HomeMy WebLinkAbout2004, 03-23 Permit App: BLD-04-03863 Demolitionpouliane
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_#Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax; (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
?I0 E . 34n
Assessor's Tax Parcel Number(s):
R 4 LC9144"I ai2 --Z-7-bu
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
❑ Change in Use ❑ Grading ❑ Manyyfactured Home
❑ Tenant Improvement ❑ Fire Safety er
OWNER/APPLICANT INFORMATION
❑ Owner: Ne, 6- Tuwspanpd/d❑
Phone: ,3ag (2(34Fax:
Address:
CK/g1l)E Sta 1 ` 01/J4 -p-
etty
ip Code
❑ Contractor:
ez
Phone: Fax:
Address:
RS' 4/of //c ❑
Applicant: LJ'+I SON SQ .. --(4401-77101()
Phone: sac -77yc� Fax: 5 -at
Address: pc, ,dot Lis 3_S"
City
Architect:
Phone:
Address:
City State Zip Code City
WA State Contractor License #: A VASO Di/tog/%1 ntact:
State Zip Code
Fax:
State Zip Code
di4-ep Lq-RSonl
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES: / VZ
MAIN FLOOR'TO SQ. FTG: icS—CI
2"" FLOOR SQ. FTG: //D
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON—SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone:
Address:
Inspector:
Address:
Fax:
City
Phone:
State
Fax:
Zip
City
State
Zip
1
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
Firm Name: Phone:
Inspector(s):
Fax:
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) 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 resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard El VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
03/11/2004 13:16 509928Biub
03-11-04 12:40PM FROM -SCAM
rmmLum
5,09477E128
T-120 P.01/04 F-308
Agency Case No
SPOKANE COUNTY MR POLLUTION CONTROL AUTHORITY
D37-7.,0, o /
6• ((C/
1101 Weft College, suite .107, Spokane, WA 99401
NOTICE OF INTENT
TO P3AFORM:
I R .4ryF+..717E,E)
MAR n 9 2004
Asarco Tan Only.
. Project 'Typt; ` W Asbestos Removal j 7. a-Asbcstap Removal di Demolition
3. L.] 12emolit1tgt t Afbeftef tt:emev:l
. Property
Owner.
r—
If TrnoS
rkQtti rl
i
Phone: Ai 3ci4—& i 3
ropetty Osman
Wang Address;
4 1
M
Mai
(air I CSCity:SOnRan l4_
State: 1 I
tE C
pf
,
.. Asbestos Aranenac4ertmtnxc run erruwntueuaa.
Coatractor. IPWALON ABATfiM NT StRVICES, INC.
Contractor
Owner/CEO: TIM $- PRAWN
daTnre,mumR' P.O. Box 30968
•
Phone: (509)928 8656
Contnetor
JobNo,:
:hy: Spokane
Stem; WA.
zip: 99223
Fax: (509)928 8785
IT.
tr ,
•
I. Site
Address: Li
Y1
3 1 1 8 E V
c
it tit 1'
�d -' R
�1/A nn,
1 7-io.9930
hojec' Manager or
:easel Pennon:
.
p • 1.a
Phone: 'C, — e
rill Asbestos Survey or
CI Marl Presumed:
14o, of
Strucalres• ey.
Date 5utvey wagWm
Conducted: toy x- 13 '• 04 _
Asbestos Found? IP Yes
LI lfNo Attach Survey
�'
1iu:{V\ Building AN AMPA,
Inspector Num tserrrA,
1Jeran_
WI? AntafNA4'V.t:alWilaaM,nUn
4
gym►+h
r/ln2[.la
Paoiobl ern; Expiration
.laa;z,renp Do • ` I'
certification14o i'E33� IT- 4 ..
v. Demolition ..
Information:
No. of
Someway; • 1
Stan
tart
r
r
T.ralttina?ire (List Fico Dept as demolition cannacmr bolow)
Q Ordered Demolition =eh copy of Order)
n. „• v" Y . saidAnoAG a ra*/ H ,
Demolition ,
CRntractor: t arena - wiguip inn Inc...'
suer prat 0a 4> �
• tlhona: ( cis- 754'J „_
G. Asbested Project
Information:
No. of Structures:
(acobac if?1
Start'
Dareo3-aa-o4
Compl on'
DES:I0�t-a
'O -i
Wk. DAWN, W Tit F Si Su
Hots:Pi. 4..3:3gp�
5 Se F
Will el tubdtos motorist be w Yeas
. d b • ro'c -. action?
• c-.. • uan to be Removed: . Liner R. - . i. -
u
'Chertaal System Insulation: • Hoileaumeee IM. Doul los. ■ Pips Ins.
Dena:
Siafdei?fi MtT 1.; la Fircprooflnt U tons 14 ?Muer U Teamed Cordal? •
Oeta:
Misc. Mat'l: comfit Ha. 1] Oaneat Pipe U blooms Mat'I, U IreoGngMat'I
Odwr:
H. Asbestos/Demolition Project Catsgorlee:
1. CI Owner-Ooeopicd Residential Asbestos Removal & Demolition PrOjat
Q Ow tsr.Qceupied Residential Demolition Project, Nb Asbestos Removal
biglao.Cog
Protect Fee.
lvaitink Period
Tt02i IlB2 1}La
Prior Nona
S25 •
525
2. d All Other Demolitions WItb No Asbestos lttfioval Pro em
10 Days
3. U 10 - 259 liner feet of 46 -159 sauce feet (see back of roan for ondnnsl'
3 Days
5150 -
■ 260 999 linear ttet or 160 -4 999 square *et
10 Daus
-'
4. -
5. 1.000 - 9 999 Tinter feet or 5 000- 49 999 square flet
l0 Des
17
6. LJ > 10,000 linea Leet ora. 50,000 sure feet
10 DWs
$1.500
7. q Fntaeacy Asbestos Project or tmerjtnssy Aemalitieg 2toimat
ry
PrJor Nance
Twice Project Foe
E. U Alternate Meana of Compliance for friable materials or L.1 DernOlitions
10 -Day Review Period
Twice Proiett Fee
9. LI Mumma means ofCompliance far nonfiableaaastoametertats
Coneurrencwith, Prnect
i naiad Project Foe
I. 1 do hereby certify nkat Se II1MW urot s natined :n due nauaeetlsn, and repplemeImI data eme$Ma helots. it m ntc ICP lir mr
.-
Rant* Mani an campltte. 1 shell not maga or altos anys,•tefms project et demolition anthems to beam matt she spplopfluie
waiting period has cinema.
jeavaiail istritta
)'halon AbateR1t3nt BeFvSoes 03-01 ...0
•
strew, 14prrsrn o
Imo
COmjielen os
performed aa•:
11/2004 13:16 5099288785
08-11-04 12:49PM FROM-SCAPCA
PHALON
5094118828
PAGE 03
T-120 P•02/04 F-308
abalone county Air Pollution Connul Authority (SCAPCA) is the local air pollution. authority for Spokane County SCAPCA's
iulation 1. Article IX and AKula X, Seaton 10.00, requires advihee notification be submitted to SCAPCA, on ad Authority approved tbrm.
any asbestos project involving materials equal to er gnaw In size than ID lineae !bet ar C8 square feet and for any demolition project,
udicsa afasbcsaoa "wax f wolvinll Mantra with p projected eabferca greater then 170 square feet. Notices of Intent should ba melted
and delivered w SCAPCA (sddres§ On [autres side) with the appropriate proJectrfee. A SCAPCA representative will review the notification,
if it la comptated corropdy, a Dopy will be returned by mall to the mailing address entered in box C and boa J. The returned copy *ill ba
t
YAM nptlfeation. Asbestos and demelitidnbra;e tl ;nvelving materials and at¢vewresineew the noti$eation tura etas lI.t d �l q^;te
,;ubiect to en other rcouttements of SCAt'CA Regulator' 1. Arnele CC and Article X. Section 10.09.
Demolfrioa - rawer ete,.ar, M, a• as rota, acuwawam lark
Contra �//_+t�) t+Spil nl 'hill TAP
si11n teras: Pl. es. q 5 S
aelang-
sum: LAR I zip; 99;69.
Olvtter/CEO, aee.ff i,ti�J'sd1
n[tsemr
Phone; al) 535 -71.144 Colab Na.:
Fart: smc--7
GUIDELINES FOR SUBMITTING AN A!BEStoW DEMdbrttON NOTIFICATION
1 A. Creek the appropriate project type
s A. Suter eat legal property armor Information. ,
cr
t C. Enter the asbestos contractor end mailing address, or other properly Whined COMpany or person pafibrmlrtg the ■sbcstus projeer,
tact the Wasaingtem Stare Dept, of Labor & Industries pr;OS13A for worker trainiag/ceIt ,Dation toquiremetlu.
x D. Cntet the project site address for the asbestos projector damolition..tnclude a deistgnered project manager ar contact person.
x E. Check asbestos survey Of rArderial presumed. • IF asbestos survey is checked. Ell.aut all tnfomunon requested. Except as provided fol
Article IX, Seaton 9.03, a0 demotitian with pr,witlout an asbestos removal must have an asbenos survey performed by an Milt D A Build Int
sector, Demolition with no asbestos discovered In the stony nut submit a copy of the smutty along With the notifoation. Asbesto:
amid projeea only may Aleck the material. Presumed box if all materials rue to be removed and disposed of as asbestos.containutg materta4
mordants with SCAPCA Regulation L Ankle OC and Ankle*, Section 10.09.
a'A Barw the dnrnotition project tnfbtntauon. if the eneture is to ba used in a training Erc, list the lire department responsibla fo
%duaap% the bum 8s the deentolitiob.coanaotor in box I. If the property owner,has been ordered to performs demolition by govdtrmen
ie1a1, sabmt a copy of chi order from rite appropriate o$helal.,
•
G. Enter ell asbestos project information, requested. All multiple structure asbestos project notifications must be submitted wilt a woe'
in including a map of the area, site address for such, structure, type end amount of asbestos in each structure, end A derailed work schedule.
1x±3. Check one project teteaory in boxes 1116, The project tee includes the demolition fee. Asbestos removal projects and demolitia;
th an asbestos: removal involving less than 10 linear feet or 48 square Ret may be feted as project category 03. An emergency obese
shat or demolition luny be requested by checking the appropriate Job sirs category in boxes 42$15 and than checking the epplionbl
temerity lox in category N7. Emergency asbesros project notlficattoas must be submitted with a lever from do property owner explairin
: nacescity Thr the emergency. Emergency demolition notticatidrtt must be submitted with a later from an authorized goverment o$ttttal t
ieensed gruelling engisver doannantin that the structure Is in imminent danger of collapse, To request an alternative menus of complbanc
r friable or nontriabie materials, check the nppmpnste Job size category in addition to the applicable eat is categories Ms and 49. A war
Se must ba submitted by an appropriately q'ained individual along with the nonftcatiun.
•
ra i. Sign thenotfieation certifying the accuracy end completeness of the information provided on dtc form.
sx J. Enter demolition contractor mailing information fon back). .
;Spdnrory amendments arc required for changes shot, increase,ple project type,.job size .category, the types of asbestos materiels m 1
moved end work schedule .changes, No .fee. R required for work schedule. changes if the oonnaemr is panictpatung in Pitt Agency wo
nodule fez program. A 560.00 processing f,.. Is raquitad far all omen einem:ments.
tr tectmical assistance, contact SCAPCA at 477.4727. • • .
mor a lunar (ds -!sats/ 2.08, [ONO