2011, 08-29 Permit App: 11002636 Demo Garage Community Development Department (Staff Use Only)
Permit Center �
CITY UE S 11703 East Sprague Avenue, Suite B 3 PERMIT NUMBER:
Spokane 3�
Spokane Valley, WA 99206 69p.
Valley Tel: (509) 688-0036 PERMIT FEE: Z( -79(
Fax: (509) 688-0037
4000
rermitcenteri sookanevalley.orq
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: 11 1 U VEec.&g.
ASSESSORS PARCEL NO.: 116-03 .030?
BUILDING OWNER NAME: 'Sack Tic!lyra
MAILING ADDRESS: Li 121 ki Veiej_C--P.
CITY: 5 c c k*l jc VA J I&'4 STATE: Up ZIP: 112,06
CONTACT PERSON NAME: 3.'5gGlG T1c1 hofs
PHONE: FAX: CELL: 19'6- 0196
CONTRACTOR NAME: 6633 Pcr oN,N
MAILING ADDRESS: 4564 S. \h MtictiCt
CITY: SPQkIR NILEY STATE: LA ZIP: lcreab
PHONE: FAX: CELL: c\`j Lk-1 OS(
CONTRACTOR LICENSE No.: 1PC-C4 OMEGA EXPIRES: 1- 13 CITY BUSINESS LICENSE NO.: 60/-FES'tag
PROJECT DESCRIPTION (Please Provide Site Sketch)
E Site Plan Provided El Notice of Intent #
[ Spokane County Utilities has approved the disconnection
Describe the scope of work in detail 'I
D(l AO Garay_ it, MQ rc rimy\ Cor ewe i' IF1 fo .1L Vct'+t
DISCLAIMER
The permitted verifies,acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwel ing,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 re uired to be submitted and subsequently approved before this application can be processed.
Signature ,� �� MEW
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Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Demolition_Permit_1-11-11.doc
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AUG 2 9 2011 J.
/1— l>03� NOTICE OF INTENT _ sa__ fnkaiiR I.a '`' . '-'
Notice of Intent No. i Spokane i
Regional 40,f
���`� FOR ASBESTOS PROJECTS/DEMOLITION
Agency Use Only i Clean Airpyency Date Stant,-A ency Use Only
Review Spokai a litegieditclean Air Agency(SRCAA)Regulation I,Article lX and,Section 10 09 for applicable requirements:
A. Project Type: 0 Asbestos Removal ❑Asbestos Removal&Demolition - demolition,No Asbestos Removal
Does thisJ ro'ect involve a fire-dama ed structure?:
p g ❑Yes VNo (If yes,refer to Sections 9.03.F.3 and 9.08) .
Does this project involve demolition by fire training?: 0 Yes liNo (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 Nol:ice of Intent(NOI)
B. Pro"a Owner: /l, e - 77/3 Fax:
P �y �SS�c Tc e� Phone:
Mailing Address: v/Z/ Al. !/t.�/... city:. p#4,,, /lr . :-$fate t,// Zip:.. 99l0?�
C. ':Site Address Contact Person: /few. .A7Kplb/V l Job Site Phor e.:1995/-705-6
Structure`'#li josa►Yc If>1'structure,provide details to identify
#2:_ #3:
#4 '#5:
D. ❑Material Asbestos Date survey performed: "-es--// AHERA Bldg Inspector,Nanie ,' ,g
Presumed Survey: Was asbestos found? I❑Yes Dir No Company: ,za.4,-;441 Cert No.:1 ,e_/O-016
p4
E. Asbestos" Start Completion For each structure listed ii section C,itemize the type and
Removal Date: Date: quantity of asbestos-containing mater:;als to be removed.
Total Linear Feet: Total Square Feet: Abatement By(if known):
Will all asbestos-containing material be removed from the structure(s)by the asbestos remol.vacompletion date?, ❑Yes ❑No
F. Demolition Start Date: G Z Demolition By p /
Information (earliest) ' �1� (if known): 4 eA//�f7 ja,v Gy,/'/;
G. Asbestos Project&Demolition Notification Waiting Period and Non-Refundable Fee Categories(additional categories-pg.2)
Your advance notification period will begin when a completed NOI,including required norirefundablefees is received by SRCAA.
Check(com•lete all boxes which a..1 ,below. .. . .
Owner-occupied,single-family residence(see the Renovation,Demo.,&Asbestos info.sheet) Waiting Period Fee
1.❑ >_10 In ft and/or>_48 sq ft asbestos project not performed by residing owner Prior No":ice $0
2.Qi All Demolition(all asbestos must be properly removed and disposed of prior to demolition) :,.:_;3 Days ., , _,:._.$30
Not owner-occupied,single-family residence Waiting Period Fee
3.ID 10-259 In 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 $250
4.❑ 260-999 ln ft and/or 160-4,999 sq ft asbestos ' ' 10 Days $500 _
5.0 >_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 ln ft or z 10,000 sq ft,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$250=_I$ .$1,250 base fee $ _
Number of 10,000 In ft increments beginning at 10,000 In ft: x$250= $ +$1,250 base fee= $
6.❑ All Demolition(this fee waived if project performed with project category 3,4,or 5,above 10 Days $250
II. Acknowledgement.The Control Officer,or duly authorized representative,shall 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 I,Article II and RCW
70.94.200. For 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 scheduled to occur,and times when the Control Officer or duly
authorized representative are investigating air quality complaints filed with the agency and/or have reason to believe that air quality violations have
occurred or may be occurring.No person shall obstruct,hamper or interfere with any such inspection.I certify that the information contained in this
notification and any supplemental informattiJion provided is,to the best of my knowledge,accurate and�fccomplete.
Business Name&Ad ess: �,✓ / Te92J ,v (Zit./ 9T?y £ f,.d✓v�-°ffW Fax:
Signature: .d_ Print Name: 4-4/ 17;:cx_yam Phone: S-7e re-
Agency Use Only: 0 NOI Deficient(see page 2) VS NOI Complete 18—Zq= PH
Date&Initial Date&Initial Page 1 a2
SRCAA,3104 E.Augusta Ave.,Spokane,WA 99207/www.spokanecleanair.orc/Ph:(509)477-4727 Fax:(509)477-6828 3/11
I. (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 Waiting Period Non-Refundable Fee
Section 9.04A.61 Prior Notice Twice the Regular Fee
Select the reason that best describes your situation:
❑Sudden,unexpected event that resulted in a public health or safety hazard.
❑The project must proceed immediately to protect equipment,ensure continuous vital utilities,or minimize property damage.
0 Asbestos-containing materials were encountered that were not identified during the asbestos survey.
0 The .ro'ect must .roceed to avoid im.osin:an unreasonable financial burden.
Amendment Refer to NOI Amendment form(Section 9.04.B)
Annual Notification Refer to Annual NOI form(Section 9.04.A.6.j)
Alternate Asbestos Project Work Practices Reference 'Waiting Period Non-Refundable Fee
8.0 Alternate Asbestos Project Work Practices Section 9.98.A 10•days Twice the Regular Fee
Exception for Hazardous Conditions Reference Waiting Period Non-Refundable Fee
9.0 Exception for Hazardous Conditions Section 9.08.0 10 days Regular Fee
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 Reference Waiting Period Non-Refundable Fee
Demolition with Nonfriable 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 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:
• :ipt: 4484 08/29/2011
t it: 1811
4ukane Regional CI.•al Air Agency
3104 E Augusta Ave
p,;kar WA 99207 5384
3, .c:rsun Construction
4' -: VanMarter
voKane Valley. WA 99206
Tr :asurer s Receipts
Memo NOl 11-008 For 4121 N. Vercler
NOl (108 for 4121 N. V 60.00
Nor lance Amt: 60.00
Total: 60.00
Mk: 4641 60.00
1t1 Tendered: 60.00
Change: 0.00
Amt Due: 0.00
SRCAA,3104 E.Augusta Ave.,Spokane,WA 99207/www.spokanecleanair.ort Issued By: Mary
08/29/2011 09:26:28
Jenna Davis
From: Knudson, Chris[CKnudson@spokanecounty.org]
Sent: Monday, August 22, 2011 9:41 AM
To: Permit Center
Subject: Address: 4121 N. Vercler l 1 tot
(L 3 (p.
Jenna,
I received a call from Ben Peterson in regards to the above listed address(parcel number:45032.0302), requiring a sign off from the
Division of Utilities sign for a demolition permit.
The above listed work does not impact the sewer system . If an addition is planned with an external connection made to the existing
home connection,a permit and inspection will be required for the alteration.
Thanks
Chris Knudson
Spokane County Division of Utilities
(509)477-7180
1