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Home My WebLink About1502 Bldg B & C E Lauridsen Blvd - Building r - ----. :f ~ORT ~ f>> "- ---- ~ 't,\1C~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 32\ EAST 5TH STREET, PORT ANGELES, W A 98362 ~. ....J , I Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 07-00000152 Date 2/15/07 723344 1502 PCC EAST E LAURIDSEN BLVD 06-30-14-1-2-0000-0000- PENINSULA COLLEGE DEMOLITION 61 r. PUBLIC BUILDINGS & PARKS o Owner Contractor STATE OF WASHINGTON GEN ADMIN OLYMPIA VEM,O - PARSHALL 3580 1ST AVE NW WA 985041000 SEATTLE SEATTLE (206) 633-5222 Structure Information ood 000 TYPE II ONE HOUR ASSEMBLY <300 W/O STAGE TILE WALL MOUNTED BRICK WA 98107 Construction Type Occupancy Type Roof Type . Sign Type . . . Fence Type ----------------------------------------------------------------~---~------- Permit DEMOLITION Additional desc BLDG PORTION B & C ALL AN&AN-l Permit pin number 95323 Permit Fee 50.00 Plan Check Fee Issue Date 2/15/07 Valuation Expiration Date 8/14/07 .00 Jj("OO~ - ~ c.v Qty Unit Charge Per BASE FEE Extension 50.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 50.QO 50.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 50.00 50.00 .00 .00 \'l( 1; :y /( 0,> ~ /~ y~ ~ ():) ~ 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. Date Signature of Owner (if owner is builder) Date T:IPoliciesl 1102 _15 building permit inwection record05.wpd (1/412005] BUILDING PERMIT INSPECTION RECORD CALL 417-48]5 FOR BUILDlNG INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. CALL 417-4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UN LA WFUL 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. ;s INSPECTION TYPE llATE ACCEPTEll COMMENTS , YES I NO FOUNDA TlON: FOOTINGS SHEAR WALLS / WALLS FOUNDATION .DRAINAGE / DOWN SPOUTS PIERS I POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR I SLAB I ROUGH-IN WATER LINE (METER TO BLDG) GAS LTNE FINAL DATE ACCEPTED BY: BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS I GIRDERS SHEAR WALlJHOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL I FLOOR I CEILING I MECHANICAL ROUGH-IN HEATP~/FURNACE/DUCTS . GAS LINE FINAL DATE ACCEPTED BY: WOOD STOVE I PELLET / CmMNEY . MANUFACTURED HOMES FOOTING / SLAB BLOCKING & HOLD DOWNS SKJRTING PLANNING DEPT. SEPARATE PERMlT#'s SEPA: P ARKING/LIGHTING ESA: LANDSCAPING SHORELINE: . FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRlCAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. I PW / CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT. f. / PLANNING DEPT. 417-4750 PLANNING DEPT. 7/ /j ! BUILDING 417-4815 BUILDING Ih)/~//" 'II / T:\Policies\1102 15 building pemit inspection record05.wpd [1/4/2005] I 1 Vi , """ ~ '"' 8 ~ t ~ (~ \\ ~ \J ! ~. 9' ~ \P. ~ o ~ ",; CITY OF , ~ORT ANGELES COpy ':.j' I. )~ ~ Public Works & Utilities Department WAS H I N G TON, U. S. A. .t' February 13, 2007 Verno - Parshall 3500 1 st NW Seattle, W A 98107 RE: Port Angeles Transfer Station / Waste Disposal Application, WDA 07-03; Building material at 1502 East Lauridsen Blvd, Port Angeles, W A We have received your application for disposal of building demolition debris from the referenced site and reviewed the testing results. Based on the testing results the debris appears to be acceptable for disposal at the transfer station. A copy of your approved application is attached. This approved application must be shown to the landfill scale attendant at the time of disposal. Wood material is to be disposed 0 f at another source. If wood material is disposed 0 f at the transfer station lead testing results must be submitted as part of this application. 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. Please call if you have questions. Very truly yours, J/U-KA-~~r Gary W. Kenworthy, P.E. City Engineer Deputy Director of Engineering Services GWK;tf Enc!.; WDA 07-03 Copy; Claudia Stromski Bldg Division N:\PWKS\ENGINEER\ WDAPPLIC\07-03 WPD FILE: Landfill Solid Waste Disposal Applications Phone: 360-417-4805 / Fax: 360-417-4542 Website: www.cityofpa.us / Email: publicworks@cityofpa.us 321 East Fifth Street - P.O. Box 1150/ Port Angeles, WA 98362-0217 - ~ " ~ ~ f' ~ f WDA- o-r-D3 PORTANGELESLANDF~L WASTE DISPOSAL APPLICATION Phone: (360) 417-4803 FAX: (360) 417-4709 To: City of Port Angeles, City Engineer 321 E Fifth Street P.O. Box 1150 Port Angeles, Washington 98362 NOTE: All questions must be answered for waste to be approved. 1. Generator Information:. Company Name: Mailing Address: Contact: Phone: Project ,Name: Project Location: jI?MO - Pa~ rhe:, / / ~~DCI IV)Jw ~,Hk I W,/ crF/o7 sJoL I~(~h~t( /0:(' t 33 . 52..2.-2- . t:-v;.O!""{v eo/lcJtlo 1-, b/il/'f JC./V~ ~ S'"t (4 Co/left 2. Other Contacts(if applicable): Consulting Firm: Contact: Phone: Contractor Name: Contact: Phone: Laboratory: Contact: Phone: ;vA . Page - 1 City of Port Angeles - Landfill Waste Disposal Application I ' 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. Include the gasoline service station number (if applicable). CERCLA/MTCA Remediation Independent Remedial Action Agency Contact: UST Removal . ,,1 C. v" 1M,. W . "J ' , J.~ v(,..~~~-,. t.- I ...."..; r J Ius t IJ. 2- ;4~k / }C?I ' ~~ 4. Waste Material Composition: (check all that apply and include percent of total) 5, Waste Material Contaminants: (check all that apply) Gasoline Metals Heating Oil Used Motor Oil/Waste Oil Other Petroleum Product Diesel Solvents Unused Motor Oil Other PCBs Unknown NOTE: Supply any MSDS information with application, if available. City of Port Angeles - Landfill Waste Disposal Application Page - 2 6. Estimated Quantity of Waste for Disposal: ~C?GO , Cubic yards / 2.. 00 Drums / Tons (estimate both) Tons (estimate both) Other NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) 7. Frequency of Disposal: X' 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 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 NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: = 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 0-25 25 - 100 101 - 500 501 - 1000 1001 - 2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards = = = = = NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete samples. City of Port Angeles - Landfill Waste Disposal Application Page - 3 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, QAlQC 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: b) Provide a narrative as to why the above analytical methods were selected: NOTE: Additional sheets attached: YES NO 10. Soil Classification: ("''''FOR PETROLEUM CONTAMINATED SOILS ONLY"'''') 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 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) J Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (OW) and Waste Code: Extremely Hazardous Waste (EHW) and Waste Code: City of Port Angeles - Landfill Waste Disposal Application Page - 4 ,--- 12. 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 material to the best of our abilities. ~i:!or Slgnalut'L [__i 1'""1 <, W!>~J / Printed Name Da.uc-. ++ c gc_y n Q. vcl op /J/U2/l1- .::r;, L . 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Page - 5 "-" rIJ . rI:J. QJ ~ Q ;.. ~. .d.). .eJ = = ..... ........ .QJ ~. .~ -< .~ = ~ Q ~. .- ~ aJ .... "00. = ~ ~ e .~ u~ ~. ~. a Q ~ ;.. .s ~ "-- h.~i u~?:li 1lO'- t: c.. . c 1't <.;suE>. t:~,';8f tti\-ag o ~ <. ,- Q ei ~1 . '-.::: .--------l---~ . -. . n . fJ~ B 8 1S ~ '': ~._ -au co >.:: c; . ~.9~'i!1; .8 ;1 ~ 2 .e .:; 'E ,~..~ 1,5 .11<e~] c!l1~~~~ "",< !l 0 0;: ,,~ E>--..u- .- e >. ~. ij ~ !.~~ ~l~i >'li<Q. 5 a1~ H . l5 -5. ~< '@1 ~ i .a! ~ ~ ..~ s' D CXl .' n 5'~!~ s~R.D~ air ~~ ... .Cl." '0 .. o'<.t:;:!- l..~~iltl ... U.!! oU-c ....'" l:' O]t'u .r E ~ .~ ~ j'g . c: "g J2" '-.: 'oil I Is III 0 i ~ [0 CI ifffi<@ Bl6u~~ t+:...u u ,- cE ,-::: U ~~S]ls 8~f~1 .. ~..~ ... --.. :_'_._...~. -- o .. . . ~~~. . . i~ d 1S._w,g .E<n\.) ! . . ~~\.)i: .. l.ti! ~ i IS ~ . ~;-E ~ . &. .e! .- ."E. ! .0 ~ . ...... ~-"i!.ti .uia-s o ;z: "i.. S > 0 _- IIl.E - .i i J; iE ~- :;;.s"C ,:: Is 1l.... I.)w....O-s... e ~ ..~] . oS ,~ 0 1:. 'i 8 . tI c.!i!HllH~&..-- .a ~ '8 'fi i oS e ~ ~ <: ~ '"" t:;.9 e 11 a tl ~ c: t-1=l r-- ~ :. kl. .: i ~.!e '~ .- 1 ~ ^ ~ . -r:: &. !i!t~:-E=U~I!: O~::> ~ > C'~ 0--510:;..... c: .g ..~ 1: < -= &. 1ft 'S -: - - i- ~ ~ Q ~ I:: .. 'C ~ ~. u CIA ~ ~ Ii: ..J < c.. 5 <.ii '> C ofi .. l ] .~ e ] i 8 j "iI D o - ... tIJ U l> . ,----- L\Ac./ -FAt> t:l~ SEP 1 8 2U06 NOWICKI ~RONMENTAL EN\1RONMENHL MANAGEMENT & COMPllANCE September 15, 2006 ATTN: Dr. Sandra Wall Vice President for Administrative Services Peninsula College 1502 East Lauridsen Boulevard Port Angeles, WA 98362 RE: Post Abatement Air Sampling - Building B and Building C Dear Dr. Wall, On Thursday September 14, 2006 Nowicki Environmental Services conducted post abatement Phase Contrast Microscopy (PCM) air sampling in Building B and Building c at the Peninsula College campus where asbestos containing cove bas mastic had been abated from a variety of wall surfaces. In addition, several Concrete Asbestos Board (CAB) panels were removed from clerestory windows in both of these buildings. . Three PCM air samples were collected from Building B and three from Building C along with one Field Blank from each location for Quality Control purposes. These samples were analyzed by Orion Environmental Services in Federal Way, WA of Friday September 15, 2006 and all came in below the Limit of Detection level (0.003 fibers per cubic centimeter or less). These results indicate that no significant fiber release occurred during the aforementioned abatement work and the area is therefore cleared for occupancy. I have attached a copy of the appropriate documentation for your review and comment. We appreciate the opportunity to be of service to you on this project. Please do not hesitate to contact me with any questions or if you require any further information regarding this sampling effort. ATCH: Orion Environmental Services, PCM Test Report, 2 pp. Nowicki Environmental Services, Chain of Custody form, 2 pp. CC: Peninsula College/Alma Chong Peninsula College/Bonnie Kaufmann 34004 9th Avenue South Suite 12 Federal Way, Washington 98003 Phone: (253) 927-5233 Fax: (253) 924-0323 Client N owickiEnvironmental Services, Inc~ 33516 9'h Avenue South, Bldg #6 · Federal Way, WA 98003 Telephone (253) 927-5233 . Facsimile (253) 924-0323 Phase Contrast Microscopy Test Report NIOSH Method 7400A Peninsula College P.O. Box 141144 Spokane, W A 99214-1144 September 15,2006 Page 1 of2 064163 September 15, 2006 Date Page Invoice Date Received Project Number Project Name 06-0221 N/A 01 LOn 0.003 02 Lon 0.002 Fibers 8 60915-42 9/14/06 100 PO 13 1300 Fields Comments 100 AdminlEast 5' Fibers/cc 0.003 Fibers 60915-43 9/14/06 PO 100 14 1400 4 Fields Comments 100 Admin/Central 3' <0.002 Fibers/cc .i~;f::~ti~~~iij1it;~~j'~k~~tt'''y:~[~~;r:,',,~;ti)''~;:,Jr~;~gj~ii!~+rb~ .' "'i~~~~~~~{~'~;tlt~;t;r[W~~~Nt~f"if~~;;'t;~,.""',n1';'rlf~N~~">;j~~~fi. 03 60915-44 9/14/06 LOn Fibers Fields Comments 0.003 9 100 AdminIBridge 4' PO 95 1330 14 Fiberslcc 0.003 ~i~~tt~~lm~;~"1\i~~i~~fJber: 04 Lon 0.002 Fibers 60915-45 9/14/06 PO 100 14 1400 4 Fields Comments 1 00 Library/Orig Canst. 3' <0.002 Fiberslcc f' .~.' ~~:~."S!:~;~~2;t::~'Sv,t:~J,{}i.;_Qil[~:~;~~ir,'::;!~~Ft,~..,~::;~t'~~~:.1r,~f,:f,~!I~;~~~j'~:;'\""j~?~r;~;!f,qi!~t\'.:;Jl~t~l?~~L1.""7j:, t"',.jJ,~fl,~i!!!~Y:?:lir;r;(~,.;~~;.r:T~~! ';~:Y:~lHPr$:Y:>:;"~.':~"" Clieilt In 'j,} ,;~'Niimber'",;(""'; {D3te'i,;:i"'!?'SampleTvpe%i;;>;;;,"Miihftes'" ,i~(LiterslMii1ute) "'i'~'(Liters) ;";, 05 LOn 0.003 Fibers 2 60915-46 9/14/06 100 PO 13 1300 Fields Comments 100 Library/offices 5' Fibers/cc <0.003 di;~rrlf'" :';,' ~'~~~t:f,r,~:'" / Date 06 LOn 0.003 Fibers ,.~ ...-,: '.~'\.,r: ;,I<\qW.}{ate"'t'(''I: (iH~?s7Mirltite ) 14 ':::"fY 01 it ili'e ': "'iLite'~s) 1330 , "Total " :"Mirim~s 60915-47 , Sample T~p~ PO 95 9/14/06 5 Fields Comments 100 LibrarylMezzanine 4' <0.003 Fibers/cc ~- Nowicki Environmental Services, Inc. 33516 9th Avenue South, Bldg #6 · Federal Way, WA 98003 Telephone (253) 927-5233 . Facsimile (253) 924-0323 Phase Contrast Microscopy Test Report NIOSH Method 7400A Client Peninsula College P.O. Box 141144 Spokane, W A 99214-1144 Date Page Invoice Date Received September 15,2006 Page 2 of2 064163 September 15, 2006 Project Number Project Name 06-0221 N/A 07 LOn N/A 60915-48 9/14/06 N/A N/A N/A Fibers o Fields Comments 100 Admin Field Blank Fibers/cc N/A ~~.DlCfrrl,~?~E!t}~'lD,i~:~['t~f;t~:;:.!N:1~:tl~b~'~}~';~~~}i~;;~,~tD'~~'~~' '!.'c, len ,,> ,,' um er"",,,.,.~ 08 Lon N/A 60915-49 9/14/06 N/A N/A N/A Fibers o Fields Comments 100 Library Field Blank Fibers/cc N/A Laboratory Method Information Microscope Nomenclature Used for Analysis: Olympus CH2 Microscope Field Size Area: 0.00785 square millimeters Effective Collection Area: 385 mm2 Blank Count Means: 0 Fibers per 100 Fields Blank Count Fiber Density: 0.0 fibers per s~uare millimeter Limit of Quantitation (LOQ): 7 fibers/mm Analys . Environmental Services participates in the AlHA PAT Program. ( ~ Reviewer ~ onna McNeal Allen Clark Laboratory Director, CEO Laboratory Analyst September 15,2006 Date: September 15,2006 Date: ()(PL1/(Q~ [RiQJJ@[H] NOWi ,a ~IRONMENT AL SER . .lCES, INc. ASBESTOS AIR MONITORING ANAL YSIS REPORT P~E IcF2- Lab Number: Project Ob - 0 J.-~I Page: Client: Pf3.l0iN .5uLA CoLl-E.G e .~ 0<1114/00 Received By: Date Sampled: Submitted By: A . OLSO;.) Date: -LO Sample Description Type Time Start Flow Fiber # Of A,PA Time End Rate Per LOD Fiber/CC GJot:t/S Sample PO,P,C Total Time Total Fields 1- I1DMIN I E.AST S: 0955 R '3 Urn gAd 0 Of 6' PO E: 1/35 [)f OO~ ~lor/3 T: t ()() v: ISa) L AD/IA! IV I (!EJ.J1f/AL, Po s: 0965- R f1 Urn i fftl 02- E: ( / -35 th Po ~ <.0\ oo't. Vt T:ioO v: 14CO L f-fOMltJ / 81<t~E s: IOCX:> R/4 Urn 1/(0 () 03 Po E: /135 tJ.-f.,(j() 3 f) l' {)(J 3 l' T: qf) v: /3.30 L LtBMRY Jc~'}JgT. Po s: (f 45 R: 11 Urn '!/to 0 Of E:(J:L5 &t602. LJ)( 00'1- Of T: {0c:XJ V:/~ L L! BRAR-l.( I oFF/~ Po s: 1145 R 13 Urn ~riJ 0'5 Sf E: /31.5 6,-oofj ~o(oo3 T: too v: /300 L ~18Mf( y/ ~JJE. !b s: 1/50 R 11 Urn sj otJ - oC:, ~I E:13~ Dt (J 03 l..iJ,IJ(J~ T: q5 v: I.:j~ L .-.<-( -4+'3 -44 ,-l{0 -4/P (A) Area Sample (PA) Pre Abatement (PO) Post Abatement (P) Personal (C) Clearance Comments: Analyst: Date of Analysis: A- Reviewer: Phase Contrast Microscopy (PCM): NIOSH Analytical Method 7400, A Rules Minimum Detection Limit: 2 FIBERS/100 FIELDS Lower Quanitation Limit (LQL): 10 FIBERS/100 FIELDS Proficiency In Analytical Testing (PAT) PROGRAM 10 NUMBER: 98003001 -------------.---------.-------.-.---.-.---------------------.---.-.-.-----------------------.-----------------------------------------------. 33516 9th Avenue South, Bldg #6 e Federal Way, WA 98003 0 (253) 927-5233. e(253) 924-0323 FAX ~ClD@[H] [---- ----- ---- lFd~~(f{) _ PAGE 2. c~ :L NOW. {I ~IRONMENTAL SER;ACES, INC. ASBESTOS AIR MONITORING ANAL YSIS REPORT Lab Number: Project 00 ~ oVJ Page: Client: PElJI!J:5rL4 ~OLLE6E Date Sampled: 09/f4-/06 Received By: --.- Submitted By: A . OL:50N Date: -l-l<6 Sample Description Type Time Start Flow Fiber Of A,PA Time End Rate Per LOD Fiber/CC # Sample PO,P,C Total Time Total Fields ADMt }..J IJIA S: f(J:)5 R: NjA Um ,/ Q1 F to-J) i3LAtJI( E: I Q)b ~ T: I V: L ( Of[) UBR.Jt-RY s: 1/55 R: Urn / 08 J)/A E: 115~ JJIA q{~-o p r E3..LD f3 L.4f'JiL. T: I v: L s: R: Urn E: T: v: L s: R: Urn E: T: v: L s: R: Urn E: T: v: L s: R: Urn E: T: v: L -i-J~ (A) Area Sample (PA) Pre Abatement (PO) Post Abatement (P) Personal (C) Clearance Comments: I Analyst: Date of Analysis: ~~ I Reviewer: Phase Contrast Microscopy (peM): NIOSH Analytical Method 7400, A Rules Minimum Detection Limit: 2 FIBERS/100 FIELDS Lower Quanitation Limit (LQL): 10 FIBERS/100 FIELDS Proficiency In Analytical Testing (PAT) PROGRAM 10 NUMBER: 98003001 _._---------_._------~----_._-------------------_._----------------.-----------------------------------------------------.-------------------- 33516 9th Avenue South, Bldg #6 e Federal Way, WA 98003 (;) (253) 927-5233 . e .(253) 924-0323 FAX ~CUJ~[}={] Notification of Demolition Permit It is unlawful for an)' person to cause or allow the demolition (or major renovation) of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. Project Site Address: 15jD2. ~\ L~JC2..I~11,J 16ol.!LplJ,~\') County: LL ~U~rV\ . City: f?n\\---- (\..I~ blZL-,'l- '> State: \.J ~ Zip:'] f:: 3 b2- Starting Date: Completion Date: *( here is a JO working day advance notification period from receipt of permit application) Property Owner: Pi1.~ IN &oL~ CviJ-i1bi--Telephone: LIJ7 -l14 4 Mailing Address: I S'D 1- 'L--A ~ ~ 'u us,; A GL0t> \~~ WI^ City: -I' , State: ~ Fax: l-f I '7 - &c;f.:,() Zip: 1536 2- . State License #: DIE W tfi eo 7'....:s:s- p p MailingAddress: V , 0, . City: T>~Hc.Jr Contact Person: CJ,J- : s ~c;...,...,LII. State: W fl Telephone:2.,;ll.. 31~ -:75 j'-( Zip: 1'J'S" if: rr Fax: Jho 2?S . 2'lS~ Demolition by Wrecking or Dismantling? ($25.00 fee) check# Training Fire Demolition? (If yes, attach fire department request for training fIre) Renovation, Alteration, Remodeling, Maintenance, or other Construction? Asbestos found or suspected* 5c-~ t't f,4?kd * An DReAA "Notice of Intent to Remove or Encapsulate Asbestos" form and appropriate fee must be submitted prior to any asbestos removal work, Asbestos removal projects involving demolition must be preformed by a Certified AsbestDs Contractor and all friable Dr potentially friable asbestos must be removed befDre any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional requirements that may apply. AHERA Certified Inspector Certification # Asbestos Survey Completed by Ne) vJ I c.K \ l~ v I eLl) f\J IV\. 111\.1 T ~ 1-.. .. his approved permit must be available at the job site Enclose $25 Processing Fee Certification of the Asb-~stos S~rvey must accompany this form 2940 B Limited Lane NW, Olympia, Washington 98502 360-586-1044 * 800-422-5623 * fax 360-491-6308 homepage: www.orcaa.org ... email: infofal.orcaa,org Rev, 07111/02 r-- a2/07/2BB7 14:45 3bB4171467 0%107/2007 14:(7 FAX ~60 491 6308 ORCAA . F~b 07 07 01:25p The va~o Compan~ PAGE 61 360-417-6216 pERfMT. L APfl'ROVBJ 'e u · COMOIfIJNAl1Y tIUf APPROYED RM' COYPUANCE wmt ~~.l;$ ""- Notification of Demolition Permit It II ~gJ :for' lIJI3' persllll ta IIILUSC or ~ow 1:ht demolltUm (Dr -Jcq- r=~D) a! Jl1l)' :IlU'U~ 1UIlCB ..u ~en_ ~D..tablJng ...-tI:ria'b have beo!ll t"mtnai fnnn Ule _ to be. clemanmed. Wllt'J,:.Sb2lIllllt IhnnmllSlC& b & oJSb~ 1SnJe= or 4aDaoJitiJm DAles, the ~er '1' operat:Or hu (lbt:ri1l8d WItt~ apprDval from OI:CAA... .A. M'inDJ applkatfml for .. 'cJesGO]iliDD &Jl$ll1 iDdude :1 carijfjc:2tion Ulat 'there IS IIIQ JcnO'IiD ~-'""COm:a1Jilil1 rlUlterial ~ll!ulng in ~ a-rea ,r the m-w:r:urc. Project Site Address; J $t.: '2. ~ L ~~ ~ 11)> A,J ~ r:... L rfl:~i':> CoUnty: . Ci1y: ~~~ .~~ ta< L.L s.. Strte: \...: ~ S~ Datt; ~~ \- ~ ~ ~Complerion. Date: .., ~ is a lO woddng day ad~ QOttft_~ perlo4 ~ ~:;~ ofpermi: ~~rlon) ~ - ... -= c.... i P-.:J ~."\. Zip:,~ e. ~ b -z-: . - . I. . "':2.!~ '<.." ,. '1_,1. ",7 ~Qt4C' l'tgpetty Owner. . u... .or... ~ ,':--'0 '.-tJ...-.'1r.:T,--,= -r , . - ;; . . Mailin.!-.....adre~ U.,-t;'L ~z:..p. ~~~~$I?I"" G'.-JJ'"">> Cit)": ?~ , S'!nt;:; .,..; ~ ~ :Fax: '-:: -: -(~{.o 7.;.... e". 'r ":;;? -2- ~_ f- '';~ Snte Lic...~c ~ P'::I..j'J'I!I7" ~D~..s:s pp De=o1ilion. by Vl~...cing Dr DL~g'? QE2:5.00 fee) I;h::d{"# Y Tza.i:ning !".!re Demolition? (.If" ycs, attach fur: depanmam teCJ.c.l:St for u:ai1rin.g me) Rennvation, Alteration, ltamodeliDg, Mamtem.nce, or oihf:f Construct:i.01l.7 .::L. Asbt~S foWld or m.o;ped2.d'" 5c~ .>ffAc4:d "* An O~CAA '"1\oUQ: uf L""~t Ul Rllmo"t Dr ~Pfl~ J..sbc-<w~ i= ~d apprcpriat= fc~ ~ be su~d l1rior ~ =y a.lbu."ID~ rer.;oval wmk. A.bCT~ MIIilv:ll p.~t:::n; in\!olv'w~ li=olili<lU =1 be prefwmcd by II C""':..f.ed ,A::b:BtOt: Cono-a<:wr a;:d /l.1l. fri,il;}e fir JKI"".u.w.iy frilIblo ~b:;jjt~ JllUO> lle J::....ovo:.:! b::fo:e :my ~Uiil:ll D!:;:in~. Refer ~ ORD>.J\ F..eg'.<l~on 1 .....r.k:le l-4 fnr a.t!dtdO";O ~W:t~appl" Demolition Co.trt:r;u;tOr: L),2.J..-l......-H, ~ j"}q ucf:J",-".{ ~c.._ t I }&.ill:ngAddress:'y, o. G ='" "l. 7 $" S . City: IJ> <:, H'.J... . Contact Pcr.;on; eLf; ~ R-~. L_1f State: W.Ii C1" -2,; 7-( 7e~on=:Z...-;11.. l.:'ES -X NO L .A.sb~-tlJli SID'Vey Completed by " -.:reon. T"' ......:+; d T ...,...,. .. L"...d I cJ" I i= v ; a. (;l cv "".;;~; T -"-- L-... ~L'..."" 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' g~ ! ~~ ' a:!Z= . ~85 ~~~ / m.:!: , ~~~ 'I :J:>~ fa~(3 I ffi~~ : ~~8 ~~~ Z:5~ ~~~ ~8~ ~~a ~~8 < ~~ ""~t3 ffEi=>", ~g!;i~ <"<il:l'i1 fu~cr:~ (/)g~~ ~~~~ ;>;"'0::'" 0::~f2~ ~~~~ ~~~~ :C1.L..~c,; ~i:do~ 0000: ~~~~ ~~5~ fa:i:@,~ ~ffl"':I e:a:~~ ooze g~S~ 3:Uu> C);c~t5 ~~~~ El;::u. <D cij L.LJ b z: (;:j ~ z: o i= ~ o ::;E L.LJ Cl L.LJ t- en i ~gj ...:-! ..:$<<>1 ~~~: !~L"H;;! ~~;;!: ~~~. ~gfE ~;z.... :I:&1~ ;Qg~ "'~< ~ofb :ii!....'" ;::~~ ~~~ "-C>o ~~5 u~f:2 @~~ 5"-z ",,~g ~ ~f2 ..... BUILDING PERMIT - APPLICATION Fill out COMPLETELY and in ThTJ{. Your application and site plan MUST B · CO:MPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent:~ F./lN _ (: ~ lW 0 ,::; b." 0 lJ k' N ,-=:/9-1,) phone: p-olG - '1"-'3 -?, J.} ':1J? Owner: !'1IJ..H ~RaV8S) f/::NN)!;,uJ./} r>r?J-J-r;;;,~ Phone: '36o-J-fJQ- 61)-01)- Address: I~ 9- ~ J-J3.00 IOC:;av" City: pwr<}-- tdV1,,~l-p-<S Zip: Cf~~ 6 G- ArchitectlEngineer: 5c J:;c. ~ r ,/ I1sJ-/Pr N 1 ,A t<-C.J.J 11~c.1S Phone: 3-06 - If t./ 'D - 34 J..j 5'f" con_to; IIr-rM 0 _ P M/.~ #1} 'k State License #:\IfM?ll< 94>61 c.. Rxp: II N" 7 Phone:~-hJJ ~~ Address: 3'S~O ,a JJv€',JJ,.\"j City: ..$EI+--n-LF:' 'v.J4. Zip: qf(jt-D7 PROJECT ADDRESS: ISO g., ~ J-I)-URIm-EJJ f3J.vD' ~J-D~ ('" ZONlNG: p 13 P LEGAL DESCRIPTION: Lot Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: p~1N8VJ-;;r eo/.-LJ:nr;;:;;- C/JIJ/ pUS TYPE OF WORK: STZEN ALUATION: D Residential D New Constr. D Re-roof D Stove . _'F. @.~ 'SF. = $ D Multi-family D Addition D MoveD Garage . SF. @ $ /SF. = $ D Commercial D Remodel D Demolition D Deck SF. @ $ /SF. = $ D Repair D Sign D Other TOTAL VALUATION '. BRIEF ~CRIPTION OF THE PROJECT: - -..- : I" A - ... .. " ..,.:1" 1 -7 .'_ - ~r:h M5,' oc;: 13l11-- J3_'lC j.vY"vdr-l./1 ",f J}t/ $-c Ij-A& I · . . ~ J COMMERClALIRESIDENTlAL: Occupancy Group:_ No. of Stories ,,_ Lot Size )Existing Sq. Ft. Total lot coverage=-- " 'L ~. % . _ Occupant Load: _ . Construction TypL. . , r& Proposed Sq. Ft. _. I .' --= = TOTAL Sq. F' n - - - : &:. ESNWetland(s): DYes D No SEPA Checklist required? DYes D No Other: APPROVALS: PLAN: BLDG: DPWU: FffiE: OTHER: PLANNING USE ONLY: 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 current fee schedules. Contact the Permit 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 permit issuance. EXPIRATION OF PLAN REVIEW: If no permit is issued within 180 days of the dat~ of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon wntten request by the applicant (see Section R105.3.2 of the International BuildinglResidential 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. J am authorized to apply for this permit an~ un~ers.tand that it /s my responsibility to determine what permits are required ,not the City's, and that I must obtain such perrmts pnor to WOrk: _ J:? / . ~4 / T,IFQRMS\BIdgP""'tfunn.wpd A-PPli~ ~ Date, -fQ 7 . I .