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Home My WebLink AboutCOM2019-00154 DEMO Bulkhead, ORCAA permit form - COM Application - 7/12/2019 r cU:'1bP3ON L,y�F MASON COUNTY PERMIT NO. 'COMMUNITY SERVICES DEPARTMENT BUILDING,PLANNING• FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg. #8, 615 W.Alder St (360)275- 467 Belfair ext. 352 Shelton,WA 98584 (360)482-5269 Elma ext.352 �4 DEMOLITION PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Port of Gweview _ NAME: MAILING ADDRESS: PO Box 3 MAILING ADDRESS: CITY:Grapeview STATE:WA ZIP: 98546 CITY: STATE: ZIP: PHONE: (369)275-5020 CELL: PHONE: CELL. EMA, IL: portofgxgpeview2@2mail.com EMAIL L&I REG# EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) 12105-51-63003 FIRE DISTRICT LEGAL DESCRIPTION(ABBREVIATED) : Detroit#2 Blk: 63 TR3 &TLS SITE ADDRESS Adjacent to: 5054 E.Grapeview Loop Road CITY Grapeview,WA DIRECTIONS TO SITE ADDRESS: Take Grapeview Loop Road to Griswold Avenue Griswold Avenue east to the water. The subiect demolition work is 2 parcels north of the boat ramp IS PROPERTY WITHIN 200 FT: SALTWATER® LAKE❑ RIVER/CREEK❑ POND[] WETLAND[] SEASONAL RUNOFF[] STREAM ❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES® NO ❑ IF YOUR PROJECT IS LOCATED ADJACENT TO OR WITHIN ANAREA THAT IS LISTED ABOVE,PLEASE CONTACT THE PLANNING DIVISION OF COMMUNITY DEVELOPMENT PRIOR TO DEMOLITION TO ENSURE REDEVELOPMENT. USE OF STRUCTURE BEING DEMOLISHED(RESIDENCE,GARAGE ETC.) Dysfunctional bulkhead HOW WILL THE DEBRIS BE DISPOSED OF?: Approved upland disposal location PROVIDE A PLOT PLAN INDICATING LOCATION OF STRUCTURE TO BE DEMOLISHED 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&void if work or authorized construction is not commenced within 180 days or if construction w rk is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPgqTION. I T Y THIS PERMIT APPLICATION OF 180 DAYS WI INV LIDATE X THE APPLICATION. 7 ' , ZoeS Signature of Applicant ate X 1-46AW 41�, C,,0W Z-_Od/ OWNER/REPRESENTATIVE/CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT r • `G YsG►ON CLF.►.ti, Olympic Region Clean Air Agency 2940 Limited Lane NW Olympia,WA 98502 (360) 539-7610•FAX(360)491-6308 Demolition Permit South Bend Office (360)942-2137 O RCA A `V Port Townsend Office (360)338-6419 www.ORCAA.org •xiaesw• 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. 3. The start date on other structure demolitions must be at least 10 working days from the submission date of the complete application and payment. 4. It 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. 5. 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. The 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 submission 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. I a OWOY CGE41. Olympic Region Clean Air Agency 2940 Limited Lane NW Olympia,WA 98502 (360) 539-7610•FAX(360)491-6308 Demolition Permit 14j South Bend Office(360) 942-2137 ORCAA Port Townsend Office(360)338-6419 �ti, �a`�� www.ORCAA.org i•�pR•JIFiftloo•�t�•. [ ] Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice-Nonrefundable [ ] Other Structures—Permit fee: $61.00—10 working day wait period -Nonrefundable [ ] Emergency Fee$51.00—must be accompanied by Government Ordered Declaration (other structures only) PROPERTY OWNER Name: Phone: (360)275-5020 Email: Port of Grapeview portofgrapeview2@ ail.com Mailing Address: City: State: Zip: PO Box 3 Gra eview WA 98546 Site Address: City: County: Zip: Adjacent to: 5054 E. Gra eview Loop Road Gra eview Mason 98546 DEMOLITION CONTRACTOR Check if same as roperty owner information. Business Name: Phone: ( ) Email: Onsite Contact: Phone: ( ) Email: Mailing Address: City: State: Zip: DEMOLITION INFORMATION #of structures bein demolished: Start Date: December 15 2018 Expiration Date: February 15,2019 Asbestos present? [ ] Yes [X] No Survey attached? ( ] Yes [ ] No Has all identified asbestos been removed? Yes No DEMOLITION PROJECT CATEGORY [X] 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 info tion in this application and supplemental data is,to the best of my knowledge true,accurate and complete. C 12'*PE v1 CGv xu� fe &4t7t-1 7 Applicant Name Signature e~1010A14 12 Date A Date Application Received Payment Info. [ ] Approved Asbestos Permit [ ] Cash [ ] Disapproved Permit# ASB00 [ ] Check: # Demolition Permit [ ] Credit Card Review date:_/_/_ Permit# DEM00 Receive date:_/_/_ Reviewed by: Agency Use Only Ageng Use On# Agency Use Only Agency Agemy Use Only 07/1 6 OVER