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Home My WebLink About414 E 12th St - Building ~ i'ORT ~ lO~~~ ~ 'L ~ ~ "l.t\~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Pl.n number Property Address ASSESSOR PARCEL NUMBER: Appll.catl.on descriptl.on Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000369 Date .899721 414 E 12TH ST 06-30-00-0-3-8325-0000- RES DETACHED GARAGE 5/21/04 RS7 RESDNTL SINGLE FAMILY 22777 EXPIRED \ Z/21/01 Owner Contractor DUNN MICHAEL L 414 E 12TH ST PORT ANGELES OWNER WA 983627940 Structure Information Construction Type Occupancy Type Other struct info NEW 576SF DETACHED GARAGE TYPE V NON-RATED GARAGES, CARPORTS, SHEDS TOTAL % LOT COVERAGE CONSTRUCTION TYPE HARD SURFACE AREA NUMBER OF STORIES EXISTING LOT COVERAGE LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE NUMBER OF UNITS 25.00 V-N 1. 00 1537.00 7000.00 576.00 2113.00 1. 00 ....:z:. - -2:.. Permit BUILDING PERMIT -RESIDENTIAL Additional desc 576SF DETACHED GARAGE Permit Fee 386.75 Plan Check Fee 154.70 Issue Date 5/21/04 Valuatl.on 22777 Expiration Date 11/17/04 Qty Unit Charge Per Extension BASE FEE 92.75 21. 00 14.0000 THOU BL-2001-25K (14 PER K) 294.00 ~, ~ -r :::s Special Notes and Comments Proposal wl.ll add a 576 sq. ft. detached garage in the rear 1/3 of the lot l.n the RS-7 for a total lot coverage of 25%. No land use issues are noted. Electrical load calculatl.ons and elctrical permits are required. ~ ----------------------------------1------------------------------------------ Other Fees . . . .. STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Perml.t Fee Total 386.75 386.75 .00 .00 Plan Check Total 154.70 154.70 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 545.95 545.95 .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 penod 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 authonty to Violate or cancel the provisions of any state or local I regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date T \PLANNING\FORMS\1102 15 [11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE \ INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS , I YES NO FOUNDATl0N: . ~ .. . . . J FOOTINGS 1~-1J..!3-(!)1-/ ) 1 , WALLS II") -'J., () - 11 "-/ X:L, FOUNDATION DRAINAGEIDOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT # ROUGH-IN PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER , AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERJOR BRACED PANEL ONL Y) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engmeenng DIVISion) SEPARATE PERMIT #'s WATERLINE I METER SEWER CONNECTION SANITARY STORM 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 ELECTRJCAL - LIGHT DEPT 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R W. / PW/ CONSTRUCTION - R.W ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T.\PLANNING\FORMS\1102 15 [11/1412003] BUILDING PERMIT - APPLICATION Fill out COMPLETELY and in INK. Your application and site plan MUST B COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 ApplIcant or Agent: MIL h 2 r...! 0 u V1 vp Owner: - 5/tMJE - Address: -4 I ~ IE.. I.;l. t" S 1 Phone ~.5-7 tJ 8,~-3 Phone: ;' IE. /::J.. f~ S r . Block: :3 g 1 CIty: PLJI-t A J"I-i I'! k.. S Phone:~ M ., 41./M J ,t ..,D State LIcense #:PN~C: 160 ~xP:~ Phone:/.. 7t> ~/81 CIty: PtJ...r A "'1d-t!-S ZIp: 9f? 1i,;J.. P~J.t AlA-rek."i ZONING: j~ S -7 SubdIVISIOn: ZIp. 983 t.,:2. ArchItect/Engmeer: Contractor pJ--{. Co IS II.J-,. r; /2 e, ') Address: PO 11b-J< 17;). PROJECT ADDRESS: q I ~ LEGAL DESCRIPTION: Lot: /., CLALLAM COUNTY PARCEL NUMBER: fiP Of.. 3 DaD () '3 S? 3 a S- tJ{)~D Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: o Residential Ji(New Constr. 0 Re-roof o MultI-faIDlly 0 AddItIOn 0 Move o CommercIal 0 Remodel 0 DemolItIOn o Reparr 0 SIgn BRIEF DESCRIPTION OF THE PROJECT: City: Exp. Date: o Stove fJ'K Garage o Deck o Oilier rhll / J SIZRNALUATION: S"7<b SF. @$ /SF = $ SF. @ $ /SF. = $ SF. @ $ /SF = $ TOTAL VALUATI9N $ c9:l7 77 ~ VI ~~.1 12.. ~7 ~ - at.{ X2'1' COMMERCIALIRESIDENTIAL: Occupancy Group: No of Stones: i Lot SIZe' -; 000 EXIstrng Sq. Ft. 15.3 7 Total lot coverage ,!)~ % Occupant Load: ConstructIOn Type: r J.. ~....., ~ & Proposed Sq. Ft S"7C::> = TOTAL Sq. Ft .2.' I . '3. APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: ESAlWetland(s): 0 Yes 0 No SEPA ChecklIstrequrred? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Bmldrng DlVlSIOn can proVIde you WIth information on the applIcatIOn and plan subIDlttal requrrements If you have questIOns. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the apphcant. ThIs figllIe WIll be reVIewed and may be revIsed by the Buildrng DIVISIOn to comply WIth current fee schedules. Contact ilie Penmt Coordmator at 417 -4815 for assistance. PLAN CHECK FEE IF a plan check fee IS due It must be subIDltted at tlle trrne the buildmg penmt apphcatIOn and constructIOn plans are subIDltted All other permIt fees are due at the trrne of penmt Issuance EXPIRATION OF PLAN REVIEW: Ifno pemut IS Issued WIthin 180 days of the date of applIcatIOn, the application will expire. The BUIldmg OffiCIal can extend the trrne for actIOn by the applIcant up to 180 days upon wntten Iequest by the apphcant (see SectIOn 107 4 of the UmfOlID BUIlding Code, CUlTent edItIOn). No applIcatIOn can be extended mOle tllan once. I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for thiS permit and understand Ihat d IS my responsibility 10 delermine whal permits are required ,nol I1Y's, and thai I must obtam such permds pnor 10 work. T \FORMS\APPS\BUJldmgpenmt wpd ApplIcant: U.A'! -<JIt}!! U~ Date "1- d q - tJ '-/ PREPARED 6/30/04, 12 42 00 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 4 6/30/04 ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER 414 E 12TH ST SUBDIV PHONE PHONE DUNN MICHAEL L 06-30-00-0-3-8325-0000- 04-00000369 RES DETACHED GARAGE PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL1 01 6/23/04 JLL BUILDING FOUNDATION FOOTING 6/23/04 AP Sam 461-0652, perm1t 1S hang1ng 1n the shed BI2 01 ~30 04 ~Lj') BUILDING FOUNDATION WALL ~ Sam 461-0652 ----------------- -------------------- COMMENTS AND NOTES -------------------------------------- PREPARED 6/23~,__~2~4~~03 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER. INSPECT~ON-T~8KET INSPECTOR JAMES L LIERLY pAGE DATE 3 6/23/04 414 E 12TH ST SUED IV , PHONE PHONE DUNN MICHAEL L 06-30-00-0-3-8325-0000- 04-00000369 RES DETACHED GARAGE PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS :::__::__~_~___::~:::~~:::::::~:::t::::::~:~~:_~~_~~:_:~:~_____________________ , , .1 :~ I ~I :':1 ':, 'I I 1'(<<" ffllCltiel 1... D/JNN 414 E 12th II Pan Angele~ WA 98362.7940 j ~ -, I 1.-' J)D . '7,1. ~t. I 9f ',i ,\~"~1" ~t. 1 (l./f' 'I 'J'1 ! \J , J.. I 1,,1? ! \ ~~1I v I 9 ~1 l.,' Ii V <- ~ 0 't '0 '-' , I - , -- ~ --- ( -- -- S .J..::...~~~ ~- ~ ~r ,.. - -- - - - - - - - - - - - - - - - - - - - - ..,. . - 'Ii. - t/t I : EI-;.v~teJ de..../.... enJ db<-\ _:_ '- .., I I .; ~ t"'1 I . I:;;' ~ /(;( : I I, I I i n." . I :;1' 1_'-1.' : I ;..-4 I I , i I . , ~-. ':' ,. - j I , I I I . t~"'~ Et-'" lit1<<~'~ 1'; 1\.. J! 1\ ': . - \& .",n.; A\~ t ~16".J rf7 ... e" a J :\ 19 \o-1~ L r. CI ... ~ 'I:,~. 'i Jl -"'"-........ ~,-~ --------- -. -. . ~ ---1-- -----t :----~.;}l4-l I I I I I I I l' II ~ltl ~ I I I I I I I jf-7i';). .. I ! j J i)'Jtr pr1' (.., bZ,,<,"t-7 ~ ,'2- * - I I I I :_------ .._--_.~ 1"- I),' J- -f - ----- - , - -.1-10- ~ .&.-..._~- ...----~----,.--.------ ftll'1 ~ VORT ~ .........o~~ 11,.'"' 'L ~ ~ 'l.,ii:,,~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property zoning . . . Application valuation 04-00000500 Date .658000 414 E 12TH ST 06-30-00-0-3-8325-0000- DEMOLITION 6/04/04 RS7 RESDNTL SINGLE FAMILY 100 Owner Contractor DUNN MICHAEL L 414 E 12TH ST PORT ANGELES OWNER WA 983627940 Structure Information Construction Type . . . . Occupancy Type . . . . . DE MO 480 SF DETACHED GARAGE TYPE V NON-RATED GARAGES, CARPORTS, SHEDS Permit Additional desc Permit Fee Issue Date Expiration Date DEMOLITION DEMO 480 SF 47.00 6/04/04 12/01/04 DETACHED GARAGE Plan Check Fee Valuation .00 o BASE FEE Extension 47.00 .... -. - Qty Unit Charge Per ...:t. Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 51.50 51.50 .00 .00 \\\ \" -\ .z _. t~ ....) iI\ .:-t Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. ' Ii/f~!{f D~ Signature of Owner (if owner is builder) (P-?"'a '-/ I Date Signature of Contractor or Authorized Agent Date T:\PLANNING\FORMS\1102.15 [11114/2003] BUILDING PERMIT INSPECTION RECORD CALL 417 -48] 5 FOR BUILDING INSPECTIONS. CALL 417 -4 735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I I PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I FRAMING JOISTS 1 GIRDERS SHEAR W ALUHOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB , WALL 1 FLOOR 1 CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE I PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LlGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT I CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W. I ENGINEERING 417-4807 PW 1 ENGINEERING \, , FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 (,,-Q.:5 -(J4 -J J. , BUILDING T.\PLANNING\FORMS\1102.15 [11/14/2003] III >-3 '" , ~:;;~8E; n", t" "' ; I H", '" '0 I "'",ZZtJ >-3t>J '" '- I t"nt>J>-3", "'''' Ul H , tI:I::d::dtI:J )> 0 0 >-3 , Zt" )>Ul 0", H .. , ~. nUl "'t>J I >-3 tJ 0 , III 0 '0 t>J. ",. 0 n",~ "' ",,,, 0t>J >-3'- 3:0 '" ",C:o OOtJ .. ~~ t"t>Jo .."'~ H t>JUl ' , .. Glo >-3>-30 ow t>J.. t>Jt>J~ 00 t>J t"- tJtJ 0, 3: t>J OOH H UlH t'" Oon '" '" H 1.11, :I: >-3 "' ..; 00)> :I: .. t>JHH 0 , t>J co UlZO wt" Ul C:UlZ: tJ, >-3 0 t"'" t>Jcot" w >-3 3:w 0'" t"1.11 H , >-30 tJj "'tJ HO 8 t>Jt>J 00 UlUl Zo t" c:n , tJ t""' H >-3H Z Ul'" n Gl '->-3 0 nH H 3: '" 00 HZ 3: H 3:Z ZUl t>J Z 3: Ul'" Z )> t>J "'t>J >-3 t" Z t>Jn Ul >-3 n>-3 Ul >-3H ~ 00 "'Z tJ '-<>-3 Z ~n 0 "''''Ul >-3 1313[ii t>J~ t>J Ult>J Ul zZtJ >-3 t>JOlH t" <: t" H t>J "' t" "' 0'0 )>)> >-3Gl t>Jt>J '" '- '" w '- o .." BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.: C-~I-o'7 Pe11l1it # a'" - 500 Date Approved: Date Issued: Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent:---.i1 ; C, h c t'~ I D u Y1 V'\ Phone: AI:>- 7 tJ 8 s'-.3 Owner: 5 2 t-\.. 'L Address: AJ I AI I;: I I ~ fA S't. Phone: City: Pt'J- t lintel/! s '- , Zip: 98' 3& ;t Architect/Engineer: Contractor Phone: State License #: Exp: Phone: PROJECT ADDRESS: ~/~ 1::, /:2 rA u City: .<; t. .. hI- f 111/14 {!'fr-> / Block: '3 ~ ') /i I~ /Jt,'1t.JOf) 111 ~ 1.2,j- tJ~~i) Zip: Address: ZONING: /? 5 - 7 LEGAL DESCRIPTION: Lot: Subdivision: CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof o Multi-family 0 Addition 0 Move o Commercial 0 Remodel A(Demolition o Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: City: Exp. Date: o Stove ...di::: Garage o Deck o Other 1)1' 61;\ /) 1/4. A SIZENALUATION: "i~D SF. @$ /SF. = $ SF. @ $ /SF. = $ SF. @ $ /SF. = $ TOTAL VALUATION $ltrfJ v:! '" f-t:INlL7'l.r<- e.x/~rIYl7 r2J-'Z.'j <- COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: & Proposed Sq. Ft. Construction Type: Existing Sq. Ft. Total lot coverage = TOTAL Sq. Ft. No. of Stories: Lot Size: % APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: ESAfWetIand(s): 0 Yes D No SEPA Checklist required? DYes D No Other: BillLDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with cunent fee schedules. Contact the Pennit 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 pennit application and constJuction plans are submitted. All other pemrit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: If no pemut is issued within 180 days of the date of application, the application will expire. The Building Official can extend the tin1e for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the UnifOlTI1 Building Code, current edition). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not t .e City's, and that I must obtain such permits prior to work. T:\FORMS\APPS\Buildingpermit.wpd Applicant: . 'if Date: J../ -:J. c; - ~ ~ CI1Y OF ~ORTANGELES o WAS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT June 4, 2004 Michael Dunn 414 E 12th Street Port Angeles, W A 98362 RE: Port Angeles Landfill Waste Disposal Application, WDA 04-11; Building demolition at 414 East 12th Street, Port Angeles, Wa~hington We have received your application for disposal of building demolition debris from the referenced site and reviewed the testing results for lead content. Based on the testing results the debris appears to be acceptable for use in the landfill. A copy of your approved application is attached. This approved application must be shown to the landfill 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. Very truly yours, ~ua \~ kt-v Gary W. Kenworthy, P.E. () City Engineer Deputy Director of Engineering Services GWK:tf Ene!.: WDA 04-1] Copy: Ken Loghry Zenovic & Assoc. N :\PWKSIENGINEERI WDAPPLICI04-11. WPD FILE: Landfill Solid Waste Disposal Applications 321 EAST FI FTH STREET · P. O. BOX 1 150 · PORT ANGELES, WA 98362-0217 PHON E: 360-417-4805 · FAX: 360-417-4542 . TTY: 360-417-4645 E-MAIL: PUBWORKS@CI.PORT-ANGELES.WA.US ~ .~~ ----- .--'t:: \\'\ ----- N \3=. . . . /IV /)-11- 01 ~I / PORTANGELESLANDFaL WASTE DISPOSAL APPLICA TION 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: M I C#"f1i--L [)UA.J~ Mailing Address: Lt I c.f JZ.. /2 7'd S...,: POll-.., AN~..i.<..-t~ t.,J/f ~8gb? Contact: JIlAlcFI-4I'>>-<.. ~v'NN Phone: 457 - ();1..f 3> Project Name: G~""-46"'t. /)~()(..,--r-IO-.J Project Location: L.J {<1 ~. I :? ~ 5"?" 2. Other Contacts (if applicable): Consulting Firm: Contact: Phone: ~~v'lc. l Anoc, l,('Ie "'?"~t:-~ a 4J()6-u.... U (7- OS'o 1 U/\.l~D~ Contractor Name: Contact: Phone: Laboratory: Contact: Phone: - IV" L L1~Jt -4 7'O"L t-<'-i) 1'Ne. ~-1 ~-r~l-i. ::lOb- 5"'-1 '7 - 6)00 - -- - ~----~-_._~~~~_._- - --._--------_._------~--_._--- ,- --.-- ~-~- --------..-------...- - City of Port Angelos - Landfill Waste Dj~;posal Application Pago - 1 r----- - . 3. Source of Waste: . Check the appropriate box below and brieny describe the project, process, and/or cleanup that will or has produced the waste requiring disposal. Include the gasoline service station number (if applicable). CERCLNMTCA Remediation Independent Remedial Action Unused Chemical Product Spill Il 'H5.7'-4N6 /(4 -vt6-t ~ 1.3-s.. FOIL !JAW ~6.u Agency Contact: UST Removal )( Other Source: bt~ ..D~N1lJUS'l~ ~ M~ /~ ~ 4. Waste Material Composition: (check all that apply and Include percent of total) . Soil % Foundry Slag _% Concrete/Asphalt % Dredge Sediments _% Preserved Wood % k/ Debris .L1lQ % . 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 Other ~ LP LM--> PCBs ~ Unknown . --.- - --. - ~._.__._-.~--,._---------._-~-- - -- NOTE: Supply any MSDS information with application, if available. City of Port Angelos Landfill Wasto Disposal Application Pago - 2 . . . 6. Estimated Quantity of Waste for Disposal: ~----- 2~ Cubic yards I Drums I 30 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 I & number of discrete samples per composite ~ Number of DISCRETE samples Lf 04/J14A ...: Lb-,4bJl-r.... <WA~~l.-\ 1'9/C. IK.- -r <.t ~1 ( ~-2t.oe ) IY:. Sl(),~ (2- LOt:.4 1/ u"vS) E UCf j:.....~".,,)~ NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 0-25 25 - 1 00 101 - 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 Angclcs - Landfill Wastc Disposal Application Page - 3 . . . . 9. Waste Analysis: The "Dangerous Waste Regulations" (WAC 173-303) shal/ 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 aI/laboratory analytical results, ONOC 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: 6B4 131 ,/70lJ()l}> , b) Provide a narrative as to why the above analytical methods were selected: IJU1.. -ro 46'~ ~ S ?.w{."I"'cni.. 7~ t$ L/~ ~ ~ P,<v,.r( O...v h~6t-1. D4 ~ -d(()(( I" ~~ rz '5 ()rJ f)A.4....J1' </) wi aJ4t,...,. Z'7.;/J VJ 4l0; ~ NOTE: Additional sheets attached: --.k:.- YES NO 10. Soil Classification: (tUFOR PETROLEUM CONTAMINATED SOILS ONLYU) Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check one) Class 1 Class 3 Class 2 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 Por1 Angeles - Landfill Waste Disposal Application Pago - 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 . ities. 7~'f 0u66-LC Printed Name Z-'\J () VI C j- 4ffoc-) L Cv Company b-Z~o4 Date I. ~ ~ 'I. . N IPOllCY_P\ 1 OOO_SW\ 1 009_0 1 WPD City of Port Angeles - Lnndflll Waste Disposal Application Page - 5 JUN~2-2004 09:14 NlJL LABS 2066341936 P.02 NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle. WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Analysis Report AIHA - IH #101861 Toxicity Characteristic Leaching Procedure - Lead (Ph) Client: Zenovic & Associates, Inc. Address: 519 South Peabody Street, Suite 22 Port Angeles, WA 98362 AUention: Mr. Tracy Gudgel Project Location: 414 12th St. Batch tI: 2407465.. Matrix: But Method: EPA 1311n0008 Client Project #:04184 Samples Received: 1 Total Samples Analyzed:1 Lab ID 24041335 Client Sample # 04184A RL mgl L 0.5 Results in mglL <: 0.5 Results in . ppm < 0.5 Sampled by: Client Analyzed by; Holly Tuttle Date: 06/02/2004 DRAFT mg/ L -Milligrams per liter ppm = parts per million Note ; Method QC results are acceptable unless stated otherwise. Bench Run No; 24-0601-6 RL '" Reporti'1J Limit '<:' = Below tho reportillQ limit Page 1 of 1 JUN-02-2004 09:14 NIJL LABS 2066341936 P.03 .NVL Labor;ltories. Inc. 4708 Aurora Ave N, Seattle, WA 98103 Tel: 206.547.0100 Emerg. Pager: 206.344.1878 1.886.NVL.LABS (685.5227) Client Zenovic & Associates. Inc. Street 519 South Peabody Street. Suite 4 CHAIN of CUSTOD' SAMPLE LOG BATCH 10 2407465.00 ). s - NVL e.tdl Number . Client Job Nurnbor (;)1(/ El,{ ~ paL Total SampIa I ~ T.... .......ITI... 0 1# ~~'.peya. .. .. 02-Hrs..' . I'~ o 4.Hns.' .. ~ 01fb 10" PlHse caI_TAT_ - ".~th Q,iys EmaII addnt.. ~.,.. if! ~.,.,-.AIoi.,... Port Angeles PtoJect Manager Tracy Gudgel PnIject a.oc.tion '-I f~ Ii.. { 2 d .5? Phone; (360) 417-D501 Fax: (360) 417..0514 o A8be8tos Air o PCM (MOSH 7400) . 0 TEM CNIOSH 7.0402) 0 TEM (AHERA) 0 TEM (ePA level II) 0 Ohit o A.beseoa Bulk o PlM (EPMKlOlR-93I116) 0 PLM (EPA Point Count) 0 PlM (EPA~) 0 TEM 1Wh' : METALS Del. Umlt Metrix RCRA....... 0 All 8 ~-:- '_ OTotel Metals 1iiHcxn eMS) 0 Ak. F.er 0 Pa~nt Ch!PS 0 Arcenlc (~) 0 Lead (Pb) 0 .. 3 8:;rClP o ppb (GFM) 0 DnnIdnG water 0 Paint Chips (Area) 0 Barium (88) 0 Mect;ury (fig) o~ (Q.I) o OuSUwipe 0 Waste Water 0 Cadmium (Cd) 0 s.Ienlum (Se) O!Nk:keC (HI) o Soil 0 ChromIum (Ct) 0 Siver (Ag) O:Zinc (Zn) .. o other TVpes o Fiberglass o Nuisance Dust U Rotometer Calibration 0 Other (Specify) Of Analysis 0 Silica o Respirable Dust {J Mold/Fungus Condition Of Package: 0 GOOd 0 Damaged (no spilage) 0 Severe damage (spiflage) Seq.t# tabID Client s.mpIe NI.W11ber CoInmeta Am 1 h<.f18"fA p(~-4S4. ..-'-4,... .~L"'~ 2 3 .. - .. 5 -- 6 - 7 8 9 ...-. 10 - 1f -....- 12 ----J=-~-~ ------- 1---- 13 '- ----- 1---- -. - --.-- 14 .-t~_n-. 15 - _ ,print B~_... .Sam.....by.~." ~~.(. R.!'lnq~by T' ~--~'I-" ..~.ceivod by I I Aoa.lyzed by I Results CaRod by r ~~ ~;~ -. I --_no I Sj..cial 1..,,,,,,llono: ...;;, ,...;.~ .. ....;'-:-i ...;,.,.. wi be ...;...:-;.: (2) -t. ..., ~. I ~ Time. 5".2,ori i lttaAt.;.l S'~.'Cf:..~ ...----. ...-.-----, - roT~ p.m TOTAL P.03 CITY OF PORT ANGELES LIGHT DEPARTMENT ." ., EIlECTRICAL PERMIT N? 15559 Port Angeles, wasb1ngtonmm../I..=..z::....m__..m...mm__.....__.m, 1~~ In accordance with the City Ordinance to regulate the installation, extension, or repair of elec- trical equipment in, on, or about any building or other structure in the City of Port Angeles, per- ~~:~~~...~~~~~~:~:::::=::-= Light OUtl.tB.......................................... S.rviee. volts ..12:9j-?:'f...9..... Type 01 Wiring: Receptacle Outlets.........._...n.____n_....... NS-ioZ'.Wwirler~B ....J.~;~....................................................' Armored Cable ..-.........................-. KW u.. Non-Metallic ---....-.....-.................-. Dryer, r ____nnn........_._.,.!,......____.____.____ .B: r!.d /1 Knob & Tuben...............___m........._ Range, KW ___d_n________n__.;.__n__ Main fuse..... -.... .......-n Water.. Heater: Enclosure ......C_T~m....n___ . KW.....b.......E...... ................. Heat: KW...:.......9. . . __. __.... Motors: sIze, vol s and phase: Type of wiring: Entrance Cable __..........___.............. Rigid Conduit ............................... Metallle Tubing ........................... Current transtormers: No. & Size_.n___________________nm........... Ser. NO...nn..n................._n..n............ Ser. No. ._......_...000000........_00_.00..00__...._. Ser. NO.._..___.n.................................... Rigid Conduit ............................... .....Metallic Tubing .............___....h._... (.../' Raceway .........._.__........._..............._ Circuits. Light-_....._..n.............n............ Utility............................................. lIeat n___.................................._...... Range ................._____._________............. Water Heater .............____.............. Motor ._._........n.................n.._h_.... Drycr..........._.________.._........................_ Furnace 00........._..........__........_........... ", Remark:~ta:..~~~:...~~.y..:~~.A:.;:~:~__.:::.__...mmm.m___...m~.~~~:..~::...:.~.:~.:.~:__.:::.:::~.:~:: .;~_=.~~_.~~~~~:::::.:.::.~..--.:--....m::~.~.~:...~.~.~.~~~.~:..:~~__m.m...--.--m~~..JlZ1l:..::--_.:...........m..:---m:_._-- NOTICE-Current must not be turned on until Certificate of Inspection has been issued. It work is to be con. cealed due notice must be given the Inspector so that work may be inspected before concealment. NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPEC-nPI\l., ~ .. \ ' 3 O'-LA__~~ r- ELECTRICAL PERMIT ..-/ .'. .._ 11'r~ (.,i -r-/J . Address....._............._........................................~....._....._.__..........___.___........____._..........._..... N? 15559 Owner ..n...._.n..__nnn_..n_......._......_.._......_......_.._n..............00_....00.................................. TenanL....n.nnnnn_nn_n..._..n.nn____._.n...nn_.nnn_nn Date..._....____._.._.._.........._......_._.._._......... ~\ Wiring Contractor ________..__________........__._................._..___._._____............................._............................. By........._.___._..........................................._.. ...... NOTICE-Cf. nt must not be turned on unt:ll Certificate of Inspection has been issued. If work is to be con. cealed due notl must be given the Inspector so that work may be inspected betore concealment. . .~ 1M Olrmpic Printers, Inc. .-'