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Home My WebLink About2013, 06-12 Permit App: BLD-2013-1093 Demolish ResidenceSpokane Valley Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenter@sookanevalley.orq (Staff Use Only) PERMIT NUMBER: PERMIT FEE: it -{ �% (•Co DEMOLITION PERMIT APPLICATION PROJECT ADDRESS: /4,!O3 iN'.r`+ .tc) fit'a Sid'i� tp i�., %Ci, ZC ASSESSORS PARCEL NO.: BUILDING OWNER NAME: I MAILING ADDRESS: l 4110 3) j, CITY: 5(.20 fr t STATE: I/i ZIP: ger CONTACT PERSON NAME: PHONE: %ci v L.c-y p FAX: CELL: CONTRACTOR NAME: p V4 zti 4- Cocsc.rettcrI0 /,VC_ MAILING ADDRESS: CITY: STATE: ZIP: PHONE: FAX: CELL: CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.: PROJECT DESCRIPTION (Please Provide Site Sketch) ❑ Site Plan Provided ❑ Notice of Intent # ❑ Spokane County Utilities has approved the disconnection Describe the scope of work in detail -ck.44. i.) yam e/ . 7-/a/vi fr7e7Z %'Za •7tJ /eL /... DISCLAIMER The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted end subsequently approved before this application can be processed. Signature Date: - / Z /3 6,0-2,013,1043 Updated 1-11-11 Page 1 of 1 http://www.spoka nevalley.org/filestorage/124/938/210/948/1496/Demolition_Permit_1-11-11.doc BL.i1-2013 -1013 13-00e7.4 Notice of Intent No. Agency Use Only - NOTICE OF INTENT ttlItift,Jiii-z Vi Spokane p I� I��j A o.� `L"f AR Lel Cte�an QirA9., FOR ASBESTOS PROJECTS / DENIM] I ION D i Only ,,._ Review Spokane Regional Clean.Air Agency,(SRG3AA)-Regulation T; Aiticle.15C arTd Section 10.09 for applicable requirements. A. Project Type: ❑ Asbestos Removal ❑ Asbestos Removal & Demolition , J Demolition, No Asbestos Removal Does this project involve a fire -damaged structure?: • Yes No (If #es3 refer to Sections 9.03.F.3 and 9.08) Does this project involve demolition by fire training?: • Yes Fffi No (See Sections 9.02.L, 9.03:F.4 & 9.04.A.6.f) How many contiguous structures does this project involve?: / Maximum of 5 structures per Notice of Intent (NOI) B. Property Owner: g f L q/7 Phone: 2t,V Sy ;,;, 'ax: Mailing Address: /4/03 �tf., �y,<74. "}c/c7 Rd City: }/C'ett(i, State: - Zip: ?C'ef.; C. Site Address Contact Person: j? %U.C€ Lc, t0 Job Site Phone: Structure #1: f ek 3,(f. ',71-9 11/ fbe4'tta toqc / oe:. If>1 structure, provide details to identify #2: #3: #4: #5: D. ❑ Material y Asbestos Survey: Date survey performed: (,--7-1? AHERA Bldg. -Inspector Name:J)/l!f ,',/e,,,,Presumed Was asbestos found? I Yes ❑ No Company: h?'� tri4,77 Cert. No.: E. Asbestos Removal Start Date: Completion Date: For each structure Iisted in section C, itemize the type and quantity of asbestos -containing materials to be removed. Do materials include disturbed or non -intact asbestos? ❑ Yes �No rh- ct .e.. J. � /Cs ./ K14—�- .S ��L, / /�/..h e/d:-cc- / -3------ i-) Y) ca S t.vl r , / T 4 A r / // il/c / h r 0 / C. l t -l- /c iri j�' Total Linear Feet: Total Square Feet: Abatement By (if known): Will all asbestos -containing material be removed from the structure(s) by the asbestos removal completion date? ❑ Yes g No F. Demolition Information' Start Date: (earliest) C„,_i ._13 Demolition By (if known) &r, `c 4-4 U.'v/( I G. Asbestos Project Your advance notification & Demolition Notification Waiting Period and Non -Refundable Fee Categories (additional categories - pg. 2) period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA. Check / com s Tete Owner -occupied, all boxes which a. .1 , below. single-family residence (see the Renovation, Demo., & Asbestos info. sheet) Waiting Period Fee 1. ❑ >_ 101n ft and/or >_ 48 sq ft asbestos project not performed by residing owner Prior Notice $0 2. Ii4 All Demolition Not owner -occupied, 3. ❑ 10-2591n (all asbestos must be properly removed and disposed of prior to demolition) single-family residence ft and/or 48-159 sq ft asbestos (also for <101n ft or <48 sq ft per Sect 9.04.A.6.a) 3 Days Waiting Period 3 Days $30 Fee $250 4. ❑ 260-999 In ft and/or 160-4,999 sq ft asbestos 10 Days $500 5. ❑ >_ 1,000 In ft and/or >_ 5,000 sq ft asbestos (see below if >_ 2,000 In ft or >_ 10,000 sq ft) 10 Days $1,250 If >_ 2,000 In ft or >_ 10,000 sq 11, the additional incremental fee added to the $1,250 base fee is calculated as the greater of: Number of 1,000 In ft increments beginning at 2,000 In ft: x $250 = $1,250 base fee = $ Number of 10,000 sq ft increments beginning at 10,000 sq ft: =l$ x $250 $ + $1,250 base fee = $ 6. ❑ All Demolition (this fee waived if project performed with project category 3, 4, or 5, above) 1 -10 Days. $250 H. Acknowledgement. specific to the control, 70.94.200. For the when renovation, authorized representative occurred or may be notification and any The Control Officer, or duly authorized representative, shall be allowed to access property at reasonable times to inspect projects recovery, or release of contaminants into the atmosphere, in accordance with SRCAA Regulation I, Article II and RCW purposes of renovation, demolition, and asbestos projects, reasonable times include, but are not limited to, any of the following: demolition, or asbestos removal appear to be occurring or are scheduled to occur, and times when the Control Officer or duly are investigating air quality complaints filed with the agency and/or have reason to believe that air quality violations have occurring. No person shall obstruct, hamper or interfere with any such inspection. I certify that the information contained in this supplemental information provided is, to the best of my knowledge, accurate and complete. Business Name Address: Fax: Signature: Print Name: A, Phone: ?r,(G¢5'y �'F,r, Agency Use Only: ❑ NOI Deficient (see page 2) (Date & Initial) T, NOI Complete JO k ate/Initial) Page 1 of 2 SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828 4/13 I. (Continued Your advance Below Checkalfboxes Emergency 7. �1 From Pg. 1) Asbestos Project and Demolition Notification Waiting Period and Non -Refundable Fee Categories notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA. are additional categories which may apply to the project categories which a ;ply,. below,; If applicable,:provide, al,l resp Notification Emergency in 1-6, on. page 1. tiye information required. Reference Waiting Period Non -Refundable Fee Section 9.04.A.6.h Prior Notice ' Twice the Regular Fee Amen Select the reason that best describes your situation: ❑ Sudden, unexpected event that resulted in a public health ❑ The project must proceed immediately to protect equipment, Asbestos -containing materials were encountered that were The .ro'ect must emceed to avoid imeosin• an unreasonable Iment or safety hazard. ensure continuous vital utilities, or minimize property damage. not identified during the asbestos survey. financial burden. Refer to NOI Amendment form (Section 9.04.13) Refer to Annual NOI form (Section 9.04.A.6.j) Reference Waiting Period Non -Refundable Fee Section 9.08.A 10 days' : :Twice the Regular Fee Reference Waiting Period Non -Refundable Fee Section 9.08.0 10 days Regular Fee Annual Notification Alternate Asbestos Project Work Practices 8. ❑ Alternate Asbestos Project Work Practices Exception for Hazardous Conditions 9. ❑ Exception for Hazardous Conditions Name of person that prepared the Alternate Work Plan: Company he/she represents: His/her certified AHERA,Project Designer No.: His/her Certified Industrial Hygienist (CIH) number or Professional Engineer (PE) license number: Demolition with Nonfriable Asbestos Roofing 10. ❑ Demolition with Nonfriable Asbestos Roofing Reference Waiting Period Non -Refundable Fee Section 9.08.B 10 days Twice the Regular Fee Name of person that determined that nonfriable asbestos roofing material could be left in place per Sect. 9.08.B: Company -he/she represents: His/her certified AHERA Project Designer No.: J. Optional: List additional parties you would like copies of this NOI and/or related notices sent to (list name & fax number and/or mailing address): Agency Use. Only. Reason(s) NOI Deficient: Receipt: 7193 06/12/2013 Acct #: 2114 Spokane Regional Clean Air Agency 3104 E Augusta Ave Spokane, WA 99207 5384 Bruce Loyd 1403 N. Boeing Rd Spokane, WA 99206 Treasurer's Receipts Memo 13-0026 1403 N. Boeing Rd 13-0026 1403 N. Boeing Rd 60.00 Non Taxed Amt: 60.00 Total: 60.00 Cash: 60.00 Ttl Tendered: Change: Issued By: Deb R 06/12/2013 10:45:39 60.00 0.00 age 2 of 2 SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.org / Ph:(509)477-472 Fax: (509) 477-6828 4/13 N.