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Home My WebLink AboutBLD2015-00409 - MECHANICAL ILDING PERMIT APPLICAN BLD15-00409 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00409 Received Date: 11/18/2015 SITE ADDRESS: 1313 IRONDALE RD PORT HADLOCK, 98339 OWNER: CHIMACUM HEIGHTS LLC PHONE: 360-379-9055 PO BOX 1105 PORT HADLOCK WA 98339-1105 9600 - HILLCREST SUBDIVISION: Block: Lot: PARCEL NUMBER: 960000108 Section: 2 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 SWAP OUT OF TANK- FROM 100 GAL- TO 120 GAL. 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 SRE 11/18/15 159425 APPROVEDTotal: $156.00 NOV 18 2015 Jefferson County DCC \lfirio, aro\rfnfo\fnr.nc\F RI n Ann Rlrl rnf 11/1R/9M6 ("---61—vca DEPITMENT OF COMMUNITY IVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 C � Tel-360.379.4450 I Fax:360.379.4451 _ -C Web:www.co.iefferson.wa.us/communitydevelopment E /e' C\�f f [U\ _i'1 ' 1 E-mail:dcd@a.co.iefferson.wa.us V�J '1 V 1� 'sWi Naz MECHANICAL PERMIT APPLICATION NOV 1 8 2015ii Steps in the Permit Process: i_--- ,, i it r .^',OViNlY -Review required submittal items to ensure all information is completed prior to submitting application „c,,Typrtilrtopg"FniT -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#: �Z i, "Date:.'i U fes ' SO Related Application#s: _ ni 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 pro anetank',only �„ JGeneral Site plan —showi propanenk, lines, and distance from tank to all existing structures. Required Submittal items--for So ar Panel installation only ,'olh' Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. Site Information 1,, Assessor Tax Parcel Number: Site Address and/or Directions to Property: 1313 )Ron d et.J-e Al Access (name of street(s) from which access will be gained: Description of Work: 1-1LPLnt.12.. Jurna,lAIA ptopo t 4-0—A(5) Wi ilk O'.o jAimonr (Iv IZt mks) Property ?wn a 1t. t,'- ,:'' Name: g m ��i m a c.w+-, 1:1-e.c.�tiv�— )L C — �cne2 IL' 911�(�8-s») ewl aN.QUei E3 Address: t<3LIS 1a0n30,,,Cf 2\ m Phone #: 31,0 - 3-I cl _1 o ss E-mail Address:pmn _ , , , a __ m Applicant/ Contra Aut _razed Agent/Representative 1, ;:,,;',, Name: Cha h ., Phone #: E-mail Address: License#: Expiration Date: Mechanical Application 1 0 Heat Source ' ., I ._ � Electric J Heating Oil l�' Propane* n Wood u II � ' Indicate-Quantity and Fixture Types Below - I' ; ',e *Propane is prohibited in Quantity; i reT pe,,1,, -`_I 'Descriptionhazardous locations such as t Fan Bath Fan and/or Exhaust Fan basements or pits or Clothes Dryer Clothes Dryer with Exhaust Vent anywhere "heavier than air" I Cook Stove ��P 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 7 1 Propane Tank LP Fuel Tank(#gallons: I lc, ) over 500 gallons, a site plan is Heat Pump required ton accompany this vivvV Generator application, and a separate Air Conditioner Fire Code approval is also required. ,rr` Installation manual must be on site at time of inspection or a °`'i (colt- 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 1 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. a�a PropertSignatyOwner(�_ P�-� c11°) ) J 5 fir, tilrlc.kSor- tI/ 1-1.1.3 Signature: VYII� "'" Print Name. Date: t,r .-^ - I+ LL L --OFFICE l SE"ONLY t � l ( � C �y�y l _Building Permit Fees li,,,,, �l(I II''�ii4�i� a4.?tjllll1i�ililllil.� Ili '�I �r1 Mechanical Permit'fee(tanks wap,woodstove,furnace.,etc h �t�, ,I llll{ISI. Ii ,� , ,$1 �'�I ' ,, I, i� 4h iIIIII Propane -Lines,tan tid appliartc-e(add'I $7 ,�� i 111 �`�r ( .I� ,,, 11,,,,,,,',.1.'' = ee difi I_ roject scanning Fee 'I 7�iF, I,� 11 _ 19.5pl ,E �; , .., Teta! Fees i �l� lil (r; � *Additional fees may apply. Mechanical Application 2 CHSINC • Page 1 of 4 • Home Inicio en Espanol Contact Search L&I Si eiRCH A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of 401741 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:09/2112012) BAKER,DAVID A,SECRETARY (End:09/2112012) 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 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**97902&SAW= 11/18/2015 CHS INC • • Page 2 of 4 Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. CHSIN**9790Z Effective—expiration 09/09/2003—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. 585203444 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 09/08/2015 09/01/2015 Expiration date 09101/2018 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 NOSavingsaccounts 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 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 .................................. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC—CHSIN**9790Z&SAW= 11/18/2015 CHS 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 99206 Inspection results dale 08/19/2011 No violations Inspection no. 315054858 Location 900 E Columbia Kennewick,WA 99336 Inspection results date 07/20/2011 No violations Inspection no. 314949959 Location 900 E Columbia Kennewick,WA 99336 Inspection results date 05/04/2011 Violations Inspection no. 314618695 Location https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**979OZ&SAW= 11/18/2015 CHSINC • Page4of4 400 Toteff Rd Kalama,WA 98625 Inspection results date 05/17/2010 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 03/3112010 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 12/23/2009 No violations Inspection no. 313674509 Location 111 N.9th Walla Walla,WA 99362-1721 ®Washington Stale 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 . 1.i IL i i 4 • i i ......„ ,, I (--,,n ; ,,..,, , ,, , ; / -}�. ��/ t, ,. � a 4,, ..,3 (),, � i ,-74 7 (i f i/' `L I 4. , ----1,C • r.°1(114,- .°1 rn 7S” 4441i3 P"5 4n-1111517 4 7i(Oa0 C�� '• .. ---7010k014 ii0(1'eg at! c yrN zo , �f►°` qQ ` I ,,,,. . "41\44.r\A-\:5 r n 7333 .r. . i L n : i # T 1 ) I 1 SIOZ l i\U l i r? I _ _ ___,_moi (� 1 I1 ' LNA �� 03 .0 i . 1 1 ite7K ,I •Ei Ir, . , 2 J --1 444esON JEFFERSON COUNTY I DEPARTMENT OF COMMUNITY DEVELOPMENT 9SyIN[S�2 ar Mon. ue.> Wed. Thur. Fri. Date: f� 7j v Time Received: ( (4 m/�J Date: X11 Contact Name:Contact Number: _ BLD: I`� `'�DQ 360 3�Q �75 Owner: 360 Address: I 3'l 3D"`)Dom" 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Framing Under ground_ Furance Setbacks Under ground Gas Rough In Air Seal Above ground Footing Exterior lines Oil Stemwall Hydronic Exterior shear Ducts Interior shear Interior lines Straps Hot Water Htr Appliance Post Hole Ventilation Underfloor Gas/Wood stove Insulation Man Homes --- Final Floor Inspection Setbacks Wall Address Posted Foundation Ceiling Block &Tile • 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#: BLD15-00409 Received Date 11/18/2015 SITE ADDRESS: 1313 IRONDALE RD Issue Date 11/18/2015 PORT HADLOCK, 98339 APPLICANT: CHIMACUM HEIGHTS LLC PHONE: 360-379-9055 PO BOX 1105 PORT HADLOCK WA 98339-1105 SUBDIVISION: 9600- HILLCREST Block: Lot: PARCEL NUMBER: 960000108 Section: 2 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, CHIMACUM HEIGHTS LLC PHONE: 360-379-9055 if different: PO BOX 1105 PORT HADLOCK WA 98339-1105 PROJECT DESCRIPTION: NEW MECHANICAL PERMIT Directions SWAP OUT OF TANK-FROM 100 GAL-TO 120 GAL. TANK 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: ( I-- BUILDING 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_Perm it_Propane.rpt 11/18/2015