2012, 08-07 Permit App: BLD-2012-1442 Demo GarageSiiokane
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
4 oermitcenterPsooka nevalley.orq
(Staff Use Only) I�
PERMIT NUMBER: rJ tc(- I- 12_ -' ` a_
PERMIT FEE: 2-2 .
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: $ (/ C:U /era
ASSESSORS PARCEL NO.: -75 L s' Z iv. /0/0
BUILDING OWNER NAME:
�'o Y C, slec 4t/'�Y
MAILING ADDRESS: S / / C - lr% S
CITY: 5o1/ 1
STATE:
zip: i Z ( Z
CONT CT(PJERSON NAME: (0ulNEn)
PHONE: C' nxp' $ 7S FAX:
CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
0 PD. NEI
CITY: STATE:
ZIP:
PHONE: FAX:
CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROSECT DESCRIPTION (Please Provide Site Sketch)
L i to Plan Provided ❑ Notice of Intent #
1K1/
Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
64/1-7--" c -,e,4 G 6= E Kr -F -/WS / c 7-0 " ,' M01t
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 o• this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Reference. odes are vailable for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or ap, oval for any iolation of federal, state or local laws, codes or ordinances. 6) Plan or additional
information may be required to be subm' ed a . . equently approved before this application can be processed.
Signature
Date:
/Z—
Updated 1-11-11 Page 1 of 1
http://www.spoka neva Iley.org/fi lestorage/ 124/938/210/948/ 1496/Demolition_ Permit_1-11-11.doc
I z - 636
! Notice of Intent No. 'I Sp0..,kant
Agency Use Only ,CteWAir
NOTICE OF INTENT
FOR ASBESTOS PROJECTS / DEMOLITION
Il•
ff‘CE WEB
AUG 2 4 2012
SPOKANE REGIONAL
rLEANfRE Y
• :
Review Spokane Regional Clean Air Agency (SRCAA) Regulation I, Article IX and Section 10.09 for applicable requirements.
A. Project Type:
0 Asbestos Removal
0 Asbestos Removal &pemolition
ca Demolition, No Asbestos Removal
Does this project involve a fire -damaged structure?:
0 YesleNo
(If yes, refer t� Sections 9.03.F.3 and 9.08)
Does this project involve demolition by fire training?:
How many contiguous structures does this project involve?:
0 Yes all°
.1-
(See Sections 9.02.L, 9.03.F.4 & 9.04.A.6.f)
Maximum of 5 structures per Notice of Intent (NOI)
B. Property Owner:
/ 'f C I M altt-4-Riv EY
Phone:
(559) g ' ,L g 54/ .s- ft.
Fax:
k. Mailing Address:
S / i 1 G' C u g -reit k p,
City:
f7P/OdEP',44-.1
r -State:
4)4_
Zip:
9 9 2.1 2___
C. Site Address
Contact Person:
go v c ,il-e4R-2.
Job' Site Phone:
4.
Structure #1:
-THE. _exTF-.. At 9 , ON Ft' 7-4(5 a -fa A -c -c- pi 60-4 4E$7
If>1 structure, provide
details to identify
#2:
#3:
....... #4:
#5:
D. D Material
ariitsbestos
Date survey performed:
/ Z-
AHERA Bldg. Inspector Name:
ffn a h V 4.
C SCa Ig 6-x-nr
Presumed
Survey:
Was asbestos found?
P Yes No
omPanY:
5' Tv cxt,'t g
ert. No.:
E. Asbestos
Removal
S
Date:
art
Completion
Date:
For each structure listed in section C, itemize the type and
quantity of asbestos -containing materials to be removed.
Total Linear Feet:
Total Square Feet: Abatement By (ifknown):
Will all asbestos -containing
material be removed from the st i, e(s) by the asbestos removal completion date?
Yes
1
No
F. Demolition
Information
Start Date:
(earliest)
2-
Demolition By
(if known):
- "
G. Asbestos Project
Your advance
& Demolition Notification Waiting Period and Non -Refundable Fee Categories (additional categories - pg. 2)
notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA.
Check / cornslete
Owner -occupied,
all boxes which al .1 , below.
single-family residence (see the Renovation, Demo., & Asbestos info. sheet)
Waiting Period Fee
1. 10 In ft
and/or .>z. 48 sq fi asbestos project not performed by residing owner
Prior Notice
0
2 !Ff All Demolition
Not owner -occupied,
3. El 10-259 In
(all asbestos must be properly removed and disposed ofprior o demolition)
single-family residence r
ft and/or 48-159 sq ft asbestos (also for <10 in ft or <48 sq ft per Sect 9.04.A.6.a)
3 Days
Waiting Period
Days
30'
Fee
$250
4. ID 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 ft, the additional incremental fee added to the $1,250 base fee is calculated as the greaterof:
Number of
1,000 In ft increments beginning at 2,000 In ft:
x $250 =
$1,250 base fee =$
Number of
10,000 In ft increments beginning at 10,000 In ft:
x $250 =
+ ,250 base fee =
6. 0 All Demolition
(this fee waived if project performed with project category 3, 4, or 5, above)
10 Days
$250
H. Acknowledgement.
specific to the control,
70.94.200. For the
when renovation,
authorized representative
occurred or may
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
be occurring. No person shall obstruct, hamper or interfere with any such inspection. I certify that the information contained in this
supplemental •ikilfiatio provided is, to the best of my knowledge, accurate and complete.
Business Name
& Add - •,Fax:
Signature:
- - 61/ (S452.)c, izs4
/--- P int Name: RO (r) C Ale/1/04- Phone: 0
-‹
NO ficient (see page 2)V:
NOT Complete 1
nu Use Only:
Datc & Initial
Da e & Initial
Page 1 of 2
SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanainorg / Ph:(509)477-4727 Fax: (509) 477-6828
3/11
.
(Continued From Pg. 1) Asbestos Project and Demolition Notification Waiting Period and Non -Refundable Fee Categories
Your advance notification period will begin when a completed NOI, including required nonrefundable fees, is received by SRCAA.
Below are additional categories which may apply to the project categories in 1-6, on page 1.
Check all boxes which apply, below. If applicable, provide all respective information required.
Emergency Notification Reference Wallin. Period Non -Refundable Fee
7. 0 Emergency
Section 9.04.A.6.h Prior Notice Twice the Regular Fee
Select the reason that best describes your situation:
0 Sudden, unexpected event that resulted in a public health
.
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.B)
siMmillINIIMmi
ii
Refer to Annual NOI form (SeCtion 9.04.A.6.j)
Reference Waitin 'l Period Non -Refundable Fee
Section 9.08.A 10 days Twice the Regular Fee
Reference Waitin Period Non -Refundable Fee
Section 9.08.0 10 days Regular Fee
• The project must proceed immediately to protect equipment,
• Asbestos -containing materials were encountered that were
0 The .roect must .roceed to avoid ina I °sin: an unreasonable
Amendment
Annual Notification
Alternate Asbestos Project Work Practices
8. D Alternate Asbestos Project Work Practices
Exception for Hazardous Conditions
9. 0 Exception for Hazardous Conditions
Name o 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 Nonfriablc Asbestos Roofing
Reference Waitin. Period Non -Refundable Fee
10. 0 Demolition with Nonfriab e Asbestos Roofing
Section 9.08,B 10 days Twice the Regular Fee
Name of person that determined that nonfriable asbestos
roofing material could be left in placeper Sect. 9.08.B:
Company he/she represents:
His/her certified YOKERA Project Designer No.:
----]J. Optional: List additional parties you would like copies of this NOI a7dlorrelated notices sent m (Iist name 8.c fax number and/or mailing address):
Agency Use Only.
Reason(s) NOI Deficient: Receipt: 5933 08/24/2012
Acct #: 1982 COPY
Spokane Regional Clean Air Agency
3104 E Augusta Ave
Spokane. WA 99207 5384
Roy McNearney
116 S. Custer Rd.
Spokane Valley, WA 99212
Treasurer's Receipts
Memo NOI #12-0036 For 116 S. Custer Rd.
NOI #12-0036 For 116 S. C 30.00
Non Taxed Amt:
Total:
Chk: 14-500614927
Cash:
30.00
30.00
25.00
5.00
Ttl Tendered:
Change:
Issued By: Mary
08/24/2012 12:20:56
30.00
0.00
SRCAA, 3104 E. Augusta Ave., Spokane, WA 99207 / www.spokanecleanair.uig / /.4 / ra ,JY) -t / /-UOLO
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