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CITY OF PORT ANGELES
DEP ARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
07-00001113 Date
434147
220 W 8TH ST B
06-30-00-0-2-6632-0000-
DIANE MARKLEY
DEMOLITION
UNKNOWN
4800
Owner
Contractor
DIANE MARKLEY OWNER
PO BOX 2835
PORT ANGELES WA 983620333
(360) 460-5639
Structure Information 000 000 DEMOLISH & REMOVE GARAGE
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
DEMOLITION
DEMOLISH GARAGE
111823
50.00
9/28/07
3/26/08
Plan Check Fee
Valuation
Qty Unit Charge Per
BASE FEE
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
9/28/07
.00
o
Extension
50.00
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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 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
f\
~ignature of Owner (if owner is builder
T:\Policies\1102_15 building penni! inspection record05.wpd [1/4/2005]
Date
BUILDING PERMIT INSPECTION RECORD
s
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 4]7-4735 FOR ELECTRlCAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES _
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY 1FORK BEFORE :::
. Il'l'SPECTEDANDACCEPTED. POST PERMIT IN A CONSPJCUOUSLOCATlON. \JV
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE I>ATE ACCEI'TEI> COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS/WALLS
FOUNDA TJON DRAINAGE / DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.l
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
DRYWALL (INTERJOR BRACED PANEL ONi 1')
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
ROUGH-IN
HEAT PUMY lFURNACE/DUCTS
GAS LINE FINAL DATE ACCEPTED BY:
WOOD STOVE / PELLET / CHIMNEY
MANUFACTURED HOMES
FOOTING / SLAB
BLOCYJNG & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEP ARA TE PERMIT #'s SEPA:
P ARKING/LIGlnING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYfUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTlUCAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTJON - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 4] 7-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING 12-21-01 J"(.;(../
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T:IPoliciesll ]02 15 buildmg permit mspectlOn record05.wpd [lf4/2005]
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BUILDING PERMIT - APPLICATION
Date Issue .
Fill out COMPLETELY and in INK. Your application, prescriptive energy
form, plans, specs, and a 8 ~" x 11" site plan MUST BE COMPLETE to be
accepted for review. (360) 417-4815 FAX (360) 417-4711
Residential projects: submit two sets of plans
Commercial projects: submit three sets of plans
Owner's Address
2Js35
Phone
Phone
Por-T ~5~
State License #
( 3 roo)
4-(06 - 5bS'l
Applicant or Agent 1) I P'rN E
Owner Sa yy\p_
p
tJ\ A. R~LEY
o. Bo~
S~li
Contractor/Engineer's Address
PROJECT ADDRESS: 2. 2- 0
lJA
Qg3h'L.
Contractor/Engineer
Expires
(d..a-J 6~
Block: 2&:. ~
00 3GOO
Phone
~v +- ~ LtJA ZONING: eN
Subdivision:
LEGAL DESCRIPTION: Lot: 5
CLALLAM COUNTY PARCEL NUMBER:
o ;;)"0l. 3~
OZl c> b
TYPE OF WORK
o Residential 0 New Constr. 0 Re-roof 0 Stove
o Multi-family 0 Addition 0 }1ove 0 Garage
o Commercial 0 Remodel }i( Demolition 0 Deck
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT:
(X r wHI h
e.lec..h-;c~ tv lV\ DkM1Q.'-k\~~ wi.
COMMERCI L/RESIDEN lAC Occupancy Group:
Existing Structure(s) basement will be s~~1p.t~T &
}'l floor Sq. Ft. &
2nd floor Sq. Ft. &
3rd floor Sq. Ft. &
Accessory Structures Sq. Ft. &
Existing Structure(s) TOTAL Sq. Ft. & Proposed Structure(s) TOTAL
TOTAL of existing & proposed structures
Maximum Height of Proposed Structure(s)
SIZEN ALUA TION
SF. @ $ /SF. = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $
Lf80D. --
Are you planning to install a lawn sprinkler system?
(Divide Total Structure(s) Sq. Ft. Footprint by Lot Size Sq. Ft.)
V ALUA TlON 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: The plan check fee must be paid at the time the building permit application is submitted. All other permit fees are
due at the time of permit issuance.
EXPIRA TlON OF PLAN REVIEW: An application for a permit for any proposed work shall be deemed to have been abandoned 180
days after the date of filing 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 oftime for additional periods not exceeding 180 days (90 days for commercial
projects) each. The extension shall be requested in writing and justifiable cause demonstrated. (IRC/IBC 2006 105.3.2)
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 what permits are required, and that I must obtain
such perm<<s Ptr to work. -
Date cr ~~J D1- Applicant nl~ '(:sn-J~
T:\FORMS\BUILDING DIVISION\BldgPermitAppl.-2006 CODE - backup.wpd
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FORTANGELES
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WAS H I N G TON, U.S. A.
Public Works & Utilities Department
LV D:A- D7 -4Cf
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-
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October 24, 2007
Diane Markley
P.O. Box 2835
Port Angeles, W A 98362
RE: Port Angeles Transfer Station - Landfill Waste Disposal Application, WDA 07-49;
Building demolition (220 West 8th Street)
We have received your application for disposal of building demolition' debris from the
referenced site and reviewed the lead paint 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.
.'-'.., ',' ".-.....i.....'.l...._l...:..'~'.-.....;
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.
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Please call if you have questions.
Sincerely,
~~~r
City Engineer
ss:tf
Encl: WDA 07-49
Copy: Claudia Slromski
N:\PWKSIENGINEER\WDAPPLIa07-49
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
i-?"
te,r~ '1...... It \ '3
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wP A- 07 - Li ~
PORTANGELESLANDFaL
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:
D-L~1U WL(Ur~
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2. Other Contacts (if applicable):
Consulting Firm:
Contact:
Phone:
Contractor Name:
Contact:
Phone:
Laboratory:
Contact:
Phone:
N \J L ~'oD v-t'v-+-O'1-; .Q ~ I ~ C- .
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Page - 1
City of Port Angeles - Landfill Waste Disposal Application
1---
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 Agency Contact:
Independent Remedial Action - UST Removal
Unused Chemical Product Spill Other Source:
~ o....,v- t'J..- q Q ~r0. 0
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4. Waste Material Composition: (check all that apply and include percent of total)
Soil % Foundry Slag - %
Concrete/Asphalt % Dredge Sediments - %
Preserved Wood % ~ Debris \"60 %
Coal Ash % Other (list)
Wood Ash % - %
-
- %
NOTE: Total must equal 100%.
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
PCBs
Other
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:
Cubic yards /
Drums /
\'2.-
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:
/' 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 3 & 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:
0-25
25 - 100
101 - 500
501 - 1000
1001 - 2000
>2000
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
=
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
=
=
=
=
=
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:
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NOTE:
Additional sheets attached:
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
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)
~ 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.
\)lCll9._Th~
Waste Generator Signature
U(~~t M A/ K-~
Printed Name
Company
\ D I L.-Y I D"1-
Date
N:IPOLlCY _P11 000_ SW\1009_01.wPD
City of Port Angeles - Landfill Waste Disposal Application
Page - 5
NVL laboratories, Inc. &
4708 Aurora Ave. N.. Seattle. WA 98103 A HI>..
Tel: 206.547.0100, Fax 206.6341936 AIHA .IH#101861 ~~
Analysis Report ACClfiED!'1l'ED
www,nvllabs.com WA. DOE#C1765 LABORATOR\f
Total Lead (Pb)
Client: Diane Marklev Batch #: 2715169.00
Address 912 West 4th 5t Matrix: Paint Chips
Port Angeles WA 98363 Method: EPA 7000B
Client Proiect #: N/A
Attention: Mrs. Diane Marklev Date Received: 10/24/2007
Project Location: NJA Samples Received: 1
Samples Anaryzed: 1
Sample RLin Results Results in
LablD CHent Sample # Weight mq/Ka in ma/Kg ~-=rcent
27098699 pai~t chip-01 0.2007 46.0 1200.0 0.1200
Sampled by: Client
Analyzed by: Michael Dougherty
Date Analyzed: 10/24/2007
DRAEJ
mgJ Kg =Milligrams per kilogram
Percent;;; Milligrams per kilogram /10000
Note: Method QC results are acceptable unless stated otherwise.
Unles.s otherwise indicated. the condition of ~II samples vyas acceptable at time of receipt.
Bench Run No: 27-1024-01
RL = Reporting Limit
'<' = Below the reporting Limit
Page 1 of 1
E~_~,-~ (; H 1~]
2715169 00
October 23, 2C--
NV_ Labs
4708 Aurora Ave. No.
SeatEie, WA S8~03
Dear Sirs;
ErlC~C5ed p\scse fir:ci paint 5G'-"""Jles .~~~~ a c--:ge J c- ~::--HshinQ at 220 V'-Ie:'
8~h St., rn Port ;~'1ge'~<}, VVa. lam 1.'-:> owrs"" of tl.." gc--,?"" and :;",QQ.j the pai~t
tested Tor [020-j 50 ! can dispo~'-" crf the -1...,hris ti1 "'-:: City of Port .:lr-~~les landfill.
1 am :"Q~I ~~<;ting a 24 hour t\..'-- around. My cl"o~k f-:- "'''';0.00 is enc1o~:'-:1.
Pfeass contact me by e-maG~: O::'--lrkr~ -:- r.lC!v....-"llbie.com
caH phore: (380; 460-5639
~ian-e ~'v;arkjey
912 V\iest 4th Si'-~"";
Port Anoe;ss, WA ,....o'?a1
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