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Home My WebLink About127 S Lincoln St Sp 22 - Building Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zonlng . . . Application valuation 08-00001301 Date 10/13/08 505215 127 S LINCOLN ST SPACE 22 06-30-00-6-4-5500-0000- ELECTRICAL ONLY RESIDENTIAL TRAILER PARK o Appllcation desc Replace pole Owner Contractor MC DONAGH, ESTATE OF ALYDANE P C/O PATRICIA M NORRIS EXECUTOR PO BOX 459 IVY VA 22945 (434) 996-8866 OLYMPIC ELECTRIC 4230 TUMWATER PORT ANGELES (360) 457-5303 WA 98363 - Permit ELECTRICAL ALTER COMMERCIAL Additional desc Permlt pin number 136218 Permit Fee 75 00 Plan Check Fee 00 Issue Date 10/13/08 Valuation 0 Expiration Date 4/11/09 Qty Vnlt Charge Per Extension 1 00 75 0000 ECH EL-COM ALT 0-200 SRV FDR 75 00 N ~ ~ Fee summary Charged Paid Credlted Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 00 75 00 00 00 Plan Check Total .00 00 00 .00 Grand Total 75.00 75 00 00 00 \ ~ - ~ b I L N r ..~ . SPECTION ELECTRICAL TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE OUGH - IN FINAL OMMENTS: PREPARED 12/04/07, 8 36:38 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES LIERLY PAGE DATE 14 12/04/07 ADDRESS 127 S LINCOLN ST SPACE 22 SUBDIV TENANT, NBR TIM MCCORMICK CONTRACTOR S & S EXCAVATING INC PHONE (360) 461-1830 OWNER PAT MCCORMICK FAMILY LLC PHONE (425) 367-2585 PARCEL 06-30-00-6-4-5500-0000- APPL NUMBER 07-00001338 DEMOLITION PERMIT: DEMO 00 DEMOLITION REQUESTED INSP TYP/SQ COMPLETED RESULT BL99 01 12/~4/07 ~ DESCRIPTION RESULTS/COMMENTS BLDG FINAL December 3, 2007 4 38 11 PM Ipangrle. TIM 425-367-2585 BLDG FINAL - DEMOLITION OF BURNED MOBILE HOME #22 PLEASE SIGN THE PERMIT THAT IS IN THE OFFICE. COMMENTS AND NOTES -------------------------------------- ~~-~ TO U~l \ ,d-; ~~ QotJ~ C61J+--~J- ~\0G" be f~ bJvtiL0 r r L.o-c V (/l'L e J 6 r }lrv,v () "-1,') $0 L- CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number Appllcation pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Appllcatlon type description Subdlvlslon Name Property Use Property Zonlng Appllcation valuation 07-00001338 Date 11/21/07 810858 127 S LINCOLN ST SPACE 22 06-30-00-6-4-5500-0000- TIM MCCORMICK DEMOLITION UNKNOWN 500 Owner Contractor II.. PAT MCCORMICK FAMILY LLC PO BOX 459 IVY VA 22945 (425) 367-2585 Structure Information 000 000 S & S EXCAVATING INC PO BOX 465 PORT ANGELES WA 98362 (360) 461-1830 DEMO & REMOVE BURNED MOBILE #22 Permit DEMOLITION Addltlonal desc DEMO BURNED MOBILE #22 Permlt pln number 115485 Permlt Fee 50.00 Plan Check Fee 00 Issue Date 11/16/07 Valuatlon 500 Expiratlon Date 5/14/08 Qty Unlt Charge Per Extenslon BASE FEE 50 00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 50.00 50 00 00 00 Plan Check Total 00 00 00 .00 Grand Total 50.00 50 00 00 00 0; ~ ~ eeL "~ ~ " 0,> 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 orwork 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 ~ 1\ ('2. \ I 01 T <>'^ ""e,a.~b l;-~ 0. ~ f?&/<k<~ Date Print Name Signature of Contractor or AuthOrized Agent Signature of Owner (if owner IS bUilder) T Forms/BUIlding DlvlslOn/Bulidlng Permit (10/01/07) wpd BUILDING PERMIT INSPECTION RECORD o -J I V'1 VJ OQ CALL 417-4815 FOR BUILDING INSPECTIONS CALL 417-4735 FOR ELECTRICAL INSPECTIONS CALL 417-4807 FOR PUBLIC WORKS UTILITIES 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 FOUNDATION: FOOTINGS SHEAR WALLS / WALLS FOUNDATION DRAINAGE / DOWN SPOUTS PIERS POST HOLES (POLE BLOGS ) 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 WALL/HOLD 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 #'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 \"Z....4....01 1'l,L. BUILDING ..' .-- Cj V\ \ -,. "5 ~ - :J S{2 \....- V\ -0 ~ @ ~ T Forms/Building DlvlslOn/BuJidll1g PenTIlt (I % I /07) wpd \J 3 o 3'6 ~"'f "-;5 ~(b 'if ,0...- 10'-.. Street Lookup Page 1 of2 Parcel Number 0630006330500000 Site Address 127 S LINCOLN ST PA J ~ ~~''"~ \""1;;;?Ti i ,"QUit;;; ~'~ ' t, ,.,$ ,< Taxpayer: PAT MCCORMICK FAMILY LLC PO BOX 459 IVY, VA 22945 PO BOX 459 IVY, VA 22945 Title Owner: PAT MCCORMICK FAMILY LLC Description: THOMPSON'S & GOODWINS SUBD LTS 13 & 14 BL 30 SUR V62 P88 Value Summary: Note: Listed values do not reflect adjustments made for exemption programs such as Senior/Disabled or Current Use programs (except Commercial Forestland properties). Land Value' 24,150 Improvements Value' 0 Total Assessed Value. 24,150 Property Characteristics: Note: Use Code IS for Assessor's purposes only Contact the appropriate planning or building departments for Zoning and allowable usage of property Use Code 9120 COMMERCIAL Land Size (acreage). 00 Note Acreage IS not listed for all properties In the Assessor's records More Information about land size Tax Status' Taxable Tax Code Area" 0010 Note Zoning and zoning codes change constantly Verify all zoning With the appropriate planning or bUilding department Building Characteristics: (Click on Bldg # for more details) JL Bldg. Type Bldg. Style Total S.F. BD BA Tax History Sales History Other parcels at this address: 0630006455000000 3630008614930000 3630008615950000 3630008620720000 3630008622000000 3630008622150000 3630008622270000 3630008628000000 3630008628300000 3630008630730000 3630008636220000 3630008637510000 3630008638730000 3630008640170000 3630008650530000 http://apps.clallam.netlwebsite/sitis_s.pgm?address= 127 &street=LINCOLN ST 11/21/2007 Street Lookup Page 2 of2 3630008653520000 3630008654330000 3630008654530000 " Qult--I http://apps.clallam.net/website/sitis_s.pgm?address=127&street=LINCOLNST&purest...11/21/2007 Look Up a Contractor, Electrician or Plumber License Detail Page I of2 Topic Index I Contact Info " T ~ , "',"~~~~'~"-'~~~"~-" , & Insurance Workplace Rights Trades & licensing Find a Law or Rule I ~ Get a Form or Publication I Look Up a Contractor, Electrician or Plumber , """' " Printer Friendly Version General/Specialty Contractor .A business registered as a construction contractor with L8:1 to perform construction work within the scope of Its specialty. A General or SpeCialty construction Contractor must mamtain a surety bond or assignment of account and carry general liability insurance. W_'<<"',<' "<"""~ License Information ] License SSEXCSE952DS ; Licensee Name S 8: S EXCAVATING INC ! Licensee Type CONSTRUCTION CONTRACTOR UBI 602477183 Verify Workers Comp PremIUm Status I Ind. Ins. Account \ 8133400 Id I I Business Type CORPORATION Address 1 POBOX 465 \ Address 2 City PORT ANGELES County CLALLAM State WA Zip 98362 , Phone 3604574670 \ Status ACTIVE i Specialty 1 EXCAVATION/GRADING I Specialty 2 UNUSED 1 Effective Date 3/10/2005 Expiration Date 3/1012009 j Suspend Date Separation Date Parent Company , Previous License ; Next License , Associated License "or" https://fortress.wa.gov/lni/bbip/Detail.aspx?License=S SEX CSE95 2DS 11/21/2007 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of2 Business Owner Information Name Role Effective Date Expiration Date BAUBLlTS, KIM PRESIDENT 03/10/2005 "B d 1ft' on norma Ion Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received ,Bond Name Number Date Date Date Date Amount Date Until #1 CBIC SG0138 03/08/2005 Cancelled $6,000.00 03/10/2005 -'~, -, , Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received , ! Insurance Name Number Date Date Date Date Amount Date I I I ATLANTIC CAS INS #3 CO L0650047981 03/10/2007 03/10/2008 $1,000,000.00 03/02/2007 ATLANTIC CAS INS I #2 CO L065004798 03/10/2006 03/10/2007 $1,000,000.00 03/09/2006 ' i ALEA I LONDON I : #1 LTD PFK026827 03/10/2005 03/10/2006 $1,000,000.00 03/10/2005, ".", ~. >'0 <0.~ 'I ~, ~ "-> ~ , , , , , Summons / Complaints Information , Tax : Summons / Cause Warrant Complaint Complaint Judgment Judgment Payment Pa Complaint Number Id Plaintiff County Date Amount Date Amount Date Ar OLYMPIC VIEW #1 062010551 PARTNERS CLALLAM 12/06/2006 $0.00 $0.00 $0 '" , '"'", , Start,a, New Sean::b Printer Friendly Version About Uti I Find a job at L&I I Informacion en espanol I Site Feedback I 1-800-547-8367 :<) Washmgton State Dept. of Labor and Industnes. Use of thIS SltC' IS subJC'ct to the laws of the state of Washmgton AcCC'ss AgreC'ment I Pnvacy and secunty statement I Intended u;e/exlC'rnal content polrey I Staff onlv lmk slllngton VISIt access.wa.gov https:llfortress. wa. gOY Ilni/bbi plDetail.aspx?License=S SEX CSE9 5 2DS 11/21/2007 BUILDING PERMIT - APPLICATION Fill Ollt COMPLETELY nnd in INK. Your application, prescriptive energy form, plans, spccs, and a 8 W' x 11 I' site plan MUST BE COMPLETE to be accepted for review. (360) 417-4815 FAX (360) 417-4711 ~ FOR OFFICIAL USE ONt y; Date RCC.:* S -07 Pennit 11: - 1'3~~ Due Approved: Dnte Issued: Residential projects: submit two sets of plans Commercial pro,jects: submit three sets of plans Applicant or Agent -r:~. 'JIP?J~~/"~ .I~ Phone "'Z~ ~~" 7- 2jaS- Owner 77{1t.p?JcGt:lr~~J~~ ..." pA-r m~or11'11Ck ff9?11r.th'~~ :/"2J1-...?f,,? -.z..:5-'f 5- , - Owner's Address ~7"7- 70~/7't/~ /U-tP" /11HAP'::>~Yk 0~ '1'"'2...:20 ContractorlEngineer ~ /J -+:~ €~ t; AI/If+:' 'Hr State License # .s.rE- J(!oJ tr~/xpjres Contractor/Engineer's Address ;:?.p; /?.;r t.Jbb...... ,~."../AWj'eH;~ Phone:lfDt)-If'W-"'36 PRO.TECT ADDRESS: J~7-7 ~~G.~/JI1. jP~/'r~"5?'"'fJ/Al!.1 ~2-~ ZONING: LEGAL DESCRIPTION: Lot: Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: TYPE OF'WORK o Residential 0 New Constr. l:I Re-roof 0 Stove o Multi-family 0 Addition l:I Move 0 Garage o Commercial 0 Remodel j(Demolition 0 Deek q Repair 0 Sign l:I Other BRIEF DE CRlPTION OF MDb\\e t-l6me.. '"-2'2 . be c!eA'\,,\oHsheJ. a SIZENALUATIO Y"e.n\ove,tl doe"to SF.@$ /SF.= $ SF. @ $ {SF. ::; $ SF. @ 5: /SF. = $ TOTAL VAJ..UATTON $ rf) ~~&>~t! ~~.. r->P COMMERCTALIRESIDENTlAL: Occupancy GroUJl: Occupant Load: Construction Type: Existing Structure(s) basement Sq. Ft. & Proposed Structure(s) basement Sq. Ft 1:1 floor Sq. Ft & 1" floor Sq. Ft. 2nd floor Sq. Ft. &. 2nd floor Sq. Ft. 3m floor Sq. Ft. &. 3n1 floor Sq. Ft. Accessory Structures Sq. Ft. & Accessory S\TUctures Sq. Ft Existing Structure(s) TOTAL Sq. Ft. &. Proposed Stnlcmre(s) TOTAL Sq. Ft TOTAL of existing & proposed structures Sq. Ft. Maximum Height of Proposed Structure(s) Ft LOT COVERAGE Lot size Sq, Ft. Existinl:; Structurc(s) Sq. Ft. Footprint Proposed Structure(s) Sq. Ft. Footprint TOTAL Structure(s) Sq. Ft. Footprint Total Lot Coverage % Are you planning to install a lawn sprinkler system? (Divide Total Structure(s) Sq. Ft Footprint by Lot Size Sq. Ft) V ALUA TJON OF CONSTRUCTION: In all cases. a valuation amount must be entered by tbe applicant. This figure will be reviewed and may be revised by the 'Building Division to comply with current fee schedules. Contact the Pelmit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: The plan check fee must be paid at the time the building pennit application is submitted. All other pennit fees are due at the time ofpormit issuance. EXPIRA TION OF PLAN REVIEW: An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date oftiling unless such application has been pursued in good faith or a permit has been issued; except that the building official is authorized to grant one or more extensions of time for additional periods not exceeding 180 days (90 days for commercial projects) cacho The extension shall be requested in writing and justifiable cause demonstrated. (IRCIIBC 2006105.3.2) 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 whet permits are required, and that I must obtain such permits prior to work. ~ Date I'.... /7'- t::j 7 Applicant ~~ ? ~ C.~ ~ 7' T:IFORMS\BUILDING DIVISIONIBldgPermllAppl.-7.006 CODE _ b~UP.WPd -r;~rAy ~... .".n G'~ t::""'~? tE- I I .. ' ,"{ ~ ~ .' ~ORT ANGBLBS Bf~ WAS H I N G TON, U. S. A. ' Public Works & Utilities Department October 19,2007 Peabody Creek RV Park 5907 70th Ave. N.E. Marysville, W A 98270 RE: Port Angeles Transfer Station - Landfill Waste Disposal Application, WDA 07-48; Mobile home demolition (127 South Lincoln # 22) 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 transfer scale attendant at the time of disposal. 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. Sincerely, /~~err~r City Engineer SStf EncI WDA 0748 Copy Claudia Stromsla N IPWKSIENGINEER\WDAPPLIC\07-48 FILE Landfill Solid Waste DIsposal Applicahons 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 --- N ~ \j) t' <: ~ ~ ~ LVDA- 01-48 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 Phone: (360)417-4803 FAX: (360) 417-4709 NOTE: All questions must be answered for waste to be approved. 1. Generator Information: Company Name: Mailing Address: Phone: Project Name: Project Location: PgAt:c{~y &.tit fLU ~:Fta7 loT'::;;. Auf.. MftYl"Ys;-vl u.....of. WA f '-/2...S--3c; 7- "1....C;;S5 ()J5fJ1o r..-.J.: \ ~11 A, Co , '7:7 S. L/~c.o'-N ftltL ~. JJ. ( 9~/l7G jA/(C, '61 L f. S--r. :it 2L 2. Other Contacts (if applicable): Consulting Firm: Z&"P-J:JJl L -1 A<:rX':./lfiTk <)" Contact: S- c,tf-- 1--1;< AD fL./ C I<.... Phone: 3h-'J 4J 7 c$O I Contractor Name: (~I\. \ r f'.)r i.........J r") . Contact: Phone: Laboratory: Contact: Phone: N V L 4f/.&;.,rtp,T 0 W-J fs)" I / (/J C . iAtV U~ r WAN' r1Ob. 5Lf7.0)00 City of Port Angeles - Landfill Waste Disposal Application Wed. 1 0/412006 0 4 PM Page - 1 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). CERClAIMTCA Remediation Independent Remedial Action Unused Chemical Product Spill Agency Contact: UST Removal -A- Other Source:~ D;:-fJ)Ll ') huJ~ Df,Jt{O U S 1:1<- f) ttllNur bto~ 4. Waste Material Composition: (check all that apply and include percent of total) Soil % _ Foundry Slag - % Concrete/Asphalt % _ Dredge Sediments _% Preserved Wood % L Debris ) I2E...- % Coal Ash % _ Other (list) Wood Ash % - % _% NOTE: Total must equal 100%. 5. Waste Material Contaminants: (check all that apply) -A- Gasoline Solvents Unused Motor Oil Other TeL-.f: LEAD Metals _ Heating Oil Used Motor Oil/Waste Oil Other Petroleum Product Diesel PCBs Unknown NOTE: Supply any MSDS information with application, if available. City of Port Angeles - Landfill Waste Disposal Application Page - 2 Wed,10/4/2006 0:4 PM 6. Estimated Quantity of Waste for Disposal: ;':;- Cubic yards / Drums / /a 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: -A- 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 4 >" \^,\(JLS -# 0 /LC;2. /Lx. FllArt I A..b I x P 0x. W\11 H~ wcoO NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 0-25 cubic yards = 25 - 100 cubic yards = 101 - 500 cubic yards = 501 - 1000 cubic yards = 1001 - 2000 cubic yards = >2000 cubic yards = NOTE 2: One composite sample shall discrete samples. 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 contain a minimum of three/maximum of five City of Port Angeles - Landfill Waste Disposal Application Page - 3 Wed, 10/4/20060.4 PM 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: I CLj~ L.-5;~<h) ALe M^- ilA ) ~ l \ /7 Cct:.i; , b) Provide a narrative as to why the above analytical methods were selected: O. ) K r,--, l" H.)~ A (".y n {' r N (" :;7 i\ uCT UYl-f, T 1J.ff/LJ:< L-0fJ,. <; A {JoE:Sll:-ICITY of )tSG T52'::TKo {"" ( ~-A /) 1?:A~>,f D A~?().J:,'S1o 'S , OUY P~;AJT I3vILDJ~ vl.-4~r~/LlACS /6 A6-f 0 F ':]Jtuc;fvyv[;,.. NOTE: Additional sheets attached: -i- YES NO 10. Soil Classification: (-FOR PETROLEUM CONTAMINATED SOILS ONL Y-) Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check one) Class 1 Class 2 Calculated Hazard Index Class 3 Class 4 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) -4 Neither Dangerous Waste (DW) 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 Wed,10/412006 0 4 PM , , 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 w te mater" I to the best of our abilities. -- s;.. 0 iJ. Printed Name -:z?&bU l <-- 1> 1;% $-C) cA AT -& S / jl) C~, Company . I /o//f>/C// Date I I City of Port Angeles Approval: '~-/~j~ Uv~~ f/tfi City Engineer t/ /P - /1- {)1 Date /t- /9-P 1 Approval Expiration Date City of Port Angeles - Landfill Waste Disposal Application Page - 5 Wed,10/412006 0'4 PM ------ ;--. P-38 PEABODY P.36 CREEK y' P-34 RI\!. PARK P.32 P.30 Pat McDonagh, Owner P.28 ;.p ~ ~ ~~ E~ b If' ~" ~} t~ ~t ~ ~ ~ t " ~ ~~ ~ ~~ ! ,}, ~ 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 @ ~ ~[ill ,J~ ~~ 1} @ .li,'f' .. N I I I ----. ----- , or-: I ~CJ) LINCOLN ST. Formerly City Center R.V. Park 127 S. Lincoln Port Angeles. WA 98362 Phone (206) 457-7092 Space No. SPEED LIMIT 5 MILES PER HOUR CHECK OUT TIME: BETWEEN 11 :00 a.m. & 12:00 noon OVERNITERS PERMANENT SPACES . QUIET. CREEK . LAUNDRY ROOM . CLEAN RESTROOMS & SHOWERS . PROPANE GAS . ELECTRIC, WATER & SEWER CONNECTIONS . WALKING DISTANCE TO FERRIES AND SHOPS ~'>~ 1+ rr e Il/. L t/ J/l J;q , ;J e/ t' I ~ or Mf' ,~f? /,J-,; C./? r;' hq -f' "'" yo f U P<? I 't-:, :r- ho f/e.. :-c -;---- j' 9;:::) ! Ie. d. CD u ( c.. '" Y'i"'e.cJ-'.t}y ~A~ - 7J,?J tftry ~(J,r ~Afi ff:~/J d '14//t;'UI'~9' ,. ~~'1I~ / / r+-0.~~JIi.t- t-~.fl?tr' {PAcl4( ;5/r;te- r1t-e rr)f)?7/Yt;~ I ~t2. zL . .:- ~- ;...~"-~ ~Q~te.~ ~ - ! r?f~~L/ m ,//2 ~c"""..-n /~ ._.~/~ea~~~~/5;-.J5:;-'!!(~~ illi!i!L .--...---"...--,.... ~ . !11~~...:.&#- 611"...rU. 2. _~_ ==J - =~~----- JUd'!:.e.; ~<E:_'4../r;y~~ ~'o/ '/ ;6#',ti!></ &-.iP_~ e:. . / / ...... L2 ~, ~? /- "- ?, / ''"'7 . 7 -. c;,po -:c: - a. .__ . _fJt.u~~..J--7"~"~-::::.-z.......~_.-/....ft-'_:"~ ...~~...... - ~~~~a- : t~g<<_~ ;P A1*'~t~~-y.-"f/--/JL:;-I#,";-------.. ;--2 A . b C' ____t::e:z&.df5._..L ..__u~ ,4--~ .y/~_ 'II J, " . .II 1'- I -1--- u_ lL I '~ I I __L ! ! ~ 11 ------.--- ---.-------.-------. . - - . "1--.---- u__..______.____________ .- _' NVL Laboratories. Inc. __ 4708 Aurora Ave N, Seattle. WA 981~ Tel: 206.547.0100 Emerg. Pager. 206.344.1878 1.888.NVL.lABS (685.5227) Client Zenovic & Associates, Inc Street _3 0\ C:: lo ~ ~,e-e.~ 1::L l CHAIN of CUSTODY SAMPLE LOG INVU w -""'" L AIB S .............~........... .22 NVL Batch Number Client Job Number 072)'2. Total Samples { Tum Around Time 0 1-Hr 024-Hrs 04 Days o 2-Hrs ~ 2 Days 0 5 Days o 4-Hrs 03 Davs 06 to 10 Days Please call rorTAT less than 24 Hrs Emell address ~~.,.. (! 2<.-UcJUI '-. AJe-r Port Angeles Project Manager } ~~ tCO&'~ Project Location - ~OCJY r:Jt<<-k....,(2.V At4-k.) 7' A",~ tCl" ~ ( W1 Phone: (360) 417-0501 Fax: (S6D) 417-0514 10 Asbestos Air 10 PCM (NIOSH 7400) 0 TEM (NIOSH 7402) [J TEM (AHERA) 0 TEM (EPA LewIn) 0 Other 10 Asbestos Bulk 10 PLM (EPAI6001R-93/116) 0 PLM (EPA Point Count) 0 PLM (EPA Gravimetry) 0 TEM Bulk METALS Det. Um't Matrix RCRA Metals DAIl8 Other Metals o Total Melals .0ppm (MS) [1 Air Filter o Paint Chips o Arsenic (As) o Lead (Pb) UAII3 ~TCLP o ppb (GFAA) o Drinking water o Paint Chips (Area) o Barium (Ba) o Mercury (Hg) o Copper (Cu) U Dust/wipe o Waste Water o Cadmium (Cd) o Selenium ($e) o Nickel (Ni) o Soil o Chromium (Cr) 0 Silver (Ag) o Zinc (Zn) o Other Types o Fiberglass o Nuisance Dust o Rotometer Calibration 0 Other (Specify) I of Analysis 0 Silica o Respirable Dust 0 Mo/dIFungus Condition of Package: 0 Good 0 Damaged (no spillage) 0 Severe damage (spillage) - - - ~~. .-'- - -- Seq.# tabiD Client Sample Number Comments - AIR 1 j'J-YZ-!::>-2- /.] .pL.~ /"..-1:~ OC.C.I' 'l"'C ~ l-c-4.6 2 I . 3 .- 4 _. n 5 - - I 6 7 - 8 - 9 , 10 11 12 ~ 13 .. . - 14 f.-.. .- - - ~ 15 .-.- Prin Below Sampled by -t::A/v Relinquished by Received by Analyzed by - Result& Called by I Results Faxed by [. -- -- ___L _ _ _ ----- - -- spec,? {;;:n;2;~ h~:' ~ wntJng. a" 'amples .." be dl'..... of two (2) ...... a"'" a..."..., i _I Af'T H' "nn' I) r')AU II \/1 I l D ^ D A TAD T [(I T II f' I'" ':l A ':l [ o " II I NVl Laboratories. Inc. - - /4708 Aurora Ave. N.. SeaWe, WA 98103 lei: 206.547.0100. Fall' 201HI~ 1Q~A l WWW.nvllaDs.com Anaiys;s I'teport r ~ AIHA .1104 # 101861 I ~~~~-J I WA . DOE # C1765 l'U.ORATGRYj J i-VAi\iii,y Cilii:tHu;wr'i5~i~ i..eacmng ....roceaure .. Leaa (t'D) (<ilent: ZenoVIC & ASSOCIates, Inc. Addr~~~' ~n1 E 6th St Suite " Port Angeles, WA 98362 Batch #: 2714651.00 !t1l_.L;-:.,... QHI~ Method: EPA 1311170008 Attention: Mr. Tracy Gudger ;:iijjg~~ i.\i\A:iton. I""eaboay CreeK RV ParK t;i2, Port Angeles, WA \,.,Iil;l/IL ~I Ultftil tf'. v (t&.~iJ. Date Received: 10/1112007 ~amples /"(ecelvea: 1 Samples Analvzed: 1 LablD r.1i~~t S!!mp!e # RL nlQi i.. Results In maiL Results in ppm 2?!!959~~ 072~' A 0.5 _ " 0= .. U.Q <. Y.U r I .:~;\~:~ ~~: ;~~~~r ~~~~ l - rn!!/! =Mi!li!"!~l"!'l!!:: n~r lit~T' - - . ppm R parts per million n~t~ Ar'!~!\J"7.,n' "nJof')/?nn-, nR4.J:T \ I J n! _ n___....L~__ I -0__'.;, . .... . "'-,tJYI "" Itt _II I IlL ..,,,,t:=;, . l:t=-f.h.....~ r"tr" ;:t~~; :Ifoc. ,.l!,ol'c. ......._........oi.-L.l_ . ._1___ _i.-,i._ -I __,_ -- ...... :...---- . ...--.--- -.__ ___..,.._ -.- ____,...WlIItfllll'.w 4111.".-"'" Wt.l.d.......""" ..,1tIIyf"hilrw. Unless otherwise indicated, the condition of all samples was acceptable at time of recelot '<' = Below the reporting Limit Northwest Asbestos Consultants 406 Reed 8t. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com ~ 10/8/07 lob Site: Peabody Creek RV Park 127 Uncoln St. Space #22 Port Angeles, WA 98362 Contacts: Zenovic and Associates Tracy Gudgel, PE 301 E. 6th St. Suite #1 Port Angeles, WA 98362 Subject: Demolition Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-10270601 Expires - 10/27/07 . Scope of work 1) Building survey and inspection to inspect for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect materials. 3) Report to Tracy Gudgel, PE of Zenovic and Associates. results of testing from Northern Industrial Hygiene, Inc. Inspection Report Requested by Tracy Gudgel, PE of Zenovic and Associates. Sampling of suspect asbestos containing building material (ACBM) on a fire damage mobile home. Metal siding, aluminum clad windows, fiber glass insulation and wood paneled walls. The following samples were taken and sent to lab. Sample #1: Entry floor vinyl with mastic. Brown Saml'le #2: Homogeneous 9" x 9" floor tile with mastic. Brown pebble pattern! Sample #3: Bathroom top layer 12" x 12" floor tile with mastic. Brown Sample #4: Silver seal roof coating. See lab attached results. ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com To Northern Industrial Hygiene, Inc. ~ 10/4/07 Tob Site: Peabody Creek RV Park 127 UncoIn St. Space #22 Port Angeles, WA 98362 Contacts: Zenovic and Associates Tracy Gudgel, PE 301 E. 6th St. Suite #1 Port Angeles, WA 98362 Sample #1: Entry floor vinyl with mastic. Brown Sample #2: Homogeneous 9" x 9" floor tile with mastic. Brown pebble pattern. Sample #3: Bathroom top layer 12" x 12" floor tile with mastic. Brown Sam,ple #4: Silver seal roof coating. Jnspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-10270601 Expires - 10/27/07 Please call with results when completed. See attachment. Thank you, 6 &bWffi~ Bob Witheridge, E.F.M. . " 215 SW 153rd StIeet Burfeo, WA 98166 OFFICE: (206) 988-1746 FAX: (206) 988-1971 eMAJL: nihlRCfJeaehelon.com NVLAPtI %GOSH..o Nofftlwest Asbeetes CensuIGIuds 4G& Reed Stn!iIIt Pelt TOlllInsend. VIA 8U6S- Pmjad lm:sian: PeslJaJy Cmek RV~ 122 /.iIIt:It1Itt $I _Bul~ Asbestos Analysis Report _ NtH BsteIt Number. 07.am154 Client Job Number: Turn Around Time: 5 Day C s=tnpfes~ -4 Lab Sample Number. 07.-e14.oD01 aient Sample Number. 1 sample DescrfpUon: VIJIyf wllllIastIc Sampte f.acatIon: Sldryfloor _ -. CGmmenlS. Chedc:ed If SampJe Not Analyzed 0 Sand paaam ItrcNm .. will .....1tacId.aI........ NSldu. AsIIestolf RIlfous CGmpoIIenIE Nort-"'~ fbuUs.QmpoIaents: Non-FIbroas ~ No AsbestG8 DeteCted 3R CeIklfDse 15,. Fiierand Bfnder 1ft SymheUt 4O'lft Vem~ ~~__ m~j QIecMd II Sample ~~ 0 . . .-jft , C6ent Sampfe Number: 2 Sample Desc1fpIlon: rxr Floor TiIIt witII MuIIc Sample t..ocaIIon: tfomo8et- _ &iniPIe comments: Brown m... pllIIIIem *"'1riIb..... fibrva L~ Ilh__.... bfown N8ldue AsbMtQt AInW compcnimlS: ~ fJIInJuS Co,,4)Oi"'= NOD-RDrouS companems: No AsbeStOS D8I8cfIMI fa Ceilrfose M~ Asphd FiJer and S1nder 1~ Filler and BInder 2% Paint 3ft Vinyl FiIJef and BIndef ClIent Sample Number: 3 S8mpIe DesCIfpIkln: t2'"X1Z"" FlaGr'1IIe and MDtic sa,..ra I,Dcalfon: lidhfOClm. YelP""'" SamdB Comlnents: lab Sample Number. Q1-CiGM4.tOG3 Checked Jf Sample Not Anatned 0 Lapr 'I Tan IIb'e8Ired vfnyl ~Fibtaus~ No -".~ Dd8cI!Id ~..htw>tfte FbDus COnIpDnenI5: Non-Fiblou& CCJmDone-nl5: 30%~ 7m6 VInyf Filer and Binder Layer 2 ow.wnJ18 matfC ~~ FIbrous Compoo"...... No Asbestos Det:efad ~ Filtou:s CompaGernIs: a ceIufDsa Non-Flbrous ~efIl$: 88'Jt FUlBr and SiRdet (SamIlfe R!IlII.dls 0llI'I!iiIU!d _ ftBt JllIDll-) Sampled by: Bob ~f.I-t1dp ReceiVed by: Jude CQIIIIIIIRp ReWRued by: Jude CummIngs 181412C01 10181ZGfJ7 1G.'II2e07 ~ J~ e 6- -- ~~ .rude CUrnmmp. t..abormuIy _ Page 1 . '" 215 SW 153rd Street Burien, WA 98166 OFFICE~ (206) 988-1746 FAX: (2OG) 988-1918 EMAtL: nihlnc@escbeton.com NVlApt 200511.0 .. _B~k As~tos Analysis. Report NortIl1iiMI ~ ConaaItan'ia 4G8 Reed StrMt Pall Townsend, WA tasa- Pn:Ijed Lccati'cn: PMbody Owk RV A:dt 121lint::* st. NtH 8atdt Humber: 07~ Cietd Job Number: Tum Arotmd T1me: 5 Day c: SaIni*S AMfyz6d: 4 Client Sample Number. 4 . S8mIlIe DescrfJdJOn: SUI CCdIIg s.mpte l.ocGtIon: Roof comments; Lab Sample Number. @1-OO914..GG04 Chedced tf SampI~ Not AMtyzee 0 Silver. blacfE, I!I.IId 1IIIIIJb8 fIIDibIe!D8llHial Alb6.lOi FiImMaJ compo..... Non-AsbeStGS FibIOUS components: i'Ja..~~4'~M~~'f29~ ~.:sL~. ~J~~~ 2'W. Cellulose ~CGmpooenIS: 30% Asphat Filer Md 8Inder 15.,.. FileT 8fld BiniN ''''91. Coatll'V ,-, ~' SF,.... by: Bob WIIheridge RIIarived by: Jude Ct.tiluinp Rftiewed by: Jude Cummings tOl4liOO7 181112G87 1G1112G07 'T-..a- e ~ - ...... CUindJinp. l.abonIlOry ~ Page 2 " Summary of Inspection Lab reports as follows; Sample #1: Entry floor vinyl with mastic. Brown No asbestos detected. Sample #2: Homogeneous 9" x 9" floor tile with mastic. Brown pebble pattern. No asbestos detected. Sample #3: Bathroom top layer 12" x 12" floor tile with mastic. Brown No asbestos detected. Sample #4: Silver seal roof coating. Silver 5% chrysotile asbestos. Approx. 600 See lab attached results: All asbestos containing building materials with a reading of greater than 1 % ~s considered a hazardous material if disturbed. Removal of any hazardous materials must be abated by a certified abatement contractor which follows the rules of the EP A and governed by Olympic Region Clean Air Agency. During building demolition, it is possible that additional suspect asbestos containing building material (ACBM) may be found with in a wall, floor, ceiling or other areas not accessible at the time of the survey. Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non-asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence. After the facility is completely cleaned out a walk through and re inspection is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the City of Port Angeles Permit Center and Olympic Region Clean Air Agency. Thank you, (5~ LJJ.;,:~wJfo Bob Witheridge, E.F.M. Olympic Region Clean Air Agency 2940-8 Limited Lane NW Olympia, WA 98502 (360) 586-1044 or 1~800-422-5623 Fax: (360) 491~6308 www.ORCM.org ..'" ....... --.,.,....,~ .."."...........".......n.u.o, ........ .... _ '___'.1_'__ "'- , . ,-_. .........................."""...>-.1._.. _ -~ ......^'''~..."..M...'...~ '-., . _ .,._~....,_"'.....'" ....., ."..."",...... , ""I."'.' ....__.. .........._".......,......."',__,__ __ .... , _""' _,... ....." I III"" .......,...,. _ ._...- ."............... Notification of Demolitio.n Permit Jl ~s unlawful for ~ny person to c4lu~e 0" ~now the demolition (0'. nUljor renovation) of lIny structure unless all oshcstos- contAininR hllltcri~ls h~ve been removed f!'Om the area tn be demolished. Wnrk slaall not commence on ~llll....bc.'ltos project or demolition unless the owner or operator hns obtained written ~1)pl"Oval from OR.CAA. A written nf1plic:atioll for a demolitiol'l shall include a ccriificntion that there is no known a~bestos~eontnjnin~ materia) rcmainioR in the nre~ of the structure. Project Site Address: ..LZ LI.. h;'H~/d County: ~ tALt.I.I.n1 CitY:~~Y-Ad"e-l~!. State~ 'tp'~ Zip: 11l3t.7~ Starting Date: II ~ '2. ~ ... ez:7 Completion Date: L ~ - Z ,0;."":. 0'" il<(Therc is a 10 working day advance notification period from receipt ofperrnit application) Property Owner::J:'~Jn t!..G.D/'HJI4.k Telephone:_'t~ 1k7 ~~3r Fax:~'r1-ff(f/ Mailing Address:~1J4?7 -7I9r41At;A~ III/ir City: hYjIfj/1'1' J'_lJkXte. State: .-t.vA I Zip: 1B"Z-Zt2- Demolition ContTactor: 5+5 €-:;!.CA.l/46',#,fl" Mailing Address: 'fi~ ~tdi::. City: 171/"1'"7- A~ Contact Person: ~JA'1 YES NO )L State License #:_s..~ e~t;~e'~2 fJS State:~~A2 Zip:.~a3'~ Telephone: ~ef! :360-11614' lfl3CJ Fax:3t6 ~ q;~-7-~t.TO Demolition by Wrecking or Dismantling? ($25.00 fee) check # nonr-efundable Training Fjre Demolition? (lfyes, attach fire department request for training fire) Renovation, Alteration, Remodelingl Maintenance, or othel' Construction? Asbestos found or suspccted* '" A n ORCAA "Notice of Intent to Remove or Encapllld~te ARbcRtoll" r01:m and appropriate fee fillst be submjl1ed prior to any asbestos removal work. A~be!lt.os removal projects jnvolving demolition must be prefutme(l by $ Certified Asbestos Contractor and al] friable or potentially friable 3sbesLos mllst be removed before any demolition begins. Refer to ORCM Regulation I Article 14 for additional requiremenrs that may apply. AHERA Certified Inspector Ccrtifieation # Asbestos Survey Completed by This approved permit must bo available at the job site F:\COMMON\FoNns\asbeatos\DemoPermit.doc Rev. 10/22/02 Endol'lc US Processing Fee Certification of the Asbestos Survey must accompany this fonn ". Starting Date: .l/ ... "7..""3 ' of!? 7' Cnmplenon J.J8"re: L ~ - L? ... c..-' ~ ,"'(There is a 10 working day advance notification period from receipt of permit applioation) Property Owner:~iM /I'J~~HI/4k Telephone:_ ~W :1k7 -75'S} Fax: 31:.0-1:.57-f'l1/ MaiJjng Address: ~9t!77 - 7d'f ~v~ fI/ 15 City: d/'~A~ J; u/ll/fJ. State:~,,9 r . Zip: 'l:B'Z70 Ji)en1oil~m COI11rador: ;5...,.. f Iif'?!Ul 2A$-r-,._~ Mailing Address: /?fi~ q6S- City:...IbrT- A"J':I:'/p,s Contact Person: Ff'Pf4'1 Telephone: YES NO State License #: ~5 rEg, ~ e'~ 1.. f) ~ State: ~A- Zip:.2U6a- Fax:~'t> - 'Lf.-7- qd.To )L Demolition by Wrecking or Dismantling? ($25.00 fee) check #- nonrefundable Training Fire Demolition? (If yes, attach fire departmentre<J.llest fortrainjng fIre) Renovation, Alteration, Remodeling, Maintenance, or other Construction? Asbestos f01Jnd or suspccted* * Ao ORCAA '":No~ Qf BLl!rtc:nt to R.emove: or Encarqulate Asb1:lIUIS" form and approprime fee ~lLo;t be Sllbmil'lecl prior to any asbestos I'emoval work. AsbcstQs removal pJt)jeds i.nvolving demolition rnU!l[ be preformed by Ii Ceni:ficd Asbestos ConTractor and a.11 friable or potentially mable 3Sbeslos muJ;t be removed hefon:: allY demolition begins- Refer to ORCAA Regulation 1 At1icle 14 for additional rcquircmcn1'~ that may apply. Asbestos Survey Completed by MIERA Certified Inspector Certification # 'This approved permit must be available at the job site Epc10se $25 :Processing Fee CCl1ifiaticm ofthe Asbestos Survey must ac::company this form F:\COMMON\Fonns'asbesltls\DemoPermit.doc R~'. 111122102 Olympic Region Clean Air Agency 2940~8 Limited Lane NW Olympia, WA 98502 (360) 586-1044 or 1-800-422-5623 Fax: (360) 491-6308 www.ORCAA.org . I. M...."........,".... M,._ .....................,..... ".,...._.........._..+'. 'W--....... '" '" r I __.~...........,,'"" r _ _M_ ....'01......' .",._...... ,__.... _" __ulll...v.......I...-................- OR . """"'.". , r - _.0_'" ..-......,....... -......,.-.....-,. ..,,, .. ..,-............ .....~~. " - I ."'M ...,....."....... ""'" . .......-..... Notification of Demolition Permit It is unbl~..1 for ""Y pCr$on to causc or allow the demolition (or ma,ior r~novation) of llny structure unless all asbeS1o/,- containiil~ materials have been ...emove.l f"J'OIQ.f:be nrea to be rlemolished. Wo-rJ, !:Ihsll not (:(lmmenCe on an allbestos pro.icd or delm;litiO'lt unless the owner or operator ball obtained written approval from ORGAA, _ A written application for <I demolition shllll include a certlficatioD that there is no known nsbestos-conblining material remaining in tbe area of the