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Home My WebLink AboutBLD2015-00212 - MECHANICAL • S 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 #: BLD15-00212 Received Date 6/24/2015 SITE ADDRESS: 2481 ANDERSON LAKE RD #119 Issue Date 6/24/2015 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 Contractor's License CHSIN**9790Z Expires 9/7/2016 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: if different: 2481 ANDERSON LAKE RD CHIMACUM WA 98325-9795 PROJECT DESCRIPTION: Propane tank install for RV 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 6/24/2016. REQUIRED INSPECTIONS: stallation per Manufacturer Specifications CO2: TI/0//S 0.Line/Appliance: 1-//D//S (1.a.J S /ti 'S `� -()f C/ ff Final Approval: '7/Z-1 i ).\ 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 6/24/2015 BUILDING PERMIT APPLIC ION BRD1e 00212 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00212 Received Date: 6/24/2015 SITE ADDRESS: 2481 ANDERSON LAKE RD #119 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: 1■P CONTRACTOR: CENEX PHONE: 360-732-4585 P.O. BOX 248 CHIMACUM WA 98325 Contractor's License CHSIN**9790Z Expires 9/7/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt Propane tank install for RV 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: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $234.00 SRE 06/24/15 156260 APPROVED Total: $234.00 JUN 242015 Jefferson County DOE 114 irlc.nnrNrla/,\inrnw\G RI n Ann Rlrl rn+ R/7417/1IS • • SON co DEPARTMENT OF COMMUNITY DEVELOPMENT ktV O . 621 Sheridan Street,Pon Townsend,WA 98368 Tel:360.379.4450 I Fax:360.379.4451 ti -C Web:www.co.jef ferson.waus/communitydevelopment E-mail:dcd@co.iefferson.wa.us �9SNI N6 MECHANICAL PERMIT APPLICATION Steps in the Permit Process: -Review required submittal items to ensure all information is completed prior to submitting application. -Mechanical Permits can be mailed into our office-and do not require an appointment. -Fees are due at time of submittal, Mechanical permits are generally issued within 5 business days. For Department Use Only Receipt#: 156a Go _ ate:^�� /5 Related Application#5: Payment#:' f a 7 3 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&l-360-417-2702 * If No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450 Required Submittal Items—for propane tank only General Site plan—showing propane tank, lines,and distance from tank to all existing structures. Required Submittal Items—for Solar Panel installation only Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. Site Information Assessor Tax Parcel Number: 9'0/ /0J O 3 Site Address and/or Directions to Property: 2 ,±119 Ct(AcdM1WvAI tS 3 Access (name of street(s)from which access will be gained: Description of Work: tJ pA NE " ti K r t1// N j'7 Lf Property Owner Name: Evergreen Coho S411411. 2481 Andcrson Labs lid. r6 Address: ChiimluaUll,WA Ma Phone#: E-mail Address:ZIY Ke -, Applicant/Contractor: Authorized Agent/Representative Name: M A zi Phone#: 045" 345 () 4 E-mail Address' rd 7Ylct .- (,, / License#: Expiration Date: ;r1Yi•, DEOEVA Mechanical Application 1 ' c-ENE_ TA) YTA- r1 . JUN 2 2 2015 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT . • 1 Heat Source Electric 111 Heating Oil G Propane' I Yi WOO Ii]1 Indicate Quantity and Fixture Types Below — Propane is prohibited in ■ Query Fixture Type Description hazardous locations such as h Fan and/or Exhaust Fan basements or pits or Fan Bat anywhere"heavier-than-air" Clothes Dryer Clothes Dryer with Exhaust Vent gas can unsafely collect. Cook Stove Cook Stove,Range Hood Exhaust Fireplace-Gas or Gas Log Insert 'Propane tanks over 125 Fireplace-Gas P gallons re wre a minimum Fireplace-Wood Fireplace-wood,Wood Stove,or g setback of i 10 ft.from Pellet Stove property line and buildings, Electric Furnace Electric Furnace or HP+/-Ducting and a site plan must be Propane(LP)Gas Furnace Propane Furnace+/-Ducting submitted with the Water Heater-Gas Gas WH Vent and Combustion Air application showing the Gas Pipe System Gas Pipe System LPG/Oil setbacks. If propane tank is l Propane Tank LP Fuel Tank(#gallons: 0-0 1 over 500 gallons,a site plan is required to accompany this Heat Pump application, and a separate Generator Fire Code approval is also 1 Air Conditioner 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 visits y re aired later ter inspections. nspectiions and Applicant may permit request notice issuance. the County's intent to enter upon the property Si ope0Ovi r Print NameNo,vceAJ5/..)9, -4 (ifiCIAJORr Date°I V/ OFFICE USE ONLY Building Permit Fees Mechanical Permit fee(tank swap.woad stove,furnace,etc I $156.00 Propane—Lines,tank,and appliance(add'I$78.00) , Project Scanning Fee $19.50 Total Fees; i m s 0 El M �, 'Additional fees may apply. 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Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries CHSINC I Owner or Tradesperson PO BOX 64089,MS 210 ST PAUL,MN 55164-0089 Principals 253-833-7220 CASALE,CARL MARTIN,PRESIDENT KING County 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 Governing persons AL ANDERSTROM ALLEN J ANDERSON; GARY ANDERSON; GAYLON G BRATLAND; JAMES BAREKSTEN; JAY D DEBERTIN; JEFF HAGEMAN; JOANNE BURMEISTER; JODELL M HELLER; JOHN D JOHNSON; JOHN J SCHMITZ; LORNE E BROWN; MARK PALMOUIST; MICHAEL BERGELAND; NANCI L LILJA; NEOL ESTENSON; PATRICK KLUEMPKE; PAUL CULVER; RICHARD L BALDWIN; RICHARD H BROWNE; SHELDON HAALAND; STEVE CARNEY; STEVEN BURNET; T F BAKER; TYRONNE MOOS; License I https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 6/24/2015