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Home My WebLink AboutBLD2015-00423 - MECHANICAL ItUILDING PERMIT APPLICA#N B Review 0423 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 "'PERMIT #: BLD15-00423 Received Date: 12/2/2015 SITE ADDRESS: 2481 ANDERSON LAKE RD#437 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: 11/) CONTRACTOR: CHS INC PHONE: PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP Install 120 gallon Propane tank. TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: PRO I 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: Typeio Amount Paid By: Date: Receipt: Approved/Date Permit $156.00 HAC 12/02/15 159465 APPROVED Total: $156.00 r 1� DEC - 12015 Jefferson County DCG 1 Nirlcmar4\d e1fnrme1F 131 fl Ann QIr! m4 +1ronn1c l�soN co DEPITMENT OF COMMUNITY 1OVELOPMENT 4t<c ei 621 Sheridan Street,Port Townsend,W 3 98368 �` Tel:360.379.4450 I Fax:360379.4451 -< Web:www.co.jefferson.wa.us/communitydevcloment E-mail:dcd Cl,co.jefferson.wa.us 7L 1-1/I NGAG 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#: tw Date:/0/4-Z.//4. Related Application#s: _ -Payment#: "j. 'i�'' ' 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-tan only.l, ii/ General Site plan —showing propane tank, lines, and distance from tank to all existing structures. Rehr wired Submittal Items—for.Solar Panel-installation only Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. SiteInformation Assessor Tax Parcel Number: # 43 2 Site Address and/or Directions to Property: Fu.oTZa,.RE'F N �c./ �c) (SKP) }79R4.. Access (name of street(s) from which access will be gained: V Description of Work: ��p ' moi_ �'gi r f< �T' R , s-fyie PropertyOwner ��/I�� ch `; �r Name: F.v fZ q R%EAi 1'1.0 (.r iiP) R l/ P /ZJLAddress: D 9�F� ��dr=� 5�d ,� � ,� k� Ind s,� �� 7 Phone #: E-mail Address: Applicant/Contractor: Authorized Agent/Representative =� Name: _ _ AT Phone#: E-mail Address: t w. License #: Expiration Date: Mechanical Application 1 40' HeatvSource +'' I �d i 1� lq j ., J r-------Ifo.- k zy 1; , 'l Electric I Heating Oil I I Propane* Wood p, I,1 , Indicate Quantity-and Fixtur`eTypes t elo , '� *Propane is prohibited in ,-Quantity„ fixture Type i Ill " --'2,1';`,7-- ',;1[,,I, -Description :~I1 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 ta'uia Propane Tank LP Fuel Tank(#gallons: 1 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 require. :ter inspectio" .. Applicant may request notice of the County's intent to enter upon the property for visits relater . tilt�., ,_af• anti., bsequent permit issuance. Property Own ,ir ��% J �/ // " Signature' L4 j ' /t Name: r7f77 X o/2 5 1 fel 4/!C k Date: (.21// II OFFICE USE ONLY Building Permit Fees Mechanic l Permitfe2 ttank-swap,woodstove,furnace etc) $156.00 Propane±t---Lines,,tank , and appliance (add'I $78..00) Project Scanning Fee $19.50 Total Fees - / � *Additional fees may apply Mechanical Application 2 S Haylie Clement From: Evergreen COHO SKP Park <ecrskp@escapees.com> Sent: Wednesday, December 02, 2015 10:05 AM To: Haylie Clement Subject: Permit for propane tank for Arthur Southwick Hi Haylie, Arthur Southwick is a leaseholder in the Evergreen Coho SKP Park, 2481 Anderson Lake Rd, Chimacum, WA 98325 His Lot number is 437. It is ok for him to get a tank and put it on his lot. He was up in the permit center and they told him he needed a letter. Not sure to whom he spoke to but since I have done this by email I would think it would be ok again. Thanks, Nancy C. Zingheim Business Manager 1 Parcel Details • • Page 1 of 2 te. "-:: .----,,,-:- JJefferson County , Database TaoIs 'Mies . v. — 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: View 2: 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 Map Parcel Plats &Survey Septic Monitorino Info „.,. /% Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH � Best viewed with Microsoft Internet Explorer 6.0 or later ge Windows- Mac http://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp?value=90110103 9 12/2/2015 CHSINC • Page 1 of 4 Home Inicio en Espanol Contact Search L&I5EARC-_ A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries CHSINC Owner or tradesperson PO BOX 518 Principals AUBURN,WA 98071-0518 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 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= 12/2/2015 CHSINC Page2of4 Construction Contractor • Active. • Meets current requirements. License specialties GENERAL License no. CHSIN**9790Z Effective—expiration 09/0912003—09/07/2018 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 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 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&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 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 N/A L&I account representative (360)902-4817 Track this contractor https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600148004&LIC=CHSIN**97902&SAW= 12/2/2015 111 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#: BLD15-00423 Received Date 12/2/2015 SITE ADDRESS: 2481 ANDERSON LAKE RD#437 Issue Date 12/2/2015 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: 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: Install 120 gallon 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 12/2/2016. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: --.1H1 ( 2 —1 (. 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\datalforms\F_BLD_Permit_Propane.rpt 12/2/2015 r'e e''�s "( JEFFERSON COUNTY t- J DEPARTMENT OF COMMUNITY DEVELOPMENT Date: 2J f Time Received: I `if am/pm on. Tue. Wed. Thur. Fri. Date: BLD: /5 -CX)'>'z3 Contact Name: Owner: Scg-ruw+cK Contact Number: 360 Q''//- 19/ Address: 07481 ANOFe i/37 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical FramingUnder ground Furance Setbacks Under-ground Gas Footing Rough In Air Seal Above ground 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 • Inspections are required to be called in by 3:00 pm to receive an inspection the next day. Do to staffing issues, at this time, we cannot guarantee that you will receive an inspection the next day. day. Unless you receive a call from us, assume we will arrive on your requested inspection day. • You may leave an inspection request 24 hours a day, and Inspections are available from Monday through Friday. • We cannot determine the time we will arrive in advance. However, if you call our office the morning of your inspection, around 9:00 a.m., we can give an estimate of when the inspector will arrive. Our general office phone number is 360 379-4450. • An approved set of plans are to be on site with building permit for all inspections. If permit and plans are not on site at time of inspection, a re-inspection fee must be paid prior to re-scheduling another inspection. • If no access, no inspections will be performed, and a re-inspection fee must be paid prior to re-scheduling another inspection. • Inspectors will not access a home that has personal affects inside when the owner is not present. • Commercial projects require 24 hour notice for inspection.