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HomeMy WebLinkAbout726 W 4th St - BuildingPREPARED 4/13/11 8 03 12 INSPECTION TICKET PAGE 9 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 4/13/11 ADDRESS 726 W 4TH ST SUBDIV TENANT NBR MICHAEL J TALLMADGE CONTRACTOR SNS ROOFING LLC PHONE (360) 681 2333 OWNER MICHAEL J TALLMADGE PHONE (360) 457 5298 PARCEL 06 30 00 0 0 9915 0000 APPL NUMBER 11 00000291 RE ROOF PERMIT BNOP 00 BUILDING PERMIT NO PR FEE REQUESTED INS "P�� DESCRIPTION TYP /SQ COMPLETED RESUyn RESULTS /COMMENTS BL99 01 4/13/11 BLDG FINAL April 6 2011 4 29 22 PM 1pangrle SEAN 681 2333 BUILDING FINAL RE ROOFED THE HOUSE COMMENTS AND NOTES Owner Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date -5- II SEtI„I A4425NAI T :Forms /Building Division /Building Permit CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 11 00000291 Application pin number 629992 Property Address 726 W 4TH ST ASSESSOR PARCEL NUMBER 06 30 00 0 0 9915 0000 Tenant nbr name MICHAEL J TALLMADGE Application type description RE ROOF Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 5587 Application desc TEAR OFF RE ROOF THE HOUSE Contractor MICHAEL J TALLMADGE SNS ROOFING LLC 1776 LITTLE RIVER RD 372 BLUE GROUSE RUN PORT ANGELES WA 983639302 SEQUIM WA 98382 (360) 457 5298 (360) 681 2333 Structure Information 000 000 RE ROOF THE HOUSE BUILDING PERMIT NO PR FEE RE ROOF THE HOUSE 183327 151 75 4/05/11 10/02/11 Qty Unit Charge Per Extension BASE FEE 95 75 4 00 14 0000 THOU BL -2001 25K (14 PER K) 56 00 Other Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 151 75 151 75 00 00 Plan Check Total 00 00 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 156 25 156 25 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 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. Plan Check Fee 00 Valuation 5587 Date 4/05/11 REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) f\o' Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) 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. Inspection Type FOUNDATION: Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING Under Floor Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow Water AIR SEAL. Walls Ceiling FRAMING. Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall Floor Ceiling MECHANICAL. Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting T:Forms /Building Division /Building Permit Date Accepted By PLANNING DEPT Separate Permit #s SEPA. Parking Lighting I ESA. Landscaping I SHORELINE. Inspection Type Comments FINAL Date Acceoted by IFINAL Date Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Date I Accepted By Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 t 3- -5 LL Applicant Property Property Contractor Contractor's License bafttot-IAc,. izoof 2-LC Address 372 gLaE C- 2JrJ SriS ok. Lct 13 Lc_ Expires 6-3 2o1( E -mail -r)-S Q4J Owner ,k� Owner's Address PROJECT ADDRESS Parcel Number Project Tvpe Brief Description. Check all that apply New Construction Addition Remodel Repair Demolition ›(Re -roof 'House garage other Heat System Heat pump wood burning stove Other Floor Areas Existing (sq. ft.) Proposed 7 g. ft.) Basement 1 1 Floor 2 Floor 3 Floor I Garage A Carport Covered Porch Deck Shed Other Total footprint of structures Site Coverage the amount of impe and other impervious surfaces. (see 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 Max. height of proposed structures Will a lawn sprinkler system be it ailed? Will a fire sprinkler system be installed? 72 w Lr4 Por4 .1 s Lot Residential sq ft. T Lot size urface on a parcel includi C 17 94 135 for exemptio Occupa y group Occup nt load Cons uction type Multi family Phone Phone p Qa 4-+- IbJ e Phone For City Use On1y Date Received L i S I t Permit l l 2 Date Approved 3(00-(0$1 -232 '3,&- Lis 7 -'52 S 3bO -6B1-233 145, (0)614A •>Je� Zoning Commercial Industrial '(tear off .re -roof lay over one layer gas fireplace pellet stove other per sq ft. Signature of of i (TOTAL VALUATION �c{rtt. structures paved drivewa sidew- ks, patios Site co -r -ge a 5- g7 b room ull baths half baths I have read and completed this application and know it to be true and correct. I am authorized. to apply for this permit and 'unde that it is my responsibility to determine what permits are required, and to obtain permits prior to worki g.on prof s Date 1 4-5 I t Print Name SE.i J /i/14r5L T.Forms /Building Division /Building permit application /o tand £31 ti ts V s\11. w tz 1211 Aes14> L$�/ V )4)S �X d CQ4 I y qr Les.* VZ cm If c 1 0Z jrri 11 a150 1 1 0o ci t vo1 li v', i -t7 c1 r rov� Q 1' -0T-I 1 t G' f 'i3.11,1 i t os l }�jP 1751 sizt Alit_ 1 a 1 fir a! .L Gti!' t 2 G Itr^ow7y ".°7 r -5 4i 150 rni0 1 f 17 r'- !'I 1 )l 9 X t f OG S N i l Z S'1'siN 1. aZ i 51\eJ -WI ��51 C 1 rl °'''1 l e S t 4r J J a 9 4 4'0 a 1412 (d 9 f, j S) r r' 1 'IQ 21' c, i, sb 101) N 1.af ?W-417*}.. �L S.1 t 01 f i- �S z XZ 85 1��+ N o� t.ot a �i r }r'c.s j. °re0A; s> 'r 41 +ai t0Z toh ty4i- �4t2htifi !41f1 5 z 95 e is Zh 6 t Silt pk si Lt c �1XS ?1 17 Q� go37 BA ooi, kV+ 511 s 1 \I.. )7a o cc `m°c7 S Lx os-y S I 1/3 A 0% sue Z (,43- 1'721 -0, Z tt 'is 'v ci t j -A0 7%44; -6751 xZh Y21V 110. 1 •al fl y)9 V4IV Jd`o%%y. rfo,., ss?'r tr}-5 arras. J` ill iaYOV 1,11.1.1/f4 ono /r ��'C �g `vw� G•��"E f ya1 OI7 L s al a t a d )v)-- ‘`11 111.Z11 e! ,F.v;. a "6ae°u3F�.t „w 4'' .:;t:- ,�,{.Yiait;,�;h?...• .5;:� 1 y e., �"Ei i 3 y o \41 n .Rr..a': n�;ares:'9 "%FG�,.::s:��-w:•nr H ;x.._ �t? r k.T W Clallam County Assessor Treasurer Property Details 56431 MICHAEL J TALLMA. Page 1 of 2 Clallam County Assessor Treasurer Property Search Results 56431 MICHAEL J TALLMADGE for Year 2011 2012 Property Account Property ID' Geographic ID Type Tax Area. Open Space Historic Property 56431 Legal Description. LOT 6 BL 99 0630000099150000 Agent Code Real 0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 11 N DFL N N Remodel Property N Multi Family Redevelopment: N Township Range. Location Address 726 W FOURTH ST PORT ANGELES WA Neighborhood Cycle 5 Res Neighborhood CD 10955130 Owner Name MICHAEL J TALLMADGE Mailing Address 1776 LITTLE RIVER RD PORT ANGELES WA 98363 -9302 Taxes and Assessment Details Property Tax Information as of 04/05/2011 Amount Due if Paid on 7. Section: Mapsco Map ID Owner ID Ownership Exemptions* 3 55428 100.0000000000% NOTE If you plan to submit payment on a future date make sure you enter the date and click RECALCULATE to obtain the correct total amount due First Second Half i Half Base Base Year Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid Amount Due 2011 151174 ST SCH STATE SCHOOL $132.37 $132.36 $0.00 $0 00 $0 00 $264 73 2011 151174 CC -GEN COUNTY CLALLAM $73 08 $73.06 $0.00 $0.00 $0 00 $146 14 2011 151174 SD #121 SCHOOL DISTRICT #121 $173.03 $173.02 $0 00 $0 00 $0 00 $346.05 2011 151174 CITY PORT ANG CITY OF PORT ANGELES $168.70 $168.68 $0 00 $0 00 $0 00 $337.38 2011 151174 PORT PORT OF PORT ANGELES $10.29 $10.28 $0.00 $0 00 $0 00 $20.57 2011 151174 NTH OLY LIB NORTH OLYMPIC LIBRARY $30.65 $30.64 $0.00 $0 00 $0 00 $61.29 2011 151174 HOSP #2 HOSPITAL #2 $30.00 $29.99 $0.00 $0 00 $0 00 $59.99 2011 151174 WSMET PK DIST WILLIAM SHORE MET PARK DIST $9 12 $9 11 $0.00 $0 00 $0.00 $18.23 2011 151174 CITY_STORMWATER CITY STORMWATER $36.00 $36 00 $0.00 $0 00 $0 00 $72 00 2011 151174 WEED_CONTROL WEED CONTROL $0.82 $0 81 $0.00 $0 00 $0 00 $1 63 2011 151174 TOTAL. $664.06 $663.95 $0.00 $0.00 $0.00 $1328.01 2010 39472 ST SCH STATE SCHOOL $131 04 $131.04 $0.00 $0 00 $262.08 $0 00 2010 39472 CC -GEN COUNTY CLALLAM $69 74 $69 73 $0 00 $0 00 $139 47 $0.00 2010 39472 SD #121 SCHOOL DISTRICT #121 $169 74 $169 73 $0 00 $0 00 $339 47 $0.00 2010 39472 CITY PORT ANG CITY OF PORT ANGELES $161 46 $161 46 $0 00 $0 00 $322.92 $0 00 2010 39472 PORT PORT OF PORT ANGELES $9.80 $9.80 $0 00 $0 00 $19.60 $0 00 2010 39472 NTH OLY LIB NORTH OLYMPIC LIBRARY $20.26 $20.27 $0 00 $0 00 $40.53 $0 00 2010 39472 HOSP #2 HOSPITAL #2 $28.61 $28.61 $0 00 $0 00 $57.22 $0 00 2010 39472 WSMET PK DIST WILLIAM SHORE MET PARK DIST $9 10 $9 11 $0 00 $0.00 $18.21 $0.00 2010 39472 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0 00 $72.00 $0 00 2010 39472 WEED_CONTROL WEED CONTROL $0 82 $0.81 $0.00 $0.00 $1 63 $0 00 2010 39472 TOTAL. $636.57 $636.56 $0.00 $0.00 $1273.13 $0.00 http. /websrv8 clallam .net /propertyaccess /Property aspx ?cid =0 &year =2011 &prop_id =56431 4/5/2011 PREPARED 10/28/09 8 28 54 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 10/28/.09 ADDRESS 726 W 4TH ST SUBDIV CONTRACTOR BRAD WASHKE CONSTRUCTION PHONE (360) 417 3978 OWNER TALLMADGE MICHAEL J PHONE PARCEL 06 30 00 0 0 9915 0000 APPL NUMBER 05 00000890 DEMOLITION PERMIT DEMO 00 DEMOLITION REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BL99 01 10/28/09 JLL BLDG FINAL October 28 2009 8 27 34 AM 1pangrle FREDA 457 5928 BLDG FINAL DEMO GARAGE NOW THERE IS A FENCE WHERE THE GARAGE USED TO BE COMMENTS AND NOTES Application Number 05 00000890 Application pin number 452120 Property Address 726 W 4TH ST ASSESSOR PARCEL NUMBER 06 30 00 0 0 9915 0000 Application type description DEMOLITION Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 300 Owner TALLMADGE MICHAEL J 1776 LITTLE RIVER RD PORT ANGELES WA 983639302 Structure Information Construction Type Occupancy Type Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge Per Fee summary Permit Fee Total Plan Check Total Grand Total DEMOLITION 472 SF GARAGE DEMOLITION 60517 Charged 47 00 00 47 00 BASE FEE Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. l4.,4 Signature of Coractor or Authorized 4nt Dzf(e T \Policies \1102_15 building permit inspection record05.wpd [1/4/2005] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Contractor BRAD WASHKE CONSTRUCTION 1118 MT PLEASANT PORT ANGELES PORT ANGELES (360) 417 3978 000 000 472 SQ FT GARAGE TYPE V NON RATED GARAGES CARPORTS SHEDS 47 00 00 00 00 47 00 00 Date 9/19/05 Paid Credited RD WA 98362 47 00 Plan Check Fee 00 9/19/05 Valuation 0 3/18/06 Due Extension 47 00 00 00 00 Signature of Owner (if owner is builder) Date T1Pnl 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 UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS 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 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 HEAT PUMP /FURNACE /DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING/LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE PLANNING DEPT 1 BUILDING 417 -4735 ELECTRICAL LIGHT DEPT 417 -4653 I 417 -4750 I BUILDING PERMIT INSPECTION RECORD FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO c\ 1 102 /5 building Hermit inspection record05.wpd 11/4/2005] YES 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 417 -4815 IA A-2- I DTI-- I NO SEPA. ESA. SHORELINE. CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT 1 BUILDING PORT T Jo,. q ok 1(.r 116—_ Applicant DT Agent: Owner /1/1A7-,° T Y e Address. /77Z L /1 Architect/Engineer. Contractor Credit Card Holder Name: Billing Address: Credit Card Type VISA MC TYPE OF WORK. Residential New Constr. Multi family Additon Commercial Remodel Total lot coverage PLANNING USE ONLY TAPolicies\BL 1102_13.wpd Applican BUILDING PERMIT APPLICATION Fill out COMPLETELY and in LNE.. Y our application and site plan MUST BE C011TPT.TTP to be accepted for review If you have any questions. call PERMITS (360) 417 -4515 FAX(360)417-47U d ec4 /at-, 4 Phone. (S_ D V 7 j C Phone" 3‘d V S 7 S City Zip Phone: W U L V 3 $4 -,os6 State License E t Address City PROJECT ADDRESS 7 ,gt y f�' �/��i�l'°� ZONING q LEGAL DESCRIPTION Lot: (.e Block. Stibd2vision. CLALLAM COUNTY PARCEL NUMBER. ©(o o a d D q91 S 0000 Re. -roof Move emolition Repair '0 Sign BRIEF DESCRIPTION OF THE PROJECT Ce /l C) COMMERCIAL/RESIDENTIAL. Occupancy Group No. of. Stones: Lot Size: Existing Sq. Ft. Cif ESA/Wetland(s). Yes No SEPA Checklist required? Yes No Other Phone. Zip R 7 Exp. Date. SIZE/VALUATION Stove SF /SF Garage SF /SF Deck SF a$ /SF Other TOTAL VALUATION 1 1 ?e Gla c 4 f/cr-/ 4 8 r'. Co )1 I) 1.4.44-d- Occupant Load, 8J Proposed Sq Ft. ate: 7 77 &S Constructor Type: TOTAL Sq Ft. Date Rec. Q 9 f y.4 Permit#t• (2tf g' QC Date Approved. f-.I q -os" Date Issued: d 9- Cq O,- APPROVALS. PLAN BLDG DPWU FLRE. OTHER. VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by :the Buildmg Division to comply with current fee schedules. Contact the Pernzit Coordinator at417 -4815 for assistance. PLAN CHECK FEE. IF a plan climb fee is due it mustbe :submitted at the time the building permit application and construction plans are submitted All other permit fees are due at the fume of permit issuance. E3 PLRATION OF PLAN REVIE7 If no permit is issued within 180 days of the date of apphcation, 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 apphcant (see Section R1 05.3 7 of the International Building/Residential Code, 2003) No apphcation can be extended more than once. 1 hereby certify that 1 have read and examined this application and know the same to be true and correct. 1 am authorized to apply for this permit and understand that it is my responsibifffy to determine what prmits erequired •:t City's, and th 1 1 must 9bfain such permits prior to work GWK:tf Encl. WDA 05 -29 Copy Ken Loghry Building div W A S H I N G T O N U S A PUBLIC WORKS UTILITIES DEPARTMENT September 15, 2005 Mike Tallmadge 1776 Little River Rd Port Angeles, WA 98363 RE. Port Angeles Landfill Waste Disposal Application, WDA 05 -29; Building demolition at 726 W 4th St, Port Angeles, WA 98362 We have received your application for disposal ofbuilding demolition debns from the referenced site and reviewed the testing results for lead content. Based on the testmg results the debns appears to be acceptable for use in the landfill. A copy of your approved application is attached. This approved application must be shown to the landfill scale attendant at the time of disposal. Please be advised that this disposal application is only for the matenals and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very truly yours, Gary W Kenworthy, P.E. City Engineer Deputy Director of Engineenng Services N:\PWKS\ENGINEER \WDAPPLIC \05 -29 WPD FILE: Landfill Solid Waste Disposal Applications GELES V 321- EAST FIFTH STREET P 0 BOX 1' 1 50 PORT ANGELES WA 98362-0217 PHONE 360 -417 4805 FAX 360 -417 4542 TTY 360 -417 4645 E MAIL publicworks @cityofpa us To City of Port Angeles City Engineer 321 E Fifth Street P O Box 1150 Port Angeles Washington 98362 NOTE. All questions must be answered for waste to be approved. 1 Generator information Company Name /0111:4 «l11Ll4CV Mailing Address 1 Li ii1 ewe_ Ad Pay 'A 6 kVA 9 63 Contact. I k -ir444,46A. Phone 4- (S7 SIM Project Name. _4 D' tw'fivJ Project Location: '72C W L/ t 2 Other Contacts (if applicable) Consulting Firm: '7 etJ1 c Ase &rc Contact. Phone Contractor Name O>Al Contact Phone Laboratory Contact A)Ick. L,y Phone 4`? r1) j r O S PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION AJ VL 1),9-6 02 4 Phone (360) 417 -4803 FAX. (360) 417 -4709 City of Port Arr (jcios Landfill W rsto Oit,posal Application [',Elio t 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 Remedialron Agency Contact. Independent Remedial Action UST Removal Unused Chemical Product Spill X Other Source iZLMI kJS1' -J4 6,d -ts4 6 0 u 5446 '61)1- v 6 .7 1S 649/%11 J 4 Waste Material Composition (check all that apply and include percent of total) Soil Foundry Slag Concrete /Asphalt Dredge Sediments Preserved Wood Debris Oil% Coal Ash Other (list) Wood Ash 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 Other 44-tv.a re P Lam° Other Petroleum Product 453tsi as 5041.+ Unknown NOTE Supply any MSDS information with application if available Diesel PCBs O A City of Port Anticlos Landfill Waste Disl)o »al Application Pogo 2 6 Estimated Quantity of Wa for Disposal 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 2A Cubic yards Tons (estimate both) Drums Tons (estimate both) 7 Frequency of Disposal x One time NOTE 1 0 25 25 100 101 500 501 1000 1001 2000 >2000 Monthly Annual Other 8 Waste Sampling Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a waste and the frequency of sampling will vary with the type and form of the waste Check the appropriate box and briefly describe how and where the waste was sampled. Include site maps with sampling locations if possible Number of COMPOSITE samples I number of discrete samples per composite ti Number of DISCRETE samples 2)C9 -AZA etD1A4Pbc 'f <4644 ,5 5 r� (F,40. (ti4 P 4, 1 ,..)-A I )0 7 7 &Al& wipit 2)6 Aft.4...".% 1)6 .7("Ziot,-1 k i 4,0 P4/ tl'L 3t-ft.. Unless prior approval has been granted by Port Angeles the following sampling frequency will be used cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards 1 composite sample 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards NOTE 2 One composite sample shall contain a minimum of three /maximum of five discrete samples City of Port Angeles Landfill Wa. to Disposal Application Pogo 3 g 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 Remediatron 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 *4 a is b) Provide a narrative as to why the above analytical methods were selected A 4Ge, nF 5 c -r c. Assidii s ./y &A tz.46 AAs, P "O 91...Cadutc. 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 Calculated Hazard Index 11 Dangerous Waste Affidavit City of Port f\ iq k's Landfill Wash Disposal I\j )Iic, 'bon Class 3 Class 4 Based on a review of the analytical test results site history and the applicable regulations this waste is classified as (check one) Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (CHW) Dangerous Waste (DW) and Waste Codo Extremely Hazardous Waste (El 1W) and Waste Codo 12 Certification We, THE UNDERSIGNED certify that this application is true to the best of our knowledge All information provided Is correct and the enclosed analytical results represent the proposed waste material to the best of our ab* 'ties Wastenerator Signture 74 c7 4 ,8 Printed Name 2 ."y00 I ,<1 17 C-i Company 9 1/0 Date N ToitcY_F11000_5M009_01 WPO City of Port Angeles Landfill Waste Disposal Application Pngo 5 NVL Laboratories, Inc. 4708 Aurora Ave. N. Seattle, WA 98103 Te1 206.547 0100 Fax: 206.634 1936 www.nvllabs.com Client: Zenovic Associates Inc. Address. 519 South Peabody Street, Suite 22 Port Angeles, WA 98362 Attention Mr Tracy Gudgel Project Location. 726 W 7th, Port Angeles Lab ID Client Sample 25078723 05282A Analysis Report Toxicity Characteristic Leaching Procedure Lead (Pb) Sampled by Client Analyzed by Ahmad lzzat Reviewed by Nick Ly mg/ L Milligrams per liter ppm parts per million Note Method QC results are acceptable unless stated otherwise. Bench Run No 25- 0906 -6 Date Analyzed 09/08/2005 Date Issued 09/08/2005 RL mg/ L 05 AIHA IH #101861 Results in mq /L 05 Batch 2512872 00 Matrix: Bulk Method EPA 1311/7000B Client Project #•05282 Samples Received 1 Total Samples Analyzed 1 SEP 1 3 2005 AIHA Environmental Lead and Industrial Hygiene D ACCREDITE LABORATORY Results in ppm 05 J cal Director RL Reporting Limit Below the reporting Limit Page 1 of 1 i!' r 3 NVL Laboratories. Inc. 4708 Aurora Ave N. Seattle. WA 98103 Tel 206.547 0100 Emerg. Pager 206.344 1878 1.888.NVL.LABS (685.5227) Client Zenovic Associates Inc. Street 519 South Peabody Street, Suite 4 Port Angeles Project Manager 24W 414 0( Project Location 7 2t, GU', 7 A4> Phone: (360) 417 -0501 Fax: (360) 417 -0514 Asbestos Air 0 PCM NIOSH 7400) 0 TEM (NIOSH 7402) LJ TEM (AHERA) 0 TEM (EPA Level It) 0 Other tO Asbestos Bulk ID PLM (EPA/600/R- 93/116) PLM (EPA Point Count) 0 PLM (EPA Gravimetry) 0 TEM Bulk METALS Dot. Limit Matrix 0 Total Metals E ppm (AAS) 0 Air Filter E 1 CLP ppb (GFAA) Drinking water Li Dust/wipe 0 Soil Other Types 0 Fiberglass Nuisance Dust of Analysis Silica D Respirable Dust 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Print Below Sampled byy r t -3 o(,t,c Relinquished by Liz- -r Ce ,/q(,u Received by Analyzed by Results Calved by] Results Faxed by CHAIN of CUSTODY SAMPLE LOG RCRA Metals All 8 O Arsenic (As) Lead (Pb) Barium (Ba) Mercury (Hg) Cadmium (Cd) 0 Selenium (Se) Chromium (Cr) Silver (Ag) Rotometer Calibration p Other (Specify) Mold/Fungus Paint Chips O Paint Chips (Area) Waste Water NVL Batch Number Client Job Number Total Samples Turn Around Time Condition of Package 0 Good Damaged (no spillage) 0 Severe damage (spillage) Seq. 01 Lab ID Client Sample Number I Comments PCKA /C�LSUI.tr BATCH ID i 2512872 00 DS2f' 1 1 -Hr 24 -Hrs 4 Days 2 -Hrs m Days D 5 Days 4-Hrs 3 Days D 6 to 10 Days Please cart for TAT less than 24 Ms Email address n.,00,' a 250""/1_ A.)4 Other Metals Li All 3 O Copper (Cu) Nickel (Ni) Zinc (Zn) I AR Company Date Time 24444%4...‘ 44,(_, 16 rJ� 3a+�w• 2 u,� ✓i c 4ffoc J... 2 j 3-0/4"/11 I 1 jj Special Instructions Unless requested in writing all samples will be disposed of two (2) weeks after analysis . CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT PERMIT NO. I B80 . DATE f /~/R8" o READY FOR WILL CALL FOR INSPECTION INSPECTION License Number: Phone: Phone: Owner/Business Address: Sq. Ft. ~ Residential Heat KW -; D )iil' Baseboard 0 Furnace/Boi ler o Heatpump 0 Other o Commercial/Industrial load 0 Add/alter circuits Total Connected load 0 Auxiliary power (attach breakdown) (list below) Total Motor load 0 Special equipment (attach breakdown) (list below) Details/Description: rJf6plh.lU'o A;pJu/../) fl.J o New Construction o Remodel ftJ Service update/alter/repair o Overhead o Underground Voltage 010' 03.0' Service size -;:lOtJ Amps o Temporary ~~ /O#I.{) ~ft_,- ~,,-~ . 1 4730 I W.S. No. Service Size Capacity: 0 O.K. 0 Not O.K. Comments o Ditch inspection OK o Rough-in/cover O.K. 1Jrrt,'Pr O.K. to connect service 7j~'f Final O.K. Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for installation o Fire Department notified of inspection o Plan Review approved/pendi ng Site Addres"7~ ~ Installer: New Meters - Dql3?ftg- . Notify the Department 01 City Light by Street Address and Permit Number when ready lor inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT.158 or EXT. 224. ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT 30,00 ~\ Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall OLYMPIC PRINTERS. INC.