The URL can be used to link to this page

Home My WebLink AboutBLD2014-00337 - MECHANICAL ("WILDING PERMIT APPLIC)N BL 4-003pe37 ("WILDING Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00337 Received Date: 9/17/2014 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: PHONE: PROJECT DESCRIPTIOP New propane tank 120 gallon for space# 635 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 APPROVED Total: SEP 1 7 2014 Jefferson County DCD 1\tidemark\data\forms\F_BLD_App_Bld.rpt 9/17/2014 (-0,90N or,. JEFFERS•OUNTY • J� 4 3 4- • • -'i\ .iA DEPARTMENT OF COMM.UNi i t'' DEVELOPMENT ti ° `4 621 Sheridan Street Port Townsend • Washington 98368 360/379-4450 . 360/379-4451 Fax gSQ-j/ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description (include separate sheets as necessary): kt ftli3OVe. &POUND }n)4- -- 1912--00k0 Tax Parcel Number: q 0 i/c'i O'3 Property Size: Fkl (acres/square feet) Site Address and/or Directions to Property: 2-4gl Yi JIO6R5o,3 f ry co C14 1MYke,M wa g83Z - b S Property Owner(s)of Record: el/a12.4 C'-0 4D 12E''St) Telephone: 3b) ;1‘5' Co 5 35' Fax: email: Mailing Address: SAME Applicant/Agent(if different from owner): J(M &LL .E b p �� ,�,/y� A,� Telephone: $?0I--b�3--'72.07 Fax: email: -TRL�.! t t(/�Jl oniiii`vt Mailing Address: 110 C Cp p4 �'I— , ft 4.1 4oD-37Qc 2— 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 Hcme ❑ Modular • ❑ Discretionary"0"or Unnamed Use Classification 0 Con mercia!* ❑ Special Use(Essential Public Facilities)** Cnange of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑ Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** Propane ❑ Long Plat** o+y j ❑ 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 -, 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 I 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 acce and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior o / Signature: Date: I 17 /2-01 The action or actions Applicant will undertake a• - -suit of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potenti 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 indivi al,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 C my development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and mp ing with the ESA. The Applicant has read this disclaim and ns and dates it below. Signature: A Date: q 17 24/41' G:\PermitCenrer\###FORTES###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc SBUILDER 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: CNS UJC (3&) 732-45gc (36 757— `fggz MAILING ADDRESS: SeD( � 6i3)5— eha, A._ EMAIL: 5�5 ildL.00 CONTRACTORS LICENSE /`' 1M RC)M "`Jvl 1! WAINS Q GhSt�1C.-�pM NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: r; New ❑ Wood Existing: G Sewer 0 Addition ❑ Steel Proposed: Bank 0 Community System C. Alteration/Remodel ❑ Concrete Total: _ Height: C Individual System C Repair ❑ Masonry _______ SEP Permit# ET Demolition Other: Bedrooms: Water Supply: Existing: _ Setback: U Private well U 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 :BC Occupancy:-_ IBC Type of construction: Will you have Food Service? Yes I No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank bove ground I an • Size of Propane Tank: I eat o : i prep). I Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes i- 7 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 I Revision Main Floor Heated EH Bld App Review: -2n°Floor Heated Consistency Review: Other Heated Base fee: fi• ea Mezzanine Additional Section: d 0 Heated Basement Plan Check fee: l Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL -- Decks 911/Rd Approach fee: Other TOTAL: $ a j--1- •010— Receipt Number: 1 c5 53O Cash/Check Number: `: \ 146 ESTIMATED COST(REQUIRED) Date: CV 1 1 L *Fair market value of all labor and materials foundation to finish Initials: ^, G:\FermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08 doc s�>N c ON COUNTY / ae „G JEFFERS ,tea$ DEPARTMENT OF COMMUNITY DEVELOPMENT YgKINUS Date: 2.7( Time Received: /b:/0 pm Mon. Tue. �g�� Thur. Date: O 0033 Contact Name: Owner Contact Number: 360 Owner: �,� _35 206 Address: 2 • - gel 433 721)f' Notes: Foundation Plumbing Framing ;Propane Tank Mechanical Framing Underground Furance Setbacks Under ground Rough In Air Seal Above ground Gas Footing Stemwall Hydronic Exterior shear Exterior lines Oil Interior shear Interior lines Ducts Straps Hot Water Htr Appliance Post Hole Ventilation Underfloor Gas/Wood stove Insulation Man-Homes Final Inspection Floor Setbacks Wall Address Posted Foundation Ceiling • • 2 v.•IN" A J ca ■ ct.2 r�.�►-. wag CHSINC Page l of 4 • • 0 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 CHSINC WA UBI No. Business type 600 148 004 Corporation License Verify the contractors 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 S12,000.00 Bond account no. 58S203444 Received by L&I Effective date https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= . ' 9/17/2014 1 Parcel Details Page 1 of 2 • • } Jefferson County Weather Station " Database Tools 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 lats&Surveys Septic Monitoring Info {g 4 t' HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=901101039 9/17/2014 0 0 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#: BLD14-00337 Received Date 9/17/2014 SITE ADDRESS: 2481 ANDERSON LAKE RD Issue Date 9/17/2014 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: New propane tank 120 gallon for space# 635 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 9/17/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: ,,,,,,, 0 IZl + 'S' 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 N tidemark\data\forms\F_BLD_Permit_Propane.rpt 9/17/2014