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Home My WebLink About918 Caroline St - Buildinge(7!) itucvago CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 06 00001257 Date 11/20/06 Application pin number 048867 Property Address 918 CAROLINE ST ASSESSOR PARCEL NUMBER 06 30 00 5 8 -0095 0000 Tenant nbr name OLYMPIC MEMORIAL HOSP Application type description PLUMBING REPAIR Subdivision Name Property Use Property Zoning COMMERCIAL OFFICE Application valuation 1800 Owner Contractor OLYMPIC MEDICAL CENTER LANDSCAPING BY COCKBURN 918 CAROLINE 4950 SEQ DUNGNESS WAY PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 681 0644 Permit PLUMBING PERMIT Additional desc Permit pin number 91058 Permit Fee 57 00 Plan Check Fee 00 Issue Date 11/20/06 Valuation 0 Expiration Date 5/19/07 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 ECH PL- EA LAWN BACKFLOW 7 00 Fee summary Charged Paid Credited Due Permit Fee Total 57 00 57 00 00 00 Plan Check Total 00 00 00 00 Grand Total 57 00 57 00 00 00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes \A null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned 1 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 �1 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 constru S of (contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T•\Policies\1 2.15R [1/05] q\, CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. INSPECTION TYPE PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE RESIDENTIAL CONSTRUCTION LW PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417-4750 BUILDING 417 -4815 T•\Policies \1102.15R 1 /05J PERMIT INSPECTION RECORD KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE CONSTRUCTION LW PW ENGINEERING I FIRE DEPT PLANNING DEPT BUILDING I I I I I I I I COMMENTS FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO 1 I 1 I 1 I I I Applicant or Agent: Owner: O/ i.11 MP[vtvvia/ N p Address: (ct c.v f at. r Architect/Engineer Contractor vw-Ascr e. hc:., State License 1431 Gc.) Address: Cl E --Cr4W% rA1nc r City .SF'e/; PROJECT ADDRESS 7/g Casa A v�ictic LEGAL DESCRIPTION Lot: Block: Subdivision. CLALLAM COUNTY PARCEL NUMBER. RK. New Constr Addition Remodel Sign y BRIEF DESCRIPTION OF THE PROJECT TYPE OF WO Residential Multi- family Commercial Repair 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 FAN(360)417 -4711 Re -roof Stove Move Garage Demolition Deck o Other COMMERCIAL/RESIDENTIAL. Occupancy Group No of Stories: Lot Size: Existing Sq. Ft. OA BUILDING PERMIT APPLICATION City Phone: Total lot coverage PLANNING USE ONLY ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other Occupant Load. Proposed Sq. Ft. Phone: Z: Phone SIZE/VALUATION SF /SF SF /SF SF /SF TOTAL VAS UATIO 6 Date: Construction Type TOTAL Sq Ft. FOR OFFICIA SE V LY Date Rec. it Permit Date Appro '719B, Date Issued: 1 1 1 i "�/Lg Zip 7F-4' Exp J/ 8iZ Phone: aff-0t3� Zip Fp ZONING C vt`t4 f1 &A au h/ -CJA C 4.2 APPROVALS PLAN BLDG DPWU FIRE. OTHER. 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 date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once. 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 the City's, and that I must obtain such permits prior to work T•\FORMS\BIdgPennitfonn.wpd Applicant- Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Owner OLYMPIC MEDICAL CENTER 918 CAROLINE PORT ANGELES Permit Additional desc Permit pin number 89946 Permit Fee 215 00 Issue Date 11/01/06 Expiration Date 4/30/07 Qty 1 00 3 00 T\Policies \1102.15R [1/05] WA 98362 Unit Charge Per 50 0000 ECH 55 0000 EA Fee summary Charged RIGHT OF WAY Permit Fee Total 215 00 Plan Check Total 00 Grand Total 215 00 CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00001181 115826 918 CAROLINE ST 06 30 00 5 8 0095 0000 PUBLIC WORKS UTILITES COMMERCIAL OFFICE 0 Contractor C &J EXCAVATING PO BOX 430 CARLSBORG (360) 683 7741 Plan Check Fee Valuation RIGHT OF WAY PERMIT STORM DRAIN C/B Paid Credited 215 00 00 215 00 00 00 00 Date 11/01/06 WA 98324 Extension 50 00 165 00 Due 00 00 00 00 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 or work is suspended or abandoned fora 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 constructio 1 I /1 0 c Signat/re of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE T•\Policies \1102.15R [I /05] RESIDENTIAL CONSTRUCTION ILW PW/ ENGINEERING 417 -4807 FIRE 417 -4653 I PLANNING DEPT 417 -4750 BUILDING 417 -4815 PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO 1 I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO I I I I I I I I CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT. I PLANNING DEPT BUILDING I I I I I I I I Application Number 06 00001228 Application pin number 432060 Property Address 918 CAROLINE ST ASSESSOR PARCEL NUMBER 06 30 00 5 8 0095 0000 Application type description ELECTRICAL ONLY Subdivision Name Property Use Property Zoning COMMERCIAL OFFICE Application valuation 0 Owner Contractor OLYMPIC MEDICAL CENTER 918 CAROLINE PORT ANGELES WA 98362 Qty Unit Charge Per 1 00 61 3000 ECH EL COMM ALT <5 CIRCUITS COMMENTS /ACTION NEEDED CITY OF PORT ANGELES PUBLIC WORKS ELECTRICAL DIVISION 321 EAST 5TH STREET PORT ANGELES. WA 98362 OLYMPIC ELECTRIC 4230 TUMWATER PORT ANGELES (360) 457 5303 Date 11/14/06 WA 98363 Permit ELECTRICAL ALTER COMMERCIAL Additional desc OLY EL PRK LOT POLE LTS Permit pin number 90514 Sub Contractor OLYMPIC ELECTRIC Permit Fee 61 30 Plan Check Fee 00 Issue Date 11/14/06 Valuation 0 Expiration Date 5/13/07 Fee summary Charged Paid Credited Due Permit Fee Total 61 30 0 UC 30 r- •00- 00 Plan Check Total 00 00 00 00 Grand Total 61 30 6130 00 00 410Pf C,g C. 0 TUMWATER Extension 61 30 r< i DITCH ROUGH -IN COVER SERVICE CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FINAL GENERAL COMMENTS: ELECTRICAL PERMIT INSPECTION RECORD I I I I I I I I I I l r PW- um.15I4961 rJ ~ORT ~ ~...~~ ~,.~ "--~ ~ ~C~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 32] EAST 5TH STREET, PORT ANGELES, WA 98362 Applicat10n Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdiv1s1on Name property Use Property Zoning . . . Application valuation 04-00001160 Date .603480 918 CAROLINE ST 06-30-00-5-8-0095-0000- DEMOLITION 12/15/04 o ;(" ~ ~ COMMERCIAL OFFICE 7000 Owner Contractor OLYMPIC MEDICAL CENTER PRIMO CONSTRUCTION 918 CAROLINE PO BOX 296 PORT ANGELES WA 98362 CARLSBORG,WA SEQUIM WA 98382 (360) 683-5447 Structure Information DEMOLITION OF EXISTING BUILDINGS Construction Type . . .. TYPE V NON-RATED Occupancy Type . . . " BUSINESS:OFF/PRO/MED/REST Permit Addit10nal desc Permit Fee Issue Date Expiration Date DEMOLITION 47.00 12/15/04 6/14/05 Plan Check Fee Valuation .00 o Qty Unit Charge Per BASE FEE Extension 47.00 -Q - Fee summary Charged Paid Cred1ted Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 plan Check Total .00 .00 .00 .00 Grand Total 47.00 47.00 .00 .00 ~ hJ DA-- (!)4-1 q (\ ~ r !4 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 ot presu to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance f con ruc ion. Signature of Owner (if owner is builder) Date T \PLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY Date Rec i{} -I?; -01-/ Pelmlt #, f!Pi:J -, [~O Date Approved - U " 1)... 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 Date Issued twd~l 0~~ ~~ c;+ City: Yc..t' + Phone: Phone: '3GJ. <...L n .If Yfj tD'n}4~ Zip: 'i~3c.~ Phone: Applicant or Agent: Owner:~ ~t 'c. Address: q 3 9 Architect/Engineer: Contractor '"1' 1\). ~ u State License #: Exp: Phone: Zlp: ZONING: Address: City: PROJECT ADDRESS: q,~ l j)( 6~ s\- LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: Block: Subdivision: Credit Card Holder Name: Billing Address: Credit Card Type VISA MC # TYPE OF WORK: o ResidentIal 0 New Constr. 0 Re-roof 0 Stove o Multi-fannly 0 Addltion 0 Move 0 Garage o Commercial 0 Remodel 0 Demolition 0 Deck o Repair 0 Sign "'~ O~er BRIEF DESCRIPTION OF THE PROJECT: ~ City: Exp. Date: SIZEN ALUATION: SF.@$ /SF.=$ SF @ $ /SF. = $ SF. @ $ /SF. = $ TOTAL VALUATION $ 7000"-- COMMERCIAL/RESIDENTIAL: Occupancy Group: No. of Stories: Lot SIZe: Existing Sq. Ft. Total lot coverage Occupant Load: & Proposed Sq. Ft. Construction Type: = TOTAL Sq. Ft. % PLANNING USE ONLY: APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: -; l The Building DIVISIon can provIde you with informatIon on the application and ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: plan submittal requirements rfyou have questions. VALUATION OF CONSTRUCTION. In all cases, a valuation amount must be entered by the applicant. Tills figure will be reviewed and may be revised by the Buildmg 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 pemnt application and constructIOn plans are submitted. All other permit fees are due ai-the time of permit issuance. EXPIRATION OF PLAN REVIEW: lfno pemnt is Issued within 180 days of the date of applicatIOn, the application will expire. The Building OffiCIal can extend the time for action by the applicant up to 180 days upon written'request by the applIcant (see Section Rl 05.3.2 of the International Building/ResIdenual Code, 2003). No applicatIon can be extended more than once. T:\R VESS\BLDG- f0l111s-brochures\2003- B uildmgpel111l t wpd Applicant: Date: IQ. 1'( "uy I hereby certify that I have read and examined thIS application and know the same to be understand that it IS my responsibility to determine what permits are required ,not the CIty' ': ,~ ,~{ ,~ " " ~ " ,~ .. , ,', , ~ORT.ANGELES WAS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT August 26, 2004 Olympic Medical Center line Street Scott Bower, Facilities Manager Port Angeles, W A 98362 \ ' RE: Port Angeles Landfill Waste Disposal Application, WDA 04-19 Building demolition' at 918 Caroline and 324 Race Street, Port Angeles, Washington We have received your application for disposal of~uilding 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. -0 -. ~ ~ ~ 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. =so ~ Very truly yours, \b'i;:~r City Engineer Deputy Director of Engineering Services ~ GWK.if Enc\ WDA 04-\9 Copy. Ken Loghry ZenoVlc & Assoc. N IPWKS\ENGINEERIWDAPPLICI04-19 WPD FILE Landfill SolId Waste DIsposal Appllcallons 321 EAST Fl FTH STREET · P. 0 BOX 1 150 · PORT ANGELES, WA 98362-0217 PHON E 360-417-4805. FAX 360-417-4542. TTY 360-417-4645 E-MAIL publlcwol-ks@cltyofpa us 1'- . . . ' ~ pORr -4.v. -I.~~ '\~~ ..~~ ~~ if ~At(O . W~- 04-2D PORT ANGELES LANDFILL WASTE DISPOSAL APPLICA TION To: City of Port Angeles, City Engineer 321 E Fifth Street P.O. Box 1150 Port Angeles, Washington 98362 NOTE: Phone: (360) 417-4803 FAX: (360) 417-4709 All questions must be answered for waste to be approved. 1. Generator Information: Company Name: Mailing Address: . Contact: Phone: Project Name: Project Location: (j/';YMIJIC ~1CA-L &d~ Of "3 'L U4~l--' ^"k.. S'1 ~1l.-1 4/IJ0'i-1h-~ 1 wA 9 f3 Z 6 Z S'CGI-t'7" g()~) ~}l.,I-t/~ tbfA/\/;4&{,,e A"JUY'l ~IHA-tlo~ 7&:> ;U I 5'" -d!. 1) -( ~ lJ IV\../\" J 2. Other Contacts (if applicable): Consulting Firm: ~OV(G d J:)(JOG, :tNG . Contact: ~~y GJOC"~(.. Phone: ~J7""'05d I Contractor Name: UN~C>wN Contact: - Phone: - Laboratory: NLI L (. I.OS()lt4-;1'blZ-'~} :t/IJG Contact: j\1'cl tlf ' Phone: 9-66 -S'f I.JO J 00 t . - ---.--------- . ----- ~ - - ---------- --- --- -- ~- . - - -- - - - ---- ----_. Clly of POl1 Angelos - Landfill Wdslo DI~;p()~)a' Appllcn!ion PilOO - 1 r . '. --- . 3. Source of Waste: , , . Check the appropriate box below and brieOy 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 Agency Contact: Independent Remedial Action - UST Removal Unused Chemical Product Spill X" Other Source: /;J~~ 1f0/t:. -(;.......;q 14ov;/z- f ~ :;;r; <k td~ aoS4c~_ 4. Waste Material Composition: (check all that apply and Include percent of total) . Soil % Foundry Slag _% Concrete! Asphalt % Dredge Sediments _% Preserved Wood % \() Debris .l.12a1o Coal Ash % Other (list) Wood Ash % _% _% NOTE: Total must equal 100%. 5. Waste Material Contaminants: (check all that apply) Gasoline Metals Diesel Solvents Heating Oil PCBs Unused Motor Oil Used Motor Oil/Waste Oil ~ Other LtI,4/j , -7C L-j> Other Petroleum Product Unknown -- - - ----- - ._--~- - ------- - ------- ~ NOTE: - -- -- - --- --------- ---- -. --- Supply any MSDS information with application, if available CIty of Port An{Jdos Landfill Wasto Disposnl Appllcntlon Pngo . 2 , . 6 Estimated Quantity of Waste for Disposal. I),) Cubic yards / Drums / 62::> 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: ~ . t One time Monthly Ar:lnua~ 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. ( 2- S- Number of COMPOSITE samples & number of discrete samples per composite ~ Number of DISCRETE samples Ii) t)<..f 2~~v4 ~. ~AA<PDS/"1'l S4r--. PL'i. ~ ./l.(J~ ~~ cY :5"70 -MJCi I ,bo.,: ~'V\ I a l..U6 - Z & (..i)..t-', 2~ ,.L..t ""tA---\ I ......>~ C> Lf22b I.S -- ~c?611''<. 614IMP~ tfA.(j~ ~ o.-c ~lfJlt\J~ ("2 toC47o.~ fi.'f~ 1A.1 "'-' Qw~ ~)C r.// V'~ ~ I"\J U; ~ ) ) 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 Angelos - Landtlll Waste Disposal Appllcallon PfI(JO - 3 '9 Waste Analysis - - - -- ------ ~-- ----- \ . The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine the appropnate analytical requirements for waste characterization. Ecology Publication #91-30 (Revised Apn/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, QNQC 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: (ifJA 7/')00 ,g b) Provide a narrative as to why the above analytical methods were selected: bUtt.. i, L. !t.{,(}( ~ (), 9.-tvc7"~ Ati4 ()~ ~t.:):H.~ ~ d /b4~ h!~ UG-r:CJ 7'~ t.Aft~ g ""\J .., #<t: . NOTE: Additional sheets attached: ~ YES NO 10. Soit Classification: ("'FOR PETROLEUM CONTAMINATED SOILS ONL V'''') Based on the analytical data and Ecology Publication #91-30. the soil classification is: (check one) Class 1 Class 2 Class 3 Calculated Hazard Index 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) --L Dangerous Waste (OW) Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW) ~ and Waste Code: [xtremely Hazardous Waste (EHW) and Waste Code' --- -~-- ----- ---- --------- -- City of POlt Anuelps Landfill Wllslo Disposal Appllcclllon Pogo. 4 - ~- . . . 12. Certification: We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All information provided is corr and the endosed analytical results represent the proposed waste material to the best 0 0 bilities. %~'1' c(ua41?L Printed Name Z1NatJIL ; 60mpany ~DLJ :11VL 8- 2--4 v' 0 t.t Date ')1'1" . I ! ~ . " City of P~rt ~~gej~~~ApP'~oval: '., ... "~~)"(" - ~ '':'~::':o~''f~-4t>~4~..;.,,':..<'~...'''' ...... "..." ... ~...^~/~...... >"''S~~'>~.r{<..<.tP'''f~"....t.:f.."=:t',,,,~/<)... ~" ....." 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"...) ,..... .....,,>,;~ ..Si'Pc.~" ..."'........ ~"",...<..,,, -:- ) . ....... ~ ......... -:. ;'}.'.. ;~f;(""" :;;"" ".., ..~...... .. .,,;../{:<.......... ..:;...(...,o.}t"';;;{"'-.rj.i~1; "<...\::... .... :-- .. ~ . :.. ... ... .. .....;"..<..<-.;,.[~)i: "'rf:)~<-;:~/ ,,':.... ..~..-::..,. Y{"":>:"..~~ ~,{~::'7.0~W~>z;.:u...;- ^, , < " ',,,,~ $">;':>~>'~'l:<:;;';"~'>'~'J"" ;,:",':,,~,;"lY~">':$;$'~;!p~:,:('~,;;<, '''.:;''::':'' ...... "'<''')~'';-,~..->/l~'''< >.......':. ..,..'" ....'..> ... N~'" ",~,:-....~<~..t.r-/~~;::?/'>l"~"~,,, .. :-...... ............ " .... ;., ......... <.... ..... / , , ;. .. "') -:,...... ..~:-::. ~\~ "': .....y:-..r..v / : ... ..~.." .......>$...~...<{.......\..~..$ ....... ~ ...," ~ ~~, ?~~~ :~:l;~,:{ ,S~:: :~.... ,'" .. .. .. ...~.....y ~)";, ~\::~:S*JP~""}~"$t....... ... " .. '-:-..:: ~ ..:'" v;{..:,,~~~~@;.t ~~;:::~;". ' (.. ^) . ..'.. y.... .. "'''~''~y$:~..~..JtJ.''''''' > .. ....... ............. ",'" '''~>''''1--11'''h:~; <"~: ," ^w"" :..^;..r::..~5t~f~.....;~;..... .: ....";..)~/Y'.......... ~... . , , , " . l , .... ......... .. ............ ""...... .. -.. .. ".. .:........{..~ ,,:../;.. .... "".. .. .. "; ?;...~/}z~...:"':"".. )... .. ... .. :.... ~.)"..":,.<;~..f~~;?::/.......~ ":...... '" .... <.. ....; <..~:~m~~t::-:.."''''~~...' ." ....,....... .. ..<:0 .. n, > , , " > , City ot Por1 Angelos - Londtill Waste Dlsposnl ApplicatIon Pago 5 NVL Laboratories, Inc. '0 4708 Aurora Ave N, Seattle, WA 98103 AIHf>.. AIHA - \H _nvlronmental L_d Tel. 206547.0100, Fax 2066341936 and Induatrlal H)'glen. Analysis Report ACCREDITED www nvllabs.com #101861 LABORATORY Toxicity Characteristic leaching Procedure - lead (Pb) Client Zenovlc & Associates, Inc. Address 519 South Peabody Street, SUIte 22 Port Angeles, WA 98362 Attention: Mr. Tracy Gudgel Project Location' 780 N. 5th St., Sequim, WA lablD 24{)6{)6~-4 24060615 Client Sample # Q42-eBA 04266B Sampled by Client Analyzed by: Holly Tuttle Reviewed by: Nick Ly Date Analyzed: 08/11/2004 Date Issued: 08/11/2004 mg/ L =Milligrams per liter ppm = parts per million Note Method QC results are acceptable unless stated otherwise Bench Run No 24-0810-15 Batch #: 2410855.00 Matrix: Bulk Method: EPA 7000B Client Project #:04266 Samples Received' 2 Total Samples Analyzed:2 RL Results Results in mg/ L in mg/L ppm (T.5 0-:0 0.6 0.5 0.7 0.7 RL = Reporting Limit '<' = Below the reporting Limit Page 1 of 1 ,. 'NVL Laboratories. Inc. 4708 AurOfI1 Ave N. Seattle, WA 98103... Tel. 206.547.0100 Emerg Pager 206 344.1878 1.888.NVUABS (685.5227) Client Zenovic & Associates, Inc. Street 519 South Peabody Street, Suite 4 CHAIN of CUSTOD SAMPLE LOG BATCH \0 2410855.00 , -.. ~ s 5<E-C'IJ'''- I ~ NVL Batch Number Client Job Number (')~ ?/., ~ Total Samples :2- Tum Around Time 0 1-Hr 024-Hrs 04 Days o 2-Hrs 02 Days as Days o 4-Hrs 03 Davs. 06 to 10 Davs Please cal/brTAT Jess than 24 HIS Email address ~ Q. ~I'. 4-r' Port Angeles Project Manager -. "1Mt.-Y is ()~()"i.(. Project Location ....2&.IV. S' c S ~ , Phone: (360) 417-0501 Fax: (360) 417-0514 10 Asbestos ~ 0 PCM (NIOSH 7400) 0 TEM (NIOSH 7402) U TEM (AHEM) 0 TEM (EPA Levell\) 0 Other to Asbestos BUlk! 0 PLM (EPAI6001R-93/116) 0 PLM (EPA Point Count) 0 PLM (EPA Gravimetry) 0 TEM Bulk ".,ET ALS Dot. Umit Matrix ReRA ~tals o .AJI 8 uther Metals o Total Melals ~~m (MSl_ [l Air Filter o Paint Chips o An;enic-1AsL-O~Le_adJeb) U All 3 ~TClJ' o ppb (GFM) TIlJnnking water UPaint Chips (Area) o Barium (Ba) o Mercury (Hg) U Copper (CU) U Dustlwipe o Waste Water o CadmIum (Cd) 0 Selenium (Se) 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) of Analysis 0 Silica o Respirable Dust 0 MoldlFungus Cond:'Jon of Package: 0 Good 0 Damaged (no spUlage) 0 Severe damag~ (spillage) - . - - . " - -- Seq.' tabiD Client Sample Number Comments AIR 1 (") Ll2.hb A t.L... u 2 (!) I.( ?L L 8 AA~ 3 4 6 6 7 8 9 10 11 12 ~ 13 -- 14 ---~ 15 -- Sampled by Relinquished by Received by Analyzed by - Resutts Called b~l Refiults Faxed byf' .~~ - On Special Instructions: Unless requested 10 wrihng. all samples will be dlsp06ed of two (2) weeks after analySIS. fU'~"- /A~ I?/.tV/,Y'S 11/14/2005 09:50 3504523498 OLYMPIC ELECTRIC PAGE 01 I &-2-1 . ELECTRICAL WORKPERMl'f APPLICATION ; Job ..ired by ~lect'lCal Contra"or U 0_0. Electrical contractor name WeclI'!: number Dale 'E~pires 1 In ie EI~t;t,.;e. Cc ee. 2.8SPI PtD'dw ., ma.tlin. address ~Z-~() fitlt1~ C;ly D.~.11 J Sla.e ZIP f'OI1 n tL1e,U WA Telephone number 1WX number 3 " ()-I/Sf~ ~ ~O !J S2- - '3 I/~ p,cml... .w.c,', ..mc OI'l/IIPiC Hw"a11 (}€#r!er ,Addren or IDlpedlon a I e /L 1'0 E, (.fLlfJ/mi>. &I- I..tjJ-hkj . 9t1b'3 cu, fir Pbone number to lehedul~ In,pectIDtI: Owner a.r dtrJi,,~d b)' R.CH'..J9.28.16J:(f) Ow,,!!,. wll/ OCCNPY 11Ig srrucrartfu1' two year: ofter this eJ~rricdJ perm/( Is jlflOJiztd.. (1) O""IIer is r~l/ir'f:d IQ TtV! art e/eclr'ical COJ!JN2ctor if tJbovt sajd property Is lor Jalt. ren' or 1(tQ.'e. Af\cr teoclins the above .!lLlte1ftmt, 1 hereby c:cnif"y tM\ 1 11m r.M ownct of the: above named property or I lieeuaccl eleemeaJ conU'aclor. I I'm making the electrical in:!llal- l&liol'l or ultcrll.tio1'l \1'1 compliance wilh the electricallawG, N.E.C., llCW. Chtropter 19.28, WAC. Chapler 296-468. The City or P011 Angeles Municipal Code, and Uti.llty Speci ficacions. SIc-nature of o_uer, 4!Ieeulul c:ontr.ctor or ~leccrluJ .dmlnlsttllor X Date: II 1'1. of; o Cash 0 Check # [J Credit Card V1SlI Cord # Mastercard Discover -------------"--- Expi12tion Date ofc.ro $'oeetio. '''61, 31:' ~8rvlC8 Information CJ NO lOAD CHANGES CJ e...boa'" _ KW o FurT'lBCe _KW o Hoal Pump _ Ton _ LAA CJ F.".Wall _ KW C Ov@fhead SolVice IJ Temp Sarvie<> o Undefground SerW:e vo~aga Phase CJ 1 IJ 3 service Slz.; _ Frieder Size: SAME DAY INSPECTION CALL BEFORE 7:00 AM 360-417-4735 . / ROUGH-IN ( THERMOSTAT -I /' SERVICE jt 1 q/Df? Dele A~p",v,d fly ./ '- ll1l.le ^pPrOYlld Ry-/ .... NlI'rtlved8)' ./ lr\/ t ~() FINAL r DITCH r FEEDER t"roP \ '- .... "/,, I. , --J12 ./ ~~B)' " D AppnmIcI P)- o". APP",vtld 8 Jnspection Area, Buildi"g 0' Equipmertllnspecte<l A cllOtl Take'l\ Electrical D,lt. Inspector /H'1'~(, M /U,;:: - /7cl:7 / / /;'1 /.; ~ pP