4078_001w' Olympic Region Clean Air Agency
2940 Limited Lane NW Demolition -
Olympia, WA 98502
ORCAA (360) 539-7610 • FAX (360) 491-6308 Notification
,OLYMPIC REGION CLEAN AIR AGENCY
Single-family Residence — Notification fee: $46.00 —14 day wait period - Nonrefundable.
[ ] Other Structures — Notification fee: $79.00 —14 day wait period — Nonrefundable.
[ ] Emergency Fee $65.00 — must be accompanied by letter explaining emergency circumstance.
PROPERTY OWNER
Name:
Mailing Address:
Site Address:
Business Name:
Onsite
iling Address:
L Le__
OR [ ] Check if same as on
DEMOLITION INFORMATION (Notification required for
# of structures being f Start Date:
demolished: `rw S --) A
one: Email:
y: r State:
City:
:y owner information.
-Phone: Email:
c
Asbestos present? M Yes [ ] No
Year Structure
project with €ootpr nt greater than 120 Square Feet)
Zip:
?y
Survey attached? Yes [ ] No Has all identified asbestos been
removed? Yes [ ] No
Is this a: j ] mobile home [ ]modular home
build on -site
DEMOLITION PROJECT CATEGORY
T[omplete Demolition --
] Training Fire — Fire Agency, Contact, Phone:
I do certify that I am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA Notification. I authorize ORCAA staff to
enter the property listed in this Notification at reasonable times for purposes of inspecting the work that is the subject of this Notification and to ensure compliance
with conditions, applicable laws, and regulations. I understand this Notification does not authorize anyone to violate federal, state, or local laws or regulation pertaining
to activities associated with this Notification. I have read and will abide by the conditions set forth in this Notification and any addendum thereto.
I do certify under penalty of perjury under the laws of the state of Washington that the information in
knowle a true, accurate and comp) e
Applicant Name
Date Received
"ayment Info.
Received
[ , ] Cash _
[ � Check: # i
FEB 18 2025
[ ] Credit Card
ORCAA
Receive date:12JJAI-
Agency Use Only
. Agency Use Only
andjUpOermtQtal data is, to the best of my
Date
Asbestos Notificat oiicat p
# aS ASB00 LI 1 `7 O
Demolition Notification
# oQS DEM00 ?LlW,
Use
7/2024
OVER
`
Olympic Region Clean Air Agency 2940 Limited Lane NW Demolition
ORCAA
Olympia, WA 98502
(360) 539-7610 a FAX (360) 491-6308 N of if i cat i o n
OLYMPIC REGION CLEAN AIR AGENCY
Demolition projects (larger than 120sq. ft.) within Clallam, Grays Harbor, Jefferson, Mason, Pacific, and Thurston
counties REQUIRE A NOTIFICATION and require that the following conditions be met prior to the demolition.
Olympic Region Clean Air Agency (ORCAA) regulations define a demolition project as the wrecking, razing,
dismantling, or burning (by a fire protection agency for training), or removal of any load supporting structural
member of a structure, including any related handling operations, making all or part of the structure permanently
uninhabitable or unusable.
The following information is merely a reference guide and not a substitute for agency regulations.
1. Notifications are required for all demolition projects with a footprint of 120 square feet or larger.
2. An asbestos survey is required for all demolition projects. The survey must be conducted by a certified
Asbestos Hazardous Emergency Response Act (AHERA) building inspector. Qualified inspectors may be found in
your local Yellow Pages, through the internet, or on ORCAA's website.
3. Asbestos samples must be sent to a NVLAP Laboratory (National Voluntary Laboratory Accreditation Program)
per 40 CFR 763.87. A list of labs can be found on ORCAA's website.
4. The start date on demolition projects must be at least 14 days from the submission date of the complete
application and payment.
5. It is the responsibility of the property owner and/or demolition contractor to ensure there is no asbestos -
containing material (ACM) present in the structure to be demolished or renovated.
All structures on the same parcel of property that are not proposed to be demolished must be identified as
such.
7. A copy of the asbestos survey and the Demolition Notification must be kept on site and be available for review
by Agency inspection personnel.
ADDITIONAL REQUIREMENTS:
In addition to Agency requirements, most building departments require a demolition permit (separate from ORCAA's
Notification). The Washington State Department of Labor & Industries may also require notification.
"Single -Family Residence" means any structure containing space for use such as living, sleeping, food preparation and
eating. This term includes houses, mobile homes, detached garages, houseboats, and houses with a "mother-in-law
apartment" or "guest room". This term does not include multiple -family units (i.e., apartment, duplex, condominium,
etc.), nor does this term include any mixed -use building, structure, or installation that contains a residential unit.
Emergency Project: A project that was not planned but results in a public health or safety hazard; the project must
proceed immediately to protect equipment, ensure continuous vital utilities, or minimize property damage; ACM was
encountered that was not identified during the survey or the project must proceed to avoid imposing an unreasonable
burden. Additional Non-refundable emergency fee.