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HomeMy WebLinkAboutPermit File 1602 12th Street CO City of Anacortes Invoice/Permit#: BLD-2016-1565 904 6th Street Applied date: 09/28/2016 P.O.Box 547 Issue date: 09/29/2016Anacortes, WA 98221-0547 ` Expire date: 09/24/2017 .:�` ' f er V (360)293-1901 Job Address: 1602 12TH ST Permit Type: Demolition Permit ANACORTES WA 98221-2113 Project: APN: P58003 Remarks: removal of one 500gaI underground heating oil tank. Owner: SEAFARER TRUST Contractor: ULTRA TANK SERVICES Address: 1602 12TH ST Address: PO BOX 30096 ANACORTES WA 98221-2113 BELLINGHAM WA 98228-2096 Phone: Phone: (360)815-5361 License#: ultratso33ck General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: Goti+Ti�t1n N�3'� Sb1l�S SE-1d THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 6.16 SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY l�l�'J 11 �-✓ ^em { CITY SF ANACORTES ' tf ' . DEMO! JI'�`ION PERMIT APPLICATION // r kukcc6es sire Address: 1 1Q�(,� �, t • t\.s ;essors Account No.: _•1l�`i ° Dater dAti -,g�Lot(s): R Block: Addition: QLgft ‘(--'t \ei Owners Name: C01, \ Ck,(\ Contractors Name:/dkTR4 /Jk 4'LF/2UI(63/1k?, Address: rLddress: �� �Gj �(�(7 /' �L l7 t m State: U) Zip: State: W �) Zip: -9�'5� 9 Phone:- - '--- W9, a® '/ Contractors License: IL7 e c2 c. k Phone: ICA--(M- c'S — 13 Have Utilities Been Disconnected? Description of proposed demolition. Water Dept.: Yes No ec ©i\M\NN ��r IC\ 1 :, (0_0(kf Electric: Yes No � � � Cable: Yes No \\Kk, ' Gas: Yes No How W. i aterials l e disposed? `1-60\K% Wk \\ V e CAC (. tj. fk oic- wA ' e t. .Q\k/LL___ , , BARRICADES TO BE PROVID--;D FOR PUBLIC PROTECTION, AREA MUST BE ROPED OFF! ,` 1 Applicant's or Agent's Signature ASBESTOS WARNING Breathing asbestos is hazardous to your health. Before starting a renovation or demolition project, survey for friable asbestos materials. Notify Northwest Air Pollution Authority prior to asbestos 1 removal or containment 1600 S. ri Street, Mt. Vernon,WA 98273 (360) 428-1617. Fire Department Approval: ft Date: d - ` Police Dept. Approval: Date: 4 1 Public Works Department r pproval: Date: ,. Museum: �- Date: ii 1 Comments: 1 ()c Burlington, WA Corporate Laboratory(a) Portland, OR Microbiology/Chemistry(c) 110Z 162C S Walnut St-9un'a0: n VIA 9&233-E90.7SS.S255.360.757.1,1C1 9150 S17 Pioneer Ct sto 91-C.•rho:ni2e,OR 970i -503 C92 7502 ibUNIVe Bellingham,WA Miaobiology(b) Corvallis, OR Anrcroblo/ogy/Chemistry(d) )Orci-,sd Or Sie:-Re::.r.;tian,.:'b153325.30'J 715 1212 .5;0 5V;Tr•'dS5ee1-Coca .Or 97333.511753.9,1 /� Bend, OR Microbiology(e) j )I J,>tf J (�t/'iM'/'�✓V // ANALYTICAL 20332L•rrpe EMI Ste 3-Vend,CR9/701-5?1.63�Sa25 V"� �1! Page 1 of 1 Hydrocarbon Data Report Client Name: Tim Fisher Reference Number: 16-29737 4501 San Juan Ave Project: FORS Anacortes, WA 98221 Report Date: 12/14/16 Date Received: 12/2/16 Approved By: pdm Authorized by: Patrick Miller, MS QA Officer Sample Description: - 1602 12th St. Anacortes Sample Date: 12/2/16 15:00 Lab Number: 72263 Collected By: Tim Fisher Date Analyzed: 12/12/16 Analyzed By: HY Cleanup Parameter Result Flag DF Level PQL MDL Units Method Lab Batch Comment NWTPH-Dx DIESEL(C12-C24) ND 1 2000 50 mg/Kg NWTPH-Dx135 a DXS_161207 50B HEAVIER OILS(>C24) ND 1 2000 50 mg/Kg NWCPH-Dx/35 a DXS_161207 508 Notation: ND-A result of"ND"indicates that the compound was not detected above the Lab's Method Reporting Limit-MRL. PQL=Practical Quantitatlon Limit is the lowest level that can be achieved within specified limits of precision and accuracy during routine laboratory operating conditions. D.F.-Dilution Factor Cleanup Level-The regulatory limit for Method ACleanup Levels(MTCA,Chapter173-340 WAC)contaminants in the specified matrix.Amended Feb 12,2001 The Cleanup level for Gasoline Range Organics(GRO)is 100 mg/Kg for gas mixtures without benzene and when the total ethylbenzene,toluene and xylenes are less than 1%of the gasoline concentration.The Cleanup level for GRO is 30 mg/Kg for all other mixtures. If you have any questions concerning this report contact us at the above phone number. Form:cHCID.rpt Burlington, WA Corporate i.abomtorj(a) Portland, OR MurabtotogylChemisby(c) 1620 S W'a'nut Si-eurfng un,WA 96233-800 755.9295•360.757.1490 9155 SW Pioneer Ct Ste:Y-1'Itl$orerX3,OR 97070-503 6927802 Bellingham,WA AFaobrology(b) Corvallis, OR Wcrobiotogy/Chemfsby(d) £066Cltnrd Ci 91s 4.0u',n;`:_'n WA93225-3107715.1212 540 S':/Th'rd Suez!-Cc'vn';i„CR97333-541.75349.16 ANALYTICAL OR Asaobio/ogy(e) ANALYTICAL 2Q312e Y:eaS:;dSi.a-€et:5,C;?97701•54163LS425 Page 1 of 1 Hydrocarbon Data Report Client Name: Tim Fisher Reference Number: 16-29737 4501 San Juan Ave Project FORS Anacortes, WA 98221 Report Date: 12/14/16 Date Received: 12/2/16 Approved By: pdm Authorized by: Patrick Miller, MS OA Officer Sample Description: - 1602 12th St.Anacortes Sample Date: 12/2/16 15:00 Lab Number: 72263 Collected By: Tim Fisher Date Analyzed: 12/12/16 Analyzed By: HY Cleanup Parameter Result Flag DF Levet POL MUL Units Method Lab Batch Comment NWTPH-Dx DIESEL(C12-C24) ND 1 2000 50 mg/Kg NWTPH-Dx/35 a DXS_161207 5013 HEAVIER OILS(>C241 ND 1 2000 50 mg/Kg NWTPH-Dx/35 a DXS_161207 50B i /6 0 2., / 2 --L-4-__ Y---i---- ____ ._ ____ .____...._ _.__ _____ __.________ _ _ ,_____. ..... ________._ ____ .... __ .._ _ ________. . _._ _ _._ ___ __ Notation: ND-A result of"ND"indicates that the compound was not detected above the Lab's Method Reporting Limit-MRL. POL=Practical Quantitation Limit Is the lowest level that can be achieved within specified limits of precision and accuracy during routine laboratory operating conditions. D,F.-Dilution Factor Cleanup Level-The regulatory limit for Method A Cleanup Levels(MICA,Chapter173-340 WAG)contaminants in the specified matrix.Amended Feb 12,2001 The Cleanup level for Gasoline Range Organics(GRO)is 100 mg/Kg for gas mixtures without benzene and when the total ethylbenzene,toluene and xylenes are less than 1%of the gasoline concentration.The Cleanup level for GRO is 30 mg/Kg for all other mixtures. • ' If you have any questions concerning this report contact us at the above phone number. Form:cHCID.rpt immonimmummummenanne ilk _ ig Puget Sound Gas Works illwalmillanullaull".111.11111- -- 425-343-5566 l'uge. tSoundGasWorks@Gmail.com 30326 36th Ave NW, Stanwood,Wa 98292 Gas Pipe Pressure Test Affidavit A•eit 4Pe._ rcet,),iteLe i For Cascade Natural Gas Company 6-I.4...s. IAA.a4 Project Address; / 6 ,7 -3 1 Th ":1-L, S i-- I Ate/s, /t4(r)/41-1- C ; k /le--''L , This gas line was tested at 15 pounds pressure for twenty minutes to check for gas leaks. Gauges were checked thouroughly so pressure will not be released. v 'N Al This gas line was soap tested to check for gas leaks. By signature of the gas pipe mechanic., the gas leak test was completed and held test. Gas Pipe Mechanic: Date 0 ti to t/ ke-. Pressure Test-1)at' 1