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Home My WebLink AboutBLD2014-00258 - MECHANICAL ILDING PERMIT APPLICAT BRDI4-002 8 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00258 Received Date: 7/23/2014 SITE ADDRESS: 2280 ANDERSON LAKE RD #336 CHIMACUM, 98325 OWNER: EVERGREEN COHO ESCAP RETREAT PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 98325-9795 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 1VP 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: PROJECT DESCRIPTION PROPANE TANK REPLACEMENT TYPE OF WORK NON SQUARE FOOTAGE: 7 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 JLA 07/23/14 151307 APPROVED Total: $152.00 JUL 232014 Jefferson County DCD \Wricm.r4\rlei.\fnrmc\G RI r Ann Rlrl rnf 7M4M/11A Xs c III 1 I 4-- 5-7 �4 0 JEFFERSON,UNTY W • , \, �14 DEPARTMENT OF COMMUNITY DEVELOPMENT _ I'' '4 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax 4 o� www.co.jefferson.wa.us/commdevelopment BINS Master Permit Application MLA: Pr.'-ct Description(include separate sheets as necessary): Rb rf' 410 c �/l)g�/1 1,;:(AG L'- c.--zu / Tax Parcel Number: "r D i/ c-.5/ C.g T Property Size: (acres/square feet) Site Address and/o Directions to Property: / • qe it-./2E,R s a/u or!/� • /7-` -! ClK/m f}c urn W4- . ?9. 3o2J� Property Owner(s)of Record: per e2 -,2 G.•tJ ,v ��'off4 5'j' f /6 "Q& Telephone: Fax: email:JCL SAP SC qr,= , (20 4, Mailing Address: ♦ 9/ 4N 19CsE c0,z X K (2 g///74cuum ti) , Y 20?...r. Applicant/Agent(if different from owner): Telephone: Fax: email: _ Mailing Address: 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 ❑ Con�mercia!* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan** Propane ❑ Long Plat** ! u Cign ❑ Plannea Rural 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: DESIGNATION OF AGENT I hereby designate • AI __ to act as my agent in matters relating to thi applica ion for permit(s). OWNER SIGNATURE / ..11 a"'"r v Date: 02 3 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is t ue 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap• ' -tion that he o,'e��is p otice. Signature: ' /./" A � Date: i� 7 , _ 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 complian with the J-'erson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl- spogsibili • ad/in • •. complying with the ESA. The Applicant has read this disclai er and si s and dates it below. Signature. / _ , i i►__ _i Date: a• G:\PcrmitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc AV-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: EMAIL.: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: I Shoreline: Type of Sewage Disposal: E New ❑ Wood Existing: E S ewer C Addition 0 Steel Proposed: Bank Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System Repair ❑ Masonry SEP Permit# _ L Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ 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: Underground Tank Above ground Tank Size of Propane Tank: Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove 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 EH Bld App Review: 2ntl 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: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: T — •Fair market value of all labor and materials foundation to finish Initials: G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms Master Permit Application 5-29-08.doc CHSINC • 0 Page l of 4 CiWashington 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 (End: 09/21/2012) Doing business as CHSINC 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 i °N oo JEFFERSON COUNTY �k� %w -� DEPARTMENT OF COMMUNITY DEVELOPMENT \t„.... , 9g G� )ate: ,Time Received: amfp m Mon. u Wed. Thur. Fri. Date: eContact Name: ) Contact Number: 360 D: 206, z_ , b f wl � address: _ �� Notes: Mechanical Plumbing Framing Propane Tank Foundation Furance Under groun round Framing__ Gas__ Setbacks Under-ground Air Seal Above ground Rough In Oil Footing Hydronic_ Exterior shear Exterior lines_--__- Ducts Stemwall Interior lines Appliance Interior shear — qpp Straps Hot Water Htr-_____ Ventilation Gas/Wood stove Post Hole Underfloor Insulation Final Inspection Man-Homes Floor — Address Posted Setbacks W all__ Foundation r�.1:r, • 1 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#: BLD14-00258 Received Date 7/23/2014 SITE ADDRESS: 2280 ANDERSON LAKE RD #336 Issue Date 7/23/2014 CHIMACUM, 98325 APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 98325-9795 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 1W 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 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: if different: 2481 ANDERSON LAKE RD CHIMACUM WA 98325-9795 PROJECT DESCRIPTION: PROPANE TANK REPLACEMENT 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 7/23/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: WI 1 ) 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 7/23/2014