PROPERTY INFORMATION: Site Address:

Transcription

1 BLD DATE STAMP - RCVD BY: APPLICANT INFORMATION (please print clearly) Name of Applicant: Telephone Number: PROPERTY INFORMATION: Site Address: Incomplete applications will NOT be accepted. For a complete application, all items on this checklist shall be submitted, unless waived by Staff. This checklist must be completed and signed by the owner or owners authorized agents at time of submittal. PERMIT APPLICATION N/A Provided Staff Provide a completed and signed (by owner or authorized representative) application and applicable fees are due at submittal. Provide a completed plumbing and Mechanical Application SITE PLAN Provide one (1) copy of proposed site plan. Drawn to scale of either 1 = 10 or 1 = 20 depending on lot size. North Arrow, location and dimensions of all property lines and easements. Vicinity map showing location and names of all roads and easements. (public and private) Show distances to all structures, septic tanks, drain fields, property lines, top of slopes or cuts and easements. Zoning (indicate): Rural Residential: Other: Urban Growth Area: Zone: Front yard: Direction: Side yard: Direction: Rear yard: Direction: Side yard: Direction: All access points, width of access. (easements and driveways). Contour lines in twenty (20) foot increments. See Parcel Map Viewer on website Building height shown on elevations at all four corners of structure. Floodplain boundaries and setback distances. See Plans for additional reuirements. Wetland or surface water (if any) and any applicable buffers. If yes, a wetland report may need to be submitted. Is the site near a Shoreline (stream, creek, lake, saltwater) if yes, please indicate? Name of shoreline: Shoreline designation: Stream type (F, S, Ns, Np): Is the proposed site within 300 feet of a slope 15% of greater? If yes, a geological report or assessment may be reuired. Existing/proposed on-site septic system and reserve areas, providing setback to structures. Existing/proposed wells (show 100 ft well radius, with distances to structures). Existing and proposed stormwater controls (downspouts, dry wells, etc.) Exterior storage tanks (propane) and HVAC euipment. PLANS N/A Provided Staff

2 Provide three (3) copies of plans (2 full size min. 18 x 24 and 1 small size) and two (2) copies of all specifications and engineering. Plans must be drawn to scale of ¼ = 1. All notations and drawings must be clear and legible. All Engineering call-outs must be on plans. Engineered plans must provide calculations/analysis. Analysis must include the following information: 2015 International Building Code Snow load (by location) Seismic zone (D-2) Exposure (by location and topography) Wind speed (85 MPH basic and 110 ultimate w/ 3 second gust) If project is in a flood hazard area, the submittal must include an Elevation Certificate, flood venting compliance and an elevation detail indicating the location of finished floor relative to the Base Flood Elevation or Design Flood Elevation as designated by surveyor or engineer. FOUNDATION PLAN Plan view of foundation/footings/pads Type, size and location of footing (stepped foundation provide detail) Elevation view of foundation steps, with final grade Cross-sections of footing and foundation (including height of wall). Floor joist and spacing (each floor). Show location of flood venting and detail the method and compliance for venting. Type and locations of hold-downs and anchors. Crawl access location and size. Insulation value for foundation (if slab or basement). See Energy Credits for additional reuirements, credits must be indicated on the plans. If project is in floodplain provide flood venting compliance including vent locations, vent type, elevation detail for venting location interior and exterior of the crawl space. FLOOR PLAN Suare-footage of each floor Use of each room Location and size of attic access Dimensions of building and rooms. Location and type of furnaces, water heaters, smoke detectors, and carbon monoxide detectors. Include location of bollard for appliances located in garage. Plumbing fixture locations Location of doors, windows (include size, egress, tempered and skylights) Insulation value in floor. See Energy Credits for additional reuirements, must be indicated on the plans. Location of ventilation fans and CFM for each. Location of whole house fan and CFM (continuous or intermittent) Location, side and type of brace wall or shear-wall panels. If structure is engineered, must supply two copies of reuired analysis (calculations) Dimensions and framing details of decks (including joists, beams, posts, ledgers. Plan MUST include size, grade, spacing, length and species or type of material) ELEVATIONS AND WALL DETAILS Typical and rated walls (garage separation) Listing of fire-resistive wall designs (duplex or townhouse) Building elevations- all 4 sides Show distance from grade at each corner. Exterior wall details when distance between overhangs is less than 5 feet. Insulation value for walls. See Energy Credits for additional reuirements, must be indicated on the plans.

3 If project is in floodplain must provide Elevation detail indicating the location of finished floor relative to the Base Flood Elevation or Design Flood Elevation as designated by surveyor or engineer. ROOF PLAN Layout of roof system Label type of roof system, rafters, engineered trusses & spacing Headers noted at each location or typical header noted. Roof pitch and covering materials Sheathing types, dimensions and fastening Attic venting (type, location and amount) Insulation value for roof (R38 vault and R49 ceiling) See Energy Credits for addition reuirements, must be indicated on the plans. ENERGY CODE REQUIREMENTS N/A Provided Staff Completed Washington State Energy Code form Plans must indicate fuel source for furnaces, water heaters and other appliances. Completed Heating/Cooling system size worksheet. Compliance to the Washington State Energy Code and reuired Credits. Construction drawings/plans MUST include all credit information on the plan details such as insulation, ventilation, furnaces, windows etc. Plans must also include the amount of credits and which credits are chosen. I verify that all reuired documents, plans and specification associated with this application have been submitted and are accurate. Signature of owner or authorized agent Print Name Date

4 MASON COUNTY COMMUNITY SERVICES PERMIT ASSISTANCE CENTER: BUILDING PLANNING PUBLIC HEALTH FIRE MARSHAL 615 W. Alder Street, Shelton, WA Phone Shelton: (360) ext. 352 Fax: (360) Phone Belfair: (360) Phone Elma: (360) Permit No: BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: NAME: MAILING ADDRESS: CITY: STATE: ZIP: PHONE #1: PHONE #2: CONTRACTOR INFORMATION: NAME: MAILING ADDRESS: CITY: STATE: ZIP: PHONE: CELL: L&I REG # EXP. / / PRIMARY CONTACT: OWNER CONTRACTOR OTHER NAME MAILING ADDRESS CITY STATE ZIP PHONE CELL PARCEL INFORMATION: PARCEL NUMBER (12 Digit Number) ZONING LEGAL DESCRIPTION (Abbreviated) FIRE DISTRICT SITE ADDRESS CITY DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S) GREATER THAN 14%: YES NO IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER LAKE RIVER/CREEK POND WETLAND SEASONAL RUNOFF STREAM TYPE OF WORK: NEW ADDITION ALTERATION REPAIR OTHER USE OF STRUCTURE (Residence, Garage, Commercial Bldg, Etc.) IS USE: PRIMARY SEASONAL NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES (Whole Bldg) YES (Part[s] of Bldg) NO DESCRIBE WORK SQUARE FOOTAGE: (propose + existing) 1ST FLOOR s. ft. 2ND FLOOR s. ft. 3RD FLOOR s. ft. BASEMENT s. ft. DECK s. ft. COVERED DECK s. ft. STORAGE s. ft. OTHER s. ft. GARAGE s. ft. Attached Detached CARPORT s. ft. Attached Detached MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER / NEW EXISTING PLUMBING IN STRUCTURE? YES NO If yes, attach completed Water Adeuacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES NO EXISTING SQ. FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 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 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 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 COUNTY CODE ) X Signature of OWNER (Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH

5 MASON COUNTY COMMUNITY SERVICES PERMIT ASSISTANCE CENTER: BUILDING PLANNING FIRE MARSHAL 615 W. Alder St - Shelton, WA Phone Shelton: (360) ext. 352 Fax: (360) Phone Belfair: (360) Phone Elma: (360) PLUMBING & MECHANICAL PERMIT APPLICATION Permit No: OWNER INFORMATION: NAME: MAILING ADDRESS: CITY: STATE: ZIP: 1 st PHONE: 2 nd PHONE: CONTRACTOR INFORMATION: NAME: MAILING ADDRESS: CITY: STATE: ZIP: PHONE: CELL: L&I REG # EXP. / / PARCEL INFORMATION: PARCEL NUMBER (12 Digit Number): Zoning: LEGAL DESCRIPTION (Abbreviated): SITE ADDRESS: CITY: DIRECTIONS TO SITE ADDRESS: TYPE OF JOB: NEW ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FIXTURES/UNITS 1 ST FLOOR 2 ND FLOOR BASEMENT GARAGE OTHER PLUMBING FIXTURES (SHOW NUMBER OF EACH) Type of Fixture No. of Fixtures Fees Toilets Bathroom Sink Bath Tubs Showers Water Heater Clothes Washer Kitchen Sinks Dishwasher Hose bibs Other Base Fee TOTAL PLUMBING MECHANICAL UNITS Fuel Type:Electric LPG Natural Gas Ductless Type of Unit No. of Units Fees Furnace Heat Pump Spot Vent Fan Propane Tank Gas Outlets Wood/Gas/Pellet Stove Kitchen Exhaust Hood Dryer Vent Solar Panel Other Base Fee TOTAL MECHANICAL OWNER acknowledge 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 OFTHIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Signature of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL Rev: 1/27/2016 JBN

6 MASON COUNTY DEPARTMENT OF COMMUNITY SERVICES SITE PLAN INSTRUCTIONS A complete, accurate, and detailed site plan is important to avoid delays in the review and approval of your project. A sample site plan and topography are located on the inside of this form. An easy to use grid, which can be used to draw your site plan on, is also located inside. The following items will be reuired, if applicable, to complete the building permit application package. Additional information may be needed depending upon individual site conditions. For more information see submittal standards and instructions on the back of this form. Submittal Reuirements Septic Approval Site Built Home Manufactured Home Man. Home Replacement Addition or Remodel Garage, Barn or Carport Retaining Wall, Deck Bulkhead or Dock, Demolition of Structure Mechanical or Plumbing Re-Roof Structure Commercial Projects Building Permit Application Form Site Plan Septic Records Septic Permit Application & Septic Design 3 Water Adeuacy Form Construction Plans Energy Code Application Form If Heated Septic Pumpers Report Existing systems older than 3 years. Property Lines Flagged Geotechnical Study See instructions on back Plumbing/Mechanical Application Form Engineered Calculations Floor Plan SEPA Road Access Permit Fire Apparatus Access Road Small Parcel Stormwater Application/Worksheet The number in the table indicates the number of copies reuired if applicable. Reuired for submittal of a complete application. A pumpers report may be reuired when a septic system is existing and has been installed for three or more years. The report, dated within the last three years, shall include the size and condition of both tank and baffles. Additional information and permits may be reuired by the Planning Dept. call extension 352 for information. If applicable, needed when site conditions reuire additional information. Engineered plans shall have design information & details transferred onto plans. One copy of the plans and calculations shall be wet-stamped. Revised 09/04/2013

7 SITE PLAN REQUIREMENTS: A complete, accurate and detailed site plan is important to avoid delays in the review and approval of your project. Use the checklist below as a tool to help you complete the site plan. 1. Scale: A scale of 1 =20, is typical but other scales such as 1 =10 or 1-40 are also acceptable. Do not exceed 1 = North arrow 3. Property line location and dimensions. 4. Label abutting streets 5. Shoreline/Surface water: Indicate creeks, streams, lakes, ponds, wetlands and other bodies of water within 300 ft of the proposed project. 6. Wetlands and Seasonal Drainage: Show setback distances from wetlands or seasonal drainage. 7. Easements: Indicate location and size of road, utility, and private easements. 8. Show All Existing Development: Identify existing and proposed structures. Include porches, decks, roof overhangs, cantilevers, and structures that will be demolished. 9. Proposed Building Footprint: Use scale to show distances to property lines, existing structures, septic tank and drainfield. Stake or flag footprint of proposed structure. 10. Sewage Disposal System: Identify septic tank location and drainfield. 11. Existing and proposed Buffers: Include open space, fences, sidewalks and parking areas. 12. Retaining walls: Proposed and existing. 13. Slopes/Site contours (Topography): Identify any slopes greater than 15%, fills or cuts greater than 4ft. that are located within 300ft. of the proposed project. Use Contour lines or arrows to show the direction of the slope. 14. Wells: Show existing and proposed, need to include all wells located within 100 ft of property. 15. Waterfront projects: Show all structures on adjacent property. 16. Driveway/ Site Access

8 SUBMITTAL STANDARD INSTRUCTIONS/INFORMATION A. Site Plan: Site plans must be drawn to scale. On at least 8 ½ x 11 paper. A checklist indicating information reuired on the site plan is listed in the site plan application. Incomplete site plans will not be accepted. B. Construction Plans: Plans must be drawn to scale, preferably ¼ = 1. Dimensions must be noted on the plans. A complete set of plans shall include foundation plan, framing plans, floor plans, cross sections, and elevations. A complete building plan will give the building department enough information on how your project will be constructed. If you plan to construct a log home, pole building greater than 864 suare feet, or a metal structure, calculations stamped by a Washington State licensed engineer or architect, will be reuired. Also, masonry or concrete structures, may reuire an engineered design. The building official may reuire additional drawings, details, sections, or stamped-engineered calculations and/or details. C. Directions to Site: Provide accurate directions to your project site. This information will be used by staff when they review the project and by building inspectors. D. Structural Engineered Calculations: Will be reuired if the proposed structure does not meet conventional construction standards. Include 2 sets with your building permit application. E. Road Access Permit: May be reuired if accessing a public road or right of way. Contact Mason County Public Works for county maintained roads at (360) , ext. 450 for more information. For state highways contact Washington State Department of Transportation at (360) F. Washington State Energy Code and Ventilation & Indoor Air Quality Code (WSEC & VIAQ): Refers to energy envelope calculations and air uality code compliance. G. Existing On-Site Septic System: Documentation of an approved on-site sewage system will be reuired. An existing system must have records and a pumpers report, dated within the last three years, per Mason County Health Services Policies. These policies are case/job specific if you have any uestions please contact Environmental Health at (360) ext H. Septic Approval or Sewer Permit: A Septic design application must be approved by the Mason County Environmental Health Department prior to permit issuance for all single family developments using septic systems. If sewer is available, sewer permits can be obtained by calling Mason County Utilities at (360) ext I. Water Availability: The local water purveyor must complete a water availability application if the project will be connected to a public water system. Private well systems reuire a water well report, or capacity test, and bacteriological test dated within the previous 12 month period. J. Site Pre-Inspection: Resource lands and critical areas checklist. Includes a site visit by a planner to identify critical areas on a site. L. Critical Area: Critical areas include shorelines, flood plains, streams, wetlands, important wildlife habitat areas and landslide hazard areas (such as steep slopes and marine bluffs). The planner may need to visit your site to decide whether a buffer zone is reuired between the critical area and the proposed structures. Please mark the corners of proposed structure(s) with flags or stakes. M. Geotechnical Study: A geotechnical assessment or report will be reuired if the parcel is located within a Landslide/ Erosion Hazard Area. N. Wetland: Areas that are inundated or saturated by surface water or ground water at a freuency and duration sufficient to support, under normal circumstances, a prevalence of vegetation typically adapted for life in saturated soil conditions. Wetlands generally include swamps, marshes, bogs, and similar areas. O. Buffer: An area of land or designated for the purpose of insulating or separating a structure or land use from a critical area or resource land in such a manner as to reduce or mitigate any adverse impacts of the developed area. P. Parcel Number: a 12-digit tax assessment number assigned to each parcel by the Assessor s Office. Q. Legal Description: This describes the parcel of land identified by the 12-digit tax identification number. It is acceptable to submit a brief legal description of the parcel as it appears on record at the Assessor s office. Legal descriptions are used to check the dimensions of a parcel and any underlying restrictions such as setbacks from property lines or easements, lot coverage, or height of buildings. R. Address: Site addresses are assigned through the Mason County Department of Community Development, for more information (360) ext S. Contractor Registration Number: Contractors must be licensed with the state. The contractor license number can be obtained from the general contractor that will be performing the work or through the Labor & Industries website at: An owner can be an owner-contractor when building on his or her own property. T. SEPA: The State Environmental Policy Act, RCW 43.21C and implementing State and County administrative rules. U. Fire Apparatus Access Road: Mason County Standards reuire a fire apparatus access road for every facility, building, or portion of a building that is more than 150 feet from an existing approved access road. When the new fire apparatus road is installed, it is to extend to within 150 feet of any portion of the exterior walls of any building. Fire apparatus Access Roads Ordinance and details are available. To reuest a copy call (360) ext. 352 K. Auifer Recharge Areas: Areas where water infiltrates the soil to the groundwater table. Call Planning Department, extension 352.

9 Setback Instructions Distances from property lines should be measured from the Furthest Projection The Furthest Projection may be an eave, gutter, land, 2nd level deck, heat pump, or propane tank. X = distance or setback (in feet) between property line and Furthest Projection. Contact a Permit Technician if you have uestions or reuire clarification. Furthest Projection Property Line House with cantilevered 2nd level, heat pump, 2 eave, and gutter. In this case, the gutter would be the Furthest Projection. X Heat Pump

10 1 =40 scale Sample Sample Site Plan Site and Plan Topography and Topography Scale: 1 = 40 Main Street Stormwater run-off path 125 Allowable Building Area 80 Wetland

11 MASON COUNTY DEPARTMENT OF COMMUNITY SERVICES BUILDING DIVISION SHELTON (360) BELFAIR (360) Elma (360) FAX: (360) WEB SITE: W ALDER STREET, SHELTON International Energy Conservation Code, as amended by WAC (IECC) Effective July 1, Ventilation code provisions are located in the 2015 International Residential Code (IRC), 2015 International Mechanical Code (IMC), & 2015 International Building Code A complete energy code application form will include information that clearly identifies compliance methods for heat sizing, thermal envelope, and whole-house ventilation. This form includes compliance instructions and information needed. Energy code compliance information, forms, worksheets, and educational information is also available on the Washington State University Extension Energy Program (WSU-EP) website. To access the website go to The website includes a heat system sizing calculator. Submit a completed heat sizing calculator worksheet when the building permit is submitted. In addition to the heat sizing calculator the website has helpful compliance information and worksheets for prescriptive and component performance options along with a glazing schedule. INSTRUCTIONS: Complete the Mason County Energy Code application and submit with a heat sizing calculator available on the WSU-EP website, see item # 4 below: 1 Identify the compliance method. The most common and simplest approach is the prescriptive method for energy code compliance. See prescriptive table R located in the instructions. The Performance Alternative approach referenced in IECC Section R405 may also be used for energy code compliance. For more information contact Mason County Building Department staff at (360) ext. 352 or WSU Energy Program at (360) Compliance must be shown on your construction drawing in addition to this application. 2 Identify the whole-house ventilation compliance method. A ventilation system must be installed in accordance with The International Residential Code, Section M1507. The most common ventilation methods include a whole-house ventilation system using exhaust fans (M ) and a whole-house ventilation system integrated with a forced-air system (M ). Other ventilation systems include whole-house ventilation system using a supply fan (M ) and whole-house ventilation system using a heat-recovery ventilation system (M ). Ventilation openings are reuired in each habitable room in accordance with M If you need additional information we recommend that you discuss with your heating and ventilation system professional. In addition Mason County staff will be happy to discuss the options if you are not sure which compliance option will work for you. 3 Identify the Additional Energy Efficiency Reuirements listed in Table R The drawings included with the building permit application must show and identify which options have been selected and the point value of each option. Each one and two-family dwelling unit and townhouses are reuired to achieve the following minimum number of credits: a) Small dwelling units: less than 1500 s. feet of heated or cooled floor area and less than 300 s. ft fenestration area (skylights, doors, windows, etc). Additions to existing building that are greater than 500 s. ft. of heated floor but less than 1500 s ft of area. Reuires 1.5 credits b) Medium dwelling units that are not included in (a) above {small dwelling}, OR (c) below {large dwelling} Reuires 3.5 credits EXCEPTION: Dwelling units serving R-2 occupancies shall reuire. Reuires 2.5 credits. 1

12 Option (R-2 occupancy is Residential occupancies containing sleeping units or more than two dwelling units where the occupants are primarily permanent in nature, including: Apartment houses, Boarding houses (non-transient) with more than 16 occupants, Congregate living facilities (non-transient) with more than 16 occupants, Convents, Dormitories, Fraternities and sororities, Hotels (non-transient), Live/work units, Monasteries, Motels (non-transient), Vacation timeshare properties.) c) Large dwelling unit is a dwelling unit that exceeds 5,000 s. ft. of heated or cooled floor area. Reuires 4.5 credits. d) Additions less than 500 s feet. Reuires.5 credits 4 Must provide a completed heating/cooling system size worksheet to verify compliance to IECC R The calculator/worksheet is available on the WSU-Energy Program website at: Staff may be able to assist with preparation of the worksheet. 5 Must meet the prescriptive option for all fenestration products. Products shall comply with the reuired U- factor listed in Table R Windows, doors, and glazed doors shall have a tested U-factor or.30 or less. When using the small dwelling option for energy credits (a) or Performance Alternative approach you must provide a fenestration schedule that identifies the suare feet and U-factor of each item. Fenestration is defined in the IECC as skylights, roof windows, vertical windows, opaue doors, glazeddoors that include products with glass and non-glass glazing materials. 6 Identify on the construction drawings the location and fuel type of the heating system, water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of proposed insulation for walls, floors, ceilings, and concrete slab floors on the building plans. 7 Not less than 75% of all permanently installed lamps in lighting fixtures shall be high efficacy lamps. High efficacy lamps are defined in IECC Chapter 2 and are considered compact fluorescent lamps, T-8 or smaller diameter linear fluorescent lamps, or lamps with a minimum efficacy 60 lumens per watt for lamps over 40 watts, 50 lumens per watt for lamps over 15 watts to 40 watts, and 40 lumens per watt for lamps 15 watts or less. If you need assistance please contact Mason County Community Development at (360) ext. 352 or WSEC compliance information and code text is also available on the WSU-Energy Program website at: Glazing Area % of Floor Fenestration U-factor Vertical (Includes doors, windows, etc.) Prescriptive Reuirements 0,1 for Mason County Climate Zone 4-C, Table R Skylight b Ceiling Vaulted Ceiling j 4C Unlimited R-49 R-38 Wall Above Grade R-21 int k,l Wall int c,n below grade 10/15/21 int + TB Floor R-30 Slab d on Grade R-10, 2 ft Heated slabs reuire R10 full slab. n Log & solid timber wall with a min. avg. thickness of 3.5 are exempt from the above grade wall insulation reuirements. All footnotes are available on WSU-Energy Program 2

13 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/ Ventilation Code Compliance Application Submit with heating/cooling system size worksheet (see instructions #4) Owner: Parcel#: Type of project: Total S. Ft. of heated area:: 1 st Floor : 2 nd floor: Heated Basement: Heating System Type: Electric wall heater Electric Central Furnace LPG Furnace Heat Pump with electric furnace Heat pump with gas furnace Ductless Heat Pump Boiler, specify fuel type: Other: Specify: Compliance Method Must Check one:: Prescriptive Option Table R (see table on previous page) Component Performance, R Calculation worksheets reuired Other (Specify): Check one Ventilatio n System Additional Energy Efficiency Reuirem ents Energy credits reuired: Whole House Ventilation system using exhaust fans & window or wall fresh air vents (M ). If using window vents be sure to order windows with vents. Whole House Ventilation Integrated with a Forced Air System (M ) Other, describe: Referencing Table R406.2, Additional Residential Energy Efficiency Reuirements, all residential units must develop credits as specified in Table Identify and describe which option(s) will be used to comply. If the table is not attached to this form you can access the table on our website at: a) Description: Small dwelling units: less than 1,500 s. feet of heated or cooled floor area and less than 300 s. ft fenestration area (skylights, doors, windows, etc). *Including additions to existing building that are greater than 500 s. ft. of heated floor but less than 1,500 s ft of floor area. Reuires 1.5 credits b) Medium dwelling units that are not included in (a) above {small dwelling}, OR (c) below {large dwelling} Reuires 3.5 credits EXCEPTION: Dwelling units serving R-2 occupancies shall reuire. Reuires 2.5 credits. See page two for description. c) Large dwelling unit is a dwelling unit that exceeds 5,000 s. ft. of heated or cooled floor area. Reuires 4.5 credits d) Additions less than 500 s feet. Reuires.5 credits (Fenestration is defined in the IECC as skylights, roof windows, vertical windows, opaue doors, glazed-doors that include products with glass and non-glass glazing materials.) Describe Energy Credit Option(s): Using Option number(s): 3

14 FENESTRATION 1 SCHEDULE USE FOR ENERGY CREDIT, a) SMALL DWELLING OPTION & COMPONENT PERFORMANCE COMPLIANCE List all windows, doors, skylights. (If needed, attach an additional sheet) 1 Fenestration is defined in IECC Chapter 2 as skylights, roof windows, vertical windows, opaue doors, glazed-doors that include products with glass and non-glass glazing materials. Manufacturer Location U-Factor Size (rough opening) Quantity Total Suare Feet Total Fenestration: windows, skylights and door area Energy Credits 4

15 (2015 WSEC ~ Table 406.2) OPTION DESCRIPTION CREDIT(S) 1a EFFICIENT BUILDING ENVELOPE 1a: Prescriptive compliance is based on Table R with the following modifications: Vertical fenestration U = 0.28 Floor R-38 Slab on grade R-10 perimeter and under entire slab Below grade slab R-10 perimeter and under entire slab or Compliance based on Section R : Reduce the Total UA by 5%. 1b EFFICIENT BUILDING ENVELOPE 1b: Prescriptive compliance is based on Table R with the following modifications: Vertical fenestration U = 0.25 Wall R-21 plus R-4 Floor R-38 Basement wall R-21 int plus R-5 ci Slab on grade R-10 perimeter and under entire slab Below grade slab R-10 perimeter and under entire slab or Compliance based on Section R : Reduce the Total UA by 15%. 1c EFFICIENT BUILDING ENVELOPE 1c: Prescriptive compliance is based on Table R with the following modifications: Vertical fenestration U = 0.22 Ceiling and single-rafter or joist-vaulted R-49 advanced Wood frame wall R-21 int plus R-12 ci Floor R-38 Basement wall R-21 int plus R-12 ci Slab on grade R-10 perimeter and under entire slab Below grade slab R-10 perimeter and under entire slab or Compliance based on Section R : Reduce the Total UA by 30%. 1d a EFFICIENT BUILDING ENVELOPE 1d: Prescriptive compliance is based on Table R with the following modifications: Vertical fenestration U = a AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2a: Compliance based on R : Reduce the tested air leakage to 3.0 air changes per hour maximum and All whole house ventilation reuirements as determined by Section M of the International Residential Code shall be met with a high efficiency fan (maximum 0.35 watts/cfm), not interlocked with the furnace fan. Ventilation systems using a furnace including an ECM motor are allowed, provided that they are controlled to operate at low speed in ventilation only mode. To ualify 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 ualifying ventilation system. 2b AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2b: Compliance based on Section R : Reduce the tested air leakage to 2.0 air changes per hour maximum and All whole house ventilation reuirements as determined by Section M of the International Residential Code shall be met with a heat recovery ventilation system with minimum sensible heat recovery efficiency of To ualify 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

16 OPTION DESCRIPTION CREDIT(S) 2c AIR LEAKAGE CONTROL AND EFFICIENT VENTILATION 2c: Compliance based on Section R : Reduce the tested air leakage to 1.5 air changes per hour maximum and All whole house ventilation reuirements as determined by Section M of the International Residential Code shall be met with a heat recovery ventilation system with minimum sensible heat recovery efficiency of To ualify 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. 3a b HIGH EFFICIENCY HVAC EQUIPMENT 3a: Gas, propane or oil-fired furnace with minimum AFUE of 94%, or Gas, propane or oiled-fired boiler with minimum AFUE of 92% To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the heating euipment type and the minimum euipment efficiency. 3b b HIGH EFFICIENCY HVAC EQUIPMENT 3b: Air-source heat pump with minimum HSPF of 9.0 To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the heating euipment type and the minimum euipment efficiency. 3c b HIGH EFFICIENCY HVAC EQUIPMENT 3c: Closed-loop ground source heat pump; with a minimum COP of 3.3 or Open loop water source heat pump with a maximum pumping hydraulic head of 150 feet and minimum COP of 3.6 To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the heating euipment type and the minimum euipment efficiency. 3d b HIGH EFFICIENCY HVAC EQUIPMENT 3d: Ductless Split System Heat Pumps, Zonal Control: In homes where the primary space heating system is zonal electric heating, a ductless heat pump system shall be installed and provide heating to the largest zone of the housing unit. To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the heating euipment type and the minimum euipment efficiency. 4 HIGH EFFICIENCY HVAC DISTRIBUTION SYSTEM: All heating and cooling system components installed inside the conditioned space. This includes all euipment and distribution system components such as forced air ducts, hydronic piping, hydronic floor heating loop, convectors and radiators. All combustion euipment shall be direct vent or sealed combustion. For forced air ducts: A maximum of 10 linear feet of return ducts and 5 linear feet of supply ducts may be located outside the conditioned space. All metallic ducts located outside the conditioned space must have both transverse and longitudinal joints sealed with mastic. If flex ducts are used, they cannot contain splices. Flex duct connections must be made with nylon straps and installed using a plastic strapping tensioning tool. Ducts located outside the conditioned space must be insulated to a minimum of R-8. Locating system components in conditioned crawl spaces is not permitted under this option. Electric resistance heat and ductless heat pumps are not permitted under this option. Direct combustion heating euipment with AFUE less than 80% is not permitted under this option. To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the heating euipment type and shall show the location of the heating and cooling euipment and all the ductwork

17 OPTION DESCRIPTION CREDIT(S) 5a EFFICIENT WATER HEATING 5a: All showerhead and kitchen sink faucets installed in the house shall be rated at 1.75 GPM or less. All other lavatory faucets shall be rated at 1.0 GPM or less. c To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the maximum flow rates for all showerheads, kitchen sink faucets, and other lavatory faucets. 5b EFFICIENT WATER HEATING 5b: Water heating system shall include one of the following: Gas, propane or oil water heater with a minimum EF of 0.74 or Water heater heated by ground source heat pump meeting the reuirements of Option 3c. or For R-2 occupancy, a central heat pump water heater with an EF greater than 2.0 that would supply DHW to all the units through a central water loop insulated with R-8 minimum pipe insulation. To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the water heater euipment type and the minimum euipment efficiency. 5c EFFICIENT WATER HEATING 5c: Water heating system shall include one of the following: Gas, propane or oil water heater with a minimum EF of 0.91 or Solar water heating supplementing a minimum standard water heater. Solar water heating will provide a rated minimum savings of 85 therms or 2000 kwh based on the Solar Rating and Certification Corporation (SRCC) Annual Performance of OG-300 Certified Solar Water Heating Systems or Electric heat pump water heater with a minimum EF of 2.0 and meeting the standards of NEEA's Northern Climate Specifications for Heat Pump Water Heaters To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall specify the water heater euipment type and the minimum euipment efficiency and, for solar water heating systems, the calculation of the minimum energy savings. 5d EFFICIENT WATER HEATING 5d: A drain water heat recovery unit(s) shall be installed, which captures waste water heat from all the showers, and has a minimum efficiency of 40% if installed for eual flow or a minimum efficiency of 52% if installed for uneual flow. Such units shall be rated in accordance CSA B55.1 and be so labeled. To ualify to claim this credit, the building permit drawings shall include a plumbing diagram that specified the drain water heat recovery units and the plumbing layout needed to install it and labels or other documentation shall be provided that demonstrates that the unit complies with the standard. 6 RENEWABLE ELECTRIC ENERGY: For each 1200 kwh of electrical generation per each housing unit provided annually by on-site wind or solar euipment a 0.5 credit shall be allowed, up to 3 credits. Generation shall be calculated as follows: For solar electric systems, the design shall be demonstrated to meet this reuirement using the National Renewable Energy Laboratory calculator PVWATTs. Documentation noting solar access shall be included on the plans. For wind generation projects designs shall document annual power generation based on the following factors: The wind turbine power curve; average annual wind speed at the site; freuency distribution of the wind speed at the site and height of the tower. To ualify to claim this credit, the building permit drawings shall specify the option being selected and shall show the photovoltaic or wind turbine euipment type, Provide documentation of solar and wind access, and include a calculation of the minimum annual energy power production. a. Projects using this option may not use Option 1a, 1b or 1c. b. Projects may only include credit from one space heating option, 3a, 3b, 3c or 3d. When a housing unit has two pieces of euipment (i.e., two furnaces) both must meet the standard to receive the credit. c. Plumbing Fixtures Flow Ratings. Low flow plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following reuirements: 1. Residential bathroom lavatory sink faucets: Maximum flow rate L/min (1.0 gal/min) when tested in accordance with ASME A /CSA B Residential kitchen faucets: Maximum flow rate L/min (1.75 gal/min) when tested in accordance with ASME A /CSA B Residential showerheads: Maximum flow rate L/min (1.75 gal/min) when tested in accordance with ASME A /CSA B

18 Name Parcel # BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 1 of 2) Per Mason County Code, Title 14, Chapter a stormwater site plan is reuired whenever a building application is made for residential development, or redevelopment¹, with more than 2,000 suare feet of impervious surface². ¹Redevelopment means, on an already developed site, the creation or addition of impervious surfaces, structural development including construction, installation or expansion of a building or other structure, and/or replacement of impervious surface that is not part of a routine maintenance activity, and land disturbing activities associated with structural or impervious redevelopment. ²Common impervious surfaces include, but are not limited to, rooftops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. Open, uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width = Area * All dimensions in feet Buildings X = X = X = X = Driveways X = X = X = Parking Areas X = X = X = Patios/Walks X = X = X = Others X = X = X = Total Impervious Surface Area (sum of all areas) Measurements for buildings are taken at the perimeter of the farthest projections (example: eaves/gutters) Length of drive begins at the right of way Any paved, gravel or packed area per definition above table Any paved, gravel or packed area per definition above table If the total impervious area of the proposed site development is greater than 2000 suare feet a Small Parcel Stormwater Site Plan is Reuired If the Total Impervious Surface Area is LESS THAN 2000 Suare Feet, please read, acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT reuired for this development activity. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owner's legal representative, or the contractor. I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the abovedescribed property for review and inspection as may be reuired. X Owner/Agent/Contractor (circle one) Date: If the Total Impervious Surface Area is GREATER THAN 2000 Suare Feet, please read, acknowledge and sign the information provided on page 2 of 2. Page 1 of 2

19 Name Parcel # BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) Based Upon the information you have provided a Stormwater Site Plan IS Reuired for this development activity. Title 14, Chapter of the Mason County Code (MCC) regulates compliance reuirements for Stormwater Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website: http// Please follow the links to "Title 14, Chapter Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter section ). You will receive a copy of the Public Works document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan". This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be reuired for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with Handout PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this, or any other, parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this, or any other, parcel. If you have further uestions pertaining to parcel drainage and stormwater management Mason County's Public Works Department can provide additional instructions, guidance and examples. (Section ) contact Public works at: Phone: (360) EXT. 450 Mail: P 0 Box 1850, Shelton WA Physical: 415 N 6th St, Shelton WA If this development has, or will have, a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. Mason County Division of Environmental Health can be reached at: Phone: (360) EXT. 352 Mail: P 0 Box 1666, Shelton WA Physical: 426 W Cedar St, Shelton WA A condition will be added to the building permit that states, in part, that all conditions the stormwater site plan will be met prior to a reuest for final inspection of the building permit. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owner's legal representative, or the contractor. I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the abovedescribed property for review and inspection as may be reuired. X Owner/Agent/Contractor (circle one) Date: Page 2 of 2

20 WAT N 6 th Street, Bldg 8, Shelton WA 98584, Shelton: (360) ext 400 Belfair: (360) ext 400 Elma: (360) ext 400 FAX (360) Application for Determination of Water Adeuacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application, with any reuired attachments for review. 4. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: Mailing Address: Parcel Number: Type of Water System Public/Community Water System (2 or more connections) Individual water source (one connection), Well Spring/surface water Other (explain) If you have more than one residence connected to this well, check the Public/Community Water System box. Date: Phone: Reason for Application Building permit Division of land: # of Parcels? SPL Boundary line adjustment Other (explain) Replacement or Remodel (please indicate name of water system below if applicable no signature reuired) Part 2: Water Connection Information Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory (WFI) Number: (write none for two-party) I am the manager of this water system. The water system has been approved for services. There are presently connection(s) in use. This will be the connection. I am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these) connection(s) without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date This form may be scanned and available for public view at J:\EH Forms\ Drinking Water Revised 1/25/2018

21 Individual Water Well Water well report (attached to application). Depth ft. Well capacity Test (attached to application) gpm gpd. The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test, which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. Satisfactory bacteriological test (attach to application). Water Resource Inventory Area (WRIA) Development within which WRIA Water use or limitation recorded... N/A Yes Well Drilled Individual Spring/Surface Water Date WDOE permit (attach to application) Method of disinfection I have reason to believe that this water source can provide at least 800 gallons per day; and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) Satisfactory Determination: This determination does not address adeuacy of the distribution system, guarantee an adeuate supply of water indefinitely in the future, or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates reuirements of Sanitary Code, Title 6, Chapter Determination of Adeuacy for Building Permits are satisfied. Additional Growth Management reuirements may apply. Chapter 36.70A RCW. Unsatisfactory Determination: Applicant s water supply does not appear adeuate to meet the needs of its intended use for the following reason(s). Reviewer s Signatures: Environ. Health: Date CSD Director: Date Page 2 of 2

22 **=== ******* $ FEE ******* MASON COUNTY COMMUNITY SERVICES DEPARTMENT ADDRESSING DIVISION 615 W. ALDER ST. SHELTON, WA (360) ext. 284 NAME: PHONE: MAILING ADDRESS: CITY: STATE: ZIP: PARCEL NUMBER: (twelve digit tax parcel number) LEGAL DESCRIPTION: PLEASE PROVIDE DRIVING DIRECTIONS TO THE PROPERTY. WHICH SIDE OF THE ROADWAY YOU WILL BE BUILDING ON IF THE ROAD INTERSECTS YOUR LAND. ANY ADJACENT ADDRESS YOU ARE AWARE OF AND SIMPLE DIAGRAM OF WHERE YOUR DRIVEWAY WILL BE LOCATED ON THE PARCEL. The Mason County Addressing Ordinance reuires you to post your new address within 30 days of assignment. It must be placed at your driveway entrance clearly visible from the road in reflective contrasting material. It must be posted to any structure with 30 days of its erection in a contrasting color, visible from the roadway or driveway. **********************************************THIS SECTION IS FOR OFFICIAL USE ONLY*************************************************** YOUR NEW ADDRESS IS: RECEIVED LOGGED IN TIDEMARK FIRE DISTRICT BILLED PAID RECPT # REV. Feb 2016 ADDRESS REQUEST FORM FILLABLE-ALDER.doc