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1201 Marine Dr - Building
CITY OF PORT ANGELES s DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - BUILDING DIVISION .� 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 11-00001268 Date 11/30/11 Application pin number . . . 506728 Property Address . . . . . . 1201 MARINE DR ASSESSOR PARCEL NUMBER: 06 -30 -00 -0 -7 -9825 -1000 - Tenant nbr, name . . . . . . PORT OF PORT ANGELES Application type description DEMOLITION Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . INDUSTRIAL HEAVY Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc DEMOLISH BOATHOUSES #20 & #28 & 4 BOATS ---------------------------------------------------------------------------- Owner Contractor PORT OF PORT ANGELES OWNER PO BOX 1350 PORT ANGELES WA 983620251 (360) 457-8527 --- Structure Information 000 000 BOATHOUSES #20 & #28 & 4 BOATS ---------------------------------------------------------------------------- Permit . . . . . . DEMOLITION Additional desc . . BOATHOUSES #20 & #28 & 4 BOATS Permit Fee . . . . 50.00 Plan Check Fee .00 Issue Date . . . . 11/30/11 Valuation . . . . 0 Expiration Date . . 5/28/12. Qty Unit Charge Per Extension BASE FEE 50.00 ---------------------------------------------------------------------------- Special Notes and Comments The Fire Department has reviewed the project application and has no comments November 8, 2011 4:00:39 PM sroberds. No land use issues anticipated. November 8, 2011 3:55:06 PM banders. OK Public Works Utility Engineering has no requirements for this plan review. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE SURCHARGE. 4.50 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 50.00 50.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 54.50 54.50 .00 .00 REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) fl{tI01 i.Q•-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 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. 1113()Ill Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms/Building Division/Building Permit I BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS Building Inspections 417-4815 Electrical Inspections 417-4735 \ Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Comments Accepted by Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY1 USE Inspection Type I Date i Accepted By Electrical 417-4735 Construction - R W. PW / Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 Inspection Type Date I ( Accepted By I \ FOUNDATION: Footings 1 Stemwall I I Foundation Drainage / Downspouts Piers Post Holes (Pole Bldgs.) E PLUMBING: 1 Under Floor / Slab I I Rough -In j Water Line (Meter to Bldg) i I Gas Line I I I Back Flow/ Water I IFINAL Date AIR SEAL: 1 Walls Ceiling 4 FRAMING: Joists / Girders / Under Floor Shear Wall / Hold Downs I Walls / Root /Ceiling 1 Drywall (interior Braced Panel Only) I T -Bar INSULATION: Slab Wall 1 Floor / Ceiling MECHANICAL: Heat Pump / Furnace / FAU / Ducts I I Rough -In i Gas Line i I Wood Stove / Pellet / Chimney Commercial Hood / Ducts ( FINAL Date MANUFACTURED HOMES: Footing / Slab j I Blocking & Hold Downs IIj Skirting j PLANNING DEPT. Separate Permit#fs SEPA: Parking / Lighting I I ESA: Landscaping SHORELINE: Comments Accepted by Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY1 USE Inspection Type I Date i Accepted By Electrical 417-4735 Construction - R W. PW / Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T,1R,,;Ir9inn ni,ricinn/Rfiidina Permit tj -I.ry "--ft— Q 3 A r 'ter. 1 PREPARED 6/07/12, 9:02:26 INSPECTION TICKET CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY ------------------------------------------------------------------------------ ADDRESS . : 1201 MARINE DR SUBDIV: TENANT, NBR: PORT OF PORT ANGELES CONTRACTOR : PHONE OWNER PORT OF PORT ANGELES PHONE (360) 457-8527 PARCEL 06-30-00-0-7-9825-1000- APPL NUMBER: 11-00001268 DEMOLITION -------------------------- PERMIT: DEMO 00 DEMOLITION PAGE 1 DATE 6/07/12 ---------------- REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL99 01 6/07/12 BLDG FINAL -------------------------�,----------- COMMENTS AND NOTES -------------------------------------- Permit # 11 -12 -log Date: (a ' (0 ' / a' I phoned the: Applicant PROJECT STATUS UPDATE 1201 A40 0 YI f�Ok- at Property Owner �,kSC WOI,WI t -Z, at 4- 7- Contractor I (lef phone messa , or discussed): The permi (has expir , or will expire soon) at What is the status of this project? C:Iease call and schedule.a final inspection. Or ubmit a "permit extension request" lette Let me know if the project is abandoned. T:Forms/Building Division/Project Status Update BUILDING PERMIT CITY OF PORT ANGELES ... `` . Attn: Building Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 �f (360) 417-4815 fax (360) 417-4711 Applicant Port of Port Angeles Property Owner Port of Port Angeles Property Owner's Address 338 W. First Street Contractor Same as Owner Contractor's Address License # Expires APPLICATION Print in ink i For City Use Only: Date Received Permit# it -J2-6,8 Pho ADate Approved 360-457-8527 Phone Phone E-mail jessew@portofpa.com PROJECT ADDRESS 1201 Marine Drive Port Angeles, Wa 98362 Parcel Number 0630 0007 9825 Lot Zoning: Industrial Proiect Tvpe & Brief Description: ❑ Residential CoA❑ Multi -family _, X Commercial X Industrial Check all that apply " � ' f- 0` t' l7 f-I0LI11-1 ❑ New Construction Upland demolition of Boathouses #28 & #2(S and 4 Derelict Boats 1140 /AS6aC4n1- ❑ Addition 1%4-r lrnm it VXh'+ be, Mf(.s,��_ ❑ Remodel Obtaining an ORCAA Demo Permit; I cnr_ bntS ❑ Repair Obtaining a waste disposal letter from the city of Port Angeles; X Demolition Se -e c�bc en,ey,+-�arr�rl nrr -�I,e ref n �*��3 +hc� hc�l s L, es f0 s ❑ Re -roof ❑ House ❑ garage ❑ other ❑ tear off & re -roof ❑ lay over one layer ❑ Heat System ❑ Heat pump ❑ wo d -burning stove ❑ gas fireplace ❑ pellet stove ❑ other ❑ Other intaSie s hi�m•�5,� t^2cnvrll Floor Areas Existing (sq. ft.) Proposed (sq. ft.) Basement 1St Floor 2nd Floor 3`d Floor Garage Carport Covered Porch Deck Shed Other *e' 684+540 sq. ft. W Q 0ye I i c o�`i OV1 4o per sq. ft. = $ i`k \` c) -Tom 01 Cabe TOTAL VALUATION $ $5)< O Total footprint of structures sq. ft. T Lot size sq. ft. = Lot coverage % Site Coverage = the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios, and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage % Max. height of proposed structures ft. Occupancy group # of bedrooms Will a lawn sprinkler system be installed? Occupant load # of full baths Will a fire sprinkler system be installed? Construction type # of half baths 1 have read and completed this application and know it to be true and correct. 1 am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects. Date Print Name Jesse Waknitz Signatur��� T:Forms/Building Division/Bldg Permit.doc Cont r WASTE SHIPMENT RECORD 1 , Waste Generated Site Name and Address owner's Name Owner's Phone No. VJ A- 2. Operator's Name and Address Operator's Phone No. KD&S Environmental, Inc. 360 P.O. Box 312 MONTESANO, WA 98563 249 5540 3. Waste Disposal Site (WDS) Name, Address and Physical Site Location V✓DS Phone No. RABANCO REGIONAL LANDFILL 1-800-927-5641 -, 500 Roosevelt Grade Rd. Roosevelt, WA 99356 4, Responsible Local, State or EPA Agency Name and Address =- O R CAA y 2940 B Limited Lane NW Olympia, WA 98502 6, Containers 7. Total Quantity 5, Description of Waste Materials No. Type m' (yd) i 12 Asbestos Containing Materials �r�v�Ia 8. Special_ Handling Instructions and Additional Information DOUBLE BAGGED & LABELED 9. OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are In all respects in proper applicable International and government regulations. condition for transport by highway according to app Signature Month Day Year Printed/Typed. Name 10,Transporter 1 Acknowledcment of Recelat of Materials Y Printed/Typed Name �Signoiur ,l� Month Day Year J ) LA,r, ,vno�ivy Transporter 2 Acknowledoment of Receipt of Materials �? Printed/Typed Name Signature Month Day Year RABANCO TRANSFER 2733 3rd Ave, S, R; Seattle, WA 206-646-2565 12, Discrepancy Indication Space .°W ., WASTE DISPOSAL RRLC ,A . ,'. 13, Authorized Waste Disposal 5iie Owner or Operator: Certification of receipt of asbestos materials covered by this manife_t = er..ceof as noted in Item 12 5 Printed/Typed Name Signature Month Day Year :'.E . WHITE P.eiurn to operator YELLOW - Waste Site PINK - Tramportsr GOLDENROD - Operotor November 10, 2011 Port of Port Angeles 338 W Firs, Street Port Angeles, Wk 98362 c- r)a r t RE: Port Angeles Landfill / Transfer Waste Disposal Application, WDA HI 1-20 We have received Your application for disposal of demolition debris from the referenced site and reviewed the testing results, Based on the test results submitted by Northwest Asbestos 'l - Consultants, Clallarn County Environmental Health Services (CCEHS) cran.urs with thp disposal of 3100 cyris of demoition, materials to the Regional Port Angeles Tran.sfer Station. A copy of your approved application is attached. This approved Cipplication Must be sh()w.%w to the transfer station scale attendant at the tient: of disposal. I'leise be advised that the disposal application is only for the rnaterials and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. 13-4 72 or e mail Please call Tom mcCabe, Solid Waste Superintendent at 360 4 8 trp-,c-abe(5)ci1vofq;j.us if you have any questions, Sinceit,ly Tom McCabe Solid Waste Supviintenclent Cc: Brian Tate, Operations rvlanaeer, Port Angeles Transfer Station Sonja Coventon, Scaie. Attendant, City of PA Unc: WDA DISPOSAL APFjj(AVjj0?1j "'(ST ATQ FT FS-' J AN SlAFR, S'(' -A Fj() N TAJ: City of Port Anpelw; AM Solid WaSIP SvperMtendent 321 E, Rhh Street P0. ')Qx 1150 PL)ft Angeles, VOashinr3ton 98,162, NIFITf:.: All mw:* S)- f,? ".'4'x_'4{: `.7 I u t. Applicart lnforrnat on; Comvmiy Nat-ne: 71 -ort of Pcrl,Angcd,s MaIngAdclmsy 118 IV. %st Sawt Pr,),t Argeles, %NA 98-362 conLam Mcne: AC 41704%', Rukd Name: r9csats Boavowes Demo Project Loudon: tint Pon.Anqr�Ipq Other Contacts pf applkahle): I'Mone: Q60) 417 4972 Fax: (36014S20972. Wurce of Wayle: Moe: plow I �1'� the Comm- NA Phone: I'Mone: Q60) 417 4972 Fax: (36014S20972. Wurce of Wayle: ti'. I �1'� the Gso Kom CA k.'e MAY!, ;)rm?hciiFe-, irlli,' 20 & 2�1,' „n,.J fcwr bo a:,^ vllasir2 MZeriaf fPCH a"Ka apply and 4cludo otycent I tozMl 'f�undry ""fag 7 VIrlod Ash NOTE: TM mysi eqkA Wom 00 5. Waste AAateda! ContmAnan": joherk P Mat dj)PQ,` 6'a S o I i n e MF�tjls . I -.- Oiesel Mew HeDtiflg Gil B 'Urn,isedMoto, Oil U`' d Nmm OflPiNilste 011 x A her vv"t Other Poroleimn Ptodurt Unknovvn Ncm: SupoN and NAUS iml€-.rmation with acphCatiam, if av;ilabb. Estimated Quantity of Waste for Disposal., :;00 Cubic yards Ions fe5timated bo,,h) Drums / Tans {estimatc-d bwh} 6 ToN Loads Vf Doh6 S NOTE: EsOmazed quamity Or Qp.awl mu,;t be .'Vitfin A% of the Quat'AiI.Y @Ct-"JTjly ,—,00 ton,; of 5.000 cubic .1; -.rd -,j 1. Frequency of I.Nspusah 7ciei t i rT ? 1- - - __ 0 u s I t h A over chirN tunmhur cf;he yvame Or A"W& ralmes Ime MAKLOY! of RignMong, AwfAW 1 hq Lwow" of a w1me awd Ac Qeowm Y 7 KAPOK§ "Y W Ow Age wul faun A Rm wmm Check dw aDomprAQ SON Aml nNiAn deurfa anw ;hc wjym �Wj S,y jewly site and mcann" wher a =106, 1% being le"lomd Imm, funnher of COMPUT U %mplev 1 Wnyher of CASUETE samply 6 :Wd I - AZ ""M VOPOW IV AWI a W 41 =0011 0WVMA*WXP cel'. %' "n Sant own WfAM &M naygmmay new WWKYWN�Q- Not %AQ1� &WE 1, wilss 0,14 "nalmil ,:Si 0, n 1f,00 bn Pal ;p1mov 1h; ch voovv ONWON Wo :0 on a, v vv ..-Is , -,`� �,, ; -: � i ' z". ; , I n !01 - SAO LUNC yords 5 compm1w worwK, hol - 1000 cupc VMS 7 compowe samphs ,2mo cow yark 20 plus onc,,-,,ampl,^,'or vuh alowm ?a cQ" ywd,� Wane AnQQ� t 1 -,C -j ti-. -voranyrawa lads QGW wow wow" myng. ranks lek-p},._. wo Chain nf Mtody Owwn Mmy wOh AK a"b"Dw. !:VTF- The simphq hhmmoy mu" be aunifiRd by the vv-,,�shir4,ton Swo Devannient a! kcalogy.) NOTE: AdIdund Toe= AwYnT YES 4 V A 1 d 10 NOTE: AdIdund Toe= AwYnT YES 4 V A 1 d T2. Special Notes for Asbestos Disposal Aflasbestas — rontaining materials IvAth the �xceptivn of roofing sujterial in good condition that is riot peeling, cracking or crumbling, with petroleum binder that still exhibits plasticity to prevent relv,3se of asbestos fibers) rttuKt * Be tightly wrapped or bagged In 6 fnif plastic with no excess air !n the packaging * Not exceed 50 pounds per bundle se labeled is asbestos with required Information regarding its origin * Be transported with a manifest in the vehicle * Arrive at the transfer station only by appointment with Brian Tate of Waste Connections at 360 -452-0427 or cell phone 36(3912-7033, so that the material can be deposited in a lock box. certifitati= We, THE 1JN()FPqGMED, curt N that thi:; application 'Is true to the best of our know'Uage. All information provided is correct and the enclosed analytical results represent proposed waste material to the best of our abilities, Waste Generator's Signature: Printed Name & Company Position Jesse W-Iknitz, Enviro Toch Company: Pon of Pod Angeles Date: 17 8 2Q11 if you have any questions please contact Tom McCabe, Solid Waste Superintendent at 4174872 or email THIS SECTION TO BE FILLED OUT BY AUTHORIZED STAFF Apppval: / I � APM -114 L& EnQnme#al Health Specialist Approval with the following conditions if applicable: LA)bp ll -)-,9 I certify under panaity of law that the statements made on this form are true and correct to the best of my knowledge, Information and belief. Tom McCabe, Solid Waste Superintendent Date I Contractor siiall pr2sent their copy of approved application to Scale Hou5e, A Del rao Rir.�n it el'-o"!5t b". el S 'r. 3n-? cli"." %v ?'i q' cz� ".qt g1l I IT A -4 �-t 4 �ttr w"j ql� S k 64 'it trip.o , ��, I 11��0_111, . -1 1'', - ZI iov: j��: d'S M x�j -p, Fw g"Ir crjmt 64% N qA t.AA FIII.�I t 'p 0!", V_� g,7 14 01" I'M ON !j lz q. w MEARM gg M. K"A' ii , p 4 ... 7%Iq co W "I "tl�_�O�,7:1,�.�:, 1, *011, k ; We !�4 gi i rj`� ? "W15, f ml 41 � C rnai Jed -4-o Tom M c016 . h 1 Pa -11 oFpoargN h, C®j lso Pu1r' ih hi5 mai lboSC Zi►�da,G 1p WASTE DISPOSAL APPLICATION PORT ANGELES SOLID WASTE TRANSFER STATION To: City of Port Angeles, Phone: (360) 417-4700 Attn: Engineering Projects Supervisor FAX: (360) 417-4709 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: r1lif Company Name: /009-T OF 100(ZT AXJCZLZ S Mailing Address: X35 GU IC'/,U/ -% PO Zi lvjcZ'lis t.uA Mc X T Contact: �1[S,f [,uAKY7/ TZ Phone: 3G U - IV/ 7 3 415 Project Name: /S o,6 7- t f�G�7tI�f tsC ,0��nb Project Location: POZT 1QJ6,CLC5 13�Tl 11A�Lll 2. Other Contacts (if applicable): Consulting Firm: lVU2THkJZSi A�5,B/--ST0s c,,L7�1nT, Contact: J,7C>13 Phone: -360--3125 OS F L/ Contractor Name:�'/� t.SiI��2�nh7 cr rnL /ffJC_ Contact:�✓� o �F Phone: Laboratory: Contact: Phone: City of Port Angeles - Waste Disposal Application (last updated September 2010) Page -11 of 4 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 7wo Unused Chemical Product Spill Other Source: / I. 0A7-1510USZ 30'�XI 8 �) Cwt= S11—f4 1144 ;r,4,/— GulTH A t vva,v AND 770.4M A�w/4 TSI-P A(>rLT ,4A� .FI FS .-3 C> A -r J1A VG Iv it fi / �n�r ✓► 13vl�, T 4. Waste Material Composition: (check all that apply and include percent of total) Soil % Foundry Slag % Concrete/Asphalt % Dredge Sediments % Preserved Wood % Debris 166 % Coal Ash % Other (list) Wood Ash % % NOTE: Total must equal 100%. 5. Waste Material Contaminants: (check all that apply) _,X NOTE: Gasoline Solvents Unused Motor Oil Other W60 i X Metals Heating Oil Used Motor Oil/Waste Oil Other Petroleum Product Unknown Supply any MSDS information with application, if available. Diesel PCBs City of Port Angeles - Landfill Waste Disposal Application Page - 2 of 5 a . 6. Estimated Quantity of Waste for Disposal: - Ob Cubic yards Tons (estimate both) Drums / Tons (estimate both) Other 7-R-Vr-lc Ljcj/1�05 r -.,F 01-Xa4'z- I 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 _ & number of discrete samples per composite Number of DISCRETE samples R// # t�10 AULA nWOFI* SLf,Arr1A61VX.0 x-1,-,0oar. AC,/L4 Ams A-sArn5 oAJ .7 -HE WL41c or .5r -Lr JU'dS!-Z" Pc> locli-r1r, 1,c0l, -544;rrAc-1-1E'b kLPqlS.T— NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 0-25 cubic yards I composite sample 25-100 cubic yards 3 composite samples 101-500 cubic yards 5 composite samples 501-1000 cubic yards 7 composite samples 1001-2000 cubic yards = 10 composite samples >2000 cubic yards 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 of 5 9. Waste Analysis: PA 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 LIST releases. Submit all laboratory analytical results, QA1QC data, and Chain of Custody sheets along with this application. (NOTE: The laboratory must be accredited by the Washington State Department of Ecology.) a) List all analytical test methods used: b) Provide a narrative as to why the above analytical methods were selected: NOTE: Additional sheets attached: YES NO 10. Soil Classification: (**FOR PETROLEUM CONTAMINATED SOILS ONLY**) 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 (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 of 5 12. Special Notes for Asbestos Disposal All asbestos containing materials (with the exception of roofing material in good condition that is not peeling, cracking, or crumbling with petroleum based binder that still exhibits plasticity to prevent the release of asbestos fibers) -must: • be tightly wrapped or bagged in 6 mil plastic with no excess air in the packaging • not exceed 50 pounds per bundle • be labeled as asbestos with required information regarding its origin • be transported with a manifest in the vehicle • arrive at the transfer station only by appointment with Brian Tate of Waste Connections so that the material can be deposited in a lock box (his cell number is 360-912-7080). 1. 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. Waste Generator Signature -Tf-s� Printed Name PU2.% a Company 1�bhl Date G4JA kn/ Tz- Pue-r A6E-zzs City of Port Angeles Approval: City Engineer Date Approval Expiration Date N:IPWKSIENGINEERIWaste Disposal Applicationslwaste disposal application- 2008 version.wpd City of Port Angeles - Landfill Waste Disposal Application Page -5of5 9 Cont -tf WASTE SHIPMENT RECORD �L-o 40v,-�(o Waste Generated Site Name and Address owner's Name 2. Operator's Name and Address KD&S Environmental, Inc. P.O. Box 312 MONTESANO, WA 98563 3, Waste Disposal Site (WDS) Name, Address and Physical Site Location RABANCO REGIONAL LANDFILL 500 Roosevelt Grade Rd. Roosevelt, WA 99356 4. Responsible Local, State or EPA Agency Nome and Address ORCAA 2940 B Limited Lane NW Olympia, WA 98502 5, Description of Waste Materials 6, Containers 7. Total Quantity No. Type M3 Asbestos Containing Materials 2 Owner's Phone No. 360 4Y1 7 Operator's Phone No, 360 249 5540 WDS Phone No. 1-800-927-56,d1 8, Special Handling Instructions and Additional Information I , DOUBLE BAGGED & LABELED 9. OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are In cli respects in proper condition for transport by highway according to applicable international and government regulations, Printed/Typed Nome Signature 10. Transporter I Acknowledgment of Rec9lot of Materials Printed/Typed Name signCtUr 4�2� 5,q-" "Ki 11- Transporter 2 Acknowledgment of Recelpt Of Materials Printed/Typed Nome Signature RABANCO TRANSFER 2733 3rd Ave, S. Seattle. WA 2V 646-2565 12. Discrepancy Indication Space WASTE DISPOSAL RRLC Month Day Year Month Day Year Month Day Year 13, Authorized Waste Disposal Site I Q,aner or Operator: CertilicotiOnOl feceiPT Of asbestos materials covered by this manifest exceOf as noted in Item 12 P -ed/Typed Name Signature lAo-r-ah Day YG a r rinj :,T F WHITE - Return to (Dperutor YELLOW - Waste Site P11 JK - Tromportst G0LDENPOD - Ops-rafor Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com Date: 10/22/09 lob Location: Boat Haven Storage Yard 801 Marine Dr. Port Angeles, WA 98362 Owner: Port of Port Angeles P.O. Box 1350 Port Angeles, WA 98362 Contact:, Jesse Waknitz P.O. Box 1350 Port Angeles, WA 98362 Subject: Demolition of boat house #28. I snector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-10230901 Expires - 10/23/10 on ` Scone of work, 1) Good faith inspection for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect materials. 3) Report to Jesse Waknitz with results. Inspection Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Boat Storave Yard Sample #1: Boat House- #28 Is 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. Date: 10/21/09 iib Location: Boat Haven Storage Yard 801 Marine Dr. Port Angeles, WA 98362 Owner: Port of Port Angeles P.O. Box 1350 Port Angeles, WA 98362 Contact: Jesse Waknitz P.O. Box 1350 Port Angeles, WA 98362 Sample #1: Boat House- #28 Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-10230901 Expires - 10/23/10 Please call with results when completed. See attachment. Thank you, Bob Witheridge, E.F.M. 05 .. . ... .... . ....... . ....... ........ .... . ......... 7 -- ----- - ---- - 215 SW 153rd Street Burien, WA 98166 OFFICE. (208) 988AT46 FAX: t206)998-i97WP 1VVLA P Lab Code: 200511.-0> Bulk Asbestos Analysis Report NwMviea Asbestos Consul" 1, NfH BatcliNumber 09-00722 406 Reed Street CTmd Job Number. Port Townsend, WA 983W Turn Around Tam: 5 Day C Pm2ecftocabon: Port ofRout AngabsB4e#ftmm Sam;fts Analyzed: I -aient Sample Number. I Client Sample Description: Saver smd coating Client Sample Location: Boat HWxm*#M an mv; ial RoagM Sample Comments: Silver coating Asbestos Fibrous Components: Nft*Asbestes ftwes Compmw&s- 22% GuloseA Lab Sample Number. 09-00722.0001 Checked If Sample Not Analyzed E) Non+-dxous Components: 90% Coating Sampled by: Bob Witheridge 1W2192M Received by: Rachel Mekjam '12422#2009 Reviewed by: Rachel Wgum 10222=1 RatW Melgaza, Ana" Rage 1 Summary of Insipection Sample #1: Boat House- #28, silver seal material on metal roofing. 8% chrysotile asbestos. Approx. 540 sq. ft. All asbestos containing building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency. During demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. 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. Copies for City of Port Angeles Permit Center and Olympic Region Clean Air Agency. Thank you, L3 Bob Witheridge, E.F.M. ["t"i U1,91.11M WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS THIS IS TO CERTIFY THAT ti bob Witheriage Participated in the EPA AHERA INSPECTOR, MANAGEMENT PLANNER Refresher Course offered by the WASHINGTON ASSOCIATION of MAINTENANCE :] The full day training program 5 covered all topics specified in the Model Accreditation Plan under .: -Section 206 of Title 11 of TSCA is . ,:� The course was taken on October 23, 2009 in Silverdale, Washington. Certificate #10230901 — Ex it on October 23, 2010 (WOO Colin MacRae Course Administrator 2714 228th St. SE, Bothell, WA 98021 (425) 485-6980 ` • NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend, WA 98368 northwestasbestosconsultants@cablespeed.com 22 360-385-0584 ►J N # D-= 7/27/11 job Location: Boat Haven 801 Marine Dr. Port Angeles, WA 98362 Owner: Port of Port Angeles P.O. Box 1350 Port Angeles, WA 98362 Contact: Jesse Waknitz Environmental Planning and Technician P.O. Box 1350 Port Angeles, WA 98362 Subiectt Demolition of boathouse. Dock - O, boathouse slip #16H a0 Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-1022201002 Expires - 10/22/11 Score ()f work, 1) Good faith inspection for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect materials. 3) Report to Jesse Waknitz with results. Inspection Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Dock - O, Boathouse slip #16. Wood frame building Approx. 684 sq. ft. had tin and fiber glass roof and some wood flooring. No suspect of ACBM. • WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS THIS IS TO CERTIFY THAT :0 0 Met", n7r. ! ` Participated in the EPA AHERA INSPECTOR, MANAGEMENT PLANNER Refresher Course offered by the WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS The full day training program covered all topics specified in the Model Accreditation Plan under Section 206 of Title It of TSCA The course was taken on October 22, 2010 in Silverdale, Washington. Certificate #1022201002 —7xp, tion October 22, 2011 Colin MacRae Course Administrator 2714 228th St. SE, Bothell, WA 98021 (425) 485-6980 a- :, ., r... S � r NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend, WA 98368 northwestasbestosconsultants@cablespeed.com 360-385-0584 Date: 10/26/11 Job Location: Boat Haven 801 Marine Dr. Port Angeles, WA 98362 PO # 136320 Owner: Port of Port Angeles P.O. Box 1350 Port Angeles, WA 98362 Contact; Jesse Waknitz Environmental Planning and Technician P.O. Box 1350 Port Angeles, WA 98362 Subject: Demolition of 4 boats. Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-1021201102 Expires - 10/21/12 Scone of work 1) Good faith inspection for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect materials. 3) Report to Jesse Waknitz with results. Insnection Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Samnle #1: Chris Craft (WN 7226 NX). Cabin ceiling material. Sample #2: Chris Craft (WN 7226 NX). Engine compartment insulation. Sample #3: Cement sailing boat (white and black). Boat base material. Sample #4: Boat (WN 4010 ME). Back panels rear of boat. Sample #5: Boat (WN 4010 ME). Cabin area wall wrap. Note: Green hulled sail boat. No suspect of ACBM. No samples were taken. ASBESTOS BULK SAMPLE DATA NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend, WA 98368 northwestasbestosconsultants@cablespeed.com 360-385-0584 To Northern Industrial Hygiene Date: 10/24/11 ,jQb Location: Boat Haven 801 Marine Dr. Port Angeles, WA 98362 Owner: Port of Port Angeles P.O. Box 1350 Port Angeles, WA 98362 Contact: Jesse Waknitz Environmental Planning and Technician P.O. Box 1350 Port Angeles, WA 98362 Samnle #1: Chris Craft (WN 7226 NX). Cabin ceiling material. Sample #2: Chris Craft (WN 7226 NX). Engine compartment insulation. Sample #3: Cement sailing boat (white and black) boat base material. Samnle #4: Boat (WN 4010 ME). Back panels rear of boat. Samnle #5: Boat (WN 4010 ME). Cabin area wall wrap. Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-1021201102 Expires - 10/21/12 See attachment. Thank y ou Bob Witheridge, EFM a Bulk Asbestos Analysis Report Morthwe-st Asbestos Consultants NIH Batch Number 11- 406 Reed Street Client Job Number Part Townsend, WA 98368- Turn Around Time: 5Day c Project Location: Boat Haven Storage Area Samples Analyzed: 5 Client Sample Number: I Lab Sample Number II-MMAOM Client Sample Description-. Cabin Calling Material Client Sample Location: Chris Cadt-WN7226H)L Boat Calling Sample Comments: Mateirlift distinguishable but Insepambles Checked If Sample- Not AnaWed White paint and brown Compressed fibrous metal Asbestos Fibrous Components: Non -Asbestos RNOUS Non-F9rous Components: No Asbestos Detected 85% Cellulose 5% ftnt it Filler and Bindff Client Sample Number: 2 Lab Samplie- Number 11-MMAM Client Sample Description: Insulation Client Sample Location: Chris Craft-WH721M 804 Engine Sample Comments: Checked It Sample Not AnaVzed C�j Layer 1 White fibrous woven hard material Asbestos Fibrous Components: Nim -Asbestos Fibrous Componuft. No Asbestos Detected 35% Fiberglass Layer 2 Gray hard nuderfal Asbestos Fibrous Components: Non -Asbestos Films Componenis-. No Asbestos Detected 1% Cellulose Client Sample Number: 3 Client Sample Description: Boat Base Material Client Sample Location: Cement Sell Boal -White and Ellack Sample Comments: 7711"f' NMA%Mus Components: 40% Fine Grains 59% Filler and Binder Lab Sample- Number II-OMWIM Checked It Sample Nol Analyzed L—T, Blade coating and while non-titrous material Asbestos Fibrous Components: Non -Asbestos Fibrous Components: Non-Fftuw Componeirts- No Asbestos Detected 95% Filler and Binder 5% Coating Client Sample Number: 4 Lab Sample Number II-MWAM Client Sample Description: Back Panels Client Sample Location: Boat WN4010FAE-Rear of Boat Sample Comments: Checked 0 Sample Not Analyzed EI (Sample remits continued on rod page.) Sampled by: Bob Wilibiwidge 10)24r2MI Received by: Fannin Udbe 11044SMI Reviewed by: Jude Cummings 1042021I Jude', LaboffaMV Manager page 1 Sampled by: Bob Witheridge 111112412otI Received by: Fermin Lblibe 101261M I Reviewed by. Jude Cummings 10AMM11 Jude Cu—nings.. Laboratory Unnager Page 2 -------------- ------- — ------------ - ------- -------- 215 SW 153rd Street Burien, WA SS166 OFME. (206) 988-1746 FAX- (M) SZB-1978 NVLAP Lab Code: X11-0 Bulk Asbestos Analysis Report Northwest Asbestos Consultants N3H Balch Number 111-001M 406 Reed Street Ment Job Number Port Townsend, WA 983W Turn Around Time- 5QaYC Project Location- Boat Haven Storzige, Area Samples Analyzed- 5 White non-fibrous hard nuderiall Asbestos Fibrous Components- Non -Asbestos Fibrous Comporw4ft-. Non-19brous Components - No Asbestos Detected 1% Cellulose 99% Filler and Binder II Ghent Sample Number: 5 Lab Sample Number-. 11-WWAM Client Sample Description: wan Wrapping Client Sample Location: Boat WNMOME-Cabln Area Sample Comments. Checked It Sample Not Ana*zed Layer 1 White coating on white woven fibrous nuderfal Asbestos Fibrous Components: Non -Asbestos Fibrous Components: NOa4:bnDUS No Asbestos Detected 2M. Cellulose 50% Coating 30% Filler and Binder Layer 2 Tan sticky material with brown residue Asbestos Fibrous Components: Non -Asbestos Fibrous Componerft: Non -Brous Components: No Asbestos DetectediI 5% Cellulose 25% Miscellaneous Aerials 70% Filler and Binder YI Sampled by: Bob Witheridge 111112412otI Received by: Fermin Lblibe 101261M I Reviewed by. Jude Cummings 10AMM11 Jude Cu—nings.. Laboratory Unnager Page 2 �^ Summary of Insnection This survey includes all areas of inspection with report results from Northern Industrial Hygiene, Inc. Samnle #1: Chris Craft (WN 7226 NX). Cabin ceiling material. No asbestos detected. Samnle #2: Chris Craft (WN 7226 NX). Engine compartment insulation. No asbestos detected. Sample #3: Cement sailing boat (white and black). Boat base material. No asbestos detected. Samnle #4: Boat (WN 4010 ME). Back panels rear of boat. No asbestos detected. Samnle #5: Boat (WN 4010 ME). Cabin area wall wrap. No asbestos detected. Note: Green hulled sail boat. No suspect of ACBM. No samples were taken. All asbestos containing building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed, a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency. During demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. 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. Thank you, Bob Witheridge, E.F.M. WASHINGTON 0 ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS I � THISBQ�c9DP• , IS TO CERTIFY THAT Bob Witherid e Participated in the EPA AHERA INSPECTOR, -� MANAGEMENTPLANNEW Refresher Course offered by the 14tMF WASHINGTON ASSOCIATION of MAINTENANCE ............ and OPERATIONS ADMINISTRATORS cam::. .. The full day training program AR . . . . . . . . . . covered all topics specified in the .................. Model Accreditation Plan under Section 206 of Title 11 of TSCA The course was taken on October 21, 2011 in Silverdale, Washington. 01 Certificate #1021201102 Expiration October 21, 2012 Colin MacRae Course Administrator 2714 228th St, SE, Bothell, WA 98021 425)485-6980 ---------- . . . . . . . . .... ....... f�"; _4gggi�" VVINVAMI-N V.I�i �i�- &m I., - , ,a � '#1 , I r�'L. 'Q I , W4�11.41k""� INQ • 2, -74' 4 T N. CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 'v 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 08 00001023 Date 8/29/08 Application pin number 612015 STATE SURCHARGE Property Address 1201 MARINE DR ASSESSOR PARCEL NUMBER 06 30 00 0 7 9825 1000 Charged Tenant nbr name PORT OF PORT ANGELES Paid Application type description DEMOLITION Credited Subdivision Name Property Use 50 Property Zoning INDUSTRIAL HEAVY 50 Application valuation 5500 00 Application desc DEMO THREE BOATS AND FOUR BOATHOUSES Owner Contractor PORT OF PORT ANGELES OWNER 00 PO BOX 1350 ' PORT ANGELES WA 98362 4 (360) 417 3454 4 Structure Information 000 000 DEMO 3 BOATS AND 4 BOATHOUSES 00 Permit DEMOLITION Additional desc DEMO 3 BOATS & 4 BOATHOUSES 54 Permit pin number 132530 54 Permit Fee 50 00 Plan Check Fee 00 Issue Date 8/29/08 Valuation 0 Expiration Date 2/25/09 Qty Unit Charge Per Extension BASE FEE 50 00 Special Notes and Comments The Fire Department has reviewed the project application and has no comments August 28 2008 3 14 28 PM sroberds Demolition of old boathouses as proposed does not pose a land use issue An approved Public Works Waste Disposal Application is required prior to taking material to transfer station Other Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 50 00 50 00 00 00 Plan Check Total 00 00 00 00 ' Other Fee Total 4 50 4 50 00 00 Grand Total 54 50 54 50 00 00 �O9 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 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 -aq-ag 401 tk4++U -l( Date Print N;311ne Signatur f Contractor or Authorized Agent Signature of Owner (if owner is builder) 'r forms/Building Division/Building PEfiiilC05/13/08).wpd 3 BUILDING PERMIT INSPECTION RECORD 0 CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS 019 CALL 417-4807 FOR PUBLIC WORKS UTILITIES CALL 417-4886 FOR BACKFLOW PREVENTION INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE Q INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. ) KEEP PERMIT AND APPROVED PLANS AT THE JOB SITE. INSPECTION TYPEI DATE I ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS SHEAR WALLS / WALLS FOUNDATION DRAINAGE / DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDERFLOOR/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 (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL /FLOOR/ CEILING MECHANICAL HEATPUMP/FURNACE/DUCTS GAS LINE IWOOD STOVE/PELLET/CHIMNEY COMMERCIAL HOOD/ DUCTS MANUFACTURED HOMES FOOTING / SLAB yI BLOCKING & HOLD DOWNS I SKIRTING FINAL DATE ACCEPTED BY. I FINAL DATE ACCEPTED BY. I PLANNING DEPT SEPARATE PERMIT /Ps SEPA. PARKING/LIGH LANDSCAPING TING I I I SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES I NO COMMERCIAL DATE ELECTRICAL LIGHT DEPT 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W / PW/ CONSTRUCTION R.W ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 I PLANNING DEPT BUILDING 417-4515 I BUILDING ACCEPTED YES NO 9.09W S 06 C7 0 POW-)-TAi G LES W A S H I N G T O N, U S A Public Works & Utilities Department August 21 2008 _ Port of Port Angeles P O Box 1350 Port Angeles, WA 98362 day WDA- o 5-�8 -zo [ Maki�z AD2 Y RE Port Angeles Landfill / Transfer Waste Disposal Application, WDA 08-28 Boat House Demolition, 1201 Marine Drive 80.0 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 station 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 Stephen Sperr P.E. City Engineer Encl. WDA 08-28 Copy Claudia Stromski N•\PWKS\ENGINEER\WDAPPLIC 08-28 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 0 Box 1150 / Port Angeles, WA 98362-0217 ,� PORT A 0 C A 0, AUG 2 0 2000 T ANGELES LANDFILL City of PotlA Sl Public WorwAs'U P )ISPOSAL APPLICATION Engineering Services Sion KS To City of Port Angeles City Engineer Phone (360) 417-4803 321 E Fifth Street FAX. (360) 417-4709 P 0 Box 1150 Port Angeles, Washington 98362 NOTE All questions must be answered for waste to be approved. 1 Generator Information Company Name POA 0+ PC, -7k A"Pip-S Mailing Address PC) SO)c 1: c) Po r4- At,,140-ec, ` WA 9 9 3\oa Contact: Phone 60 4 0- 3L�s L ' Project Name 1�00+ -A P-;-04�e Project Location ":�~ M0"r(VLQ- C)nve- Pt, -,-t AIA�nA-es ) WA 2 Other Contacts (if applicable) Consulting Firm No U& OLsLes-6 Cb-vlsu� Contact: Po' WA'LW J-0ef- Phone (;(oo) 39,5- 6584 Contractor Name Contact: Phone Laboratory* NoA�z- TvAi4t-ta Contact* Qa" RJyz'6L Phone City of Port Angeles Landfill Waste 'Disposal Application Page 1 of) 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 �4 c j boas a 4 wz, &4" boaV"ses AvJ s BP oci Azwe vt /A) l l `1 In e 1 (� we b.eP t� tALS &,t0+ 4u t t aee� rk,i.t.d� w1X be-ewtY�t lst�tll�C. � vL e vV e `�or l tiaNe�n J 4 Waste Material Composition (check all that apply and include percent of total) Soil % Foundry Slag % Concrete/Asphalt % Dredge Sediments % Preserved Wood % X Debris 100% 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 C"�potor Oil Used Motor Oil/Waste Oil X` _ Other V Other Petroleum Product Unknown NOTE Supply any MSDS information with application if available City of Port Angeles Landfill Waste Disposal Appiicatio i Page 2 of 5 6 Estimated Quantity of Waste for Disposal a 00 Cubic yards / Tons (estimate both) Drums / Tons (estimate both) Other appra,,oVv44(.0 4rttc"-- lutes 0-( d&ns 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 afprox (o 4vuckloac s 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 aid i u2.rl-e s"4 by , NaP` weS� J4s6-es�zs �.� 0 -,VA -6,Cl U,o t� astes6s NOTE 1 Unless prior approval has been granted by Port Angeles the following sampling frequency will be used 0-25 cubic yards = 1 composite sample 25-100 cubic yards = 3 composite samples 101 -500 cubic yards = 5 composite samples 501 -1000 cubic yards = 7 composite samples 1001 2000 cubic yards = 10 composite samples >2000 cubic yards = 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 C isPosal Application Page 3 of 5 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 b) Provide a narrative as to why the above analytical methods were selected NOTE Additional sheets attached YES NO 10 Soil Classification (**FOR PETROLEUM CONTAMINATED SOILS ONLY**) 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 (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 Applicatioi Page 4 of 5 )12 Special Notes for Asbestos Disposal All asbestos containing materials (with the exception of roofing material in good condition that is not peeling cracking or crumbling j with petroleum based binder that still exhibits plasticity to prevent the release of asbestos fibers) must: be tightly wrapped or bagged in 6 mil plastic with no excess air in the packaging not exceed 50 pounds per bundle be labeled as asbestos with required information regarding its origin be transported with a manifest in the vehicle arrive at the transfer station only by appointment with Brian Tate of Waste =Connections so that the material can be deposited in a lock box (his cell number is 360-912-7080) 1 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 Waste GeneFator Signature =Printed :Nam _ VO r4 04- PGY+ Aj.deS Com an _ p -y - SS-'a0-0� Date - Citi of, Port Angeles Approval City Engineer �1 d h� Date Approval Expiration Date N:\PWKS\ENGINEER\Waste Disposal Applications\waste disposal application- 2008 version.wpd Cily of Port Angeles Landfill IJVaste Disposal Application Page � of 5 ..r. n-l'n? i Wigg--.. 4a,.- ,oRCAA a` � °dFF 1iff�#501,•SbESU1�' Olympic Region Clean Air Agency 2940-B Limited Lane NW Olympia, WA 98502 (360) 586-1044 FAX (360) 491-6308 Port Angeles office (360) 417 1466 Raymond Office (360) 789-3652 Nvwww ORCAA.org Demolition Permit [ ] Residential [ ] Commercial �� � y 3�oo-i 5 Permit fee: $25.00 per structure. Non=refundable. **10 Working Day wait period** -4 � boa±"Lz.ses PROPERTY OWNER Name.1 �y Phone: (3b0) 411-3HS� Oi-� O pnV-�1 A �P5 FAX. Email: Mobile: ( ) Maihng Address: �0 Bob l3SO6es T C1 - -State: WA 7i . Site Address: 73a 'Bo0*k0,J.Q'k& ve Ci or� ,Q-cu�•��s State: WA- Zip rIg3(o-Q DEMOLITION CONTRACTOR M Check if same as property owner information Business Name: Phone: ( ) Email: FAX. ( ) Onsite Contact: Phone: ( ) Mobile: ( ) FAX. ( ) Mailing Address: City- State: Zip - DEMOLITION INFORMATION # of Structures being demolished. Start Date: Completion Date: Asbestos present Y Survey attached V N Will all asbestos be removed Y N DEMOLITION PROJECT CATEGORY [�(( Complete Demolition [ ] Training Fire - Fire Agency [ ] Government Ordered Demolition - Attach copy of Order [ ] Renovation, Alteration, Remodeling, Maintenance, or other Construction , I have read and will abide by the conditions set forth in this permit and any addendum thereto I do hereby certify that the information in this application and supplemental data described herein is, to the best of my knowledge, accurate and complete M�& r R) 1-0 Appltc�t Name Signature Date Date Application Received Payment Info [ ] Cash [ ] Check # [ ] Credit Card [ ] Approved [ ] Disapproved Review date: _/_/_ Recc;vr• date:—/—/— Reviewed h�- i A eixy Use Only _ �_1� n�� Use Only _ _ ncJ- i, �. OU 02/25/08 =asbestos Permit Permit # ASB00 Demolition Permit Permit # DE1\400 flxen. y Use „! Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com Date: 5/23/07 Tob Location. Boat Haven and Boat Storage Yard 801 Marine Dr Port Angeles, WA 98362 Owner: Port of Port Angeles P.0 Box 1350 Port Angeles, WA 98362 Contact;, Susan Bauer P.O Box 1350 Port Angeles, WA 98362 Subject: Demolition Insnector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-10270601 Expires - 10/27/07 Scone of work 1) Good faith inspection for asbestos containing building materials (ACBM) 2) Survey, sample and record suspect materials. 3) Report to Susan Bauer with results. Inspection Report The inspection started with a visual survey looking for.Asbestos Containing Building. Material (ACBM) Boat Haven 1) Boat House #2- I Float Metal siding and roof, wood flooring .and plastic windows. No suspect ACBM. 2) Boat House #58- YC Cross Metal and wood siding, metal roof and wood floor No suspect ACBM. 3) Boat House #22 J Float Wood siding, metal roof and wood floor No suspect ACBM. 4) Boat House #73- J Float Metal siding and roof, wood floor No suspect ACBM. 5) Boat House #21 J Float Metal .siding and roof, wood floor No suspect ACBM. 6) Boat House #15- O Float Metal siding, plastic roof and wood floor No suspect ACBM. 7) Boat House #59- O Float Metal siding, metal roof and wood floor No suspect ACBM. 8) Boat House #62- O Float Metal siding, metal roof and wood floor No suspect ACBM. 9) Boat House #63- O Float Metal siding, plastic roof and wood floor No suspect ACBM. 10) Boat House #64- O Float Wood siding and floor, metal roof No suspect ACBM. 11) Boat House #71- O Float Wood siding and floor, metal roof No suspect ACBM. 12) Boat House #75- O Float Wood siding and floor, metal roof and some fiber glass insulation No suspect ACBM. 13) Boat House #36- O Float Metal siding and roof wood floor No suspect ACBM Note: Boat House #79- 0 Float at both visits was inaccessible Brat Storage Yard * Boat #1- WN793 1MC- approx. 32 ft., all wood mostly dismantled. No suspect ACBM. #Boat #2- Chris Craft boat approx. 36 ft., all wood mostly dismantled. No suspect ACBM. qrl- SUmmary of Insnection -All- asbestos containing building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency _During renovation it is possible that additional suspect asbestos containing building material (ACBM) may be found. 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 Copies for City of Port Angeles Permit Center and Olympic Region Clean Air Agency Thank you, Bob Witheridge, E.F.Nf IE 1� THIS IS' TO CERTIFY THAT Bob itheri e Participated in the EPA AHERA INSPECTOR, MANAGEMENT PLANNER Refresher Course -offered- by the. WASKINGTO-14- ASSOCIATION- of MAINTENANCE and OPERATIONS ADMINISTRATORS The full day training program -._ covered all topics specified In the Model Accreditation- Plan -u-nder-- Section 206 -of Title 11 of -TSCA The course was taken on October 271, 2006 in Silverdale, Washington. Certificate #10270601 - Expiration October 27, 2007 Colin MacRae Course Administrator 2714 228th St. SE Bothell WA .98021 (425) 456-4568. 0 C WASHINGTON ASSOGIATIDN-of MAINTENANCE and OPERATIONS ADMINISTRATORS THIS IS' TO CERTIFY THAT Bob itheri e Participated in the EPA AHERA INSPECTOR, MANAGEMENT PLANNER Refresher Course -offered- by the. WASKINGTO-14- ASSOCIATION- of MAINTENANCE and OPERATIONS ADMINISTRATORS The full day training program -._ covered all topics specified In the Model Accreditation- Plan -u-nder-- Section 206 -of Title 11 of -TSCA The course was taken on October 271, 2006 in Silverdale, Washington. Certificate #10270601 - Expiration October 27, 2007 Colin MacRae Course Administrator 2714 228th St. SE Bothell WA .98021 (425) 456-4568. 0 C Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com Date: 4/29/07 .LQb Location. Boat Haven Storage Yard 801 Marine Dr Port Angeles, WA 98362 Owner: Port of Port Angeles P.O. Box 1350 Port Angeles, WA 98362 Contact: Holly Hairell P.O. Box 1350 Port Angeles, WA 98362 Subject: Demolition Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-10190704 Expires - 10/19/08 Scone of work 1) Good faith inspection for asbestos containing building materials (ACBM) 2) Survey, sample and record suspect materials. 3) Report to Holly Hairell with results. Inspection Report The inspection started with a visual survey looking for Asbestos Containing.- Building - Material (ACBM) Boat Storage Yard Boat #1- Carol Jean- approx. 50 ft., all wood-. Sample #1, Heating system pipe wrap .Approx. 3 lin. ft. Sample #2, Heating system pipe insulation. Approx. 5 lin. ft. Boat #2- Leonard- approx. 35 ft., all wood. Sample #1, Deck coating. Silver Sample. #2, Cabin roof coating. Black i 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. Date: 4/21/07 JQ12 LQca i.Qnn Boat Haven Storage Yard 801 Marine Dr Port Angeles, WA 98362 Owner: Port of Port Angeles P.O Box 1350 Port Angeles, WA 98362 CQ=C- . Holly Hairell P.O Box 1350 Port Angeles, WA 98362 Boat #1- Carol Jean- approx. 50 ft., all wood. Sample #1, Heating system pipe wrap Approx. 3 lin. ft. Sample #2, Heating system pipe insulation. Approx. 5 lin. ft. Boat #2- Leonard- approx. 35 ft., all wood. Sample #1, Deck coating. Silver Sample #2, Cabin roof coating. Black Insvr Bob Witheridge AHERA - Building Inspector / Management Planner WAMOA - 0042-10190704 Expires - 10/19/08 Please call with test results when completed. See attachment. Thank you, ' r Bob Witheridge, EFM 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 9881746 FAX. (206) 988-1978, EMAIL. nihinc@_eschelon.com NVL4P# 200511-0 Bulk Asbestos Analysis Report Nonhwea Asbestos Consultants NIH Batch Number 08-00328 406 Reed Street Ctrl Job Number Port'Fownsend. WA 98368- Turn Around Tom: S Day C Pn4ed Locafinn: SW Marine Dow Peel Argab-, WA Samples Analyzed: 4 (Xient Sample Number iA Lab Sample Number 08-00328.0001 CFEW Sample Description: HeafiM System Pipe Wrap Cgeirt Sample Location: Beat Haven Storage Yard - Cand Jwn (Boat 01) Sanole Comments: Checked ff Sample Not Analyzed D Rust Colored woven fibers Asbestos Fibrous Components: Non4kSbeStOS F&MIS Qmm.wom.c.46- Non-Fiturous Components: No Asbestos Detected 90% 9ass 10% Miscellaneous Materials . ........... "4"' IR, )14 A '4 El P X Oient Sample Number 1B Lab Sample -Number 08-00328.0002 Client Sample Description: Henfing System Pipe L, � IUE.. Client Sample Location: Sam Hkven Stange Yard - Carol Joan (Boat #1) Sampie Comments- Checked 9 Sample Not Analyzed D While and brotan 110motis I ASMSTOS HUMM Components: Nor"isbestos Filmous; Qu wjmwem4". Non -Ferrous Components: No Asbestos Detected 3% Celalm 10% Misfle9aneous Materials 87% Mineral Wad and Beads Chert Sample Number 2A Lab Sample Number 08-M28.0003 Cliefft Sample Description: SHver Deck CxaWV Chent Sample Location: Boat Havm Storage Yard - Leonard (Boat #4 Sanwk, Comments: Wood not a Checked If Sample Not Analyzed Multiple gray paint byem on wood Asbestos Fibrous Components: Wxi-Asbestos Fibams Cauganents: Non -Fibrous Components: No Asbestos Detected 1% Cellulose 99% Paint Con"mmnts: Materials distinguishable but inseparable fln (Samnpfe reuft camim, ed a n. next rege � Sampled by, Bob Witheridge 4J21r2M Received by" Jude Cummings Reviewed by- Rachel Melgoza 4rl9rAMW Rachel Melgoza, Analyst Page 215 SW 163rd Street Burien, WA 98166 ; OFFICE: (206) 998-1746 FAX. 1206) 988-1978' EMAIL. nihinc@eschelon.com N•t LAP# 200611-0 Bulk Asbestos clysis Report Northwest Asbestos Consultants NIH Batch Plumber. 08-00328 405 Reed street Cid Job Number. Pant Townsend, WA 98368- Turn Amund Time: 5 Stay C P=id Location: Bal Marine Dnm Pad Afgohn WA Sarnpies Analyzed: 4 Cunt Sample Plumber 2B Lab Sample Number 08-W328.0004 Cfttt Sample Description: Black Rood Coating (Cabin) Client Sample Location: Beat Haven Storage Yard-- L (Boa 92) Same Comments: Checked 9 Sample Not Analyzed O Blank fibrous asphalt Asbestos Fibrous Components Fibrous Cwmposrents: Non -Fibrous Components: ����/..+4�1' i�.�. i}�if��i;tµ,�:"(lroy��`P"lf R �}LSrh L� jri•#aiy"� 3% Celulose 9D% Asphaff Fdler and Birder SMS"4e, . tf,.rlr : dn" ti� :! :-i, ni` >' f$.fiw' .'.iiG ... i:."'..;�;i "" {'ii't'•'t� /•;yi`' 3 '•3:'i7"`' ; { ' >it:; '• f,. „Cti''rtt�;:'. . ;(:' 1ij'<. i'f +�.,y�r�,r;-,.a-r; 4 ..i,.A,,, '# ,,a� =r'•.� t ,n'}.; .As q'• _ ,.ns. •csrr,. c s,.l, r •r;x.r, t'i.,Yf.,;�'rr:r't,b�l;?i�Ni":+�'s"y t .t..g..•. q�'s S ��'•'tfi'r' �, ,. y r•I F: � 4 � isi?7' ��;. • '4rat.'•,wa ;�Yy ;sta' .� r;, : Ir r_st'' i' a'rjF 1. v I( �1 1. Yl•: �BS. '+'��tr nil l:�5 nS•S�ItV.Su4:'h.4; :'fb. < r±��� .:5�' hd. ' � ':t�: ' ;�� „l� Flli�;-e,'•fl•1�3� ".�'',.- , , Z:.�' t`}•r Sampled by Bob Witheridge 412MM Received by Jude Cumm ixns 41r=AWS Reviewed by Rachel Metgaza 4r'291208 Rachel Melgaia' Analyst Page 2 Summary of Insnection Boat #1- Carol Jean- approx. 50 ft., all wood. Sample #1, Heat ng system pipe wrap Approx. 3 lin. ft. No asbestos detected. Sample #2,. Heating system pipe insulation. Approx. 5 lin. ft. No asbestos detected. Boat #2- Leonard approx-. 35 ft., all wood. Sample #1, neck coating Silver a.. No asbestos detected. Sample #2, Cabixt roof coating. Black 7% chrysotile asbestos. All asbestos containing; building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed a certified -abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency During demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. Should such suspect material be discovered an AIIERA 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 Copies for City of Port Angeles Permit Center and Olympic Region Cleari Air Agency Thank you, Bob- Witheridge, E.F.M. I WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS THIS IS TO CERTIFY THAT Bob Witheridge- Participated In the EPA A -H ERA N S P-ER9 T MANAGEMENT PLAN N ER Refresher Course offered by the WASHINGTON ASSOCIAJ11014 of MAII�T.�NANCE ane OPERATIONS ADMINISTRATORS -- The full day training program covered all topics specified in the - Model Accreditation Plan under Section 206 of Title II of TSCA The course was taken on October 19, 2007 In Silverdale, Washington Certificate #1 01 90704 — Expiration October 19, 2008 Colin Mac ae Course Administrator 2714 228th St. SE Bothell, WA 98021 (425) 485-6980 a i pyl•n�n�NM11�h•11•ll�n•x•R•n•x•x•x•xob>!-X• X•X•x-x•A•l O t= AUG -8-2009 ©_ 2-2F FF:0I'1 TO _3504173445 F 2 Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwcstasbestosconsultants@cablespeed. com Siabiect: Demolition of boat house #57 #9, #70, #57 p�+mtor: Bob Witheridge AHERA Building inspector / Management Planner WAMOA - 0()42-10190704 Expires - 10/19/08 8/08/07 ,tel,-C-aIi= Boat Haven Storage Yard 801 Marine Dr Port Angeles, W_A 98362 Q -x; Port of Port Angeles P.U. Box 1350 Port Angeles, WA 98362 SQ&W.U; Holly Hairell P.O. Box 1350 _ -Port Angeles, WA 98362 Siabiect: Demolition of boat house #57 #9, #70, #57 p�+mtor: Bob Witheridge AHERA Building inspector / Management Planner WAMOA - 0()42-10190704 Expires - 10/19/08 AUca-6-2008 01 23P FROM TO 13504i17344F P 3 ScQ12e of work 1) Good faith inspection for asbestos containing building materials (ACBM) 2) Survey, sample and record suspect materials. 3) Report to Holly Hairell with results. 1,12,Spec tion -'Ren= - The inspectii-n _started with a visual survey looking for Asbestos Containing Building AIateriaL4-AG-��I}- at_..', Boat #67 .Hansen- "J" Dock Boat #9- _ Hines- "J" Dock Boat #70- Chandler- "0" Dock .�s Boat #57- Taylor- '0" Dock AUG -e-2008 Gil 23P FROM TO 13bG,�1 r 344 P 4 Boat #67 Hansen- J" Dock No asbestos detected. I Boat #9- Hines- "J" Dock No asbestos detected. Boat #70- Chandler- "0" Dock No asbestos detected. �C Boat #57 Taylor- '0' Dock No asbestos detected. All asbestos containing buildibag' materials. with a reaciirjg--g*�ter than° 1% is onsidered a hazardous 1xiaterial if disturbed. If removed a certiiiFd abateinent -contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency During demolition Itis possible that additional suspect asbestos containing building material (ACBM) maw be found. Should such suspect .material be discovered an AHERA certified inspector -will have to sainple 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. Copies for City of Port Angeles Permit Center and Olympic Region Clean Air Agency Thank you, Bob Witheridge, EX M. 01 23F FROM WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS THIS IS TO CERTIFY THAT TO 1350-41---Q45 P c:. - I Ed ;i Participated in the EPA AHERA INSPECTOR 'MANAGEMENT PLANNER Refresher course offered by the WAS14INGTON ASSOClA-110N of MAINTENANCE and OPERATIONS ADMINISTRATORS The full day training program covered all topics specified in the Model Accreditation Plan under Section 206 of Title It of TSCA The course was taken on October 19, 2007 in Silverdale, Washington Certificate #10190704 — Expiration October 19, 2008 Colin Mackae Course Administrator 2714 228th St. SE, Bothell, WA 98021 (425) 4,85-6980 NZ .8 ot iik .z. it WSW L W1---.rr BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn. Building Permit Technician 321 E. Fifth St. Port Angeles, WA 98362 (360) 417-4815 fax (360) 417-4711 Applicant or Agent Po cif Ray -t- Auq { d5 Property Owner Pori- c+ P43Y A-tmdes Property Owner's Address P6 1.36 l: Contractor/Engineer b�-�o F p�-E� Contractor/Engineer's Address License # For City Use Only Date Received -2(3 -®2 Permit # - O 17 Date Approved o Ph e (g(00)q 1-7-3LF54 Phone WA 01%36a Phone Expires 12ci moa-%"ne PROJECT ADDRESS bnm Qoy+ Au gees, WA- 9$3(o3 Parcel Number (�(`„ -A en ot16 7 q $2_ ; Lot J Zoning Proiect TVoe & Brief Description. ❑ Residential ❑ Commercial ❑ Multi -family ❑ Industrial Check all that apply ❑ New Construction � ®�� ��p — VL -0 v�raIv o r P.�2cyt1-t�� �a 6 avS25 ❑ Addition ❑ Remodel Qi,, OVGAA pe*- 1} - 0 kA a inf 4P OU o 1 e,44?4- - �r t)tA T :pj,, a. ❑ Repair Re -'Bo0qAAnk4s affzer v�41 6eA i vt ovtk au'o ,J- d i,u, A -o rei_,,zNxc6vx 4- AQ_ 'P3-WAAAt,,& 6vktk ❑ -roof , . 4M MAJ)V %fO)A Is rhWtI.efeJ U4B "Idid.e. a `Demolition 3 books d. 4 boaktnkses 0 ❑ Heat System ❑ Heat pump ❑ wood -burning stove ❑ gas fireplace ❑ pellet stove ❑ other ❑ Other Floor Areas Basement 1St Floor 2nd Floor 3`d Floor Garage Carport Covered Porch Deck Shed Other Total footprint of structures Existing (sa. ft.) Proposed (sq. ft.) Max. height of proposed structures �_C) Will a lawn sprinkler system be installed? Will a fire sprinkler system be installed? per sq ft. = $ TOTAL VALUATION $ S, SdO sq ft. T Lot size sq ft. = Lot coverage % ft. Occupancy group # of bedrooms Occupant load # of full baths Construction type # of half baths /have read and completed this application and know it to be true and correct. /am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects. Date S�-�0-0 Print Name h l rel, Signature - T:Forms/Building Division/Bldg Permit Appl.-2006 Codoc WASHINGTONTy"ORTANGELES U SA Public Works & Utilities Department July 9 2007 Port of Port Angeles P O Box 1350 Port Angeles WA 98362 WDA -off -Z-4 RE. Port Angeles Landfill / Transfer Waste Disposal Application, WDA 07-31 Boat House Demolition, Marine Drive 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 station 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 JZU4LCGt.4tdz;� Stephen Sperr P.E. City Engineer Encl. WDA 07 31 Copy Claudia Stromski N:\PWKS\ENGINEER\WDAPPLIC 07-31 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 0 Box 1150 / Port Angeles WA 98362-0217 P. il wp' - a7-;�q +OF pORTgHGtc PORT ANGELES LANDFILL = WASTE DISPOSAL APPLICATION To City of Port Angeles, City Engineer Phone (360) 417-4803 321 E Fifth Street FAX. (360) 417-4709 P O Box 1150 Port Angeles, Washington 98362 NOTE. All questions must be answered for waste to be approved. 1 Generator Information. Company Name: Plve'r of '6&t,T /%.4, -.c. -.,r Mailing Address A o. 3.,Y /3550 16A.t.9 4^V..<,tis t,.A 9da 6 L Phone y 17- 3 4 314 Project Name: &A --t It Z04 �.15«.wu 1.,.•� Project Location /t4,4,,4 ,.^ 6t, /4. - Az s g.,,-;ec,-cs 1&?oy 14+t. -I 2 Other Contacts (if applicable), Consulting Firm: 2�+�weLsecT C Contact:� > �uEld. C. Phone. (4l )-ems Contractor Name A2s of ?--> A.•r��c� S Contact: &1-144 Phone. cl/7 - 39 31-I Laboratory* AVL L LA*,t•t �1 Contact: /Vick t-( Phone 2.0 L - 54 ) - (Nov City of Port Angeles Landfill Waste Disposal Application Wed, 10/4/2006 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) CERCLA/MTCA Remediation Agency Contact: Independent Remedial Action UST Removal Unused Chemical Product Spill_ Other Source. 65 -us 4 Waste Material Composition Soil Concrete/Asphalt Preserved Wood Coal Ash Wood Ash (check all that apply and include percent of total) % Foundry Slag % % Dredge Sediments % % k Debris /0 O % % Other (list) NOTE. Total must equal 100% 5 Waste Material Contaminants (check all that apply) Gasoline Metals _ Solvents Heating Oil _ Unused Motor Oil Used Motor Oil/Waste Oil )C1 Other fq '7cLO' &46 Other Petroleum Product Unknown NOTE. Supply any MSDS information with application if available. City of Port Angeles Landfill Waste Disposal Application Wed, 10/412006 0:4 PM Diesel PCBs Page 2 Ir f 6 Estimated Quantity of Waste for Disposal Cubic yards Tons (estimate both) Drums / 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 K 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 :5 & number of discrete samples per composite U-440—tr Number of DISCRETE samples L°4'0'p�tMoot's 4U a 4 A .4 a'70 4> -^An, -A A-- J 12 M73, dgs-b' d7/ X'fJ #61, 't62 44" &4r qavg4 0-)Jb� C - '(4"bolA, 6A AINWtw&.61 1K NOTE I Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used 0-25 cubic yards 1 composite sample 25-100 cubic yards = 3 composite samples 101 500 cubic yards = 5 composite samples 501 1000 cubic yards = 7 composite samples 1001-2000 cubic yards = 10 composite samples >2000 cubic yards = 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 Wed, 10/4/2006 0:4 PM I 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 -0 AP41311 ; 70004 b) Provide a narrative as to why he above analytical methods were selected RV sr ac t Guo a K.c0 04,,v ds -c -o 5��.+cTKc S ✓1�/lQs > of %4k Aw-,-' b"s-4 l404 6cL lM4-a,L S'1,6-S'1,6-04P,�� i�4 "( IUD AAA k ,*4.c /tom &4-,r i(o� o/✓ Act0a X P4a-t tedvtc 7.cs- rr� /�W jdQ w*6 �o i � 4cAc& d4, •�9�J' PlA u6 6e a2 LJ �1t,y �1�c. u / 6 dr-,A6 h tccr,f 4s /4,X0 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 (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 Wed, 10/4/2006 0:4 PM 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 materiaVto th/el est of our abilities. Waste Generator Sig ature Printed Name —2410OJl c. � Q Company 7 /4 Date City of Port Angeles Appr Pr � ,� I. 7C k City Engineer o Date ' / x-131 /D �— Approval Expiration Date City of Port Angeles Landfill Waste Disposal Application Wed, 10/4/2006 0:4 PM Page 5 NVL Laboratories, Inc 4708 Aurora Ave. N Seattle, WA 98103 7 0100 F 206 634 1936 AIHA IH # 101861 A AIHI ACCR6DIT6D Tel 206 54 ax. www nvllabs com Analysis Report WA DOE # C1765 LABORATORY, Toxicity Characteristic Leaching Procedure - Lead (Pb) Client: Zenovic & Associates, Inc Batch #- 2709142.00 Address. 301 E. 6th St. Suite 1 Matrix: Bulk Port Angeles WA 98362 Method EPA 1311/7000B Client Project #' 07106 Attention Mr Tracy Gudgel Date Received 06/13/2007 Project Location Port Angeles Marina Samples Received 2 Samples Analyzed 2 RL Results Results in Lab ID Client Sample # mq/ L in mg/L ppm 27062208 07106A 04 < 0 5 < 05 27062209 07106B 04 < 0 5 < 05 Sampled by* Client ` Analyzed by- Ahmad Izzat Date Analyzed 06/15/2007 Reviewed by, Nick Ly Date Issued 06/15/2007 *LV, Techni ctor mg/ L =Milligrams per liter RL = Reporting Limit ppm = parts per million <' = Below the reporting Limit Note Method QC results are acceptable unless stated otherwise Unless otherwise indicated, the condition of all samples was acceptable at time of receipt. Bench Run No 27-0614-4 Page 1 of 1 NVL Laboratories. Inc. CHAIN of CUSTODY 4708 Aurora Ave N, Seattle, WA 98103 Tel. 206.547 0100 Emerg. Pager 206.344 1878 SAMPLE LOG 1.888.NVL.LABS (685.5227) Client Zenovic & Associates, Inc Street —:-5 U \ C (- "— �c e-eA I Port Angeles Project Manager 2vac-t 6 �n�.tL Project Location P-c,,Z-f BATCH ID 2709142 00 NVL Batch Number Client Job Number 7/a(- 7 Total Samples <- Tum Around Time ❑ 1 -Hr ❑ -4-Hrs ❑ 4 Days ❑ 2-Hrs D2 Days ❑ 5 Days ❑ 4-Hrs ❑ 3 Days ❑ 6 to 10 Days Please call for TAT less than 24 Hrs Email address 174c 7` c= ,c, c• -1T Phone: (360) 417-0501 Fax: (360) 417-0514 J❑ Asbestos Air 1 O PCM (NIOSH 7400) [ITEM (NIOSH 7402) LJ TEM (AHERA) ❑ TEM (EPA Level II) ❑ Other j 10 Asbestos Bulk 1 p PLM (EPA/600/R-93/116) ❑ PLM (EPA Point Count) ❑ PLM (EPA Gravimetry) p TEM Bulk 11,61ETAL.S Dot. Limit MatrixOther Metals ' RCRA Metals ❑ AN 8 Cl J.otal Metals 21 'ppm (AAS) r-1 Air Filter ❑ Paint Chips U All 3 TCLP n ) [) Drinking water ❑Arsenic (As) O Lead (Pb) ppb (GFAA) 9 C1 Paint Chips (Area) p Barium (Ba) ❑ Mercury (Hg) ❑ Copper (Cu) U Dust/wipe ❑ Waste Water ❑ Cadmium (Cd) ❑ Selenium (Se) ❑ Nickel (Ni) ❑ Soil ❑ Chromium (Cr) ❑ Silver (Ag) ❑ Zinc (Zn) ❑ Other Types I❑ Fiberglass C3Nuisance Dust ❑ Rotometer Calibration (D Other (Specify) of Analysis 0 Silica ❑ Respirable Dust ❑ Mold/Fungus ) Condition of Package: O Good ❑ Damaged (no spillage) ❑ Severe damage (spillage) Seq. Lab IDClient Sample Number I Comments I A/R I 2 O -)Io -CL,�5 C44--) 3 4 Ij 5 6 I 1 8 I � 9 10 I I 1 I 11 If 12 j I 13 14 15 Print Below Sign Beloyf if Comoany Date Time Sampled by 2 U Y C LSC Relinquished by -- Received by 10 WIJ7 1.2 Analyzed by lAt _� -- -- /' c' _ Results Called by - Results Faxed by Special Instructions Unless requested in writing. all samples will be disposed of two (2) weeks after analysis. 1 n , JUN 28 2087- g 21AM---NVL LABORATORIES INC ;10 086E—P 2 NVL Laboratories, lnc 4708 Aurora Ave. N- Seattle, WA 88103 ,q q _ aA9b�6a I ,�'„""";,,i Tel. 206.647.0100, Fax: 634.1836 Analysis Report WA 130E#C1765 www.nvllabs.com Report �'''�MO��� 1 Toxicity haraeteristic Leaching Procedure - Lead (Pb) Client: Zenovic & AssociateE., Inc. Address: 301 E. 6th St. Suite 1 Port Angeles, WA 98 362 A"Wauaw lk TVACY Gudgel Project Location: Port Angeles Marina Bc& r ib� #79 Lab 1p Client Sample 27066029 07106C Sampled by Client Analyzed by Tanveer Khan mg/ L =Milligrams per liter ppm = parts per million Note Method QC results are acre Unless otherwise indicated, Hatch #• 2709756.00 Method, EPA 131 V7000B Client Proiect #' 07106 Date Received: 06/26/2007 Samples Received: 1 Samples Analyzed: 1 RL Results Results in msa/ I_ in rna/L ppm 04 40.5 < 0.5 Date Analyzed: 06176/2007 DRAFT } RL = Reporting Limit 'o.' a Below the reporting Limit unless stated othervAse. edition of all samples was acceptable at time of receipt JUN 28 2007 4 21AM NVL LABORATORIES INC _ _-NO.0865- P 3 t4VL- Laboratoelles, Inc. CHAM of CUSTODY IBK 7C " k0 4708 Aurora Ave N. Seattle. WA 9810SAMPLE LOG � ! �� f 5&00 TO: 206.547.010a Emerg. Pager: 2W.344. fIT 1.888.WL..LASS (665"5227) Client Zenoft & Peres, im. WVL Batt% Humber Street U\ C-. G""'` � ��'� CrfcM Job Number �! t)(0 Port `A�n�g�eles Total Samples - f Projactlllansljer i '�'1 'GT _ Tum Around rime p 1-Hr Z �-m 0 4 Days akrs'�� ©s PrtLAtation &nT A% i,-4s 4g �� (3-HrS ❑ys Days .. j%"w. �! Presse call lbr TAT less than 24 His l�� Email a�'ess 'L� �r+�y'rL,�lrt' 4 MQ1I4174MI t=ax. 3fi414t7-0514 Jo Asks Air (1] pCls (N10SH 7400) a]TEAM (NIOSH 7402) E! TEAR (AHERA) 1] TEM (F-PA level It) 0 Other tCr Asbeams Huft to PW (EW lei a"MM F+r Z) PW (FRA Gam) D TEM Pour METALSRA i! "Ofitt RCRA McWs D AN 8 r n � Me�ppm �i Pair a PSWA om" Q Asp tAea) 41."d W% 5C� O ppb (� A)) O Drinld g war ❑ Paiint Chips (Asea) ❑ Barlum (8a) 0 Menxsy (Hg) 0 NCopper {N�u) i U f] Waste taster O Cadmium (Cd) ❑Selenium (Se) + ❑ � -- ID Chrmrxu n (Co d Ofver (Ag1 ---- --... -._ [1 Other Types O Fiberglass O Dust O Rotameter Catbraiion O Other'(SpWly) of Analysis Seca O �le Dust 0 Mok))Fungus Condition of Paulsaae: 0 Good O Damagg* (no spillage) [3 Severe d9mgp.tsQNlage) Seq.0 Lab ID Client Sample umber r Comsrf IAfR 2 I 3 4 6 _ 6 7 — b 8 10 11 12 13 ` 14 Print Belowsign Ier_ /1 comoany Sampled by ��,s� [-� Relinquished by -Agcy I9'ati.44 4 -uOcNc foke-C — Received by Q_.Ttgnx Results Called by - - -- Special Instructions: Unless reque-swi In writing, all samples will be disposed of two (2) weeks afar analysis. PC Time 1� FP°"r"" 4CITY OF PORT ANGELES N DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES WA 98362 taivry Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Owner MILLER III JOHN Z 503 E 3RD ST PORT ANGELES Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date 05 00000560 Date 7/11/05 887360 1201 MARINE DR 06 30 00 0 0 0900 5540 54 JOHN Z MILLER SIDING INDUSTRIAL HEAVY 5382 WA 983623401 BUILDING PERMIT RESIDING BOAT HSE 53801 148 75 7/11/05 1/07/06 Contractor PENINSULA BUILDING 1128 WEST 16TH ST PORT ANGELES (360) 457 5376 NO PR FEE Plan Check Fee Valuation Qty Unit Charge Per BASE FEE 4 00 14 0000 THOU BL 2001 25K (14 PER K) Fee summary Charged Paid Credited Permit Fee Total 148 75 148 75 00 Plan Check Total 00 00 00 Grand Total 148 75 148 75 00 WA 98363 00 5382 Extension 92 75 56 00 Due 00 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 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 iolate or cancel the provisions of any state or local law regulating construction or the performance of construction Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T-\Policies\1102_15 building permit inspection record05 wpd [1/4/2005] BUILDING PERMIT INSPECTION RECORD 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. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORKBEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE I DATE I ACCEPTED I COMMENTS YES I NO I FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE / DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR/ SLAB ROUGH -IN WATER LINE (METER TO BLDG) GAS LINE I` BACK FLOW / WATER AIR SEAL I` WALLS CEILING FRAMING JOISTS/ GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T BAR INSULATION SLAB WALL/ FLOOR/ CEILING MECHANICAL I` HEAT PUMP / FURNACE / DUCTS GAS LINE I` WOOD STOVE / PELLET / CHIMNEY COMMERCIAL HOOD / DUCTS MANUFACTURED HOMES FOOTING / SLAB BLOCKING & HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s SEPA. PARKING/LIGHTING ESA LANDSCAPING I I I I SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE I RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO IELECTRICAL LIGHT DEPT 417-4735 ELECTRICAL LIGHT DEPT /PW/ CONSTRUCTION R.W �CONSTRUCTIONR.W ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING (/ 417-4815 F x� ���'� / BUILDING T \Policies\ 1 102_ 15 building permit inspection record05 wpd poar.4 BUILDING PERMIT - APPLICATION . = 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 (360)417-4815 FOR OFFICIAL USE O LY_ Date Rec. 3 Permit #• Date Approved. Date Issued: Applicant or Agent: i S r �n. I U K t/2. P e .Gti'F Phone: Owner- -� r phone - Address. LA a58 l-) , 1 (0-0— r City- Zip Architect/Engineer- ( Phone: Contractor_ v ! !��LJ(41tteaLicense #• +9'Exp 2" Phone.�l ,�.� X Address. 1 I 29 t ij , ( 6-rA- City- P A , b ) A , Zip PROJECT ADDRESS P_P, YMAri A14 <.7 16 , /),t,�,r�jLONNING LEGAL DESCRIPTION Lot: Block: Subdivision -GI±_ CLALLAM COUNTY PARCEL NUMBER. Credit Card Holder Name: Billing Address: City - Credit CardType VISA MC # Exp. Date: TYPE OF WORK. SIZE/VALUATION p ' f ❑ Residential ElNew Constr ❑ Re -roof ❑ Stove SF @$' a_.4:/ /SF = $ 36 (,i� ❑ Multi -family ❑ Addition 4. Move ❑, Garage -SF @,$ /SF = $. ❑ Commercial ❑ Remodel ❑ Demolition ❑ Deck SF @ $ /SF = $ ❑ Repair ❑ Sign ( Other ++ TOTAL V LUATION & BRIEF DESCRIPTION OF THE: PROJECT ----.,, COMMERCIAL/RESIDENTIAL.:Occupancy Group• Occupant Load: . No. of Stories. _ Lot Size- Existing Sq. Ft. & Proposed Sq. Ft. Existing lot coverage % & Proposed lot coverage % = Total lot coverage PLANNING USE ONLY ESA/Wetland(s) ❑ Yes ❑ No SEPA Checklist required? ❑ Yes ❑ No Other• ' Construction Type - TOTAL Sq.Ft. APPROV S. PLAN-4� BLDG _ DPWU FIRE OTHER. BUILDING 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. Thus 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 107 4 of the Uniform 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 ,notity's, n fha est obtain such permits prior to work. T•\FORMS\APPS\Buildingpermit.wpd Applicant: ////A"7:?Date: __i�7 Q Q ll PROPOSAL ! P4E�V-Li VL f Proposal Submitted To Name} Streetl'ZI'i%Y%(gr y re- k4l4 city/% ' / State .z4)W- L :Sheet•;Nb. Work To Be Performed At. StreetC./L City 7PIW State _. ` Phone 0 ob J `Date of Plans Architect J We hereby propose to furnish the materials and perform the labor necessary for the completion of r r e s 7,1 (�3 l All material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of - -- Dollars [$5--3 81 with payments to be made as follows /.f yipCc4 !! Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an Respectfully submitted extra charge over and above the estimate. All agreements contingent — upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Work Per men s Compensation and Public Liability Insurance on above work to be taken out by Note -This proposal may be withdrawn by us if not accepted within days. mss• .a` ....,.. �. ,. , ., . Y� ;....... , ,m, .. .... . , , ,�. _ .... , ..... ... . _, ;}. ,,c:. .... ... ....,1,. ,� ,��,. . ., ACCERTANCE:QF'PFIOR©SPL ,.. ".`Th,e abbv4r.ices specifications and7condit;ons-aye sati"tfactory.and_hre;hOe6y;acce' ed' Y u; ce lit brined:tb:doal e:work-as;specified. Y.. ze.} Pa ment well, be:iriade°=as=putlined�above. r sY • . �� ` ` ` _ Signature `Y =SUI�•J►fLL Zi;;; 1 OWNER/APPLICANT CITY OF PORT ANGELES PUBLIC WORKS -BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 BOB PRICE 2114 WEST 8TH STREET PORT ANGELES, WA 98362 360/452-8046 T: BOB PRICE --SLIP 80 S: CONTRACTOR OWNER VARIOUS Port Angeles, WA 99360 206/000-0000 PROJECTINFO ISSUED: 3/26/2002 PROPERTY LOCATION 1201 MARINE DR Lot: 1 PERMIT NO: 13308 Block: 12 ® Long Legal Subdivision: TLE PP#1226000 Parcel No: 063000000900536 ARCHITECT N/A , 98360-0000 360/000-0000 Project Value: $300.00 SFD Units: 0 Commercial: 0 Project Type: RE -ROOF SFD SQ FT: 0 Industrial: 0 _ Occupancy Type: Garage: 0 f 1 Occupancy Group: MFD Units: 0 O Construction Type: MFD SQ FT: 0 Zoning Use: M1 7 PROJECT NOTES INSTALL NEW METAL ROOFING ON BOAT HOUSE, SLIP 80 I"I RECEIPT#8896 FEES ASSESSMENT Building Permit: $23.50 Misc Fee 1: $0.00 Plan Check: $0.00 Misc Fee 2: $0.00 State Surcharge: $4.50 Misc Fee 3: $0.00 House Moving: $0.00 Manufactured Home: $0.00 Sign: $0.00 TOTAL FEE: $28.00 Plumbing: $0.00 AMOUNT PAID: $28.00 Mechanical: $0.00 BALANCE DUE: $0.00 Radon: $0.00 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 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 I regulating construction or th7perfo ance of construction. Signature of Contractor or Authorized Agent Date Sig ature of OvJner (if owner is builder) Date BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTIONT'YPE I{ DATE I ACCEPTED t YES ' NO FOUNDATION: FOOTINGS WALLS ' E FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SF-PARATE PERMIT: # J ROUGH -IN PLUMBING UNDERFLOOR/SLAB I IS iROUGH -IN ' WATERLINE ' GAS LINE I BACK FLOW / WATER ( ' AIR SEAL WALLS I CEILING J FRAMING JOISTS/ GIRDERS SHEAR WALL ' WALLS ROOF/CEILING DRYWALL T -BAR INSULATION SLAB ' WALL/FLOOR/CEILING MECHANICAL HEAT PUMP ' WOODSTOVE/ PELLEVCHIMNEY /INSERT 1(1(1(1 HOOD/DUCTS PW UTILITIES/ SITE WORK (Engineering Diviswn) SEPARATE FER [IT ft's: 1 WATERLINE, METER SEWER CONNECTION j SANITARY I STORM ' PLANNINGDEPT. SEPARATEPERMtT#'s `SEPA: PARKING/LIGH LANDSCAPING TING I 1 I SHORELINE: FINAL. INSPECTIONS REQUIRED PRIOR TO OCCUPANCYtUSE RESIDENTIAL DATE YES NO COMMERCIAL ELECTRICAL - LIGHT DEPT. CONSTRUCTION R.W, i PW/ ENGINEERING FIRE PLANNING DEPT. BUILDING CV.PPL.WPD 417A735 417-4807 417-4653 417-4750 )� 417-4816 ELECTRICAL LIGHT DEPT CONSTRUCTION -R.W. PW / ENGINEERING FIRE DEPT. PLANNING DEPT. BUILDING COMMENTS DATE ACCEPTED YES NO �i CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST:_ Date (' Time Received by�l1 (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excay. Other INSPECTION NOTES: Inspected: Date 2 Time By Rernwks- RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: ❑ Unimproved ❑ Gravel ❑ Asphalt ❑ PCC ❑ Other []Repaired by City Work Order # ❑ Repaired by Permittee ❑ COMPLETE ❑ No Damage Found ❑ INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) COMMENTS/ACTION NEEDED CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 321 FAST 5TH STREET. PORT ANGELES- WA 98.162 . . .................. App!ication Number .. . . 06-00000153 Date 2/16/06 Application pin number , . . 101744 Property Address ... . . . . 1201 MARINE DR L-10 ASSESSOR PARCEL NUMBER: 06 -30 -00 -0 -7 -9825 -1000 - Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . UNKNOWN Application valuation . . . . 0 Owner Contractor ------------------------ PORT OF PORT ANGELES ------------------------ ANGELES ELECTRIC PO BOX 1350 524 E. IST ST. PORT ANGELES WA 983620251 PORT ANGELES WA 98362 (360) 452-9264 ---------------------------------------------------------------------------- Permit . . I . . . ELECTRICAL NEW COMMERICAL Additional desc . . ANGELES/ 100A 480V SVC Permit pin number 71027 Sub Contractor . ANGELES ELECTRIC Permit Fee . . . . 78.70 Plan Check Fee .00 Issue Date 2/16/06 Valuation 0 Expiration Date 8/15/06 Qty Unit Charge Per Extension --------------------------- 1.00 78,7000 ECH EL -COM 0-100 NEW SRV FEEDER 78.70 ------- Fee summary Charged ----------------- ------------------------------------------ Paid Credited Due ---------- Permit Fee Total 78.70 ---------- ---------- ---------- 78.70 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 78.70 78.70 .00 .00 COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD 4LL 4174735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINWUM 24 HOUR. NOTICE. ITIS UNLAWFUL TO COMER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEi'TIGi) COMMENTS XES NO DITCH i Rouuli-IN I SERVICE FII! AL I GENERAL COMMENTS: 2-7-06 14W�l r -1 dare Pw-1102.1514 CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT N° 17200 Port Angeles. Washington --------- --_ .'"1...-----•- ............ ---•-•. 19_1T_0 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- mission is hereby granted to do electrical work as listed below. /c.:Y % `�rJ�-intOccupancy.... Address -) -- •----------- -Wt-�� i t �! - ' - Owner ----------------------J------ '= '4= A-�'= Tenant - - ------- -- - WiringContractor ---- * -r _-_----------------_- --- By--------------------------------------------------------------------- Light Outlets ............................... ... ...... Service, volts --- ...........�........... Type of Wiring: Receptacle Outlets ....................... ........ No. wires ............ r r��, orad Cable ............................. Dryer. KW .......... ------------------------------- Size wires ... •.hr. 6 ICA( GK✓ , Non -Metallic .................--..........__ Range. KW.-...._--....._---------_------...-_ Water Heater: KW Heat: KW ----------------------------------------------- _ Motors:I-Aejo size, volts and phase: 3o----- ...2.. ...............--- ------------------------- Total Load ............................. Remarks: s Permit Fee Main fuse ...................................... Enclosure ----------------- Type of wiring: Entrance Cable ....... ...................... Rigid Conduit ---------- . Metallic Tubing ._.._.................. Current transformers: No. & Size ....................................... Ser. No .............................................. Ser. No .............................................. Ser. No . .......................................... _ Ser. No .................. ........................... Treas. Receipt.,,,, Knob& Tube ................................. Rigid Conduit ............................... Metallic Tubing ........................... Raceway ....................... Circuits, Light ................................... _.. Utility............................................. Heat---- ----------------------------------- __-- Range............................................. Water Heater ............................... Motor . ....................................... ..... Dryer------------------------------------------------ Furnace_......................._......_........... Total....................................... ---------------------------------------------------- ---------------------------------------------------- ----------------------- --- -_------ ----------_------ -----------------------------------• No .ir r, n, z:wtl ur ,. rz...— NOTICE—Current must not be turned on until Certificate of Inspection has been Issued. If 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 INSPECTION Address ... Owner ---.- Wiring Co: NOTI( cealed due ELECTRICAL PERMIT N? 17200 Tenant........................................................ ........... •.......................................................................................................................... By.............................................................. Tent must not be turned on until Certificate of Inspection has been issued. If work 113 to be con - must be given the Inspector so that work may be inspected before concealment. IM t Olympic Printers, inc.