HomeMy WebLinkAboutPermit MI97-0088 - PETERSON RESIDENCE - DEMOLITIONM 008
City of Tukwila
(206) 431-3670
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
MISCELLANEOUS PERMIT
WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES,
APPLICANT IS PROCEEDING AT THEIR OWN RISK.
Parcel No:
Address:
Suite No:
Location:
Category:
Type:
Zoning:
Const Type:
Gas /Elec.:
Units:
Setbacks:
Water:
Wetlands:
336590 -1250
14433 59 AV S
DEMO
MISCPERM
R1.72
V -N
001
North:
N/A
Contractor License N
Permit No:
Status:
Issued:
Expires:
MI97 -0088
ISSUED
07/24/1997
01/20/1998
Occupancy: DWELLING
UBC: 1994
Fire Protection:
.0 South: .0 East: .0 West: .0
Sewer: N/A
Slopes: Y Streams:
OCCUPANT PETERSON JIM
14433 59 AV S, TUKWILA, WA 98188
OWNER GYLDEN MABEL A
14443 59TH S, TUKWILA WA 98168
CONTACT JIM PETERSON Phone: 206 824 -7018
20731 SECOND S.W., SEATTLE, WA 98166
************************** * ** * * * * * * * * * * * * *•k * * *** * * * * * * ** *irk * * * *** * * * * *•k * * ** * * * * * * **
Permit Description:
DEMOLITION OF EXISTING SINGLE- FAMILY RESIDENCE
INCLUDING WATER & SEWER CAPPING.
********************************** k******************* •k * * * * * * * * * * *. * * * * * * * * * * * * * * * **
Construction Valuation: $ 2,000.00
PUBLIC WORKS PERMITS: *(Water Meter Permits Listed Separate) Eng. Appr: JJS
Curb Cut /Access /Sidewalk /CSS: N
Fire Loop Hydrant: N No: Size(in): .00
Flood Control Zone: N
Hauling: N Start Time: End Time:
Land Altering: N Cut: Fill:
Landscape Irrigation: N
Moving Oversized Load: N Start Time: End Time:
Sanitary Side Sewer: N No:
Sewer Main Extension: N Private:
Storm Drainage: N
Street Use: N
Water Main Extension: N Private: Public:
********k******************************************** * ** * * * * * * * * * *•k* * * * *k * * ** * * * * **
TOTAL DEVELOPMENT PERMIT FEES: $ 2,246.50
*********** * * * * * * ** * * * * * * * * * * * * * * * *• * * * * ** ****** k*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Public:
Permit Center Authorized Signature:_
Date: __-1:c211:q)...
I hereby certify that I have read and examine •° this permit and know the same
to be true and correct. All provisions of law and ordinances governing this
work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or
cancel the provision of any other state or local laws regulating construction
or the performance of work I am authorized to sign for and obtain this
developmen
Signature:
Print Name.
This permit shall become null and void if the work is not commenced within
180 days from the date of issuance, or if the work is suspended or abandoned
for a period of 180 days from the last inspection.
LL
Address: 14433 59 AV S.
Suite:
Tenant:
Type: MISCPERM
Parcel #:;336590 -1250
Permit. No: MI97 -0088
Status: ISSUED
App i i ed 06/23/1997
Issued: 07/24/1997
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Permit Condittons:
1. Temporary': erosion: control measures shall be implemented. as
the•,ftr,st order of bus•iness.,.to pr.e.vent sedimentation off-
site or into existing Cur m dr a.3fia'ge ;}ijac:i.l;ities.
2. The site shall hape;rl aneri"t erosisit °"con;t'rol:...measures in
place as 'soon as p;o:ss'ible after final grading has, been
completed anda,prnl°or to th0F }ina1 Inspectiorl,
-3 ALL CONSTRUCTION ACTIVI=T�Y'.AS'SOC•IATED .•WITH z THI DEMOLITION
SHALL BE LIMITED `TOfWI;THIN 10', ,O,F THE BUTLDINC,,.�EXTER�IOR,
4 Sewer andwater ut`il:itiesr: shall be•p1'ugged rat tie mafiris if
''they are"''to, b.e abandoned. I'f they w•i 11 be,.used again '•ire,
the n"ea ;'fueUr''e, for:, a "'new bui 1di =n:g, they sha1,1 be capped
at thOroperty 1 tile and. at !the water meter respe+cut`i�,v.e,1;y.
5. No changes will be madeto'`t'he plans unless appr ovecl by t
Tukwi;j;a Bisl.lding.' Division,
6. All permits inspection records; and approved plans shall
eVaftlabte at the j ob' s i.te-pr or, to., the start of any con,
stru+:tion These documents;'ae to be 'maintained and avail -
abJ'e unti1, final insp'ec.tion.'ap,proval; is..,granted.
Rerove ra11. weeds,- concrete, stone 'foundations, flat', con
cr0e, concrete patios, ;masonry Wail-garage floors:, dr iv,e-
ways:, a d simi;lar•struct'ur es -and all :loose miscel lanerous
t�,€ o � c
Mate�r^i a 1 . «1Pnope sap' san'ita'ry sewer. a;nd water connec
tlQIs�, pro pierly ffll +arv<<otherwi of.'prote t 'al.l basements,
.ce 1 \1 ns ;r „sept l<c. tanks, wells an'd o.ther .•e>`cava,t i ons ;'
• Validity " o•tr'` ~Perini t The i ssuancer£'o F_;:a`-, permi or approval
p1an's ,A specif ica,t ions, ' and computations 'shal�,1 not;'be''- con-
strueo'+.to 'be a per Mit for, or an� approval, off',`.. any violation,`r
of an °yr'ot the pro.v.:isions of the )building code•',or of any ;
other ordinance. of the jurisdi:ct`.ion. No pe "rnrit presuming to
give authorityr.to?'vio°la-te or cancel the provisions of thls
code shat`) „be v`a'l id.
CITY OF TUKWILA
Permit Center {.
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Project Nutri...r:
Permit;Number:
Miscellaneous Permit Application
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mall or facsimile.
Project Name/Tenant: P.?I � s0v•
Description of work to be done:
alsto ✓6 C,ST/ it 2f33, p /cdr-
Will there be storage of flammable /combustible hazardous material in the building? ❑ yes 0 no
Attach list of materials and stora • e location on se • arate 8 1/2 X 11 • a • er lndlcatin • • uantities & Material Safet Data Sheets
■ Above Ground Tanks ■ Antennas /Satellite Dishes ■ Bulkhead/Docks ■ Commercial Reroof
Demolition ❑ Fence ❑ Mechanical ❑ Manufactured Housing- Replacement only
Parking Lots ❑ Retaining Walls ❑ Temporary Pedestrian Protection /Exit Systems
❑ Temporary Facilities ❑ Tree Cutting
V alue of Construction
t0
Tax Parcel Number:
336S-9o— 12So —09
.
Site Address:
i�/'-Ir,'3 �-9 —S o
„_ City State /Zip:
iMkiick ,...,Pc,
Property Owner:
.7 as ? Ai
City /State /Zip:
Phone:
t3.2 V— G 7' 44--
Y, I.) - c'7
/
Street Address: ,�, rondo
°?2/ S`-s
S a
712-y
City State/Zip:
'-t c /6fo
Fax #:
13 2 y -7 0 / a
_�
Contact Person: M
/
Phone:
O
7 S 7 ! /3^
Street Address:
City State /Zip:
Fax #:
Contractor:
Phone:
Street Address:
City State /Zip:
Fax #:
Architect:
Phone:
Street Address:
City State /Zip:
Fax #:
Engineer:
Phone:
Street Address:
City State /Zip:
Fax #:
MISCELLANEOUS :PERMIT .REVIEW 'AND'APPROVAL. REQUESTED: :(TO BE HUED !OUTBYAPPLICANT)
Description of work to be done:
alsto ✓6 C,ST/ it 2f33, p /cdr-
Will there be storage of flammable /combustible hazardous material in the building? ❑ yes 0 no
Attach list of materials and stora • e location on se • arate 8 1/2 X 11 • a • er lndlcatin • • uantities & Material Safet Data Sheets
■ Above Ground Tanks ■ Antennas /Satellite Dishes ■ Bulkhead/Docks ■ Commercial Reroof
Demolition ❑ Fence ❑ Mechanical ❑ Manufactured Housing- Replacement only
Parking Lots ❑ Retaining Walls ❑ Temporary Pedestrian Protection /Exit Systems
❑ Temporary Facilities ❑ Tree Cutting
APPLICANIREQUEST.FOR MISCELL'ANEOUS:PUBLIC WORKS, PERMITS'
n Channelization/Striping ❑ Curb cut/Access /Sidewalk Fire Loop /Hydrant (main to vault) #: Size(s)•
❑ Flood Control Zone ❑ Land Altering: 0 Cut cubic yards 0 Fill cubic yards 0 sq. ft.grading/clearing
in Landscape Irrigation Sanitary Side Sewer #: ❑ Sewer Main Extension 0 Private 0 Public
❑ Storm Drainage Street Use ❑ Water M�sion 0 Private 0 Public
❑ Water Meter /Exempt # Size(s)' 0 Deduct 0 Water Only
❑ Water Meter /Permanent # if Size(s). 3/9 ” C «PP /n.
❑ Water Meter Temp # Size(s� Est, quantity gal Schedule:
71 Miscellaneous Moving Oversized Load/Hauling
MONTHLY SERVICE BILLINGS TO:
Name:
Phone:
Address:
City /State /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER METER DEPOSIT /REFUND BILLING:
Name:
Address:
IPhone:
City /State /Zip:
Value of Construction - In all cases, a value of construction amount should be entered by the applicant. This figure will be
• reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules.
Expiration of Plan Review - Applications for which no permit is issued within 180 days following the date of application shall
expire by limitation. The building official may extend the time for action by the applicant for a period not exceeding 180 days
upon written request by the applicant as defined in Section 107.4 of the Uniform Building Code (current edition). No application
shall be extended more than once.
Date application accepted:
Date application expires:
I 3- -
Appllcatlon 1ak (initials)
ALL MISCELLANEOUS P .' .SIT APPLICATIONS MUST BE SUB ` ED WITH THE FOLLOWING:
➢ ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
➢ BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
➢ ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
➢ STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON
LICENSED STRUCTURAL ENGINEER
➢ CIVIIJSITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER
(P.E.)
❑ •
SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR
PERMIT REVIEW
Submit checklist No: M -9
Above Ground Tanks/Water Tanks'- Supported, directly upon grade
exceeding 5,060 gallons and a ratio of height to diameter or width
which exceeds 2:1
❑
Antennas /Satellite Dishes
Submit checklist No: M -1
❑
Awnings /Canopies - No signage
Commercial Tenant Improvement
Permit
❑
Bulkhead/Dock
Submit checklist. No: M -10
in
Commercial . Reroof" . `
Submit checklist . No: M -6
❑
Demolition
Submit checklist No: M -3, M -3a
❑
Fences - Over 6 feetin Height
Submit checklist No: M -9
❑
Land Altering/Grading/Preloads
Submit checklist No: M -2
❑
Loading Docks
Commercial Tenant Improvement
Permit. Submit checklist No: H -17
❑
Mechanical (Residential & Commercial)
Submit checklist ' No M -8;
Residential only - H -6, H -16
❑
Miscellaneous Public Works.Permits
Submit checklist No H -9
in
Manufactured Housing (RED INSIGNIA ONLY)
Submit checklist No: M -5
❑
Moving Oversized Load/Hauling
Submit checklist . No: M -5
❑
Parking Lots .
Submit checklist No: M -4
❑
Residential Reroof - Exempt with following exception: If roof structure
to be repaired or replaced
Residential Building Permit
Submit checklist No: M -6
❑
Retaining Wails - Over 4 feet in height
Submit checklist No: M -1
in
Temporary Facilities
Submit checklist No: M -7.
❑
Temporary Pedestrian Protection/Exit Systems' , .
Submit checklist No: M -4
0
Tree Cutting.
Submit checklist No: M -2
❑ Copy of Washington State Department of Labor and Industries Valid Contractor's License. If
not available at the time of application, a copy of this license will be required before the
permit is Issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Building Owner /Authorized Agent If the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND / AM AUTHORIZED TO APPLY FOR THIS
PERMIT.
BUILDING
NER OR , UTHO -i
' AGENT:
Signature:
111111110
Date: t. a 9 7
—
Print nam:
OS
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(r'}- ice 0$J.
P y 6 Yc lj�.
1 Fax ri71 o2i, %0/6,
Address:
�,
73 r2
Ciitty'' /St�� i�o d w �-
t�1T L 9 i' /6 10
MISCPMT.DOC 7/11/96
:7777717711:171777,77771777777777
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CIlY OF 1UKWILA, WA e . 1RFINSMIT
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1RANSMI1 Number P9700619 Amount: 2.246.50 07/24/97 12:43
Payment Method; CHECK Notation: PETERSON CONST. Init: KOP
POrmit.No; $197-0088 Type: MISCpERM MISCELLANEOUS PERMIT
,eroel. No 336590-1250
Site Address: 14433 59 AV. 5_ . .
,. . Total 'Fees: .2446.50
TMs :Payment 2i246:.50. Total ALL PMte: 2v24S,.,50
'Balance.: '. .0Q
*************‘A***********.k*******************,
Account Code 'DeScriptlon ': -. 'Amount
• BULLOING - NONRES ' . • 42.00
.. STATE IOILDING: SURCHARGE .' 4.50
, . BUILDING BOND/DEPOSIT .' :: 21200..00 ::
000/322.100
000/386.•04
000/386.908 .
INSPECTI'N O.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 9818
INSPECTION RECORD
Retain a copy with permit
Loci-
PERMIT NO.
(206) 431 -3670
Project:
.t • . jrn
Ty,e of inspe tit
•# Is4 �a 0.
Date called: • ( q,..)
a.m.
Address: )1.4q3.3 01 pv
Special instructions:
Date wanted:
Requester:
01 rn
Phone No.:
G�
Approved per applicable codes.
Corrections required prior to approval.
CO'AMENTS:
lInspector:
rk��.y -✓'^ .. , . I Date:
$42,00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100, Call to schedule reinspection.
INSPECTION NO.
RINSPECTIcN RECORD
etain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #.100, Tukwila, WA 98188
(206) 431 -3670
1 ec
a of ins action:
p
Ce� asp �-��y, II
yeola~Ilinstructions: `-'�'
Dit calla
L.. t:J Y"1
'NI 3`L,, e?i.-�
■^f 1 G LX-O 9- i.�CVCI �..CC�
D wa t .: ('��~1
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a.m.
p.m,
Requgster:
-k x"'
P--
Uv1' 1 — \ () ((i.YA
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o)) 1 Litti-�r�,
E] Approved per applicable codes.
v1
Corrections required prior to approval.
COMMENTS:
0n rJ P Li G- t4 Y-v-5 tit A' L. .
Inspector:
Date: 9
/1
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection,' fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
/0'
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
INSPECTION flECORD
Retain a copy with permit
7
PERMIT NO. ;�
v
(206) 431 -3670
Project:
Type ion: G
f ��
,,,
Address:
Date called!
' rn.
Special instructions:
Date wanted:
Requester:
Phone No,:
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Inspector:
Date:
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection.
City of Tu vita
Inspection Request
Department of Public Works — Engineering Division
Phone: (206) 4310179
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Project: %
Permit No.: m
_ Cj���
Site Address: JLp,L3
f9tbg,5
Date Called: c� /fin Icy 7
(�� /
Type of Inspection:
0 ' 1 I I h
— (halo U-T t (FA,
Date Wanted:
.m. • p.m.
,
Requester: ji ti'1
Phone No.: 90 7
01 c-
Special Instructions:
1 li
(GREG) Electronic Mail 9 -19 -1997 9:44a
Desktop Edit Send! Draft! Record! Window Help
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a To: DAVE -GRAGE
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a Subject: 14433 59th Ave. S. Permit MI97 -0088
a Importance: normal Receipt: Yes CC- Receipt: No
a Attachment: <none>
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aDave, a
aThe above subject was signed off 9/18/97. Since the developer will a
abe constructing a new residence in the immediate future, the capping a
aof water service at the main was not required. The meter is still in a
athe box and in the shut off position. Not sure if you wanted to remove a
a
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athe meter or just lock it.
aGreg V?
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Department of Community Development
Steve Lancaster, Director
MEMORANDUM
FROM
DATE:
SUBJECT:
LAURIE ANDERSON, FINANCE
SHELLIE BATES, PERMIT CENTER --4g2
SEPTEMBER 23, 1997
RELEASE BOND /DEPOSIT
Please release the $2,200 bond /deposit to PETERSON CONSTRUCTION.
The demolition work was signed off by the building inspector on
September 18, 1997. The original transaction was July 25, 1997, Receipt
#2422 for $2,200.00.
Please return the check to me and the applicant will pick it up at the permit
center.
Thank youl
Building Official
Da
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TIiAqSMI1' Number: R97006i.9 Amount: 2,246.50 07/24/97 12.4.1
Payment Method: CHECK Notation: PETERSON C0N5T. Init: KJP
PLirmit No: MI97•-0083 Type: i4ISCPP:RM MISCELLANEOUS PERMIT
'Parcel. No: 3:U590-1250'
Site Address: 14433 t39 .AV S
Total ;zees: 2 »246.50
rPr i s • Payment 2.246'.50 Total ALL. Pmts; 2, 246.5h0
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Acc'aunt • Codo
000/322.100
000/306..;904
000/386.905
• Description
'BUILDING - NONI2ES
STATE BUILDXNG SURCHARGE:
•
'WILDING UUND/0Et'C)JIT•
Amount
42.00
4.30
2.200.00
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TO:
FROM:
DATE:
SUBJECT:
City of Tukwila
Department of Public Works
John W. Rants, Mayor
NOTIFICATION OF UTILITY PERMIT ACTION
Permit Center
Public Works Engineering
June 25, 1997
Peterson, Jim 5FR
Residential Demolition
14433 59th Avenue South
Permit No.: MI97 -0088
Contact Person: Jim Peterson
Phone: (206) 824 -7018
Ross A. Earnst, P. E., Director
THE FOLLOWING PUBLIC WORKS PERMITS HAVE BEEN APPROVED FOR ISSUANCE
IN ACCORDANCE WITH THE PLANS APPROVED ON JUNE 25, 1997:
Residential Water Line (capping)
Residential Sanitary Side Sewer (capping)
PERMIT FEE
No Charge
No Charge
TOTAL: $0.00
Two copies of the confirmed Utility Permit Application and plans are attached for inclusion in the
permit file.
JJS /sal
CF: Development File (with copy of application and plans)
PW Utilities Inspector (with copy of application and plans)
Finance Department (with a copy of application)
'J -.. -18'11 i • _'..41. l .J'..'1J111.'
Agency Case No.
9700314
Agency Use Only
ET SOUND AIR POLLUTION CONTROL At CY
110 Union Street, Suite 500, Seattle, WA 98101 -206
NOTICE OF INTENT
TO PERFORM:
Date Received
PSAPCA JUN 191997
Agency Use Only
A. Project Type: J 1. C] Asbestos Removal 1 2. Asbestos Removal & Demolition [ 3. ❑ Demolition, No Asbestos Removal
B. Property
Owner:
Property Owner's
Mailing Address:
,J Prr-►G t' c92.ir�
/L. /L. y3
Phone: ( ?off) Y.?-?- 8z 2
—1 City: / UW /t. p'
State: (itj '6\ Zip: 7 0P/t91
C. Asbestos PLEASE PRINT CLEARLY, 7 S WILL BE YOUR RETURNMAIUNGLABEL
Contractor: S FL
Contractor
Owner /CEO:.
ailing Address:
Phone:
.--
Contractor
Job No.:
C. :
State:
Zi•:
'Fax: ■ • - se
Start
Date: Ft-, 5 er. P
.- ' •,ik
Demolition TAINT NAME HERE. ER IAII)Nd ADDRESS IN BOX 1 NBA IF TRAINING BURN ENTER FIRE DEPT. HERE
Contractor: .J'/ /1.1 41`i, /
D. Site
Address: ) Li L/3)
$300
$750
s (D
_
City: 7 v/LL1 /CA
aer i
Phone:
S 9
i'-'(
State: w'
(2t.K.) a —2.
Zip:7,4'498
/ O /3—
Project Manager or
Contact Person:
E. (Ai Asbestos Survey or
❑ Mat'l Presumed:
' No. of /
Structures: (
Date Survey was
Conducted: S7 /,5 /c. 7
Was Asbestos Found? xi Yes
❑ If No, Attach Survey
AN AIWA SURYEY 15 REQUIRED Room Au. DEMOLITION PROTECTS AHE,RA Building
Inspector Name: /'1 �(� IV /. E' /L C_
-z--r lc o ,Q
Certification No.:
Expiration
10 Days
F. Demolition
Information;
No. of
Structures:
Start
Date: Ft-, 5 er. P
• Training Fire (List Fire Dept. as demolition contractor below)
❑ Ordered Demolition (attach copy of Order)
Demolition TAINT NAME HERE. ER IAII)Nd ADDRESS IN BOX 1 NBA IF TRAINING BURN ENTER FIRE DEPT. HERE
Contractor: .J'/ /1.1 41`i, /
Phone: (2e ') , 27 %D /8
$300
$750
G. Asbestos Project
Information:
No. of Structures: /
(see back if > 1l
�Completion
Date: (/l L/q /
I Date: . 7
Wk. Days; M T W Th F Su
Hours: • s M O 3 F'
Total Quantity to be Removed: . Linear Ft. V
T � Square Ft.
Yes
Will all asbestos prof ct comp ti t� No
removed by project completion? ❑ NO
Thermal System Insulation: 1 ❑ Boiler\Pumace Ins. O Duct Ins. Cl Pipe Ins.
Other: "1/ N 00 Hf /Q1 eski 1 a1 b
Surfacing Mat'l: [ ❑ Fireproofing ❑ Paints • Plaster ❑ Textured Coatings
Other.
Mist, Mat'1: 1
IQ Cement Bd. ❑ Cement Pipe ❑ Flooring Mat'1 • Roofing Mat'l
Other:
H. Asbestos/Demolition Project Categories:
1. ❑ Owner - Occupied Residential Asbestos Removal Project
Owner- Occupied Residential Asbestos Removal & Demolition Project
Owner - Occupied Residential Demolition Pro'ect, No Asbestos Removal
Notification Waiting
Project Fce
' period
Prior Notice
NO - R
N EFUNDABLE
$25
2.0 All Other Demolitions With No Asbestos Removal Project
10 Days
$150
3. ❑ 10 - 259 linear feet or 48 - 159 square feet (see back of form for options)
3 Days
$150
4. Cl 260 - 999 linear feet or 160 - 4,999 square feet
—TO
10 Days
10 Days
$300
$750
1,000 - 9,999 linear feet or 5,000 - 49,999 square feet
6. ❑ 10,000 - 49,999 linear feet or 50,000 - 99,999 square feet
10 Days
$2,000
7. ❑ 50,000 - 99,999 linear feet or 100,000 - 149,999 square feet
10 Days
$5,000
8. ❑ 100 000+ linear feet or 150 000+ s• uare feet
10 Da s
$10 000
9. • Emer: nc Asbestos Pro'ect or • Emer_enc Demolition Pro'ect
Prior Notice
Twice Pro'ect Fee
10. • Alternate Means of Compliance for friable materials or • Demolitions
10 -Day Review Period
Twice Project Fee
11. ❑ Alternate Means of Compliance for nonfriable asbestos materials
Concurrent with Project
Twice Project Fee
1. I do hereby certify that the tnfotmation contained in this notification, and supplemental data described herein, Is to the best of my knowledge
accurate and complete. I shall not cacao or allow any asbestos project or demolition activities to begin untll the appropriate waiting period has
1 elapsed.
Completeness Review
Performed By:
PSAPCA Font No. 66-160 (Revised 10/96) AM
1
PQ.Y m* Coo ck Dopy
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER
PROJECT NAME
DEPARTMENT:
RSPD
BUILDING DIVISION
IC WORKS
1
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MI97 -0088
PETERSON JIM
DATE 6/23/97
FIRE PREVENTION ❑
STRUCTURAL Li
NP
PLANNING DIVISION ❑
PERMIT COORDINATOR .
DETERMINATION OF COMPLETENESS: (T,Th)
NOT COMPLETE ❑
COMPLETE
COMMENTS
DUE DATE 6/24/97
NOT APPLICABLE ❑
TUES /THURS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRED El
ROUTED BY STAFF ❑ (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
APPROVALS OR CORRECTIONS: (ten days)
DUE DATE 7/08/97
APPROVED fl APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL
DATE
CORRECTION DETERMINATION:
DUE DATE
APPROVED ( l APPROVED W/ CONDITIONS ❑ NOT APPROVED (attach comments) ❑
REVIEWERS INITIAL
DATE
(Cecofcadon of occupancy required. )
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PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER M197-0088
PROJECT NAME
PETERSON J114
DATE 6/23/97
DEPARTMENT:
BUILDING DIVISION r
PUBLIC WORKS
FIRE PREVENTION C PLANNING DIVISION 0
STRUCTURAL PERMIT COORDINATOR Q
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE
COMMENTS •
NOT COMPLETE
DUE DATE 6/24/97
NOT APPLICABLE
TUES /TIHURS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRED E
ROUTED BY STAFF U (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE (— Z4-411
1
APPROVALS OR CORRECTIONS: (ten days)
APPROVED
REVIEWERS INITIAL
DUEDATE 7/08/97
APPROVED W/ CONDITIONS . NOT APPROVED (attach comments)
DATE 6 -24 -°l %
CORRECTION DETERMINATION:
APPROVED El APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) El
(Certification of occupancy required.
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PROJECT NAME PETERSON JIM
DEPARTMENT:
BUILDING DIVISION
PUBLIC WORKS
DATE 6/23/97
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FIRE PREVENTION U PLANNING DIVISION
STRUCTURAL PERMIT COORDINATOR Q
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE n
COMMENTS •
DUE DATE 6/24/97
NOT COMPLETE E NOT APPLICABLE .1;3"-'
TUES /THURS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRED
ROUTED BY STAFF fJ (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE
6.7ze9
APPROVALS OR CORRECTIONS: (ten days)
DUEDATE 7/08/97
APPROVED n APPROVED W/ CONDITIONS ❑. NOT APPROVED (attach comments) 0
REVIEWERS INITIAL
DATE
CORRECTION DETERMINATION:
DUE DATE
APPROVED I I APPROVED W/ CONDITIONS p NOT APPROVED (attach comments) Q
REVIEWERS INITIAL
DATE
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PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER MI97 -0088
PROJECT NAME PETERSON JIM
DATE 6/23/97
DEPARTMENT:
BUILDING DIVISION D FIRE PREVENTION E PLANNING DIVISION r
PUBLIC WORKS STRUCTURAL 0 PERMIT COORDINATOR El
DETERMINATION OF COMPLETENESS: (T,Th)
COMPLETE n
COMMENTS '
DUE DATE 6/24/97
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TUES /THURS ROUTING: PLEASE ROUTE E NO FURTHER REVIEW REQUIRED g
ROUTED BY STAFF ri (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE ! -Of � 3-
APPROVALS OR CORRECTIONS: (ten days)
DUE DATE 7/08/97
APPROVED n APPROVED W/ CONDITIONS ❑. NOT APPROVED (attach comments) Q
REVIEWERS INITIAL
DATE
CORRECTION DETERMINATION:
APPROVED Fl APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
DUE DATE
NOT APPROVED (attach comments) Q
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, PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER MI97 -0088
PROJECT NAME
PETERSON JIM
DATE 6/23/97
DEPARTMENT:
BUILDING DIVISION El FIRE PREVENTION PLANNING DIVISION 0
PUBLIC WORKS ■ STRUCTURAL PERMIT COORDINATOR Q
DETE
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NOT COMPLETE E
DUE DATE 6/24/97
NOT APPLICABLE Ej
COMMENTS
TUES /TFIURS ROUTING: PLEASE ROUTE :41 NO FURTHER REVIEW REQUIRED E
ROUTED BY STAFF El (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
DATE OCIl. 9 -7
APPROVALS OR CORRECTIONS: (ten days) DUE DATE 7/08/97
APPROVED n APPROVED W/ CONDITIONS E NOT APPROVED (attach comments) Q
REVIEWERS INITIAL
DATE 0.r/y7
CORRECTION DETERMINATION: DUE DATE
APPROVED n APPROVED W/ CONDITIONS
REVIEWERS INITIAL
DATE
NOT APPROVED (attach comments) 0
(Certification of occupancy required. )