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Home My WebLink AboutBLD2013-00176 - MECHANICAL 143UILDING PERMIT APPLICAN BLD13-00176 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00176 Received Date: 6/11/2013 SITE ADDRESS: 2481 ANDERSON LAKE RD 519 CHIMACUM, 98325 OWNER: EVERGREEN COHO ESCAP RETREAT PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 EVERGREEN COHO ESCAPEE RESORT SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C HS 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 New 120 propane tank TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 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 06/11/13 142162 APPROVED Total: $228.00 JUN 11 2014 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 2/13/2014 / • • Park Model Permit w Name of Leaseholder(s): i a t \ `j'o it N 4- 434-ea di-n 4 1 514 , � �{eAtp),n t '`x" � 4A284,_,/06 o"- 1.■\/ ,Lot # �I�. JUNE 1 2013 , S` Date submitted: AEFMERSON COUNT'( t 4 OM Of COMMUNITY OEVEIOPMEN� \ 3 \ s .-. n ii :4_ a v.) I 5-)1 Approved by: ` Z IT O -54\1 6Y- . a ��r Lot Management: 1 _1 P taor11- \ 1 li I _ __ }'Y) \ 3f.- �\ / 3 Plc t i \ i \ , Board Member: \ t in \ //O/f 1 i -.---A 1 1 Date approved: Directions: 1. In the space above, sketch the outline and location of the park model. Include required distances from front, back and side of the lot. Completion date Lot Management Signature 4,, ,sON co JEFFERSON COUNTY W . ' �� DEPARTMENT OF COMMUNITY DEVELOPMENT 0 "' ` '� 621 Sheridan Street •• Port Townsend ••Washington 98368 III JUN ? 213 360/379-4450 • 360/379-4451 Fax _ L .q p� www.co.jefferson.wa.us/commdevelopment i 1 S`$7NG`S JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT Master Permit Application MLA: Project Description(include separate sheets as necessary): .Z-14D`t 51-g-D-Ort. e ?/etc TA-1--IC— V2 0 ,..e_A Tax Parcel Number: al 01,t 0 \O ck Property Size: (acres/square feet) Site Address and/or Directions to Property: &L/1l /4,,/De-kson kale 20 7q - C/Iim.4cum, kl,4 - 94a.7a—Property Owner(s)of Record: a/ to 2eE4 e o .&k/9 /'i4ic/e_ Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): ' .3-0 Pr-N R-6 A-1— &,W-. ,4 gts.N tj Telephone: - g-to a az., Fax: #--51 email: Mailing Address: 2-t%I I\F-T*b EF-'°14 1-1.c_,. (;-..3: 9I C .411.2. 1.. What kind of Permit?(Check each box that applies ❑Lot or Road Segregation DBuilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached ache d/Detached 0 Use[C(a),C(d),or C] ❑ Manufactured Home .❑ Modular - ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential ** p ( ssential Public Facilities ❑ Change of Use ) 9 ❑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)* 0 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 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 inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applica' n that he Qr she wants prior notice. Signature: _ Date: Ca ( i b( ( 3 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 developm.,t code.The Applicant acknowledges that he,she or it holds individual and non-transferable re ponsibility for.dherin to and corm,,ing with the 'LA. The Applicant has read this disclaimer and signs and dates it below. Signature: I __, _4de +�! Aitt46 Q,tc.� Date: ‘ l 4 / 3 • • 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: GENE O RACTO OR MANUF CTURED HOME INSTALLER: PHONE: FAX: �I )1' ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: D New ❑ Wood Existing: 0 Sewer D Addition ❑ Steel Proposed: Bank ❑ Community System D Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System D Repair ❑ Masonry SEP Permit# D 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 Pro•ane Tank •ndlor A••liance Installation •ermi mark all items below that a••I : I Underground Tank - 'bove ground Tank Size of Propane Tank: /a,O 1 Heat Stove I Cook Stove 1 Woodstove 1 Fireplace Insert I Hot Water Tank I 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. FQr Ciffice Use Only, Amouint . Revision Square Footage Current Proposed ' Main Floor Heated EH Bid App Review: 2"°Floor Heated Consistency Review: Other Heated Base fee: AAR Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Baseme t State Surcharge fee: Other Unheated Pot Water Review fee Garage/Carport % SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 2 2 S Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: • • 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#: BLD13-00176 Received Date 6/11/2013 SITE ADDRESS: 2481 ANDERSON LAKE RD 519 Issue Date 6/11/2013 CHIMACUM, 98325 APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 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 983259795 PROJECT DESCRIPTION: New 120 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 6/11/2014. REQUIRED INSPECTIONS: Skj,, 'e v- VS t zl O� ,, ,,,okAA. . Tank/Line/Appliance: FinalApproval: )4._ 1u--3i- 1-� oe I'co""' t-;c ' BUILDING INSPECTION HOT-LINE REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFC Office Hours 9:00 a.m. -4:30 p.m. Morn HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 6/11/2013 „soN P ;°a JEFFERSON COUNTY '., DEPARTMENT OF COMMUNITY DEVELOPMENT Date: de pm Mon. Tue. Thur. Fri. . I. - Date: /6)Ved/3 W BLD: �� 7L Contact Name: �a, ar/hp -zp/7/y2-,tP Owner: ' ' ' .4 erk10 Contact Number: Address: 7'ifA L Mia ' 206 — ,;2: g Notes: ._v 0. __ - •/JL! n „Al i _/ 5 I Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground 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