HomeMy WebLinkAboutBLD2014-00058 - MECHANICAL 1113UILDING PERMIT APPLICAON BLD14-00058
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00058 Received Date: 2/19/2014
SITE ADDRESS: 2481 ANDERSON LAKE RD #224
CHIMACUM, 98325
OWNER: EVERGREEN COHO ESCAP RETREAT PHONE: 360-385-6538
2481 ANDERSON LAKE RD
CHIMACUM WA 98325-9795
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**9790Z Expires 9/7/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION INSTALL 120 GAL PROPANE TANK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW 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 $228.00 MEB 02/19/14 145779 APPROVED
Total: $228.00
Jefferson County DCD
+irlemorlArlfe\forme\G RI Il Ann Rlrl rn+ 9/1O/9l11A
,�w 'six eOL. JEFFERSWOUNTY III
4' DEPARTMENT OF COMMUNITY DEVELOPMENT
"' ` '.4 621 Sheridan Street • Port Townsend •Washington 98368 CC‘360/379-4450 • 360/379-4451 Fax ( L( --
qsp www.co.jefferson.wa.us/commdevelopment
87N
Master Permit Application MLA:
Project Description(include separ. e sheets as necessary)
-eP VIA et-es .gas 'H b e
Tax Parcel Nurr el, , L .r, _ . . Property Size: //C)f X 7d (acres/square feet)
Site Address and/or Directions to Property:
',AA' YU . i I 13
_ t a Q G., r oil
Property Owner(s)of Record* .,. - Sk • -4 * L L .
Telephone;340 oS 6'53 8 Fax: email:1i.
Mailing Address:
L. 4) ( to ru cz e r.Soh1 L t {2„43 c, R w t,4 a hi W 4 - c7g�a
ApplicantA ent(if different from orner):C'U.d P ble U e ka __,,
Telephone.,; 6O 201 tD 9 °" Fax: email: ���>�'Nv1.C�'- �� cow..
Mailing Address: .O. Ray` /61 6' a OR T pc[LOCI� co ��, 3
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 Clas ification , r_--3_
❑ Commercial* ❑ Special Use(Essential Public Facilities) o =-----1
❑ Change of Use ❑ Boundary Line Adjustment F
❑ Address ❑ Road Approach_ ❑Short Plat** o -.n N_
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** r rn n
Propane j o2 ❑ Lon Plat** -1
CI
u Oiyn ❑ Planned Rural Residential Developmen l )/Amel9dme
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** r =� a
❑ Stormwater Management ❑Shoreline Master Program Exemption/P evisiaas**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial De ent*`
❑Temporary Use ❑Shoreline Management Variance -0 rn
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use Di 'ct -• I. ,-ndm�' , I
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Pro ram Ar > r ie
*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:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 inspect' ns. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the apa ion that he r ss)te/�niants prior notice.
Signature. . .. f' ,��.f(.-/� � Date;'do 0.9d14. "
The action or act•ns Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered sp- ies 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 e in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfera es•,.nsibilitio or ad ering to and complying with the ESA. The Applicant has read this�d/isclaimer and,signs and dates it below.
Signature: �`v„• - "i ■ i._4 Date ^- 2c) - -1j/q
G:\PermitCenter\#• •FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
allBUILDER 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 suming the respons ility of the General Contractor for the proposed project.
Signatu / ✓„Q.A.t vi__ Date)-028— 1c /LI.
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
t c 2.- of ii-- _Dud its TA.i r;s 6) 5,1i t j g 6 [ (6 D) 7`1 0 9 o 0
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: /59 Q4.?fl co)& a• PHONE ( ) FAX:( )
MAILING ADDRESS: `JC•I I E/14/ ;S q s 2 z EMAIL
Project Type: i* /'�FraLme Type: Bathrooms: r Shoreline: Type of Sewage Disposal:
.,1$1 New g Wood Existing: 4 Sewer
C Addition X Steel Proposed: Bank A. Community System
0 Alteration/Remodel ❑ Concrete Total: 1 _ Height: ❑ Individual System
❑ Repair ❑ Masonry — SEP Permit# _
D Demolition Other: Bedrooms: Water Supply:
Existing: _ Setback:
Proposed: � Private well 0 Two Party
TyJ a of Heat: p ❑ Public
1A,kj Total: i 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:
Underground Tank I Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank l Pellet Stove I Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
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 Current Proposed For Office Use Only. Amount Revision
Main Floor Heated �S y EH Bld App Review: .
,39 2nd Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
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: $
Receipt Number: 1("14 )
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: S
'Fair market value of all labor and materials foundation to finish 2/71r q 74
Initials:
4
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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•
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#: BLD14-00058 Received Date 2/19/2014
SITE ADDRESS: 2481 ANDERSON LAKE RD #224 Issue Date 2/19/2014
CHIMACUM, 98325
APPLICANT: EVERGREEN COHO ESCAP RETREAT r PHONE: 360-385-6538
2481 ANDERSON LAKE RD ® ,,,(\/
CHIMACUM WA 98325-9795 Jo " l ew '�` p
SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: W��r
PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01
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: 360-385-6538
if different: 2481 ANDERSON LAKE RD
CHIMACUM WA 98325-9795
PROJECT DESCRIPTION: INSTALL 120 GAL PROPANE TANK
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 2/19/2015.
REQUIRED INSPECTIONS:
Tank/Lin ppiiance: A 5/ J%1 1
vv J
FinalApproval: 05/y /T
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_Pemiit_Propane.rpt 2/19/2014
4SON C
4`' °-, JEFFERSON COUNTY
,'
^�_ DEPARTMENT OF COMMUNITY DEVELOPMENT
cs'it i N C2 0 /
Date: ,..,7-// Time Received: 4.2(5 ame0 Mon. Tue. Wed. hur. Fri.
Date: /-C-
B L D: / C/ Contact Name:
Owner: Contact Number: 360 10/ 6, 99
Address: a 27() /},p_ir3)4y Lf< f 2,z y 206
Notes:
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground PC Furance
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
JEFFERSON COUNTY �i/� NO. 1 779
DATE //4 J /
RECEIVED FROM ) N Y `Q
DESCRIPTION BARSN AMOUNT
CURRENCY G::: .),..)4...").--
COIN C.ab
I .a. CHECKS
cn
61144-
JiQIO5'k .
m
RECEIVED BY TOTAL .-'