HomeMy WebLinkAboutBLD2005-00344 SFR - BLD Permit / Conditions - 10/25/2005 ii IJpe1.LIUL I LII 10\NV vrYLI-
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2005-01293
OWNER: JEFF BAKER RECEIVED: 8/1/2005
CONTRACTOR: LICENSE: EXP: ISSUED: 10/25/2005
SITE ADDRESS: 440 E BLUE SKY LN SHELTON EXPIRES: 4/25/2006
PARCEL NUMBER: 221332400040
LEGAL DESCRIPTION: TR 4 OF SE NW (N1/2 S1/2 E1/2 SE NW)
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New SFR Pickering Rd. to right on Blue Sky Ct. Go left at fork and follow
General Information Construction & Occupancy Information Square Footage Information
No. of Bedrooms: 4 Type of Constr.: VB
Type of Use: SF Insp. Area: No.of Bathrooms: 3 Occ. Group: R3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: No. of Stories: 2 Occ. Load: Building:2,658 Garage-Attached 696
Valuation: Building Height: Occ. Status: Primary Basement: coy porch 64
Manufactured Home Information Setback Information Shoreline& Planning Information
Water Body:
Make: Length: Ft. Front: E 100.0 Ft. Shoreline: Ft. SEPA?: No
Rear: W Ft. Slope: Ft. Shoreline Desig.:Model: Width: Ft. Side 1: N 65.0 Ft. g.: Not Applicable
Year: Serial No.: Side 2: S 139.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures FEES
Mechanical Fixtures
Type Qty. Type Uly. tfpe By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 8/1/2005 $1,002.66 S22005
Hosebibs 2 Furnace<100K 1 Planning Review Fee KKK 8/1/2005 $155.00 S22005
Kitchen Sink 1 Ventilation Fan 5 Adjust Plan Check Fee DLC 8/11/2005 -$10.92 S12005
Laundry Tray 1 Woodstove 1 Building State Fee DLC 8/11/2005 $4.50 S12005
Lavatories 4 Heat Pump 1 Building Permit Fee DLC 8/11/2005$1,525.75 S12005
Water Closets (Toilets) 3 Dryer Vent 1 Mechanical Fee DLC 8/11/2005 $131.90 S12005
Mechanical Base Fee DLC 8/11/2005 $23.50 S12005
Water Heaters 1
Bath Tubs 3 Plumbing Fee DLC 8/11/2005 $110.00 S12005
Plumbing Base Fee DLC 8/11/2005 $20.00 S12005
1
Clothes Washer EH Plan Review CEW 8/22/2005 $75.00 S12005
Total $3,037.39
BLD2005-01293 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2005-01293
CONDITIONS FOR
BLD2005-01293
1) 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
perry revocation.
X -)
2) 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
Ins ?l for shall be made prior to requesting additional inspections.
X
3) The internationnl 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 r ads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
XAI7
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
Depjjnent prior to any further inspections being performed or approvals granted.
X
5) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that
require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the
access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background.
Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted
by the jurisdiction and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
insK��)
tions.
X
6) 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
1-8047-0982. 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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BLD2005-01293 Please referto the following pages for conditions of this permit. 2 of 5
7) ApproyØ per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
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
Bull, irlg Department prior to any further inspections being performed or approvals granted.
X42
9) No additional clearing can occur west of approved building structures as there is a forested wetland. A wetland delineation by a qualified biologist will be
required for any future proposed building or clearing west of the approved building structures in order to determine category of wetland and its associated
buffer
X � ,A
10) 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 " ' sled" and approved.
X
11) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Depar rent prior to any further inspections being performed or approvals granted.
12) 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
remov IIpf approved documents will result in failure of required building inspections.
X )
13) 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
Buildi ,Department prior to any further inspections being performed or approvals granted.
X -,
T
14) Washington State Energy Code Compliance has been approved using the following:
Heat Type:Other fuels, Compliance Method: IV,Window(Max U-Factor):0.40, Skylight(Max U-Factor):0.58, Doors (Type/Max U-Factor):0.40 or less, Wall
insul i n R-21, Floor insulation R-30, Ceiling Insulation R-38.
X P
15) 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).
X �1�
BLD2005-01293 Please refer to the following pages for conditions of this permit. 3 of 5
16) 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
chargeØ end shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
/1
17) 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
permit re o ation.
X !'D
18) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project
X M
19) 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.
X�
20) All property lines shall be clearly identified at the time of foundation inspection. X
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 ordinances and building regulations.
X 46 T
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 not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have prevented action from being taken. No more than one extension may be granted.
X
23) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
c nn� s, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.X2
24) OWNER MUST SHOW PROOF OF ñTISFACTORY WELL LOG AND WATER SAMPLE PRIOR TO TEMPORARY/PERMANENT OCCUPANCY OF
THE RESIDENCE. X
BLD2005-01293 Please referto the following pages for conditions of this permit. 4 of 5
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 on the 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.
OWNER OR AGENT: LG` -� DATE:
BLD2005-01293 Please referto the following pages for conditions of this permit. 5 of 5
9/1/2005
2:08PM
Fees Associated With
�o Case#: BLD2005-01293
Due
Type Description Revenue Account Number Date Paid By Fees Paid History
PLCK Plan Check Fee 001.125.140.345.83.00.0000 8/1/2005 KKK 1,002.66 1,002.66 0.00
Plan Check Fee 001.125.140.345.83.00.0000 8/1/2005 KKK 0.00 0.00
PLRV Planning Review Fee 001.125.145.345.83.03.0000 8/1/2005 KKK 155.00 155.00 0.00
Planning Review Fee 00 1.125.145.345.83.03.0000 8/1/2005 KKK 0.00 0.00
ADJ Adjust Plan Check Fee 001.125.140.345.83.00.0000 8/11/2005 DLC -10.92 0.00 -10.92
STFE Building State Fee 650.170.010.386.00.05.0000 8/11/2005 DLC 4.50 0.00 4.50
PRMT Building Permit Fee 001.125.140.322.10.00.0000 8/11/2005 DLC 1,525.75 0.00 1,525.75
MCH Mechanical Fee 001.125.140.322.10.00.0000 8/11/2005 DLC 131.90 0.00 131.90
MCHB Mechanical Base Fee 001.125.140.322.10.00.0000 8/11/2005 DLC 23.50 0.00 23.50
PLM Plumbing Fee 001.125.140.322.10.00.0000 8/11/2005 DLC 110.00 0.00 110.00
PLMB Plumbing Base Fee 001.125.140.322.10.00.0000 8/11/2005 DLC 20.00 0.00 20.00
EHPR EH Plan Review 150.300.000.346.50.54.0000 8/22/2005 CEW 75.00 0.00 75.00
Total Fees:$3,037.39 Paid:$1,157.66
TOTAL REMAINING DUE: $1,879.73
Page 1 of 1 CaseFees.rpt
MASON COUNTY PERMIT NO. 1LS~. �
BUILDING PERMIT APPLICATION �� \a1426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANMINE R ATI N j CONTRACTOR INFORMATION
Owner Company Name - —
Mailing Address O 8A sky U. Mailing Address
City '56Ih State i1k Zip Code S City State Zip Code
Phone_ 11 2- Other Ph._41 - f(0" Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# DOB _,$ 73 Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well L .r Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. o D Fire District
Legal Description
Site Address (Please ir2c1ude street na e, street number and city) '`f4D f) '5 y l.N.
Directions to site o dbi RIL, - 11 '
W
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE [� ` SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor ' :- 2nd Floor //:�.
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X Date: /" a5
Owner-/ownerspresentative/Cont for (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APP OVED DENIED NOTES
Buildin Department Q
Plannin De artment G
Environmental Health DepartmentOO /'1 /
Fire Marshal
t"J p e S"
FEES
Buildin Permit Fee . _1' Site Ins ection
Plan Review Fee D 9 EH Review Fee
Plumbin & Base Fee ,- I ' V Plannin Review Fee
Mechanical & Base fee .S /_ ;It)D Other
Wood /Gas/ Pellet St ve Fee State Fee
Violation Fee 0-'` Pre-Paid at Submittal
Valuation $ 1 4 ___, TOTAL FEES
7? v �y
( it)
7
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic. # DOB Drivers Lic. # DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/ No
Is property within 200' of Saltwater Lake River/ Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or 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 A PROGRESS INSPECTION.IITIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X � ,� l� Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department P Z ID 3dbd
Fire Marshal
FEES
Building Permit Fee Site Ins ection
Plan Review Fee EH Review Fee 7
Plumbing & Base Fee Plannin Review Fee
Mechanical & Base fee Other
Wood / Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION ��
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360)427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone /A ) Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building p Describe Work
No. of Bedrooms 7 No. of Bathrooms Square Footage- 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null &void if work or 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department 1�41^ti ñ o(o
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.
PLEASE PRESS HARD
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton,WA 98584
Shelton (360) 427-9670 • Belfair(360) 275-4467• Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INF ATI N L CONTRACTOR INFORMATION
Owner 4-- Company Name
Mailing Addres ct Mailing Address
City '-I hov'_State (.fie. Zip Code City State Zip Code
Phone '12-7 )- Other Ph. 31 -_3$ Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic. # DOB - I' 7.5 Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city) '9G I°/mac Lvl She z/ , G 1 =S, y
Directions to site n� A5 &Vt cJ P&""' 4
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New i--' Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of f Fixtures Fees Fuel Type:Electric�' LPC.z_ Natural Gas Heat Pump
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace I
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater / Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove I
Dishwasher Kitchen Exhaust Hood
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 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 County access to the above described property and structure for review and inspection.
PROOF OF CONTINU ION OF WORK S BY MEANS OF A PROGRESS INSPECTION.
X
Date: /
Owner,/ ner5 R presentative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grou T e Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Ins ection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
PERMIT NO.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670• Belfair (360) 275-4467• Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City k. I lbw. State 1. Zip Code $ City State Zip Code
Phone Other Ph._ t`' n Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. i✓ Fire District
Legal Description
Site Address (Please include street name, street number and city) ,4i/ R/vr '•°
Directions to site
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNIT
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC� Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink 4 Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer _ utlets
Kithen Sinks Woo as/PelletStove—
Dishwasher _ en Exhaust Hood
Hosebi s Dryer Vent
Other I Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
(b' // ners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grou T e Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Ins ection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
J 'z = goo Na'Th -- - [ 1
RE EIVED
AU I0125 .X005 . PLANNING
426 . CEDAR ST
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MASON COUNTY'DGO FLAT=MNC
#' SITE PLAN F;LQUI: D TO BE ON SITE
00 - CHANGES SUBJ 'P
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Mason County Permit Assistance Center
`` Planning Intake Checklist
Owners Name: /I ier Date: _ /
Project: Sr7a Reviewed By:
Commercial Development: YES Comments:
Planner: GBM TSC CMM KJ SNG BJR
Site Plan: �,NorthArrow PLAKI v RECE"fE D
2' Property Dimensions: 3 C ' X
Streets and Driveways Shown. Road name: I�t,.e AJu
le.,j �L
All Existing Structures shown with setbacks 42,6 W. CLEAR ST:
Well Location, Septic and Drain-field Shown with setbacks _
Identify all surface water (streams,ponds, shoreline,wetlands, etc.) e/ra
Topography(slopes)
Gls Proposed Structure Setbacks (Direction/Setback):
F: LI //CC R: 1-J / 51: A) / S S2: -S' / /39
ce Utility and Drainage Easements: Yes No (if yes enter condition#5022)
Other Easements
Accessory Appurtenances /u< /t
❑ County Access Permit Needed(add condition#0010)
❑ State Access Permit Needed(add condition#0020)
Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700
Are there any impediments that may restrict access to your site? (dogs/gates)
Shoreline and Planning Info
Setbacks: Shoreline: Slope:
Shoreline Designation: Comprehensive Plan: Rural Zonin
--Not Applicable ❑ Agricultural RR 2.5 5 10 20
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ Conservancy ,��Rural ❑ RI
❑ Natural ❑ RAC ❑ RNR
❑ Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban Growth Area ❑ MPR
❑ Unknown ❑ Unknown
Water Body(type of water if unnamed):
SEPA: Ye No Unknown
Flood Plain: YES NO Unkno ap
Aquifer Recharge: YES NO Jn1wn Map#
Tags/Cases:
RLC/SPI Case: 6-Year Dev. Moratorium: YE COO
Eagle Nest Tag: YES NO Other YES
Addressing: Check box if needed ❑ Reviewed by:
Revised:07-12-2005 I:\PLANNING\CHARELL&RENEE\PLANNING INTAKE
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES jLI/I
August 03, 2005 PO BOX 1666 Shelton WA 98584
Shelton (360) 427-9670
Fax (360) 427-8442
JEFF BAKER Elma (360) 482-5269
E 470 BLUE SKY LANE
SHELTON WA 98584 Belfair (360) 275-4467
Case No.: BLD2005-01293 Parcel No.: 221332400040
Dear Applicant:
Your building permit cannot be approved by Mason County Environmental Health until the
following are completed and turned in:
Application for Water Adequacy
Water bacteriological analysis.
Well Log
Please call me at (360)427-9670, ext. 554 if you have any questions.
Sincerely,
Trish Woolett
Environmental Health
Mason County Health Services
Comments:
8/3/2005 1 of 1 BLD2005-01293