HomeMy WebLinkAboutPermit Building 2010-6-28
Status
,
Issued
CITY OF SPRINGFIELD
Building/Combination, Permit
PERMIT NO: COM2010-00831
ISSUED: 06/28/2010
APPLIED: 06/28/2010
EXPIRES: 12/28/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
1
SITE ADDRESS: 812 G ST
ASSESSOR'S PARCEL NO.: 1703351206900
Springfield TYPE OF WORK: Site Work Only
, '.' "TYPE OF USE: Demolition
Residential
PROJECT DESCRIPTION: Demolish house and shed
Owner:
Address:
SPRINGFIELD SCHOOL DISTRICT 19 . es 'lOll to
525 MILL ST teClll11 \.l\ili\'l
SPRINGFIELD OR 97477 ... Ote901l ~~~"e OlegOllse\ \O{\t\
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Contractotlll 0 Cl ,<oil {'(Ia.'1elllel. It-lo\J\ili\'1 t-Icti\?ense
STANTON &it . \MlIii> ~l!)!e901l_ 32-23L\~lr323 '
1I1l{'(l I G INFORMATION
Expiration Date
. 05/0912012
Phone
541,688-7038
Contractor Type
General
VB
# of Stories:
Height of Structure.
Type of Heat:
Water Type:
"Ra'~ge Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
# of Units:
Primary Occupancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
u/a
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATIO;~ ~o?-\(
\'I?-C \r \S \'0\01
t-\OI\'8~I~)\f\\.\. :{\\\S \'c?-\'J\\\O?- :'
1\-\\S wsW fM~\ld. ~DO\'o\c\)',
ilUll~l7~ ~e~'\\;:f>.~1X ,.,." .
co\JK~)Q,~f\'( '?W~.
. ;'{,,~80. '_
I,PUBLIC IMPROVEMENTS ~
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
L\:iL.I: l.t ..",t
I valu~i~ontle~~riPtion ,
....'
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I of 2
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CITY OF SPRINGFIELD
Building/Combination Per,mit
PERMIT NO: COM2010-00831
ISSUED: 06/28/2010
APPLIED: 06/28/2010
EXPIRES: 12/28/2010
VALUE:
I..
Status
Iss u ed
. .~ .,"" ;
. ,~
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax'
541-726-3769 Inspection Line
I"d, .,,, . .
_ :.:T.iJtaI..Vlilue.of Project
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IF" n~'d I
. ,:.0', ,ees ,.af .
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Demolition
'. Sanitary or Storm Sewer Cap
Amount Paid Date Paid Receipt Number
$6.96 6128110 2201000000000000752
$5.80 6128110 2201000000000000752
$58.00 6128/1 0 2201000000000000752
$58.00 6128110 2201000000000000752
Total Amount Paid
$128.76
I ,,!~I~n Revie.\Vs I
Demolition: After demolition is complete, s~$~1tis.-~j~~Jd or septic is pumped and filled and inspection is
requested and approv~d, and all debris is removed from the site.
Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as
required by the code.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information herenn is true and correct, and I further certify that any arid' all work performed shall be done in accordance with
the Ordinances ofthe City of Springfield and the Laws ofthe State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are iri:compliance with ORS 701.005 will be used on this project.
I fnrther agree to ensnre that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the fron't:O'r'th'e'prope~tY~ and the approved set of plans will remain on the site at all
times during construction.
~U'_~d 4. 6c)c-/C)
Owner or Contractors Signature
Date
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City .of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000752
Date: 06/28/2010
IO:14:07AM
Job/Journal Number
COM20 1 0-00831
COM20 1 0-00831
COM20 1 0-00831
COM20 1 0-00831
Description
Demolition
Sanitary or Storm Sewer Cap
+ 12% State Surcharge
+ 5% Technology Fee
.". ..~.;
Amount Due
58.00
58.00
6.96
5.80
$128.76
Payments:
Type of Payment
Check
Paid By
GREG PAYNE CONST
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
CJC
51230
In Person
Payment Total:
$128.76
$128.76
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Page 1 of 1
6/28/20 I 0
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
DEMOLITION PERMIT APPLICATION
Address: ~/;), G ~
Structure to be Demolished: &~. rI-- ;;;,e,,tJ
Job Number: C c>v-- ?C>r 0 - c::> 0 g'1 /
The applicant is hereby notified that any redevelopment of the subject site must
comply with all of the applicable laws, codes, ordinances, polices and plans in
effect at the time the redevelopment proposal is accepted as complete for City
review. This would include correction of substandard conditions associated with
the present development. Examples of such corrections may include
modification of inadequate drainage facilities; compliance with building set-
backs from property lines; correction of substandard sidewalks and street
improvements, including driveway width and placement; and other corrections
which may be necessary to comply with existing development standards.
Furthermore, if an existing use is demolished or otherwise removed prior to the
development of the proposed use, then the system development charge credit for
the previously existing use shall expire two years after the date of issuance of the
demolition permit or other removal of the previously existing use. (Springfield
Municipal Code 3-416(1)).
My signature below indicates that I have read and understand the above
conditions relating to the demolition of the above mentioned structure.
~/21/'U51 0
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Date
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SPRJNGFIELD
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
DEMOLITION PERMIT APPLICATIONS
Your demolition permit is currently being processed. There may be a slight delay, of
up to 2 working days for small structures, due to the time required to review the
history of the structure to determine if it needs to be documented before demolition.
This documentation is for archival purposes only and will not affect the granting of
the demolition permit. Ifthe structure is very large or complicated the
documentation process may take up to a maximum of 4 working days.
Documentation will consist of photographing the building, taking measurements and
making scaled drawings. The documentation will be undertaken by the City at no cost
to you. Documentation is being done on all structures dated prior to 1940 that may
have historic importance to the City's development.
THIS DOCUMENTATION WILL NOT IMPEDE THE DEMOLmON PROCESS.
An age cut-off of 1940 was chosen because this is the date that the National Parks
Service and The Springfield Development Code use to determine potential historic
significance.
If you would prefer to complete this documentation yourself you must provide the
City with the following information: 1) black and white photographs of each
elevation, a floor plan with measurements, and 2) a set of elevation drawings with
measurements.
Thank you for your patience.
I grant the City of Springfield permission to enter my property to complete
documentation prior to the requested liemolition of the structure located at:
Address: '2? I l .,,-- +
,
Property Owner Signa
Date: c;.. /r r:;/ U I 0
Job Number: Cc::MA .0\ 0-
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,~. 'iER\Cl20 SF~\{h":!~.l)i5~i:1L~f~ "IETER},l'..l:"l,)WNE.D. HU'f.;...o:(.~,~r.:.n ~"~';'1ttLi~ 8';,J$fNr:.;~";
Environmental Remediation
Asbestos/Lead/Mold/Drug Labs/PCBs/Heat & Moisture Detection/C02 Drv Ice Blasting
/l COfpr,'il-r:"r.,,:,:,,"NT TO EX.C~-;:!.U::;.l'!(.::t~
CCB #64090
23525 Hwy. 99 E. Harrisburg, OR 97446
PH 541-995-6008 FX 541-995-1015
Email ateziWatezinc.com Website www.atezinc.com
PROJECT COMPLETION NOTIFICATION ASBESTOS
Date: 05/06/10
ATEZ, Inc. Project Control Number: 100432
Client: Mr. John Seraceno
Springfield School District
1890 N 42"d
Springfield, OR 97477
Project: Remove asbestos containing sheet vinyl from restroom, hall, and kitchen
Former Community Transition Program
812 G Street
Springfield, OR 97477
Attention: Mr. Seraceno,
Attached please find all the documentation pertaining to the proper removal and disposal of:
LRAPA NOTICE
1. Paid for and provided the required LRAPA Notice (permit)
RESTROOM-ADJACENT HALLWAY-DINING ROOM AND KITCHEN
2. Removed THREE HUNDRED square feet (300 SF) of asbestos-containing Brown and Tan
square pattern Sheet Vinyl (mastic is NAD) on underlayment over T&G wood flooring by
creating a negative air containment and establishing and maintaining a minimum of -0,02
negative pressure on the WC during work and by removing the underlayment to which the
Sheet Vinyl is applie'd
KITCHEN BENEATH THE SINK IN THE CABINET
3. Removed SIX square feet (06 SF) of asbestos-containing Clover pattem Sheet Vinyl
(mastic is NAD) on T&G wood flooring by creating a negative air containment and
establishing and maintaining a minimum of -0.02 negative pressure on the WC during work
and by removing the underlayment to which the Sheet Vinyl is applied
DISPOSAL RECEIPT
4, Properly dispose of waste and provide the DEQ ANS-4 disposal receipt
This Work will be completed as a Class II, Friable, Full-Scale, Non-Prevailing Wage, AHERA, Pre-
Demolition, LRAPA Asbestos Abatement Project.
If additional hidden asbestos containing materials are uncovered during the demolition process you
must cease work and contact an asbestos abatement contractor to properly remove and dispose of
the additional materials per DEQ, LRAPA and EPA regulations.
The work was completed on 4/27/10 by a certified asbestos abatement supervisor and certified
asbestos abatement workers. The work was completed without incident incompliance with EPA,
DEQ/LRAPA regulations. '
The waste is being stored at 23525 Hwy 99 E Harrisburg, Oregon until it is transported under cover
to Coffin Butte Landfill for disposal. At that time, you will receive an ASN-4 form showing the waste
was disposed of in compliance with appropriate regulations. .
Included under this same cover, please find copies of the LRAPA Notice, Contractor's License and
Employee Certifications, Air Monitoring results, and ASN-4 (disposal document). If any further
information is required please call our office at 541-995-6008. .
Thank you.
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R6bert R Kinyon, Presi nt , Inc.
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STATE OF OREGON
CONSTRUCTION CONTRACTORS BOARD
LICENSE CERTlFICA TE
LICENSE NUMBER: 64090
This document certifies that:
ATEZ INC
23525 HIGHWAY 99 E
HARRISBURG OR 97446
is licensed in accordance with Oregon Law as a Residential General Contractor arid a Commercial General
Contractor Level 1.
License Details:
EXPIRATION DATE: 0210212011
ENTITY TYPE: Corporation
INDEP. CONT.STATUS: NONEXEMPT
RESIDENTIAL BOND: $20,000
COMMERCIAL BOND: $75,000
INSURANCE: 54,000,0001 $4,000,000
RMI: ROBERT R KINYON
HOME INSPECTOR CERTIFIED: NO
LEAD BASED PAINT LICENSED: YES
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FULL SCALE ASBESTOS ABATEMENT CONTRACTOR LICENSE
Department of Environmental Quality
1550 N.W. Eastman Parkway, Suite 290
Gresham, OR 97030
Telephone: (503) 667-84.14 exl. 55022
Issued in Aecordancc with the Provisions ofORS 468A.710
ISSUED TO:
LICENSE NUMBER:
ATEZINC
23525 HWY 99 E
HARRISBURG OR 97446
FSC535
EXPIRATION DATE:
MARCH 1,2011
INFORMATION RELIED UPON:
Asbestos Abatement Contractor License Application sublTlined JANUARY 28, 2010
ISSUED BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY
. ''1 '
T Oo",;L'=__________
Kathy Amidon-Acting Air Quality Manager
Northwest RegiOn/Gresham Omce
FEB 0 3 2010
Date
Thc contractor named above is herewith authorized to conduel asbestos abatement in the State of
Oregon subject to thc tenl1S and conditions of Oregon Administrative Rules (OAR) Chapter 340
Division 248, including thc conditions listcd bclow.
I. The contraetllr shall cnsure that each worker perf0n11S asbestos abatement work in
compliance with OAR 340-248-0010 through 340-248-0290 and other applicable statc
and federal asbestos abatement regulations.
(
TEN-DAY AND NON-FRIABLE NOTIFICATION OF INTENT TO REMOVE OR ENCAPSULATE
ASBESTOS IN LANE COUNTY, OREGON
Lane RegIonal Air Protection Agency
1010 Main Street
Springfield, OR 97477
541 736-1056, Fax: 541 726-1205, toll free 877 285-7272
Type of Abatement Project Category and REQUIRED Fee
D Emergency Waiver {Add 50% to required fee) S
D Non-FriabLe (5-Day Notice)
o Residential Project (Occupied Residence, n!!! for Demolition)
D .::. 40 lin/80 sq ft (Small Scale, Short Duration)
o > 40 linear/80 square feet;.::. 260 Linear/16O square feet
:x > 260 Linear/16O sqtt;.::. 1,300 linear/SOD sqft
o > 1,300 linear/SOD sqft; .::. 2,600 linear/I ,600 sqft
o > 2,600 linear/I ,600 sqft; .::. 5,000 linear13,5oo sqft
o > 5,000 linear/3,5oo sqft;.::. 10,000 linear/6,ooo sqtt
o > 10,000 linear/6,000 sqft; .::. 26,000 linear/16,OOO sqft
o > 26,000 linear/16,OOO sqft; .::. 260,000 linear/160,OOO sqlt
D ~ 260000 linear /160000 sqft
For LRAP~, Use:
ProjeCt:
Fee Rec'd: S'
CKeck #:
)( DemoLition
0 Removal S46
0 Encapsulation S46
D Renovation $46
0 Maintenance/ReJljlir $'98
Other_ $ 394
$ 494
Has a survey been $ 855
completed? $ 986
Yes)l{ NOD $ 1;579
II Yes By ~ S 2,632
Whom? S 3,290
, ABATEMENT PROJECT INF RMATlON
Site Name Phone
Site Address ,City 5/1Y"' '" 'It:. ...o,~ ',() (l..
LocatIon of Asbestos at the site + , ,
Site Category: D school D resii:lence D col ege n industrial D commercial D other
Start Date1:l~'1'- -Ii) Completion Date~ Hours on Site<<;""" 'SfY\'\ - Days on Site "",
Emergency project notification requested: D No D Yes n Discussed with Date
TYPE OF ASBESTOS MATERIAL
Type ~ Percent of~, 'i"'S''? () C l^N LA <.;r\.LL, D Estimate)(Lab
Quantity of asbestos In proJect 3C'l" \ D LInear )(.Square D Cubic feet
o pipe insulation 0 tape D cementatious(eg: tronsite) D floor tile D roofing D felt 0 sprayon
o valve packing 0 mastic !l( sheet vinyl D other '
WORK PRACTICES AND REMOVAL PROCEDURES
~ wet method D dry methods with air filtering 0 glovebag ,:S.containment'>(l negative air
<>'iHEPA vacuum 0 vacuum truck with HEPA filter 0 other
Ambient air monitoring to be performed: "I:Jes D no
DISPOSAL PROCEDURES .'
D chute to dropbox D hand-load dropbox l(wetted and double bagged D other
D waste stored on site in secured container (waste secured off site ate>?"'iJ'\4. ,.., ""1 C. l\r."Y'~ \", '"
"]ii.Waste removed daily D other U
DISPOSAL SITE
o Short Mountain offin Butte
ABATEMENT CONTRACTOR
Contractor Name
Mailing dress
City ~ State ZIP
Competent Person 4. r' 0 - en ZUelCl)ficate No
PR:~:V~,pOA fe&p-~l.
Clty~ ' State~ zlP'tN-n
.
Name (Please P I?
Signature
EmaiL
Is'this a revision to a revious notification? Yes D No 0
License No. F S c. ~ 1Y3
Phone 5Il~- 1 "lL/- c...'3'T'S
frTE~ J:~ )
Phone Qt:j5bdC18'
Date 4-1 e;--/ /")
A5II:07D109
Form Available on LRAPA website: www.lrapa.org
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EHSi
Labotalories'
Environmental Hazards Services, l.l.C.
7469 Whitepine Rd
Richmond, VA 23237
Telephone: 800.347.4010
Fiber Count
Analysis Report
Client:
ATEZ Inc.
P.O. Box 126
Harrisburg, OR 97446
Report Number:
Received Dale:
Analyzed Dale:
Reported Date:
10-{J4-()3807
04/29/2010
05/04/2010
05104/2010
ProiecUTestAdd~: 100432; Former Community Transition Program; 812 G
St.
Cliant Number: Laboratory Results Fax Number:
38-1287 541-995-1015
E
Lab Sample Client Sample Volume Fibers/Fields FiberslCC NarrativelD
Number Number Liters III
10-04-03807-001 0427AD1-100432 2880 4.0/100 <0.005
10-04-03807-002 0427P1-100432 180 26.0/100 0.071
10-04-03807-003 0427P2-100432 220 28.0/100 0.062
10-04-03807-004 0427PE-100432 60.0 36.0/100 0.29
Method: NIOSH 7400, Issue 2,08-15-94
Analyst: Kathy Sizemore
Reviewed By Authorized Signatory:
~. t/;;;:,
Howard Varner
General Manager
Inter1aboratory Sr for fiber count ranges 5-20, 20-50, and > 50 respectiYelyare 0.136, 0.118.0.111. lntralaboratory $r for fiber count ranges 5-20, 20-50,
and >50 respectively are 0.179,O.108,0.052-lor Mar1< Case; 0.189, 0.108. 0.050 lor Kathy Sizemore; and 0.175, 0.105, 0.050 lor an other analysis.
NOTE: The condition of the samples analyzed was acceptable upon receipt per Iaboralofy protocol unless otherwise noted on this report. Resulls
represent the analysis of samples submitted by the cfient sample location, description, area, volume. etc., was Pl'O'Vided by the client. The submission of
blank samples is required by sampling methodologies. EHS sample resulls are blank co_, per NIOSH 7400, when the client submits blank samples.
If the report does not contain the result for a fiekj blank. it is due to the fad that the client did not include a field blank with their samples. This report
cannot be used by the client to claim product endorsement by NIIU\P or any agency of the U.S. Gow!mment. This report shall not be reproduced except
in full, without the written consent of the Environmental Hazards Service, L.L.C. Califomla Certification #2319 NY ElAP #11714.
Method Level of De\edion: Estimated al7 fiberslmm2.
LEGEND
L = liters
fiberslcc = fibers per cubic centimeter
fiberslmm2 "" fibers per square millimeter
Page 1 of 1
t:NVIKUNMt:.N I AL HALARDS SERVICES, L.L,C.
1489 Whlteplne Road Richmond, Virginia 23237Phonll {804) 275-4788 Fax (804) 275-4907
;, CHAIN OF CUSTODY FORM
Company Name: A TEZ Inc.
AddrNa: 23825 Hwv. 99 E. \
City, State, Zip: Hanol.burtt. OR 97448
EHS Client Account #: 38-12.7
Phon. #: Hf-99S-800'
Fax #: tu1-99S-101~
Emall: davldOatezlnc.~
Sample # -
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Contact Name: .
Sampler Nam.:
Project #:
other Metals
Indoor
AirQu~lity
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0427 AD 1-1 00432
0427P 1-1 00432
0427P2-100432
0427PE-100432
4/2712010 .
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I~eceived by: Signature: V/ J r I YJ/ IJ/ A..A )
I~eleased by: Signature:' (I
IReceived by: Signature:
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412B12010
Jodie
Adalberlo Va/enzue/.
1CKU32 Fonner Community
TranalUon Program .12 G St
Particulate: T
Air Volum
OR
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OR
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Araalcr . J
12 LPM 240 Mln
2 LPM 90 Mln
2 LPM 110 Mln
2 LPM 30 Mln
DatefTime:
DatefTime:
DatefTime:
Date/Time:
1 ()..04.0a807
11111I11~111111j11
Due Date:
0510412010
- (Tuesday)
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Job Number. 1M l(? r . , Date: tJ'f /11' r li a.
Job Name: Fv:..o..t,~ C.~AA Tt11- (J~ -
Client Name:
number
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Exac:l Location
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Type afWort<
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