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Home My WebLink AboutBLD2025-01038 SFR - BLD Inspections - 4/22/2026 Department of Community Development 0MASON COUNTY 615 W.Alder St.Bldg 8,Shelton,WA 98584 COMMUNITY DEVELOPMENT 360-427-9670 ext.352 Permit Assistance Center,Building,Planning www.MasonCountyWA.gov INSPECTION CARD AND CERTIFICATE OF OCCUPANCY** To schedule an inspection call or visit https://masoncountywa.gov/departments/community_developmenVbuilding/inspections/index.php Permit Number BLD2025-01038 Date Issued 10/17/2025 Issued By Project NEW 3-BEDROOM SFR W/ATTACHED GARAGE Site Address 1970 E Island Lake Dr Applicant Medcalf,Kara Contractor BLACK BEAR CONSTRUCTION LLC Contractor Phone 925-948-6521 Primary Code 2021 IBC,IRC,IFC,IEC,IMC,& Type Permit Type NEW SINGLE FAMILY RESIDENCE Occupancy -APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS. -DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED. -THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION,FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY. -ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION. -OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION. **THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED.** PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET Public Works Access/Driveway Other Health Septic Well Deptartment Planning Site Inspection Department Fire Marshall Fire Apparatus Access Fire Sprinkler Auto Fire Alarm Hood and Duct Other Final Building Building Official: Community Services Designee Department Concrete Setbacks (( Z 3ZQ Slab Footing Perimeter Point load Footing Footing Interior Footing Decks/Porches Foundation Stem Walls Other Rough-In Groundwork Plumbing Framing f — G-2G JG Groundwork Mechanical Plumbing Groundwork Gas Pipe Mechanical Gas Piping 1-3a-2G Shear Wall Nailing - 2.- 5 G Underfloor ///r-1Zr Other Insulation Slab Ceiling t-3D _ G .?t2,. Floor Vaulted Ceiling Jr Walls I - Vapor Barrier Other Wallboard Interior Wall Brace Panels Fire Walls Nailing Other Final Building ZZ 2 toDF� Manufactured Setbacks Setup Home Concrete Foot/Runners Final Other fs1 f ( L/-i7-zEn bcc see INSPECTION RESULTS Pagel MASON COUNTY Department of Community Development 0 COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584 Permit Assistance Center,Building,Pidnn,ng (360) 427-9670 ext. 352 Application# BLD2025-01038 Application Type NEW SINGLE FAMILY Owner ADAMS THOMAS O RESIDENCE Parcel # 320065002079 Site Address 1970 E Island Lake Dr Shelton, WA 98584 Inspector Inspection Type Date Status Comments 1-26-26-JQ 1. Gas piping is to be on test at the time of inspection, current condition the gauge is Joshua GAS PIPING INSPECTION 01/26/2026 FAIL currently at"0" psi Quarders please have the piping on test and the gauge read 15psi WILL CHECK AT INSULATION INSPECTION INSPECTION RESULTS Pagel 1) MASON COUNTY Department of Community Development COMMUNITY DEVELOPMENT 615W Alder St, Shelton, WA 98584 Permit Assistance Center,Building,Planning (360)427-9670 ext. 352 Application # BLD2025-01038 Application Type NEW SINGLE FAMILY Owner ADAMS THOMAS O RESIDENCE Parcel# 320065002079 Site Address 1970 E Island Lake Dr Shelton, WA 98584 Inspector Inspection Type Date Status Comments 4-17-26 DEC 1. INSULATE ALL WATER LINES IN GARAGE. HOT WATER TANK AND WATER FILTRATION SYSTEM. 2. SEAL PENETRATION IN DRYWALL BY AIR HANDLER. 3. PROVIDE BLOWER DOOR TEST RESULTS OF 0.6 ACH/HR OR LESS 4. SEAL EXTERIOR PENETRATIONS AT HEAT PUMP AND ELECTRIC METER Drew Carlson BLD-FINAL INSPECTION 04/17/2026 FAIL 5. LINES FOR SMALLER HEAT PUMP ARE INSULATED WITH WATER LINE INSULATION AND NOT UV RESISTANT. PROVIDE UV RESISTANT COVERINGS FOR LINE SETS. EMAIL PICTURES OF CORRECTIONS AND INCLUDE PERMIT#, NAME ON PERMIT AND ADDRESS. DREWC@MASONCOUNTYWA.GOV PROJECT WILL FINAL WHEN I CONFIRM RECEIPT OF EMAIL. TEMPORARY OCCUPANCY 180 DAYS OK Mason County Mason County - Division of Community Development H C 615 WBAi ding 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov BLD2025-01038 NEW SINGLE FAMILY RESIDENCE PROJECT DESCRIPTION: NEW 3-BEDROOM SFR W/ATTACHED ISSUED: 10/17/2025 GARAGE SITE ADDRESS: 1970 E ISLAND LAKE DR SHELTON EXPIRES: 04/15/2026 PARCEL: 320065002079 APPLICANT: Medcalf, Kara OWNER: ADAMS THOMAS O 1970 E Island Lake Dr PO BOX 818 Shelton,WA 98584 SHELTON, WA 98584 360-789-3967 OTHER: Travis Adams OWNER'S REP: Arhutick,Lynette 1970 E Island Lake Dr 1673 S. Market Blvd,#132 Shelton, WA 98584 Chehalis,WA 98532 3604904461 360-520-1251 GENERAL CONTRACTOR'S LICENSE: BLACK BEAR CONSTRUCTION LLC License: BLACKBC831J7 8645 Kimmie St SW Expires: 01/30/2026 OLYMPIA,WA 98512 925-948-6521 VALUATIONS: FEES: Paid Due Covered Deck/Carport 372.00 $8,928.00 Plumbing Base Fee $30.00 $0.00 R-3 VB Residential, one- 2294.00 $383,946.78 Planning Residential Review $275.00 $0.00 and two-family Fee U VB Utility, miscellaneous 768.00 $51,056.64 Mechanical Base Fee $30.00 $0.00 Technology Surcharge $108.92 $0.00 Plumbing fees for new single $232.00 $0.00 family residence Building Plan Review/Change of $140.00 $0.00 Use-Onsite Sewage Building Permit Fee $3,206.00 $0.00 Mechanical fees for new single $211.00 $0.00 family residences Residential Energy Code Fee $160.30 $0.00 State Fee-Residential $6.50 $0.00 Plan Check Fee $2,083.90 $0.00 Mechanical Fees $87.00 $0.00 Plumbing Fees $9.00 $0.00 Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 1 of 8 Mason County Mason County - Division of Community Development 615 W. Alder St. NSC Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 Total: $443,931.42 Totals : $6,579.62 $0.00 FIXTURES (qty Mechanical Fixtures Qty Plumbing Fixtures 1.0000 Gas Outlet(s) (1-5) 1.0000 Gas-piping systems (for first set of 1-5 outlets) 1.0000 Propane Tank(s) REQUIRED INSPECTIONS Setback Inspection Rough- Plumbing Inspection Footing Inspection Mechanical Inspection ................................................... — — — — — — — — — — — — — — — — — — — — — Foundation Wall-Pre-Pour Inspection Gas Piping Inspection . ............................................. — — — — — — — — — — — — — — — — — — — — — — — Underfloor Inspection Insulation Inspection ...................................................... — _ __ — — — — — — — — — — — — — — — — — — — Shearwall Inspection Connection is to be verified by Health or Utilities ...................................................... — _ — - — — — — — — — — — — — — — — — — — Framing Inspection BLD-Final Inspection CONDITIONS * The use, handling and storage of hazardous materials or flammable and combustible liquids is not allowed without the approval of the Mason County Fire Marshal. * All property lines shall be clearly identified at the time of foundation inspection. ---------------------------------------------------------------------- * All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way. ........................................................................................ * When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For 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. For more information contact Public Works, at(360)427-9670, ext.450 or 100 W Public Works Dr. Shelton. The building permit will not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled and approved. * All other necessary permits from Mason County, Washington State, Federal Agencies, and/or other agencies/groups that are required for this proposed development and construction must be obtained PRIOR TO DEVELOPMENT AND CONSTRUCTION. * Landings and stairs must meet the same setback conditions as any permitted structure;and, must be shown on your site plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed. ------------------------------------------ ------- -_..-- --------------.._--.---- ------- * Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. . ...................... . .___--------...._-_._..------------_...------........------------.....------------.. * 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. -----------------------------------------------------------_—_ Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 2 of 8 Mason County Mason County - Division of Community Development 615 W. Alder St. �C Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 * Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). * 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 contact the Mason County Public Works Department prior to construction at Ext 450 * All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may grant one or more extension of 180 days, upon the receipt of a written extension request prior to permit expiration. Letter must indicate that circumstances beyond the control of the permit holder prevented action from being taken. * All changes to "approved"building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. * All construction must meet or exceed all local and state ordinances in addition to the International Codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. * 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 with 110 mph gust factor. * The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. * The foundation/footing must be placed on undisturbed, firm-native soil. Proper frost depth, minimum 12 inches, shall be observed below grade in undisturbed soils. .............................................. ---....._.. * 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. ..............a_-.____..-_, . ----_._..-.-............ * The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility of the applicant, owner or contractor to make the required corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. * OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION UNLESS OTHERWISE APPROVED. Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 3 of 8 0 Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 * REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacturer's installation instructions. A drip edge shall be provided at eaves and gables of shingle roofs. * All RED stamped approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections being performed or approvals granted. * A minimum of 90 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section R404.1. * Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the farthest projection of the structure. Front setbacks are measured from the front lot line or road easement boundary, whichever is closer. * Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor & Industries(L&I). For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415- 4000. * Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Code 14.28 and 14.17. Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 4 of 8 Mason County j. Mason County - Division of Community Development 615 W. Alder St. IV C Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 Adopted Washington State Energy Code Compliance has been approved as follows: Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window (Max U- Factor):0.30, Skylight (Max U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-20+5ci, Floor insulation R-30, Ceiling Insulation min. R-60, Vault Insulation R-38, and Slab Insulation R-10. 4 For heating system using a heat pump that meets federal standards for the equipment listed in Table C403.3.2(2) or C403.3.2(9) or Air to water heat pump units that are configured to provide both heating and cooling and are rated in accordance with AHRI 550/590 2.3 Compliance based on Section R40 .2: Reduce the tested air leak ' e to 0.6 air cha ges per hour maximum at 50 Pascals, or for R-2 Occupancies, optional compliance based on Se ion R402.4.1.2: educe the tested air leakage to 0.15 cfm/ft2 maximum at 50 Pascals AND All whole house ventilation requirements as determined by Section M1505.3 of the International Residential Code or Section 403.8 of the International Mechanical Code shall be met with a heat recovery ventilation system with minimum sensible heat recovery efficiency of 0.80. Duct insulation shall comply with Section R403.3.2. To qualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the maximum tested building air leakage and shall show the heat recovery ventilation system. 3.6 Air-source, centrally ducted heat pump with minimum HSPF 2 of 9.4 (HSPF of 11.0). A centrally ducted air source cold climate variable capacity heat pump (cc VCHP)found on the NEEP cc VCHP qualified product list with a minimum of 9 HSPF 2 (10 HSPF) may be used to satisfy this requirement. In accordance with Appendix RC, all air source centrally ducted heat pumps in Mason County shall be a cold climate variable capacity heat pump as listed on the NEEP qualified product list. 5.7 Water heating system shall include one of the following: Electric heat pump water heater with a minimum UEF of 2.9 and utilizing a split system configuration with the air-to- refrigerant heat exchanger located outdoors. Equipment shall meet Section 4, requirements for all units, of the NEEA standard Advanced Water Heating Specification with the UEF noted above To qualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the water heater equipment type and the minimum equipment efficiency The stamped approved site plan is required to be on-site for inspection purposes. If an inspection is requested and the approved site plan is not on site, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 5 of 8 Mason County Mason County - Division of Community Development 615 W.Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 " Installation of heating equipment in a single-family residence shall meet the requirements of the current WSEC R403, applicable sections of the IRC, and IMC. Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.7. Heating and design load calculations for the purpose of sizing HVAC systems are required and shall be calculated in accordance with accepted practice, including infiltration and ventilation. Design calculations shall be available for inspection during inspection. Referencing IRC M1601.4, all ducts, air handlers, filter boxes, and building cavities shall be sealed. All joints of duct systems and seams shall be made substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Closure systems used with rigid fibrous glass ducts shall comply with UL181A and shall be marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape. Closure systems used with flexible air ducts and flexible air connectors shall comply with UL181 B and shall be marked 181 B-FX for pressure- sensitive tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings shall be mechanically fastened. Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181 B and shall be marked 181 B-C. Crimp joints for round metal ducts shall have a contact lap of at least 1-1/2 inches (38 mm) and shall be mechanically fastened by means of at least three sheet-metal screws or rivets equally spaced around the joint. Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation instructions. Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be insulated to R-8 DUCT TIGHTNESS TESTING shall be conducted by person(s)trained to perform such testing. A signed affidavit documenting test results in accordance to IECC/WSEC Section R403.3.3 shall be provided to the Mason County Building Department prior to the final occupancy inspection. Affidavit forms are available on at the WSU-Energy Program website titles, "Duct Leakage Affidavit"or"Duct Leakage Testing Results(Existing Construction)." Duct tightness testing is not required if the air handler and all ducts are located within the heated space. * CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 6 of 8 QC Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 A permanent certificate, completed by the builder or registered design professional, shall be posted on a wall in the space where the furnace is located, a utility room, or an approved location inside the building. When located on the electrical panel, the certificate shall not cover or obstruct the visibility of the circuit directory label, service disconnect label, or other required labels. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Chapter 4, and air leakage results of the blower door test conducted. Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 4 air changes per hour when tested with a blower door in accordance with WSEC Section R402.4.1.2. The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required for additions less than 500 square feet. Reference WSEC R402.4.1.2. Compliance certificates are available online at the WSU Energy program website titled, " WSEC 2021 Certificate"and are available in '/.or%sheets. Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC Section R315. Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling. EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances), repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or created. * Disclaimer: Mason County does not require a survey to obtain a building permit.As a result,site plans may not reflect accurate data. It is the applicant's responsibility to comply with setback requirements. * 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/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. 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. All building permits shall have a final inspection performed and approved by Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 7 of 8 Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov NEW SINGLE FAMILY RESIDENCE BLD2025-01038 * Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered. A.) Drainfield/Reserve requires a 1 Oft setback from all footing/foundations. B.) Septic tank(s) requires 5ft setback from all footing/foundations. C.) No foundation/ Perimeter Drains within 30ft, down gradient of Drainfield/ Reserve area. D.)No Cut Bank(s) (greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/Reserve area. A separate inspection in addition to the inspections required in the IBC, Section 110 shall be required in accordance with the 2021 IBC, Section 1705.12.2 and Section 1707.1. An additional inspection is required when shear wall fastener spacing is required to be 4 inches or less. The shear wall schedule shown on sheet designate wall(s)type_and with fastener spacing 4 inches or less. The required inspection may be performed by the Mason County Building Department, a WABO certified inspector, certified to inspect lateral connections, the Engineer of record (EOR), or an authorized representative of the (EOR). The special inspector's duties and responsibilities shall be as specified in Chapter 17. When a third-party inspector is used to perform the inspection, special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton, WA 98584 and available on site for review by the Building Official. Inspection reports shall be completed and submitted to the Mason County Building Department in a timely manner and shall be submitted prior to the framing inspection of said project. All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must meet the installation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks. " Setbacks are measured from the furthest projection of the structure. X I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued By: Contractor or Authorized Agent: 7 ' 7Date: r Printed by:Anna Schaffran on:10/17/2025 01:09 PM Page 8 of 8 MASON COUNTY Permit No: hag COMMUNITY DEVELOPMENT S N C Permit Assistance Center, Building,Planning BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:Thomas Adams/Medclaf NAME:Black Bear Construction,LLC MAILING ADDRESS:Po Box 818 MAILING ADDRESS: CITY:Shelton STATE:WA ZIP:98584 CITY: STATE: ZIP: PHONE#1: PHONE: CELL: M7PHONE# • EMAIL : EMAIL' L&I REG#BLACKBC831J7 PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER Q NAME Evergreen Permitting/Lynette Arhutick EMAIL Permits@evergreenpermitting.com MAILING ADDRESS 1673 S.Market Blvd,#132 CITY Chehalis STATE WA ZIP 98532 PHONE 360-520-1251 CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 320065002079 ZONING LEGAL DESCRIPTION(Abbreviated) ISLAND LAKE SI-IORELANDS BLK:2 LOT:79 S.L. FIRE DISTRICT SITE ADDRESS 1973 E Island Lake Dr CITY Shelton DIRECTIONS TO SITE ADDRESS Easton W Alder St toward N 601 St.take 3rd exit Cl round about,contktue onto N let St.continue onto N 1301 St.right at N 13th,contkwe on E erockdale Rd.Drive to E Island Lake Dr IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ❑,. SNOW LOAD:25 psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER ❑ LAKE 0 RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑ TYPE OF WORK: NEW El ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER 0 USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residence IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOM HEATED STRUCTURE? YES(Whole Bldg) ❑.• YES(Part[s]of Bldg)❑ NO❑ DESCRIBE WORK New 3 Bedroom SFR SQUARE FOOTAGE: (proposed) 1ST FLOOR 1336 sq.ft. 2ND FLOOR 958 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK 372 sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAIi . sq.ft. Attached, 'Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING El PLUMBING IN STRUCTURE? YES 9 NO 0 Ifyes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 9 NOD EXISTING SQ.FT. EXISTING BEDROOMS ° PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3 OWNER 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 and I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permittapplication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON NTY CODE 14.08.42) Signature of OWNER ust be i ned b the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH