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Home My WebLink AboutBLD2015-00408 - MECHANICAL • 0408 B BUILDING PERMIT APPLICA•N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00408 Received Date: 11/18/2015 SITE ADDRESS: 2481 ANDERSON LAKE RD#542 CHIMACUM, 98325 OWNER: RICKY L BOWERMAN PHONE: 209-406-6807 2481 ANDERSON LAKE RD LOT542 CHIMACUM, WA 98325 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 1V1 CONTRACTOR: CHS INC PHONE: PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NEW MECHANICAL PERMIT INSTALL 100GAL. PROPANE TANK WITH LINES 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 SRE 11/17/15 159423 APPROVED Total: $156.00 APPROVED NOV 18 2015 Jefferson County DCD Rfirlcmnr41rhfo1fnrme1F RI fl Ann Rid rn+ li/i R/9f it ,w¢yO'' c'oe JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT g /5HIN( Date: 1/ � . Time Received: q =Lc-3 am/pm Mon. op Wed. Thur. Fri. Date: j2/(//5 BLD: (j - 6/0Contact Name: Owner: (( c y CAO i(YILLI\ Contact Number: 360 Address: 487 It,0!•AAA r L • 206 2Oq _ cliCk (,g'07 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas X 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 ��oN c DEPARTMENT OF COMMUNITY IIVELOPMENT t, �6 621 Sheridan Street,Port Townsend,WA 98368 W - �� Tel 360.379.4450 Fax:360 379 4451 -< Web:wwcv.co.Jefferson.wa,us/cominunitti-develgpment B-mail:dcd@co.iefferson.wa.us LT :1 �Sh l NG,O 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#:L c'2..b Date � ..it 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 ,i IL 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: qtic — 101 -069 Site Address and/or Directions to Property: 1k ( Q two v_RS o N r\k K 4.. .-- tt, k o-v 6 k'a. Cil l r+rl P W t+1 u0r. c $S a-z Access (name of street(s) from which access will be gained: Description of Work: -----Ln S-316 .a.,,aGI 1bo VtnPwat_ —71eAike._______, Property Owner r 1" '1' '11, Name: „\i,. ' :::.c,-.�,S(trirnt>,t1 , Address: 1tt_ 11 lLtd' �YLS,G•hl INtAg.4. RN, ko`r "�`! O_N1\mtaq,Q A I, a. , GCs_' Phone #: Act' . yt)\0 — 6 fdt;`k E-mail Address: Rrcsw tA@ tAti I Applicant/Colt c �Auth r ze Agentjftepresentative Name: Phone #: E-mail Address: _�� License #: Expiration Date: ' Mechanical Application 1 ,,i • S Electric ri Heating Oil Propane* Wood IJ 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 unsafety 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, Propane (LP)Gas Furnace Propane Furnace+/-Ducting and a site plan must be 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: ) 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 o this a p tion and subsequent permit issuance. Property Owner np Signature: Print Name: ��Qi0,4 1,. 'v 1'�_0/1,14iA, Date: tt I • t•S 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 Mechanical Application 2 Map Output • 0 Page 1 of 1 ArcIMS HTML Viewer Map 1._sra3663m . ntt04fi29 964t6te67' -� � I_ -.-yam_ „__-._..- fGt5U 132 90„0,0,4 i 493149W2 `^"-"__ y--... iJ �..-�.A.... .,..,abs 1 : ,5h t Aiit64G05 981541424 . , i .. . '"'-Ft115pO e Avv"-'-_.---.. 861.4111027 Legend a^. pt`6 1.. j E SeiactQd FBatWe6 mieed 1183 43 .� A.'- .tr.,) 64E16ma6 A/50,.."51, Staikk AV uc_raada 1 7 'mama= 71 14"'"1" Tdmmu aaas Ayv �Wftt61639 I. .—___ N—saw Aa g WOW.,W Av---^g______\ ^_„,Ff 961.169461 Itiyym Av ytiatba. 1 13 Andaman Lake Alf* 3 ( _ 86114217 tmameam I 1 9901.964&331 {+(1t{ 96116<0*3 /y 165mi624 __ 941165626 1 ._.. 4 ' '961141483 31aa .:_-YAA,A.Cm'McaAA:9a1ees b3 1zp35116021 a 461fcl FOR INFORMATIONAL PURPOSES ONLY- JefFerson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity.Data contained in this map is limited by the method and accurac of its collection.Tue Nov 17 12:00:34 2015 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=... 11/17/2015 Parcel Details • • Page 1 of 2 jj nJefferson 7 _ate: 114r`yStiMail- � ' A � t .:atiirn=;° -•:, ..7--17.7.i--:: ' Home '. County Into Departments Search ...i.... } III (i INI. Ism Wim.. ,, ��I ( w«..nmmmv 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 Fre 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 Ma Parcel lets &Surveys Se.tic Monitorin. Info ' ' Jeffersor County HOME I COUNTY INFO I DEPARTMENTS I SEARCH .= , Best viewed with Microsoft Internet Explorer 6.0 or later pa Windows - Mac http://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp?value=901101039 11/18/2015 CHSINC • • Page l of 4 Home Inicio en Espanol Contact Search L&I St .PU1' A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 40 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 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 0 DEBERTIN; JEFF HAGEMAN; JOANNE BURMEISTER; JODELL M HELLER; JOHN D JOHNSON; JOHN J SCHMITZ; LORNE E BROWN; MARK PALMQUIST; 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 Verify the contractor's active registration/license/certification(depending on trade)and any past violations. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 11/18/2015 C H S INC • • Page 2 of 4 Construction Contractor Active. ............._......._....._.............._........ Meets current requirements. License specialties GENERAL License no. CHSIN**9790Z Effective—expiration 09109/2003—09/07/2016 Bond Westchester Fire Insurance Company $12,000.00 Bond account no. K09235450 Received by L&I Effective date 10/27/2015 11/21/2015 Expiration date Until Canceled Liberty Mutual Ins Co $12,000.00 Bond account no. 58S203444 Received by L&I Effective date 10/05/2012 11/21/2012 Cancelation date 11/21/2015 Bond history Insurance ................... Old Republic Ins Co $1,000,000.00 Policy no. MWZY305412 Received by L&I Effective date 09/06/2015 09/01/2015 Expiration date 09/01/2018 Old Republic Ins Co $1,000,000.00 Policy no. MWZY305412 Received by L&I Effective date 09/01/2015 09/01/2015 Expiration date 09/01/2016 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&l Tax debts No L&Itax 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 .._............................ https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**9790Z&SAW= 11/18/2015 C H S INC • Page 3 of 4 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 NIA 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. Inspection results date 08/25/2015 No violations Inspection no. 317937476 Location 900 E Columbia Drive Kennewick,WA 99336 Inspection results date 09/14/2011 No violations Inspection no. 315180448 Location 153 NW State Ave Chehalis,WA 98532 Inspection results date 08/26/2011 No violations Inspection no. 315093930 Location 7902 N Division St Spokane,WA 99208 Inspection results date 08/19/2011 No violations Inspection no. 315054858 Location 900 E Columbia Kennewick,WA 99336 Inspection results date 07120/2011 No violations Inspection no. 314949959 Location 900 E Columbia Kennewick,WA 99336 Inspection results date 0 510 412 01 1 Violations Inspection no. 314618695 Location https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**979OZ&SAW= 11/18/2015 CHS INC • Page 4 of 4 400 Toteff Rd Kalama,WA 98625 • Inspection results date 0511712010 Violations Inspection no. 313999716 Location 433 N Columbia Connell,WA 99326 Inspection results date 03/31/2010 No violations Inspection no. 314140948 Location 433 N Columbia Connell,WA 99326 • Inspection results date 03/31/2010 No violations Inspection no. 314140955 Location 528 S Booker Rd. Othello,WA 99344 Inspection results date 03/31/2010 No violations Inspection no. 314140963 Location 3132 Rd.ONE Moses Lake,WA 98837 Inspection results date 12/2312009 No violations Inspection no. 313674509 Location 111 N.9th Walla Walla,WA 99362-1721 ®Washington State Dept.of Labor&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**9790Z&SAW= 11/18/2015 • a, 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#: BLD15-00408 Received Date 11/18/2015 SITE ADDRESS: 2481 ANDERSON LAKE RD#542 Issue Date 11/18/2015 CHIMACUM, 98325 APPLICANT: RICKY L BOWERMAN PHONE: 209-406-6807 2481 ANDERSON LAKE RD LOT542 CHIMACUM, WA 98325 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 1W CONTRACTOR: CHS INC PHONE: 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 MECHANICAL PERMIT Directions INSTALL 100GAL. PROPANE TANK WITH LINES 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 11/18/2016. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 12r—I —13- 0)^--- 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\FBLD Permit Propane.rpt 11/18/2015