2007, 02-07 Permit App: 07000366 Demolition Workshop��T*� �/ `` Permit Center
S Kane 11707 E Sprague Ave, Suite 106
.,,,.0 Valle Spokane Valley, WA 99206
Y (509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org
Demolition
Notice of Intent
Permit Application
PERMIT NUMBER:
PERMIT FEE:
Commercial
Lsidential
SITE ADDRESS:
ASSESSORS PARCEL NO:
Building Owner: NI lL e_
f h./ /"J
Name:
Address:
City: C rty ,k ac v T--
State: wyl ,
Zip:
Phone:
Fax:
Contact Person
Name: Mt. L
Phone:
rjt•-k- -tC)
G rer,\acvr5
Contractor:
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic leo:
Exp Date:
City Business Lic. No:
Describe the scope of work in detail* * * *NOTICE OF INTENT REQUIRED****
remove Flo ( (oo Work-S1-1oP Frorv\ S tie
Cost of project: $
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. 6) Plans or
additional information may be required to be submitted, and subsequently approved before this application can be
processed.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature Date j - 14 - °
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005
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AgencY.Usc .'
SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY
1101 West College, Suite 403, Spokane, WA 99201
NOTICE OF INTENT
(NOI) TO PERFORM:
` "" 51 `
I
FEB 0 7 2007
Agency Use °"l' I
A. Project Type:
1. ❑ Asbestos Removal
2. U Asbestos Removal & Demolition
3. U De1#_i_11.
No Asbestos Remov;ll I
B. PrePertY a r Lpp
Owner: /vl(',rip las S. rxaN14
Phone: 50/ wg3)09
(If available)
Fax: SD1 .aa6-as- f
Property Owner's toggo N. Wes+ Newman 4k. pr.
Mailing Address:
City: Newman Lk
State: kik
Zip: if OAT
C. Site
Address: 1,3 XI t • 1.41$ Aite. _
City: 611.2tNAerc.5
State: WA
Zip: 990/(,
Responsible SiteJob
Contact Person: N t G V.. 8 uwt t•I
Site
Phone: N ire
D. dAsbestos Survey or
❑ Material Presumed
If survey ppeef�oormed, was asbestos found?
0 Yes Ulf No, Attach Survey
Date Survey
Conducted: 4/ /a?
No. of Structures:
(see back if>I)
AHERA Building f 'wry Ca , it/a/
Inspector Name: A.AO5z .c, s Grp do S
Certification I Exp.
Number, g.C2 - aG - o C 7 Date:��/5�C
E. Asbestos Project
9
No. of4ttructurer a: ` `
%Start
Completion
Wk -Hays.
Ho�
Information:
(see back if>i I
Date: a- i O -0I
Date:
�¢
Total quantity
to be removed:
Ln.
Feet
Sq.
Feet
Will all asbestos material be U Yes
removed by project completion? 0 No
Will work schedule Yes
fax pgm. be used? 0 No
List individual type and quantity of materials to
be removed or provide an attachment of same:
51Neaar r tt.kak Shcel t,„ Quit,
r ,
Abatement
Contractor.
Phone:
Fax:
Mailing
Address:
City:
State:
I Zip:
F. Demolition
Information:
No. of Structures:
(see back if>1) I
Start
Date: a _tD-0l
U Training Fire (List Fire Dept. as demo. contractor
below)
0 Ordered Demolition (attach copy of Order)
Demolition
Contractor:
Phone:
Fax:
Mailing
Address:
City:
State:
Zip:
G. Asbestos/Demolition Project Categories:
Does this project involve a fire -damaged structure? 0 Yes o
Notification
Waiting Penod
Non -Refundable
Project Fee
1. ❑ er-Occupied Residential Asbestos Removal & Demolition
lH Owner -Occupied Residential Demolition Project Only •
Project *
Prior Notice
$30
2. ❑ All Other Demolitions With No Asbestos Removal Project
10 Days
$250
3. ❑ 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
3 Days
$250
4. ❑ 260 - 999 linear feet or 160 - 4,999 square feet
10 Days
$500
5. ❑ > 1,000 linear feet or> 5,000 square feet
10 Days
$1,250
6. ❑ Emergency Asbestos Project or 0 Emergency Demolition Project
Prior Notice
Twice Project Fee
7. ❑ Alternate Means of Compliance for Friable Materials or U Demolition
10 Days
Twice Project Fee _
8. ❑ Alternate Means of Compliance for Nonfriable Asbestos Materials
10 Days
Twice Project Fee
9. ❑ Exception for Hazardous Conditions
Concurrent with Project
Regular Project Fee
* The two categories in G.1 apply only to owner -occupied, single-family residences, which means any non -multiple un't building containing living
space that is currently occupied (prior to and after renovation/demolition) by one fami y who owns the property as their domicile. One of the
categories in G.2-9 must be used for all other renovation/demolition projects. For more information, contact SCAPCA at (509) 4774727.
11. 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):
I. I certify that the information contained in this notification and any supplemental data provided is, to the best
of my knowledge, accurate and complete.
-21f-i ease, 62-7 d 7
• ., . leteness Review
'a 61 cdmjelete
0 Notdeficient -
`c7 U�
Signature Representing Date
Use Only
Your advance notification period will begin when a completed NOI, including required fees, is received by SCAPCA.
A copy of the asbestos survey, completed notification & all amendments must be available for inspection at all times at the job site. 1.101 8/06
Tes°information provides an overview of Notice of Intent requirements. It is not intended as legal advice or as a substitute to applicable laws
and regulations. The Spokane County Air Pollution Control Authority (SCAPCA) is the local air pollution authority for Spokane County.
SCAPCA's Regulation I, Article IX and Article X, Section 10.09, requires advance notification be submitted to SCAPCA, on an Authority
approved form, for any asbestos project involving materials equal to or greater in size than 10 linear feet or 48 square feet (per structure, per
calendar year) and for any demolition project, regardless of asbestos content, involving structures with a projected roof area greater than 120
square feet. Asbestos and demolition projects involving materials and structures below the notification thresholds listed above are still subject
to all other requirements of SCAPCA Regulation I. Article IX and Article X. Section 10.09.
GUIDELINES FOR SUBMITTING AN ASBESTOS / DEMOLITION NOTIFICATION
Notices of Intent (NOIs) should be mailed or hand delivered to SCAPCA with the appropriate non-refundable project fee (NOIs may be faxed
to SCAPCA if a prepayment account has been set-up with SCAPCA). SCAPCA will review the NOI to ensure that, based on available
information, there is no missing information, the form has been filled out correctly, appropriate fees accompanied the NOI, and the project
start date(s) comply with the advance notification periods (e.g., prior notice, 3-day notice, 10-day notice, etc.). Unless otherwise indicated, all
information requested on the NOI form must be provided for it to be considered complete. After the NOI is reviewed, a copy will be returned
(via fax, if possible) to the parties listed in box B, E, F, and/or H. SCAPCA's completeness review (lower, right-hand comer of form) is not
required prior to beginning work, provided the NOI meets all applicable requirements. However, if work begins on a project and it is
subsequently determined that a complete NOI was not received by SCAPCA, a Notice of Violation may be issued.
Box A. Check the appropriate project type.
Box B. Enter the legal property owner information.
Box C. Enter the project site address for the asbestos project or demolition. Include the name of a responsible site contact person and a
telephone number where he/she can be reached (preferably a cellular telephone number where the person(s) can be reached on-site).
Box D. Check asbestos survey or material presumed. If asbestos survey is checked, fill out all information requested. Except as provided for
in Article IX, Section 9.03, all renovation and demolition projects must have an asbestos survey performed by an AHERA Building Inspector.
Demolition with no asbestos discovered in the survey must submit a copy of the survey along with the notification. Asbestos removal projects
only may check the material presumed box if all materials are to be removed and disposed of as asbestos-containing materials in accordance
with SCAPCA Regulation I, Article IX and Article X, Section 10.09.
Box E. Enter the asbestos project information, including contractor and mailing address or other properly trained company or person
performing the asbestos project. For multiple asbestos projects or demolitions provide a work plan, including a map of the structure(s)
involved, site address of the structure(s), the amount and type of asbestos-containing material in each structure, and a detailed work schedule.
For projects where a detailed work schedule cannot be provided the work schedule fax program must be used. When using the work schedule
fax program, asbestos contractors or property owners are not required to submit amendments for work schedule changes occurring between the
start and completion dates. SCAPCA may allow asbestos contractors or property owners to use the work schedule fax program for non-
multiple asbestos projects or demolitions, provided the asbestos contractor or property owner has good reason(s), as determined by SCAPCA,
which are conveyed to SCAPCA in writing with the submittal of the Notice of Intent. Contact the Washington State Dept. of Labor &
Industries for applicable training/certification requirements.
Box F. Enter the demolition project information. If the structure is to be used in a training fire, list the fire department as the demolition
contractor. If the property owner has been ordered to perforin a demolition by government official, submit a copy of the order from the
appropriate official. Refer to above paragraph for requirements on multiple structure projects.
Box G. Enter all project information requested. All multiple structure asbestos project notifications must be submitted with a work plan
including a map of the area, site address for each structure, type and amount of asbestos in each structure, and a detailed work schedule.
Check one project category in boxes #1-5. The project fee includes the demolition fee. Asbestos removal projects and demolition with an
asbestos removal involving less than 10 linear feet or 48 square feet may be filed as project category #3. An emergency asbestos project or
demolition may be requested by checking the appropriate job size category in boxes #2-5 and then checking the applicable emergency box in
category #6. Emergency asbestos project notifications must be submitted with a letter from the property owner explaining the necessity for the
emergency. Emergency demolition notifications must be submitted with a letter from an authorized government official or a licensed
structural engineer documenting that the structure is in imminent danger of collapse. To request an alternative means of compliance for friable
or nonfriable materials, check the appropriate job size category in addition to the applicable box in categories #7 and #8. A work plan must be
submitted by an appropriately trained individual along with the notification. Box #9 is reserved for the Exception for Hazardous Conditions.
Box 11. Optional — list other parties involved with the project that you wish to receive a copy of the notification if it is considered deficient
and/or when it is considered complete.
Box I. Sign the notification certifying the accuracy and completeness of the information provided on the form.
Mandatory amendments are required for changes that increase the project type, job size category, the types of asbestos materials to be
removed and work schedule changes. No fee is required for work schedule changes if the contractor is participating in the work schedule fax
program. A $0.00 processing fee is required for all other amendments.
For technical assistance, contact SCAPCA at (509) 477-4727.
Your advance notification period will begin when a completed NOI, including required fees, is received by SCAPCA.
A copy of the asbestos survey, completed notification & all amendments must be available for inspection at all times at the job site. NOI 8/06
•
February 1°2007
19322 E 4ei
Spokane Valley WA.
Specialty Environmental
&.2626 Trent ave. Spokane WA. 99202
(509) 535-1313 FAX: (509) 535-5304
RE: Asbestos Inspection
I have performed a visual inspection of an out -building at 19322 E 4r" in Spokane
Valley WA. and found no materials needing sampled as suspect for asbestos.
The building was previously used for hay storage and is intended to be
disassembled for reuse.
The structure is constructed with wood and metal framing with steel siding and
fiberglass light panels. The floor is dirt with a partial concrete section, with no
insulation or heat source. The roofing had no visible sealant or mastics.
Attachment A is a list of building materials considered to be suspect as asbestos
containing. If any of these materials are encountered during the disassembly of the
structure, it should be sampled by an accredited Building Inspector and analyzed for
asbestos content prior to any activity impacting the material
Jim Guinn,
Asbestos Building Inspector
Certification Number: BIR -06-057
Expiration Date: 8-15-07
Procedure for Communicating Survey Findings to Affected Parties:
A summary of the results of the asbestos survey shall be posted, either by the,property
owner or the owner's agent (e.g., general contractor) at the work site or communicated
in writing to all persons who may come into contact with the material. A signed
acknowledgment by a responsible party (owner or owner's representative) should be
included in or attached to the report. The acknowledgment should be similar to the
following:
1 acknowledge that I have read and understand this report I further acknowledge that
hidden asbestos materials may exist in concealed areas that may be exposed during my
work. If suspect materials (refer to attachment A) are discovered, I will treat the material
as asbestos containing until testing proves otherwise."
Firm Name: /U i Bt. Nr 1
Signature: —Gr ---t ✓� -
NamN;L_I Tygey NN
Title:
Address: ro 2Lu N 'v -rest Nevnsn
1 )4• 17r -
Kevin -ion Lk. W W. dig 026-
PhoneNumber: jiH 31o$ Date: 2-7-07
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AHERA Building Inspector Refresher Training
In Accordance with TSCA Title H Date of Training: August 15, 2006 in Post Falls, ID
Certification Valid through August 15, 2007CertificationCertification Number. BIR -06-057 Date of Examination: August 15, 2006
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