20150349 Permit Pkg 12232015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: MT TERRACE BUILDERS
Address: 14730 STATE RT 507
YELM WA 98597
Property Information:
Site Address: 15624 COATES RD SE
Assessor Parcel No.: 22719230400 Subdivision:
Contractor Information:
Name: MT TERRACE BUILDERS
Address:
14730 STATE RT 507
YELM WA 98597
Contractor License No.:
Project Information:
Project: DEMOLITION
Description of Work:
DEMO EXISTING HOUSE
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
DEMOLITION
Permit No.: 20150349
Issue Date: 12/23/2015
(Work must be completed within 180 days)
Phone: 360- 458 -1502
Owner: MT TERRACE BUILDERS
Lot:
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
MT TERRACE BUILDERS
TOTAL FEES:
Applicant's Affidavit:
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
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered in the �Statt/e�of Washington.
Sianature l' ' �C Z Date I Z l 2-41 ) cs t 5
Firm
Fees
$ 50.00
$ 50.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -3244
REC #: 00216989 12/23/2015 1:46 PM
OPER: CO TERM: 001
REF #: 24536
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150349 50.000R
MT TERRACE BUILDERS
15624 COATES RD SE
DEMO 50.00CR
TENDERED: 50.00 CHECK
APPLIED: 50.00-
CHANGE: 0:00
�ISf)3L4q
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 15-(C)1y' co*T j dd Parcel #:
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: i
Project Value:
Building Area (sq. ft) 1" Floor 2 I Floor Garage Deck
Basement Carport Patio
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAME: MocAa -&. '-TLn 2,
ADDRESS izAAW ST itT s6-9- EMAIL
CITY Yl.vt STATE wyN ZIP: �- TELEPHONE ?6.0 ,767 o &&
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.
1 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.
Applicant's Signature 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 perio VM
105 Yelm Avenue West (36 -
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
7 Emergency
PROPERTY OWNER
Olympic Region Clean Air Agency
2940 Limited Lane NW
Olympia, WA 98502
(360) 539 -7610 - FAX (360) 491 -6308
South Bend Office (360) 942 -2137
Port Townsend Office (360) 338 -6419
www.ORCAA.org
Demolition Permit
Name: Mountain Terrace Builders LLC
Phone: (360) 458 -1502
Email: mtterracebuilders @gmail.com
Mailing Address: 14730 State Route 507
City: Yelm
State: WA
Zip: 98597
Site Address: 15624 Coates Rd SE
City: Yelm
County: Thurston
Zip: 98597
DEMOLITION CONTRACTOR
Contractor Name: Topline Development Phone: (360) 507 -0868 Email: toplined @gmail.com
Site Contact Person: Mike Kempinski Phone: 3605070868
DEMOLITION INFORMATION
# of structures being demolished: 1 Start Date: 10/9/2015 Expiration Date: 10/8/2016
Asbestos present ?❑ Yes ONo Survey attached? W Yes ONo All identified asbestos was removed under
Asbestos Permit # 15ASB005025
DEMOLITION PROJECT CATEGORY
W Complete Demolition
❑ Training Fire Fire Agency, Contact, Phone:
❑ Renovation, Alteration, Remodeling, Maintenance, or other Construction
I do certify that I am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application /permit. I
authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this
application /permit and to ensure compliance with permit conditions, applicable laws and regulations. I understand that granting of this permit by
ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read
and will abide by the conditions set forth in this permit and any addendum thereto.
I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is, to the
best of my knowledge true, accurate and complete.
Electronically submitted by:
Permit Conditions New Start Date 10/12/2015
Date Application Received Payment Info. Approved
Total Fee: $60.00 Disapproved
9/29/2015 Receive date: 9/29/2015 Review date: 10/5/2015
Reviewed by: TG
Agency Use Only Agency Use Only Agency Use Only
OVER
Asbestos Permit:
Permit# 15ASB005025
Demolition Permit:
Permit # 15DEM004180
Use Only
Olympic Region Clean Air Agency
2940 Limited Lane NW
Olympia, WA 98502
(360) 539 -7610 - FAX (360) 491 -6308
South Bend Office (360) 942 -2137 Demolition Permit
Port Townsend Office (360) 338 -6419
www.ORCAA.org
Demolition and renovation projects within Clallam, Grays Harbor, Jefferson, Mason, Pacific, and Thurston counties
REQUIRE A PERMIT 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, leveling,
dismantling, or burning (by a fire department for training purposes) of a structure, making the structure permanently
uninhabitable or unusable. Renovations include the removing of load bearing structural members, but not to the extent
to make the structure uninhabitable.
The following information is merely a reference guide and not a substitute for agency regulations.
1.A good faith asbestos survey is required for any demolition. The survey must be conducted by a certified Asbestos
Hazardous Emergency Response Act (AHERA) building inspector. Qualified contractors and inspectors may be found in your
local Yellow Pages, through the Washington State Department of Labor and Industries, or on ORCAA's website.
2.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.
32he start date on other structure demolitions must be at least 10 working days from the submission date of the complete
application and payment.
4.14 is the responsibility of the property owner and /or demolition contractor to ensure there is no asbestos - containing
material present in the structure to be demolished.
S.Any and all structures on the same parcel of property that are not proposed to be demolished must be identified as such.
6.A copy of the asbestos survey and approved Demolition Permit must be kept on site and be available for review by
Agency inspection personnel.
7.Mhe original demolition permit will expire 1 year from start date. If the permit expires and the project is not complete, you
must submit and pay for another demolition permit. Under no circumstances will a project be extended beyond 1 year from
original start date.
ADDITIONAL REQUIREMENTS:
In addition to Agency requirements, most building departments require a demolition permit (separate from ORCAA's
Demolition Permit). The Washington State Department of Labor Industries and the local fire authorities may also require
notification for asbestos removal projects.
"Owner Occupied Residential Dwelling" means any single family housing unit which is permanently or seasonally occupied by
the owner of the unit both prior to and after the proposed project. This term includes houses, mobile homes, trailers,
houseboats, and houses with `mother -in -law apartment' or a `guest room.' This term does not include structures that are
demolished or renovated as part of a commercial or public project; nor does this term include any mixed -use building,
structure, or installation that contains a residential unit, or any building that is leased or used as a rental, or for commercial
purposes.
fmpic Region Clean Air Agency - Online Payments
Page 1 of 1
Olympic Region Clean Air Agency
r serving Clallarn, Grays Harbor, Jefferson, P&son, Pacific, and Tfwrston Counti
O RCA
Step 1: Select Payments Step 2: Review and Submit Step 3: Cor)firmation and Receipt
Step 3: Confirmation and Receipt
Result: Payment Authorized
Confirmation Number: 20273656
Your payment has been authorized successfully and payment will be processed.
Olympic Region Clean Air Agency thanks you for your payment. For questions about your account, please call 360 - 539 -7610 Please
permittee receives an approved permit from ORCAA. Thank you for using our bill payment services.
Please save or print a copy of this receipt for record keeping purposes.
My Bills
(Description
I Permits payment of $60.00 on Permit Type Demolition
Customer Information
First Name:
Jody
Last Name:
Clifford
Address Line 1:
14730 State Route 507
Address Line 2:
City:
Yelm
State:
Washington
Zip Code:
98597
Phone Number:
3604581502
Email Address:
mtterracebuilders @gmail.com
Payment Information
Card Number: * * * * * * * * * ** *5794
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