HomeMy WebLinkAboutBLD2025-00585 - BLD Permit / Conditions - 7/3/2025 Mason County
Mason County - Division of Community Development
615 W.Alder St.
ONyCy Building 8
Shelton,WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
B DD2025-00585 NEW SINGLE FAMILY RESIDENCE
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE ISSUED: 07/03/2025
SITE ADDRESS: 300 NE HAVEN LAKE DR TAHUYA
EXPIRES: 12/30/2025
PARCEL: 223305000307
APPLICANT: ATKINSON RICHARD&MONICA OWNER: ATKINSON RICHARD&MONICA
300 NE HAVEN LAKE DR 300 NE HAVEN LAKE DR
TAHUYA,WA 98588 TAHUYA,WA 98588
253-297-1342
VALUATIONS: FEES: Paid Due
Covered Deck/Carport 2664.00 $63,936.00 Mechanical Base Fee $30.00 $0.00
R-3 VB Residential, one- 1624.00 $271,808.88 Plan Check Fee $2,468.21 $0.00
and two-family Technology Surcharge $126.41 $0.00
U VB Utility, miscellaneous 3176.00 $211,140.48 State Fee-Residential $6.50 $0.00
Building Plan Review/Change of $140.00 $0.00
Use,-Onsite Sewage
Plumbing fees for new single $232.00 $0.00
family residence
Mechanical fees for new single $232.00 $0.00
family residences
Building Permit Fee $3,797.24 $0.00
Planning Residential Review $275.00 $0.00
Fee
Plumbing Base Fee $25.00 $0.00
Residential Energy Code Fee $189.86 $0.00
Total: $546,885.36 Totals : $7,522.22 $0.00
FIXTURES
(fi Mechanical Fixtures Qty Plumbing Fixtures
1.0000 Dryer Vent(s) 1.0000 Number of Clothes Washers
1.0000 Kitchen Exhaust Hood(s) 1.0000 Number of Dishwashers
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Page 1 of 7
t..
Mason County
Mason County - Division of Community Development
3q 615 W.Alder St.
`f D, t Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2025-00585
(3y Mechanical Fixtures .(qty Plumbing Fixtures
1.0000 Heat Pump(s) 1.0000 Number of Water Heaters and or Vent
1.0000 Propane Tank(s) 2.0000 Number of Kitchen Sinks
2.0000 Gas Outlet(s) (1-5) 2.0000 Number of Showers
2.0000 Spot Vent Fan(s) 2.0000 Number of Toilets
3.0000 Bathroom Sink
4.0000 Number of Hose Bibs
REQUIRED INSPECTIONS
Setback Inspection Mechanical Inspection
...................................................... — __.. — — — — — — — — — — — — — — — — — — — — — — —
Footing Inspection Gas Piping Inspection
Foundation Wall-Pre-Pour Inspection Rough-Plumbing Inspection
...................................................... — — — — — — — — —— — — — — — — — — — —— — — — —
Underground Plumbing Framing Inspection
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Slab Insulation Insulation Inspection
-------------------------------------------- — — —'— — — — — — — — — — — — — — — — — — — — — —
Radiant Piping Inspection Connection is to be verified by Health or Utilities
—
SLAB,INSPECTION BLD-Final Inspection
------------------------------------------------------. — —.—— —_ ——— —. — ——— — — — — ———— — —_
CONDITIONS
* 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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* 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.
* 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 n County prior to construction.
* 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.
.. - __....._- ----- - ------------------------------ - - --
* 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.
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Mason County
• s I"'1v, M1
Mason County - Division of Community Development
615 W.Alder St.
N C Building 8
Shelton,WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2025-00585
* 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. '
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* 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.
- - ---------------------------------------------------------------------------•-------..---------------.----
* 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.
* 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.
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* 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.
---------------------------------------------------------------•-•---------------------------------....._._...
* 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 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:
* 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.
* 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.
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* 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.
---------------------------------------------------.-..-...._--.------------------------------•------..._..._.
* 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.
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• 1
Mason County
• Mason County - Division of Community Development
3q 615 W.Alder St.
k, Building 8
Shelton,WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2025-00585
* 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 5 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.
* 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.
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* ,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.
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* 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.
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* 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.
* 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).
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* 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.
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Page 4 of 7
Mason County
Mason County - Division of Community Development
3q 615 W.Alder St.
`�aNC Building 8
Shelton,WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2025-00585
* 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 UL1-81 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 IECCWWSEC 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"Duet Leakage Testing Results(Existing Construction)." Duct tightness testing is not
required if the air handler and all ducts are located within the heated space.
--------------------------------•---••---------------------------------------------------•---------- ---------
* 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.
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* 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.
* 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 property lines shall be clearly identified at the time of foundation inspection.
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Mason County
Mason County - Division of Community Development
615 W.Alder St.
Cy. Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2025-00585
* 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
* 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.
" 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.
* 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.
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When parcel development requires direct access to state road(s),a Road Access Permit or Approval must be granted and
approved by the Washington State Department of Transportation. For more information contact Washington State
Department of Transportation, at(206)357-2620, ext. 630.
* 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.
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* 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.
" On-site Septic System final installation approval required prior to temporary/final occupancy of the residence.
-__--- ------ ---- - ---- ------ ----- --------- -- ---- --- -------------
* 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.
* No additional sink may be installed in the shop/garage without review from planning for ADU compliance
* Approved up to authorized heights of 35'. Height shall be measured by taking the average of the natural or existing
topography of the portion of the lot, parcel, or tract of real property which will be directly under the proposed structure and
shall be determined by averaging the ground elevations at the midpoint of all exterior walls of the proposed structure.
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Page 6 of 7
Mason County
Mason County - Division of Community Development
615 W.Alder St.
aNsC, Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
NEW SINGLE FAMILY RESIDENCE BLD2025-00585
* 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 charged and shall be collected by the
Building Department prior to any further inspections being performed or approvals granted.
----------------------------------------------------------------------------------------------------- ------.
In addition to the inspections required in IBC, Section 110,the owner,the engineer or architect of record acting as the
owner's agent shall employ one or more special inspectors who shall provide inspections during construction on the types of
work listed under Chapter 17 and as specified by the design professional. The special inspectors duties&responsibilities
shall be as specified in Chapter 17.
Special Inspection Agency: Krazan &Associates Inc.
Special Inspections Required:
Cold Form Steel Trusses Spanning 60 Feet or Greater.Per IBC 1705.2.4
Concrete Construction Per IBC 1705.3&Table 1705.3
Post Installed Mechanical Anchors Per ICC ESR
Special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton WA 98584
and available for inspection. Inspection reports shall be completed and submitted to the dept. in a timely manner and shall
be submitted prior to the framing and final occupancy inspections.
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: tV•t, , VJt1sov
Contractor or Authorized Agent: Date: S
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Page 7 of 7
Department of Community Development
MASON 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_development/buildinglinspections/index.phpp -
Permit Number BLD2025-00585 Date Issued 07/03/2025 Issued By
Project NEW SFR W/ATTACHED GARAGE
Site Address 300 NE Haven Lake Dr
Applicant ATKINSON RICHARD&MONICA
Contractor
Contractor Phone
2021 Primary Code UPS 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 -1 -3S Ec Slab - g-Y•1f f7
Footing Perimeter '7-Jy-?s �, Point load Footing
Footing Interior Sld�— Footing Decks/Porches.
Foundation Stem Walls Other
Rough-In Groundwork Plumbing 7�cl;2f ix/) Framing 57fLv I tap,Z &A (n '
Groundwork Mechanical - Plumbing -p'i4 4'
Groundwork Gas Pipe Mechanical g-
Gas Piping cr. o•a .0q" Shear Wall Nailing
Underfloor
Other -
Insulation Slab 97-Y t f&V Ceiling
Floor Vaulted Ceiling
Walls CJ_a 7_Z 6 d) i Vapor Barrier
Other SL < Z3
Wallboard Interior Wall Brace Panels Fire Walls
Nailing
Other
Final Building '.2, lb
Manufactured Setbacks Setup
Home
Concrete Foot!Runners Final
Other
�di T 4- j%luOr Qr •; -�AS5 Q M v.cC F4 act-o26
j2€,
1 -3-.Z3-26 Del)
Special Inspection Requirements
MASON COUNTY
COMMUNITY SERVICES
BLD2025-00585 Atkinson Barnominium 300 N.E. Haven Lake Dr. Tahuya WA 98588
Permit Number Project Title Project Address/Parcel Number
Applicants of projects requiring Special Inspection or Testing per Chapter 1704&1705 of the International
Building Code, as amended by Washington State. Please acknowledge and return this form to the Mason
County Permit Center.
THESE INSPECTIONS ARE NOT PERFORMED'BY THE BUILDING DEPARTMENT AND MUST BE
PERFORMED BY QUALIFIED SPECIAL INSPECTORS, HIRED BY THE OWNER AND APPROVED
BY THE COUNTY PERMIT CENTER. Individuals certified in a special inspection category by
Washington Association of Building officials(WABO)or individuals employed by a recognized testing
laboratory and under the direct supervision of a Registered Professional Engineer are typically
considered qualified at the discretion of the local jurisdiction having authority for enforcement.
BEFORE A PERMIT CAN BE ISSUED: The Owner or his/her representative, on the advice of the
responsible Project Engineer or Architect, shall fill out completely, sign and submit two (2) copies of the
attached"Structural Tests and Inspection Schedule"to this Department for review and approval including
any requirements related to the Mason County Municipal Code.
The Owner, General Contractor, and Inspection/Testing Agency, where applicable, shall also
acknowledge'the following conditions applicable to Special Inspection and/or Testing.
1. Inspection/Testing Agency shall submit names and qualifications of on-site Special Inspectors
to the Building Inspection Permit Center for approval PRIOR TO PERMIT/S BEING ISSUED.
2. All Special Inspections shall be noted on the approved plans or attached approved
documents.
3. All special inspections shall be approved by the County or as recommended by the Engineer
-of Record (EOR).
4. It is the responsibility of the General Contractor to review County approved plans for additional
inspection or testing requirements that may be noted or required per IBC as noted on
approved plans.
5. The General Contractor is responsible'for proper notification to the Inspection/Testing
Agency for items listed on this form.
6. Special Inspectors shall provide detailed reports on company letterhead to the Building
Inspector of all required-inspection activities. These may also be provided when the inspector
visits the jobsite for the scheduled inspection but must be completed before the subject of
inspection is approved by the building inspector.
7. Copies of all ongoing laboratory and testing reports shall be sent directly to the Building
Inspector by the Inspection/Testing Agency or other responsible party within a reasonable
time to test results.' d
8. BEFORE A CERTIFICATE OF OCCUPANCY APPROVAL CAN BE ISSUED: The
Inspection/Testing Agency shall submit a FINAL REPORT LETTER stating that all items
requiring testing and inspection have been fulfilled and reported and a final inspection report
shall be provided. A copy of the statement is to be maintained at the jobsite for the Building
Inspectors review prior to final inspections.
Page 1 of 4
Special Inspection Requirements
MASON COUNTY
COMMUNITY SERVICES
ACKNOWLEDGEMENTS
Prior, to issuance of a building permit, the Owner, on the advice of the Project Engineer or Architect, shall
complete, sign,and submit this form to the County Permit Center.
Declaration of Owner -
I, as the owner of the project, declare that the testing agency firm/s or individual/s listed herein are hired by me to
perform "Special Inspections" and/or "Structural Testing" in accordance with the provisions of the International
Building code(IBC) Chapter 17.
Rick Atkinson 7/1/25
Owner @rint) Owner(Signature) (date)
Declaration of Registered Professional Architect/Engineer
I, as the design professional in responsible charge of the project listed herein, declare that the special
inspection listed herein are required for this project in accordance with the provisions of the International
Building Code (IBC) Chapter 17.
James Dow P.E. �A S DOS,
Architect/Engineer(print) ���o� 8j��
Architect/Engineer Stamp/Signature (date) Z'
r°¢ 250048dS ��
8sr0 AL ��G
Testing Agency Name/Contact No Special Inspections Requied for Titan HD Anchors.
info: Install per manufacturer reccomendations.
James Dow P.E. Engineer of Record for,Wood Framed Structure
The Special Inspection/Testing Agency listed above must have a current Portfolio of Qualifications
on file with the County prior to performing work.
Declaration of the General Contractor
I, as the General Contractor of the project, agree to comply with the "Contractor Responsibility" items
noted herein.
Rick Atkinson 7/1/25
General Contractor(print) General Contractor Signature (date)
Page 2 of 4
Special Inspection Requirements
MASON COUNTY
COMMUNITY SERVICES
Required Special Inspections
International Building Code; Chapter 17:
A completed and signed copy of pages 1 through 4 of this form shall be submitted to the
"Permit Center" prior to building permit approval.
Engineer shall check the applicable items:,
❑ Special inspection of fabricated items 1704.2.5
❑ Submittals to the building official 1704.5
❑ Structures over 75' in height located in Seismic Design Category D, 1704.6.1
❑ Structures classified as Risk Category III or IV located in Seismic Design Category D, 1704.6.1
❑ Steel construction& structural Steel 1705.2.1
❑ Cold form steel deck 1705.2.2
❑ Open-web steel joists & girders 1705.2.3
❑ Cold form steel trusses spanning 60 feet or greater 1705.2.4
❑ Concrete construction 1705.3 & Table 1705.3
❑ Shotcrete 1705.3
❑ Welding of reinforcing bars 1705.3.1
❑Material Tests 1705.3.2
❑Masonry Construction 1705.4
❑ Empirically designed masonry, glass unit&masonry in Risk Category IV 1705.4.1
❑Vertical masonry foundation elements 1705.4.2
❑ Wood construction 1705.5
❑ High Load Diaphragms 1705.5.1
❑Metal-plate connected wood trusses spanning 60 feet or greater 1705.5.2
❑ Soils 1705.6 & Table 1705.6
❑ Driven deep foundations 1705.7 & Table 1705.7
❑ Cast in-place deep foundations 1705.8 &Table 1705.8
❑ Helical pile foundations 1705.9
❑Fabricated'items 1705.10
Page 3 of 4
Special Inspection Requirements
MASON COUNTY
COMMUNITY SERVICES
❑ Special inspections for wind resistance 1705.11
❑ Structural wood 1705.11.1
❑ Wind resisting components 1705.11.3
❑ Cold formed steel light frame 1705.1-1.2
❑ Special inspection for seismic resistance 1705.12
❑ Special inspection for structural steel per 1705.12.1
❑ Seismic force-resisting systems 1705.12.1.1
❑ Structural steel elements 1705.12.1.2
❑ Special inspection for structural wood per 1705.12.2
❑ Special inspection for cold-formed steel per 1705.12.3
❑ Designated seismic systems 1705.12.4
❑Architectural components 1705.12.5
❑ Plumbing, mechanical & electrical components 1705.12.6
❑ Storage racks 1705.12.7
❑ Seismic isolation systems 1705.12.8
❑ Cold-formed steel special bolted moment frames 1705.12.9
❑ Testing for seismic resistance 1705.13
❑ Structural steel 1705.13.1
❑ Seismic fore-resisting systems 1705.13.1.1
❑ Structural steel elements 1705.13.1.2
❑Nonstructural components 1705.13.2
❑ Designated seismic systems 1705.13.3
❑ Seismic isolation systems 1705.13.4
❑ Sprayed fire-resistance materials 1705.14
❑ Physical and visual tests 1705.14.1
❑ Structural member surface conditions 1705.14.2 (1705.14.3 through 1705.14.6.3)
❑ Mastic & intumescent fire-resistance costings 1705.15
❑ Exterior insulation& finish systems (EIFS) 1705.16
❑ Fire-resistance penetrations and joints 1705.17
❑ Penetration firestops 1705.17.1
❑ Fire-resistant joint systems 1705.17.2
❑ Testing for smoke control 1705.18
❑ Testing Scope 1705.18.1
Page 4 of 4
- t-
S • cial Inspector R quit m nt�s
f1L15O21 COUNTY - .
COMMUN(IY SERViCFS
BLD2025-00585
RICK AND MONICA ATKINSON, 300 NE:HAVEN LAKE DR.TAHUYA,WA 98588
Project Address/Parcel Number
Pro
Permit Number Project Title j
Applicants of projects requiring Special Inspection or Testing per Chapter 1704&1705 of the International
Building Code, as amended by Washington State.Please acknowledge and return this form to the Mason
County Permit Center.
THESE INSPECTIONS ARE NOT PERFORMED BY THE BUILDING DEPARTMENT AND-MUST',BE
PERFORMED BY QUALIFIED SPECIAL INSPECTORS, HIRED BY'THE OWNER AND APPROVED
BY THE COUNTY PERMIT CENTER. Individuals 'certified, in a, special inspection category by
Washington Association of Building officials(WABO)or individuals'employed by a recognized testing
laboratory and under the direct supervision of a Registered Professional Engineer are 'typically'
considered qualified at the discretion of the local jurisdiction having authority for enforcement.
f � l
BEFORE A PERMIT CAN BE ISSUED: The'Owner or his/her representative, on the advice of the
responsible Project Engineer or Architect,shall'fill out completely, sign and submit two (2) copies of ithe
attached"Structural Tests and Inspection Schedule"'to this Department for review and approval including
any requirements related to the Mason County Municipal Code.
The "Owner,, General Contractor, and Inspection/Testing Agency, where applicable,' shall also
acknowledge the following conditions applicable to Special Inspection and/or Testing.
1. 'Inspection/Testing Agency shall submit names and qualifications of on-site Special Inspectors
to the Building Inspection Permit Center for!approval PRIOR TO PERMIT/S BEING ISSUED. �I
2. All Special Inspections shall be noted on the approved plans or attached approved
documents. Yf
3. All special inspections shall be approved by the County or as recommended by the Engineer
of Record (EOR).
4. It is the responsibility of the General Contractor to review County approved plans for additional'
inspection or testing requirements that may be noted or required per IBC 'as noted ,on
,approved plans.
5. The General Contractor is responsible for proper notification to the Inspection/Testing
Agency for items listed on this form.
6. Special Inspectors shall provide detailed reports on company letterhead to the Building
Inspector of all required inspection activities. These may also be provided when the inspector
visits the jobsite for the scheduled inspection but must be. completed before the subject'of
inspection is approved by the building inspector.
7. Copies of all ongoing laboratory and testing reports shall'be sent directly to the Building
'Inspector by. the Inspection/Testing Agency or other responsible party within.a reasonable
time to test results.
8. BEFORE' A. CERTIFICATE 'OF OCCUPANCY APPROVAL, CAN BE "ISSUED: The
Inspection/Testing Agency shall submit a FINAL REPORT LETTER stating that all items.
requiring testing and inspection have been fulfilled and reported and a final inspection report.
shall be provided. A copy of the statement is to be maintained at the jobsite for the Building
Inspectors review prior to final inspections.
Page 1 of 4
;t Le1spiamm1ts
o Re =
MASOKCOUM
COA1NTIYSt VICC5
{
ACKNOWLEDGEIVIENTS ,
Prior to issuance.of a building'permit,,the Owner,,on the advice of the Project Engineer or.Architect, shall
complete,sign,and submit this form to the County Permit Center.
Declaration of Owner
I, as the owner of the.project,declare that the testing agency firm/s or individual/s listed herein are hired by me to
perform "Special Inspections"-and/or"Structural Testing" in accordance with the provisions of the International
Building code(IBC)Chapter 17.
Rick Atkinson 7/1/25
Owner(print) Owner(Signature) (date)
Declaration of Registered Professional Architect/Engineer 'g
I, as-the design professional in responsible charge of the project listed herein, declare that the special
inspection listed herein are required for this project in accordance with the provisions of the.International'
Building Code(IBC) Chapter 17.
SAADY AM IN
N
Architect/Engineer(print)
Architect/Engineer Stamp/Signature(date)
'r' 57344
tCI S7 G
{
IGNED.0612512025
"Testing Agency Name/Contact Krazan&Associates,INC. 1230 Finn Hill Rd NW, Ste A,
info: Paulsbo WA 98370
Rob Michaelson 360-598-2126
The Special Inspection/Testing Agency listed above niust have a current Portfolio-'Of Qnalificat 'ons
on file with the County prior to performing work.
Declaration of the General Contractor
Las the General Contractor of the project, agree to comply with the"Contractor-Responsibility" items
noted herein. a I'
P — / —
General Contractor rit) G eral Contractor Signature (date),?
t
Page2of4 -
Ir ,
S C Ct Q q
,,,,SICOU-rY
COMMUNITY SERVICES
Required Special Inspections'
International Building Code; Chapter 17:
A completed and signed copy of pages 1 through 4 of this form shall be submitted to the;;
"Permit Center" prior to building permit approval.
Engineer shall check the applicable items:
❑ Special inspection of fabricated items 1704.2.5
L O Submittals to the building official 1704.5
Structures over 75' in height located in Seismic Design Category D, 1704.6.1
.,❑ Structures classified as Risk Category III or IV located in Seismic Design Category D, 1704.6.1
❑Steel construction& structural Steel,1705.2.1
❑ Cold form steel deck 1705.2.2
❑ Open-web steel joists & girders 1705.2.3
0 Cold form steel-trusses spanning 60 feet or greater 17052.4
0 Concrete construction 1705.3 &Table 1705.3
❑ Shotcrete 1705.3
❑ Welding of reinforcing bars 1705.3.1
❑Material Tests 1705.3.2 ;F
❑ Masonry. Construction 1705.4
❑Empirically designed masonry, glass unit&masonry in Risk Category IV 1705.4.1
o P� Y � g rY
Vertical masonry foundation elements 1705.4.2
❑Wood.construction 1705.5
❑ High Load Diaphragms 1705.5.1
❑Metal-plate connected wood trusses spanning 60 feet or greater 1705.5.2
❑'Soils 1705..6 &Table 1705.6
❑Driven deep foundations 1705.7 &Table 1705.7
❑ Cast in-place deep foundations 1705.8& Table 1705.8
0 Helical pile foundations 1705.9
❑Fabricated items 1705.10.
® Post Installed Mechanical Anchor per ICC ESR
Page 3 of 4
---
',r peci I In�pect�ion R � ui e �
M.iSON cou&ry
COMMUNM sntvicrs
❑Special inspections for'wind resistance 1705.11 ti
❑ Structural wood 1-705.11.1.
❑Wind resisting.components 1705.11.3
❑ Cold formed steel light frame 1705.11.2
❑ Special inspection for seismic resistance 1705.12'
❑ Special inspection for structural steel per -1.705.12.1
D Seismic force-resisting systems 1705.12.1.1 '
❑ Structural steel elements.1705.12.1.2
O Special inspection for structural wood per 1705.-12.2
❑ Special inspection for "cold-formed steel per 1705.12.3
❑Designated seismic.systems 1705.12.4
D,Architectural components 1705.12.5 -
❑Plumbing,mechanical& electrical.components .1705.12.6
O Storage racks 1705.12.7
❑,Seismic isolation systems 1705.1.2:8
❑ Cold-formed steel special bolted moment frames 1705.12.9 k {
❑Testing for seismic resistance 1705.13
❑ Structural steel 1705.13.1 {,
❑ Seismic fore-resisting systems 1705.13.1.1
❑ Structural steel elements 1705:13.1.2
❑ Nonstructural components 1705.13.2 r
❑ Designated seismic systems 1705.13.3
❑ Seismic isolation systems 1705.13.4
❑ Sprayed fire-resistance materials 1705.14
❑ Physical and visual tests 1705.14.1
❑ Structural member surface conditions 1705.14.2(1705.14.3.'through 1705.14.6.3) ,k
❑ Mastic&intumescent'fire-resistance costings 1705.15
O Exterior insulation&finish systems(EIFS) 1705,16
❑ Fire-resistance penetrations and joints-1705.17 '
❑ Penetration firestops 1705.171
❑ Fire-resistant.joint systems 1705.17.2
❑ Testing:for smoke control 1705..18
❑ Testing Scope 1705.18.1
Page 4 of 4
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