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HomeMy WebLinkAboutBLD2014-00331 - MECHANICAL •UILDING PERMIT APPLICATtN BLD14-00331 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00331 Received Date: 9/11/2014 SITE ADDRESS: 1321 DABOB POST OFFICE RD QUILCENE, 98376 OWNER: JEFFREY DELIA PHONE: 360-531-1520 1321 DABOB POST OFFICE RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701044014 Section: 4 Township: 27 N Range: 1V1 CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*044OW Expires 9/7/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO! Install New Heat Pump & Air Handler TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: HTP CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 S152.00 SRE 09/10/14 151487 Total: $152.00 " f SEP 10 2014 ',- aterson County D C�� D \\tidemark\data\forms\F_B LD_App_Bld.rpt 9/11/2014 .46)q— .. 3 i 44.(<'¢5oN `Oa ERSON COUNTY c.... PARTMENT OF COMMUNITY' DEVELOPMENT 621 Sheridan Street 1 Port Townsend,WA 98368 Web:www.co.jefferson.wa.us/communitydevelopment 1/1 NGCo Tel:360.379.4450(Fax:360.379.4451 Email:dcd a(�.co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): ,4 L G f1 /4-T 1 0114 P 1 A A l fi o IZ. Tax Parcel Number ' -lo Io' 0 / Property Size: I \ ,- ` ) Site Address and/or Directions to Property: p rty: 3Z r ?)abob Pori- • " e—, Ro \D sEP 014 V Property Owner(s)of Record: , t°et. Telephone: - • - 31 - 1 2 G Fax: : •! Mailing Address: f_ S 1 r /it i[GC-. 1_ ' - i�'i t .�1 OPMENT f nFp-v�1 Applicant/Agent(if different from owner): 4.11.c/t S `+- a I Telephone: 33 3C ""b / 2evk Crs�jr • p �"�(� � 3 Fax: email: � Gnti►iu� Mailing Address: '• F. t 0 . / __, e r' A 14• I. Wh3t kind of Permit?(Check each box that applies ❑Lot or Road Segregation HBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑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** ❑ Sign ❑ Planned 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 •1 o to act as my agent in matters relating to this application for permit(s). 941 OWNER SIGNATURE ._ A/ J"� Date: 0 /D 0 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli n that he h wants prior notice. Signature: Date: i/©..3/ o/ 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-/1> .--•a nsibil' dhering to and complying with the ESA. The Applicant has read this disclaimer sig and dates it below. Signature: / / Date: D ego y / 07/24/201_ • 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: Pen/hStiA Ile•C f Co • ( ) ( ) MAILING ADDRESS: '.1 . / C 4 . EMAIL: / ,r / • e•k. �l. CONTRACTOR'S LICENSE WAINS NUMBER: p£l1/INi . O OUV NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: L New n Wood Exis UI Sewer E Addition FT Steel Pro• ?`•' E ( �"/ 11 L Community System ❑ Alteration/Remodel ❑ Concrete n. n Individual System n Repair a Masonry 1 I . SEP Permit# E Demolition n Other: Bed _. Water Supply: Exis I : SEP 1 0 201 Setba lc: ❑ Private well n Two Party Type of Heat Pros.:-4-.0 ✓ ' UI Public }t c,T Poly fl/Alf atat; Name of System: JEFFERSON COUNY DEPT.OF COMMUNITY DEVTLOPMENT If this is a Commercial Protect 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 Cook Stove Woodstove Fireplace.nsert rehtO i evotS telleP I knaT retaW toH I Is this appliance being installed in a Manufactured/Mobile Home? Yes CO 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: ll'ov 2""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: )5 ) ar 7 Cash/Check Number. /,3f2 90 ESTIMATED COST(REQUIRED) Date: /� /O/ / [Fair market value of all labor and materials foundation to finish `� / Initials: 07/24/201_ • • i ) b () 1 7 c � Y �— L sz> co ft% .-2-.) 7 --... ..,,t amvi ma Crk ) -'h 7P 4. p „..), -,, ,--...--.. ) R s n V) ra m Q c N Fl -% Irc . ov. I FP 1 0 2014 fl.,; i JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT CHSINC Page l of 4 • • Washington State Department cf 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—09/07/2016 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= 9/11/2014 C H S INC Page 2 of 4 10/05/2012 • 11/21/2012 • Expiration date Until Canceled Bond history Insurance Old Republic Ins Co S1,000,000.00 Policy no. MWZY302766 Received by L&I Effective date 09/08/2014 09/01/2014 Expiration date 09/01/2015 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. This company has multiple workers' comp accounts. Active accounts L&I Account ID Self Insured. 700,394-00 This business is certified to cover its own workers'comp costs. No premiums due. Doing business as CHS INC Estimated workers reported N/A L&l account representative (360)902-4817 Track this contractor Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Citation issue date 09/14/2011 No violations Inspection no. 315180448 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 9/11/2014 C H S INC Page 3 of 4 Location • • 153 NW State Ave Chehalis,WA 98532 Citation issue date 08/26/2011 No violations Inspection no. 315093930 Location 7902 N Division St Spokane,WA 99208 Citation issue date 08/19/2011 No violations Inspection no. 315054858 Location 900 E Columbia Kennewick,WA 99336 Citation issue date 07/20/2011 No violations Inspection no. 314949959 Location 900 E Columbia Kennewick,WA 99336 Citation issue date 05/04/2011 Violations Inspection no. 314618695 Location 400 Toteff Rd Kalama,WA 98625 Citation issue date 05/17/2010 Violations Inspection no. 313999716 Location 433 N Columbia Connell,WA 99326 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 9/11/2014 C H S INC Page 4 of 4 Citation issue date • • 03/31/2010 No violations Inspection no. 314140948 Location 433 N Columbia Connell,WA 99326 Citation issue date 03/31/2010 No violations Inspection no. 314140955 Location 528 S Booker Rd. Othello,WA 99344 Citation issue date 03/31/2010 No violations Inspection no. 314140963 Location 3132 Rd.0 NE Moses Lake, WA 98837 Citation issue date 12/23/2009 No violations inspection no. 313674509 Location 111 N.9th Walla Walla,WA 99362-1721 ©Washington State Dept.of Labor&industries.Use of this site is subject to the laws of the state of Washington. A4c1'ss ashingt an`l https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 9/11/2014 Jefferson County Building Division Permit Number: BLD14-00331 Applicant: DELIA BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Mechanical Systems FINAL FINAL Building A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION q,Z3I FINAL INSPECTIO MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# : \\tidemark\data\forms\F_BLD Permit_BIdg.rpt 9/11/2014 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00331 Received Date: 9/11/2014 SITE ADDRESS: 1321 DABOB POST OFFICE RD Issue Date 9/11/2014 QUILCENE, 98376 Expiration Date 9/11/2015 OWNER: JEFFREY DELIA PHONE: 360-531-1520 1321 DABOB POST OFFICE RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701044014 Section: 4 Township: 27 N Range: 1V1 CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 9/7/2016 PROJECT DESCRIPTION: Install New Heat Pump &Air Handler TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: HTP 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: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit S152.00 SRE 09/10/14 151487 Exist: Exist: Total: $152.00 Prop: Prop: Total: Total: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY