING SQUARE FOOTAGE Verify that boxes are filled in. If there is a garage, verify whether it is attached or detached. Include square footage information for mobile homes (you can multiply length X width to determine number) . 6. USE OF BUILDING Is it a residence, garage, greenhouse, etc. . .? DESCRIBE WORK (i.e. mobile home addition, addition to a house, etc. . . ) 7. TYPE OF JOB Verify appropriate boxes are marked. 8. MOBILE HOME INFORMATION Verify appropriate boxes are marked. If factory order, please put factory order # in mobile home serial #. If unit was assembled prior to June 15, 1976, refer to procedures handout for "Obtaining Installation Permits for Mobiles Assembled Prior to June 15, 1976." 9. SHORELINES If any water is on or adjacent to property within 200 feet, #9 must be complete. Once permit is entered into Tidemark, it will be routed to the Planning Department. If property is not on water, then put "none" or "n/a". 1 0 10. SITE PLAN DRAWING Must have setbacks from all property lines, easement lines and structures. Drainfields septic tank location, outbuildings, etc. . . 11. TOPOGRAPHY DRAWING If property is flat write "flat" on the topography section. If house or structure is near a slope or hill, drawing must reflect this. 12. OWNER OR CONTRACTOR AFFIDAVIT Owner or contractor must sign affidavit statement and date it. 13. ACCEPTED BY Whoever is accepting permit information must sign your initials and date form on the bottom of page 3 or use date stamp and initial on back of permit. 14. PRINTS Need two sets of prints unless it is a stock plan. For stock plans, we only require one copy. Co 15. WATER ADEQUA � -'-� h LL i1C For new residences and mobile . PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST AND BACTERIAL TEST. If they are on a public water system, verify the water system is in compliance with State requirements. 16. WSEC & V & IAQ CODE Required for all residential, additions and commercial buildings. Energy Code compliance form needs to be COMPLETED. Verify heat source (no wood or pellet stoves are permitted as primary system) . Window schedule must be filled out and reflect what appears on submitted building plans. If applicant has decided to go with the PUD in a Long Term Super Good Cents program, we require a copy of the signed agreement with the utility. 17. PLUMBING/MECHANICAL This form must be completed for any structure with plumbing and mechanical excluding mobiles/modulars. 18. FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to map located at counter. 19. ROAD ACCESS PERMIT If you will be accessing your driveway from a County road, contact the Public Works Department in Mason County Building I, 427-9670 extension 450. Access from State Highways requires Department of Transportation approval. Contact office (206)895- 4753 (Port Orchard) . * ACCEPTED BY: (L9t \ ** DO NOT ACCEPT PERMIT APPLICATION WITHOUT PRINTS AND REQUIRED DETAILED INFORMATION (SETBACKS, ADDRESSES, PARCEL # AND WATER) . "checklst.blg" 10/05/93 checklst.blg 2 9/20/93 /- 12 times the h Too of =" r�'Iff///_. egtt a! Structure = 11�, Maz• Skge to at a Foot rq Face of I Tae of Not to 41c2ad 40',A- Structure Slope 3�3 TYPICAL STRUCTURAL ScTBACX BUILDING OFFICIAL MAY APPROV' ALTERNATE Tacxs a CL EARANC-S Scout I" = 20' Sample Site Plan 24!• 153' I4 AG 32' 20' o PR0PdSED a ��- �' RESI0ENCI: L ORA.. _ ntta a EDGZ OF 8.4 N X Septic Tony m 68'• T J 2a• c d0' — - - - - - -- - • ,c_ _ - - - - _ _ i - -- - - - -. -hlir�5'sdbau , Will(se*121 238' U _ TYPICAL SITE PLAN ►" = 2Q' J. OCE 1406 Masan U. Or. N 1 ACCESS PERMIT Mason County Road Department Permit Number: 4240 _ 411 North Fifth Road Name : Thomas P.O. Box 1850 Road Number : 29610 Shelton, WA 98584 Road Location: Subject to all terms, conditions and provisions written or printed below or on any part of this form, Permission Is Steve Coble Hereby Granted To: E 1450 Island View Road Grapeview, WA 98546 427-9005 To Install: single family access Location: On corner of Thomas and Island View Road - will be staked and flagged. Parcel Number: ga�/o�o� L// ®boy Legal Description: West 330 of that portion of Govt. Lot 2 - Sec. 22 , Tn. 21, Range 2 WWM A bond in the amount of $ 25 . 00 accompanies this permit . Receipt Number: 13746 Check Number: 5002 Contractor Address City/St/Zip: Phone : 426- Lic. Number: Expires: Specifications: Access to be graveled to property line with 3" depth of clean gravel. Culvert to be aluminum, concrete or polyethylene. Access will be staked and flagged by Permittee for pre-inspection. Culvert will lay in line of ditch. Access will be pre-inspected by this office prior to installation. Culvert to be minimum of 12" diameter by 20' length. Access installation shall be in accordance with county specifications. Commercial/Multi use access shall require STOP Signs, installed in conformance to the MUTCD manual, at intersection with county road. No work shall be done under this permit until the party to whom it is granted has communicated with and received instructions from the road supervisor at : 427 -9670 ext . 450 or at 1-800-562-5628 ext . 450 . RESULTS OF SITE INSPECTION: See Attachment "A" This permit shall be void and bond forfeited to Mason County unless the work herein contemplated shall have been completed on or before: 19 Dated at Shelton, Washington, this day of , 19 Issued by: Title: GARY YANDO, DIRECTOR PyON.STgTFO s U DEPARTMENT OF COMMUNITY DEVELOPMENT U O T z PLANNING - SOLID WASTE - UTILITIES N Y Y BLDG. I • 411 N. 51 ST. • P.O. BOX 578 SHELTON, WA 98584 • (360) 427-9670 1864 DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order, the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter "permitting actions"), which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. 4. - -q ail __ Date (Parcel No. or Legal Description) Property owner's signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL) STATE OF COUNTY OF On this_day of__________, in the year , before me Notary Public, personally appeared personally known to me to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed it. WITNESS my hand and official seal. -For County use only - Re iew,d y pplicanl on (Date) Notary's signature Staff Initial: _ _ My Commission Expires: