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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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Application Number
Applicat10n pin number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr, name
Appl1cation type descr1ption
Subd1v1s1on Name
Property Use
Property Zon1ng
Appl1cat1on valuat10n
07-00001296 Date 11/06/07
326432
1033 E 9TH ST
06-30-00-0-2-7790-0000-
RAY GRUVER
DEMOLITION
RS7 RESDNTL SINGLE FAMILY
29360
Owner
Contractor
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RAY & PENNY GRUVER
2802 S LAUREL ST
PORT ANGELES WA 98362 ~"31 L'se..l Lo.t'I e
(360) 457-4567 Porr ~'" e\e.,s W (\ 983 be...
Structure Informat1on 000 000 DEMO HOUSE (360) J )
--------------------------------------------_____________~~]_~~_Q:~tL_______
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 commenc ithln 0 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commen ed,o' quired ins ctions have not been requested within 180 days from the
last inspection. I hereby certify that I have read and xamine t . applicati n and know the same to be true and correct. All provisions
of laws and ordinances governing this type of work WI be co lied . h whe er specified herein or not. The granting of a permit does .---J
not presume to gl authority to violate or cancel the rovisio s of an state r local law regulating construction or the performance of \...,../'
construction. g?
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OWNER
Don LoVe -rruck; 1"\5
Perm1t
Additional desc
Permit p1n number
Permit Fee
Issue Date
Expirat10n Date
DEMOLITION
DEMO HOUSE
114850
50 00
11/06/07
5/04/08
Plan Check Fee
Valuat10n
Qty Un1t Charge Per
Extension
50.00
BASE FEE
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Perm1t Fee Total 50.00 50.00 00 .00
Plan Check Total 00 00 00 00
Grand Total 50.00 50 00 00 00
Dat
T FormslBUlldmg D,vlslOnlBUlldmg Permit (10/01/07) wpd
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Signature of Owner (if owner is builder)
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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 IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS / WALLS
FOUNDATION DRA[NAGE / DOWN SPOUTS
PIERS
POST HOLES (POLE BLOGS )
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP/FURNACE/DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY FINAL DATE ACCEPTED BY
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERM[T #'s SEPA
PARKING/LIGHTING ESA
LANDSCAPING SHORELINE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R W / PW/ CONSTRUCTION - R W
ENGINEER[NG 417-4807 PW / ENGINEERING
F[RE 4 [7-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
--
BUILDING 417-4815 )1I-n~-{)7 -:\ LL BUILDING
T FOIms/BlIl[dll1g Dlvlslon/BlIlidll1g Penmt ([0/0[/07) wpd
FORTANGELES
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WAS H I N G TON, U. S. A.
Public Works & Utilities Department
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July 9, 2007
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Ray Gruver
210 East 7tl1 Street
Port Angeles, W A 98362
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RE: Port Angeles Landfill / Transfer Waste Disposal Application, WDA 07-30; Building
demolition at 1033 East 9th Street
We have received your application for disposal of building demolition debris from the referenced
site and reviewed the testing results for lead paint content. 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,
0::fs~jw
City Engineer
GWKtf
End WOA 07-30
Copy Claudia SlrOmskl
N \PWKS\ENGINEERIWOAPPLlC 07-30
File Landfill Solid Waste Olsposal Applications
Phone 360-417-4805 I Fax 360-417-4542
Website wwwcltyofpa us I Email.publicworks@cltyofpa.us
321 East Fifth Street - POBox 1150 I Port Angeles, WA 98362-0217
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PORT ANGELES LANDFILL
WASTE DISPOSAL APPLICATION
To: City of Port Angeles, City Engineer
321 E Fifth Street
P.O. Box 1150
Port Angeles, Washington 98362
Phone: (360) 417-4803
FAX: (360) 417-4709
NOTE: All questions must be answered for waste to be approved.
1. Generator Information:
Company Name: ~y G (J. \It v'~A-
Mailing Address: 'ZJo ~ff 7'''1:.'' S
- -;:
loz~ A /\J t:' 4-<.. i. ~ ~ 9~36'2
Phone: l.fS7- 6567
Project Name: ~-')!."'t J()..;.......oc... .",)".)
Project Location: /D33 /lA$? q ~ 5"~ . Pc5/Z ? ~tf"~~
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2. Other Contacts (if applicable):
Consulting Firm: Z c:;,uo\l,c. f ~Sd c-1 J AJ (..
, Contact: ~4Ct' 4' ui>tf'f c..
Phone: VI7-0Q)\
Contractor Name: ()~"...,.J
Contact: ----
Phone: -
Laboratory: ~VL t..A16tA~~ h'-
Contact: -74 AJv~ /c~;;
Phone: re6 ') ~1.(7 - 0100
City of Port Angeles - Landfill Waste Disposal Application
Page - 1
Wed,10/4/2006 0.4 PM
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
Independent Remedial Action
Unused Chemical Product Spill
Agency Contact:
UST Removal
~ Other Source: ~o ~~6.e'S
4. Waste Material Composition: (check all that apply and include percent of total)
Soil - % _ Foundry Slag - %
Concrete/Asphalt - % _ Dredge Sediments - %
Preserved Wood - % ~ Debris ID'O %
Coal Ash - % _ Other (list)
Wood Ash - % - %
- %
NOTE: Total must equal 100%.
5. Waste Material Contaminants: (check all that apply)
Gasoline
Solvents
Metals
Diesel
PCBs
---L-
Unused Motor Oil
Other .~.s ~<e:. h'2. -rcLP L..tC-4c!)
_ Heating Oil
Used Motor Oil/Waste Oil
Other Petroleum Product
NOTE:
Unknown
Supply any MSDS information with application, if available.
City of Port Angeles - Lanclfjll Waste Disposal Application
Page - 2
Wed, 1 0/4/2006 0 4 PM
6. Estimated Quantity of Waste for Disposal:
z.S-
Cubic yards /
Drums /
<.{o
Tons (estimate both)
Tons (estimate both)
Other
NOTE:
Estimated quantity for disposal must be within 20% of the quantity actually
disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.)
7. Frequency of Disposal:
~
One time
_ Monthly
Annual
Other
8. Waste Sampling:
Proper characterization of the waste for disposal requires the collection of representative
samples. The methods and equipment necessary for obtaining representative samples of a
waste, and the frequency of sampling, will vary with the type and form of the waste. Check
the appropriate box and briefly describe how and where the waste was sampled. Include
site maps with sampling locations if possible.
Number of COMPOSITE samples ~ & number of discrete samples per composite .5
Number of DISCRETE samples -2-
A - wtPOS' S4.......,p(~ ~ 561 ,lJt,-v S;~,.....J6 I x.
Ii~o/l. "'1'~......... ( WI4''''''lJ I ~ ~~4/L -?'"'21- &\t.UVA) I ~ l~iYL'
"'1<.J..-.. (AJ~ ') I 2. \( l.{ ~A"""d (\JAI~""'.v1""<D)
NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling
frequency will be used:
0.25 cubic yards =
25 - 100 cubic yards =
101 - 500 cubic yards =
501 - 1000 cubic yards =
1001 - 2000 cubic yards =
>2000 cubic yards =
NOTE 2: One composite sample shall
discrete samples.
1 composite sample
3 composite samples
5 composite samples
7 composite samples
10 composite samples
10 plus one sample for each additional 500
cubic yards
contain a minimum of three/maximum of five
City of Port Angeles - Landfill Waste Disposal Application
Page - 3
Wed, 10/4/200604 PM
9. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine the
appropriate analytical requirements for waste characterization. Ecology Publication #91-30
(Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall
also be used to characterize petroleum contaminated soils from UST releases. Submit all
laboratory analytical results, QA/QC data, and Chain of Custody sheets along with this
application.
(NOTE: The laboratory must be accredited by the Washington State Department of
Ecology. )
a) List all analytical test methods used:
ILPA (311/70008
b) Provide a narrative as to why the above analytigp' methods were selected:
t:Ju't ,:. AK d'? S?"-WCTLJ-t."i &SS/~/U-r"'1 ()~ Cof'Ac1 ~1f6
p~(...rf O^I .s -tltvc 7"o.tt~
NOTE: Additional sheets attached: -1- YES
NO
1 O. Soil Classification:
(**FOR PETROLEUM CONTAMINATED SOILS ONL Y**)
Based on the analytical data and Ecology Publication #91-30, the soil classification is:
(check one)
Class 1
Class 2
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)
k
Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW)
Dangerous Waste (OW) and Waste Code:
Extremely Hazardous Waste (EHW) and Waste Code:
City of Port Angeles - Landfill Waste Disposal Application
Page - 4
Wed, 10/4/200604 PM
12. Certification:
We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge.
All information provided is correct and the enclosed analytical results represent the
proposed wa~al t the st of our abilities.
Wast enerator Signa
r;;~..,... 4.)044-(..
Printed Name
?'<..ui>tlic. ~ h"n c, ~<...
Company
J/6/07
Date
CI~OfPO~r~
City Engineer
-:r/oo//()r
r
Date
o-131IiJr-
Approval Expiration Date
City of Port Angeles - Landfill Waste Disposal Application
Page - 5
Wed.10/4/2006 0 4 PM
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I 4"708 Aurora Ave. N., Seattle, WA 98103 I 1"-.= J J
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Client: Zenovic & ASsoclBtesllnc.
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Port Angeles, WA 98162
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Project LocatIon: 1 U3;;J l::ast ~m <::it I
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,tl,o.m = parts 'per million I '<' = Below the reporting Limit
Note. iviethuu QC ra5U:ts are aCCcii~t!e un!e~~ !~E!ted ~then./!fi~A
Unless otherwise indicated~ condition of all sam~les was acceptable at time of receiQt.
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Samoles Rece'tvea: 'I
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Street.50\ G ~_lo ~ S'1e.e~ ~ \
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Client Job Number (571 :; 'l
T~! ~mpl_ (
Tum Around Tune 0 1-Hr 024-Hrs 04 Days
o 2..Jirs TBJ 2 "Days 0 5 Days
o 4--Hrs 0 3 DayS Q6 to 10 Davs
f'.ln.1;c r.oaU for TAT liB &IIan 24 HIS
E.-ilii.U iddress ~M4!&"".IV'h:.. "'J&.<>I
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~ (360\ 41.7..0501 Fa: 360l 417-0514
o Asbestos AIr 0 PCM (NIOSH (400) D TEM (NIOSH 7402) [J TEM {AHEM> 0 TEM (EPA Level 11) 0 Other
CJ ~ 6uik OPtIit (EPMSOOtR-B3t /t6't Q PtM(~ Poml~ D Pal {EM ~~ D TEM/kNk
r.ETALS Oet. Umit Matrix ReM "'15 0 All 8 oUter Metals
UTolal \IlIe\.a1S &ppm (AAS) a~;r Rife! D Pm ~ 0 I>>.t&en'IC \~) D \.ea6 Wb) U AlU
IS!, TCLP 0 ppb (GFAA) 0 Orinki~ wal~ CJ Paint Chips (Area) D Barium (Be) 0 MereuI)' (tig) 0 Copper (Cu)
U Dust/! ~ipe 0 waste Water 0 Cadmium (Cd) 0 Selenium (Se) ~ Nickel (Ni)
o Soil 0 Chromium (Cr) 0 Silver ~) u z.r.: <Znl I
o OIher Type.; 0 Fiberglass [J NulGan oe Dust 0 Rotorneter Calibration 0 other (S~) I
of Analysis 0 Silica 0 Respm lb1e Dust 0 MoldlF~us \
Condition of Package~ 0 Good Cl Damage~ (no spillage) 0 S~~re ~~~1~pnlags)
Seq.. .. Lab j1) Client Sample MUinber Comw..mU
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2
3
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5
I 6
7
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9
10
11
12
13
14
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Print Below Sian BelOVl / / ComOBllY____
Sampled by "7~'1" CuDtcc. /fY ~ l! fJ ~Vt ~.:t ~ "1-<.
Relinquished" ~e"" d"'~_ ~ ~ J L( ?~c.+.:..1 ~tf:..(
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Results Called br ~._"._ . i .__ ___
Resu\\s"~"'~L. \ .__.L ___ . .1.
Specia'lnstructions.; Unless reqU8SI~i;-~iin9' all samples will be di';~~~-of~o (2)~ after analysis.
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Applicant
Owner
Owner's Addre
Contractor/Engineer
Contractor/Engineer's Address
License # (Do VI L:,ve
PROJECT ADDRESS )C2~
Parcel Number 0-0 () '\)0\) 2- 77 6 0 ~ ~
BUILDING PERMIT APPLICA TION 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
For City Us~ Only'
Date Received \ \ - tc 1
I \. ~ '1 II )b7 Permit# 01- l b
,\:J ,-1 Date Approved
Phone
Phone 2/r0-d~b1-
Phone
~
Lot
Zoning
Proiect Tvpe & Brief Description:
Check all that apply
o New Construction
o Addition
o Remodel
o Repair
oRe-roof
Jl\Demolltlon
o Sign
o Heat System
o Other
o Commercial
o Multi-family
o Industrial
~l
o projecting 0 awning
Total Sl n area s ft Maximum allowed Sl n area s ft
o Heat pump 0 wood-burning stove 0 gas fireplace 0 pellet stove 0 other
o other
Floor Areas Existing (Sq. ft.) Proposed (Sq. ft.)
Basement @$ per sq. ft. = $
~I F1o<ill 8. D '-C) CJ
2nd Floor
3rd Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
TOTAL VALUATION $ cP1J!))
.
Max height of proposed structures
WIll a lawn spnnkler system be Installed?
Will a fire spnnkler system be Installed?
Total footpnnt of structures
sq ft . Lot size
sq ft = Lot coverage
%
ft
Occupancy group
Occupant load
Construction type
P Iy for thiS permit and
rior to working on
I have read and completed this application and know It to be true and correct
understand that It IS my respo sibllty to dChlne what permits are reqUired,
proJe~.
Date \ '\ 6 Print Name Signature
T Forms/BUlldl 9 Dlvlslon/Bldg Permll Appl-2006 de doc