2013, 09-12 Permit App: BLD-2013-1840 Demo, Remove MHCommunity Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@ sookanevaIIev.orq
(Staff Use Only) �Q%
PERMIT NUMBER:' a'D(j 1 " j V
PERMIT FEE: YYYYYY
DEMOLITION PERMIT APPLI L Tim
PROJECT ADDRESS: 2414 N. Bowdish
ASSESSORS PARCEL NO.: 45091.2206
BUILDING OWNER NAME: Gregory Feldhusen
MAILING ADDRESS: 3424 W. Dalke Ave.
CITY:
Spokane
STATE:
ZIP: 92 r i
CONTACT PERSON NAME: Creg Feldhusen
PHONE: 509 389-7818
Fax:
CELL:
CONTRACTOR NAME:
Larson's Demolition, Inc.
MAILING ADDRESS:
PO 13ox 4535
Cny: Spokane STATE: Wk ZIP: 99220
PHONE: 509 535-7944 FAX: 509 535-8087 CELL: 509 994-3995
CONTRACTOR LICENSE No.: LARSODI164RU ExPIREs: 12/31/13 CITY BUSINESS LICENSE NO.: 600556997
PROJECT DESCRIPTION (Please Provide Site Sketch)
611 Site Plan Provided El Notice of Intent # 13-0055
Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
Demolition and Removal Fire Damaged Double Wide
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 subm(tted and subsegyjntly approved before this application can be processed.
Signature
Date:
Method of payment: ❑ Cash
Bankcard #:
® Check ❑Visa 0 Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\Forms\Building forms\Demolition Permit App.l.doc
Sep. 11. 2013 12:38PM SPOKANE CLEAN AIR
/3..00,5
No. 3512 P. 1
Lscgcadcdn
SRCAA, 3104 I3. Augusta Ave., Spokane, WA 99207 / w..vw.spokaneoleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828
4/13
n9.
,'f'y ;3f.?%110A1•`�.ty,,
Spokane NOTICE OF INTENT
Air L, 1 (1R OW S 1(,s PK(111.( 1.`,: IPI N1011110\ ° '' ; ri.i'V v►
Notice of Intent No.
Agency Use Only
Review. Spokane Regiensl Clean Air Agency (SRCAA) Regulation I, Article IX and Section 10,09 for npplioabl° requirements. '
A, Project Type;
0 Asbestos Removal J VI Asbestos Removal & Demolition
0 Demolition, No Asbestos Removal
Docs this project involve a foe -damaged structure?:
isii Yes ■ No
(If yes, refer to Sections 9.03.F.3 and 9.08)
Does this project involve demolition by fire training?:
0 Yes gNo
(Sea Sections 9.021, 9.03.F.4 &9.04.A.61)
How many bontiguous structures does this project involve?:
1 iii_
Maximu n of 5 structures per Notice of Intent (NOD)
B, Pro . e Owner :
• .t.�
phone:
co ' =' ` •79 I Fax:
'......
Mailing Address:
4211 . 0. e ' P_ .
City:
osI)e State:
n,
zip:
'' --147-
C. Site Address Contact Person: - „ „r- at ► .: Job Site Phone: 1
C.
i,' `- !: e
101111=11 ,T �, '... ► j 101,11 fa ; r17;' If>1 structure, provide details to identi
IIIEEIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMI #3:
1111101 #5:
D. ❑tKaiortal
�Aabestoa
Rate surveIA,
Y1�� [� It �.3
A>;iERABIdg. Inspector ; � IctorName: � u ��.
• Ii
Presumed
Survey:
Was asbestos found?
i : Yes ■ No
Company:
Cert. No.:
E. Asbestos
Removal
Start
Date:
Completion
Date:
•
For each structure listed in section C, itemize the type and
quantity of asbestos -containing materials to be removed,
Do materials include disturbed or non-intac asbestos?
0 YC5 [] No
W. 171 tic A It AA. CIIY/tS SI e/itlf : aur iy t. r k# 64 -
1 ...s,
N, h' i L-61.41 , -' 414. t1J C 4-ri(J `#.-' i) CI' Z )
Total Linear Peet:1 'Total Square Feet:' (Abatement By (if known): 1
Will all asbestos -containing material be removed from the structure(s) by the asbestos removal completion date?
-1?.
0 Yes 0 No
Demolition Information
St ate: earliest)
1/2°/ / ?
_
Demolition By .
(if imown),
`a r 1 I/ 1
F- T
G. Asbestos Project &:Demolition Notification Waiting Period and Non-Refutidabte Fee Categories (additional categories - pg. 2)
Your advance notification period will begin when a somgm_04 NOD, including required nonrefundable fees, is received by SRCAA.
Check / complete all boxes which a..l below. ..
(h\ncr-ntculricd,'ingic-fnriiy residence (see the Reru,vatiun. Deinu...F .\sbea(os into. Sheet} 1\1iting Period lee
1.0 >_ 10 In ft and/or > 48 sq ft asbestos project not performed by residing owner
. Prior Notice .
SO
3 bays ..
$30
2.
Nut
■
Other-uccut,ied,
All Demolition (all asbestos must be pro . erly removed and disposed of ' iior to demolition)
moire-l.iislil\' iesitiellec
...
11,titin: Period
•
Fee
3.
❑ 10-259 In ft and/or 48-159 s' ft asbestos also for <10 In ft or <48 sq ft . er Sect 9.04.A.6.a)
. 13 Days
$250
4.
■
260-999 In ft and/or 1604,999 s59 ft asbestos
10 Days '
' .$500
5.
■
1,000 In ft and/or z 5,000 sq ft asbestos (see below if 2,000 In ft or z 10,000 sq ft)
I0 Days ,
$1,250
If i' 2,000 In fl.or>_ 10,000 sq ft, the additional incremental fee added to the S1,250 base fee is calculated as the greater
of
Number of 1,000 In ft increments beginning at 2,000 In ft:
x $250 =
S
4- $1,250 base fine =
$
Number of 10,000 sq ft increments beginning at 10,000 sq ft: x 5250 =
$
+ $1,250 base fee =
S
6. All Demolition (this fee waived if project performed with project category 3, 4, or 5, above) I 10 Days
$25�
H. Acknowledgement The Control Officer, or duly authorized representative, shell be allowed to access property at reasonable times to inspect projects
specific to the control, recovery, or release of contaminants into the atmosphere, in accordance with SRCAA Regulation 1, Article 11 and RCW
7094.200. Rot the purposes of renovation, demolition, and asbestos projects, reasonable times include, but are not limited to, any of the following:
when renovation, demolition, or asbestos removal appear to be occurring or are soheduled to occur, and times when the Control Officer or duly
authorized representative aro investigating air quality complaints filed with the agency and/or have reason to believe that air quality violations have
occurred or may lie occurring. No person shall obstruct, hamper or interfere with any such inspection. I certify that the information contained in this
notification and any supplemental information provided is, to the best ofmy knowledge, accurate and complete.
Business Name & Address: "—� Pax:
Signature: ] Print Name: j - . -' . , , ' A Phone.3 7 78/6
Agency.Use Only:
0 NOT Deficient (see page 2) (Date & Initial)
)4 NOI Complete , (Date/Initial)
Page 1 of 2
SRCAA, 3104 I3. Augusta Ave., Spokane, WA 99207 / w..vw.spokaneoleanair.org / Ph:(509)477-4727 Fax: (509) 477-6828
4/13
n9.
Sep. 11. 2013 12:39PM SPOKANE CLEAN AIR
No. 3511 r
1.
(Continued From Pg. 1) Asbestos Project and Demolition Notification Waiting Period and Non -lendable Fee Categories
Your advance notification period will begin when acru plated N01, including required nonrefundable fees, is received try SRCAA.
Below are Additional categories which may apply to the project categories
C3reck all boxes wiych apply, below. If applicable, pto'v 'de all respective
Lino gull il \utilirrti1;t
7. Emergency
in 1.6, on page L
information required. .
1{clet:.it- 1b;iitmr Pc. lutt trrt-•i.el5nnl;tbi..Icc
Section 9.44.A. 6.1t Prior Notice afcc rile Regular Fee
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-e.ontnining materials were encountered that were
■ The . •'cot must , . — . to avoid irn, , sin; an unreasonable
1Hivil Ittit`lit
.11.1111AI NOlilic;t ikttll
aiternnte.A0Leyl,is I'roject 11nr1, t't•aclicc.
8. Q Alternate Asbestos Project Work Practices
L\CC.t)tirul fr.'. fI: LAI ll0tls (clidiiinn'
9.0 Exception for Hazardous Conditions
or safety hazard.
ensure continuous vital utilities, or minimize property damage.
not identified during the asbestos survey.
financial burden.
f( 1P1 to \t)1 .AinclujnIel( 1Otni 1`,C(tiun'I.04,111
MIIIIMMEMIIIMININENIMINMENN
I{i fvf t0 4171iva1 Ni)I liar -rel (JCctIon 0.114..A.b,t1
IIIIMENIMMINIMIIIIIINIMMINIMININIIIME
ltefercuce A\:mint_ l'ctitrtl Nun-I{ca nk.151& Fe
Section 9.Q8.A 10 days , . Twice the,Regular Fee
I elefclic,. A\;iitillt; Periutl Noii-I i tud;il)k I'Cc
Beeson 9.48.0 10 days Regular Fee
Name of person thatprepared the Alternate Work Plan:
Co any he/she - •
His/her certified AH13RtA Project Designer No.:
His/her Certified Industrial Hygienist (CIH) number or
Professional Engineer (PE) lioense number:
I) n ulitluu with V`tintri,lbl;? .asbestos Rmttin,
10.0 Demolition with Nonfriable Asbestos Roofing
Refcreitc' 1V';titiUll I'ci'inti \oit Itcfun,l,lble I ed
Section 9.08.E 10 days Twice the Regular Pee
Name of person that determined that nonfriable asbes#os
roofing material could be loft in place per Sect. 9.011B:
Com.an he/she represents:
His/her certified ABERA Project Designer No.:
.Y.
Optional: List additional parties you would like copies of this NOI t ' " ling address); t
Agency Use Only.
Reason(s)N01 Deficient:
Receipt: 14281!9 COPY 09/11/2013
SS o1 ane
E Regiional Clean Air Agency
ve
Spokane, WA 99207 5384
00 feldhusen
3424 w Daike
Spokane. WA 99205
Treasurer's Receipts
Meso Ill 2013-0051
2013-0051
Non Taxed Mt:
Total;
Chk: 6081
Ttl Tendered:
Change:
Issued By: Barb
09/11/2013 11:44:02
250.00
250.00
250,00
250.00
250.00
0.00
SRCAA, 3104 B. Augusta Ave., Spokane, WA 99207 / www,sookaraicanair.org/Ph:(509)477-4727 Fax (509) 477-6828
Page 2 of 2
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