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HomeMy WebLinkAboutCOM2016-00095 Final Demo Storage Bldg - COM Permit / Conditions - 5/8/2018 0 0 ............ ic 9 CONCRETE MECHANICAL MANUFACTURED HOME > rn Footings/Sethadm Date By Gas Piping Ribbons 0 Interior Date By Interior-Date By Date ay C) X Eater ce Date By Exterior-Date By z Cn Set-up Point Load I Isolated Footings INSULATION BG I SLAB INSULATION Date By Date By Data By FIRE DEPARTMENT Foundation Wails cf) Floors Date By 0 Date BY Data By DECKS 0 FRAMING waft Date By 0 Date By Date By PROPANE TANKS 17, Vault 0 PLUMBING Date 13Y Dante 'Y Gundwork Attic OTHER X ro Date By Date By Type. P DRYWALL Date By 0 D.W.V InL Brace Wall Type- 0 Dole BY D Date By C Date By 114 .' ' FINAL INSPECTION WaUw Line Fire Seperation Date By Date By Date By 6 Pass or Request Inspect. coo Type of Insp. Fail Date Date Done By Comments 0: 645 CD 0 ` MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT 111ONMAIVII L.111t;�JVV�YG/-/GVL Mason County Phone: (360)427-9670, ext. 352 615 W Alder St Shelton, WA 98584 COMMERCIAL BUILDING PERMIT COM2016-00095 OWNER: MARY M KNIGHT SCHOOL DISTRICT RECEIVED: 7/14/2016 CONTRACTOR: LICENSE: EXP: ISSUED: 7/19/2016 SITE ADDRESS: 2987 W MATLOCK-BRADY RD ELMA EXPIRES: 1/19/2017 PARCEL NUMBER: 620223360000 LEGAL DESCRIPTION: SW SW EX&TR 2 SE SE SEC 21; TR 1 NE NE SEC 28; S 18/86 PROJECT DESCRIPTION: DIRECTIONS TO SITE: p I DEMO PERMIT FOR STORAGE BLDG (OLD MUSIC/ARTS LOCATED WITHIN THE MARY M KNIGHT SCHOOL DISTRICT CAMPUS BLDG) 1 General Information Construction&Occupancy Information i Type of Use: EDUCATION Insp.Area: No. of Units: Type of Constr.: Type of Work: DEM Fire Dist.: 12 No. of Bathrooms: Occ. Group: Valuation: No. of Stories: Exit Design. Load: Building Height: Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: Model: Width: Building: Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline&Planning Information Front: Ft. Shoreline: Ft. Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Side 1: Ft. SEPA?: Comp. Plan Desig.: Side 2: Ft. Fire Protection System Information Auto Fire Alarm System?: Emergency Key Box?: Standpipe?: Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2016-00095 Please refer to the following pages for conditions of this permit. Page 1 of 4 1 c� O ? v V v N CD O 1 oX X � o a3 — o CD =rcr _� Oo ZYrno Ecr g CD :C)CDo 3 O Q j O m v m CL CD ? n a n) 3 m — CD v o S, o v -I ° cc 6" 0 X �� � a CD CD o -gym m 0 Qo cu \. c 3 o ° a) XOM cnc N w cn Q j Q N C = � � W— @ � Q �a < CD Q N N N cn N . v O M (D O M O_ — 070 cn O O N (n (n N fu C<D Z ch v co N (n < O n CD (D O O �. 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Port Townsend Office(360)338-6419 www.ORCAA.org :a �YJ:a"si3r`,'`,rs`!e?�"tSw�.,^"'.✓ ', Emergency PROPERTY OWNER Name: Mary M.Knight School District Phone: (360)426-6767 Email: l Mailing Address: 2987 W. Matlock-Brady Rd City: Elma i State: WA 1 Zip 98541 Site Address: 2987 W. Matlock-Brad Rd City: Elma Y tY: �County Mason i Zip 98541 DEMOLITION CONTRACTOR Contractor Name: Self ^� Phone: (000)000-0000 Email: Site Contact Person: Phone: (360)426-6767 DEMOLITION INFORMATION #of structures being demolished: 1 Start Date: 8/1/2016 Expiration Date: 8/1/2017 Asbestos present? Yes 'No 1!Survey attached? Yes �No All identified asbestos was removed under Asbestos Permit# N/A DEMOLITION PROJECT CATEGORY lam,'Complete Demolition ...........---...---....-----•-- ------------------- C Training Fire Fire Agency,Contact,Phone: Elma Fire Department _ Renovation,Alteration,Remodeling,Maintenance,or other Construction I do certifythat I am the owner,authorized agent of the owner,-or authorized contractor for the propertysubject 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 setforth 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 As of July 25,_2016,ORCAA has not approved the use of this structure for a training fire. — i !Date Application Received s Payment Info. Approved iIi Asbestos Permit: Total Fee: $61.00 Disapproved iPermit# ASB l i I Demolition Permit: 7/11/2016 Receive date: 7/25/2016 Review date: 7/25/2016 Permit# 16DEM004412 Reviewed by: RTM i I � Agency Use Only Agency Use Only .—A Agency Use Only ° agency Use Only OVER -.,-�r.�rv..--,.,.,_;.,.f.:-.-mgrs^=-..-crag.: ;+=_�".. -.•...�"�-'f'"2s-:rv.,.�syrn -,rr_'I'"+.-i'^-"-*-'—.---,-m,--,:r.--sm.-.' '+.^'-. -ln .....'t .. ... - ....I��Ef'rn.v - 10: Hage 2 of 7 2016-07-25 19:29:34(GMT) 13604916308 From:Debbie Moody cdox,cz— Olympic Region Clean Air Agency 2940 Limited Lane NW N Olympia,WA 98502 (360)539-7610-FAX(360)491-6308 South Bend Office(360)942-2137 Demolition Permit Port Townsend Office(360)338-6419 i0l www.ORCAA,org Demolition and renovation projects within Clallarn,Grays Harbor,Jefferson,Mason,Padfic,p.nd Thurston counties REQUIRE A PERMIT and require that the following conditions be met prior to the demolition. Olympic Region Clean Air Agency(ORCAA)regulatioris'define a4lm eolitiori project as the wrecking,razing,leveling, dismantling,or-burning(by a-fire department for training purposesi)'of a.structure,making the structure,permane.ntly-, uninhabitable or-unUsable.,Renovations include the rernoWirik of load beating structural-members,but not to the-extent to make the structure uninhabitable.:: The following-infor n substitute --e I mationFis-mer�ly a ref6re cegUide'and-not-asU st gu�ations. 1.9 go6d faith a' sbesto§..surv.6y is reqUire'd f6r any dernblitiori:::The survey 15e'-ciion'ducted by-a.certified Asbestos Em rg' h' e-sponse. Act.Hazardous. e - k :Rey ... (A1­IERA)building 1nspectoK.QuqIified contractors local Yellow Pages,through theWashi4t6i�i.state'Department of La b6r".a*nd iiidustnles_ r on ORCAX.s webs ite. 2.19bestos-samples must be sent to a*NVLAP'Laboratory(NatjonAl•VoluntarV'i: boratorY.-APcreditafion Program)per40 CFR,.. 163.87'.A list of-labs:can be:found on.011CAA.'s'website:. 31he''start date on other structure demolitions-must be at-least ID.workihg:days from the submission dateof.the.compjet6 application and:payrnedt.­. .4.9'is the responsibility the property,owner and/or jdemplitioh'c'brktactor to ensure there.is no asbestos-containing material present in th6sitru�&Uret6 be . . . . d emolished.. * , 5.9ny arid all structure's parce[of prd;ertyikatar6.not-propose to be,cemolitfiedmuitb6lde"n tfleii. �e,:,�pl on site-anicl-b ilable-foreeVieW-by''Ug copy ofthe�'asbestos.surveV acid approved 6em6litori'Pet k e avai ,Agency inspection personnel. i 7.Mhe original demolition permit will•expire 1-.year from-Airt-date..if th6:permit expires:and the you-mustsubmit-.andpay foit a-hother. clemblitibriv. c1ftumstancdswIII:aa6r6leiA be extended beyond' yea r :,.fr�o: :origi-n -sta it . ... .... m at ADDITIONAL REQUIREMENTS.'..:, An addition to Agencyrequirenjents,most b'LipOingo6iDbrfm6nts..requiie:ademdiition'p6.rmii:(Sepaiate-fro'm ORCWs h th 6'Demolition Permit),Th6'Wa's! ikton*�i�tebepaftrn6nt-of La'b6�'in'dustri6s.dndth�-locaifir�'.4u ori es.mayals"o.require, not ification for asbestos removat.projects. ".Owner. ccupied Residential Dwelline'meansar y's'ingie-.family housing unit which is permanently or seasonally occupled'.by.. the owner of the unit both prior to and after the proposed pr6j6ft'.Th!s term inpludes"hPuses,mobile.homes,'frallers, 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;hot does this ierminclude.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.commercia'l purposes. a. to •wl a • J �wui V cs' z i�, fu r r\j 1� LL Lm o �C -J :!= 00 00 u .�n Lji s�'�A �� ► {U � p � z LM ra Lm f < � } r L .(1) v w M c ...._ , • �.. CL E Lm SEATTLE ASBESTOS TEST LLC } Analyzing Quality Lynnwood Lab:19701 Scriber Lake Read,Suite 103,Lynnwood,WA 98036,T81:425.673.9850,Fax:425.673.9810,NVLAP Accreditation Lab Code:200768 Bellevue Lab:12727 Northup Way,Suite',Bellevue,WA 98005,TeIA25.861.1111,Faxc425.861.1118^NVLAP Accreditation Lab Cade:200876 Seattle Lab:4500 9th Ave.NE,Suite 300.Seattle,WA 98105,Te1:206.633.1111,Fax:206.633.4747,NVLAP Accreditation Lab Code:201057 Email:admingseahleast)estostpst.com,Webaitp:Www seaftleasbestestest.com CHAIN OF CUSTODY V9ulk Asbestos ❑Point Count 400 Q Paint Count 1000 O Point Count Gravitrteuic p Other(Speclty) ❑t Hour u 2 Hours Li Same day(4 to 6 Hrs.) u 1 Day U Day. Fax: �09) Marry M Knight S.D. #of Samples: � Jobs ��¢� y� . Matlock Brady Rd. 4 27 - Project Manager: v 1`� P14 A lie Elma, WA 98541 z - SEO# CLIENT SAMPLE# SAMPLE DESCRIPTION LOCATION NOTES 1 i"1K "lib gIkl •+- j`4Li t 2p�Z `46 d 3 ' " { 0 v Q SW 5 _ 6 7 IW 6 9 10 11 12 J 13 14 15 16 17 19 20 ( YI (} L7 Print Name Signaturl Company Date Time Sampled: f ESO#113 f Relinquished: l7etivered- Rerstvad: u Seattle Asbestos Test 0�- > Analyzed: Seattle Asbestos Test Reported: Seattle Asbestos Test $eaala Asbestos Test""ants the test results,to be of a precision nonnnl for tlto typo and moUodotogy emptayed ror each semplo submitted snit dixfaima any ethor warrants,sxpr dt or implied^ including warranty or rytness for a particular txnpoaa and warranty d meruhentabitity,3aattle Asbestos Test amepts rto legal responsibiiilq for the�urpose tar unlrlr the client uses the test results.By signtn�on This form,the clients agree to relieve Seattle Asbestos Teat of any liability that may adsa from the test results.It rs the okenrs responslbi ity to make sure the samples are appropdataty taken acorn ng ro federal and local regulations.Invoices paid late may be charged of Interest,and invoices go to collection may be charged 17 o to 25%of collection tee.NSF eheeles M![t e charged of ken 50. Results reporting method: ❑phone ❑Fax VAiEmall ❑Piek-up riCompoa1w all wallboard sam sple D Text result to phone E lPoint count ....._%or less asbestos page 1 o1() 1 t Questions? SEATTLE ASBESTOS TEST, LLC p-i�rk INVOICE o St Ana a message. 19701 Scriber Lake Road#103,Lynnwood,WA 98036,Tel:425.673.9850,Tei:425.673.9810_ 12727 Northup Way,Suite 1,Bellevue,WA 98005,Tel:425.861.1111,Fax:425.861.1118 4500 9th Ave.NE,Suite 300,Seattle,WA 98105,Tel:206.633.1111,Fax:206.633.4747 Email:invoice@seaitleasbestostest.com Invoice Date: 7122/201610_:0 Warning page • • _ • • is intended to the client specified. Invoice Number. 201612025 Violations wil +- - • •-• - • reported to ourSecurity Dept. Date Due: 08-21-16 Accounts Payable/Wayne Whiton Amount: $160.00 _ Cosmopolis School District 1439 4th Street,Cosmopolis,WA 98537 Amount w/interest: $160,00 BATCH# DATE JOB# PROJECTION LOCATION TAT TYPE SAMPLES UNIT NOTES/ AMOUNT PRICE REFERENCE Mary M 2987 W. Matlock Brady 201612025 7/19/2016 Knight S.D. Rd., Elma,WA 98541 3 d pim 8 20 $160.00 Subtotal: $160.00 Grand Total: $160.00 T make a PDF file of thislnvoice�simply goto"File"menu and then"Download As"and then"PDF document". o Notes on Payment, (1)Invoice can be paid by checks,cash or credit cards.Checks should be made payable to Seattle Asbestos Test and mailed to the address given above.(2)Past due invoices may be charged of interest and be referred to collection.Please consult Seattle Asbestos Test regarding the status of a particular invoice.Referral for collections is automatic for all invoices greater than$50 and more than 120 days past due.(3)Customers who are referred to collection will be charged the original amount of the invoice plus a collection fee that ranges from 17%-25°1A of the outstanding balance.(4) When paying invoices please make sure to either insert the original invoices with the payment or write all the invoice numbers on the check.(5) Checks with no sufficient fund will be charged a$50 processing fee.(6)Pricing may change without prior notice. Thank you for your businessl SEATTLE ASBESTOS TEST Seattle Laboratory:4500 91h Ave.NE,Suite 300,Seattle,WA 98105.Tel,206.633.1111.Far.206.633.4747,NVLAP Lab Code:201057-0 ANALYTICAL LABORATORY REPORT PLM by Method EPAJ600IR-931116 Alto.: Mr.Wayne Whiton Client: Cosmopolis School District Address: 1439 4th Street,COSMOP011S,WA 98537 Job#-. Mary M Knight S.D. Batch& 201612025 Data Received' 7/19/2016 Samples Rec'W 8 Date analyzed; 711912016 Samples Analyzed: 8 Project Loc.: 2987 W.Matlock Brady Rd.,Elma, WA 98541 Analyzed by: Casste Huang Reviewed by Steve(Fanyao)Zhang,P771d—wt Lab ID Client Sample ID Layer Description % Asbestos Fibers Non-fibrous Components % I Non asbestos Fibers Brown fibrous None 1 MMK-001 1 Paint,Filler 65 JCellulose material with paint detected 2 MMK-002 1 Brown fibrous None Paint, Filler 63 Cellulose material with paint detected 1 Brown fibrous None Filler 64 Cellulose material I detected 3 MMK-003 2 Black/brown mastic None Mastic/binder 3 Cellulose detected 3 Light gray fibrous None Filler 61 JCellulose I material detected 4 MMK-004 I Brown fibrous None Paint, Filler 66 Cellulose material with paint detected Brown fibrous None 5 MMK-005 material detected 2 Blackibrown mastic Nonedetected Mastic/binder 4 Cellulose White powdery None 1 Filler, Binder 3 Cellulose 6 MMK-006 material detected I 2 White chalky None Bindedfil 25 ler, Cellulose, Glass 1 material with paper detected Gypsum/binder fibers 1 Blue/brown woven None Filler, Binder 85 Synthetic fibers fibrous material detected 2 Gray mastic None Mastic/binder 3 Cellulose 7 MMK-007 detected 3 Off white woven None Filler,Binder 81 Synthetic fibers fibrous material detected 4 Brown mastic None Mastic/binder 4 Cellulose detected I 8 MMK-008 1 Black asphaltic None Asphalt/binder, 26 Glass fibers material with sand detected [Sand pia co� MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360)275-4467 Belfair ext. 352 BUILDING•PLANNING•FIRE MARSHAL (360)482-5269 Elma ext. 352 Inspection Hotline(360)427-7262 Mason County Bldg. 8, 615 West Alder Street 1854 Shelton,WA 98584 www.co.mason.wa.us CORRECTION/INSPECTION REPORT PERMIT/CASE NUMBER: Go tt ZA{ ADDRESS/LOCATION: Z F8 F CJ, Im,�-6Lout 6ZA4 y re-� FINDINGS: W 1 l CC- ® ��,,�,©.�� ��L T2���rJC� dLA S o,J �va,ili.Ju►Jb�� '20171 P� �L{'�AArJ1rr_�'t GaV�2 tit A-CCAcK 2 �n _! �J « M�1 v? t,f2G, �4 �osl -1 WI 154 ey� i r.� w1/Yt Chns �� Items listed above must be corrected to gain compliance. THIS IS NOT A COMPLETE INSPECTION [] This structure has been inspected by Mason County Building Department and the items listed above are in VIOLATION of Mason County laws and/or o'rdinances.', Call for re-inspection when corrections are made before proceeding with any further work. Make corrections, items will be checked on the next inspection. /�_ OK to Date: Please contact our office regarding possible Department: 6j.4 structural(damage incurred by recent natural/man made"disasters.This is NOT a Inspector: CORRECTION NOTICE. DO NOT REMOVE THIS TAG MCC14.12 �� 4. �. •l.� Tr'c,-�gij� F .1.4T _ �I ell. { �.,w•� 1 *k s .�� r�.� '4k"-�;. �A'�2,"�1.., d .W ^nr• {{�.s. �� 1'y Y �n � Iq� ..i�r ... F � � .. Y,�q S 17.'J t ¢. �•:�,a�.. Mf.« at it Ve F j'r'•' 'e�C 7- t• rk y~'.t r ,fi.,• f �i,; p yr sgg:,Rd. '"� � i -��.� .':r q. I.W r ,,_••9 A. ,n �.. :� � ,:� +{h j t. w.l t "'a'M• c -4a i.' 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'�� '( ti+. - �Iq'y. �.^flf'. ^r�i' �.;r, 1' - '^�S ��' 4 •,q' .r -f � +* L- :��y��*R"` d'�'�••hS�-' �� 'f�'l°�„"� �� �- � .� � 14'�� � �'• Y' ' MAY^' v'll f '�-` '' �. �'L �--,.'jam!' q :�� �}�t y��"s•+•. � �n -� • ''� �' `rd 5 t,,,��'.. Wit.•. � : ��.5 � >..t� "'"",�Rom,.N„ � ,: I 'F i k; '�„ t 71 ~;� � 1 .a�f7r,°.ah s n* . F .t?L M f fiR ri ' � 1 ' °� �� � - - � 1 ((�'t=` � .-3� '�'v .:'. r i•,�• �"; a.�'�., X r�. ?5 r�i .•g• s, t k_ �''+N ,��yeyi�"'`tA'.4 .���' •�54 ..1 �.e i��: i;: e-' � ri'"��i.. �:�4�rc � +� _���ri :.� !kt�'t r4;,,�. Y 1 _ ._ '�.' ��n v. s• � ,FM. ..} �� .�..sv�t+�R.•{q,Mt;� �: f rK. .�""'•3ksa; t •jg�r-� Y +� n=. "$,•�. ."'Y,f�c � .�- i e e4ry�� f (' e t 10 N •" fin.. �.•" ,y „�'ti°"' ' ':• •' 't� u �;'� .d}. ;> hr � � a n I � C3, "-, '« � •s,* 'p .++4� ra•a, ���� � �'� a �� ": vµ�>.. ��,� �wit'+ s°� >:�" °�"�;" `� " s u�`k ,`n eta '( '► Y Jul. 11. 2016 12: 13PM Mary M. Knight No. 2528 P, 5 010 eL �y... Olympic Region Clean Air Agency 2940-B Limited Lane NW Olympia,WA 98502 �I (360)539-7610•FAX 360 491-6308 • Port Angeles 3 0 417,1466 Demolition Permit i.. g ) Raymond Office(360) 942-2137 www.ORCAA.org rj Ofvner occupied residential dwelling—Permit fee: $35.00—Prior Notice-Nonrefundable (' Other Structures Permit fee: $60.00-10 working day wait period-Nonrefundable [ � Emergency Fee$50.00-must he accompanied by Government Ordered Declaration(ocher structures only) PROPERTY OWNER Name: Phone: (did)S/7G �7y J Email:✓e -Y�fa,7 ✓11. /'�.-�.��� 5�.1�,,u/ �s�-2,� Faye; Mobile: ) Y�7 -�Ssi4 ( ) Mailing Address: City: State: Zip: Site Address: City: State: Zip: teen& 09-d DEMOLITION CONTRACTOR KI Check if same as pro erry owner information. Business Name: Phone: Onsite Contact: Phone: ( ) Mobile: ( ) Fax: ( ) Mailing Address: City: State: Zip: DEMOLITION INFORMATION # of structures being demolished: Start Date: Completion Date: AK I I r r A_ Asbestos present? 1-1 Yes D4 No Survey attached? rYes No Has all identified asbestos been removed? Yes Fj No DEMOLITION PROJECT CATEGORY N-] Complete Demolition M Training Fire-Fire Agency,Contact,Phone: 11I;(ce �✓ewnr Renovation,Alteration,Remodeling,Maintenance,or other Construction I do hereby certify that all identified asbestos has been removed aid the information contained on Ibis form and rapplemental data described her-tin is, to the best of my knowledge, aespxrate and/complete. Jam, Applicant Name Signature Date Date Application Received 'Payment Info. [ ] Approved Asbestos Permit [ ] Cash [ ] Disapproved Permit# ASB00 [ ] Check: # Demolition Permit [ ] Credit Card Review date:_/_/_ Pcrmit# DE1v100 Receive date:^/_/_ Reviewed by: Ageny Use Ony/ A-gency Ure Ox6 AK6119Use On ,en Use On 02/13 OVER Jul, 11. 2016 12 : IIPM Mary M. K n I g h t No. 2528 P. 1 MASON COUNTY PERMIT NO.Ckm 2DI U - no q 6 COMMUNITY SERVICES DEPARTMENT BUILDING v PLANNING.FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason Cour::y Bldg.#8,615 W.Alder St (360)2754467 Belfair ext.352 Shelton,WA 98584 F: yz� 1�9X (360)492-5269 Elma ext.352 DEMOLITION PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: H q, /97- NAME: 'w ,,•, MAILING ADDRESS- a� r 7 W. Z/, MAILING ADD SS: ;2f -7 W, CITY: STATE: w✓J zIP: 9rsy/ CITY: Z/,r,., STATE: 4r zip: ysry/ PHONE:3 6 o y,�& -4 ,d 7 CELL: PHONE: CELL: EMAIL: EMAIL: G 11-71 4#1 ,,A. 1/. ,./, L&I REG# EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) W_622_ SS (pC000 FIRE DISTRICT 1-2- LEGAL DESCRIPTION(ABBRE'VIATED) :_�w 54d _q e-rx;_ 6E Sr 5;c Al ; T1z r NE NE $Ec s8 SITE ADDRESS .298y W MArrgce, $RAeV R/S CITY E MA DIRECTIONS TO SITE ADDRESS: IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE[] PdVERJCREEK[] POND[] WETLAND❑ SEASONAL RUNOFF[] STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 140% YES❑NO-' IF YOUR PROJECT IS LOCATED ADJACENT TO OR WITIIINANAREA T11AT IS LISTED AB0VE PLEASE CONTACT THE PLANNING DIVISION OF COMMUNITY DEVELOPMENT PRIOR TO DEMOLITION TO ENSURE REDEVELOPMENT. USE OF STRUCTURE BEING DEMOLISHED(RLSMF_NCP,GARAG> P TC.) HOW WILL THE DEBRIS BE DISPOSED OF?: PROVIDE A PLOT PLAN INDICATING LOCATION OF STRUCTURE TO BE DEMOLISHED Arr, �l� OWNER/CONTRACTOR acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below,I declare that I am the owner,owners legal representative,or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided Is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null 8 void if work or authorized construction is not commenced within 180 days or If construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 160 DAYS WILL INVALIDATE THE APPLICATION. X // Signature of App nt Date X Z/lC rr J', 1 ic_�,.r�S' OWNER/REPRESENTATIVE/CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTIV V( TA.L.Rt_t�O.E�.._; AkPRO DENIED D.Ajt TA; QTk5ICONDITIO�S BUILDING DEPARTMENT PLANNING DEPARTMENT COVERED PLAY AR �. CONST lam .N BALL FIELDS . . o OP ti Q N �$ ELEMENTAI`tY SCHOOL CONSTRU 19M OVER HED HIGH SCHOOL S ueED1 CONSTRUCTED M IC/ART BUILDING 'pump HOUSE ' CONSTRUCTED PORTABLE ►+ANY CLASSROO E PARKING LOT y�Mo L.1st-I�.D z DISTRICT MAINTENANCE o &BUS GARAGE N lJl N SITE_PLAN..--_ NARY I11I,. KNIGHT. SCHOOL..DI.STRICT Jul, 11. 2016 12 : 12PM Mary M. Knight No, 2528 P. 3 .i A2, BUILDING IDENTIFICATION 1 . Building Name and No: Mary M. Knight Elementary Musk Portable No. 1249 2. Address route 41, Box 134 3. City Elma 4. State Washington 5. Zip 99541 6. Type a+ Building School /Portable 7- Grade Span K - 2. Building Size 3Q' x 200 , 6O0 Square Feet 9. Year Built/Acquired 1955 Y.ear (s) Added To --- Year (s) Modernized -- 10. Principal Name ,Tames, Millet' 11 - Building Telephone (206) 426-6767 (District) 12. Building Inspector (s) ! Arthur G. . Getchman - #4I18014 William R. Moulton - ESI41256 17. Business Af r i l i at i ran: CSD 4 113 14. Address 601 McPhee Road SX. 15. City Olympia It. State WA 17. Zip 98502 is. Telephone 1206) 5S6-2933 19. Accreditation Couras(s) : Certificate(s) Attached 20. Refr-euher Course: Not apRl i cabl e at this time 21- Friable and/or Sunp9ot Friable AGSM Present in Building? No 22. Non-Friable and/or Suspect Non-Friable ACBM Present in Building? No 23. Signature of Inspector (s) : Attached 24. Location of binder- containing inspection and plain information for this building if other than this one. B. OTHER INFORMATION: This is south of the elementary building. -rhe room has a carpet floor, 12" x 12" acoustic the on wiling and walls, and electric heat with no thermal systems insulation 1 Jul. 11. 2016 12: 13PM Mary M. Knight No. 2528 P. 4 BuiLOrN :r,tys��c roe( ) �2jAI_ c PG We the undersigned attest that all the information contained herein is corract to our best knowledge and belie-F. nspeator Date Arthur G. Getchman #Az 18010 2