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20130296 Permit Pkg 08192013 �O�TH�A$ City of Yelm Permit No.: 20130296 C � a Community Development Department Issue Date: 8/19/2013 (Work must be completed within 180 days) Building Division Phone: (360)458-8407 """'"`�° Fax: (360)458-3144 Applicant: Name: RICK ROCHESTER Phone: Address: 4810 45TH. SE LACEY WA 98503 Property Information: Site Address: 106 SECOND ST NE Owner: RICK ROCHESTER Assessor Parcel No.: Subdivision: Lot: Contractor Information: Name: RICK ROCHESTER Phone: Address: 4810 45TH. SE LACEY WA 98503 Contractor License No.: Expires: 0/00/0000 Project Information: Project: DEMOLITION Description of Work: Sq. Ft per floor: First Heat Type(Electric, Gas, Other): Second Third Garage Basement Fees: Item Contractor Fees DEMOLITION RICK ROCHESTER $ 50.00 TOTAL FEES: S 50.00 Applicant's Affidavit: OFFICIAL USE ONLY I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints: Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants, easements and restrictions of record. If, pplying as a contractor,I further certify that I am currently Final Inspection: registered in the State of Washington ✓✓�� i ' � ' � � � -/� �';' Date: Signature �� . �� ,� Date Firm By' _ �lt� Of e��o2 (36 ) REC#; 001367TERM: 001�1�01� ��04 PM OPER: CO REF#: TRAN: 33.0000 6UILQI50.00CRITS 2U130296 ROCHESTER, RICK 106 SECOND ST N50.00CR pEMO TENDEREp: 100.00 CASH APPLIED: 50.�0- CHANGE: ^� � , CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM N^ Project Address: ��C� �''— �'✓ Parcel#: f �'A Subdivision: Lot#: Plan #: Zoning: ❑ New Construction ❑ Re-Model/ Re-Roof/Addition ❑ Home Occupation Sign ❑ Plumbing ❑ Mechanical ❑ Mobile/ Manufactured Home Placement ❑ Other Project Description/Scope of Work: Project Value: Building Area (sq. ft) 15' Floor 2"d Floor 3�d Floor Garage-2 car 3 car Covered Patio Covered Porch Patio Deck # Bedrooms_ # Bathrooms_ Heating: GAS/OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on the parcel? /fyes, a completed environmental checklist must accompany permit application. BUILDING OWNER NAME: ��'C,�'G'�c?�� - C°�V �� '�- ADDRESS �(�/� `f� /�U4� - �C EMAIL CITY ,�':�C'�/ STATE (�,,R- ZIP�' '�' � TELEPHONE .��5�=- �� -- SJ��= ARCHITECT/ENGINEER LICENSE# ADDRESS EMAIL CITY STATE ZIP TELEPHONE GENERAL CONTRACTOR �� .<<� �, , TELEPHONE �'��-��r�-5 �`� ADDRESS ef;� �-fS �C�, EMAIL � CITY ' '' -- STATE�ZIP Q f' '� FAX CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE# PLUMBING CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE# MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE# Copy of mitigation agreement with Yelm Community Schools, if applicable. I hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above described property will be in accordance with the laws,rules and regulations of the State of Washington and the City of Yelm. �-- ��' � �- �9_ �� Applicant's S�gnature Date Owner/Contractor/Owner's Agent/Contractor's Agent(Please circle one.) All permits are non-transferable and will expire if work authorized by such permit is not begun within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days �rrr 105 Yelm Auenue West (360)458-3835 Yelm, WA 98597 (360)458-3144 FAX www.ci.yelm.wa.us C,��GIOn'CyE�,-� Olt•mpic Rcg�on Clean Air Agenc} ,o�,ti�' ��;, 2940-Fi Limi�ed Lane NV;� , °'�n�� Ol��mpia, �l'A 98�Q2 �� (360)539-7610 •FA� (3G0) 497-63D8 Demolition I'ermi� �� o�' Port Angeles office (360)417-1466 `*�•� Q�(�Ag �,�l./ Rat�mond OfSce (360) 942-2137 �4rJy�Rt �S �� u�.ORCAf�.oi� �\ 4�•!lflE[SOk•w �i" �j O��n�er occicpied residential dwelIing--Permit fee: $35.00—Prior Notice -Nonrefundable � Other Structures—Permit fee: $60.00—10 working c�ay vc�ait period -Nonrefundable [ j Emergency Fee $SQ.00—must be accompanied by Gavernrnent Ordered Decfaration(other strucrures on1}�) PROPERTY OWNER Name: Phone:�a ��_��:•r�mail: �, � � �� -�'`4�'�± /,J`�� ,� F11: ( ) �Mobile: � ) Mailing Address:r /� ! Cit}�: State• ZiR• �, ,•%1� r!�l �t,`� �-"��cf� �'��; �,r�✓°l�-�/' � �� !':�--(i �. Site Address: Cit�l: �r � State• Zi � ri�9 `��f' n� `!�%�;/t `�/ � �r� ��-�. �:o?��-°, / �...: � , �' %;�, DEMOLITION CONTRACTOR Check if same as ro ert��owner information. Business Name: Phone: ( ) Emai1: Fax: ( ) Onsite Contact Phone: ( ) A�obile: ( ) Fax: ( ) Maiiing Address: Cit��: State: Zip: DEMOLITION INFORMATION # of structures being demoIished: 5 Date: Co tion Date: � � ° —�"�—�`t .'Z� � ��l�`'�r.� �r Asbestos present? [� Yes [�No Survey attached? [� I'es ; No Has all idenrified asbestos been removed? [� Yes (�No DEMOLITION PROJECT CATEGORY (� Complete DemoIiuon �; Training Fire—Fire Ag�ncp, Cont�lct,Phone: : Renovation,Altera[ion,P.emodeIinR,Naintenance,or other Construction I do bereby certify tha� a11 identified a.rbestos ha.r been removed arrd the information contained on tbit form and rupplemental data de.rcribed bereirr , to the beft af my knov�ledge, accurate and cam�lete. �'�' J �!-•:/�'� �-�'l I�_ -''�'` ,/`'?" _ `�%� ��, t�<'.��.-�� _.,�_/:!_,�. t� � 1 . I Applicant Narie Signature Date Date App,Iic�tYO�;Receii�c� � � Pa�•ment Info. [ ] Approved A_sbestos Permit [ � Cash q, [ ) Disapproved Permit# ASB00 �''. � . '` _. ['�]'�heck: r�,- L t �� D�moIition Permi: [ ) Credit Card Retrieu�dat�:_/_/_ Permi; #t��EI�I00�� R�.�it�dac 4�`/_/_ Revie�t�ed bj•: ,'1�errc� i.i.r� Oni�� Apen�� li.re G�rl�� ,A,Qe�tc� ��.re O�rl�� Apei7n lire O�r/7� �?!1� 0 V�P. �_�___.__ iP . . T . ; . T T R Pt�c,�Flc� RIM E�VIIZO�VM��;Tf�L, I�c. E BULK SAMPLE ANALYSIS REPORT c�iENT: Richard Rochester PACRIM#: 2103.0277 4810 45`"Avenue SE REPORT#: 2013-04-0045 Lacey, WA 98503 DATE RECEIVED: 4/5/2013 ANALYST: Willlam F. GOIIOWay PROJECT: NOt Given DATE ANALY2ED: 4/8/2013 REPORT BY: Safah Kf eltl@►' REPORT DATE: 4/$/2013 SAMPLE DATE: 4/3/2013 TURNAROUND: 3 DByS PAGE: 1 Of 2 Attached is the result of analysis of two (2) bulk samples submitted for asbestos identification: lab ID #2013-04- 0045 through 2013-04-0046. The samples were analyzed in accordance with method EPA-600/R-93/116: "Method for the Determination of Asbestos in Bulk Building Materials". Unless otherwise noted, the samples were inhomogeneous; subsamples of components were analyzed to achieve representative ana�ysis. Separate layers of layered samples are analyzed and reported separately. Unless otherwise stated, asbestos content was quantified by calibrated visual estimation (CVES). CVES concentrations are reported in 2 to 3 percent ranges for fiber concentrations ranging from 1-10%, and 5 percent ranges for concentrations greater than 10%. Samples in which asbestos was not observed are reported as "none detected". Limitations and Uncertainty: Factors such as sample quality, sample size, interfering matrix material, fiber size, and fiber concentration contribute to the uncertainty of asbestos concentration measurements in bulk materials. Relative errors exceeding 100% may occur in samples containing <1-10% asbestos. Relative errors are typically below 30% in samples with greater than 10% asbestos, and approach zero as the asbestos concentration approaches 100%. Asbestos fibers with diameters below approximately 0.25 micrometers are not detectable by PLM. These extremely fine fibers may occur in such products as floor tile, adhesives, and cement products. This limitation can be overcome, however, by the use of alternate analytical methods, such as Transmission Electron Microscopy (TEM). The sample analyzed in this report was provided by third parties not subject to control by Pacific Rim Environmental, Inc. (PRE). Consequently, the results presented represent microscopic examinations in PRE laboratory facilities and PRE makes no representation as to sample collection techniques or procedures. Test results pertain only to the samples submitted for analysis. This report cannot be represented by the client to claim product endorsement by NVLAP or any agency of the U.S. Government. This report shall not be reproduced except in full without written permission from the laboratory. NVLAP Accredited LAB#: 101631-0 Reports j Sample submitted by: Third Party Reviewed By: s� ` �� Approved Signat � 6510 Sou(hcenter Bl�'d., St�. �r�=} �v��-��.pacr�men��.��otli 1'f��nr: (Zt�6) 2��-<i9C� Seattle, WA 9H I$8 Fa�: (206;t 2�4-)096 Pacific Rim Environmental, lnc. BULK SAMPLE ANALYSIS REPORT c�iENT: Richard Rochester PACRIM#: 2103.0277 4810 45'"Avenue SE RePORT#: 2013-04-0045 Lacey, WA 98503 DATE RECEIVED: 4/5/2013 ANa�YSr: William F. Golloway PROJECT: Not Given DATE ANALYZED: 4/8/2013 REPORT BY: Safah Kf@I11@f REPORT DATE: 4/$/2013 SAMPLE DATE: 4/3/2013 TURNAROUND: 3 DayS PAGE: 2 Of 2 Client/Lab ID Sample Date Number Location and Description Asbestos Type(s)/°� Other Material(s) Analyzed 1 Sheet rock. Layer 1 (Over spray): Layer 1: Cellulose (<1%), 4/8/13 None Detected Wollastonite (5-7%), Binder, 2013-04-0045 White, chalky, texture-like Mineral Aggregate. over spray (layer 1) on Layer 2 (Mud): light grey-painted, white, None Detected Layer 2: Cellulose (<1%), chalky mud (layer 2) on Mineral Aggregate, Binder, white-painted, white, Layer 3 (Mud): Paint. chalky mud (layer 3) on None Detected white, chalky drywall with Layer 3: Cellulose (<1%), brown paper (layer 4). Layer 4 (Drywall): Mineral Aggregate, Binder, None Detected Paint. Layer 4: Cellulose (7-10%), Gypsum, Mineral Aggregate, Binder. 2 Vinyl flooring. Layer 1 (Tile): Layer 1: Mineral Aggregate, 4/8/13 None Detected Binder, Vinyl. 2013-04-0046 Light brown and white, wood-grained-pattern Layer 2 (Mastic): Layer 2: Cellulose (<1%), flooring (layer 1) with None Detected Adhesive, Mineral Aggregate. dear, tacky mastic (tayer 2). This report shall not be reproduced,except in full,without written permission from Pacific Rim Environmental,Inc.