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Home My WebLink About1943 Rstrm1 W Lauridsen Blvd - BuildingPREPARED 5/16/08 9 00 19 INSPECTION TICKET PAGE 9 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 5/16/08 ADDRESS 1943 RSTRM1 W LAURIDSEN BLVD SUBDIV TENANT NBR LINCOLN PARK RESTROOM CONTRACTOR PHONE OWNER CITY OF PORT ANGELES PHONE (360) 417 4566 PARCEL 06 30 00 1 1 5100 0000 APPL NUMBER 08 00000509 DEMOLITION PERMIT DEMO 00 DEMOLITION REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BL99 01 5/16/08 LL BLDG FINAL May 16 2008 8 41 57 AM 1pangrie LEON 912 0249 BLDG FINAL DEMO RESTROOM AT LINCOLN PARK PLEASE CALL LEON 30- MINUTES BEFORE YOU GET THERE SO HE CAN MEET YOU HE HAS THE PERMIT WITH HIM COMMENTS AND NOTES CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 08 00000509 Date 5/12/08 Application pin number 569104 Property Address 1943 RSTRM1 W LAURIDSEN BLVD ASSESSOR PARCEL NUMBER 06 30 00 1 1 5100 0000 Tenant nbr name LINCOLN PARK RESTROOM Application type description DEMOLITION Subdivision Name Property Use Property Zoning PUBLIC BUILDINGS PARKS Application valuation 2500 Application desc DEMOLISH THE OLD CAMPGROUND RESTROOM Owner Contractor CITY OF PORT ANGELES OWNER PO BOX 1150 PORT ANGELES WA 983620217 (360) 417 4566 Structure Information 000 000 DEMOLISH CAMPGROUND RESTROOM Permit DEMOLITION Additional desc DEMOLISH RESTROOM Permit pin number 125682 Permit Fee 50 00 Plan Check Fee 00 Issue Date 5/12/08 Valuation 2500 Expiration Date 11/08/08 Qty Unit Charge Per Extension BASE FEE 50 00 Special Notes and Comments The Fire Department has reviewed the project application and has no comments May 9 2008 3 42 56 PM sroberds The proposal will result in a demo only no land use issues anticipated Public Works Utility Engineering has no requirements for this plan review Other Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 50 00 50 00 00 00 Plan Check Total 00 00 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 54 50 54 50 00 00 Separate Permits are required forelectrical 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. 5 o-7 L Co' L&- er/ Date Print Name Signature of Contractor or Authorized Adent Signature of Owner (if owner is builder) T Forms /Building Division/Building Pemiit (10 /01 /07).wpd 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 FOUNDATION FOOTINGS SHEAR WALLS 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 N's PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 I FIRE 417 -4653 I PLANNING DEPT 417 -4750 I BUILDING 417 -4815 T Forms /Building Division/Building Permit (10 /01 /07).wpd BUILDING PERMIT INSPECTION RECORD DATE ACCEPTED YES NO SEPA. ESA. I SHORELINE, FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE DATE YES NO COMMERCIAL 417 -4735 ELECTRICAL LIGHT DEPT COMMENTS I FINAL DATE ACCEPTED BY. FINAL DATE ACCEPTED BY. CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT ±„6 I BUILDING DATE I I I I 15 -ILrrg 1 L-- I c oQ 1 Q C ACCEPTED YES I NO I 0 May 8 2008 W A S H I N G T O N U S A Public Works Utilities Department City of Port Angeles Attn. Cory Delikat P O Box 1150 Port Angeles, WA 98362 RE. Port Angeles Landfill Transfer Waste Disposal Application, WDA 08 -12 Restroom building demolition at Lincoln Park, Port Angeles We have received your application for disposal of building demolition debris from the referenced site and reviewed the testing results for lead and asbestos 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 m 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 Stephen Sperr P.E. City Engmeer Encl. WDA 08 -12 Copy Claudia Stromski ORT ANGELES N:\PWKS\ENGINEER \W DAPPLIC 08 -12 File: Landfill Solid Waste Disposal Applications Phone 360- 417 -4805 Fax 360- 417 -4542 Website www cityofpa.us Email publicworks @cityofpa.us 321 East Fifth Street P 0 Box 1150 Port Angeles WA 98362 -0217 May 7, 2008 Jim Breitbach preformed a lead test check on the paint on the Lincoln Park Restroom. This was done on 5/5/2008 Results were negitive. Corey Delikat Street/Park Superintendent Parcel Number Project Type Brief Des Check all that apply New Construction Addition Remodel Repair Re -roof Demolition Heat System Other Floor Areas Basement 1 Floor 2n Floor 3 Floor Garage Carport Covered Porch Deck Shed Other Total footprint of structures T Forms /Building Division /Bldg Permit Appl. 2006 Code doc BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn Building Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 Applicant or Agent Qa�� .�ec Q 4� t Property Owner PQ�tkc Property Owner's Address Contractor /Engineer C,- Contractor /Engineer's Address License PROJECT ADDRESS \43 W Q (03o 00 ;co cription. Residential m Commercial Multi- family Industrial t,J.)e IA .1 v IFINCAAV.. 131 tcwrr.! yai.64 •1 CieCrrr...... c•—k- C inersii, Po.1` V L), 11 hp e-- .t \`e c..el p-,. w disc iN.P v t &e -,c%A. rtN*c. )e tn�•-.0 4-- I.,)c {o J r r ea V s.&N. NN&cts 1_ tn%6 P.. .a, !a. A U 1,,,, �i ,Y s-ecA mescr t y L.ti J Or. Q. eft S I c:u$ 4 l..3ci.. es, L I1 -4ti,..�.e�.t♦ b.. Puy (Ce Sk-_6 �t w a p;n \k :.,,Z :.,,Z p(pp2,- \e- r ani_ Heat pump wood burning stove gas fireplace pellet stove other Existing (sq. ft.) Proposed (sq. ft.) Max height of proposed structures ft. Occupancy group Will a lawn sprinkler system be installed? Occupant load Will a fire sprinkler system be installed? Construction type i Date 9.30 d$ Print Name For City Use D Received a Permit# M5 -50 ate Approved Ph e y1'1- 4/561 Phone Phone 4 -(li -ctS6C, Expires L avr i` s .e� Lot Zoning per sq ft. TOTAL VALUATION 5aC sq ft. Lot size sq ft. Lot coverage Ok Signature 0orev of bedrooms of full baths 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. pr F p°RT. co Of 1615111 To City of Port Angeles City Engineer 321 E Fifth Street PO Box 1150 Port Angeles Washington 98362 NOTE. 1 Generator Information Company Name Mailing Address Contact: Phone Project Name Project Location All questions must be answered for waste to be approved. 2 Other Contacts (if applicable) Consulting Firm Contact. Phone Contractor Name Contact: Phone Laboratory Contact. Phone PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION �v a� Vora Nt. ye�1 RC) UU l \C'1 rw C IVICo ,1ACC >Iu, o.r`L eS- fcs rt. e.land I LuA{-•CASPr. Phone (360) 417 -4803 FAX. (360) 417 -4709 r A- 08-17_ City of Port Angeles Landfill Waste Disposal Application Page 1 3 Source of Waste Check the appropriate box below and briefly describe the project, process and /or cleanup that will or has produced the waste requiring disposal Include the gasoline service station number (if applicable) CERCLA/MTCA Remediation Agency Contact. Independent Remedial Action UST Removal Unused Chemical Product Spill Other Source 4 Waste Material Composition (check all that apply and include percent of total) Soil Concrete /Asphalt r Preserved Wood Coal Ash Wood Ash NOTE. Total must equal 100% Unknown Ok 95 5 Waste Material Contaminants (check all that apply) Foundry Slag Dredge Sediments Debris k. Other (list) Gasoline Metals Solvents Heating Oil Unused Motor Oil Used Motor Oil /Waste Oil Other Other Petroleum Product NOTE. Supply any MSDS information with application if available Ok Diesel PCBs City of Port Angeles Landf Waste Disposal Application Page 2 6 Estimated Quantity of Waste 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 aN 7 Frequency of Disposal NOTE 1 One time Monthly 8 Waste Sampling' 57, q\\...s.L, J 14- Proper characterization of the waste for disposal requires the collection of representative samples The methods and equipment necessary for obtaining representative samples of a waste and the frequency of sampling will vary with the type and form of the waste Check the appropriate box and briefly describe how and where the waste was sampled Include site maps with sampling locations if possible Number of COMPOSITE samples number of discrete samples per composite Number of DISCRETE samples Unless prior approval has been granted by Port Angeles frequency will be used 0 -25 25 100 101 500 501 1000 1001 2000 >2000 Cubic yards Drums cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards I a 5 Tons (estimate both) Tons (estimate both) Annual Other the following sampling 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 Waste Disposal Application Page 3 9 Waste Analysis S rte i r 0 The Dangerous Waste Regulations' (WAC 173 -303) shall be utilized to determine the appropriate analytical requirements for waste characterization. Ecology Publication #91 -30 (Revised April 1994) 'Guidance for Remediation of Petroleum Contaminated Soils shall also be used to characterize petroleum contaminated soils from UST releases Submit all laboratory analytical results QA/QC data and Chain of Custody sheets along with this application (NOTE. The laboratory must be accredited by the Washington State Department of Ecology a) List all analytical test methods used b) Provide a narrative as to why the above analytical methods were selected NOTE. Additional sheets attached 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: YES NO 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 (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code Extremely Hazardous Waste (EHW) and Waste Code City of Port Angeles Landfill Waste Disposal Application Page 4 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 abilities ocey 'S Was Generator Signature oit2.:CN Printe Name L y _k c e2C. Company L 3 a O S Date N: \POLICY P \1000 SW\1009 01 WPD City of Port Angeles Landfill Waste Disposal Application Page 5 i Figure C.3 Problem Waste Disposal Acce Generator contacts City of Port Angeles or CCEHD* requesting to dispose of problem wastes at the PALF' City sends an approval letter to the generator. Yes Upon receipt of the waste at the landfill, the gate attendant verifies that the quantity received is within 20% of the quantity reported in the WDA (within 10% for >7500 tons or 5000 cy 44 Yes CCEHD or City of Port Angeles R forwards the generator a copy of the PALF WDA' (Attachment A to Waste Acceptance Policy) *CCEHD. Clallasrt Counth Environmental Health Division No tance Process Generator completes and submits to City the WDA including laboratory analytical results and quality control information. City of Port Angeles Engineer, or designated representative signs WDA and forwards a copy to CCEHD for their review and authorization. City of Port Angeles, City _op Engineer or designated representative reviews WDA for completeness and accuracy 44 Yes PALF• Port Angeles Landfill WDA. Waste Disposal Application City notifies generator in writing of reason for disapproval and forwards copy to CCEHD. Generator may resubmit WDA after addressing City and or CCEHD concerns. 1 I .FY-6-2008 06 29P FROM f: I pate: 5/6/08 lob Locaticin. A 1i i Contact: 1; I I Owner: Subject:, Inspector:1 Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants®cablespeed.com Lincoln City Park Port Angeles, WA 98363 City of Port Angeles P.O. Box 1150 Port Angeles, WA 98362 Corey Delikat Parks Superintendent P.O. Box 1150 Port Angeles, WA 98362 Demolition Bob Witheridge AHERA Building inspector Management Planner WAMOA 0042-10190704 Expires 10/19/08 TO 13604524972 P 2 !1 ;MAY -6 -2008 06 29P FROM I 1) Good faith inspection for asbestos containing building materials (ACBM) 2) Survey, sample and record suspect materials. 3) Report to Corey Delikat with results of testing by Northern Industrial Hygiene, Inc. jnspection,geport The inspection started with a visual survey looking Material (4CBM) Single stork restroom facility Approx. 200 sq ft. Compositidn roof, cement floor, no heat or windows. insulation Sample re ults are as follows: Sample #11 Composition roofing material. Sample #2a Roofing paper Sample wad sent to lab. See results. for Asbestos Exterior had TO 13604524972 P 3 Containing Building T -111 siding and no I 11 i!! IAY -6 -2008 06 29P FROM i ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360- 385 -0584 northwestasbestosconsultants @cablespeed.com To Norther Industrial Hygiene, Inc. Rate: 4/30/08 Locatic)n. Lincoln City Park f Port Angeles, WA 98363 Owner: City of Port Angeles P.O. Box 1150 Port Angeles, WA 98362 Cow art: Corey Delikat Parks Superintendent P,O. Box 1150 Port Angeles, WA 98362 1 Sample #4 Sample #2 Inspector:1 Please call wiitp test results when completed. See attachm Thank yota oe, Bob Withetidge, EFM Composition roofing material. Roofing paper Bob Witheridge AHERA Building Inspector Management Planner WAMOA 0042- 10190704 Expires 10/19/08 TO 13604524972 P 4 :MAY-6-2008 06 29Pi FROM f .t 4,, 215 SW 153rd Street Button, WA 98166 OFFICE: 1206) 91111-4746 FAX 12061 988-1971 I e EMIL nildneeeschelon.cons l; I 1 MAP* 200511.0 ;i 11 14 ORTHE R'N Noreeree Aspeetes Conseemes 4111 Reno Sr* Put Tetvesambk WA 11198- Pit Limb CI y Pwlc Pad Asvapit WA iit ,I Cant Samp Number. I tab Semple Number 011011343.0001 1 fl COW Su Oesolgiott Reelleg Neodd I CNN Sam* lAcetiOn: NOM= 1 i i Sample Cond. Chodoed If Sample Not Analyzed El I Ten, boom end Neck peeks as We& Abram meimet i SallelNe MIMS COMpONIMIC NonAribmins Filmes Cemponeett Non-Fimes Completents: No Asbestos Dinalind ins Fiber.= 40% Amapa 50% Aspire. Filer and Sem A 4 ,i, i, 'Z 'i_ v i 4 1; 0.' 4 0 '4,,V..:4 M,'. 4. ,1.1, 4: 4.11-. s.. Client SMlp I Number 2 Cen Semple Description: iteallog Paper tab Semple Number 01140243.0062 t i CNN Stattpli Locution: ROOM. Sande CernMertet Chodad 11Sainpie Not Mmtyzed 0 I Okra alma sopa Asbestos Nkomo Ceopeneser NookanalosFileoesCempoonee Non4ibous Componoto Il No ANbeatea Oalectod 40% Celkame GO% Aspen Mar ad Nam I I i V• i 1" ,c. 40 av ,s v,. 4, 4 4. 'i, A 7 'Ir k S 11 I .1 i i 1 1 1! i Vompled irr. Bob Willosidge 4111VISA Receked by Female Me aftrall Reviewed ay: Jude Onmovingi MON Bulk Asbestos Analysis' Report Maim Nun= 1s40243 ant Job Number. Tun Anined The: I Dity C 61111110119 Anstwatt 2 Adz Comellogo, 141/0111111111, Iliteapr TO 13604524972 P 5 NIP 1 tMAY -6 -2008 06 30P! FROM Summary f Inspection 4, si fi This survey includes all areas of inspection with report results from Northern Industrial ygiene, Inc. Sample #1:1 Composition roofing material. No asbestos detected. Sample #24 All asbestos containing building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed the owner or a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency During demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. Should such suspect material be discovered; an AHERA certified inspector will have to sample and test the material to prove it is of non asbestos. Northwest ;Asbestos Consultants is not responsible for identification of hidden materials t are not identifiable with reasonable diligence. Copies for City of Port Angeles Permit Center and Olympic Region Clean Air Agency Thank you; Bob Withez1idge, E.F.M. Roofing paper No asbestos detected. TO 13604524972 P 6 t FAY -6 -2008 06 30P FROM WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS The course was taken on October 19, 2007 in Silverdale, Washington Certificate #10190704 Expiration October 19, 2008 WASHINGTON ASSOCIATION at MAINTENANCE and OPERATIONS ADMINISTRATORS THIS IS TO CERTIFY THAT Bob Witheridge Participated in the EPA AI IERA INSPECTOR, MANAGEMENT PLAN N ER Refresher Course offered by the The full day training program covered all topics specified in the Model Accreditation Plan under Section 206 of Title H of TSCA Colin MacRae Course Administrator 2714 228th St. SE, Bothell, WA 98021 (425) 485 -6980 TO 13604524972 P 7