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HomeMy WebLinkAboutBLD2014-00212 - MECHANICAL BUILDING PERMIT APPLICfTION BLD14-00212 Review Type: I� Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00212 Received Date: 6/13/2014 SITE ADDRESS: '22e0 ANDERSON LAKE RD #3.36-1..., Z CHIMACUM, 98325 OWNER: JUDITH A MYERS PHONE: 360-301-5945 2481 ANDERSON LK RD#222 CHIMACUM WA 98325 EVERGREEN COHO ESCAPEE RESORT SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 REPRESENTATIVE: PHONE: II� PROJECT DESCRIPTION NEW PROPANE TANK 120 GALLON TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 SRE 06/11/14 148781 co nn APPROVED JUN 132014 Jefferson County DCD It � o \\tidemark\data\forms\F_BLD_App_Bld.rpt 6/13/2014 • J • rike>` 'Ox c JEFFERS COUNTY "�, DEPARTMENT OF COMMUNITY DEVELOPMENT I" `. 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ' 0 www.co.jefferson.wa.us/commdevelopment rN Master Permit Application MLA: Project Description include separate sheets as necessary): FrD a 1: - - )gi)gawp il Tait Parcel Number: qD/) f 0 o Property Size: (acres/square feet) Site Address and/or Directions to Property: / 4244/ AY0eV*5014 0 '1 ' A ►t/ z, Cii II I " s.z6 Property Owner(s)of Record: ' A ' ' a .0 I. ■.�We, '_ Telephone: '3IpD` 335 - 6538 Fax: :�1o1�"d'T' — 5f / ? email:�°C!"5�2p t%C f1 ��hj Mailing nt/Ag Address: (if di I / Vk owner):1.k l2 -i1. i . (.ji/rhOt�-�VI7 ,C. 6'832-0 Applicant/Agent(if different from owner): ,4 1t L �• Telephone:' 1- Fax: email: / i 0bi�'i" 7 • ailing Addres What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification I ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** g Propane ❑ Long Plat** ❑ Sign .. ❑Planned Rurai Residential Development.(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions*'' ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: P A J DESIGNATION OF AGENT I hereby designate cLa.,,f A , M, .✓�.9 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE" 4-` .44-it '— Date:66 1/144 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the app/' tion that he or she wants prior notice. 410111 Signature: Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer-•le responsibilit for• -ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: la/.,.4, ,/4 . //a�./.� Date: (DI j1//4 r'.\n_..__[J'__.__\444.44cr1D TOC44444\TDTI cr1DTo0 r`..-..--.TIDTI c....v..\Td n.._:.A-1:—. --r nn no a__ ti • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ` ( ) ( ) MAILING ADDRESS: i n 0246 Jj� EMAIL: CONTRACTOR'S LICENSE ✓� / �" WAINS NUMBER: NUMBER „ ARCHITECT/ENGINEER: /�j)f_ vQ'14bria�1► 5 PHONE (344),01.11.5e 'FAjX•:(G )734 ./92 MAILING ADDRESS: (Set • uDn EMAIL , br @ in cem Project Type: Frame Types pathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed:, Bank ❑ Community System ❑ Aferation/Remodel, O •Concrete •Total, - Height: • ❑ Individual System O Repair • ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type,of'Heat: Proposed: 0 Public • Total Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank XAbove ground Tank Size of Propane Tank: I'U Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water T k I Pelleittove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / I) When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage 1urrent Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: v C3 Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: I - qv . Receipt Number: k(,/$�9.t1 Cash/Check Number: Y 1 140.2117- ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Co( 1 10 Initials: n '. 414344Tl1Dn 10444444\1-1Dr•U DT..fC\ T1Dil II.........\ (IQ A",.. Parcel Details • • Page 1 of 2 Jefferson County Home County info Departments Search Parcel Number: 901101039 SEARCH Parcel Number: 901101039 Printer Friendly Owner Mailing Address: EVERGREEN COHO ESCAP RETREAT 2481 ANDERSON LAKE RD CHIMACUM WA983259795 Site Address: 2481 ANDERSON LAKE RD CHIMACUM 98325 Section: 10 School District: Chimacum (49) Qtr Section: NE1/4 FreDist: Chimacum (1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 211 Planning area:Tri-Area (4) Sub Division: EVERGREEN COHO ESCAPEE RESORT Assessor's Land Use Code: 7500 - RESORTS, R.V. PARKS Property Description: EVERGREEN COHO ESCAPEE RESORT I RECREATIONAL VEHICLE PARK 177 SP Click on photo for larger image. a Permit Data Assessor Bldg Data Map Parcel Plats&Survey Tax,A/V, Sales Info Septic Monitorino Info °. Jefferson Cowrty HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later •Windows- Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?PARCEL NO=901101039 6/10/2014 Map Output • Page 1 of 1 ArcIMS HTML Viewer Ma• ,+ion,.. santa '.1 4 111.1T4'l 1 ttit It* 11,64., fit 4: , # t 4 IS"; t«a 1 4 wilt - ..--'7"-t-'-'1' - Legend f', i Si a Se+teted Hatu es 1 t ►i 4. t 4 s y f 0* County Ur ° .p a 0t44 * w rt es .. r:r ? S ,/ rc nwac V$ i`*t i Parcels-41 4 'it 48x1 t %* °,¢y 2011 A,d.I Photos I $ Its t 1 ,6 t ' . D t ,, t r ,, 1 :IX 41= .711Tem liter:. Mils pandit. Jaliarsal Carey Ca**&nom GIII I niFf:A 1 FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity.Data contained in this ma.is limited b the method and accura of its collection.Tue Jun 10 2014 14:17:19 GMT-0700 Pacific Da li.ht Time • http://maps.co.j efferson.wa.us/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&C1... 6/10/2014 2481 Anderson Lake Rd- GI Ile Maps Page 1 of 1 2481 Anderson Lake Rd Explore this area i r i ■ R,. ‘ * t,,.,;4, A 11" ' * * 1\ .' * ‘ \\t.:„„ti, \ VI)..k." r*. \ % ;-ii likt Iiii\ .r '4: d % , • •• L 5 ,\ t D't m.A • s , * . r ilk A It ! gt. COraaPr DK reve1- Map data©2014 Google 20 ft https://www.google.com/maps/place/2481+Anderson+Lake+Rd/@48.0220161,-122.78594... 6/10/2014 4 4 4 21 c- oy\ e 10-v) , __ 6t 1 C.---,c— 6;4- ( 0-1....,\ 1- - + -4 2-- A.------- .-/----- -- ---- \ --,S ,_.----------------- ,__---- ----------- ‘- I e' C' 1A-1-ej ~■._ . \I") - i - -- cl v4. .(.\_ visp _ r- „ — — ( -77ki –.%"1-* ' —56k1 -6171-Ave. — SMI-Th A •A ____ .._.__ • kjefi Wilk 7"V 0 0 MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00212 Received Date 6/13/2014 SITE ADDRESS: 2481 ANDERSON LAKE RD #222 Issue Date 6/13/2014 CHIMACUM, 98325 APPLICANT: JUDITH A MYERS PHONE: 360-301-5945 2481 ANDERSON LK RD#222 CHIMACUM WA 98325 SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: if different: 2481 ANDERSON LAKE RD CHIMACUM WA 98325-9795 PROJECT DESCRIPTION: NEW PROPANE TANK 120 GALLON Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/13/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: ,6--2.77-)Y BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 6/16/2014 CHSINC Page 1 of 4 0 CoWashington State Department of Labor & industries CHSINC Owner or tradesperson PO BOX 518 CASALE,CARL MARTIN AUBURN, WA 98071-0518 253-833-7220 Principals KING County CASALE, CARL MARTIN, PRESIDENT EGAN, THERESA MARIE, VICE PRESIDENT MCENROE, JOHN DANIEL, VICE PRESIDENT LILJA, NANCI LEE, SECRETARY KASTELIC, DAVID ALLEN, TREASURER C T CORPORATION SYSTEM, AGENT ESTENSON, NOEL, PRESIDENT (End: 09/21/2012) WESTBROCK, LEON, VICE PRESIDENT (End: 09/21/2012) BAKER, DAVID A, SECRETARY I (End: 09/21/2012) Doing business as C H S INC WA UBI No. Business type 600 148 004 Corporation License Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. CHSIN**9790Z Effective—expiration 09/09/2003—09/07/2014 Bond Liberty Mutual Ins Co $12,000.00 Bond account no. 58S203444 Received by L&I Effective date https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 6/9/2014 �es— c0G2 JEFFERSON COUNTY (�f 0 DEPARTMENT OF COMMUNITY DEVELOPMENT , � � 6 IMPDate: biLS 01,07 Time Received: 01,07 am/ r Mon. Tue. Wed. • Date: 6'2J' 6--2, 7 BLD: /C-/-,2/,2- Contact Name: Owner: Contact Number: 360 30) 5•% 7' Address: 77,0:1„.j 206 01 -� 2 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance---k- Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling