06-104658' City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
■
Demolition Perm #: 06- 104658 -00 -DE
Inspection Request Line: (253) 835 -3050
Project Name: CHOI
Project Address: 737 SW 328TH PL Parcel Number: 683782 0130
Project Description: Demolition of fire damaged residence w /foundation to remain.
Owner
Applicant
Contractor
CHUN Y CHOI
RANDY JOHNSON
UNIVERSAL BUILDING
JACQUELINE CHOI
UNIVERSAL BUILDING
UNIVEBI005MF (7/1/07)
737 SW 328TH PL
8300 61ST AVE NE
8300 61ST AVE NE
FEDERAL WAY WA
OLYMPIA WA 98516
OLYMPIA WA 98516
98023 -5225
Additional Permit Information
CONDITIONS:
After a spection is come A#di p -v d, Please contact Kari Cimmer by e-mail at
Karii b t�,ci.federal- way.wa.us to receive a refund of cash bond.
I hereby certify that the above i
the occupancy and t use
P
P
is correct and that the construction on the above described property and
Fdance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: fir ' %-& 9- V) -&-n Date: 9. 14 -4
•` THIS CARD IS TO nVMAIN ON -SITE X ,
CITY OF Community m Rt p
Develo p Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 06- 104658 -00 -DE
Owner: CHUN Y CHOI
Address: 737 SW 328TH PL
FEDERAL WAY, WA 98023 -5225
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On -going inspections
are logged on the back of this card.
❑ Final - Building (4050)
Approved
By C Date 1( Y
RECE &D
r'ederajway SEP 14 2006 PERMIT
C0mwx7Y DEYELOPMEMr
3332S8mAyENVE� fN•pp� OF FEDER ' CATI O N
FmzRALWAY,WA 98063 -9718, BU(LDING D
?53435- ?607• PAX ?53,835- ?609
www.d(n•Red n*my.wm
- an
SITE ADDRESS
Z
will not be
C
SF MF CO ME EL PLCDDE EN FP
ited. Please print leatbiu /in ink) or tune.
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # C) LOT SIZE (s}J
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(A-ch swouft ~la kMW lW daaatpuanl
ROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING . ❑ PLUMBING ❑ MECHANICAL
DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this hermit only)
wSa �i� _ ��_ ��♦ 1,�a It - Iia MEW
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
�ti o'er (2-6 ) 4'49 - Sb3 n
MAILING ADDRESS C STATE, ZIP
47 3-r S vet 3
COMPANY NAME
Q
U N
APPLICANT NAME
OFFICE PHONE
OFFICE PHONE '
t LC-71t-5#4%—
— ul (- D, .,.
MAILING ADDRESS
�{-`:
CITY, STATE, ZI
�f- igS7�6
CELL PHONE
(36o ) 789
-1$8(
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
$_B L l l
Woo )4.93
-Mv99-
CONTRACTORS REGISTRATION NUMBER loopy of card required with "ch appltcat(oul
EXPIRATION DATE
v iv V G $ '= o o 5 M
07/ o/
107
COMPANY NAME
APPLICANT NAME
OFFICE PHONE '
MAILING ADDRESS
CITY, STATE, ZIP
CELI. PHONE'
RELATIONSHIP TO PROJECT
FAX NUMBER
o Architect ❑:Tenant
❑ Agent o Other (Describe)
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK
SPRINKLERED.BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED %REQUIRED? ❑ YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN . ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
0 0
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SO. FT.
BASEMENT
. SUMPS
WASHING MACHINES
URINALS
FIRST
VACUUM BREAKERS
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ssmve
neorwse
TOTAL
EMMON
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
number of eaeh type of fixture to be installed or
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS
BBQS FANS
BOILERS FIREPLACE INSERTS
COMPRESSORS FURNACES
.DUCTS GAS PIPE OUTLETS
BATHTI,JBS 1 «Tub/sho comw
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS __,
. SUMPS
WASHING MACHINES
URINALS
LAVS fs.th— "
VACUUM BREAKERS
I eerWy under penalty of perjury that the infw7no
am authorised by the owner of the above promises to
harmless the City of Federal • Way as to any claim line
such claino, which may be by any p ludic
arises out of the rslian jt city, in nq office
this application. �f
NAME /TITLE
RELATIONSEV TO
o Agent
as part of this project. Do not include existing fvd4res to.
OAS LOOS REFRIG. SYSTEMS
HOODS Icoemacdat► WOODSTOVES
RANGES MISC (Desenbe)
GAS WATER HEATERS
b
WATER CLOSETS pogo' MISC (Describe)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
n furnished by me is true and correct to the best of my knowledge, and further, that I
wform the work for which the permit application is .made. I further agree to hold
ling costa, expenses, and attorneys' fees Incurred in the investigation and d4(ense of
the undersigned, and filed against the City of Federal Way, but only where such claim
and employees, upon the accuracy of the information supplied to the city as a part of
Contractor a Architect o Other
13......1 ..PA L \L7o+.An.dn \Da.+.+:• Awnl:nofinn
i
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`" Avenue South
PO Box 9718
Federal Way WA 98063 -9718
253- 835 -2607; Fax 253 - 835 -2609
www. c ityoffed eralway. corn
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning
Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and
submittal of an environmental checklist may be required, which will extend the time period before a demolition permit can
be issued.
❑ Prior to submitting a demolition permit, the following items (as applicable) must be signed by the respective
agency (see attached Demolition Permit Contact List).
NoTE TO APPLICANT. Utilities shall be disconnected and services performed, if applicable, prior to issuance of the demolition permit. All applicable
items below are to be signed and dated by the respective agency representatives.
1. ASBESTOS ABATEMENT
(Copy of approval form and asbestos survey from Puget Sound Clean Air
Agency provided)
(City of Federal Way Building Official)
2. GAS SUPPLY
(Gas to be shut off, meter removed and final bill paid)
A/4
(Puget Sound Energy)
3. SEPTIC SYSTEM
(Tank to be removed or tank to be drained and filled)
(King County Environmental Services)
4. SANITARY SEWER (Check applicable box)
• Sewer line capped at property line
• Existing sewer line to remain and be used by proposed new structure
LA
(Sewer District)
S. GARBAGE
(All household garbage disposed off and final bill paid)
(RST Disposaf /Federal Way Disposal)
❑ Completed Construction Permit Application form
❑ Provide the following fees:
& ELECTRICITY
(Electricity to be shut off and meter removed)
NId-
(Pug tSound Energy)
7. FUEL STORAGE TANKS
(Above or below grade fuel tanks, have been pumped or removed
under Fire Department permit prior to any dismantle /excavation)
(Federal Way Fire District #39)
8. WATER - Public Source (Check applicable box)
❑ Meter to be removed and final utility bill paid
o Meter to remain and be protecte
(Water Supplier)
* * * * ** OR * * * * **
9. WATER - Private Well (Check applicable box)
• Private well filled and capped
• Private well to be used for other purposes
(King County Environmental Services)
1. Demolition Permit Fee
2. Automation Fee
3. WA State Surcharge
4. Cash Bond Deposit
$65.50
5.00
4.50
500.00 (Refundable upon Completed Final Inspection)
$575.00
Bulletin #122 — January 1, 2006 Page t of 1 k: \Handouts \Demolition Permit Requirements
Aug, 31, 2006 5; 51 PM
LIMITED SCOPE ASBESTOS INSPECTION
Single Family Residence
737 SW 3281h Place, Federal Way, WA
PROJECT: limited Scope Asbestos Inspection
LOCATION: Single Family Residence
737 SW 328`h Place
Federal Way, WA 98023
CLIENT: Universal Building Inc.
8300 6151 Avenue NE
Olympia, WA 98516
SITE CONTACT: Randy Johnson
0. No. 0018 P. 1 /10
NO`UVICKI
NVTRONMENY`AL
EM180NbONiAL MANAGEASNT Y CONdWC4
Phone: (360) 459 -1646
FAX: (360) 493 -1699
PROJECT Identify asbestos containing material (ACM) in this single family residence that has
DESCRIPTION: experienced a fire and that may be impacted by upcoming renovation work.
EXECUTIVE This limited scope asbestos inspection was conducted at the subject facility on Friday
SUMMARY: August 1B, 2006. None of the materials sampled on this date tested positive for
asbestos content.
This inspection was limited to only those areas that might be impacted by upcoming
renovation work. No samples were collected from the electrical and lighting systems
as they were energized at the time of the inspection. Electrical and lighting system
components should be presumed to be ACM until tested. Locations from which the
samples were collected are keyed to the accompanying site sketches.
BUILDING The structure is a two story approximately 2,700 square foot vacant single family
DESCRIPTION: residence of traditional wood frame construction dating from the 1990s timeframe
with an attached two car garage. The exterior is clad with painted wood siding and
the roofing is wood shake. The interior is made up of a living room, family room
kitchen with adjoining eating area, formal dining room, guest room, three bathrooms,
four bedrooms and an attached two car garage.
Interior partition walls and ceilings are made up of wood framing covered with
painted and textured gypsum wallboard. Exterior walls are insulated with blown in
material.
Flooring on the main level is made up a variety of hardwood, sheet vinyl, carpet over
pad and bare concrete (in the garage). Flooring on the second level Is comprised of
carpet over pad and sheet vinyl.
Windows are insulated vinyl units. Doors are both solid and hollow core wood.
None of the exposed plumbing was insulated. Heat is provided to the structure via a
forced air gas furnace. None of the visible ductwork was insulated. An unjacketed
gas water heater was present.
34004 9th Avenue South
Suite 12
Federal Way, Washington 98003
Phone: (253) 927 -5233
Fax: (253) 924 -0323
Aug. 31. 2006 5;51PM No. 0016 P. 2/10
INSPECTION On Friday August 18, 2006 Nowicki Environmental Services inspected the Subject
DATE: property and collected the samples described in this report.
INSPECTOR �)
ENDORSEMENT: �G�CF./Vto�rti'
Ron Coleman
PROJECT j'� i
REVIEW: ' c: '
Alan Olson
ANALYSIS Polarized Light Microscopy
METHOD:
PARMMRS: The Puget Sound Clean Air Agency (PSCAA) and Washington State Department of
Labor and Industries (L&I) regulations require an inspection of all buildings for the
presence of asbestos - containing materials (ACM) prior to renovation and demolition.
ACM is identified as those building materials containing one percent (1.0 %) or more
of asbestos as verified by laboratory analysis. All building materials fabricated prior
to 1980 are assumed to contain asbestos unless proven otherwise by a licensed
building inspector.
DEFINITIONS: ACM is subdivided into three types;
(1) Surfacing Materials: These are defined as those materials that are sprayed -on,
toweled -on or otherwise applied to surfaces including, but not limited to, lath and
plaster, acoustical plaster on ceilings, paints, fireproofing materials on structural
members or other materials on surfaces applied for decorative purposes.
(2) Thermal System Insulation (TSI): These materials are defined as those applied to
pipes, fillings, boilers, tanks, ducts or other structural components to prevent heat
loss or gain.
(3) Miscellaneous Materials: All other building materials that may be ACM but not
surfacing materials or TSI fall into this category.
SAMPLES Eleven primary samples were collected for this inspection. As mentioned in the
EXTRACTED: Executive Summary on the first page of this report, none of the materials sampled on
this date were found to be asbestos containing. Locations from which the samples
were collected are keyed to the accompanying site sketches.
Sample
Description
Location
Anal sis
01
White sink undercoating
Kitchen
Non - Detect
02
Vinyl sheeting and associated tan mastic
Utili Room
Non - Detect
03
Fiberglass insulation
Exterior Walls
Non - Detect
04
White insulation
Attic
Non - Detect
05
White vinyl sheeting and associated mastic
Bath II
Non- Detect
06
White Vinyl s ieeting and associated mastic
Bath III
Non- Detect
07
Joint compound and associated wallboard
Upstairs Hallway
Non - Detect
08
Roofing felt
Gara a Roof
Non- Detect
09
Joint compound and associated wallboard
Kitchen
Non- Detect
10
Joint com ound and associated wallboard
Breakfast Area
Non - Detect
11
Siding paper
Garage Exterior
Non - Detect
Limited Scope Asbestos Inspection
737 5W.12811 !Place, Federal Way, WA P8023
IVowickl EnvJronmental Serv/ces Project # 06 -0318, August 2006 Page 2 03
Aug, 31. 2006 5;51PM No. 0018 P. 3/10,
LIMITATIONS: During renovation of this structure it is possible that additional suspect ACM may be
discovered in other areas /systems not accessible or tested at the time of this survey.
Should such suspect material be discovered, an AHERA- certified building inspector will
have to sample and test the materials to provide evidence that they are non- asbestos
containing.
Nowicki Environmental Services is neither responsible for the classification of
materials that are not identifiable with reasonable diligence, not for the identification
of materials beyond the scope for this project as we understand it.
No hard measurements were taken of this structure; all square /lineal footage figures
are approximate rough estimates to provide perspective and scope.
Disclaimer
rh /s report and Its contents are limped to the scope and activities performed at the subject Property" described.
We represent that our serv/ces were performed within the Ilm /ts prescribed by applicable regulations and in a
manner consistent with the level of care and skill ordinarily - XerdSed by other professional consultants under
similar dreumstances. No other representation is made to the cifent, expressed or 1 /ed, and no w4manty or
guarantee is Included or intended.
L/m/ted Scope Asbestos Inspection
137 5'W 3280 place, federal Way, WA 99023 page 3 of 3
Nowicki f�n✓lronmental $ervices Project # 06 -0318, August 2006
Aug. 31. 2006 5:51PM Ajr'P
li
{
No. 0018 P. 4/10
Aug. 31. 2006 5: 51 PM
No. 0018
P. 6/10,
.
O•
rion Environmental
Services
34004 9* AVehue South ♦ BuDding A Sulte 5 ♦ Fcdernl Way, Waahlbfon 98009-6740
Seattle 874 -8118 ♦ Tacoma (2$3) 952 -6717 ♦ Facsimile (253) 927 -4714 ♦email 0FJQN6717 @aol
WBE W2F5912535 Telephone (253)
Polarized Light Microscopy Test
Report
EPA Method 600/R- 98/116
Client Nowicki Environmental Services, Inc. Date
August 22, 2003
34004 9'h Avenue South, Building #12 Page
Page I of 2
Federal Way, WA 98003 Invoice 063763
Date Received August 18, 2006
Project Number 06 -0318
Client / Project Name 737 SW 3281° Place — Federal Way, Washington
Client Orion Sample Asbestos
Number Stereo Scope Exam Treatment Percent Tyne
Other
Fibers
Number
01 60818 -01 White Sink Undercoat Chloroform
ND -
Cellulose
Homogeneous
02 60818 -02 Vinyl Sheeting w/White -
ND -
Cellulose
Felt Backing
Homogeneous
Tan Mastic Chloroform
ND -
Cellulose
Homogeneous
03 60818 -03 Fiberglass Insulation
ND -
Cellulose
Fiberglass
Homogeneous
04 60818 -04 White Insulation Tease
ND -
Cellulose
Fiberglass
Homogeneous
05 60818 -05 White 'Vinyl Sheeting '
ND _
Cellulose
w /Felt Backing
Homogeneous
Tan Mastic -
ND -
Cellulose
Homogeneous
06 60818 -06 White Vinyl Sheeting -
ND -
Cellulose
w/Felt Backing
Homogeneous
Tan Mastic -
ND
Cellulose
Homogeneous
07 60818 -07 Joint Compound -
ND -
Cellulose
Homogeneous
Wallboard -
ND -
Cellulose
Homogeneous
08 6081808 Roofing Felt Ash
ND
Homogeneous
Aug, 31. 2006 5:52PM No, 0018 P. 7/10
O•
rion Environmental Services
34004 96 Avenue Soutb • Building A Suite 5 ♦ FtdetW Way, Wasbtngton 981103.6740
W.BE WV5912535 Telephone Seattle (253) 874 -8118 • Teconte (253) 953 -6717 ♦ FacsitnUe (353) 927 -1714 *email ORION6717 @401
Polarized Light Microscopy Test Report
EPA Method 600/R.- 981116
Client Nowicki Environmental Services, Inc, Date August 22, 2003
34004 9°i Avenue South, Building #12 Page Page 2 of 2
Federal Way, WA 98003 Invoice 063763
Date Received August 18, 2006
Project Number 06 -0318
Client / Project Name 737 SW 328th Place -- Federal Way, Washington
Client Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatmen Percent —Type _ Fibers
09 60818 -09 Joint Compound ND - Cellulose
Homogeneous
Wallboard - ND - Cellulose
Homogeneous
Wallboard - ND - Cellulose
Homogeneous
10 60818 -10 Joint Compound - ND - Cellulose
Homogeneous
Wallboard - ND - Cellulose
Homogeneous
1l 60818 -11 Siding Paper Ash N)D - Cellulose
Homogeneous
Dup: Laboratory QA/QC Duplicate; M; Mastic ((a), (b), (c), etct. Sample layers numbered from front to back.
Comments: For layered samples, each component has been analyzed separately. ND moans non -detect for
asbestos fiber by EPA Method 600/R- 98/116, Per EPA guidelines, samples will be archived for 30 days and
then disposed of Disclaimers: PLM has been ]mown to miss asbestos in a small percentage of samples that
contain asbestos. Thus negative PLM results cannot be guaranteed_ This report Nay only be reproduced in full
with written approval of ORION Environmental Services.
Analyst 10. 4 Reviewed By
Nelson B. Miles III
Aaron Halverson
Sr. Industrial Hygienist Laboratory Manager
t
CO
N 0
n
z
A 3
� N
q `u
_ J
Ul
O
k
N
A
z
x�
c,
-.
A
G'1
Tim
�)IJIOW
m �
x
x
o o '
OD r
N
O
O
V
C
a'
1
J
Q
N
4
P�
rF
to
0
r� ML
m
fmt
r�
1:t
r-t
O
Olt 'd L100 ' °N WdoS:s 9041 le 'gad
N
�
�
rP
�
1• h
poll
b
PK
=,
Old
�
p
let
Ul
o
r� ML
m
fmt
r�
1:t
r-t
O
Olt 'd L100 ' °N WdoS:s 9041 le 'gad
Agency Case No.
N
AGENCY ° " " ``-' �-�1 ►te1.J
110 Union Street, Suite 500 � p o J 2UU6
Seattle, WA 98101 -2038 t"
200600782 www.pscieanair.org pwt LEAN
NOTICE OF INTENT``
A Proieet Type: I. ❑ Friable Asbestos Removal 2 ❑ Fri able Asbestos Removal A Demolttton 3 Demolition Onfv
B. � � <f461-- _ --
Property Owner: C Phone: 2 S>9 9 ' 50310
Mailing Addres : -F57 5 w 3 2—e P G4'r-e
Ci C—t' �"_ State "-- Zip: 9-F
C. Asbestos NLEASEPR/MCLEA Y. r7ilS LLBEYO �RREIi7RxMA1Ll (,LABEL.
Contractor: O_r E
- --
Owner /CEO:
Mailing Address:
Was Friable Asbestos Identified? Uyes WNo
Contractor
Structures:
Phone:
Job No.:
AHERA Building
Inspector: A
Certification #:
- C-0 fit
Ex . Date: J G,v Ze ?.00-7
City:
State:
Zip:
Fax:
13oileffutnace Insulation U Duct Insulation Pipe Insulation LJ Fireproofing Paints Plaster Textured Coatings
D. Site �—� S W 3� Y L Icity:
Address: � (.11
`�'
Site p
Manager: R J O'tEry 5411.', @ ILocalPhone: 3604. 45q - r (p 4-k-
E. Asbestos Survey or
No. of
Date of Asbestos
Was Friable Asbestos Identified? Uyes WNo
P�+C�umed
Structures:
Survey: 1 2on6
Was Nonfriable Asbestos Identified? ❑Yes QlNo
Attach a copy of the survey when friable asbestos
AHERA Building
Inspector: A
Certification #:
- C-0 fit
Ex . Date: J G,v Ze ?.00-7
has not been identified.
Completion Date: Hours:
Total . to be Removed: Linear Ft.
Will all friable asbestos ❑ Yes
Square Ft. materials be removed? ❑ No
F. Demolition Start
I
No. of 1. Training Fire (List Fire Dept.)
Information: Date:
Structures: 12. ❑ Ordered Demolition attach copy of Order
Demolition Insert demolition contractor's mailing address on back Will nonfriable asbestos be left in place during demo? U Yes W No
Contractor: VN ,S�q $�� ,t, t :FG
If yes, list type and qty. Note disposal requirements in Step 6 (on back).
A. Prior Notice
B. 10 Days*
A. $25
project)
Asbestos removal can be in upon notification; demolition must wait 10 days)
G. Friable Asbestos
Project NONE
Work Days: M T W Th F Sa Su
Information: Start Date:
Completion Date: Hours:
Total . to be Removed: Linear Ft.
Will all friable asbestos ❑ Yes
Square Ft. materials be removed? ❑ No
13oileffutnace Insulation U Duct Insulation Pipe Insulation LJ Fireproofing Paints Plaster Textured Coatings
.,,,,.,...p. vulumu% V r'riayierworingmaterlal timer:
H. Asbestos/Demofition Project Categories:
Notification Period
Project Demolition
L Single- Family Residence (owner - occupied):
Fee Surcharge
A. ❑ Asbestos Removal Project Only
B. 1W - Demolition Project (with or without asbestos removal
A. Prior Notice
B. 10 Days*
A. $25
project)
Asbestos removal can be in upon notification; demolition must wait 10 days)
Note: !f the single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes
JA or 1B may be checked If this is not an owner- occupied residence, one of the categories listed below must be used instead. A single
omit resid nce does not include rental property, multi-family units, or any mixed -use buildin .
2. U All Other Demolitions (with no Asbestos removal or Nonfriable Asbestos
10 Days
$100
only or less than 10 linear feet and/or 48 square feet of friable Asbestos
Friable Asbestos Projects other than Single Famil-v Residence):
Asbestos Demo
3. LJ >_ 10 - 259 linear feet and/or 2t 48 - 159 square feet of asbestos
Prior Notice 10 Days
$100 $100
4. L3 260 - 999 linear feet and/or 160 - 4,999 s uare feet of asbestos
10 Da s
$200 $100
5. Li > I Q00 linear feet and/or >5.000 s uare feet of asbestos
10 Days
$600 $ ifl0
6. Emergency Asbestos Project or U Emergency Demolition Project
j
Prior Notice
$50 Emergency Fee
(Single-Family Residences are exempt from cinergency emergency fee. however, property owners must provide a
written emer enc r nest)
I. I certi that the info n contained in this notification &supplemental data is, to fhe best of my knowledge, accurate & complete. Agency
AU6 3 t 20 _
Puget Sound Clean Air Agency Fort No.: 66 -160 (Revised 2/05) TS
IF n I V CJ'
�j /
O d 1
AMOUNT. K S-0
RCP% NO. :2 �- .(
The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
111, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency
forms. Asbestos removal and demolition projects involving materials and structures below the notification threshold are
still subject to all other requirements of Regulation III Article 4.
After receiving a complete notification with the appropriate project fee, the Agency will review the form and return a
copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification.
J Demolition
Contractor: N V -5 to 1 iJ N
C
Owner /CEO:
Moiling Address: g� Q Q
��
o
Phone: '� S
- 9 ' �O 4—%
Contractor's
Job #:
I S9
city: L- .�
Li a
State: W
zi : 9
Fax- 3 0 .4° 3 • I log
GUIDELINES FOR SUBMITTING AN ASSESTOSIDEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn Ceiling material, sheet vinyl flooring, cement
asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single - family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi- structure projects, attach supplemental sheet with a site map
(include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure.
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the
notification of a demolition vroiect when only nonfriable asbestos or no asbestos is identified on the survey.
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training fine. Additional training fire
requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition,
check yes and list the type and quantity of material. Note: Demolition debris containing nonfriable asbestos materials must be
labeled as "nonfriable asbestos- containing waste" and be deposited at an authorized waste disposal facility.
Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as
popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc.
Step & For owner - occupied Single -Family Residential projects, check BOX H1A for renovation projects or BOX 111B for
demolition projects (with or without asbestos removal). Asbestos removal may be conducted after a complete notification is
received, but demolition activities can only begin on the 1 e day after the notification is received. Note. If the single fancily
residence is owned by one family who has been or will be using the residence as their domicile, bares IA or IB may be checked A
single family residence does not include rental property, multi family units, or any mixed -use building.
For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 -
5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
(additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box 1 - 5 and the
applicable emergency box in H6. All emergency requests must be accompanied by a letter from the property owner demonstratinthe
need to conduct the nroiect immediately in accordance with the requirements in Regulation III. Section 4.03 (c)
Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box I.
Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
work schedule changes if the -contractor is participating in the Agency work schedule fax program. A $25.00 processing fee is
required for all amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can be downloaded from the Agency web page at www.pseleanair.org.
For technical assistance call (206) 689 -4058 and for administrative inquiries call (206) 689 -4090.
Puget Sound Clem Air Agency Forth No.: 66-160 (Revised 2105) TS