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" , OIl ~ pORT ~ ~4.0~~~ O,.~ ~ -- "l.fi:~ CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 08-00000927 Date 639066 808 E FRONT ST. 06-30-00-5-1-2330-0000- DAVE ANSTETT DEMOLITION 9/03/08 COMMERCIAL ARTERIAL 10000 Application desc DEMO TWO BLDGS: 480 SQ. FT. & 886 SQ. FT. Owner Contractor DAVID J ANSTETT OWNER 820 E FRONT ST PORT ANGELES WA 983623613 (360) 457-4484 Structure Information 000 000 DEMO TWO BLDGS: 480 SF & 886 SF permi t . . . . . Additional desc . Permit pin number Permit Fee Issue Date Expiration Date SANITARY SEWER HOOK UP 132381 300.00 9/03/08 3/02/09 Plan Check Fee Valuation .00 10000 Qty Unit Charge Per 1.00 300.0000 EA SAN SEW CAP/PULL W/M Extension 30D. DO Special Notes and Comments The Fire Department has reviewed the project application. and has no comments Public works electrical engineering has no requirements for this plan review. An approved Public Works Waste Disposal Application is required prior to taking material to transfer station. Sanitary sewer lateral to be capped at property line by owner. An inspection by public Works Engineering prior to back fill of ditch. 24 hour advance notice is required. Water meter and service line to be removed at water main by City crews. Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 300.00 300.00 .00 .00 Plan Check Total .00 .00 .00' .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 304.50 304.50 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date ,Q(}~ ~ Signature of Owner (if owner is builder) t;'-..3 -o~ Date T:\Policies\11 02.15R [1/05] PERMIT INSPBCTION RECORD L CALL 417-4807 FOR UTILITY INSPECTION$. PLEASE~}{.OVIDE A MINIMUM 24 HOUR NQTICE. IT IS UNLA WFUL TOCOVE!l, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMITJN'A CONSPICUOUS LOCATION:~' .\:,- ,:. - INSPECTION TYPE PW UTILITIES (Engineering Division) WATERLINE / METER SEWER'CONNECTioN SANITARY STORM SITE DRAIN'AGE ,. SITE EROSION'CONTROL PARKJNG SIDEWALK '. CURB & GUTTER ,bRIVEWA Y.APPRQACH BACK-FLOW DEVICE " " , '.., ;s,. ,,'. . . n "... ;1,'::" ':.:' ,i,,)' . .(. ;c'., . " ," . . . '- ','",_ _. _', ... .M'_ KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE ~'>., " ", DATE ACCEPTED YES NO ::: ',;,",.' :c:' '" ,.,,'. ">;,:'c", ........::,,"::. ,,,,"::'; ',"', ;'.:;;\:/ /. ..'" '.il. " "". ,: v... _ ~~ l "" ;~ - " ',t., ;:: .:'1,,: ",., ":.,.',< ,. :....:.;',". ',,,' <," " "",;::",., COMMENTS ";., .:' ,-J! ,'- . :,j,G .,1,"'- ',' .. '. .\1 " :" .'",:t:t,,' I:>~' ~', ~ ',-,:., '" I ":I:' '. .:~.. " ,', ",. ": "'.;! : .;",,' ;,.'; ...' I,C.S", : <~."t:. ,".):\, ",: T:,' " ", I I:,i~}: \;\' " " , , ,." .' " .~ i '\.: f:.i \:\ \ ,i;+ ",~:.: ',h' ,~;iji';' ':;,:' "'"".. .;"','> 'i'~i .. ....,. ...." " ... :.;. RESIDENTiAL"",:", ,.....':.j:: ":';!;'.. :..';, " FIRE,."","';' " ""':' CONSTRUCTION R. V/l 'pw / ;/{~ ENGINEERING, . ' " ,PLANNING DEPT. BUILDING I , '. T:\Po1icies\1102.15R [1/05] ""'<""" .' '.' :;:;: !', ~ ,,;,:,',; ;,'. ."., ,i.. ., '"~,, '>"'-' I'~ I,':, "'..' cf ""'~:''': r,,," .\:;,;".,:.'. ',,> .., ~ .F '<, ~,< .;'::~! . ",. .~.:; . ,. ,..' l ,iC-.. . ..'.~...; ,,'~',' ;', '_h,~ ~.f-" ,"- ~!_..,..,~. ," FINAL INSPECTIO.NS REQUIRED PRIORTO OCCUPANCY/lISE" :,.,,,, .'''''-DATE' YES: ',' NO" ";., COMMERCIAU-:).:c::.,. -"':DATE:':""- 417-4807 417-4653 417-4750 417-4815 I~:'?:' '::;:;, " ,.,,:: " '. "::';. : ~ "~ ;~ , " . ". ~ .' " 'I' . "~. _..j... ~ ~ . " CONSTRlICTION: R W. PW / ENGINEERING '" ,." FIRE DEPT, PLANNING DEPT. BUILbING '"f .., '. " -;- 1 .i ':' ,.". : "';" :-'~iACCEPTED' YES' i.. NO':' .: '>., ,'.1:,-., ;','''; '"' " .... CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DTVISION 32] EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name . . Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 08-00000927 Date 639066 808 E FRONT ST 06-30-00-5-1-2330-0000- DAVE ANSTETT DEMOLITION 9/03/08 COMMERCIAL ARTERIAL 10000 Application desc DEMO TWO BLDGS: 480 SQ. FT. & 886 SQ. FT. Owner Contractor DAVID J ANSTETT OWNER 820 E FRONT ST PORT ANGELES WA 983623613 (360) 457-4484 Structure Information 000 000 DEMO TWO BLDGS: 480 SF & 886 SF Permit . . . . . Additional desc . Permit pin number Permit Fee Issue Date Expiration Date DEMOLITION DEMO TWO BLDGS 131219 50.00 9/03/08 3/02/09 Plan Check Fee Valuation .00 o Qty Unit Charge Per BASE FEE Extension 50.00 Special Notes and Comments The Fire Department has reviewed the project application and has no comments . Public works electrical engineering has no requirements for this plan review. An approved Public Works Waste Disposal Application is required prior to taking material to transfer station. Sanitary sewer lateral to be capped at property line by owner. An inspection by Public Works Engineering prior to back fill of ditch. 24 hour advance notice is required. Water meter and service line to be removed at water main by City crews. Other Fees STATE SURCHARGE 4.50 171 I f'Jq/p_/ <2 '/ '0/ 0" 0& Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 50.00 50.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 54.50 54.50 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. q - ~-O<is' Date D Cu~ A KI.cNQ.."1't"" Print Name l~Q. ~~ Signature of Contractor1or Authorized Agent Signature of Owner (if owner is builder) T: Forms/Building Oivisionil3uilding Permit (05/13/08). wpd BUILDING PERMIT INSPECTION RECORD () C)Q , --D \'J -J CALL 4] 7-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. CALL 4] 7-4807 FOR PUBLIC WORKS UTILITIES. CALL 4 17-4886 FOR BACKFLOW PREVENTION INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA TJON. KEEP PERMIT AND APPROVED PLANS AT THE .JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS SHEAR WALLS / WALLS FOUNDATION DRAINAGE / DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE FINAL DATE ACCEPTED BY: BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR W ALLIHOLD DOWNS WALLS / ROOF / CEILING DR YW ALL (INTERIOR BRACED PANEL ONL Y) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP/FURNACE/DUCTS GAS LINE WOOD STOVE / PELLET / CHIMNEY FINAL DATE ACCEPTED BY: COMMERCIAL HOOD / DUCTS MANUFACTURED HOMES -- FOOTING / SLAB BLOCKING & HOLD DOWNS SKIRTING PLANNING DEPT. SEPARATE PERMIT II's SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R. W. / PW/ CONSTRUCTION - R. W. ENGINEERING 4 I 7-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING ! 12~/I'I~g :1'1L ~ ex> IT) ~ ~ 4- ~. t7 ~ ".... :1.1:.._ T""\: .:_:___11"1. "1-1:_.. Tl___~:.If\</l'l/nQ\....",,1 "- ., ,:j , .~ i' -I ~; .... ,. .'. ; :';:J '. ,0"( 'I '. . :~~ : ' -' "..": ::...:~: .' ,.,~. ~\ ':. ';"j , ./:{i ; . --.- "i '; '(~ -,>,:,;:1 .":.::.~ r '.. ; '.; ,-' ~. ..,':':~~.:~j. , ~ . ~ J . '. ." " - "~ ...._ "_ J..f . "{. . ~ \ .: ~ ._- #."'.,..,'" :-.1 . '.. : -. ., ., .' : '. ',' .r" . <:- ; . ~ '. . ,. ' . . ," '. ":: ... "- ~ORTANGELES ()Jl;)A-/Q E3-'ZC( W1 hcE WAS H I N G TON, U. S. A. Public Works & Utilities Department September 2, 20Q8 Dave Anstett 16 Riverside Rd Sequim, W A 98382 ,~~,.., ~ : RE: Port Angeles Landfill! Transfer Waste Disposal Application, WDA 08-29; Building demolition material from 808 East Front Street "i ;.. -\ We have received your application for disposal of building demolition debris from the referenced site and reviewed the testing results for asbestos content. Based on the asbestos testing results it appears to be ac'ceptable for disposal at the transfer station. A copy of your approved application is attached. This approved application must be shown to the transfer station scale attendant at the time of disposal. . I ......, ' Please be advised that this disposal application is only for the materials and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. . J Please call 360-417-4807 if you have questions. Sincerely, ""4 j;w.U~~F Stephen Sperr, PoE. - City Engineer Encl.: WDA 08.29 Copy: Claudia Strornski Waste Connections N:IPWKSIENGINEERI WDAPPLlC 08.29 File: Landfill Solid Waste Disposal Application, "i Phone: 360-417-4805 / Fax: 360-417-4542 Website: www.cityofpa.us / Email: publicworks@cityofpa.us 321 East Fifth Street - PO. Box 1150/ Port Angeles, WA 98362-0217 wDA- 08-2.-1 PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION To: City of Port Angeles, City Engineer 321 E. Fifth Street P.O. Box 1150 Port Angeles, Washington 98362 NOTE: Phone: (360) 417-4803 FAX: (360) 417-4709 All questions must be answered for waste to be approved. 11. Generator Information: Company Name: Mailing Address: Contact: Phone: Project Name: Project Location: DAVP." ?)flJSTeTf ~ \v 121 J fr .<:... ~[)e S(l~ u~ '11\. W A (SA (\1\ c;_ 3Coo L-f (p t ~og E Qa () e eel C( 8 ~ g~ qo q I \. EOeryrt'f>iA) ("uf!d,5\ )~ 6.1 ~,eO-VT Rovr , !2. Other Contacts (if applicable): i i , I I I I Consulting Firm: Contact: Phone: Contractor Name: Contact: Phone: Laboratory: Contact: Phone: i L~___.._._.__.__ .. Ell U flO IY1 fw-JtJL ser(J~{F 5 I!f~ey Ef Rfckrij~ 0),53 ~7q 8/1[( ()0./ N tv 0 -+=- (1)qokv7 D.lJu e A-tv 5 k 1+ ~'-o L-/fol 9oP! \ ~ ., {. 012/ /)v\J r!ll.jUlr6t'l.'~~,,-"'n' k e,p{l., Lf> i ( J! 5 ol() 253- &7Y 8//2} Ute. City of Port ;'.ngeles - Landfill Waste Disposal Application Page - 1 of 5 13. Source of Waste: Check the appropriate box below and briefly describe the project, process, and/or cleanup that will or has produced the waste requiring disposal. Include the gasoline service station number (if applicable). CERCLA/MTCA Remediation Agency Contact UST Remov$1 Other Source: Independent Remedial Action Unused Chemical Product Spill Wood , SZ9(jCT~f2 I /f~D S J/o c.J.5-( . [4. Waste Material Composition: (check all that apply and include percent of total) I i i I I I I I I Soil 0% Foundry Slag -0-% Concrete/Asphalt Q% Dredge Sediments -0-% Preserved Wood 0 % Debris //JO % - . Coal Ash 0 %. Other (list) Wood Ash 0 % % -- - % NOTE: Total must equal 1 00%. ~ Was~-Material Contaminants: (check all that apply) , Gasoline Metals Heating Oil Used Motor Oil/Waste Oil Diesel Solvents PCBs iJ'DN't, I I I I u_~__~________J Unused Motor Oil Other Other Petroleum Product Unknown NOTE: Supply any MSDS information with application, if available. City of Port Ange!es - Landfill Waste Disposal Application Page - 2 of .C:; 16. Estimated Quantity of Waste for Disposal: I I I I I NOlA- 't. . Cubic yards / Drums / /(J , - Tons (estimate both) Tons (estimate both) I4L IV 7 /I- '-l.. Other NOTE: Estimated quantity for disposal must be within 20% of thf:) quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) [7. . F;.;qu-'ncy of Disposal: I' $-- One time OJ/€. Dt)y Monthly Annual Other ~ Waste Sampling: Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a waste, and the frequency of sampling, will vary with the type and form of the waste. Check the appropriate box and briefly describe how and where the waste was sampled. Include site maps with sampling locations if possible. Number of COMPOSITE samples ~ & number of discrete samples per composite Number of DISCRETE samples /J17 A-(Il (O~y ,c;~/~r <" , , I I I I i i I I I. I J NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 0-25 L2~ - 1no -101 - 500 501 - 1000 1001 - 2000 >2000 = 1 composite sample - ----3 composite samPles--:::, = 5 composite samples = 7 composite samples = 10 composite samples = 10 plus one sample for each additional 500 cubic yards One composite sample shall contain a minimum of three/maximum of five discrete samples. cubic yards CtJbl~S cubic yar s cubic yards cubic yards cubic yards NOTE 2: City of Port Angeles - Landfill Waste Disposal Application Page - 3 of 5 (It '0_- __~____________, ! 9. Waste Analysis: The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine the appropriate analytical requirements for waste characterization. Ecology Publication #91 "'30 (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum contaminated soils from UST releases. Submit all laboratory analytical results, QA/QC data, and Chain of Custody sheets along with this application. (NOTE: The laboratory must be accredited by the Washington State Department of Ecology. ) a) List all analytical test methods used: 0/(> /(X,J l~flJ/1i . w lli j1 / 'C 5ee b) Provide a narrative as to why the above analytical methods were selected: L_~OTE:_ Additional sheets attached: -Y- YES NO 11110. Soil Classification: (**FOR PETROLEUM CONTAMINATED SOILS ONL Y**) ;(/0 SoiL I Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check one) Class 1 Class 2 Class 3 Class 4 Calculated Hazard Index ;JON L 111.--;-D~ngerous Waste Affidavit-... -/loNe I Based on a review of the analytical test results, site history, and the applicable regulations, I: this waste is classified as: (check one) Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Waste (EHW) and Waste Code: City of Port Angeles - Landfill Waste Disposal Application Page - 4 of 5 12. Special Notes for Asbestos Disposal I I .. .._ ___ _____ - _____i _u ---.-----...- _ _ 'I All asbestos containing materials (with the exception of roofing material in good condition that is not peeling, cracking, or crumbling with petroleum based binder that still exhibits plasticity to prevent the release of asbestos fibers) must: be tightly wrapped or bagged in 6 mil plastic with no excess air in the packaging not exceed 50 pounds per bundle be labeled as asbestos with required information regarding its origin be transported with a manifest in the vehicle arrive at the transfer station only by appointment with Brian Tate of Waste I Connections so that the material can be deposited in a lock box (his cell number I is 360-912-7080). ..____-.-J 1. Certification: We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All information provided is correct and the enclosed analytical results represent the proposed waste materia the best of our abilities. ') Waste Generator Signature j}/)() ~ lug-e n- Printed Name - .E u e c.A of,/' e '-f! v.../ r; 1//)'1 CtvJ Company $ -dl-()~ Date City of Port Ang.~ City Engineer ~ tj- z,;tJ 8 Date Approval Expiration Date //-- Z -08 N:IPWKSIENGINEERIWaste DisjJGsal Applicationslwaste disposal application- 2008 '!ersion.wpd City at Port Angeles - Landfill Waste Disposal Application Page - 5 of 5 C'''''.. //) cjf6 '< " /II",,~ / '-""'-" \1, , "'-' " . Orio n Environmental Services 'I?' WBE W2F5912535, 34004 9th Avenue South + Building A Suite 5 + Federal Way, Washington 98003-6740 Telephone Seattle (253) 874-81I8 +Tacoma (253) 952-6717 + Facsimile (253) 927-4714 +email ORION6717@aol Polarized Light Microscopy Test Report EPA Method 6001R-98/116 NOW Environmental Services, Inc. 34004 - 9th Avenue South, Suite # 12 Federal Way, W A 98003 Date Page Invoice Date Received August 5, 2008 Page 1 of 1 083725 July 31, 2008 Client Client Name / Number Project Name Client Orion Number' Number 01a 80731-54a 01b 80731-54b 02 80731-55 03a 80731-56a 03b 80731-56b 04 80731-57 05a 80731-58a 05b 80731-58b Dave Ansteff / L08-0211 N/A Stereo Scope Exam Sample Treatment Asbestos Percent ~ Other Fibers Tan Rock Pattern Vinyl Sheeting wi Blue Felt Backing Homogeneous Tan Mastic Assoc. wi 01a NO Cellulose Chloroform NO Cellulose Tan I Rose Marble Pattern Vinyl Sheeting wi Black Felt Backing , Homogeneous NO Cellulose Tan Vinyl Tile Homogeneous NO Dark Mastic Assoc. wi 02a Chloroform NO Cellulose Popcorn Ceiling Texture Homogeneous NO Skim Coat Assoc. wi OSb NO Cellulose Plaster Homogeneous NO Cellulose Dup: Laboratory QA/QC Duplicate; M; Mastic [(a), (b), (c), etc.]: Sample layers numbered from front to back. Comments: For layered samples, each component has been analyzed separately. NO means non-detect for asbestos fibers by EPA Method 600/R-98/l16.Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus negative PLM results cannot be guaranteed. Per EP A guidelines samples will be archived for 30 days then will be disposed of. This fI~pOrt may only be reproduced in full with written approval of ORION Environmental Services. Analyzed By Don,vu;v McNeaL Reviewed By Duvv1.MYRc;u,~~ Donna lYlcNeal Dennis Rauschenberg Laboratory Director / CEO Laboratory Analyst Leading P.nvironmenta[ Comp[iance Consu[ting Into tfie 2pt Century ., *' He. arr\{eJ for- o.n. ORCA" ~oUtron ~aYnt+ ,. . BUILDING PERMIT A PPLlCA TJON Print in ink Applicant or Agent Property Owner Property Owner's Address Contractor/Engineer Contractor/Engineer's Address License # CITY OF PORT ANGELES Attn: Building Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 (360)417-4815 fax (360)417-4711 For City Use Only: Date Received -, -3 ( -02- P..ermit# 08-~ ate Approved l; r Pho 3'~o &./S7 -4l.4~ Phone :31.d:J A41111 - cr 0'1 l ,cRONT Phone Expires €b8trASr Parcel Number . PROJECT ADDRESS Lot Zoning Project Type & Brief Description: Check all that apply o New Construction o Addition o Remodel o Repair oRe-roof ~emolition o Heat System o Other Floor Areas Basement 15t Floor 2nd Floor 3,d Floor Garage Carport Covered Porch Deck Shed Other ~ o Residential o Commercial o Multi-family o Industrial Existing (sq. ft.) Proposed (sq. ft.) @ $ per sq. ft. = $ ! rRu/Je/<ff e>c.v~ ev Will III/C/C- f.6u/~.r d if Co v--~r/ . VUl4-4ev c~eo{.... " .(:!-- ~ et,J err ( ~.ped t!) ..f-~ Deer,. Lve'll 13e.- P/lJJJD.riy d,}r~o/t'-d 0-(; Wool) r/t'<"W//IIv L!/tffkr 9~,14A!c"~ J'?ool" sf bI~.{f -fo Cf-H ., J t.AJ I II TIJL;t Vv t.t~ TK~ 4/K1. t; el-A I-e fk~ .d ~e'€C/e Tt'€hitt~ d TOTAL VALVA TlON $ .() OalJ I have read and completed this application and know it to be true and correct.' ram authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on ~* a Date'7-';l3-o8 printName'PJ(}e.,4~ Signature l ~ ~ T:Forms/Building Division/Bldg Permit AppL-2006 Code.doc. '-... '-... '-... / '-... " / i' ';(;l:-. / 1'0 " / 'I) tIS: " ' t.-.... / '-... :, '-... ,<>; ~ ~ .~ ~ ~ <i. / / / / / / / / / / / / / I / '-... I '-... '-... .'.. ..... ...... " L,*- (O'.~~ '-... " 7,s '1,& t.- '-... '-... o ,.. , , , ' , ' , , , , .$,' '-... '-... 07/23/2008 15:31 FAX 360 491 6308 ORCAA 141 002/002 Olympic Region Oean Ajr Agency 2940-B Limited Lane NW Olympia, WA 98502 (360) 586.1044 · FAX (360) 491-6308 POI. Angeles office (360) 417-1466 Raymond Office (360) 789-3652 wwww.ORCAAorg Demolition Permit 1 J Residential [ J Commercial Permit fee: $25.00 per structure. Non-refundable. **10 Working Day wait period** PROPER1'y OWNER Name: ue- A (VSTc '1\_ Mailing Ad&ess: , \..J6I ..~, c:> Phone: ( fAX: Gt)': Email: Mobile: Stl\te: WA- State: LUt+ fJJ qb( 1'07/ ~jp: C(d3 E3OJ- Z' : q ~ pe ,~ 5T DEMOLITION CONTRACTOR [ ] ~~ck if same ,\$ Bu.c;iness Niul1e: lYlf S'e J.. ~ Onsite Contact: Mobile: ( Mailing Adil FAX: at}': State: Zip: DEMOLITION INFORMATION ~TSt~ett11'es being demolished: I Start Date: AsbestOs present Y N Survey attached Y N , 'k5hkt bel n., R>/I~ OPV DEMOLITION PROJECT CATE~RY [ ] GlmpMte Demolition [ ] Training Fire - Fire Agency: [ )'Govemment Ordered Demolition - Attach copy of Order Renovation, Alteration, Remodeli,n ,Maintenance, <;>r other Constl1.Iction "-,~ Completion D~te: wm all asbestos be removed Y N ,,4/1 6v5tJlt'C' ~f;Ie'C!.f, o/ied'~J'J+ ..--3 I have rtad~lld will abide by the conditions set fortb in tbis penm alld (my addendum thereto. I do hereby certify thallhe illformation illlhiJ application and Hlpplctnf!l1tal data described erein is, to the best of my knowlcdge, accurate and complete, j)~~ Applicant 'Name ~ SIgnature 7-~& -0 &- Date Date Application R.ecejv~d-' ,- Payment Info. [ ] O1sh [ ] Check: # [ J Credit Cud [ ] Approved [ ] Disapproved Review datt: / / Asbestos Pcm,it Permit # ASBOO Demolition Pennit Permit # _DEMOO A ~ Use Only 02/25/08 ' _,~~ Use OVER 07/23/2008 15:30 FAX 360 491 6308 ORCAA ~ 0011002 Olympic Region Clean Air Agency 2940-B l..im.ited Lane NW Olyrnpi.." WA 98502 (360) 586-1044. FAX (360) 491-6308 PoItAngeles Office (360) 417-1466 Raymond Office (360) 789-3652 ...-www.ORCAA.o~ DemoIitio~s projects within Clallam, Grays Harbor, Jefferson, Mason, Pacific and ThurstDn counties REQUIRE A PERMIT and require that the following conditions be met prior to the demolition. Olympic ~gion Oean Air Agency (ORCAA)reguJations define a demolition project as the wrecking, razing, lewling, dismantling, or burning (by a fire department for trnining purposes )of a snl1cture, malung the stmctu~ pennanently uninhabitable or unusable. Reno'Vl1tions include the removing of load bearing structural members, but not to the extent to make the structure u.ninhabitable. The following infonnation is merely a reference guide and nOt a substit\.lte for agency regulations. 1. The start date must be at least 10 working days from the submission date of the complete application and ~ayment. ..sc-~ - S;r k..... ~ ~~ -ks ~ - 4-L- 1-4 {j 2. g,=>od faith asbestos survey must be conducted by a certified Asbestos Hazardous Emergency Response Actl (ABERA) building inspector. A list of qualified cOlltracto~ and inspecton may be found in your local YeI\ow Pages. through the Washington State Department of Labor and Industries, as well as search engines on the Internet. 3. A copy of the asbestos survey and Demolition Pennit must be kept on site and be available for review by Ag~ncy inspection personnel; 4. An~~ and all structures on the same parcel of property that are nOt proposed to be demolished must be iderltified as such; 5. It is: the responsibility of the building owner and! or demolition contractor to ensure there is no ACM pre~ent in the structure to be demolished; 6. Nuisance laws are appljcable to the demolition, including nuisance related to the unreasonable interference with the enjoyment of Me and propenyand the depositing of particulate matter on other property. ADDITIONAL REQUIREMENTS: In addition Ito Agency requirements, most building departments require a demolition permit (separate from ORCANs Demolition Permit). The Washington State Department of Labor & Industry and the local fire marshal may also require notification for asbestos removal projects. Telephone nwnbers for these entities are listed in the Govemmelllt Listing area of the telephone book. Residenti~l Dwelling: Any non-multiple unit building containing space for uses such as living, sleeping, and preparJtion of food aod eating that is owned, used, occupied, or intended or designed to be occupied by one fa.mily as their domicile. lbis term includes houses, mobile homes, trailers, houseboats, and houses with 'mother-in-law aD;:'~f or 'guest room' 11m term does not include strucrures that are demolished or renovated as an & ~. __iai:q': pub.lic PT?ject. Nor d?e~ this te~ inc u e any lnixed-use building, stmcrure, or installation that contams a ieSldenoal Unit, or any bwlding that IS leased or used as a rental. 'L;;J4 {)eJu-L ~~ ~1.A~dhj.-_ Q) E o I '- .::J o I~ c ._- en 10 .+-, i~ ,.0 len ,<( \.I- o en c o -- +-' co U o -I '0) - I~ ( ..~ Ie.. 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'CD ..... ::1 ro ~ O,(f) a!i!::c 0.0, idi,CDa O?,I' ~ ,', ,:~ < S' ;:!:;: \:J aco -<( 0' "H.(l) .0""'< -;i.l(/) c:".., ::;ro-..,CD CD CD (f) a '<hi.sa. ~. 0 "0 - < (/) !!? (') a:~~' ~ '0 D)f ('), c;?1!5% ~ ; tG~~\_ \,,' \~, '~~;:"" \\1:.;:'- !',,'d, "'" ,if "'~~~"~' ,~\ ' .~;:i~;:'.~ ~'>> . ~ JO... (~.;....~.~~.i~ ';' en..,; '. .,,,"}p..-;:.:...i..... H ~~. '/a' 'j ~. cr ':f./ ',l\' ~ .." f;>-O CD" / :,' :~,~ . ('1):/ ~'; .., ... o en -.... "~--'., .;.,--.... r;/ pORT ~ fir "'-~ ~ ~.,~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00001108 Date .838660 808 E FRONT ST 06-30-00-5-1-2330-0000- COMM REMODEL 12/08/04 COMMERCIAL ARTERIAL 3000 Owner Contractor o N CHRISTENSEN TRUSTEE 820 E FRONT ST PORT ANGELES WA 983623613 OWNER Structure Information Construction Type Occupancy Type . . . . . Other struct info . . . . ADD/ALTER/REPAIR TYPE V NON-RATED BUSINESS:OFF/PRO/MED/REST NUMBER OF UNITS 1. 00 Permit BUILDING PERMIT - COMMERCIAL Additional desc Permit Fee 106.75 Plan Check Fee Issue Date 12/08/04 Valuation Expiration Date 6/07/05 69.39 3000 ~ Q 0\) Qty Unit Charge Per Extension 92.75 14.00 \\\ BASE FEE 1.00 14.0000 THOU BL-2001-25K (14 PER K) Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 106.75 106.75 .00 .00 Plan Check Total 69.39 69.39 .00 .00 Grand Total 176.14 176.14 .00 .00 1--, Cl ::::.. ---+- V1 --t Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not pres e to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of ~onstr ~on. f"-- r; - ~ -uL/ Date Signature of Owner (if owner is builder) Date T:IPLANNING\FORMSII 102.15 [I 1/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGEnJOWNSPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I I FRAMING JOISTS 1 GIRDERS SHEAR W ALLIHOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKINGILIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R. W.I PWI CONSTRUCTION - R. W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNING\FORMS\I 102.15 [11/1412003] BUILDING PERMIT - APPLICATION Fill oui COMPLETELY and in INK. Your npplicatioll and site plan MUST R COMPLETE to be accepted for review. If YOll have any questions, call PEEMITS (360) 417-4815 FAX(360)417-4711 Applicant orAgent: _l~,.; b nt.JWZll'-o:;. Ov;'Iler: -L::r..LV"'c\ ~. ~ 3J<;'. ~"lt Address: ~ f FSL(''Vvi .5, Architect/Engineer: U { A. Contractor Phone: -~~. L{~7 -L.fl....f ~\o'( PIlone: 1-(6 ~ - (3 3 b City: -l?-)oIL{ '~''"Y-'lu...- Zip: q ~?6 ). Phone: State License #: Exp: Phone: Address: PROJECT ADDRESS: ~ O~ ( City: Zip: ZONING: LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: "S=R0-}..rc- ~. I Block: ~ ()Jt..'t AU(~ Subdivision: Credit Card Holder Name: Billing Address: Credit Card Type VISA MC # TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof o Multi-family 0 Addition 0 Move R:. Commercial ~ Remodel " Demolition o Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: City: Exp. Date: o Stove o Garage o Deck o Other ~~v-e... SIZEN ALUATION: SF. @$ /SF. =$ SF. @$ /SF. =$ SF. @ $ /SF. = $ TOTAL VAlUATION $1 ?~7CJO OC) f\dd,.o",- c"A "^'<:~ f'"t"~1<:'l>-1:"- f':>_lCi'-pJ'>o.--10 1"' u..c-411 . COMMERCIAL/RESIDENTlAL: Occupancy Group: Occupant Load: & Proposed Sq. Ft. No. of Stories: Lot Size: Existing Sq. Ft. Total lot coverage Construction Type: = TOTAL Sq_ Ft. % APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: ESAIW etland( s): 0 Yes 0 No SEP A Checldist Iequired? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can pIovide you with infoImation on the application and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with cunent fee schedules. Contact the Pernnt Coordinator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of pemnt issuance. EXPIRATION OF PLAN RE'i'1EW: 1fno pennit is issued within 180 days ofthe date of application, the application will expire. The Building Official can extend the tinle for action by the applicant up to 180 days upon written request by the applicant (see Section R1 05.3.2 ofllie International BuildingIResidential Code, 2003). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City' that I must obtain such permits prior to work. lit Date: 1 (- I ':):'oy T:\RVESS\BLDG-fDlTIlS-brochures\2003- B uildingpennitwpd BASE IS 2x4 PLATE OVER EXISTING FLOOR ON CONCRETE FOUNDATION fRAME IS 2x4 ON 16" CENTERS EXTR IS T.l11 PLYWOOD INTR]S 5/8 SHEET ROCK 8 <Ii' ;:.. '" ~)( ~.J~~{ 1 Co., " l>. L-''"''- \.J I 7/ftp S\a~"4L: S~ ltv~Ju^..~ 1 r'~ ~ ,r &ffJ,LW~fe All2- SGl'4- / -l u~o 1 ~J-; o~ 12'-1 13116" 808 E front SI Port Angeles, WA ~ ---? ";- "' 12'-11/32" 1!!1 'I' '" N FILE \... N e TV OF RT NGEl..ES - Constmction Plans '" -ph , Issuance 01 this permit based upon these plans. SPt~cifi- ~-7 ~1!3. let data shall not prevent the !Jl':Jing olllclal Ir,!TI thrreafter requiring the correcl,lon of errors In said p! ns. speciftc?lt1cns and other dat(j O! ffGrTl prel,lcnt;ng I "ding oper-:-t~Jns being carried on thereunder 'when in vi01atlon of ail cr,d~s and ordl:J2nces 01 thiS JurisdictIOn. (SECTION 3D3(c) . Un arm u:!dlng Code.) By .JtL 19'-63;16" Approval Date