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Home My WebLink AboutBLD2014-00388 - MECHANICAL IJILDING PERMIT APPLICAT BLD14-00388 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00388 Received Date: 10/20/2014 SITE ADDRESS: 2481 ANDERSON LAKE RD 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: 1V1 CONTRACTOR: CENEX PHONE: 360-732-4585 P.O. BOX 248 CHIMACUM WA 98325 REPRESENTATIVE: JIMMIE CLASEN PHONE: 509-990-3544 2481 ANDERSON LAKE RD #615 PROJECT DESCRIPTION INSTALL 120 GAL. PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: PRO 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: outing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 SRE 10/20/14 151663 APPROVED Total: $152.00 OCT 202014 Jefferson County DCC 6mci Led 0.1)1 Gp pi. cavil- l io L-( - . . l i \\tidemark\data\forms\F_BLD_App_Bld.rpt 10/20/2014 B.► -383 47 ov ��-soN co� DEPARTMENT OF COMMUNITY D LOPMENT egOit ,, 621 Sheridan Street,Port Townsend,WA 98368 ti 4 Tel:360.379.4450 I Fax:360.379.4451 t ly Web:www.co.jefferson.wa.usicommtuntydevelopment I I f�C � 0V ,, '� E-mail:dcdCa�co.jeffeison.wa.us 1 I) �SHINO'° , 1 n; OCT 2 0 2014 MECHANICAL PERMIT APPLICKI10 Steps in the Permit Process: JEFFERSON COUNTY -Review required submittal items to ensure all information is completed prior to submitting appi MUNITY DEVELOPMENT -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. Ijp l 't F ,N;. .ah i� �' 4 i, ar nt, i,f S N'r T,, i,. ,ai r NI a i s �"� y r� i�t _e�'�-•��y p � 'I N %w "`� ' ,y :;. ! ;�' .�- r� ,4;*, 4�s,r a€ a s A �. b 3 FPM�4 i tdI +g' 7 ynr.� f j e...,, N , ° NIA pie k a wt, N I� —5 dq 7!.,, it .,in ��kPi ia s oii � `�' Is this application for use in a Mobile/Manufactured Home? * If Yes: A permit from Washington State Department of Labor and Industries, not Jefferson County, is required for appliances installed within a mobile/manufactured home. L&I-360-417-2702 * If No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450 r r'�#p 7 , i e I,.n p ¢t E l)iN 'a° 6°-a , °^UY w;11'1:11'0,11;� N -- .. i �, , 4 4-' � y a,'Y 4AI N III 1 V1 Complete Site plan - Please refer to the site plan checklist to ensure all items are on the site plan. la Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. q � °`� a ,�N 1i 1 5 P'nut(flpU ��, yy3 = mill I IL fi '�"i,ip i� !V ',:.'4111177:,7 ' ° .�� •� ;+ ;° i �a i _ ` k ,3 4,) li_ 0 ili 9d°. 4'' t,1011,ad 4��1 N"k ='' (l ,sn,..�, 69,--W--r,'-., F-4s4 ... 1,% ' z- :!�rc.!ild,, '4 , , i,-41, A.,,,r- oN A,,,,-�..._.,—_, ?,i�h� u §-` l N 5_�-..�� ' 5. 4''�: Assessor Tax Parcel Number: elp i 1010 3 9 Site Address and/or Directions to Property: L' .21 poen-so ea_. (,►ct-iz- i) Access (name of street(s)from which access will be gained: o "Lo J/`e Description of Work: 5 e`l - t70 CA-2_ (2.0(�A<lucr ii�Ia Erg,n�Eia nN.=su , Ir't``r ;° - w u� N . I1 ,n _ ,". � ) - a R�I ,,"-;r,,uls' i4, T,,a f x ��$''�' ®', t N N,�Ioi�ird �("°" i- =M�Iiih�q. ., ��,t.R�pp� ,,,w�,th. 51,, �I7 9 �y * � v1V� �. =��,d $ ��., r.�� l��e� �4 � + �I1 Nn"�� eh��4}.< ,,"Name: Z�Z ) GO 40 '2-( 5. r r Address: 26 t. /4-I-4)01--Sc--) L K-Lo (2-0 - 1 pLA'M r-1" �"b ''' Phone#: E-mail Address: .*K..pQ c,=Pc5 .corn-y Mr . `e 3�0 3� t��3� �- _s Please contact Authorized Agen /Representative with project info. Property Owner Signature: Date: /A v2% �- (y �, ,, � a ,� " ,, -�..-z n 5 ?= �iJ'' = -`�, m �7 it �I nd� �("n�i "J� ' ® • Nt/contr ° R "'' : • se i ?, �i ,,n E ,;'l'- s kt �I , -iv r 7kI C N0Ndn Nii § `t t'Nk �t Name: --,: C-Lg s /i)'11r�, . ,/. ' Phone#: � 1,. \ �-(,C i�( a � , E-mail Address -- r�f� ` ' License#: Expiration Date: In L 1 ropes' Mechanical Application 1 c\(),a ��°� I" \Or c r are �t Will = " ar ' -4' inl� _��° f ,I ii U li,, AtI, p�� € 1.l` "r liti C . Electric Heating Oil Propane* +i Wood �F (� t u( r y ell '� r " 9 a �I6 t �_ , � ' , *Propane • prohibited in �` ��` 7� hazardous locations such a.s Fan _ Bath Fan and/or Exhaust Fan basements or pits or V Clothes Dryer Clothes Dryer with Exhaust Vent anywhere "heavier-than-air" V Cook Stove Cook Stove, Range Hood Exhaust gas can unsafely collect. Fireplace-Gas Fireplace-Gas or Gas Log Insert *Propane tanks over 12¢ Fireplace-Wood Fireplace-wood,Wood Stove,or gallons require a minimum Pellet Stove setback of 10 ft.from Electric Furnace Electric Furnace or HP+/ Ducting property line and buildings, V Propane(LP) Gas Furnace Propane Furnace+/- Ducting and a site plan must be submitted with the V Water Heater-Gas Gas WH Vent arad Combustion Air application showing the Gas Pipe System Gas Pipe System LPG/Oil _ setbacks. if propane tank is Propane Tank LP Fuel Tank(#gallons: ) over 500 gallons, a site plan is Heat Pump required to accompany this Generator application, and a separate Air Conditioner Fire Code approval is also required. Installation manual must be on site at time of inspection or a re-inspection fee will be charged. 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the propert y for visits related to this application and subsequent permit issuance. Signat re: Print N a m e: GWl�oa� Date: IL W/i t1 0� t Ii iiG�'" i° � ti .ar _ Ii { �� ' z _ tah i'TM"ki 1` F 11' 4 tl h� ,k Al,,- �'" it i t�P _ d s F ii4 `:&R'i , ,, ii µr 4 - 3I yi u r�- -r ti il� m'. iat '7� e�'-' �lI a� "` VA t II ndyai Ere ' f 6 r x-aw t a A ti , �-. w �b , i 1 �: �.. Ir k ® 9 iii: =r-�,iEr �;. p 8* °'* '£� , a YT r _2 r'4 a � �� r3:`�i i F �1[ ��+�'-" L �'�� eI�t��i7��Y a er:.de ,t�tt1'a3£l2t $ i � � 1. F,t'a a r e a x � •Ii nce{ad $7 O) ; Ka � Y, `Gi #�t�.Irex'4 �1 M�.y► �� t � 7 �'P ��'y.,� F�t+�agt ro .� a PIS E"'.f ,,,, Fh ' lam' A I�'�'a5; � -Lfir O 11,, i�afr w *Additional fees may apply Mechanical Application 2 • fO\P 6-L-()Vt o_ ECEOVEB Q OCT 20 2014 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT qr: CHSINC Page 1 of 4 • Olik Washington 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 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**979OZ 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.ln .vva.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**979OZ&SAV7= 9/17/2014 C H S INC Page 2of4 10/05/2012 11/21/2012 • Expiration date Until Canceled Bond history Insurance Old Republic Ins Co $1,000,000.00 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 ail 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&I 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/verffy/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 9/17/2014 C H S INC Page 3 of 4 Location • 1 • 53 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**979OZ&SAW= 9/17/2014 Cl} SINC Page 4of4 Citation sue date �N�� 03/31/2010 ,�' No violations Inspection no. 314140848 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 12/230009 No violations Inspection no. 313674509 Location 111 N.9th Walla Walla,WA 99362-1721 (0 Washington State Dept.of Labor&Industries Use of this site is subject to the laws of the state of Washington. Access ,—'p : ure.bd.wa.gov/vccFu/7)' 0]48004 i l. C _FlSIN**979(]Z&cS ^ 014 Parcel Details Page 1 of 2 S •e erson ounty ,,,,, 1,_ -fir .'40% 1.4,.....v.,, ,,,N" ''''''w - . ° ".. '�riysra , . `nzt '''' " ? {gas,.,,.. a 1 i 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 WA98325-9795 Site Address: 2481 ANDERSON LAKE RD CHIMACUM 98325 Section: 10 School District:Chimacum (49) Qtr Section: NE1/4 Fire Dist:Chimacum (1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 0211 Planning area:Tri-Area (4) Sub Division: Assessor's Land Use Code: 7500 - Resorts - Seasonal - RV Parks Property Description: EVERGREEN COHO ESCAPEE RESORT RECREATIONAL VEHICLE PARK 177 SP Tax,A/V, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats&Surveys Septic Monitoring Info itiri,� Jefferson County - HOME I COUNTY INFO I DEPARTMENTS I SEARCH 4 Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.coj efferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=90110103 9 10/20/2014 • I 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#: BLD14-00388 Received Date 10/20/2014 SITE ADDRESS: 2481 ANDERSON LAKE RD Issue Date 10/20/2014 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: CENEX PHONE: 360-732-4585 P.O. BOX 248 CHIMACUM WA 98325 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: 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 10/20/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: j 1/ Final Approval: U 1 z-t-/ I (--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_Permit_Propane.rpt 10/20/2014 4,1fli,0. CO °. ..,., JEFFERSON COUNTY. 4. DEPARTMENT OF COMMUNITY DEVELOPMENT Date: /1/3 Time Received: ID:o2 &pm Mon. 41, Wed. Thur. Fri. Date: PA BLD: f!i - 3.6g Contact Name: Owner: Contact Number: —.3.68 5o( q46 1511t' Address: a 0i AlcierS6P LK ZI ,15 206 Notes: Foundation Plumbing Framing P pangjan0 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