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09-102789i Demolftion City of Federal Way ��.//. Community Development Services Permit #: 09- 102789 -00 -DE P.O. Box 9718 Federal Way, WA 98063 -9718 Inspection Request Line: 253 835 -3050 Ph: (253) 835 -2607 Fax: (253) 835 -2609 p q ( 1 Project Name: LIFEWAY CHURCH Project Addressl3k3"SW 356TH ST Parcel Number: 302104 9020 Project Description: Demolish (1) single family home Owner Applicant Contractor NEHEMIAH GROUP LLC LANDMARK HOMES INC LANDMARK HOMES INC 5015 SW DASH POINT RD PO BOX 26116 LANDMHI033DG (02/28/10) FEDERAL WAY WA FEDERAL WAY WA 98093 PO BOX 26116 98023 -2041 FEDERAL WAY WA 98093 CONDITIONS: After ilnspection is complt a�.,pprtaved please contact K.L. Cimmer by e-mail at Kar} ba2$35 Ii y t -2609 to receive a refund of cash bond. THIS CARD IS TO REMAIN ON -SITE CITY OF _ Construction Infection Record Federal Way INSPECTION REQUE TS: (253) 835 -3050 PERMIT #: 09- 102789 -00 -DE Address': 157 SW 356TH ST Owner: FEDERAL WAYi WA 98023 4301 Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE THIS LARD. 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 ;%j Date`�� For inspector reference only O Rough Electrical t7 FINAL - Electrical Approved Approved By Date By . Date � CW .��� ��- La���� Federal Way %510 p MIT YCOMMUNJTYDEVEJAPMENTSERVICES SF MF CO ME EL PL EE EN FP 33325 8m FEDERAL A , WA 98063-9718 • PO BOX 9718 �p *LICATION FEDERAL WAY, X -260 G 253 -835 -2607• FAX 253 -835 -260 www.cit a ederatwa - c® The following is required information - an incomplete application will not be accepted. Please print legibly (in ink.) or type. SITE ADDRESS I a 1 5 4) .V ` / SUITE/UNIT # ASSESSOR'S TAX /PARCEL # 3- i ® T - _ LOT SIZE (sf LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) FI fife �k f_ "j (Attach wpJ ate pwe for kmdw begul descrfpff N PROJECT •• • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this nerrnit on L �r 1 '5 f7 PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER NAME j �' i'h '. t� ,l0 11 L' OFFICE PHONE (d�.7 M�TLINGyA1�DRESS L`O/1/1F C11Y 5i'I''iF4 �q ® F'C�GLU( l/ PRIMARY PHONE O t ) do), - 9 qx% CTTY FE�G'jD�G'j//ERAL WAY BUSINESS LICENSE NUMBER IotUq- ors -SL MAILING ADD FAX NUMB) ER 053 ) W 7 -Y65d C117f, TATS. /{G� i y /W, j 1'f E -MAIL ADDRESS CONTRACTOR PROJECT CONTACT LENDER EXISTING USE ANY 7' fits' tvlk ✓K 1b.1$5 ��1� APPLICANT NAME OFFICE PHONE (d�.7 M�TLINGyA1�DRESS L`O/1/1F C11Y 5i'I''iF4 �q ® F'C�GLU( l/ CELL PHONE - CTTY FE�G'jD�G'j//ERAL WAY BUSINESS LICENSE NUMBER IotUq- ors -SL TIO,NDATE ) 1 t FAX NUMB) ER 053 ) W 7 -Y65d CONTRACTOR'S REGISTRATION NUMBER L#) N 1A 03 3& a b 0 'nON DATE to E -MA L DRESS ° I Caw► cis �h f COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING RF.SS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent ❑ Other FAX NUMBER NAME BOW l DW " (W 0113 Y) ONE a2 - My, NAME Per RCW I9.27.095: Lender igrorJnation is required (f project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP PHONE EXISTING ASSESSED /APPRAISED VALUE PROPOSED USE VALUE OF PROPOSED WORK SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/RE$UIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER R LAKEHAVEN ❑ H'IGHLINE ❑ TACOMA ❑ PRIVATE (WELT.) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ MGHLINE K PRIVATE (SEPTIC) PROJECT FLOOR AREAS 0 AREA DESCRIPTION EXISTING FT. PROPOSED SQ. FT. TOTAL SQ. FT. BASEMENT BBQS FANS GAS WATER HEATERS MISC (Describe) FIRST FIREPIACE INSERTS HOODS (co —rdbM COMPRESSORS SECOND RANGES DUCTS GAS LOG SETS THIRD ❑ YES o NO UP /SEPA/SU? ADDITIONAL FLOORS (DESCRIBE) ❑ NO PLATTED LOT? ❑ YES ❑ NO DECK (❑ COVERED OR ❑ UNCOVERED ?) DEMO PERMIT REQUIRED? ❑ YES ❑ NO GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS mi°f6 raoeowm corer. TMALZXI n Sr "rv. Nnor Sr rorAL 61 "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type of jbdure to be installed or relocated as part of this project. Do not include existing fatures to remain. Value of Mechartical Work $ (A COPY OF BID OR ES7ML47E MUST BE INCLUDED Wild APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC (Describe) BOILERS FIREPIACE INSERTS HOODS (co —rdbM COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG. SYSTEMS BATHTUBS (or'Nb /Shower combo) LAVS Mathr smim) URINALS MISC (Describe) DISHWASHERS RAINWATER SYSf VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS abna q ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS I certM under penalty of perjury that I am the property owner or authorised agent of the property owner. I certVy that to the best of my knowledge, the iYUormation submitted in support of this permit application is true and correct. I certo that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibilityfor compliance with local, state, or, federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the Investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the igformation supplied to the city as a part of this appliettti#ry SIGNATURE: ❑ NEW ❑ ADDITION ❑ ALTERATION o REFAIIt ❑ TENANT UI ?RROiVEBEENT BUILDING SHELL ONLY? o YES ❑ NO BASIC PLAN? ❑ YES ❑ NO ZONING DESIGNATION CHANGE OF USE? o YES ❑ NO NEW ADDRESS REQUIRED? ❑ YES o NO UP /SEPA/SU? o YES ❑ NO PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO Bulletin #100 — January 1, 2008 Page 2 of 4 MHandoutAPermit Application W-HEN.:R'ECORDED RETURN TO: Name...,, NEHEMIAH GROUP Addriss: --FEDERAL WAY V)LA Q 90 23 E212416 X1 COUNTY,-14A TQX P;kE OF 11# Escrow Number: 246116624: File'il foF."Reo6rd at R'equist of: STEWART TtrL.] ��-,..9TATUTOAY • The Grantor(s),"Sk .151`6VIN J K � .-.GO0ANQ.-.',� consideration of Ti;; Dollo�s and offl r go6d and warrants to NEHEM!AH GROUP L4,-C, A the following described real, estate; "situated '.'I THE NORTH 200 FEET OF THEVEST.414 HALF OF THE EAST HALF OF tHE'SOLITF. QUARTER OF SECTION 30, TOWNSHIP 2, 0 I;z- opbl 5v-., STEWART TITLE (ARANTY DEED qN ' le K. GOO, HUSBAND AND WIFE for and in id.valuable consideration In hand paid, conveys, VASHINGTON LIMITED LIABILITY COMPANY tMe 06uiif :pf KING gtkpte of Washington: LF OF THE EAST NORTHEAST W. M., IN KING COUNTY, WASHINGTON; EXCEPT THE NORTH 30 FEET CONVEYED TO KIN(j-:CQtJNTY FbRAOAO: U P RPO$ES BY INSTRUMENT RECORDED UNDER RECORDING , AND EXGEPT.-*THE.6OUTH 12 FEET OF THE NORTH 42 FEET CONVEYED:Td* KING COUNTY FOR kOA0 ' lYO PURPOSES BY INSTRUMENT RgCoMbE 3ER.*106 Q.O'UNTY RECORDING NOS. 8910160166 AND 8908070217. ........... Su93ECT TO: h AT-TER-S­ O-F PUBLIC RECORD Assessor' ?ropeqy TOX PirceOAcbount*•Number. 302104-9118-05, LEVY 1205 D =eJ 7. 2Q05 • SHERWIN KJ G TkNNIIE>:K. GOO STATE OF Washington COUNTY OF KING I certify that ,e satisfactory evidence that SHERWIN K.J..,606 and AN . �IE K. GOO are the p lb .d. before me, and said pe.: rspns.4cknowhidg$d:ihat they iigned this ry. instrurn it to be their free and volunta:: . ac(-for iti6 us4l*nd •Ou*§es mentlo r rt. . .......... Dated: 141 111"Morvip NaAaw,-CARRIANNE BALLOU Nota Public in and for the State of Washiro ton My appointment expires: June 21, 2005 JUL -10 -2009 06:41 From:ELECTRIC F*T REP 2533956806 To* 927 4652 P.2/2 JUL, -09 -2009 15:22 From: 07/00 /2009 LU!03 FAX 223 927 4652 Lm LIMof FLederal Way 'v k �,d4y To ; E533956806 P.i "2 ednarlc Heaes �OOOt /OOOP Dsr�e�torr oRCostreuerrrDS�se ,aarNter�rst�r+� a J 3332 .1.8* Avenn South PO Box 07 ;8 R Fsdartl Way WA 900639718 kD d`3 353.833.t507; Fax 3s.34E35 -2509 vnvvr eitvulyedCnd=rlkft DEMOLITION PERMIT REWREMENTS A demWi dw peanit is required to remove ay► Mettim or 9reoteres on a lmbion pmplay. t'1wk with the citv'e pier 4 Division to we I I P*P011 ""oft d,ra>uwtds &a trial an Ww»artlet>W -whew An envRroott wjzj st ylaw aad eubrWtW of an cnviwmtmtal oboal hd may br: rcWff4 wl ich wti) cztaed the time peri9d bat'orc a dwidlidon parinit cm be issued C] lry iW % 4 detgolitio. ommk the (bllow he item {vt eppllmble) otest beAped by the rape cave Aiy % "Uahed Dam l.wan Punait Cantact Ney7rav�rss�cv� UtlW /essAallbtdtseva�t��dsrwrltts ileect bslt>w ors fo 8! F�� if'4rpfwalk pfor � immsce a,/'cir dsnrdlrfar yaa�e.,t0 apy/icn�e tai �aedw a�rricy rrtrsrJ►�cu IFWY_­� - I r: ri Al 7 j f (� � ee ranorec�pt tetrseo qg ttnk,ed and t,>16e� 0 4. S7M><t'ARY itk{NMR (Chem epplhable box) 0 Saner line capped at property Thee a t3WIV sewer Mat to "Wn and he med by p mp Ned teen gnxWre E3 Cotlt IM"d Cuadrtrcdoff Pertalt App&mtloe [o,,n O T mvkl i the Solard" &es : 1 remwnd (Abme or � 9 f1w t have beet, ,p �aa5tatlon) B. WATW • POft Swum (Check applkable bait) o MdW to bE rentarm aid WW UW bll psis t Md to nrneln and be pratedad tom. ya+�� Gti «w�Mea♦ 9. WATER- Prlrshs Wed ( Chsck sppilcable Door) R RM*Wd ad and COW a Prtiebe Wd tb be tp�fgr_oiiaRepeses &MKMWW 5"Vims ) DwwwUd u rftMftF= W0.08 Z. Aatemetipa Fce 540 3. WA Mat. Swcba p 4..150 4. Cash Bond Dept Eau S58U.00 (!same "ble ■pea CGovow fbd knuc ") > oln -Jwwoy1. w c'w -ton TU aPA�ndfdofl70o�itRagapa�ppi MAY - 28-2008 WED 12:56 PM East Public Health C OF PAX No! , 3L'. -�•.`, ark MICA MSrrr os CohtMtsrrrt v D33325 8o Avetwe Soudt 5 �i�3iC.� � pO Hox 9718 + ^ ,G-�441 Federal Way WA 98063 -9718 M (Zt �t'li b 25S3- 835 -2607; Fax 253.835 -2609 eral Way Homes 5y-7V 4.50 50 FAX N0, 1264919 P. 01 @000z/ ooaa DEMOLITION HERMIT REQUIREMENTS A demolition permit is required to remove any ettuqure Or structures on a subject property. Check with the City's Planning Division to see if the proposal exceeds thresholds r2aat trigger an ortvtranmentat review. An environmental review and submittal of an environmental checklist maybe required, which will extend the time period before a demolition permit con be issued. 0 Prior to submitting n demolition penult, the fallowing items (as appytcable) Must be signed by the respective agency (sec attached Domolltion Permit Contact List). 1Y0N ra.tpPL'!GltYa: Utilities a/tuill hadlsconrtected and servkesperformed, lfapplteable, prior to /smancs of the d'r.rnoUtlon par►nit..tll appltcarbla !talus below are to be,f(u,� and OY the respec&e pgc►tcY repKSentattvar . Agency provided) i. ASBgSTDlS ABATEMENT (Copy of approval form and asbestos survey from pu9et'Sound Clean Air (Clty0f era ay otfidal) z. GAS SUPPLY (cis to be shut usY, mew removed and final belt paid) (Puget d F.rter9lt 3. setmc SYSTEM •(Tank be removed or kank � be drained and IIQed) King County Err nmental Ices) • i{. 9pp1TARY SEWER (Check applicable box) A Sewer Ilse gypped at property line E3 E,gstk g sewer Ilse to remain and be used by proposed new strucbae r 5.OARl6AGE (AU household garbage disposed off and final hill paid) s. gl- EC'rltlCiTY . (peckrRclty to be shutoff and motor rernovect) (Jet hnergy) . y. FUEL STORAGE TANKS ' under Fire pepat'Gitteiit perrniC Prior ba a ��ntl%xcavation) (south long Fire and Rescue) • 8. WATiER ^ ppblic Soulree (Check applicable box) p Meter babe removed and Anal udply bill ptdd K Meter to remain and be proEad ed sower) ear*+rr OR r****x g. INATf+R - Private Well (Check applicable box) • prNate well filled and capped • private well to be used for other purposes (lnfl county Environmental SeMoes) a • � (RST�sposal/Federal way fit) Q Completed Construction Permit Application form Q Provide the foAowing fees: '1. Demolition Permit Fee 2. Automation Fee 3. VVA State Surcharge t}. Cash Bond Deposit 0,a0 (Refimdsble upon Completed Final YnspeeHeu) $580.40 Bulletin #122 — ]canary 1.2aa8 � Pogo •I of 1 klHendoufsTemalitian Permit RAgppstim fS `MAY -23 -2008 FRI 03;39 PM Eas e Public Health 0 FAX N0. 1JW964919 05/23/2008 14:22 FAX 253 027 2 Landmark Homes P.O. Box 26118 Foderal Way, WA. 89pg3 Phony: 253- W-6118 Fax: 263 -0274852 FAdMEMBILMOM -AMW ax--�. P Landmark Homes, Inc. %..,L.r 4 Few Re: oc: O Unbent in FQr.RgMgw 13 Ploa :e comment lie Reply CI Plana* Recycle P. 01 Rj0001 /0004 Ti %K�.w Ii `MAY -23 -2008 FRI 03:39 PM Eas e Public Health C FAX N0. 1IV964919 P. 02 4.5/23/2008 14:22 M 253 927 A' Landmark homes I�0403/0004 Instructions Fur competing farm: This farm is to be carnpleted by any persons Permanently removing a septic tank, seepage pit, cesspool, or other on�site sewage system wastewater tanks from service. Complete and submit this report to the heath of!'icer within thirty (30) days of the abandonment. Authorityter 13.04.054 the Code of Kin Count Board of Health, Title 13, Return Completecl ]corm to the I+ollowing Address: Da°` east ate Public Health Center 143_ 0 SE Eastgate Way VIA, Bellevue, WA 98007 Phone (206) 2964932 �^ pt}O'P C V11 General Ynfornnation (Please print): Name of owner /Occupant of Property: Address_ Telephone: e Date of Report: Wastewater Tank Data: Type of Sewage Tank: Septic Tank Pump Tank _ Holding Tank Other-' Number of Compartments Pumped: Number of Gallons Pumped: — Checklist Item "Yes No Not Applicable Comments Sentaee removed by an approved pum er7* Tank lid removed or destroyed`? __ '.Cank void billed with compacted soil? *OSS Pumper Name: Ding County Certification Number: Reason for wastewater tank abandonment: —Property being served by public sewers Property being served by replacement tank Comments: Signature; Date: 1 1� lteporl of Wastewater Tank Abandonmcnt: Print Dote 5/12/09 pornis/sewage/form.96 IIAY -23 -2008 FRI 03;39 PM Easf�e Public Health C FAX N0, 1964919 0,5/23/200& 14:23 FAX 253 027 4 Landmark Homes w P. 03 IJ0004/0004 M o, O co C1 >i 44 ►Yr A N � O a �A r4 QP4 PW 0 A PO i� S 2 w U N1 cv O OD �CN E �>1 W E FQ n Ln r� M 6{} O Ln O M W1 � � N M t9 fli� U LL+ a� d b I M cz Ci- a ax W ' v7 O rr 0 co N N Ntl;1 4 U N d v aD In v tik�w�"' d1.P M o, O co C1 >i 44 ►Yr A N � O a �A r4 QP4 PW 0 A PO i� S 2 w U N1 cv O OD �CN E �>1 W E FQ n Ln r� M 6{} O Ln O M W1 � � N M t9 fli� U LL+ a� d b I M cz Ci- a ax W V+ p� W tj Ntl;1 U N d v aD In v M o, O co C1 >i 44 ►Yr A N � O a �A r4 QP4 PW 0 A PO i� S 2 w U N1 cv O OD �CN E �>1 W E FQ n Ln r� M 6{} O Ln O M W1 � � N M t9 fli� U LL+ a� d b I M cz Ci- a ax W W W U z . q 3606792123 WM OAK HARBOR 0 08:28 07 -10 -2009 0 WASTE MANAGEMENT 32650 SR 20, Ste E105, Oak Harbor, WA 98277, Phone (360)679 -6200, Fax (360)679 -2123 FAX COVER SHEET T lj it k o l " Date: ( c C o Phone: Fax: �� —O� From: - kjio Number of Vages Including Cover Sheet: MESSAGE: Phone: W/1 (2--LS&LL WARNING: This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential or exempt for disclosure under applicable law. If you are not the intended recipient, you are hereby notified that any use, dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone and return this original message to us at the address above via the US Postal Service. Thank you. 112 36067A2123 WM OAK HARBOR 08:39 07 -10 -2009 2/2 ' Cus- tomer: 831 -26189 1` /ilUi2u09 NEHEMIAH GROUP LLC 121 SW 356TH ST Current 6/30/2009 5/31/2009 4/30/2009 3/31/2009 Total Due .00 .00 .00 .00 .00 Item # Date Misc Type Code Debit Credit .00 Balance 748690 05/31/08 Adjustmnt WO .94 26.48 720003 05/31/08 Adjustmnt CXR .92 25.56 720003 05/31/08 Adjustmnt C %U 1.98 23.58 720003 05/31/08 Adjustmnt WO 23.58 .00 Unapply 08/14/08 2114 Adj Total Payment SLB 27.53 27.53 .00 27.53 - Unapply 08/16/08 Adjustmnt DXR .96 26,57_ Unapply 08/16/08 Adjustmnt DXU 2.05 24.52 - Unapply 08/16/08 Adjustmnt RBD 24.52 .00 Adj Total 27.53 .00 Total .00 Fl-Switch Modes F3 =Exit F5 =Refresh Fll =Late Payment Fees F12 =Previous F13-Start At Date. F14 =Include Archived items F18-Bottom. print =print Detail 0 Assured Quality Environmental, Inc. 2702 A Street Tacoma WA 98402 253 -572 -7175 Fax number 253 - 779 -4020 Send to:. From: Liz Landmark Homes Attention: David Ddte: 5/19/2008 -Fax Number: 253 - 927 -4652 Phone Number: (253) 572 -7175 ❑ Urgent Q Reply ASAP ❑ Please comment D Please Review ❑ For your Information Total pages, including cover. Good Faith Asbestos SCOPE OF WORK On May 9,2008 Assured Quality personnel conducted a "Good Faith'" asbestos survey (per U.S.E.P.A. (A.H.E.R.,A,. guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State Labor & Industries) ' of a residential structure located at 212 SW 350 Street Federal Way, Washington. Field inspection, data collection and report generation were based on the following Scope of Work: • Perform visual inspection to identify and inventory all accessible suspect - asbestos containing materials. • Bulk sampling and analysis of all identified suspect asbestos - containing materials. • Provide written report. BASIC CONSTRUCTION The structure is a Residential structure built around the 1960's or 1970's.. The, exterior siding of the structure is wood siding. The roof of the structure is composite roofing. HEATING AND VENTILATION SVSTLM Base board air system provides the heat in this structure. PLUMBING SYSTEM The plumbing is metal piping. INFERIOR CONSTRUCTION FINIMS AND FLOORMG Interior Construction Finishes, and miscellaneous: Inside construction is wood, cellulose wallboard, and dry wall. The dry wall and taping materials were sampled as per AFMRA Protocol. Vinyl flooring materials with relating backing and mastics were also sampled per each located homogenous area. C• SAMPLE METRODS AND LABORATORY INFORMATION A walk through inspection of all areas was peribrmed to identify 'which building materials may have the potential for containing asbestos. After identifying the suspect asbestos - containing materials, bulk samples were collected, placed in plastic bags, numbered and recorded. Care was taken to clean all tools between sampling in order to avoid cross - contamination. The samples and appropriate chain of custody forms were then sent to Orion Laboratories to be analyzed for the type and Assured Quality Environmental. Inc. April 14, 2003 Good Faith .Asbestos Survey content of asbestos, if any. The samples were analyzed using Polarized Light Microscopy (PLM) Stain Dispersion Technique in accordance with EPA, Methods 600/R- 93/116. The following section contains tables listing all materials sampled by location, description, type, asbestos percentage (if any) category, and results of materials sampled. SUMMARY OF MATERIALS FOUND POSITIVE Upon completion of the survey and review of the laboratory data, the following materials were found to contain asbestos at the structure designated as 212 SW 356" Street Federal Way, Washington. • No Asbestos was detected in any sample collected., • The Structure is safe for demolition. DEFINITIONS Asbestos means the asbestiform varieties of ,A,ctinolite, Aimsite (Cummintonite- gmerite), Tremolite, Chrysotile (Serpentine), Crocidolite (Riebeckite), or Anthophyllite. Asbestos - Containing Material means any material containing more than one percent (1 %) asbestos as determined using the method specified in EOA regulations (Polarized Light Microscopy). Friable means materials that can be crumbled or reduced to powder by hand pressure. Homogeneous Areas means an area which appears similar tbroughout in terms of color, texture, and date of materials application. Miscellaneous Materials means interior building material on structural components, structural members of fixtures, such as floor and ceiling tiles; and does not include surfacing material or thermal system insulation (AHERA definition). Surfacing Maternal means material that is sprayed -on, troweled -on, or otherwise applied to surfaces, such as acoustical .plaster on ceilings, and fireproofing materials on structural members, or other materials on surfaces for acoustical, fireproofing, or other purposes (AHERA definition). Thermal Systems Insulation means material applied to pipes, fittbags, boilers, breeching, tanks, ducts or other interior structural components to prevent heat loss or gain, or water condensation., or for other purposes. CONCLUSION Abatement and disposal of asbestos- containing materials must be conducted by a Washington State Licensed Asbestos Abatement Contractor using Washington State Assured Quality Environmental Inc. April 14, 2008 Good Faith Asbestos Survey Certified Asbestos Abatement Workers. Should employees or contract personnel encounter any suspect asbestos- containing materials, it is their responsibility to: • Contact a representative of the owners. • Consult the inspection report to determine whether or not the suspect material contains asbestos. • Ensure that all employees and contractors are informed and advised of the location and type of materials that contain asbestos. Any additional hidden or covered suspect materials, discovered during demolition or renovation, that are similar to those identified in this survey must be treated as asbestos - containing materials unless determined otherwise by laboratory analysis. Note; Assured Quality Environtnental does not guarantee approximations of quantities of ACM, which may be listed with the analysis. It is therefore recommended professional abatement price and/or disposal quotes be obtained by inquiring as to fees per area of specific ACM material (i.e. square or linear foot, etc.), or by site assessment. Any and all materials identified ' as ACM in this report must be abated prior to ACM disturbance, renovation, or demolition. All materials 'identified as ACM must be professionally abated by a licensed asbestos abatement contractor prior to any disturbance. A copy of this report should be kept on site during any asbestos abatement,, renovation, or demolition. Please contact the undersigned for any further assistance or if arty questions or concerns arise relative to this report. Sincerely, . Andrew Mantonya AHERA Building Inspector 3508- 08 -01 -01 Expiration Date January 9,2009 Assured Quality Environmental Inc. April 14, 2008 Good Faith Asbestos Survey Appendix #A INSPECTOR'S CERTIFICATION Assured Quality Environmental Inc. April 14, 2008 z . . 0 x Poi w z x O U Q� O U-- m 0 � `r W Z w U Q � a 0 PEN w.. � O O V a z 0 f" z l< i J m 0 z �t z� Q oz Ul a S IL LU 2 V. W a U x p� Z Ix U. U. o0 u A -0 oz wz � x� N Q lk N N h IL Q M o oa IT J 0 00 U O N U v� 9 z d C�r �]a V U Good Faith ,Asbestos Survey Appendix #B FIELD DATA / LABORATORY'RESULTS Assured Quality Environmental Inc. April 14, 2008 May. 9. 2008 5:01 PM NOW Environmental Services No, 8755 P. 15 ORION'Environmental Services An Environmental Compliance Consultiu Firm Polarized Light Microscopy Test Report EPA Mediod 600/R- 98/116 Client Assured Quality Fnvironmental, Inc. Date May 9, 2008 Page Page I. of 2 2702 "A" Street Invoice 081876 Tacoma, WA 98402 Date Received May 7, 2008 Project Number N/A Project Name 212 SW 35e Street Federal Way, Washiagwn Client Orion Sample Asbestos N� Number Ster Scope Exam eat Per nt TI Other AM-01a 8050744 Temaxre - NI) - Assoc. w/ AM-01b AM-01b 80507 -44b Wall Board Ash ND - Fiberglass Cellulose Homogeneous AM-02a S0507 -•454 Texture - ND - Assoo. W/ AM -02b AM -02b 8050745b Wa11 Board Ash ND - Fiberglass Cellulose Romogeneous AM -03a 8050746& Te=re - ND - - Assoc_ wl AM -03b AM -03b 80507 -46b Wall Board Ash ND - Fiberglas6 Cellulose Homogorteous AM-04 80507 -47 Ceiling No - ND - Cellulose Homogeneous AM -05 80507 -48 off -White and Tan Pattern - ND - Cellulose Gray belt Backing Homogeneous . AM -06a 80507 -49a Light Gray Vinyl Sheeting - ND - Man Made Fiber Self Adhesive ' Homogeneous AM -06b 80507 -49b White Leveling Cornpound Crushed ND Assoc. wl AM -06a AM -07 80507 -50 White and 0my VinYl ND - Man Made Fiber Sheeting wl Gray Felt Backing flomogoneous 34004 -- 9`1' Avenue South ♦ Suite 5 ♦ Fedcral Way, Washingto►, 98003 -6740 * Tacorna (253) 952 -6717 ♦ Seattle (253) 874 -9118 ♦ Faosimile (2S3) 927 -4714 i Email lnfo @0ri0nES,110t WJJF W7.1<c`021I0743 May, 9, 2008 5:01 PM NOW Environmental Services No, 8755 P. 16 O"ON Environmental Services An Environmental Compliance Consulting Firm Polarized Light Microscopy Test Report EPA Method 600/R- 98/116 Client Assured Quality Environmental, Inc. Date May 9, 2008 2702 "A" Street Page Page 2 of 2 Tacoma, WA 98402 Invoice 081876 Date Received May 7, 2008 Project Number N/A Project Name 212 SW 35e Street Federal Warr, Washington Client Orion Sample Asbestos Other Numb pigmb ar Stereo Sco a Exam Treatment Percent T e Fibers AM -08a 80507 -51a Cream and Tan Vinyl - ND - Cellulose Sheeting w/ Gray Felt Backing Homogeneous. AM-08b 80507-51b Orange Mastic Chloroform ND Cellulose .Assoc. w/ AM -08a AM-09a 80507 -52a Cream, Tan, and Blue - ND - Cellulose Vinyl Sheeting w/ Gray Felt Backing Homogeneous AM,09b 80507 -52b White Mastic Chloroform ND - Cellulose Assoc. w/ AM-09a AM -10 80507 -53 BlKlv'Red Roofing Ash ND - 1~iberglass Homogeneous Cellulose AM -11 80507 -54 Black and Gold Roofing Ash ND - Cellulose Homogeneous Fiberglass Dup: laboratory QAfQC Duplicate; M; Mastic [(a), (b), (c), etc,]. Sample layers numbered fivm front to back Comments: For layered samples, each component has been analy=d eaparawly, ND means nom- daooct for jwbestos fibers by EPA Method 600 /k- 98 /116.Disc1aitners: P1,M has been known to miss asbestos in a sm211 percentage of samples that contain asbestos. Thus, these laboratory results represent due diligence, however negative or <1 % PLM results can not be $uaranteed, Per EPA guidelines samples will be archived for 30 days then will be disposed of. This report may only be reproduced in full with written approval of ORION Ew ironme rvices. Analyzed By Reviewed By stn' uechenbe onnan M*O'NeNl Laboratory Analy Laboratory Director / CEO . f-w& g 0wommadaf Compflava Cowu&V Into tine 21" Cry 34004 - 9th Avenue Sputh ♦ Suite 5 • Federal Way, Washington 98003 -6740 ♦ Tacoma (253) 952 -6717 • Seattle (253) 874 -8118 ♦ Facsimile (253) 927 -4714 ♦ Email Info(rOrionFS.nct WBE W217921.9763 Cbpfe of Custody *ad Semple Inventory Record 'CI ttrtt Roof AU am` .r#�eeat�,b a � tleotl*n �1.R.�41J -- z °AroJect Kinbtr _ _ — - 1'eit:�oitt Feteltnlle fart fltiier Namfxr �� � O�ee anrline per ttrntplQb I+s ttt�7ECd roe'X" to the fox ol'Ibs eptaBle tnt�ulrio be�raned, i£eeriya a Is netiMe4 writo 6n �edficasquort 0 3. Liv*ae tart r"urtmd tuffamad 's` time (br�t►npler, I.aboniorp wi1F ri h91wr pl sno uniesr Indte O 0 olNawist. r *man* o: T !6 © Now (3 some DRy Cl 24 WWI .E3 41 Nbum M'3 DW CJ s DW C] 7 Days 0 other ' C'40- ABi aRZ�il� Ea,vtraat�rea i�erviGea, Avtoue $ou4Y* NaMing Bulk 54 096r'st Wt7,MPadl. 9461 ;4744 'ktte ianc8estilt -; 253)$' 14- ltifBTsea�as- (5531961- �7a7Fiwh�le 3 927.471 r San IG4 �u Y 0 (} N!A C) band C3 1► iud C1 Rkpremd PIK Chats of Custody and SampW loveniory Remrd I Ct it of 1460+ w Miut66e a � A Xtlu116tt rte.. ' IYa; jrel lCon�bi r %>ap�art haesba,�e or ' t"7R.ZQ.�1'Ellvlr �fiarvscelt \ ��C��� ✓ " "�lF9fi Avcrue Sout�� edMligt A3ul(a �. �WWferN NfsA V11w 1406i�r7�i ��/ 7elept+tnc5ss111e -i2S3 ti7s.a1lSrAe.rra -Gt�s s�l.F'1►Yil+wtmik 3)9374714 +ac , ��I.1110! I]1w I Isla rr�rr■i� rrrrrrr�rrrr�r��rrr�r�r�r����� rr�rrr� rrrrir�rrrrrlrrrrrrrr�r��� r�rs■� rrrrrrrrrrrr�r�rrrrrsr��i �rrrrrrr ■rr�rrr�r�rrrrrtrr�rrrrrr���� ����rrrirr�riir rriirrrililil i� 4444414 ■r��rrrr�irr�i�l • .i� K! �. M1. lr i . '. i ... I oiI: `e•i'l i�:� -- i�a : -�a,.� Ji ._, r �� ri_. r 0 Now 0 f� 0 24 Floure E 13 0 r r. maw ' w -- Off t.-Fand E2 Wited r� ■ rp 0 May. 9. 2008 5:01PM NOW Environmental Services No. 8755 P, 19 . AWPSD UPS ' ENV1R0,_NAMTALL I34C. AHERA ff VEY.&ANM SMET LOCATION: MI c4 Power kvaikble-. YES No" Water A'vvlable: YES N61", X kA , U5 Wo 41 SA1PLE # SAMPLE DES s i4N LOCATIONS' TY IJ I F 11111 11!2111 �16&14111 I V"4 A 1 Ago May. .9, 2008 5:02PM N W Environmental Services No. 8755 P. 20 QUALUITY ZMU0NMNTAL9C, � °� 1 �J AHERA, VE'Y IAMpI SF EET CATION: � • , � Power Available: M Water A.vaflable: 'YES Ply? UIC 4q �T SAMPLE #- SAWL' E DESCM]MON Ns TX SIIB TE VT LR DR Wallboard Plaster Kitchen Mastic' Ceiling Tile # of Bath Conc" PCT Roofing # Of BR CAB Slip Sheeting Piping Boiler amilation Laundry HaIlway Other Other i Ducting Tape Due ft Wrap Roof Window Glazing Exterior Other: VT B Wallboard plosttsr Kitchen Mastic Ceiling Tile ## of Bath Concrete PCT RAafing _ # of BR CAB Slip Sheeting Laundry I foe# Other Ma fpfo: Piping Boiler Jnsuladon Mway. Tht ft Tap Ducting Wrap Roof Window Glazing Exterior Other: other VT LR DR wood Wallboud Plasiel Aften Mastic Ceiling Tile # of Bath _ Concrete (( PCT Roo ft # of BR_ CAB Slip Sheedq Piping Boiler Imlation Lawdrp Hallway Other Uther io: Dulling Tale Ducting Wing hoof Window Glaxir►g Exterior Other: Other VT LR DR Wood Wallboard Plaster Kitchen AU-0 Mastic Ceiling Tile Concrete PCT Roofing # of OR _w.. CAB Slip Sheeting piping Bailer Insulation Lao uk Hallway Other Other info: Ducft Tape Ducting Wrap Roof Win&W QL12ing tenor May. 9, 2008 5:02PM NOW Environmental Services No. 8755 P. 21 AM_JIKEM &R D Q AZ, ��I oI C. 1 AURA SURVEY ALE S1 wT AT YON; 12 --1 - cr Available: YES � Water Avaitabk -. YES J SAWLE # SAI►� LY, DESCRYPTION LCICAT[ONS QTY $ TE VT 3�' LR DR Yffiod �Wallbom-d Plaster Kitchen Mastic Ceiling Tile f Bath 2, Concrete PCT Roofing of BR _ CAB Slip Sheeting Lain Outer Other i • Piping Boiler Laulation Hallway Ducting Tape Duedtg Nup Roof Window GIazing Exterior Other, Other VT VS LR DR Wallboard J)bster .Kztcbcn ~� Mastic Ceiling Tie it of Bath Concrete PCT ,moiling # of BR SCAB ' �ltp Sheeting Laundry � Otlw her —info : Pipes Boiler Insulation HuRway. . Dui Tape Ducttng Wrap Pff I;pp Window Glazing Exterior Other: Other VT YS LR DR d Wallboard Plaster Kitchen Mastic Crating Tile # of Bath _ Concrete PCT Roofig # of BR CAB Slip shoe ng Latn k Other Othff wo: Piping Holler Insulation Hall" ay Ducting Tape Ductiug Wrap Roof %Imdow Glazing Exterior "^ Other: Other VT LR DR ood Wallboard Plaster Kitchen Maed Ceiling Tile # of Bath _ Concrete PCT Roofing # of BR CATS Slip Sheeting Otltier _ . Other info: Piping Boiler Insulation Hallway Ducting Tape Ductiq Wrap Rgof Window Crlazing 060x: C SSURED UALIT L ENVIRONMENTAL INC. 2702 "A" St. • Tacoma, WA 98402 5727175 Bill To Landmark Homes PO 13ox 26116 Federal Way, WA 98093 Invoice General Contractors Specializing in Asbestos/Lead Removal, Interior Demolition and Mold Remediation Seattle (206) 763 -7177 Port Orchard (360) 769 -7175 Fax Date Invoice # 5/12/2008 4904 Job Name 212 SW 356th St., .Federal Way,WA. ip "O`'ifl' Terms Rep Project # Bulk sample analysis. Net 30 TF 425.00 Description ! ij. + Qty Rate Amount Bulk sample analysis. 17 25.00 425.00 Performed a "C7ood Faith" asbestos survey r „ygrh "i ''i'<,:;;9; r;!i 250.00 250.00 • %i:, ��:i ':SSE •`il•!' "' ��j Si,l�;il • ' {:!.; •t. ii��•I; vj; I�: j,. i� I" It is a Measure doing business with you. Total $675.00 Balance Due $675.OQ Approved Transaction Page 1 of 1 pscleana i r.org Puget Sound Dean Air Agency Notification Case #: 200901595 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $75.00 Credit Card Transaction # VSJF3EA43D68 Transaction Date 07/23/09 Owner's Name Nehemiah Group LLC Phone (253) 202 -9429 Project Street Address 121 SW 356th City Federal Way Zip 98023 Contact Person Jason Litowitz Phone (253) 927 -6116 Mailing Address PO Box 26116 Federal Way, WA 98093 This project includes a demolition. Demolition Start Date 08/03/09 Completion Date 09/15/09 Demolition will be completed by a demolition contractor Demo Contractor Landmark Homes Inc. Contractor Job # Contact Jason Litowitz Phone (253) 927 -6116 Mailing Address po box 26116 federal way, WA 98093 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed. The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single - family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History If you have questions, contact us at asbestos @pscleanair.org or 206.689.4058. https:Hsecure.pscleanair.org /Asbestos /Approved.aspx 7/23/2009 1