Loading...
HomeMy WebLinkAboutBLD2015-00311 - MECHANICAL IUILDING PERMIT APPLICA•N BRD e5- 003311 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00311 Received Date: 9/14/2015 SITE ADDRESS: 2280 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: 1 I CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: 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 $156.00 JLA 09/14/15 159173 P, ,uR `,4/ED Total: $156.00 SEPI42015 Jefferb,;r, DCD \\lieinmrr41iia1.,fnrmclr RI rl Ann RH rn/ OFIAIwo Parcel Details • Page 1 of 2 Jefferson Cu :Databas e oos mm O Wecam 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) Sewer: Drainage: Bank: View 1: View2: Zoning 1: RR-20 - Rural Residential Zoning 2: Zoning 3: 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 Mao Parcel Plats &Surveys Septic Monitoring Info lit) Jefferson County 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?value=901101039 9/14/2015 C H S INC • Page l of 2 Home Inicio en Espanol Contact Search L&I St k.tt('1 A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing thi ft)Washington State Department of Labor & industries C H S INC Owner or tradesperson PO BOX 518 AUBURN,WA 98071-0518 Principals 253-833-7220 CASALE,CARL MARTIN,PRESIDENT KING County 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"97902 Effective—expiration 09/09/2003—09/07/2016 Bond Liberty Mutual Ins Co $12,000.00 Bond account no. 585203444 Received by L&I Effective date 10/05/2012 11/21/2012 Expiration date Until Canceled Bond history 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. ,nn 1011 nn This business is certified to cover its own 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 Location 153 NW State Ave Chehalis,WA 98532 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**97902&SAW= 9/14/2015 CHSINC • • Page2of2 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 ©Washington State Dept.of Labor 5 Industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**979QZ&SAW= 9/14/2015 • (rsDE•TMENT OF COMMUNITY•VELOPMENT .ON OG 621 Sheridan Street,Port 1onnsend.\1.1 9$368 � Tel: 360.3?9.445(1 Fax.360.3-9.4451 C Web.Wmw.co.ietterson.'.aus.con::m nit•:devel,,p:ten; F-mail:dcd(Fi co.letferza)nx.a.us 11,gS1-1INCzC°� 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#: Date: Related Application#s: Payment#: 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 Required Submittal Items-for propane tank only LGeneral 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: 9011 O/ ai F Site Address and/or Directions to Property: F/ f/rltkr. n Lake /(°d. ..Ot 'a.? mal_rum 0/9 97,3 5 Access (name of street(s) from which access will be gained: Description of Work: Property.Owner Name:&Lk (ID m Address: a S1 19nd,erson 1_, Ic,Le RA, C;hrrnacrwm 14,4 91325 0 b - 3SS^ -o Phone #: (��3 �5 E-mail Address: Applicant/Contractor: Authorized Agent/Representative _ Name: Rober+ W. 4- Mary M , fro ff" Phone #: a /4- (,q q - j '7 /g, E-mail Address: Thfri t7@qma;J roM License If: Expiration Date: O ` 1 Mechanical Application 1 CAsi •• • , Heat Source Electric I Heating Oil Propane* Wood Indicate Quantity and Fixture Types Below *Propane is prohibited in Quantity Fixture Type Description , hazardous locations such as Fan Bath Fan and/or Exhaust Fan basements or pits or Clothes Dryer Clothes Dryer with Exhaust Vent anywhere "heavier-than-air" Cook Stove Cook Stove, Range Hood Exhaust gas can unsafely collect. Fireplace -Gas Fireplace-Gas or Gas Log Insert *Propane tanks over 125 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, 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 Propane Tank LP Fuel Tank(#gallons: 'I 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 property for visits related to this application and subsequent permit issuance. Propert Own Q • Signature:' Print Name ' - - �,a,LTy�6L-€,A. 3S•K Date: ( SOP c. OFFICE USE ONLY Building Permit Fees Mechanical Permit fee(tank swap,woodstove,furnace,etc) $156.00 Propane—Lines,tank, and appliance (add'I $78.00) Project Scanning Fee $19.50 Total Fees* *Additional fees may apply Nfechanical Application 2 ' • • S ;fe Plan . k Name of Leaseholder(s): Rober i- I rot+ fl ry Lot # (atea Date submitted: Approved by: /0i F ° com bus4-.1 1� l\( source Lot Management: } 5';o4-)us" Prom Pry --ran Board Member: I `V Date approved: Directions: I. In the space above, sketch the size and location of the deck in relation to your RV. 2. In the space below, describe the materials you plan to use for the support structure and the decking. II' Completion date Lot Management Signature rev. 9/5/13 • . 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 #: BLD15-00311 Received Date 9/14/2015 SITE ADDRESS: 2280 ANDERSON LAKE RD Issue Date 9/14/2015 CHIMACUM, 98325 '4/6"Z 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: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 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: NEW 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 9/1412016. REQUIRED INSPECTIONS: Z/( '"7�� Installation per Manufacturer Specifications/CO2: tt' r es Tank/Line/Appliance: 10 /1/ IS • 067j-i. Final Approval: t 12/tr ,4157i3 . 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 1\tidemark\data\forms\F_BLD_Pe rm it_Propane.rpt 9/14/2015