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Home My WebLink About1032 Columbia St - Building CITY OF PORT ANGELES r� DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 w Application Number 11- 00000885 Date 9/08/11 Application pin number 559090 Property Address 1032 COLUMBIA ST ASSESSOR PARCEL NUMBER: 06- 30- 00 -5 -3 -0400 -0000- REPORT SALES TAX Tenant nbr, name CLALLAM CNTY PUB HLTH DIS on your state excise tax form Application type description DEMOLITION Subdivision Name to the City of Port Angeles Property Use (Location Code 0502) Property Zoning COMMERCIAL OFFICE Application valuation 0 Application desc DEMOLISH THE HOME "OUT- BUILDING" Owner Contractor CLALLAM CO PUB HOSPITAL DIST 2 D H ENTERPRISES DBA OLYMPIC MEDICAL CNTR PO BOX 631 939 CAROLINE ST FORKS WA 98331 PORT ANGELES WA 983623909 (360) 374 -9500 (360) 417 -8628 Structure Information 000 000 DEMO HOUSE OUT BLDG Permit DEMOLITION Additional desc DEMO HOUSE OUT BLDG Permit pin number 191197 Permit Fee 50.00 Plan Check Fee .00 Issue Date 9/08/11 Valuation 0 Expiration Date 3/06/12 Qty Unit Charge Per Extension BASE FEE 50.00 Special Notes and Comments It is the responsibility of the building owner and /or demolition contractor to contact ORCAA (Olympic Region Clean Air Agency)for demolition permit needs regarding asbestos abatement. Olympic Region Clean Air Agency 116 W. 8th St., Suite 113 Port Angeles, WA 98362 (360) 417 -1466 or 1 -800- 422 -5623 www.ORCAA.org The Fire Department has reviewed the project application and has no comments August 24, 2011 9:55:26 AM sroberds. The proposal will result in demolition of a sfr in the CO zone. No land use issues anticipated. August 23, 2011 1:06:19 PM Tim 417 -4706. Electric meter and service conductor need to be removed fink( �.I� prior to demo. Contact Light Ops to schedule 417 -4724 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. 6, Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms /Building Division /Building Permit 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 Date Accepted By Comments 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 FINAL Date Accepted by 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 FINAL Date Accepted by MANUFACTURED HOMES: Footing Slab Blocking Hold Downs Skirting PLANNING DEPT. Separate Permit #s SEPA: Parking Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By Electrical 417 -4735 Construction R.W. PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 T:Forms /Building Division /Building Permit CITY OF PORT ANGELES m DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Page 2 Application Number 11- 00000885 Date 9/08/11 Application pin number 559090 REPORT SALES TAX Special Notes and Comments on your state excise tax form Sewer lateral shall be exposed to the property line, an t o the City of Port Angeles eles inspection by Public Works Engineering is required. The y g sewer lateral will be capped.If the sewer lateral is to be (Location Code 0502) reused, a 4" X 4" X 8' pressure treated post, painted green and marked S. S. Stub indicate depth to service to the nearest foot. Attach a 12 gauge galv. wire to cap and stake. 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 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. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms /Building Division /Building Permit 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. Og Inspection Type Date Accepted By Comments 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 FINAL Date Accepted by AIR SEAL: Vv 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 n Commercial Hood Ducts FINAL Date Accepted by MANUFACTURED HOMES: Footing Slab Blocking Hold Downs Skirting PLANNING DEPT. Separate Permit #s SEPA: Parking Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By Electrical 417- 4735 Construction R.W. PW Engineering 417 -4831 Fire 417 -4653 0 Planning 417 -4750 Building 417 -4815 3-/(9 T:Forms /Building Division /Building Permit °iw CITY OF PORT ANGELES %/'16.1e PUBLIC WORKS UTILITIES 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number 11- 00000885 Date 9/08/11 Application pin number 559090 REPORT SALES TAX Property Address 1032 COLUMBIA ST ASSESSOR PARCEL NUMBER: 06- 30- 00 -5 -3 -0400 -0000- on your state excise tax form Tenant nbr, name CLALLAM CNTY PUB HLTH DIS Application type description DEMOLITION to the City of Port Angeles Subdivision Name (Location Code 0502) Property Use Property Zoning COMMERCIAL OFFICE Application valuation 0 Application desc DEMOLISH THE HOME "OUT- BUILDING" Owner Contractor CLALLAM CO PUB HOSPITAL DIST 2 D H ENTERPRISES DBA OLYMPIC MEDICAL CNTR PO BOX 631 939 CAROLINE ST FORKS WA 98331 PORT ANGELES WA 983623909 (360) 374 -9500 (360) 417 -8628 Structure Information 000 000 DEMO HOUSE OUT BLDG Permit PUBLIC WORKS INSPECTION Additional desc SEWER CAP INSPECTION Permit pin number 191957 Permit Fee 55.00 Plan Check Fee .00 Issue Date 9/08/11 Valuation 0 Expiration Date 3/06/12 Qty Unit Charge Per Extension 1.00 55.0000 HR PW INSPECTION 55.00 Special Notes and Comments It is the responsibility of the building owner and /or demolition contractor to contact ORCAA (Olympic Region Clean Air Agency)for demolition permit needs regarding asbestos abatement. Olympic Region Clean Air Agency 116 W. 8th St., Suite 113 Port Angeles, WA 98362 (360) 417 -1466 or 1- 800 422 -5623 www.ORCAA.org The Fire Department has reviewed the project application and has no comments August 24, 2011 9:55:26 AM sroberds. The proposal will result in demolition of a sfr in the CO zone. No land use issues anticipated. August 23, 2011 1:06:19 PM Tim 417 -4706. Electric meter and service conductor need to be removed prior to demo. Contact Light Ops to schedule 417 -4724 e 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. k::77 e--" fir 9 ne Signature of Contractor or Authorized Agent Date Signature of Owner (if ow is builder) Date T:Forms /Building Division /Public Works Permit PERMIT INSPECTION RECORD CALL 417 -4831 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE r INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO PW UTILITIES (Engineering Division) WATERLINE. METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE; SITE EROSION CONTROL PARKING i.:..;:.; C URB GUTTER DRIVEWAY,'APPROACH, BACK FLOW DP/ICE."." 4 S, k r 1 Y 5 F s 4 1 5 a ..,"-.,.'.'0,-.,-.",',--"%:,.... `k� a y t r ti rr a m '3, ti •n; .i, tl<..,a ss> FINAL" INSPECTIONS.REQUIRED PRIOR TO OCCUPANCY /USE r a I ES NO COMMERCIAL DATE ACCEPTED RESIDENTIAL DATE e YES. „.NO„,.. CONSTRUCTION R W P.W CONSTRUCTION, 'R.W ENGINEERING 41i-4837 'f PW ENGINEERING FIR 417-4653 FIRE DEPT. PLANNING DEPT 417 47 50 PLANNING..DEP.T. BUILDING 4 .a s BUILDING `4815 '''''2•4•1;''''''„"• r i t i T Forms /Bwldm Division /Public Wor P t, i y CITY OF PORT ANGELES N PUBLIC WORKS UTILITIES a_ G1F 321 EAST 5TH. STREET, PORT ANGELES, WA 98362 Page 2 Application Number 11- 00000885 Date 9/08/11 REPORT SALES TAX Application pin number 559090 on your state excise tax form Special Notes and Comments Sewer lateral shall be exposed to the property line, an to the City of Port Angeles inspection by Public Works Engineering is required. The (Location Code 0502) sewer lateral will be capped.If the sewer lateral is to be reused, a 4" X 4" X 8' pressure treated post, painted green and marked S. S. Stub indicate depth to service to the nearest foot. Attach a 12 gauge galv. wire to cap and stake. Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 55.00 55.00 .00 :00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 59.50 59.50 .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 violate 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: Forms /Building Division /Public Works Permit PERMIT INSPECTION RECORD CALL 417 -4831 FOR UTILITY INSPEC'T'IONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE` ACCEPTED COMMENTS YES I NO PW UTILITIES (Engineering Division) WA TERLINE /METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING _SIDEWALK s..r rte, ,z >'�ais` a 'CURB GUTTER DRIVEWAY APPROACH, BACK FLOW DEVICE: 14 a- t w l,y .tk FINALINSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL z DATE YES'. r NO COMMERCIAL DATE ACCEPTED. CONSTRUCTION R W P,W! .CONSTRUCTION„, ENGINEERING;:` 417 -4807 PW ENGINEERING FIRE 417.4653 FIRE DEPT.. PLANNING DEPT 417 -4750 PLANNING. DEPT. BUILDING ¢I s ,BUILDING '4815 •e ,Y T Forms /Bwldm Dfvision/Pu_biic Works•'Permu N N H H I I 0 I H I I I M I 1 W 1 N W W I 1 a a 0 a 0 l 1 U l p 1 g 0 1 p 00 0 O N 1 E N 0. 1 N CA 03 0 0 1 H 0 H 1 N M d U N N N oa N 01 0 a a 1 u W 1 C U H 1 Id 7 1 H W W 1 F q zz zo m wm1 00 as w 0010 xx U E 1 m a s 01 0 H a l .1 I, z F h 1 0 0 1J q z c z 0 1k i N a H o Vl C 1 0 0 F 41 vl U U 1 z N 0 W W 1 w H p z a s l O U 01 ZZZN I N 1 z N zzI 00 0 a 0 z H H F H U a O ul U H a N H H q H F W H H 0 11 0 U 0 0 U a o z 1 w x H 0 O W W r7 fa 0 F H o H 1 q a W z a a o F 1 X 0 H m o o a l F W W x o 0 W 'a W 1 F M a H Wow 1 Ul a O KC r4 Z Ul 41 1 i 10 -'0 04 rn Q H a 1 z z w o o N N t E a ro I a U 2 U o o a W 0 X W 0 0 1 0 0. w 0 0 1 L 0 0 N W 1 0)1) 40. I P 0FF H M 0w 1400, 40 LO 01000001 1 0 0 a H H 1 a E F 1 0 4 1 0 o M M 0 I 1 a 1 00 a Z O al a q F S W w Vl U o 1 H 0z0 0 0 E .1 az W N a 1 F W U .7 1£ m W F 1 0 z z z a a 1 a a 01 a U 4 H 0 0 a< i a F m PROJECT STATUS UPDATE Permit I I 103 CO V 1/y00 1 C 5 \P Date: 1 2' l5' IZ 1 phoned the: Applicant at Property Owner at Contractor at (left a phone message, or discussed): The permit (has expired, or will expire soon). What is the status of this project? Please call and schedule a final inspection. Or Submit a "permit extension request" letter. Or Let me know if the project is abandoned. 5( I ed rio) o h -'k C 0 e✓' uses. carYl on notia.c&X1 pq7ce T:Forms /Building Division/Project Status Update R��a �aSi ►n �mw Q i o °Rr BUILDING PERMIT APPLICATION Print in ink i Oba CITY OF PORT ANGELES Attn: Building Permit Technician i For City Us`Only: Date Received -It 321 E. Fifth St., Port Angeles, WA 98362 Permit ;;,i (360) 417 -4815 fax (360) 417 -4711 i ate Approved j Applicant "te 5L/A) P one 4//7 %zIS Property Owner 6,y/w &il 4L Ce l Phon Property Owner's Address 939 Clia. L/ OCC Contractor 1587) D41.1 E►' ar.pirises Phone Contractor's Address PO 66A t 6 rt<S W Ps 9 8 33 i License Expires E -mail PROJECT ADDRESS 'c 3Z. CoLv 6/p 87 Parcel Number 06300 .3(:)V-616 4 1_01/4Z EL d/Zoning C6 Project Type Brief Description: Residential Multi family Commercial Industrial Check all that apply W aS$ W`i't 1 r o be o' r\ .4 *he P. A fir&n S ecil'ew% New Construction :..1. 7 /lTr �L�i %Q ir k. Addition ClecA4 44jeedes .�ea.c ✓c.� Pef.sc'd a-s d ORCA.1 rc 6e.6l rrr.� c Remodel pe .I A ja.b eat iii on_ ie. zol e"..)6. Je., Repair 7 ea 01.64-A4 c-I cz pa 0/1k1 /rot Op A- tLs 6 ,L 1€ i 54 e ADemolition 4 e-re tP.hnr) l t s h e. h eyoSp_, 4 "n01- 6U i 16(649" Re -roof 10 House garage other tear off re -roof lay over one laer Heat System Heat pump wood-burning stove ,4c as fireplace o pellet stove other f Other L ;F/ F-i iv die cafte( zr Eli a A) Ca'P.n oL erw Floor Areas Existing (sq. ft.) Proposed (sq. ft.) Basement /Zl 1- ,e- per sq. ft. 1 Floor Z-1 7 2 "d Floor Z g Z _4}- 3` Floor Garage Carport Covered Porch Deck Shed /12- .4e,- Other TOTAL VALUATION Total footprint of structures /7S`I' sq. ft. T Lot size Pi QDa 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 I have read and completed this application and know it 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, and to obtain permits prior to working on projects. Date 5./6).201/Print Name A@4 6e East t A_ Signature q.1 c mil t k. T:Forms /Building Division /Bldg Permit.doc NOTES Permit I t bSS 1 lf \j(L. cLit! KININKFROMIIMLIV Ra-or E orvuo 1 T:Forms /Building Division/Notes lie 0 ''.''''z'f:',1,..'/' ,t,'/, f.„' t. Clallam County Assessor Treasurer Property Details 61785 CLALLAM COUNTY Page 1 of 1 Claliam County Assessor Treasurer Property Search Results 61785 CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2 for Year 2011 2012 Property Account Property ID: 61785 Legal Description: P S CO -OP COLONY SUBDIVISION LOTS 1&2 BL 4 Geographic ID: 0630005304000000 Agent Code: Type: Real Tax Area: 0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 89 Open Space: N DFL N Historic Property: N Remodel Property: N Multi Family Redevelopment: N Township: Section: Range: Location Address: 1032 E COLUMBIA ST Mapsco: PORT ANGELES, WA Neighborhood: x ref Exempt Ref Region 5 Map ID: 2 t Neighborhood CD: 50985200 Owner Name: CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2 Owner ID: 18291 Mailing Address: DBA OLYMPIC MEDICAL CENTER Ownership: 100.0000000000% 939 CAROLINE ST PORT ANGELES, WA 98362 -3909 Exemptions: EX Taxes and Assessment Details Property Tax Information as of 08/16/2011 Amount Due if Paid on: M. 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. Click on "Statement Details" to expand or collapse a tax statement. First Half Second Half Year Statement ID Base Amt Base Amt Penalty Interest Base Paid Amount Due R Statement Details 2011 156203 $36.82 $36.81 $0.00 $0.00 $73.63 $0.00 Statement Details 2010 44480 $36.82 $36.81 $0.00 $0.00 $73.63 $0.00 Values Taxing Jurisdiction Improvement Building Sketch Property Image l Land Roll Value History Deed and Sales History Payout y Agreement 1 This year is not certified and ALL values will be represented with "N /A Website version: 9.0.32.2200 Database last updated on: 8/16/2011 3:55 AM 2011 True Automation, Inc. All Rights Reserved. Privacy Notice http: /websrv8.clallam. net propertyaccess /Property.aspx ?cid =0 &year= 2011 &prop id 61785 8/16/2011 Linda Pangrle From: Linda Pangrle Sent: Tuesday, September 06, 2011 10:18 AM To: 'Roger A. Easling' Subject: RE: 1032 Columbia Demolition Attachments: #11 -885 1032 Columbia St payment fee.pdf Hi Roger, Thanks for the informative e -mail. I attached a copy of the payment sheet for the $55.00 fee. It is a public works department fee. Roger Vess wrote the comment below, that explains the fee and will print on your permit. "Sewer lateral shall be exposed to the property line, an inspection by Public Works Engineering is required. The sewer lateral will be capped. If the sewer lateral is to be reused, a 4" X 4" X 8' pressure treated post, painted green and marked S. S. Stub indicate depth to service to the nearest foot. Attach a 12 gauge galv. wire to cap and stake." If you have questions about the $55.00 fee, please contact Roger Vess at 417 -4812. I am ready to issue the permit as soon as you have paid the fee. Thanks, Linda From: Roger A. Easling i mailto :reasling @olvmpicmedical.orgl Sent: Tuesday, September 06, 2011 8:07 AM To: Linda Pangrle Cc: Scott Bower; Cameo F. Sorensen Subject: 1032 Columbia Demolition Linda- Another fee, you say? If so I need something to submit showing what it is for. We are having Tracy over at Zenovic do lead test and submit for waste disposal application, but...will not be needed as this waste will be transported direct to a recycler in Olympia, misc metal elsewhere. Demolition contractor name is D &H Enterprises, PO Box 631, Forks, WA 98331 We will be removing asbestos on Thursday and Friday 9/8 -9 and Demolition to start 9/12 RQriez 544 Construction Projects Supervisor Olympic Medical Center Confidentiality Notice: This e -mail message, including any attachments, is for the sole use of the intended individual(s) named above and may contain confidential, privileged, and /or protected information. Any 1 unauthorized review, use, disclosure, copying, or distribution of its contents is prohibited. If you are not the intended recipient, you have received this email in error. If so, please notify the sender immediately by reply email and delete /destroy the original and all copies of this communication. Also know that Internet e -mail is not secure. In choosing to communicate with Olympic Medical Center by email you will assume these confidentiality risks. Internet messages may become corrupted, incomplete, or may incorrectly identify the sender. 2 Z 4 s x �r �Ty a f f s rn a H 1 F i G "F t') N, 1. U. S. s I I NOPKS U J IL_ITIES DEPARTMENT August 08, 2011 Olympic Medical Center 939 Caroline Street Port Angeles, WA. 98362 RE: Port Angeles Landfill Transfer Waste Disposal Application, WDA #11 -18 for Olympic Medical Center House Demolition 1032 Columbia We have received your application for disposal of demolition materials from the referenced site and reviewed the testing results. Based on the testing results of the materials it 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 the 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 Tom McCabe, Solid Waste Superintendent at 360- 417 -4872 or e -mail tmccabe@cityofpa.us if you have any questions. Sincerely Tom McCabe Solid Waste Superintendent Cc: Brian Tate, Operations Manager, Port Angeles Transfer Station Sonja Coventon, Scale Attendant, City of PA Enc: WDA C:Waste Disposal /correspondence 1 I j POPTa J WASTE DISPOSAL APPLICATION PORT ANGELES SOLID WASTE TRANSFER STATION To: City of Port Angeles Attn: Solid Waste Superintendent Phone: (360) 417-4872 321 E. Fifth Street Fax: (360) 452 -4972 P.O. Box 1150 Port Angeles, Washington 98362 NOTE: All questions must be answered for waste to be approved. 1. Applicant information: Company Name: -'VM Q kC 14 Mailing Address: 3 CA •4 S r7 J 'c. 4 4 's, w,4 90 Contact: 4 e. 4, e 4-4,564- Phone: y 1 -8 Project Name: IbuS1 01 4 404/ Project Location: /03 2 dnLtiin/619 2. Other Contacts (if applicable): Consulting Firm: 4SS06, Y�.c Contact: 7 e 4 C`7' 4 (cc_ Phone: k("2- 06 Contractor Name: 0 ri.✓1�ic�utLS Contact: Ag 2yc 6 AS ki Phone: 6 10-- c tlY1 Laboratory: Af �q��a- ��Q,t� Pvt.- Contact: .(71 Phone: -.5 N7 0100 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: CJ Independent Remedial Action [1 UST Removal CI Unused Chemical Product Spill /Other Source: City of Port Angeles Waste Disposal Application Page 1 of 4 (last updated January 2011.) 4. Waste Material Composition: (Check all that apply and include percent of total) Soil Foundry Slag Solvents Dredge Sediments Preserved Wood Debris /DQ Coal Ash Other (list) Wood Ash NOTE: Total must equal 100 5. Waste Material Contaminants: (check all that apply) Gasoline Metals Diesel Solvents Heating Oil PCBs Unused Motor Oil Used Motor Oil /Waste Oil Other Other Petroleum Product Unknown Note: Supply and MSDS information with application, if available. 6, Estimated Quantity of Waste for Disposal: 2 s' Cubic yards 20 Tons (estimated both) Drums Tons (estimated 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 the waste was sampled. Identify site and location where material is being removed from. Number of COMPOSITE samples: [t Number of DISCRETE samples: Cl 11 IL 3A 4.4eisr 54t. 6` 4w LAArit 2 �`7 v�z�. e �1� a e 9� City of Port Angeles Waste Disposal Application Page 2 of 1 (last updated January' 2011) 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. 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 November 1995) or any future updates "Guidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum contaminated soils from underground storage tanks releases. Submit all laboratory analytical results, QA /QC data, and Chain of Custody sheets along with this application. (NOTE: The sampling laboratory must be accredited by the Washington State Department of Ecology.) a) List all analy 'cal test methods used: A 13( 7ooe6 b) Provide a narrative as to why the above analytical methods were selected: 44 04 s- �ccai" 14//35 14//35 Pv� w s�3�/y 6/ (,44o 45fo D 4/ r/ *els z5 Su2vE /a errxhas o% 4- sou >as oCc rs-) WI2j1I 4"'"C411..16 P e 4//2 eCT- C,vt a...�r NOTE: Additional sheets attached: L 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: (ch/eeck one) [Y either Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: 1 Extremely Hazardous Waste (EHW) and Waste Code: City of Port Angeles Waste Disposal Application Page 3 of 4 (last updated January 2011) 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 binder that still exhibits plasticity to prevent release of asbestos fibers) must: Be tightly wrapped or bagged in 6 mil plastic with no excess air in the packaging o Not exceed 50 pounds per bundle Be labeled as asbestos with required information regarding its origin a Be transported with a manifest in the vehicle o Arrive at the transfer station only by appointment with Brian Tate of Waste Connections at 360 -452 -0427 or cell phone 360 912 -7080, so that the material can be deposited in a lock box, 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 represe (proposed waste material to the hest of our abilities. Waste Generator's Signature: j `fie Printed Name Company Position G crJ(,CC F! tv,Jl2.! Company: f, Date: (1 /7/// If you have any questions please contact Tom McCabe, Solid Waste Superintendent at 417 -4872 or email tmccabc(n?cltyofpa.u,. THIS SECTION TO BE FILLED OUT BY AUTHORIZED STAFF /1 --/K N D A Applo al: 1 F� ironme al Health Specialist Date Approval with the following conditions if applicable: I certify under penalty of law that the statements made on this form are true and correct to the best of my knowledge, Information and belief. .1 r' 1..t...'a ;I Tom McCabe, Solid Waste Superintendent Date Contractor shall present their copy of approved application to Scale House. A Demolition Permit must be obtained if demolition occurs In the City. Permit forms are available at the building counter at City Hall or on the City's website under the link hhtp: /www.cityof pa.us/ Phone 360 -417- 4815 City of Port Angeles Waste Disposal Application Page 4 of 4 (last updated January 2011) NVL Laboratories Inca 4708 Aurora Ave. N., Seattle, WA 98103 M 41HA Tel: 206.547.0100, Fax: 206,634.1936 AIHA -1H 4 101861 .tr www.nvIlabs.com Analysis Report WA DOE C1765 LABORATORY Toxicity Characteristic Leaching Procedure Lead (Pb) Client: Zenovic Associates, Inc. Batch 3111594.00 Address: 301 E. 6th St, Suite 1 Matrix: Bulk Port Angeles, WA 98362 Method: ERA 1311/7000B Client Project 11163 Attention: Mr. Tracy Gudget Date Received: 08/18/2011 Project Location: 1032 Columbia, Port Angeles, WA Samples Received: 1 Samples Analyzed: 1 RL Results Results in Lab ID Client Sample mq/ L in mg /L ppm 31060743 11163A 0.5 0.5 0.5 i Sampled by: Client Analyzed by: Yasuyuki Hid Date Analyzed: 08/23/2011 r.'� Reviewed by: Nick Ly Date Issued: 08/23/2011 ^'"L Illlrecfor mg/ L Milligrams per lite f�L deporting Limit pprn parts per million M Below the repad:iricl l.irnit Note Method QC results are acc n uniess t teri otherwise Unless otherwise indicted tie conrinwn of all samples w i' acc. ar nt t irie r f t Enpt. ?e:rc.ri Run No. 31-0822-04 BATCH ID NVL_ Laboratories. Inc. CHAIN of CUSTODY 3111594.00 4708 Aurora Ave N, Seattle, WA 88103. Tel: 206.547.0100 Emerg. Pager. 206.344.1878 SAMPLE LOG 1.888.NVL.LABS (685.5227) Client Zenovic Associates, Inc. NW, Batch Number Street U\ G (,,y"' C e y Client Job Number '3 Port Angeles Total Samples Project Manager �/LaC1 ac./04.14 Tum Around Time 1 -Hr El 24 Hr5 4 Days D 2 -Hrs D 2 Days (R5 Project Location /032 tXtik,,4/ /nz ,4 ��ri�d w a D 4-Hrs D 3 Days D 6 to 10 Days Please call for TAT less 24 Ms Email address Y e ZI-w vac.. -v! -r J Phone: (360) 417 -0501 Fax: (360) 417 -0514 L(-1 Asbestos Air i D PCM (NIOSH 7400) 0 TEM (NIOSH 7402) LJ TEM (AHERA) 0 TEM (EPA Level II) 0 Other J [D Asbestos Bulk 0 PLM (EPA/600/R- 83/116) 0 PLM (EPA Point Count) 0 PLM (EPA Gravimetry) D „TEM Bulk IMTALS Dot. Limit Matrix RCRA Metals 0 All 8 Other Metal D Total Metals {131"jp (AAS) Cl Air Filter 0 Paint Chips D Arsenic (As) 0 Lead (Pb) U All 3 U..i 1 CLP 0 ppb (GFAA) 0 Dunking water 0 Paint Chips (Area) 0 Barium (8a) 0 Mercury (Hg) 0 CoPPer (Cu) I LI Dust/wipe 0 Waste Water 0 Cadmium (Cd) 0 Selenium (Se) 0 Nickel (Ni) Soil 0 Chromium (Cr) 0 Silver (Ag) 0 Zinc (Zn) D Other Types 0 Fiberglass El Nuisance Dust 0 Rotometer Calibration Ll Other (Specify) or Analysis 0 Silica D Respirable Dust 0 Mold/Fungus Condition of Package: Good 0 Damaged (no spillage) D Severe damage (spillage) Seq. ff Lab ID Client Sample Number Comments A/R 2 3 4 5 7 8 10 r 11 12 I 13 14 15 Print Below S n Bel�''`� Conmany Date Time I Sampled by -7;r- y 6---.(M4(-- __j l �T -✓o,,lc EA5k,, ..z, D�� Relinquished by 7:2.467” rawer, Z %�wvrG 5 .4* b' i tr. 1 /2!_ L J Received by i 6., 4 1 �i �1�._S B \f i 0 Ana by 7 �v� 1 L Results called by I ,,11-..'----1----1 LResutts azet y l r-I,.,.y,t -v.1 A I .1 1 7 24 Special Instructions: Unless requested in writing. alt samples will be disposed of two (2) weeks after analysis. ..._-1 N A R 4 R 11 O V S August 23, 2011 Tracy Gudgel I ,I. Zenovic Associates, Inc. L p B S 301 E. 6th St. Suite 1 Port Angeles, WA 98362 H A Z A R D O U S M A T E R I A L S S E R V I C E S RE: Metals Analysis; NVL Batch 3111594.00 Dear Mr. Gudgel, Enclosed please find the test results for samples submitted to our laboratory for analysis. Preparation of these samples was conducted following protocol outlined in EPA Method SW 846 -3051 unless stated otherwise. Analysis of these samples was performed using analytical instruments in accordance with U.S. EPA, NIOSH, OSHA and other ASTM methods. EgIV1 A f� For matrix materials submitted as paint, dust wipe, soil or TCLP samples, analysis for the n 102063 T presence of total metals is conducted using published U.S. EPA Methods. Paint and soil results are usually expressed in mg /Kg which is equivalent to parts per million (ppm). Lead (Pb) in paint is usually expressed in mg /Kg (ppm) Percent or mg/cm 2 by area. A Dust wipe sample results are usually expressed in ug /wipe and ug /ft TCLP samples are reported in mg /L (ppm). For air filter samples, analyses are conducted using NIOSH and ACCREDITED OSHA Methods. Results are expressed in ug /filter and ug /m Other matrix materials are LABORATORY analyzed accordingly using published methods or specified by client. The reported test #10 861 results pertain only to items tested. Lead test results are not blank corrected. For recent regulation updates pertaining to current regulatory levels or permissible exposure levels, please call your local regulatory agencies for more details. This report is considered highly confidential and will not be released without your approval. Samples are archived for two weeks following analysis. Samples that are not retrieved by the client are discarded after two weeks. Thank you for using our laboratory services. if you need further assistance please feel free to call us at 206 547 -0100 or 1 -688- NVLLABS. Sincerely, G r NVL LABORATORIES. (NC 4708 AURURA AVE N Nick Ly, Technical Director SEATTLE. WA 91i103.651b TEL ?.96.5 7.91 ®0 WWW. Y a11aGs. COM Enclosure: 1.888.NVl.LA85 I6fl5.5 ?2:71 PAX 206.634.1936 IyllaDs4'nvllabs.;unl tS I L. t l u NVL. Laboratories. Inc. CHAIN of CUSTODY 1 11 594.0 4708 Aurora Ave N, Seattle, WA 98101 Tel: 206.547.0100 Emerg. Pager. 206.344.1878 SAMPLE LOG 1.888.NVL.LABS (685.5227) Client Zenovic Associates, Inc. NVL Batch Number Street 3 U\ C L, `mac eeA Client Job Number U Port Angeles Total Samples Project Manager ~�/LiG� GvclG'� Tin mound Time 1 -Hr 24 Hts 4 Days O 2 0 2 Days [3'S Uays ect Location Q w g, o A z, r�^'li �°sf P'r'o! J 32 4-Hrs 3 Days O 6 to 10 Days Ptease call for TAT less than 24 firs Email address ''�.4LY a Zi-u, d /c. Phone: (360) 417 0501 Fax (360) 417 -0514 O Asbestos Air [l PCM NIOSH 7400) TEM (NIOSH 7402) (J TEM (AHERA) TEM (EPA Level II) 0 Other f Asbestos Bulk 0 PLM (EPA/600/R- 93/116) 0 PLM (EPA Point Count) D PLM (EPA Gravimetry) O TEM Bulk j METALS Dot Limit Matrix RCRA Metals 0 Alt 8 Other Metals [I Tptai Metals C (AAS) f Air Filter D Paint Chips Arsenic (As) 0 Lead (Pb) U All 3 [VTCLP a ppb (GFAA) 0 Drinking water 0 Paint Chips (Area) Barium (Ba) Mercury (Hg) 0 Copper (Cu) LI Dust/wipe 0 Waste Water Soil 0 Cadmium (Cd) 0 Selenium (Se) 0 Nickel (Ni) Chromium (Cr) Silver (Ag) 0 Zinc (Zn) Other Types 0 Fiberglass 0 Nuisance Dust Rotometer Calibration El Other (Specify) of Analysis 0 Silica 0 Respirable Dust 0 Mo)d/Fungus Condition of Package: 0 Good Damaged (no spillage) Severe damage (spillage) Seq. Lab ID Client Sample Number Comments AIR 1 1 14 4 2 3 4 5 6 7 -T 8 9 10 11 12 13 14 15 T Print Below Si e n Bel. Company Date Time Sampled by Mr T -✓ov /c 64.04 -4 =11 /"-w Relinquished by -?/L-q;1 ,�JOGk 9 �G. y l7 1 r /2j/ Received by 1 2 I 1 -\.L l� 1 "1 Analyzed by Results Called by Results Faxed by Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after analysis. 1 09/07/2011 15:12 3604178627 ONO PLANT OPS PAGE 01/12 7 /eiky NORTHWEST ASBESTOS CONSULTANTS 41 7 Surveys, Inspection, Sampling AHERA Building Inspector Mgmt. Planner. EPA Certification WAMOA -0042 406 Reed St, Port Townsend, WA 98368 northwestasbestosconsultants @cablespeed.r_om 360 -385 -4584 8/8/11 rob 1atioIL. 1032 Columbia Sr. Port Angeles, WA 98362 PO M15948 Owner: Olympic Medical Center 939 Caroline St. Port Angeles, WA 98362 Contact: Roger Easling, Construction Projects Supervisor ,Suljject: Demolition Jnspector: Bob Witheridge AHERA Building inspector Management Planner WAMOA 0042-1022201002 Expires 10/22/11 09/07/ ?011 rW1) 14:[ I'I,'X /RX.NO 6'i;O1 VW) 09/07/2011 15:12 3b041 '862( OMC PLANT CJPS PAGE 02/12 Scppef work 1) Good faith inspection for asbestos containing building materials (ACBM), 2) Survey, sample and record suspect materials. 3) Report to Roger Easling with .results of testing. lie ion Renox� The inspection started with a visual survey looking for Asbestos Containing Building Materials (ACBM). Two story home with basement had composition roof, wood clad windows and wood siding material on cement foundation. Electric and wood heat. Wood and vinyl floors. Sample #1; Living room, hallway, dining room and main floor bedrooms. Wall material. Eamnle #2 #2: Kitchen, bathroom, hallway and closets on main floor. Floor vinyl with mastic. Lt.Green Sample #3: Main floor bathroom bottom layer foor vinyl with mastic. Green S tele #4. Main floor bathroom cove base, Black Sample #5: Main floor ceiling material. Sample #6: Upstairs northwest bedroom floor vinyl with mastic. Multi. ran and green. Sample, #7: Upstairs northwest acoustic ceiling material. $,pie #8: Upstairs bathroom and hallway. 9" x 9" floor vinyl with mastic. Brown pebble pattern. Sample #21 Rock wool insulation in attic. Sample #10: Window glazing material. Sample #11:, Roofing material. Green Sample #12: Basement laundry and storage rooms. 9" x 9" floor tile with mastic. Gold fleck pattern. Sanole: t..3.;. Basement laundry room wall vinyl with mastic. Green Sarnnle #14: Basement bathroom floor vinyl with mastic. Tan pebble pattern.. S.axn zle #.15: Basement sheet rock. <"p,).11 Basement north and south storage rooms and laundry, 12" x 12" ceiling tile. 09/07/?Oil 210) I_'! 1.5 [TX /iii NO 62801 I [6 002 09/07/2011 15:12 36041.791 ;27 UMC PLANT OPS PAGE 03/12 ASBESTOS BULK SAMPLE DATA NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHE7A Building Inspector Mgmt. Planner .EPA Certification WAMOA-0042 406 Reed St. Port Townsend, WA 98368 northwestasbestoscon .sultants @cablespeed.cozn 360 -38S -0584 To Northern Industrial Hygiene Date: 8/2/11 Iob Local:14:21X 1032 Columbia St. Port Angeles, WA. 98362 PO M15948 Owner: Olympic Medical Center 939 Caroline St. Port Angeles, WA 98362 Cnittarr: Roger Basling, Construction .Projects Supervisor Sample #1: Living room, hallway, dining room and main floor bedrooms. Wall material. Sample #2; Kitchen, bathroom, hallway and closets on main floor. Floor vinyl with mastic. Lt.Green Samoje #3: Main. floor bathroom bottom layer foor vinyl with mastic. Green Sample #4; Main floor bathroom cove base. Black Sample #5; Main floor ceiling material. Sample #6: Upstairs northwest bedroom floor vinyl with mastic. Multi. tan and green. Sample #7: Upstairs northwest acoustic ceiling material, Sample #8: Upstairs bathroom and hallway, 9" x 9" floor vinyl with mastic. Brown pebble pattern. Sample #9: Rock wool insulation in attic. Sample #10; Window glazing material. Sample #1 1; Roofing material. Green 09/07/2011 WED 14:10 1'I'X_ /RX N0 62601 i�/�000 00/07/2011 15:12 3664175627 OMC PLANT OPS PAGE 04/12 Sarno Jejt12,1 Basement laundry and storage rooms. 9" x 9" floor tile with mastic. Gold fleck pattern. 111111e #13; Basement laundry room wall vinyl with mastic. Green S4mp1 #14; Basement bathroom floor vinyl with mastic. Tan pebble pattern. 51 #15: Basement sheet rock. .temple #16: Basement north and south storage rooms and laundry. 12" x 12" ceiling tile. lnspertor: Bob Witheridge AHERA Building inspector Management Planner WAMOA 0042 1022201002 Expires 10/22/11 See attachment. Thank you, f Bob Witheridge, U9/07/J,0(I SS'liI) :1 4:1 5 ;Tx /RA NO 3 Zoog 1149..N11 2011 15: 12 36E141 72G27 01.10 r1. ANT 000 PAGE 05/1 2 21S SW 153rd Street Burien, WA 911186 OFFICE: (2,00) 90134746 FAX (206) .913e,-1S711 1 ,1‘ '1 1- 1 NVLAP Lab Code: 200511-0 irtaresurrwroo.I., wisitcaswegiw,. InP■ra Bulk Asbestos Analysis Report Northwest Asitos Consultants Nlbi Batch Number: 11-0050a 406 Reed Street Client-lob Number. Port Townsend, WA 9i3388-- Turn Around TimA &OayC Project Location: 1032 Columbia &re*, Pert Angeles. WA Samples Analyzed: 10 Client Sample Number: 1 Lab Sample Number. 11-00506.0001 Client Semple Description: Walt Material Client Sample Location: Living Room, Hallway. Dining Room A Main Floor Bedrooms Sump/4e Comments: Materials distfrigulsbable bet insePateble checked ff Sample Not Analyzed 0 White paint on groan and white grttty material Asbestos Fihroint errat poonnts: Non-Asbestos Flb-ous Components: NO41 Components No Asbestos Detected 2% Celltllose 35% Aggregate 43% Filler and Binder 21)% Paint Client Sample Number 2 Lab Sample Number: 11-005013,0002 Client Sample Description! Ligitt.Green Floor Vinyl with Mastic Client Sample Locator: Kitchen, Bathroom, HaiNray Closets an Main Flour Semple Comments: Materials distinguishable but insep Checked If Sample Not Analyzed Li White and pale-green pebble pattern vinyl with white fiber:v:5 backing and black librous asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: Conuk)se 13% Asphalt Fier and Binder 30% Filler and Binder 40% Vinyl Filler and Binder Client Samn+e Number. 3 Lab Semple Number: 11.-00506.0003 Client Sample Description! Green Floor Vinyl with Mastic (Bottom Layer) Client Semple Loc.ation: Main Floor Bathroom Sample Comments: titaterinis distinguishable. but Inseparable Checked If Sample Not Amelyzed fl m atIci k...green pebble pattern vinyl with white Fibrous bacMog and black fibrous asphalt Asbestos Fibrous Components: Non-Asbernos Fibrous Components: Non-FThrous Components: TiPZORMFAIN,PLIY,Z,D 7% c 15% Asphalt Finer ancl Binder 45% Vinyl Filler and Binder 25% Filter and Binder Client Sampie Number 4 Lab Somple Number! 11-00500.0004 Client Sample Description. Black Cove Base Client Sample Location: Main Floor Bathroom Sample Comments: Checked if Sample Not Analyzed (Semple results continued on next page.) SLample br Bob WItheridge 8/2.12011 Received by: Fermin thihe 81312011 ?1,cc47-1--sf7,— Reviewed by: Rachel Melgoze B/S12011 Rachel Mefgoas. Analyst Page 1 09/07/20.1.1 WEI) 14 1 ETX/P,X NO 02)101 fa 005 i 9/'F 15:12 3GF1417CIG27 OH'iC PLANT i_iPS PAGE N6 /1.2 r f 5Yr' r 215 SW 153rd Street Burieri, WA 96188 01 FiGF' (246} 988' -1745 FAX: 42¢6j 988 -1978 .l>r s NVLAP Last) Cnctn: 260911-0 Bulk Asbestos is ysas Report Northwest Asbestos Consonants NIFi Batch Number: 11d050e 406 Reed Street Client Job Number. Port Townsend, WA 98396- Turn Around Time; 5 Day C Project Location• 1n37 Colum8ie Street. Port Angelus. WA Samples Anotyzod: 16 LaYef 1 Brack vinyl l 1 Asbestos Fibrous Components: Non Asbestos Fibrous: Componeets: Non Fibrous Components. ido Asbestos Deter 100% vinyl Filler and brinier Layer 2 Light.broam sticky adhesive Asbestos Fibrous Cornpon nts; Non- Aebeetoa Fibrous C nent Non- Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler And Binder Client Sample Number 5 Lab Sample Number; 11-0050 LO0O5 Client Sample Caecaption: Ceiling Materiel Client Sample Location; Min Floor Semple Comments: Materials distinguishable hut inseparable Chocked If Sanipte Not Analyzed White paint on white 9rttty material Asbestos Rbrous Components: Non Asbestos Fibrous C mponenta: Non•Flbroue components: No Asbestos Detected 2% Cellub,a 35% Aggregate 40% Filler and Binder 23% Paint Client Semple Number. 6 Lab Sample Number- 11-0O5011,0006 Client Sample Description: Multi Tan &Green Floor vrryi with Mastic Client Sample Location: upstairs NW Bedroom Sample Comments: Materials distiin7utshable but inseparable Checked 11 Sample Not Analyzed r) Mutticofored patterned Vinyl with black fibroses I pbait backing Asbush:* Fibrous Component: Non Asbestos Fibrous C. ..manta: Non Fibrous Components: No Asbestos Detected 25% Cellulose 45% Asphalt Ft11er and Binder 30% Vinyl Fitter and Binder Client Sample Number, 7 Lab Sample Number, 11 Client Sample Description: Acoustic Ceiling Material Client Sample Location: Upstairs NW Ceiling Sample Comments: Materials dbstingulslrable but in Checked if Sample Net Analyzed 0 white paint on light- brown 1r turn reseed tfai Asbestos Fibrous Components: Non Asbestos Fibrous ponerits: Non -Pbrovs Components No Ases DeteCt 8596 Cellulose 10% Filler and Binder 5% Paint (Sample results continued on next Pot Sampled by: Bob Wlthertdre 8/2/2011 Reorived by: Fermin bribe Reviewed by Rachel Met 81.011 RaF8xe1 8e}nsria, Meiyst Page 2 09 /07 /201l 11'11) 1.41: i5 f `l'X/RX NO l3 ,G01 RI 09. 15:12 3604178627 1.11MC PLANT OPS PAGE 07./1 2 215 SIN 153rd Streret Burien, WA 98156 OFFICE; (206) 9884740 FAX: (20£0, 988-1978 NVLAP Lab Code: 200511-0! PQM, irneo.o. Bulk Asbestos Analysis Report Northwest Asbestos Consultants N114 Belt Number: 11-00606 406 Reed Street Cfiete Job Number Port Townsend, WA 96368- Tem Around Time: 5 clay C Project Lorxrtion; 1032 Colt/male Street Pod Angeles, WA Sini Analyzed: 16 Client Sample Number: Lab Semple Number; 11-00506.0008 Client Sample Descliption: 9" X9" Bows Pebble Pattern Floor Vinvl vrittl Marafc Client Sample Location: Upstairs Bathroom Hallway Sample Commenter Materials distinguishable but inseparable Checked fiSample Nor Analyzed D brown and tan speckle pattern vinyl with black mastic resldue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: 1 Celli- 2% Asphalt Faier and Binder 30% Aggregate 55% Vinyl Filler and Binder Client Sample Number. 9 Len Sample Number: 11-00506.0009 Client Sample Description: Rock Wool insulation Client Sample Location: Attic Sample Comrnenttr Checked t Sample Not Analyzed fl Dark-gray fibrous material watt wood shavings Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non.Fibroue Components: No Asbestos Detected 5% CellulOse 95% Mineral Wool and Beads Client Semple Number 10 Lab Sample Number: 11-00so6.eo19 Client Sample Description: Window Glazing Material Client Semple Location: Window Sample C,ommenis: Materials distinguishable toot inseparable Checked If Sample Not Analyzed ti White paint on gray grainy compressed material Asbestos Fibrous Component: Non-Asbestos Fibrous Components: Nrm-Fibroes Components: 761, Arj,11 MarOW,g 68% F9let arrd Binder 20% Fine Grains 10% Paint Client Sample Number 11 Lab sampte Number: 11-00508.0011 Client Sample Drsscrl 121 o n Roofing Material Client Sample Location: Roof Semple Comments: Checked If Sample Not Analyzed n (Sample results continued on next papa.) Sampled by Bob Mile-tido ar22011 Received by: Fermin Uritte 6/3/2011 Reviewed by: Rachel Meigoze 815/2011 Meitacari, Anatyst Page 3 1)9/0//2011 001) 14 I 5 /RA: NO 8280 007 EY:I/07. 15:12 3684178b27 OMC PLANT CPS PAGE 11:::; 71 2 215 SW 153rd Street Burien, WA 98166 OFFICE: pos) 9311-1746 FAX (20S) 995 1 1 1 NVLAP Lab Code: 2(19511-0 wirceratmee. 11441.:3. Bulk Asbestos Analysis Report Northwest Asbestos Consultants N1H Batch Number: 11-O0)8 405 Reed Street Client Job Number, Port Townsend, WA 50306- Turn Around lime: 5 Day C Project Location: 1032 Columbia Strelit, Port Angokn, WA Sarnpies Analyzed: Green and black gravet oh black fibrous asphalt with smolt pebbles Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Flbrorm COMPOIVITtC: No Asbestos Rabected 10% FlberglasS 40% Aggregate 50% Asphalt Filler and B4rider Client Sample Number: 12 Lan Sample Number 11-005040012 Client Sample Descfintion' it X 9 Gold Fleck Pattern Floor Tile with Massie Client Sample Location, Basement Laundry Storage Rooms 1 Semple Comments: Checked If Sample Net Analyzed Layer 1 Multiple shades of brown patterned vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Nnn-Flbrous Components: rl';),?;■:4;0"M 30% Aggregate 68% Vinyl Filler arxl Binder Layer 2 Black asphalt (maStic) Asbestos Fibrous Components: NoreAsbentos Fibrous ComponernW Non-Fibrous Componerrta: No Asbestos Detected 3% Cellulose 95% Asphalt Filler and Binder 1% Hair 1% Synthetic Cliont Sample Number 13 Lab Sample Number: 11.00506.0013 Client Semple Description. Green wan Vinyl with Mastic Client Sample Location: Basement Laundry Room Sample Comments: Materials distinguishable but inistparabie Checked If Sample Not Analyzed 0 Green vinyl with black fibrous asphalt backing, red coating and white compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 35% Asphalt Filler and Binder 25% Filter and Binder 20% Vinyl Filler and Binder Client Sample Number. 14 Lob Sample Number. 11430500,0014 Client Semple Description: Tan PeObte Pattern Floor Vinyl with Mastic Client sample Location' Basement rtantroom Sample Comments: Materials distinguishable but inseparable Checked If Sample Nat Analyzed 0 (Sample results continued on noxt page) Sampled by Rob VIlltberidge 81212011 Received by Fannin Uribe 8/3120111 RgiltiiMied by Rachel kilelgara afFir21)11 Raebsil Metwaga, Alutfsa Pog-e .4 09/0'7/2011 14 15 TX/RX 80 1200 I ra 906 119/FIT't2011 15:12 3604178627 Ot...1C, PLANT riPS RGE 5:12 215 SW 153rd Stet Busier), WA 98166 ,t.`c`FP tl• OFFICE: (206) 986-1 746 FAX (2c5) 988-1576 F■ Ir NVLAP Lab COde; 200511-0 ticks reliins.e.s.. Ivit Nort. rrani.,„ Bulk Asbestos Analysis Report Nonhwost Asbestos Consultants Nihi Batch Number: 11-00508 Atie Reed Street Client Job Number Port Townsend, WA 68368- Torn Around Time: 5130y C Project Location: 10.32 Columbia Struot, Port Angdos, WA Samples Anatyzect 16 Brown and Ian pebble pattern vinyl with white fibrous backing and gold mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: ;RigingigeirMigtitiAriRM 7% C el IU10Se 40% Filler and Binder 40% Vinyl Filler and Binder Client Semple Number. 15 Lab sample Number. 11-00508.0015 Client Sample Description' Shmtrock Client Semple Location: Basement Semple Commente: Materials dEstinoulsturible is inseparahle Checked If Sample Nat Anstyzed fl Tun paper on off-white fibrous compressed material Asbestos Fibrous Components.: Non-Asbestos Fibrous Components: Non-Fitwooe Comnononts: No Asbestos Detected 25% Cellulose 70% Filler and Binder L 5% Fiberglass Client Sam*. Number. 18 lab Sample Number 11 Client sample Description: 12" x ir Ceiling Tile Client Sample Location: Baserrrent North and South Storage Rooms and Laundry Semple Comments. Molesters distinguishable but Inseparable checked II'S:ample Not Analyz-ed fl Tan paint on huht-brown fibrous compressed mnletial Asbestos Fibrous CAxiiponents: Non-Astrestas Fibrous Coonponents Non-Fibrous Component< No Asbestos Detected 85% Cellulose 10% Filler and Binder 5% Paint Sampled by nob WIthaddge 81212011 ROCMISKI by: Fermin LIrlbe 5/s12011 Reviewed by: Rachel Melpoza 815/2011 Rachel IVIelgozek Analyst Page 5 0 9 7/2 0 1 1 11171) 1.4 i 5 1 Tx/12x 65) 6 .611.] 16 009 09/07/2011 15:12 35@4178627 OMC PLANT OPS PAGE 10/12 SUSn]7 pry Sample #1,;. Living room, hallway, dining room and main floor bedrooms. Wail material. No asbestos detected. rilale_ #2 Kitchen, bathroom, hallway and closets on main floor. Floor vinyl with mastic. Lt.Green. 10% Chrysotile asbestos. Approx. 320 sq. ft. Samtale #3; Main floor bathroom bottom layer foor vinyl with mastic. Green 8% Chrysotile asbestos. Approx. 54 sq. ft. r Saat�le #4; Main floor bathroom cove base. Black No asbestos detected. 5.$1.1naLe...e.5.1 Main floor ceiling material. No asbestos detected. Sa;nnt� Upstairs northwest bedroom floor vinyl with mastic. Multi. ran and green. No asbestos detected. San1p1e #7: Upstairs northwest acoustic ceiling material. No asbestos detected. Sami Upstairs bathroom and hallway. 9" x 9" floor vinyl with mastic. Brown pebble pattern. Z% Chrysotile asbestos. Approx. 98 sq. ft. Sample #9; Rock wool insulation in attic. No asbestos detected. Sample ;#10: Window glazing material. Homogeneous to all wood framed windows, Z% Chrysotile asbestos. Sample #1] Roofing material. Green No asbestos detected. Samnle #1.Z; Basement laundry and north storage room. 9" x 9" floor tile with mastic. Gold fleck pattern. 2% Chrysotile asbestos. Approx. 472 sq. ft, mold #1 Basement laundry room wall vinyl with mastic. Green No asbestos detected. ,Saiiinle #14; Basement bathroom floor vinyl, with mastic. Tan pebble pattern. 13% Chrysotile asbestos. Approx. 20 sq. ft. Sample #15: Basement sheet rock. No asbestos detected. ai ,.6.; Basement north and south storage rooms and laundry. 12" x 12" ceiling tile. No asbestos detected. See lab res',. is O;3; (➢7 00_ 1 SLT:1) 7 4: 1 ITX /fZX NO 821:0.1 R] 010 09/A7/2011 17/2011 15:1'2 36a1178b27 OMC PLANT OPS P:=26E 11/12 All asbestos containing building materials with a reading of greater then 1% must be removed by a certified abatement contractor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency. During building demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found with in a wall, floor, ceiling or other areas not accessible at the time of the survey. 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 not identifiable with reasonable diligence. After the facility is completely cleaned out a walk through and inspection is required by the original. AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the local permit center and Olympic Region Clean Air Agency. Thank you, Bob Witheridge, E.F.M. 09/07/2011 14E1) 14: t TX /R1 NO 62601 ri01,1 IJ'a /F1;'/201.1 15:12 36f74178627 OP PLANT OPT PAGE 7.2,'].2 rri�y�..—.. '..5.6i' %Va, e6 L" >s w Y' 'S N. A•y!!:'...,� /..(f ��I K J rFi ��.�511 i: F!lf+P .1!.•�'� 1,/..,f,/' ,.J ,...4. ...''v .4. c !1arr o. 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S AP i• ∎ftr p O WASHINGTON o 9, r 1 �kr a p� 9 ASSOCIATION al e ,1 I s MAINTENANCE aril s ti F:{.'``'*w M OPERATIONS "`"J, *r �i ADMINISTRATORS :c. :`1. ;r t x k tilro ;h ,d ry fit: ..?...:'(P K -w, Via' 1.: THIS IS ,r P:..,. TO CERTIFY 1/4,:,,,,.1.-.:': 1 ,.ti• •`S R FY THAT :a j� it 45 :::ii..- 1‘9... r c Participated in the p 1�f .3,� 9: %�n, EPA AHERA q ,Y� jY.." 'i..1 �1l �t� ti N ti ii ,•,.4 .1 INSIPE T f.. MENT AU' ::Y -K I J ANAY� PLANNER �•r ,I,'r i?T,'!, Refres a se off re r,.r •``i r %r h rCour e d bythe WASHINGTON tit NGTON ASSOCIATION of MAINTENANC k: I =:r Y P and OPERATIONS 1 r. si o l►TIONS AD MINISTRATORS F'.� 0 T full x I a -K M1 day training program 4F f covered all topics specified in the 1,1. Model Accreditation 4 2 :y creditation Plan under a pp y�: Section 206 of Title l I of TSCA course was taken on O 4 s The co rs n cto ber 22 2010 t in Silverdale, in 4 ,W ashington. x; Certificate #1022201002 �;,+i x,..,. ate x#102 Expi .tion October 22 2011 4 d y f rtY Colin MacRae Course Administrator s 271 22 SE, Bothe A 8021";'�' f t (42b) 485 6580 z k ti Z 4 }.S 4 44:4' m? "s6fa of P mn e oo;e ,i On 400 O a ao iiiii i �u W, nc nsf f.• tf;\c.on a I p 1 a 0 49fa;e 4 •�a s K 3 Irgi "140` :]L�1`t' f� ?,r t 0, +1 r 1 t' y 1 f tNig y 4 i� I; 4414 �•66e i rl')�'`�N'I' l7 t 1 1 !1 1, i }I4a rfr I Y 1\\ f "li 1 i s o a r �n 'a •g C r /,yt i I M f S l '1 fir; t al a Zt t l V i 1 J r t f fr r 1 fiq 1 tl fi '''e. 74 e a r 'I N °i�`' r 1 4>( qYN q'7 w,4 Ii np7 i °k rp 4� w� a 1�Y 1L 'r �w e..ef A1 s'!' f' u •t1C PI... t 6 +em M "�v to r JF y i "...'1,4 5 K.• r y r td lu;.? u 154.•. f 1 wr,9r Y44V 1 ID i 09/07/20.11 11't l) .I. I Il'A /RX NI) 62001 id 0I2 Det ils/Description: I -1 I I I j I w.s.1 No. Service Size Cap~city: 0 O.K. 0 Not O.K. Comments o 9itch inspection O.K. o lJpugh-in/cover O.K. ~ o;y'9.-K. to connect service cnlnal O.K. ~.\ .' . ",---"'" . CITY OF PORT ANGELES LIGHT DEPARTMENT PERMIT NO. ;;;U(} 7 3~uh'f ELECTRICAL PERMIT DATE Site Address; o READY FOR INSPECTION License Number: o WILL CALL FOR INSPECTION Phone: Installed By: Ow er/BuSiness: Ph&'!j:;-SOO 3 Sq. Ft. Ow er/Business Address: Residential Heat KW Baseboard 0 Furnace/Boiler Heatpump 0 Other Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel o Service update/alter/repair 'l6 Overhead ([j Undergroun(j /, ,I/) Voltage Id&~!f/ illl10 030 Service size c;Qg.O Amps o Temporary o Add/alter circuits o Auxiliary power (list below) o Special equipment (list below) ('fi~ Jo , ~I..d ~ /h.'f? 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/pending Site IAddress: Permit/Receipt No. ::2./() 7 G L",\ ~'It- ~~I't-~ New Meters o Noti,fy the Depart ent of City Light by Street Address and Permit Number when ready for 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 457-041jr} EXT.158 or EXT. 224. ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ifT ;;lO M .llJ\.v..- . " . Inspector Amount paid :~J: :,~::~: ~N:dress YELLOW - file by number PINK - Top: Eng. Bottom: Customer GREEN - Top: Inspector. Bottom: City Hall CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . INSPECTION REPORT. . . . . . REQUEST: Date II ' z..fo - en Time I 2. fJ M. Received by tJ~ '" I~ ,: (phone'l;'erson) Location of Work to be inspected 1()3'Z. t::. Cc I V"" 1;, "'- Name of person requesting inspection j)~".... "5 ;:-. Address of person requesting inspection r 6>,,tJ Yc...r--",( 17"1- E) , Type of Inspection (circle appropriate one): s+ Sewer Foundation Framing Chimney Plumbing Final Phone No. t.fli-'f~'1~ Permit N~ Sewer Excav. Othe\..... ~C\...-te..0 INSPECTION NOTES: Inspected: Date /I, 2-'--07 Remarks: I<.ef'o..\'re-.J.. oz." Time 2- ~M C. "!-. ~':q.... br..n.\<::: /1 . C- By V'~.-1.. I So _' wITt... ""- r-e,,:J&~r , b.....uJ, . RESTORATION REQUIRED . . . . .. YES NO X ~ -- ii C. Lolv\I"\.b:- 51', n 3'ltt!' i 5"8 , ~ S' z cr ,A 0 J ."" \..) . 0 '2. SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved DGravel o Repaired by City o Repaired by Permittee o No Damage Found o Asphalt 0 PCC 0 Other Work Order # !S () S l./ z.. - 1'1 'i o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)