Loading...
HomeMy WebLinkAboutBLD2013-00191 litUILDING PERMIT APPLICA!N BLDI3-00191 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00191 Received Date: 6/20/2013 SITE ADDRESS: 308913 HWY 101 BRINNON, 98320 OWNER: PLEASANT HARBOR MARINA& PHONE: 360-796-4611 GOLF RESORT LLP 308913 US HIGHWAY 101 BRINNON WA 98320-9719 PLEASANT HARBOR MARINA SHORT P SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 502152013 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DEMO EXISTING BISTRO TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: ( 12' b 11 Type Amount Paid By: Date: Receipt: Approved/Date Permit $76.00 MEB 06/17/13 142180 APPROVED VED State Building Code $4.50 MEB 06/17/13 142180 �!!['"" Ii�.l Total: $80.50 OCT 2 8 2013 Jefferson County DCD \firicmerlr\rlo+o\fnrnne\G RI n Ann P1,1 rn+ ai)ni)n1'z • • ice / 5- iq / Dt,ifik-'3 ',0,0 18.:-.‘'- narmy raror ca mia�ry Ni'" i e218niele She•Parrot/mad cu a d•w.00ldtingrlr a n Nese ' 300187&M60. 90008794461 Fat . .` mmaa)e4rnalhu. illas ier Penult Application Mk • NOM Oeoadpleitenduds wpm*sheets salweeear , • _ --.1 . es .e l Asti Sib ,1eiho a el. a IS/ST , aGetls�,4s,` TacPleolttylalieee: 90215 01 T ; P)lrrl*.. ;, 1 D t� SbsAddlMSaoerler b�a�: 'SCAPAS V� v�\o\ r.oOl• `)J 01%At Pesporgr. .,4• _, WAAA*s VA 'tit 6, ▪ Adds N eln0Acceded: i s;..�-L.A... A ..L' • i• . bbedofPrmat?(Check mob bootie applies O M o d P a o 8lemdeldp Phil DaealPi000Pernk 0Iloikrob floor,la ior of Reilmaida Rona&We 0 tingle Porelp 0 Swop Aredoadlaslr4i ed 0 Ca t lded tlw{ICal,CO.a c •• - NesedrabeeedHorne 0llodda DflW' enerr(r or thosinsed theCllei4la4t.i t enaeseebd" 08podelWaroisarWelPolk RNM10" 0 Chew dUse 0itoededlly Lino Mueletw- HorosBltelneis 0Colbps I 0 elndletilhe Pilo _ C aro 0 Pleran oeiadMeddem e"` IOC" 0 Aiowsd'Vaer Urns oonikleryMneyele �6t01otawMMr Neneger wnt 0 8blesl is NNW Novato llaaprsdMeaB lbndelones O PMnApproerl Admit*Dera eAen(BP'AM)* 0 Rhodes#rrreptsent6ebelydelDevdopoont"" .14 0M�iMootasunriesion• 0OeampeebeueinrP molUOC timdUse OhlitelMep?enendina* O Pored P— ---Aml uk .0 avak-YserYodaben 0Adhreeu Ow*Shona,Wier Proem Aowedmen! • •Mgtrapyis.i '- 11ppRaeroe Ceedbeaea. 0 Tio0 aossiedriesaPnerteelballorsIbelimose rblr►Irllrlrjr Iaoel�.teltrjt 1ltdllerll flits ■ tJ' t AA •c..NCD .-s- ., 1�in%q o tleeo.branf9lele m baofes",pwitleesnBetsndl�/rglelllsappNawanaorpenollp awireneewaust ."4,‘ Debt U41e 16 • IteRrieOleeVAellenOwbetsi sMisaillos Wrwdnlea Mob,gab snneMeoMwerlkis tee ad.ssi b II*Mat el Me.her al Meta sdas.?ay e weed!YYMmdrraeraeieius eta_.ete_Wlectradr byes oet.rMreit ell umpeatiblisappilkolos pocket mgr Matta ads Oral aftmeant'NAL 111Mo nip soIsemidsmayandbetiln.abed.rdlksonCow.apin eV Millasjoempiek sesteeele.mossoeee$meeisMesand e inem wide key►fe.eWnpaearseplret,Ulbweeeets yeea wluRaferlrsa sebrunsdfrpenl s.I*psma 1tooser epee topertile deeesadrypeet*My so Anew Cow aebanpgp ee,wpaemoloser.pMetw eeiForm allappleikm 'ram end sgwgMedtesreep o sore. Oen evens we feRdwbyoll bsnwAed adeeeaeepploee'M rsamMeCo r*k ware MOD les Mho epplisellallothe oreOrpoi in 3 — . The Won eteoloneA ppbntWearddNss1NeultotthelmamosraNi peerteg sop snyrlrysat*mtmsaenowtlaOeeM.r wMmkpeeed epodes see mil INS bwpeentdlehe era semi egm edepodes esleMSeaesaesdeAeodieeeeldeedberlaeeeoare leeleupsedrpeossAst•orillWatehssee Gooey meeanomehrekbeee*Os apppnNmteaseAoeelketMMbe ienMMtoo wow We wet Instate MEM 1 taeRMoeisIsMM.P mleldea gawp er vow orate kw*oebNMB atrardeserdrirlskaapellnuturL aden60 amo Bm ore bicompient.site Nlee Jedbnml CestMaradopment aode.7MApplemtr owl seek'MeempMeMACeepeaetjr Isaad NM Ma WA.711mAml sathsrlMiM! 1g517%11714,.._ Mpeelkem ( �— �„ tbetm. — aasaggil.kiisSO-uae J U�r 1 7 2013 k JEFFERSON COUNTY DEPT OF COMMUNITY DEVELOPMENT • • OUILARSIMEM lfT The slow damas ddoesle a6y.aMlytarttAeymil s0awnaed1Mpanelnfaansedbadn,theft"I snotbmodoallaalaasodOMt they IA be.samdaotaen pomdyrofMaedentalCaabaabrbraaemoiledtie Signotuer Mr ( ) ( ) . Wins AO ns= Ewa: coanuhcroR'a Wass war* • Mum= NUMBER • ( ) P ( ) Monsw lootaoau .'Ewa Protest TtPir Fume rood •• SheaM S $aaapa Dlgtoaat Addllon ed Propoeeak — �t ;el Commonly gin n ANna6onlRemodel omets Totrl: 2 Type of Nest D Pub ii Pnalas.a� Totet ef Water Supply: Eidollm _ o Prince wiell 0 Tiro Psrly b Nord Ittliklmaamonlandsumusgenswitadwam Nim isrof s Spam Centime Propose* 'T d Member d�Pattdaap IBCOcoupe cy: A2 leaaoat. anapioyn: etc) 1°lgroab •11 n49.- Type dooraslnaoionc 11— veal you h.,e rood Sundae?Yoe/4 I Underground Tank 1 Above pound Tea* Sloe of Rowe Tank 1 Heart Sbw 1 Coot Stone I Woodland, I Fbepleoe breed 1 Hot W terTank I Mkt fibre 1 Curer kalkillaggagigglaggigajulkaftentubbibubse Yes/ No _ When gppipfdpAraprwilIoIesWfaprepeno task you mast alas synod is anapb shown*an&Ike Smarraipropa* Nisi,link Imam andsis,spsmeee*eatraiepopaneSinksselprepe,S►Natdd,bindtngs+seefwifevein essiplisisis. inslading in+aiawnoNV& . . t;taanaat . . • • Main Floor Heated A ** ., r Floor Heeled - (_[%4 OonefNeney Revisor . other Headed `t"f(` Bees for ' 1Aa:asnine X► Additional Bestow Heeled Basement Plsai Check fen Unheated 8eseamerd Slob gee to Other Wheeled Pot NbMr Rorie*fsec OsnegeriCatpoat 8I*1OYAt. • Demos lilUtd AppaoodHsx 'Oiler TOTAL: s • Receipt Number. • Cesh Cbeekth aber. • - -?, .. , ; 1 ;=, f s- - , ..,,. Dow Wei I'maN�Nmisadafi barsifistibisifa+da�7sbabtali Waft " PORMAMmerermitippimerma 5-99.eedoe • • MAIERSTASe M The atm cilia abionetdeeele abreerMyih nithyaleSe OeaewMeepo olall ar.reiWe b.thelWararrtioeraeicartraat.sodere Goys*bese.a* ers neponeblIty dale General eai radorerr*.premed pageol. illpealure Duly Gomm oamiw on OR Linournolliodo HO Elowo .se • PHO m ( ) ( ) • MameADORBiE BMIt„ — CONTRACTORa - PHONE( ) FAX( A>Oee . TYPII: F flaiwoona: SIwoollas-. Typs offbwillio obpo.ak - Now WWood Exile*. a Savor o Addlbn Proposed -'9'L---- an Irmo*To 2 Bt Spasm o.Roo* 0 Mowry Alf Va. 0 oeenolNon 0 other. Badraarrrs: ; Typo d Hoot Solbodc a Rhode wall C TO*Pady Tout y 0 Pubco • Number of Paging Spso.. Censee Papa s& 'I V Number old Packing Numberd *dudes owners,tenants,employees,een) convert Aepo..d 110 1f a L IBC Occupancy: f'12 IBC Typo'of oorawuolion: t -- WM you has Food Ssndoo?Y..I Ng 1 Underground Tank 1 Abaft wooed Tank Sin of Propans Took I Heat Stove I Coot Okra I VlAoodelow 1 Rroplaas Mead I Hot Water Took I PrMet Sloes 1 C Yes! No _ When appking fora pradtie be&apreprar&took you amattalsossabalt a aft plan attsaire all albs building*,allproperty aa%am*bag,*sad mink Memos flora Mae papaw tank isaeprops prinos,braidings andMPticsyeefearcamponem4r. Sao *ow Mewl Floor Fl.eted G. = _ /( vc age 2"-Floor Hooted %.4"-S ae delerrhq Review• Other Meted ewe bee. • Mamie& Additional Sect= Heeled B.aarnene Plan Clinic fax uNbrted low 1/e %O Other t.lnh.abd • Pot WOW Sco leiarfa. 1-1- Dad. MWApproaahINK _. TOTAL: $ • Receipt Number t ii/A CooldChook Numb= !4611 EatMuTEIo AREQUOMED) 5i5' $ oars . IWO'a.dal ateafallitiorNod 0 C. :.. .• •-- �•. ,•.; �.it -. t ..• - -••.. t, I JUN 1 7 2013 •1 JEFFERSON COUNTY DEPT OF COMMUNITY DEVELOPMENT 0 • �„, JEFFERSON COWRY ,,, ; 11111PAIMMITOP camilLINRY 0111M/LOPINSIP '. 621 lth.ridllt Moot•P ItTamlbad•1Atllllici rrt OMB . .1,1 • 360Y7844451 Fax Mahler PcnilitApp&Ntlion MLA: ROM IDsoodollori(Induds ammo*.ir..lnasrreaeetayk , • t,.,,,,, - 404 4v5trAt.. SebF,s. baih44oa s Ba iI M,ea-i-tifl 84.Jid.f+4.,. Tat.Pa eNntbp.r: S 1V S;Lb111 p gaga, $ iola?3% (lmenllr.aNtnq UsAddb.rsandtor 10 SCOSC10 S \)4' 41 Y.ar■ \)J\ at%1 gate.-110b101tiram All Tidaltrlrrrrrlr(Choc subbattha.pples __t ,. d.y�_ DwrNbli4-Perndt 0Yfasionce dharrM orRaa.eaabl.Ea illy CI Sole rusk O Owego AtNdr.d!Dolochrd 0 d.rilortd ttsaag),c «q” ��a`M'iwdHomo 0 WOK 0Dlocall.rwytrarif.rwerdMMamoili anon o� du.. 0 �`6iA. r a.rarPaM.Ff ►"' o Addis's 0 Road 0 Shot Plot** o norm lloinos ©Came Industry OSirigBb Mon M Phil* 0 Rowe 0 Pionnod ll.rs(fteldorld aar.loprunt pillBiNrrenirerls• 17 Nimrod Ira'Ur owsiolonog Mej& 0 Plat VosolorrMlloollan*' O Shook*adderPr.psm nft rndRwAdons" oPMW.ppram Advance Ooknoirr h grim. D .ls l ongnrant Sshd.aYDawlap uo t6* , Tom 0 Milos Tol 000swi./aaion* 0 camodiwWne Pisi+NO[lttsd aloe Mild WpMnrdaart o Food Pololo oAabllMamof91 loorYarded s 0.Il it oon Om*Shoal*MMMrr Avower Amardm.nt • •IbiragMtaPYa- pdar.iw QosMra• o TaMsa Catponso ory iog tel/1NId/1d�71r111111 . Ibr ildd PlispRs■i Q2.C,AA -S- ,- rAtItb SOV 1 S C!,`A,fGM boot sF is mewswrbglerrappinr.n for p.radl(s). 4,,e alt.. Date: reitle 1(t3 • irfo611111111 olOolaeloalue.a mods lloilloblo rtleswwldaiMalt,irid Maul____ taboo andaeaettaIMUalrt Whorabinadodlls Pay a MMtltYhMradara ymiiaaaauMddittandelbyIhrom isthe eaftImpcktoNs'N osroep.dtt nyrraavkra aft pirmai adlandvoid tallow ern team irdiswily arid adorn.wveJamas Coo*apdrvKatode sodoospsk orst000k IsmourioolrroWoO rod mown IN in.ritsow mom ogor stAllo onotokrios000mpoomorloalmgraortloPoolt i..rtibpa I bar SOW lo waft svoos yR.lwhrto Mina Coo*onobamplopoes,aPwewoi.sw opals tweeelkmomal Auvfbe iadn.aid NWimPe btlrrrMlmo.Mrr. airtlegenlIalle APtdwbtg►•Nbeaaara.dart.soreoppluattotbfMrtuel:ganq►irrnobs dam Imo of so applprlO�Mt�#rx Jr,dar The aoloseraotbra,App_r_Baer adarWaM•#reitatMr>wmrooadwar rrrpoefol ollrtpsn+Maasermwrivrwrodsr .+Mmg000l woks ad mil Indio sp oltidlolrar oho arrder lrred*Moo relassio essoMOrdtololoUmlbarBoom mins VirisOm.dep000aAse'MeV Mono Ooody aim woomost000 togs opplooldibst Is oceorsotiol es opoolgoo aaenaeWs p.mdt limbos lrraeduloatddrbtiaIOW PmOiddtbd,poop or vim dill floalin*on WWI dmsdrbp.ad*MN vag rdtblywrr oalooN moo Moos soiieaapimoo MOtho alb000n avow emluji1øTh oAppeoulto4 et rstllliIso ser1biblarwreYt ' mil i.�aaelir►�r. MrarMtgbggArMabirrti.6fA TleAp/frwrterr Noe lbt4dibdrinr •oo dies t.1 Miersrrt egoolou CN� plae, �-�- .Z l alrrritioplk iaaa,>Fal s IMMO. m --- ffi r 0 ,----- C) M S = 6- c..' fill • • r; \\ H --ri H TI elD H \ r –7 n E Z NJ H I I I 1 a :K i it tit L \ ' I I Z 0 ! lifil N 7 z \ &•,,- . fah, it 2 0 . . ...i \ \\ I I Z -rl 0 0 .., e -.) 0 ,,...,,,„ ,.... .. 00 -414- .4.4.■4 .. ,.. CI 4.■ 1 I ' ..4 t... me 1:1 a El i =T ® L ,1111111 ..1 _ I I t ■4 e■ III boar 0 EL II . 11 f.” f'l , a A 'IIII11:1 /1:;i: .,.111111 13 C , 1 .._ — filli .i. T , I ' r■ -=- - =7___[. , il 1 n c • --1 ---' .1 ' -7 Iliel st. „, 'II 111E1 . ■41. J.- mil 7 Effl I ■4 01.■ I sum tam .41:4.) / 1 V ▪u 1 n ■ 1 1 -.1)-,- AI H I 0 k -4 . a It / 1,/ / H u 1---IF ., . J R577 II —— r ,.d Q \•-...r ' A A 11 r ri 1 ° 1 . II 1 11 (-- _ 1> -,, .:(0 ILO 0 C C 1 1 i 11 I 1 1 o o p I r C * i — 1 ii r I 0 .— lil; I -4 L , 11 1 , Li Li 1 , • it–/ U 1.--- ✓ ' > 0) — co R° o 0) in 1 rr) , O 4, O 1 z .... o 4.,4 I -ri r " O E 0 xt (.: -. . f • f ORCAA Permit Application Status Permit Status 0 Approved Cl Disapproved Notes Review Date 06/05/13 Reviewed by sears. Permit# 13DEM003500 Expiration Date 09/30/2013 06/05/2013 Application Received Amount Due 60.00 pd. 6/5/13KLE ❑Cash 0 Check 0 Credit card Additional notes or permit conditions jrn' I, . f�. JUN 1 7 2013 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT Olympic Region Clean Clean Air Agency(AAA) 2 Limited Lane NW voloh, 366.539-1610 FAX 1 PortAngeles Office 4 17-14188,- DEMOLI110t4 PERM � Demolition and renovation projects within Clallam,Grays Harbor,Jefferson,Mason,Pacific and Thurston counties REQUIRE A PERMIT and require that the following permit conditions be met prior to demolition or renovation. 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 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 an 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 demolition 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,as well as any subsequent amendments, must be kept on site and available for review by Agency inspection personnel. 7. Use the Completion Notification and Amendment Form to make changes to the original permit. 8.The original demolition permit will expire on the Completion Date.To change the completion date,a Completion Notification and Amendment form must be received PRIOR to expiration. 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 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.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 use as a rental,or for commercial purposes. PROPERTY OWNER • • Name Mailing address City ZIP State Pleasant Harbor Marina ancj 308913 U.S. Hwy 101 Brinnon 98320 Wa Site address City ZIP 308913 U.S.Hwy 101 (Brinnon ( 98320 FAX Phone number Other contact number Email 360-796-4611 206-714-1482 1 (don©pleasantharbormarina.com DEMOLITION CONTRACTOR ❑ check the box if same as property owner information Business/Contractor Name On-site contact 1Ron's Earthworks, INC. E-mail Mailing address City ZIP 1 18315 Waller Rd E ( Tacoma 198443 Phone number Other contact number DEMOLITION PROJECT INFORMATION Number of structures being demolished (1 Start date Completion date Is asbestos present? 109/09/13 ( 109/30/13 No Attach your asbestos survey below NW asbestos report.pdf Has all identified asbestos been removed Yes DEMOLITION PROJECT CATEGORY © Complete demolition ❑ Training fire-(complete fields below) ❑ Renovation,alternation,remodeling, maintenance or other construction If training fire,provide fire protection agency name, point of contact and telephone number ❑ Owner occupied residential dwelling-Permit fee:$35.00-Prior Notice-Nonrefundable 0 Other Structures-Permit fee:$60.00-10 working day wait period-Nonrefundable ❑ Emergency Fee$50.00-must be accompanied by Government Ordered Declaration(other structures only) Attach declaration below PLEASE MAKE A NOTE OF YOUR FEE. Applicant name Date (Pleasant Harbor Marina and Golf Resort, LLP. 1 06/05/13 • • By checking the box and clicking"Submit"at the bottom of this form,you hereby certify that all identified asbestos in the project area has been removed and the information contained on this form and supplemental data described herein is,to the best of my knowledge,accurate and complete. O I agree • • NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend,WA 98368 northwestasbestosconsultants @cablespeed.com 360-385-0584 Date; 9/4/12 tob Site: Pleasant Harbor Marina 308913 Highway 101 Brinnon,WA 98320 QktLICIL Statesman Corporation 7370 Sierra Morena Blvd. Calgary,AB T3H 4119 Contacts: Statesman Corporation 7370 Sierra Morena Blvd. Calgary,AB T3H 4119 Don and Diane Coleman Pleasant Harbor Marina 308913 Highway 101 Brinnon, WA 98320 subject: Demolition Inspector: Bob Witheridge AHERA- Building inspector / Management Planner WAMOA-0042-1021201102 Expires- 10/21/12 • • Scope of work 1) Building survey and inspection to inspect for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect material. 3) Report to Don Coleman with results of testing from Northern Industrial Hygiene, Inc. Inspection Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Two story building had,T111 wood exterior siding,metal clad windows and metal roof. Carpet and vinyl floors on cement foundation. Forced air eletric heating system. Samples are as follows: Sample #1: Dining hall bathroom. Floor vinyl with mastic.Tan Sample #2: Dining hall bathroom. Cove base with mastic. Gray Sample #:4 Dining hall ceiling tile. Sample #4: Back storage wall and store ceiling material. Sample #5: Sheet rock tape and mud. Homogeneous Sample #6: Upstairs office area.Kitchen, hallway and bathroom. Floor vinyl with mastic. Tan and gray. Sample #7: Upstairs office cove base. Gray Sample #8: Upstairs porch floor material. • ASBESTOS BULK SAMPLE DATA NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector/ Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St.Port Townsend,WA 98368 northwestasbestosconsultants @cablespeed.com 360-385-0584 To Northern Industrial Hygiene, Inc. bate: 8/30/12 lob Site: Pleasant Harbor Marina 308913 Highway 101 Brannon, WA 98320 er: Statesman Corporation 7370 Sierra Morena Blvd. Calgary,AB T3H 4H9 Contacts: Statesman Corporation 7370 Sierra Morena Blvd. Calgary,AB T3H 4H9 Don and Diane Coleman Pleasant Harbor Marina 308913 Highway 101 Brannon WA 98320 Sample #1: Dining hall bathroom. Floor vinyl with mastic. Tan Sample #2: Dining hall bathroom.Cove base with mastic.Gray Sample #:3 Dining hall ceiling tile. Sample #4: Back storage wall and store ceiling material. Sample #5: Sheet rock tape and mud. Homogeneous S. •.ple #6: Upstairs office area. Kitchen, hallway and bathroom. Floor vinyl with mastic. Tan and gray. Sample #7: Upstairs office cove base. Gray Sample#8: Upstairs porch floor material. juspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA-0042-1021201102 Expires- 10/21/12 See attachment. Thank you, Bob Wi eridge, .F.M. 215 SW 153rd Street Burien,WA 98166 OFFICE:(206)988-1746 FAX:(206)988-1978 IRTHERIN NVLAP Lab Code:200511-0 _._.m.Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00548 408 Reed Street Client Job Number: Port Townsend,WA 88368- Turn Around Time: 5 Day C Project Location: 308913 lighway 101,Brinnon,WA . Samples Analyzed: 8 Client Sample Number: 1 Lab Sample Number: 12.00648.0001 Client Sample Description: Tan Floor Vinyl with Mastic Client Sample Location: Dining Hail Bathroom Sample Comments: Checked If Sample Not Analyzed El Layer 1 Tan and white patterned vinyl with grayish-tan fibrous backing and yellow adhesive Asbestos Fibrous Components: Non Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 10% Cellulose 40% Filler and Binder 5% Fiberglass 20% Foam 25% Vinyl Filler and Binder Comments: Materials distinguishable but inseparable Layer 2 White vinyl with tan fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 10% Cellulose 30% Filler and Binder 35% Foam 25% Vinyl Filler and Binder Comments: Materials distinguishable but inseparable Client Sample Number: 2 Lab Sample Number: 12-00548.0002 Client Sample Description: Gray Cove Base with Mastic Client Sample Location: Dining Hall Bathroom Sample Comments: Checked If Sample Not Analyzed Layer 1 Pale-blue and gray vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 100% Vinyl Filler and Binder Layer 2 Yellow adhesive with tan powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 2% Cellulose 98% Filler and Binder Conanients: Materials distinguishable but inseparable =Er�'3i::{s.,.-..-��.�.., ;2^..: 'r,;. _.,r......5:, -. ...1...a. ,..`.`r ....:: h.0-.; ..k.,`?-1* .-�.:: .-� _;C<°::.`,t'^"4. - n..7,•�t'4§"^�.. ... ....:�'4e.�--.::�C;l:\%Sw":.�:;�;=: Client Sample Number: 3 Lab Sample Number: 1200548.0003 Client Sample Description: Ceiling Tile Client Sample Location: Dining Hall Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed fl (Sample results continued on next page.) Sampled by: Bob Witheridge 8130/2012 Received by: Fermin Bribe 8/31/2012 Gf� r7.4*.- Reviewed by: Rachel Melgoza 91412012 Rachel Melgoza,Analyst Page 1 215 SW 153rd Street Burien,WA 98166 OFFICE:(206)988-1746 FAX:(2061988-1978 t T H `? .: - NVLAP Lab Code:200511-0 Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number. 12-00548 �w.__ e_4 H4N~5tiv4YaY 406 Reed Street Client Job Number. Port Townsend,WA 98368- Turn Around Time: 5 Day C Project Location: 308913 Highway 101,Brinnon,WA Samples Analyzed: 8 White paint on off-white fibrous compressed material with brown coating Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 30% Cellulose 50% Filler and Binder 13% Mineral Wool and-Beads 7% Paint Client Sample Number. 4 Lab Sample Number. 1240548.0004 Client Sample Description: Ceiling Material Client Sample Location: Back Storage Wall&Store Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed 0 White paint on 8ghtlbrown fibrous compressed material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 80% Cellulose 5% Filler and Binder 15% Paint -,......i. .. "2' F rT„`..K..... ... '...s.' .�.,.:.._as.rvs. � . ✓I...T 35:.�:r:vA l 'e5' Client Sample Number. 5 Lab Sample Number 12-00548.0005 Client Sample Description: Sheetrock,Tape&Mud Client Sample Location: Homogenous Sample Comments: Checked If Sample Not Analyzed 0 Layer 1 White paint on white compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 2% Cellulose 75% Filler and Binder 23% Paint Continents: Materials distinguishable but inseparable Layer 2 Off-white paper and white compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 35% Cellulose 65% Filler and Binder Comments: Materials distinguishable but inseparable Layer 3 Tan paper and white powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 90% Cellulose 10% Filler and Binder Comments: Materials distinguishable but inseparable (Sample results continued on next page.) Sampled by: Bob Wltheridge 8/30/2012 Received by: Fermin Uribe 8/31/2012 ' "- Reviewed by: Rachel Melgoza 914/2012 Rachel Melgoza,Analyst Page 2 • • 215 SW 153rd Street Burien,WA 98166 OFFICE: (206)988-1746 FAX:(206)988-1978 I LKI:C' T E NVLAP Lab Code:200511-0 Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number. 12-00648 406 Reed Street Client Job Number. Pod Townsend,WA 98368- Turn Around Time: 5 Day C Project Location: 308913 highway 101,Brinnon,WA Samples Analyzed: 8 Client Sample Number. 6 Lab Sample Number. 12-00548.0006 Client Sample Description: Tan&Gray Floor Vinyl with Mastic Client Sample Location: Upstairs Office Area,Kitchen,Hallway&Bathroom Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed El Off-white/tan/gray vinyl with off-white fibrous backing and yellow adhesive Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 10% Cellulose 30% Filler and Binder 10% Synthetic 25% Foam 25% Vinyl Filler and Binder i r..,' 3.+°?a :s>-tt -..s,?fir sue.--;"--';sv4-.::>sre3.-, :�,:a:.3lSs .:v-<E,._.•a,- >�,.. .r. ._ .,:::.4s' :1„xafi._.��s,z£ao£a,:sc:5;,,vy�,`�: -r. .a.n:.. .. .h'. cc Client Sample Number. 7 Lab Sample Number, 12-00548.0007 Client Sample Description: Gray Cove Base Client Sample Location: Upstairs Offic Sample Comments: Checked If Sample Not Analyzed ❑ Layer 1 Gray vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 100% Vinyl Filler and Binder Layer 2 Off-white pliable material,white paint and white powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 1% Cellulose 89% Filter and Binder 10% Paint Comments: Materials distinguishable but inseparable Client Sample Number: 8 Lab Sample Number 12-00648.0008 Client Sample Description: Floor Material Client Sample Location: Upstairs Porch Sample Comments: Checked If Sample Not Analyzed Orange and yellow gravel on black fibrous asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Fiberglass 35% Aggregate 50% Asphalt Filler and Binder ,v;4.....r::Yx -F - - ...;x;.:-� �...ivu_,_..__ -.'.off..`- :_,„ac..x ,..x, „�.. ...,-.:dw..c c.--;ti._,_, ._�..y;��s"✓^Y<;.:.,_�'r. .':?f�i,'.-..,..-a,,., ��, _...... .;R�^,. .,�..,,_..,_..c Sampled by: Bob Wltheridge 8/3012012 Received by Fermin Uribe 8/31/2012 Reviewed by Rachel Melgoza 9/4/2012 Rachel Melgoza,Analyst page 3 • • Summary of Inspection, Lab reports as follows: Sample #1: Dining hall bathroom. Floor vinyl with mastic. Tan No asbestos detected. Sample #2: Dining hall bathroom. Cove base with mastic. Gray No asbestos detected. Sample #:3 Dining hall ceiling tile. No asbestos detected. Sample #4: Back storage wall and store ceiling material. No asbestos detected. Sample #5: Sheet rock tape and mud. Homogeneous No asbestos detected. Sample #6: Upstairs office area. Kitchen, hallway and bathroom. Floor vinyl with mastic. Tan and gray. No asbestos detected. Sample#7: Upstairs office cove base. Gray No asbestos detected. Sample #8: Upstairs porch floor material. No asbestos detected. All asbestos containing building materials with a reading of greater than 1%is considered a hazardous material if disturbed. Removal of any hazardous materials must be abated by a certified abatement contractor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency. During building demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non-asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence. Thank you, Bob Witheridge, E.F.M. � �{ JEFFERSON COUNTY �9SflI N.,° DEPARTMIT OF COMMUNITY DEVELO�IENT f Date: / /S Time Received: a/pm Mon. ue Wed. Thur. Fri. Date: Cf l� BLD: 13-- / / Contact Name: Owner: Contact Number: 360 5910 v5-5.- Address: SogctJ3 (/9/ 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection____ - Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 PERMIT#: BLD13-00191 Received Date 6/20/2013 SITE ADDRESS: 308913 HWY 101 Issue Date 10/28/2013 BRINNON, 98320 APPLICANT: PLEASANT HARBOR MARINA& PHONE: 360-796-4611 GOLF RESORT LLP 308913 US HIGHWAY 101 BRINNON WA 98320-9719 1 SUBDIVISION: PLEASANT HARBOR MARINA SHORT P Block: Lot: PARCEL NUMBER: 502152013 Section: 15 Township: 25N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, PLEASANT HARBOR MARINA& PHONE: 360-796-4611 if different: GOLF RESORT LLP 308913 US HIGHWAY 101 BRINNON WA 98320-9719 PROJECT DESCRIPTION: DEMO EXISTING BISTRO Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/28/2014. REQUIRED INSPECTION: FinalApproval: /51/g 9/4/;,/# BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday SPECIAL CONDITIONS APPLY- SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS FOR CASE#BLD13-00191: 1.) Health approval of this demo permit is based on the understanding that the property owners are aware that any future building permits (including one to re-build this facility) shall not receive approval from JCPH until all identified drinking water and waste water issue are fully resolved. \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 10/28/2013