HomeMy WebLinkAbout815 W 9th St - Building CITY OF PORT ANGELES
Nal DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 12- 00000176 Date 3/26/12
Application pin number 682448
Property Address 815 W 9TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06-30-00-0-2- 6066 -0000
Application type description RES NEW SFR on your state excise tax form
Subdivision Name
Property Use to the City of Port Angeles
Property Zoning RS7 RESDNTL SINGLE FAMILY' (Location Code 0502)
Application valuation 107000
Application desc
NEW 1260SQ FT SFR
Owner Contractor
HUETHER LYNDON /PENNY A P R CONSTRUCTION INC
815 W 9TH ST 181 WINTER RD
PORT ANGELES WA 983635723 PORT ANGELES WA 98362
(360) 457 6761 ✓y,►
Permit BUILDING PERMIT RESIDENTIAL 1� i 1.20
Additional desc 1260 SQ FT SFR
Permit Fee 1059.45 Plan Check Fee 688.64
Issue Date 3/26/12 Valuation 107000
Expiration Date 9/22/12
Qty Unit Charge Per Extension
BASE FEE 1020.25
7.00 5.6000 THOU BL- 100,001 -500K (5.60 PER K) 39.20
Permit MECHANICAL PERMIT
Additional desc SFR W /ATTACHED GARAGE
Permit Fee 97.20 Plan Check Fee .00
Issue Date 3/26/12 Valuation 0
Expiration Date 9/22/12
Qty Unit Charge Per Extension
BASE FEE 50.00
3.00 7.2500 EA ME -VENT FAN (SINGLE DUCT) 21.75
1.00 10.6500 EA ME- STOVE /FIREPLACE /MISC. APP. 10.65
1.00 14.8000 EA ME- HEATER(SUSP /WALL /FLOOR -MTD) 14.80
Permit PLUMBING PERMIT
Additional desc SFR W /ATTACHED GARAGE
Permit Fee 142.00 Plan Check Fee .00
Issue Date 3/26/12 Valuation 0
Expiration Date 9/22/12
Qty Unit Charge Per Extension
BASE FEE 50.00
5.00 7.0000 EA PL- PLUMBING TRAP 35.00
1.00 7.0000 EA PL -WATER LINE 7.00
4.00 7.0000 EA PL -DRAIN VENT PIPING 28.00
1.00 15.0000 EA PL -SEWER LINE 15.00
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.
46„6:7204".
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T: Forms /Building Division /Building Permit
1
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 -4815 Electrical Inspections 417 -4735
Public Works Utilities 417 -4831 Backflow Prevention Inspections 417 -4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
T•Frrmc /Pliilriinn rlivicinn /Rnilrlinn Permit
Lam.'
CITY OF PORT ANGELES
liM DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
1I1111/ 321 EAST 5TH STREET, PORT ANGELES, WA 98362
Page 2
it' M1 Application Number 12- 00000176 Date 3/26/12
Application pin number 682448 REPORT SALES TAX
Qty Unit Charge Per Extension on your state excise tax form
1.00 7 .0000 EA PL WATER HEATER 7.00 to the City of Port Angeles
et Special Notes and Comments (Location Code 0502)
March 14, 2012 4:20:44 PM permits.
DEMO FOR CARPORT MUST BE COMPLETE PRIOR TO FIRST BUILDING
INSPECTION.
March 26, 2012 2:59:54 PM hcatuzo.
1 DEMO of carport and existing structure must be complete
prior to footing inspection. Please call 417 -4815 to
schedule an inspection for the DEMO work prior to first
e inspection.
w3i,w Address numbers shall be plainly visible from the street.
Address numbers shall be a minimum of six inches high and be
of contrasting color from the background.
March 26, 2012 1:28:31 PM sroberds.
The proposal will result in demo of a sfr and reconstruction
of a new sfr for total lot coverage of 30% -site coverage of
t,'+'. 50 No land use issues anticipated if carport is reduced
at time of foundation.
Electrical load calculations and electrical permits are
required.
March 9, 2012 9:18:23 AM banders.
Contact electrical inspector or electric engineering for
approved electric service location.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch. 24 hour advance
notice is required. Public Works Inspection request line
417 -4831
Other Fees STATE SURCHARGE 4.50
Fee summary Charged Paid Credited Due
Permit Fee Total 1298.65 1298.65 .00 .00
Plan Check Total 688.64 688.64 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 1991.79 1991.79 .00 .00
4
1C
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
mull 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
ofolaws 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.
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD
C2 el
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS (r
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments CZb
FOUNDATION:
Footings (4. to au-
Stemwall t,.f a` JLu
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In S• i a rT
Water Line Meter to Bld•
Gas Line �t r�
Back Flow Water FINAL Date T' 2D Accepted by 1 1 t1
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor ti NO
Shear Wall Hold Downs
Walls Roof CeilinE I&
pall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling S• 2 1 /a 3 U.
MECHANICAL:
Heat Pump Fumace FAU Ducts 1
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date I Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815 2-v' l-- J
T•Fnrrnc /P. i iiiriinn fli ,icinn /Ri iilriinn Pprmit
ffp„...,C ,,(l CITY OF PORT ANGELES
U PUBLIC WORKS UTILITIES
321 EAST 5TH STREET, PORT ANGELES, WA 98362
LCD
Application Number 12- 00000176 Date 3/26/12
Application pin number 682448
Property Address 815 W 9TH REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06-30-00-0-2-6066-0000-
Application type description RES NEW SFR on your state excise tax form
Propert erty Use i Us Name
Property to the City of Port Angeles
Property Zoning RS7 .RESDNTL SINGLE FAMILY (Location Code 0502)
Application valuation 107000
Application desc
NEW 1260SQ FT SFR
Owner Contractor
HUETHER LYNDON /PENNY A P R CONSTRUCTION INC
815 W 9TH ST 181 WINTER RD
PORT ANGELES WA 983635723 PORT ANGELES WA 98362
(360) 457 -6761
Permit SANITARY SEWER HOOK UP
Additional desc
Permit Fee 135.00 Plan Check Fee .00
Issue Date 3/26/12 Valuation 107000
Expiration Date 9/22/12
Qty Unit Charge Per Extension
1.00 135.0000 EA SAN SEW RECON 135.00
Special Notes and Comments
March 14, 2012 4:20:44 PM permits.
DEMO FOR CARPORT MUST BE COMPLETE PRIOR TO FIRST BUILDING
INSPECTION.
March 26, 2012 2:59:54 PM hcatuzo.
DEMO of carport and existing structure must be complete
prior to footing inspection. Please call 417 -4815 to
schedule an inspection for the DEMO work prior to first
inspection.
Address numbers shall be plainly visible from the street.
Address numbers shall be a minimum of six inches high and be
of contrasting color from the background.
March 26, 2012 1:28:31 PM sroberds.
The proposal will result in demo of a sfr and reconstruction
of a new sfr for total lot coverage of 30% -site coverage of
50 No land use issues anticipated if carport is reduced
at time of foundation.
Electrical load calculations and electrical permits are
required.
March 9, 2012 9:18:23 AM handers.
Contact electrical inspector or electric engineering for
approved electric service location.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch. 24 hour advance
notice is required. Public Works Inspection request line
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. P 3/
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:Forms /Building Division /Public Works Permit
PERMIT INSPECTION RECORD
CALL 417 -4831 FOR UTILITY 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 NO
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB GUTTER
DRIVEWAY APPROACH
BACK -FLOW DEVICE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R.W. PW/ CONSTRUCTION R.W.
ENGINEERING 417 -4807 PW ENGINEERING
FIRE 417 -4653 FIRE DEPT.
PLANNING DEPT. 417 -4750 PLANNING DEPT.
BUILDING 41-7- BUILDING
4815
T: Forms /Building Division /Public Works Permit
pORigl, CITY OF PORT ANGELES
a,'` N PUBLIC WORKS UTILITIES
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Page 2
Application Number 12- 00000176 Date 3/26/12
Application pin number 682448 REPORT SALES TAX
Special Notes and Comments on your state excise tax form
417 -4831
to the City of Port Angeles
Other Fees STATE SURCHARGE 4.50 (Location Code 0502)
Fee summary Charged Paid Credited Due
Permit Fee Total 135.00 135.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 139.50 139.50 .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 Signature of Owner (if owner is builder) Date
T:Forms /Building Division /Public Works Permit
PERMIT INSPECTION RECORD l
CALL 417 -4831 FOR UTILITY 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
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL J
PARKING
SIDEWALK
CURB GUTTER
DRIVEWAY APPROACH I I I
BACK -FLOW DEVICE
I
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R.W. PW/ CONSTRUCTION R.W.
ENGINEERING 417 -4807 PW ENGINEERING
FIRE 417 -4653 FIRE DEPT.
PLANNING DEPT. 417 -4750 PLANNING DEPT.
BUILDING 4b7- BUILDING
4815
T: Forms /Building Division /Public Works Permit
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BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES For City Use Only:
1 '41:4
Attn: Building Permit Technician 2 g- 1 Date Received
321 E. Fifth St., Port Angeles, WA 98362 Permit tz- rice
(360) 417 -4815 fax (360) 417 -4711 Date ApprovedAt J 4
Applicant LA, ,�/G md/
P ill S7_ -26,7E
Property w n e r y J I j z, Phone
Property Owner's ddress S 15 tAJ. c:/ th ST J
Contractor A e°'R Gie 774/4C/ Phone
Contractor's Address
License Expires E -mail
..iL tit
PROJECT ADDRESS 1/ 9 .S r
Parcel Number Lot Zoning
Project Type Brief Description: XResidential Multi family Commercial Industrial
Check all that apply
New Construction
Addition
Remodel
o Repair
,gt Demolition
Re -roof House garage a other tear off re -roof o lay over one layer
Heat System a Heat pump a wood- burning stove a gas fireplace j pellet stove gather roger He
o Other
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement per sq. ft.
1 Floor 1 ll�
a Floor
3 Floor
Garage 7 e o
Carport .0
Covered Porch /Gil'
Deck
Shed
Other
1-(1)44 TOTAL VALUATION 1 07
Total footprint of structures 2 sq. ft. Lot size 74 sq. ft. Lot coverage
Site Coverage the amount or impervious surface on a parcel, including structures, paved driveways, sidewalks patios,
and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage,_ 1
3
air
Max. height of proposed structures 7 ft. Occupancy group of bedrooms J
W
4
ill a lawn sprinkler system be installed? /422_ Occupant load of full baths
Will a fire sprinkler system be installed? Construction type V- F2, of half baths
have read and completed this application and know it to be true and correct. am authorized to apply for this permit and understand s
that it is my responsibility to determine what permits are required, and to obtain permits prior to working on -cts,
Date 2,-A (Z Print Name/IL-AA/ /Zk I-I 2.&z L/ Signature j
T: Forms /Buu Division /Building permit application
ar t As L
ALLEY
0.00.
I PROPERTY LINE
4
Exl8Tfl exlaT�io
i GARAGE CARP R� I�
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REMOVE
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AIL 1 �,4„ I 1
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SMACK 1 T.0
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tk: PROPERTY LINE �,r�' PL._L"'C"
P fi
PRESCRIPTIVE APPROACH-SIMPLE FORM
For the Washington State Energy Code (WSEC) 2009 Edition
Climate Zone 1
cow GoveRtmeNt Site Information: Building Department Use Only:
Lot: Permit
Address: i Notes:
City:
State: 144?- Zip:
Contact:
Phone: 457
Phone 2: 4/42t 2 7
FAX:
WSEC Table 6 -1
PRESCRIPTIVE REQUIREMENTS FOR SINGLE FAMILY RESIDENTIAL OR DUPLEX
CLIMATE ZONE 1
(Unlimited Glazing Option Only)
Glazing G lazing U Factor Door �W
WaII Wall x
Vaulted Interior Exterior Slabton
Option Area of U .Ceilin Above E Floor
Fl oor' V ertica l O ver h e a d F ac t or g Ce�h Gr a de Below 't Below F ,Concrete
�.,r .4 Grade Grade ice:
R 49
III Unlimited 0.30 0.50 0.20 R -38 R -21 R -21 R -10 R-30 R -10
R-38 8 int TB U =0.029 2'
adv
This Project complies with the following:
The project is a single family residence or duplex.
4 The project is a wood frame OR all of the insulation is interior or exterior of the framing.
All building components meet the requirements listed above.
4 The project will meet all other provisions of the WSEC and VIAQ.
The Project will take advantage of the following exceptions to the prescriptive option.
602.6 Exception 2. One unlabeled or untested exterior swinging door, 24 sq.ft. or less, may be
installed per unit for ornamental, security, or architectural purposes.
Location of the door taking this exception:
602.6 Exception 2. If a door is mostly glass, it should meet the requirement of the vertical
glazing U- factor listed above.
Location of the door(s) taking exception:
Type of Heat Source: 1
T:Forms /Building Division/Prescriptive Approach Simple Form
2lzz t z 3 a 1- 1 A 400 s
I
Contractors or Tradespeople Detail Page 1 of 2
Cr Washington State Department of
Labor Industries
Contractors or Tradespeople Detail
Return to List Start a New Search g Printer friendly
Verify Workers' Comp Premium Status Check for Dept. of Revenue Account
About General /Specialty Contractor
A business registered as a construction contractor with L &I to perform construction work within the scope of its
specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and
carry general liability insurance.
Business and Licensing Information
Name A P R CONSTRUCTION INC UBI No. 602550178
Phone No. (360) 457 -6761
Address 181 Winter Rd Status ,3.? Active
Suite /Apt. License No. PRCONRC948CF
City Port Angeles License Type 1,1 Construction Contractor
State WA
Effective Date 2/6/2006
Zip 98362 Expiration Date 2/13/2014
County Clallam
Suspend Date
Business Type Corporation
Parent Company Specialty 1 General
Specialty 2 Unused
9 Other Associated Licenses
License Name Type Specialty Specialty Effective Expiration Status
1 2 Date Date
A P R Construction Re-
PRCONRC968DE General Unused 3/5/2004 3/5/2006
CONSTRUCTION Contractor Licensed
-,.J Business Owner Information 8 Hide All
Name Role Effective Date Expiration Date
RICHARDSON, ALAN P President 02/06/2006
RICHARDSON, PATRICIA F Secretary 02/06/2006
Q Bond Information
Bond Bond Company Bond Account Effective Expiration Cancel Impaired Bond Received
https: fortress .wa.gov /lni /bbip/Result.aspx 2/21/2012
Contractors or Tradespeople Detail Page 2 of 2
Name Number Date Date Date Date Amount Date
Until
1 CBIC SF4293 12/14/2005 $12,000.00 02/06/2006
Cancelled
7; Assignment of Savings Information
No records found for the previous 6 year period
Insurance Information j+
Insurance Company Name Policy Effective Expiration Cancel Impaired Amount Received
Number Date Date Date Date Date
Contractors
8 Bonding INSSF4293 02/19/2012 02/19/2013 $1,000,000.00 02/13/2012
lnsuranc
i
7 CBIC INSSF4293 ,02/19/2011 02/19/2012 $1,000,000.00 02/24/2011
6 CBIC INSSF4293 02/19/2010 02/19/2011 $1,000,000.00 02/01/2010
5 CBIC INSSF4293 02/19/2009 02/19/2010 $1,000,000.00 02/12/2009
4 CBIC INSSF4293 02/19/2008 02/19/2009 31,000,000.00 02/25/2008
3 CBIC INSSF4293 02/19/2007 02/19/2008 31,000,000.00 02/22/2007
2 CBIC INSSF4293 02/19/2006 02/19/2007 $300,000.00 02/06/2006
El Summons /Complaint Information
No unsatisfied complaints on file within prior 6 year period
E Warrant Information
No unsatisfied warrants on file within prior 6 year period
Washington State Dept. of Labor Industries. Use of this site is subject to the laws of the state of Washington. Access
o asi ingtoi0
https: fortress .wa.gov /lni /bbip /Result.aspx 2/21/2012
J
S SURED
UALITY ENVIRONMENTAL INC. General Contractors Specializing in Asbestos/Lead
2702 "A" St. Tacoma. WA 98402 Removal, Interior Demolition and Mold Remediation
Tacoma (253) 572 -7175 Seattle (206) 763 -7177 Port Orchard (360) 769 -7175 Fax (253) 779 -4020
March 7 2012
Alan Richardson
ATR Construction
181 Winter Rd
Port Angeles WA 98363
Re: Asbestos Abatement Quotation
915 West 9th St
Port Angeles WA 98363
Alan:
Assured Quality Environmental appreciates:t is opportunity to provide you with this
proposal foi Asbestos Abatement :services... We look forward to working with you, and hope
that our proposal meets your xequirements.
Tkl(IREE THOUSAND SEVEN HUNDRED FOUR DOLLARS ($3,704.00)
SALES TAX.
SCOPE OF WORK
1) Remove approximately 537 SF of Pop Com Ceiling :Texture contaminated
Content.
2) Remove approximately 6 windows;
CONDITIONS:
1) Price includes Asbestos Liability Insurance for Two Million ($2,000,000) Dollars.
2) Price includes Disposal of ACM.
3) All work will be strictly performed per EPA,. WISHA° Standards.
4) Price is based on Power and Water being provided 1y.tkie Owner.
5) Price is based on all items removed from the area of abatement prior to our
1 Mobilization.
6) Price includes one $325.00 permit_
7) Price includes air monitoring by AQE, Inc. only.
8) TERMS: PAYMENT IN FULL UPON COMPLETION OF WORK; 1.5%
Interest charge due on unpaid balance.
t
Page 2
EXCLUSIONS:
1. Price does not include Sales Tax.
2. Price is based on one mobilization.
3. AQE can not be held responsible for staple holes and tape residue during the
construction of our containment.
4. AQE can not be held responsible for any gouges or damage to the sheet rock
during the removal process.
5. Price does not include the replacement of any items removed.
Thank you for giving us the opportunity to bid this project for you. If you have any
questions regarding this bid, please contact us at (253) 572 -7175, or on my cell phone
253 377 -7890.
Respectfully submitted, Acceptance of Proposal
'01 By:
M' A1A�R c Date:
Projec _ex
2
NORTHWEST ASBESTOS CONSULTANTS
Surveys, Inspection, Sampling
AHERA Building Inspector Mgmt. Planner
EPA Certification WAMOA -0042
406 Reed St Port Townsend, WA 98368
northwestasbestosconsultants@cablespeed.com
360 -385 -0584
Billing:
Date: 3/2/12
Job Location: 815 W. 9th St.
Port Angeles, WA 98363
Contact: APR Construction, Inc.
Alan Richardson
181 Winter Rd.
Port Angeles, WA 98362
Subject: Demolition of fire damaged home.
Regards to survey inspection and testing.
1) Survey, testing and inspection. $395.00
2) Sample, handling, postage
9 samples at $35.00 ea. $315.00
Balance due upon receipt: $710.00
Thank you,
e
Bob Witheridge, E.F.M.
�1
J
ELECTRICAL PERMIT 9
CITY OF PORT ANGELES
CR
360-417-4735
v m
Application Number 12- 00000585 Date 5/14/12
Application pin number 281220
Property Address 815 W 9TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -2- 6066 -0000- on your excise tax form
Application type description ELECTRICAL ONLY
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
1160 sqft house new
Owner Contractor
HUETHER LYNDON /PENNY SIMPSON ELECTRIC
815 W 9TH ST 243036 W HWY 101
PORT ANGELES WA 983635723 PORT ANGELES WA 98363
(360) 457 -9270
Permit ELECTRICAL NEW RESIDENTIAL
Additional desc /1(�
Permit Fee 120.00 Plan Check Fee .00 v
Issue Date 5/14/12 Valuation 0
Expiration Date 11/10/12
Qty Unit Charge Per Extension
1.00 120.0000 ECH EL -R -SQFT FIRST 1300 120.00
Fee summary Charged Paid Credited Due
Permit Fee Total 120.00 120.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total .120.00 120.00 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE i
ROUGH -IN �i �q
FINAL 7
I 20
COMMENTS: G l
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Se.
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE\BUILDING
ELECTRICAL INSPECTION
lball
WIRING REPORT
Ow .sc" F 417 -4735
DATE: PERMIT INSPECTOR
Z 1 rcia
OWNER
CONTRACTOR
ADDR
ESS
8 S� T
APPROVED OT APPROVE D
DITCH
ROUGH IN /COVER
SERVICE
FINAL
CORRECTIONS NEEDED: MO ?c 'Ll Tc L,All1JDRy
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
DO NOT REMOVE
CITY OF PORT
NGELES PERIVXTI' ,APPLICATION U
Building Division/Electrical In C
spectiolp 7:: l!. t. S
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 ti i
Ph: (360) 417 -4735 Fax: (360) 417 -4711
Date: S LIZ- INSPECTIONS
v 1 2 Single Family Dwelling
Plan Review May Be Required,,P Co let�e Electrical Plan Review Information Sheet
Job Address; 8 1. LA) ,E' f--,
Building Square Footage: .________1j.1JQ 0 e(..1
Description ofebove a- ,5C C.
Owner Info ion Contractor !information
Name: Vehrx f we, .t- -1.-P Name:___,) ,f'(J t� c�+r r C' C;
Main dress: I -LL-
City! g irA .State: •gyp: P EE, City: 1 a
Phone; Fax: Phone; '7 7. Fen: 1^.-^4
License Exp. license Exp. Li 11,7 ID r•--1
?tem Unit Charge Qt Total (Qty Muttip fed by Unit Charge)
Service/Feeder 200 Amp. 120.00
Service/Feeder 201.100 Amp. 146.00
Service/Feeder 401 -600 Amp 205.00
Service/Feeder 6014000 Amp. 262.00
Service/Feeder over 1000 Amp. 373.00 1
Branch Circuits 1-4 75.00
Branch Circuit W/ Service Feeder 5.00
Branch Circuit W/O Service Feeder 63.00
Each Additional Branch Circuit 5.00
Temp. Service/ Feeder 200 Amp. 93.00
Temp. Service/Feeder 201 -400 Amp. $110.00
Temp. SeMce/Feeder401.600 Amp. 149.00
Temp. Service/Feeder 601 -1000 Amp 168.00
Portal to Portal Hourly 96.00
Signal Circuit/ Limited Energy -1 2 Family Dwelling 64,00
Manufactured Home Connection $120.00
Renewable Electrical Energy 5I(VA System or Less 102.00
Thermostat 56.00 S
NEW CONSTRUCTION ONLY:
First 1300 Square Ft- 120.00 166 124.00 J 1?-0, CZ Each Additional 500 Square Ft. or Portion of 40.00
Each Outbuilding or Detached Garage 74.00
Each Swimming Pool or Hot Tub 110.00
D 020, O C Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am The owner of the above named properly or a licensed electrical conk actor. I am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296-4614 The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Slgr attire of owner, electrical contractor or electrical administrator. 0 cm check
l iI� Of CreditCardl t ,I
r
L"G'L((;,;' %L• C p oet 5 0110112012
ELECTRICAL PERMIT N
CITY OF PORT ANGELES Co
360 417 -4735
Application Number 12- 00000363 Date 4/02/12 p1
Application pin number 626413 vv
Property Address 815 W 9TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -2- 6066 -0000- on your excise tax form
Application type description ELECTRICAL ONLY
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Temp pole
Owner Contractor
HUETHER LYNDON /PENNY SIMPSON ELECTRIC
815 W 9TH ST 243036 W HWY 101
PORT ANGELES WA 983635723 PORT ANGELES WA 98363
(360) 457 -9270 ONO
Permit ELECTRICAL TEMPORARY SERVICE
Additional desc
Permit Fee 93.00 Plan Check Fee .00
Issue Date 4/02/12 Valuation 0
Expiration Date 9/29/12
Qty Unit Charge Per Extension
1.00 93.0000 ECH EL -TEMP SRV 0 -200 SRV FDR 93.00
Fee summary Charged Paid Credited Due
Permit Fee Total 93.00 93.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 93.00 93.00 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE livN\Q ti.1 tt 1 1
ROUGH -IN
FINAL )ti r
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
NEC ET, '1,5,. i 1-----:;.;ry,.. NRrile..,... N
CITY OF PORT ANGELES PERMIT APPLICATION /i I "^zap,.,-
Building Division/Electrical Inspections Q M;> VI
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 ELECTRICAL CS
Ph: (360) 417 -4735 Fax: (360) 417 -4711 INSPECTIONS �.1
Date: 3 -30 -12
1 2 Single Family Dwelling
*Plan Review May Be Reauired Please CiQ Epctrical Plan Review Information Sheet
Job Address: .>-1
Building Square Footage:
Description of above e r 1 -e. or n qt.... 0 to P err, Sin e ill ReS i dMCe
Owner Infor ation Contractor Information
Name: H u-e 4 -r Name:. j i r 1 j C 1 f t Lt-e--
Mailing Aril s' 14 Mailing Address: OX. 1 C a,
City State: Zip: '`3.' f
City: A State: l,r)A Zip: 'WM.
Phone: Fax: Phone: g(5_21_9_,KAD Fax ,rPfrz
License Exp. License 1 Exp.
Ite�r Unit Charge (�(t Tota Qty Multi r lied by Unit Charpel
Service/Feeder 200 Amp. 120.00
Service /Feeder 201 .400 Amp. 146.00
Service/Feeder 401.600 Amp 205.00
Service/Feeder601 -1000 Amp. 262.00
Service/Feeder over 1000 Amp. 373.00
Branch Circuits 1-4 75.00
Branch Circuit W/ Service Feeder 5.00
Branch Circuit W10 Service Feeder 63.00
Each Additional Branch Circuit 5.00
Temp. Service! Feeder 200 Amp. '93.00 _......T____
s 0
Temp. Service/Feeder201 -400 Amp. 110.00
Temp. Service /Feeder 401.600 Amp. 149.00
Temp. Service/Feeder601 -1000 Amp 168,00
Portal to Portal Hourly 96.00
Signal Circuit/ Limited Energy 1 2 Family Dwelling 64.00
Manufactured Home Connection 120.00
Renewable Electrical Energy 5KVA System or Less 102.00
Thermostat 56.00
NEW CONSTRUCTION ONLY:
First 1300 Square Ft. 120.00
Each Additional 500 Square Ft. or Portion of 40.00
Each Outbuilding or Detached Garage 74.00
Each Swimming Pool or Hot Tub 110.00
9 L; OTotal
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making
the electrical installation or alteration In compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 68, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signat of owner, electrical cont r tor or electrical administrator, 0 Cash 0 Check
De cmett cord a
irt 4 "A _.4 1/ i 0"1,2 01/0112012
a CUKi:.
CITY OF PORT ANGELES
e DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
a
tor Application Number 12- 00000330 Date 3/26/12
Application pin number 650960
4. Property Address
ASSESSOR PARCEL NUMBER: 06-30- 00-0-2- 6066 -0000 REPORT SALES TAX
Application type description DEMOLITION on your state excise tax form
Subdivision Name
property use to the City of Port Angeles
Property Zoning RS7 RESDNTL SINGLE FAMILY (Location Code 0502)
+h• Application valuation 9000
Application desc
DEMO CARPORT
n, ,ark Owner Contractor
HUETHER LYNDON /PENNY A P R CONSTRUCTION INC
815 W 9TH ST 181 WINTER RD
PORT ANGELES WA 983635723 PORT ANGELES WA 98362
(360) 457 -6761
Permit DEMOLITION
Additional desc DEMO CARPORT
Permit Fee 50.00 Plan Check Fee .00
Issue Date 3/26/12 Valuation 0
Expiration Date 9/22/12
Qty Unit Charge Per Extension
BASE FEE 50.00
Other Fees STATE SURCHARGE 4.50
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
f l 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. i
ti af&f4 C/ 3242 l2/ ;�,itiv J c 41 So N
i s
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
0 t r
""'.T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments Ca
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Wat Li
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU /Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping _SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
.r :2■ 1\3
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750 11 T O
Building 417 -4815 rt 1 1'?'
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BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
For City Use Only:
Y Attn: Building Permit Technician Date Received 3' 21' 12
321 E. Fifth St., Port Angeles, WA 98362 Permit 2'
(360) 417 -4815 fax (360) 417 -4711 Data Approved
Applicant r-c_c_ Phone 7 cis 3
Property Owner ii-)P h ne -ece, 11 Phone
Property Owner's Address S 2S (Ae,et 9i4 p c� c� Q� C 9 g
Contractor Pe_ C /1c<<1` Phone to 7S
Contractor's Address g A /c� 6q ��1�, e 983 G Z
License boa ss o i 3 Expires 1 a/3 i c2 °t1 -mail c� r
PROJECT ADDRESS C /6771, (xic g Ds
Parcel Number Lot Zoning
Protect Type Brief Description; Residential o Multi- family Commercial o Industrial
Check all that apply
New Construction
o Addition
Remodel
o Repair
)4Demolltion Cv
o Re -roof House garage other o tear off re -roof lay over one layer
o Heat System Heat pump o wood- burning stove o gas fireplace pellet stove other
o Other
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement per sq, ft.
1 Floor
2 Floor
3`' Floor
Garage
Carport F 7,
Covered Porch
Deck MAR 2 b 9n12 4�
Shed
Other
eilaFGF-PORTANGELES
BUILDING DIVISION p
TOTAL VALUATION 0 0 d
Total footprint of structures sq, ft. Lot size S O (y4 sq. ft, Lot coverage
Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios,
and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage
Max. height of proposed structures ft. Occupancy group of bedrooms
Will a lawn sprinkler system be installed? Occupant load of full baths
Will a fire sprinkler system be installed? Construction type of half baths
I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand
that it 1s my responsibility to determine what permits are required, and to obtain permits prior to working on ..'ects.
1 Print Name //i,x1.0 SignaturAle
T:Forms /Bulld permit application
MAR/12 /2012,10N 10:36 AM OACAA FAX Ni). 3604916308 P. 001/001 I)
\f/ (A °il
....6? Olympic Begion Man Man lift tlgoney J 'G' 2940-2 Limited Lce NW
Olympia, VPA 98502 Commercial
(960) 539 7610 FAX (360) 491 -6308
'S /I'D UJ[�CAA Pact Angeles Office (360) d17 -1466 Asbestos Permit
q$ ie. Ra mi Oi Office (360) 942 -2137
r wwwr.ORCAA.otg
Comm Str uctu re. 1 1 Owner Occupied Residential Dwelling
\10 Workh g Dar wait period 'riot Notice
PROPERT'E OWNER
N Phone: G,_ 0) l' t- Erna
'CI, e' PAX Mobile:
NI:: pa S d W sue N A Wit' �"sz at 1113‘.2
Co n P Phone -7 0 Email;
i 0 i! liN r Mebi1
Si d mx .Cltq: Zi•'
4 (,t t NI ►0 trAatr 4 TA. ..3
ASBESTOS CONTRACTOR.
Contractor /Bu ass Na y• Phone:. )572 7 1 l -wadi:
t1 U1�1.�R J k tP nn er cA( RAM >77q-1.4arpuile:
.l e
1 70 Z•. t.. st'. `f cb.v S S A �r �o z
PRO CT INFORMATION
cut t Pug Work SltiftDays• bPock Shift Hours:
3 1 2 -J I C
1 Z um 3 I aJ 1 Z M v w T_ s sa su A 5‘,.() 3: 3b,30,i
Strum= to be abated: 1 To Quantity to be Squasc Fczt 63. Linear Fete Qb
teutavo•
»iaposal Situ 14-11b Cb tAp3DiF1 DI Will this stntctuie_be dao*olisbed steer asbestos.
WiU all identified asbestos be tetnoved from 'cennoval Yes M- No
structure Yes fr No
Circle Material being removed: Botlet/Ftunaee _Duct Insulation —Pipe Ins don ireptoofng
is _J'1a er _,Cement Bc.acd _Cement Pipe _Flooring _hoofing I'extured.Coating
1. •the: ()DO■Y
A EsTasImO CA'TEGORY NONREFUNIABY.E Ir
E.
1 10 259 linear or59 square feet $150
2'- U -1 250 -999 linear. or 160 -4,999 square feet $325
3 1 1 1,000 9,999 lincat of 5,000- 49,999 sq feet $650
4 1'10,000+ linear or 50,000 square feet $1,300
I 'Emergency .$50
1'Annnal, limo of 260 ligear feet oc 160 square feet $500
1 bar. read and will abide by the eenditiov: set forth it: ibii periwig and ark a1deadaoar Obcren Ti. beret, eerrify that the
hrferaation is zAir liolicaiins god suppboenrat data Jrrrr bed berets, it, to.14c.ben efpry kaanladgr nerve aerd. romp fire..
j,( 449 lA 3 (4 itT
Applicant Name Sigaztuxe Date.
Dare Application Received Payment Info. 0Q Approved Asbestos P, tt
E�, I Cash J pp oved tannic CSB00 ['7
EI�/ED. r zc DemolidaAesmit
4--i clit Card i 'as Review dare Permit Et3400 4
MAR? 0 a9 2012 /P I a._ Reviewed Vii~' S 'Yes f, INC
Receive dar��____J by urr�
UN Oudy ,e Use O A Um Orr Ufa 0-
10/2 Ca 4 OVER
I.' i7/5 )7 Th (Pt 1
0,((yOk.0 N u
MAR /23/2012/FRI 04:22 PM ORCAA FAX No, 3604916308 P. 001/001
1 -ad 437, Olympic,Rc6on,ClanilirAgency
2940 -a Un�ii dImia NW
A9` Olympia WA 9&502
I (36) 5394610 PAT(560) 401 -6308
e. Tort Angeles office (360) 417 -1466 Demolition Permit
ORCAA y Rayraossd, Office (60)94,7r2137
Owner occupied residential dwelling— Perntitfee: $35.00 PrforNotice Nonrefundable
IQ Other Structures Permitfee: $60.00 —10 working day wait period Nonrefundable
PROPERTY OWNMI.
N. Phaac G i a to Z s0:
N'L l trl, it Fea Nfolrac
ligiarnIMENEll crik0fr et a 3 LO+ IIM
nmaormoN CONTRACTOR 1Maritsasoeas ProPsITPoaraeriu matimt
e,�m�¢cs Nun Thcnc 641") ��515` 8axta+lC
B cs Cyr $Aef t �(Cf A`Yl l) FAX 3
NaitoCont Contact Phone •Mobac:
Ma= Addse 11�WI�Skj P CiIA)P p �a 7C e 1j State J 2 4113 n?i
D MOLrrION INFORMATION
*of 5ttuctures being,detno�fished: ti tulips= 3 r 9 1 17- Completion Date 1 11 1 y 1 Z
Asbestos peexene _No gutvep attached or
Xes _.No Has all ide�t6ed ssb s
terove i Yes .s ATo O A s'it
ReItoIW
EMOIX ONrulE r CATEGORY o oWre ansplem Dmulitiaa
C rroirive Fire Fite Agaary:
Renovation, Almation Remodeling, Maintenances, et Oh* Cons"•
(1 ecy �itio Fee erf $61.00.(rowt be aoco upcm ed by Government Ordered De t..Ca eecoal only)
!knee zest! =twill abide by me condidans art m this permit sad ally sddeadum thetets. I do botchy ecr47)-
*nail ids ifted'asbestos has be tz removeld sad the af Otmatiao io tibia applis. dnri sag svpplCmeadol dan.
dcsaibcd herein ny to the best ofmyiaottrfotfge, accurate aad oompdete.
Lt 0111-r. C''' C t 1 1 1°17:- -31 1 7 1 1Z—
ApplicantNaine Signature Date
Date pplimion•Receive i Parma ran. [1 ll Approved. Asbestos Petn it l 1 cash C ��=ad ncv LL+SEoo
RECEIVED Roviewdaoe:� 110" Demolition
lal�
mAR 0.9t tt Receive slat L/ RevicucAbF V�
Aim a a 4 e g Ulm• Amur Me Only Amy the 91
•01300
CAA OVER
03/2e/2012 06:39 3604524972 uuKYYAKU R r. w iIvvo
s CITYo� Q T N. EL S WASHINGTON, I NGTON, U. or
f,
''',.4„,•,,.. T om PUBLIC-WORKS UTILITIES DEPARTMENT
1
1• 4.4
-511
March23, 2012
f +r APR Construction Inc.
i H 1 81 Winter Road
�-:1 k t 13 v- k p o rt Angeles, WA 98362
k y RE: Port Angeles landfill /Transfer Waste Disposal Application, WDA #12-4
We have rec application for removal of the demo carport from the referenced site and
...r a.,. reviewed the testing results. Based on the test results submitted by Zenovic and Associates Inc.
it -A and Northwest Asbestos Consultants ,Clallam County Environmental Health Services ICCEHS)
di
N concurs with the. disposal of 15 tons of demolition from 815 W 9•. Street to the Port Angeles Y;' s
Regional-Transfer Station.
7.11:".',1,;, 3s yam. N
:■a A copy of your approved application is attached. This approved application must be shown to the
A •transfer station scale attendant at the time of disposal
i•- Please be advised that the disposal application is only for the materials and quantities listed in the
application. Materials' notlisted or in excess of the quantities noted may re quire separate applications and approval.
v,.
A_ Please call Tom McCabe, Solid Waste Superintendent at 3604174U; or e-mail
,7 0 k tmccabe@citvo if.you have any questions :4x=
Si c l
Wu ,f i1 ere
t :✓mot -r
yap u
,�IQrAt. VA1 f om McCabe r -,:e fi-'- K r Solid Waste Superintendent
f 7,4`,:„• e,g43.v.. F
g. r: Cr- Brian Tate, Operations Manager, Port Angeles Transfer Station
4 Sonja Coventon,Scale Attendant, City of PA
?.;.•44 r?; Enc: W DA
-t ,dr C:Waste Disposal /correspondence i•
r g g
s
N' 321 EAST FIFTH STREET P. O. BOX PORT ANGELES. WA 98362-0217
P 360 -.417 -4805 FAX: 360- 417 -4542 TTY: 360- 417 4645
"*-5E 'p E -MAIL: PUf K
WOR CI. PORT-AN_GELES.WA.1S
-JAM
nfi?7. 44 3' i% 1 .4: 1 '.:70.-
V:1/4L /ZUI ub:40 311040[4S( CORPYARO 114354 P_002/005
Pl...C2X n,
ti■) N\ l'fL
0 I Li 1/7_) 11-- t) r
4 WASTE DISPOSAL APPLICATION 1 i
PORT ANGELES SOLID WASTE TRANSFER STATION p
To: City of Port Angeles Phone: (360) 417 -4872 r
Attn: Solid Waste Superintendent Fax: (360) 452 -4972
321 E. Fifth Street
P.O. Box 1150 v 7`∎
Port Angeles, Washington 98362
/2I
NOTE: All questions must be answered for waste to be approved.
1. Applicant Information: n 1 L
Company Name: ,r c ("u t r On IA c. �r
(-C)i R tr., R u
Mailing Address: (r
t e t iftt c1 r a 9 il A:76 L
Contact: r t (n.► r c A cu r/C,4: i9‘
Phone: 5 c- h 4 14/ a t. 75
tit r
Project Name: i+
1 Protect Location: i 1. 1 94 5 P /Jf141.j,, ►1 J
2. Other Contacts (if applicable):
Consulting Firm: Z 9InTCL`J Cr"'
RECEIVED
Contact:
Phone: 360 ""1 !"1 -nSf31
Contractor Name: MAR 2 1 2012
contact:
Phone: CLALLA:+, COUNTY NHS
Laboratory: r.)‘) l„ li s lut
EtrvikaradDITFL HEALTH DN�SiON
Contact:
Phone:
fP t, 7 67L)
3. 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. lndude the gasoline service station number (if applicable).
I CERCLA /MTCA Remediation Agency Contact
0 independent Remedial Action 0 UST Removal
i 0 Unused Chemical Product Spill tOther Source: 81 ea 5:nj1 t F.... pi f y re6,c .e ?c..
i .�Gxa c .vv. n`4..t
I:
I City of Port Angeles Waste Disposal Application Page 1 of 4
(last updated January 2011)
03/22/2012 06:40 3604524972 CORPYARD t4354 P.003/005
4. Waste Material Composition: (Check all that apply and include percent of total)
Soil Foundry Slag
Solvents Dredge Sediments ,96
Preserved Wood Debris
Coal Ash v other (list)
i/ Wood Ash 3 -t--b Sa 4. a /15
NOTE: Total must equal 100%.
5. Waste Material Contaminants: (check all that apply)
Gasoline Metals Diesel
Solvents Heating Oil PCBs
Unused Motor Oil Used Motor Oil/Waste 011
Other Other Petroleum Product
Unknown
Note: Supply and MSDS information with application, if available.
6. Estimated Quantity of Waste for Disposal:
Cubic yards 15 Tons (estimated both)
Drums Tons (estimated both)
Other.
NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed- (10% for projects over
I
7,500 tons or 5,000 cubic yards)
7. Frequency of Disposal:.
One time Monthly Annual other
8. 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 the waste was sampled.
Identify site and location where material is being removed from.
Number of COMPO 1TE s d Number of DISCRETE samples:
J
City. of Port Angeles Waste Disposal Application Page 2 of 4
'{Iasi updated 7arivary�'2D�2j"�
03/?2/2012 06:40 U604Z4J(Z UUKYYRKU 04:104 r.uu4/uuO
NOTE 1 Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used:
0 —25 cubic yards 1 composite sample
25 —100 cubic yards 3 composite samples
101— 500 cubic yards 5 composite samples
501 -1000 cubic yards 7 composite samples
1001— 2000 cubic yards 10 composite samples
>2000 cubic yards 10 plus one sample for each additional 500 cubic yards
NoTE 2: One composite sample shall contain a minimum of three /maximum of five discrete samples.
i s
9. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173 -303) shall be utilized to determine the appropriate analytical
requirements for waste characterization. Ecology Publication #9130 (Revised November 1995) or any future
updates "Guidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum
contaminated soils from underground storage tanks releases. Submit all laboratory analytical results, QA /QC data,
and Chain of Custody sheets along with this application.
(NOTE: The sampling laboratory must be accredited by the Washington State Department of Ecology.)
a) List all analytical test methods used:
it
I 0
b) Provide a narrative as to why the above analytical methods were selected:
nAilki&X Pie It,
NOTE: Additional sheets attached: 0 YES NO
10. Soil Classification: *FOR PETROLEUM CONTAMINATED SOILS ONLY*
Based on the analytical data and Ecology Publication #91 -30, the soil classification is: (check one)
class 1 Class 2 Class 3 Gass 4
Calculated Hazard Index
11. Dangerous Waste Affidavit:
Based on a review of the analytical test results, site history, and the applicable regulations, this waste is classified as:
(check one)
Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW)
Cl Dangerous Waste (DW) and Waste Code:
0 Extremely Hazardous Waste (EHW) and Waste Code:
li
City of Port Angeles —Waste Disposal Application Page 3 of 4
I {iastupdatedfaruaty X931
tUHPYARD 14354 P. 005 /005
12. Special Notes for Asbestos Disposal
All asbestos containing materials (with the exception of roofing material in good condition that is not peeling,
cracking or crumbling, with petroleum binder that still exhibits plasticity to prevent 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 Connections at 360 452 -0427 or cell
phone 360-912-7080, so that the material can be deposited in a lock box.
1 Unification:
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 proposed waste material to the best of our abilities.
Waste Generator's Signature: f
Printed Name &Company Position ,a/j
Company:
Date:
If you have any questions please conflict Torn McCabe, Solid Waste Superintendent at 417 -4872 or email
tmccabe(a'►cityofoa.us.
I
THIS SECTION TO BE FILLED DUT BY AUTHORIZED STAFF
Approval:
Environmental Health Specialist Date
Approval with the following conditions If applicable:
i certify under penalty of law that the statements made on this form are true and correct to the best of my
knowledge, information and belief.
1,
Tom McCabe, Solid Waste Superintendent Date
Contractor shall present their copy of approved application to Scale House.
A Demolition Permit must be obtained if demolition occurs in the City. Permit forms are available at the
i budding counter at City Hall or on the City's website under the link hhtp /www.cityof pa.us/ Phone 360 -417-
4815
City of Port Angeles- Waste Disposal Application
Page 4 of 4
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FEE RECEIPT NUMBEA
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
. APPLICATION AND ELECTRICAL PERMIT
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PERMIT NUMBER
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TOTAL FEE.'
CaNT. LIC. NO. TIME TO COM PLETE NO. STORIES LEGALQCCUPANCY
ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
8 121 I.. \ ')(? --, "t I \'r-;
C RRECl ADDRESS IS AESPONSIBllITY OF APPLICANT PERMITS WITH WRONG ADDRESSES ARE CANCE~lED
Owner '("
Owner's Address' '2, \:::, I. 0 {J -<..,,- 9"\ '"
Day Phone ~~(-~O ';S J.-. .
Installation By
Installers Address
App1icati~n is h~r~~y made fqr Permit to install Electrical Equip_m~nt as follows:
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Installers Phone
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Wiring Methqd
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NUMBER AMP 120V 24QV NUMBER AMP 120V 240V_ . . .
USE OF CIRCUIT CIRCUITS PEA 10 100R FEE USE OF CIRCUIT CIRCUITS PEA 10 100R FEE
CIA 30 CIA 30
LIGHT SIGN
LIGHT I :;t...e> V lit. Cd 50 VOLTS
OR LESS
CONVENIENCE " MOTOR
CONVENIENCE . MOTOR
APPLIANCE . MOTOR "
DISHWASHER FIRE ALARMS - -
.
DISPOSAL BURGLAR ALARM .
RANGE MISC.
OVEN
WATER HEATER
.. ..
LAUNDRy
DRYER REINSTALLATION LIGHT FIXTURE #
FURNACE . SUB TOTAL FEE . .
GAS. Oil
FURNACE ENERGY FEE
ELECTRIC BASIC FEE ,
ELECTRIC HEAT . ... , If 00
TOTAL FEE
ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
A.C. UNIT AMP PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS
.
SERVtCE AW.G.
I SUB-TOTAL It. I) I) SIZE OF GROUND SIZE OF ENTRANCE SWITCH
.
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I,certlfy that the work to be performed under this permit will be done by the installer a
DateAPPlication-madeX '3 -' /--' r 191f}"' By
. ,
conformance with the N.E.C. Electrical Code,
-.
WNER (OR AUTHORIZED .AGENT)
,permission is hereby gl.ven to~do the ab.ove described work, according to the conditions hereon and acco dingto the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances, of .the 9ity of Port Angeles: . . ~ r . ~ ...
d.' DIRECTOR, OF CITY LIGHT
Date Permit Issued 5 - ~- )"> r S- ~Z.NS:P;/o!!/? ~~
Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in
Writing on Permit Placard. A. . Permits Phone: 457.0411 Ext. 158.
WARNING
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
WHITE. Original CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
OLYMPIC PRINTERS, INC.
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
.
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3 -:rt- (f$' ///2)2- O.K. FOR COVERING
, O.K. TO CONNECT SERVICE
6- t! - 'bJ /flEx FINAl. O.K.
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