2008, 09-17 Permit App: 08003669 Demolitionx
Permit Center
Scarr oe 11703 E Sprague Ave, Suite B-3
pokane Spokane Valley, WA 99206
.Valley. (509)688-0036 FAX: (509)688-003Zrp 17 7,50g
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Community Development
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Demolition
Permit Application
PERMIT NUMBER: r.
PERMIT FEE: gC f
Commercial
11 Residential
SITE ADDRESS:
S u N . t-oa&=s
ASSESSORS PARCEL NO: G. S I-1 7 02_54
Building Owner:
Name: '2dU% shy t, t
Address: 84w C. We c,,a-I�...c Pik 'Qizl vie
Name:_� Co6�/••0✓
Phone: s-sy- aC Fax: s--2•-s--2•-t,...{9t.10_,
_
Cont ctae lob 1ci 10 Exp Date: `Zl z.7.40,
l
Address:: 7/ iv /414,0,_.4._JL6,
City: _pa.vA1y` State: u4A
Zip
v76
Phone: J Fax:
9 gp3 9/63
741P .t.33
Contact Person
Name: 1�,✓ �vf�,....�
Phone: sag 24' 23ys
Contractor:
Name: '2dU% shy t, t
Address: 84w C. We c,,a-I�...c Pik 'Qizl vie
City: Sip, VCA."2 State: (.....45„, Zip:C21-
I
Phone: s-sy- aC Fax: s--2•-s--2•-t,...{9t.10_,
_
Cont ctae lob 1ci 10 Exp Date: `Zl z.7.40,
l
City Business Lic. No: (0.2D2...4.3
34.3 5 }4
Describe the scope of work in detail
C� c X01 sl..; r.c.‘ A w.,DL ‘\
,# . site plan is provided.
okane County Utilities has approved the disconnection.
Notice of Intent # e91 $"- e7 ?
ap
The permittee verifies, acknowledges and agrees by their signature that: 1) Ownership of this City of Spokane Valley
Permit inure to the property owner. 2) The signatory is the property owner or has permission to represent the property
owner in this transaction. 3) All construction is to be done in'full compliance with the City of Spokane Valley
Development Code. 4) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or ordinances.
Ownership of res,velopment rights granted by any issued permit inure to the property owner.
Signature
Method of Payment:
❑ Cash
Bankcard #:
❑ Check
Authorized Signature:
REVISED 2/16/07
Date
❑ MasterCard ❑ VISA
Expires: VIN#:
S' L.; < (fu
RECEIVED 09/17/2008 11:52 5fl3btitit7bd
Sep. 17. 200$ 11:51AM SPOKANE CLEAN AIR
V rGrCl`91 I L4LI 11 .rcr R
No. 5939 P. 2
Your advance notification period will begin when a completed NOI, including required fees, is received by SRCAA.
A coov of the asbestos survey_ completed notification & all amendments must he available for insoeetion at all times at the iob site. NOI 710
SRCAA NOI No.
6,7-c 3. - 7
Agency Use Only
SPOKANE REGIONAL CLBAN AIR AGENCY (SRCAA)
1101 West College, Suite 403, Spokane, WA 99201
NOTICE OF INTENT (NOI)
For Asbestos Projects and Demolition Projects
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11
�aie teRveu YsLA.fl
SEP 1 7 2008
SCPOit 47!! (fi iL
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A. Project Type:
1. ❑ Asbestos Removal
2. 0 Asbestos Removal & Demolition
3.
, tWErfilmarm—
H. Property
Owner: 2,,i /} j 4 e:2, 0.,„..b l~ eui
Phone: 5--.07 ?93q/4,
(If available)
Fax:
Property Owner's.l•
Mailing Address: 6-1/. ,(i Aka,�,S
City: -W 14946e
Statzj 4
Zip:'rr°/d.
C. Site
Address: 5—// n% • Al—ii"- iiiiti
City: *. a*gay
State:4'4.
Zip/v
Responsible Site
Contact Person: )4,,J L �)/
Job Site
Phone: 7
/e" 3
D, ,Asbestos Survey or
0 Material Presumed
If survey erformed, was asbestos found?
0 Yes If "No" for any structure, attach
survey
Date Survey
Conducted: q -71--e
V
No. of Structures:
(see back
i
if>1)
ABER& Building ,. I
Inspector Name: 5//- nn wnet irk. I� I- 11 ��� 3,L
Certification
Number: g/v1 07
e9/5,'""
Exp.
Date:44—' '
E. Asbestos Project
Information: .
No. of Structures:
(see back if>1)
Start
Date:
Completion
hate:
Wk. Days: Su
Hours:
M T W Th F Sa
—Total quantity
to be removed:
I , - • Ln.
Feet
S
Feet
ill alt b toTSmat ri ' li "lye `^ Lt'f1
removed by project completion? Q No
-Will work schedule
fax pp.:. be used?
O e'Y' s — "
0 No
List individual type and quantity of materials to
be removed or provide an attachment of same;
Abate hent
Contractor:
Phone:
Fax:
Mailing
Address:
City:
State:
Zip:
F. Demolition
Information:
No. of Structures: Start
(set back if> 1) Date: 02/015
0 Training Fire (List Fire Dept. as demo. contactor below)
❑ Ordered Demolition (attach copy of Order)
Demolition n
Contractor: u2e b tC I /- , . j 1 f , ,,,,,
Phone: 5 .?'/ 017%17
Fax: .5-3g 479a/
Mailing
Address: g. V.f p I. �,4 I t Mck 9/2 e
City: .5/n A/t -e--
State: W /},
Zip: 1.70 7
G. Asbestos/Demolition Protect Categories;
Notification
Non -Refundable
Does this .ro'ect involve a fire -damaged structure? U Yes U No
Waiting Period
Project Fee
1. Owner -Occupied, Single -Family Residence Asbestos & Demolition Project *
Cif Owner Single Residence Demolition Project *
dor Notice
30
-Occupied, -Family
2. 0 All Other Demolitions With No Asbestos Removal Project
r
10 Days
$250
3. U 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
3 Days
$250
4. 1.1 260 - 999 linear feet or 169 - 4,999 square feet
10 Days
$500
_
5. Ll > 1,000 linear feet or > 5,000 square feet
10 Days
$1,250
6. U Emergency Asbestos/Demolition Project (attach "owner's letter")
Prior Notice
Twice Project Fee
77. -Li Alternate Means of Compliance for Friable Materials (attach plan)
10 Days
Twice Project Fee
8. LJ Alternate Means of Compliance for Nonfriable Materials (attach plan)
10 Days
Twice Project Fee
9. U Exception for Hazardous Conditions (attach plan)
Concurrent with Project
Regular Project Fee
10. U Demolition with Nonfriablc Roofing_Leit in Place
10 Days
Twice Project Fee
* The two categories in 0.1 apply only to owner -occupied, single-family residences, which means any non -multiple unit bui ding containing living
space that is currently occupied (prior to and after renovation/demolition) by one family who owns the property as their domicile. One of the
categories must be used for all other asbestos/demolition projects. For more infotmation, contact SRCAA at (509) 477-4727.
—�-
IL Optional; List additional parties you would like copies of this NOI and/or relatednotices sent to (list name & fax number and/or mailing address)!
I. I fy that the information contained in this notification and any supplemental data provided is, to the best of
my ... ow ; , e c tuate and complete.
• ompleteness Review
r: ' I I complete
D NODI deficient -
• See Attached
Signature Representing Date
For demolition projects, this NOI expires 12 months from the earliest listed asbestos/demolition project start date.
oir
�
L.-- r i(7f4
Agency Use Only -`�
Your advance notification period will begin when a completed NOI, including required fees, is received by SRCAA.
A coov of the asbestos survey_ completed notification & all amendments must he available for insoeetion at all times at the iob site. NOI 710
RECEIVED 09/17/2008 11:52 bil968800d I 5V rtr<i ii i �try i trcrr�
Sep. 17. 2008 11:51AM SPOKANE CLEAN AIR No.5939 P. 3
Mountain Consulting Services, LLC
9922 E Montgomery Dr, Suite 9
Spokane Valley, WA 99206
509-924-9236
509-924-2287
September 12, 2008
Mr. Don Coburn
511 North Hodges Road
Greenacres, Washington 99016
Project Number: S08-105.1
Dear Mr. Colburn:
Mountain Consulting Services, LLC (Mountain Consulting) is pleased to provide this summary
for the pre -demolition asbestos survey of the suspect asbestos containing building materials
associated with your double -wide manufactured home located at 511 North Hodges Road in
Greenacres, Washington 99016.
Mr. Samuel W. Bailey Jr., EPA -accredited AHERA building inspector, certification BIR -07-015,
expiration 12-19-08 conducted a field survey of the structure on September 11, 2008.
All sampled suspect building materials included in this structure were all proven to be free of
asbestos minerals by microscopic examination. The tested suspect building materials are listed
as follows:
• Gypsum Wallboard. Paneling (south half of structure)
• Joint & Taping Compound Mud (associated with sheetrock)
♦ Gray Vinyl Sheet Flooring (VSF) (kitchen and dining room)
• Gray 12"x 12" Vinyl Floor Tile (VET) (utility room)
• White VSF (bathroom)
• Tan & White VSF (southwest entry threshold)
♦ Rough Ceiling Texture (south bedroom)
• Tan 9"x 9" V1 T (original flooring north half of structure)
Tan Vapor Barrier Paper (under exterior metal siding)
• White Tar Sealant (associated with exterior roof system)
No other suspect building materials associated with the structure were tested for asbestos
content.
This letter is a summary of services provided and results of the analysis that will be described in
the complete survey report. Please read the full report for further relevant details of the
investigation.
RECEIVED 09/17/2008 11:52 5096880037
Sep, 17. 2008 11:51AM SPOKANE CLEAN AIR
511 N. Hodges Road
9-12-08
SV PERMIT CENTERFR
No. 5939 P. 4
If you have any questions about this summary, please call me at (509) 924-9236. It was a
pleasure working with you, and we look forward to working with you again.
Sin
Mo' = onsulting Services, LLC
Sam " W. alley Jr.
Operations Manager
s.bailev@nacs-environmental.com
Page 2
RECEIVED 09/17/2008 11:52 5096880037
Sep. 17.. 2008 11:51AM SPOKANE CLEAN AIR
Spokane Regional Clean Air Agency
1101 W. College Ave., Suite 403
Spokane, WA 99201-2094
Phone: (509) 477-4727
Fax: (509) 477-6828
www.spokanecleanair.org
5V HEKM1 1 (JEN I EKI-K
No. 5939 P. 1
From:Debbie Riley
Fax
1J Urgent
For Review in Per Your Request
Comments:
[ Please Reply
24 -Hour Air Quality Report: 477-2571 Burning Information Line: 477-4710
POKE COUNTY
SPOKANE COUNTY
DEPARTMENT OF BUILDING & PLANNING
1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
Site Information
Project Information
Site Address: 511 N HODGES RD
Parcel Number: 55173.2546
Subdivision: LABERRY MOBILE PARK ADD
Block: 6 Lot: 46
Zoning: UNK Unknown
Owner: COBURN,DON
Address: PO BOX 142130
SPOKANE VALLEY, WA 99214
Building Inspector: Dan Howard
Water Dist: CONSOLIDATED ID #19
Project Number: 08005283 Inv: 1 Issue Date: 9/17/2008
Permit Use: SEWER ABANDONMENT - TEMPORARY/RECONNECT
Applicant: COBURN,DON
PO BOX142130
SPOKANE VALLEYWA 99214
Contact: ROBS DEMOLITION
3810 E BOONE #203
SPOKANE, WA 99202
Setbacks - Front:
Group Name:
Project Name:
Phone: (509) 710-2335
Phone: (509) 534-2970
Left: Right: Rear:
Permits
Sewer Connection Permit
Contractor: ROB'S DEMOLITION
SEWER CONNECTION
License #: ROBSDDI97ORR
1 $85.00 PROCESSING FEE
Total Permit Fee:
1 $15.00
$100.00
**FOR SEWER INSPECTIONS CALL THE UTILITIES DEPT AT (509) 477-3604 FROM 8:30-5:00 MONDAY -FRIDAY PRIOR TO
COVER. ONE WORKING DAY NOTICE REQUIRED. PERMIT ALLOWS FOR A 30 -MINUTE INSPECTION. ADDITIONAL
INSPECTION FEES APPLY AFTER 30 MINUTES.
**INSTALLER IS RESPONSIBLE TO INSURE ALL WASTEWATER DRAINS ARE CONNECTED TO THE SEWER AND MAY
BE REQUIRED TO PERFORM TESTS FOR VERIFICATION. INSTALLER IS TO FIELD LOCATE AND CONFIRM THE
ELEVATION AND POSITION OF SEWER STUB PRIOR TO ANY OTHER EXCAVATION.
**SEWER STUBS ARE TO BE CHECKED PRIOR TO CONNECTION TO ENSURE THAT THEY HAVE ACCEPTABLE GRADE
AND ARE CLEAR AND UNOBSTRUCTED TO THE MAIN. SEWER LINES SHOULD BE CONSTRUCTED TO ALLOW FOR
GRAVITY FLOW FROM THE LOWEST LEVEL OF THE STRUCTURE.
**THE INSTALLER AND THIS PERMIT MUST BE PRESENT AT THE JOB SITE AT THE SCHEDULED INSPECTION TIME.
BOTH STATE LAW RCW 19.122 AND COUNTY CODE REQUIRES THE INSTALLER TO GIVE NOTICE OF EXCAVATION TO
OWNERS OF UNDERGROUND FACILITIES.
**CALL 1-800-424-5555 BEFORE YOU DIG --AT LEAST 2 WORKING DAYS IN ADVANCE. SPOKANE COUNTY CODE
REQUIRES THE INSTALLER COMPLY WITH ALL REQUIREMENTS OF THE WA STATE DEPT OF LABOR & INDUSTRIES,
INCLUDING THOSE RELATED TO TRENCH SAFETY.
Payment Summary
Total Fees AmountPaid AmountOwing
$100.00 $100.00 $0.00
Tran Date Receipt # Payment Amt
9/17/2008 4542 $100.00
Processed By: SHATTO, JULIE
Printed By: HINTZ, FAITH Page 1 of 1
PERMIT