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06-103138 • - City of Federal Way Demolition Permit #• 06-103138-00-DE Community Development Services #: P.O.Box Federal Way,WA 9718 98063-9718 Ph:(253)835-2607 Fax(253)835-2609 Inspection Request Line: (253)835-3050 • Project Name: HOLDERMAN Project Address: 30156 16TH AVE SW Parcel Number: 515320 0395 Project Description: Demolish approximately 2,020 sf residence w/attached 240 sf garage. Owner Applicant Contractor , TIM&SUSAN HOLDERMAN TIM&SUSAN HOLDERMAN GILLIARDI LOGGING&CONSTRUCTION 30157 16TH AVE SW 30157 16TH AVE SW INC FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 GILLII*004J0(6/14/08) PO BOX 16 ELBE WA 98330 Additional Permit Information CONDITIONS: After final Inspection is completed andapproved contact Kari Cimmer via e-mail- kari.c a�I a .ityoffederalway.com for release of bond. PERMIT EXPIRES Sunday, June 22, 2008 Permit Issued on Friday, June 23, 2006 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: Date: .O a-3-06 • THIS CARD IS TO*MAIN ON-SITE CITY OF Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 06-103138-00-DE Owner: TIM & SUSAN HOLDERMAN Address: 30156 16TH AVE SW FEDERAL WAY, WA 98023-3451 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 L (,it) Date 7 7.O4 , ip:A, • e A 06 - / „Cleral Way PERMIT \° N1TY DEVELOPME1VT SERVIS ECEIVED SF MF CO ME EL 17/1LDN FP 333 M AVENUE SOUTH•PO BOX 9718 F ERAL WAY,WA 98063-9718 PPLICATION TD r7°....,....s..........,..,,,,,,L) 253 835 2607•FAX 253-835-2609 luN 2 3 204 www c(tuoffecleralwau corn V The ollowin! is r ,,;LA yl .:guL;;..; ::,, telt incom■lete a. ,lication will not be acce,ted. Please ■rint le!ibl_ (in ink)or _ , •. I'd PROPERTY INFORMATION 1 r,\ 1 r,a i 1_ SITE ADDRESS ourD to t to• NIWZ, ().) SUITE/UNIT# ASSESSOR'S TAX/PARCEL# r... I 6 ?) 3- 0 - D6 °1 5 LOT SIZE(Si) I101300 Sk4 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) licI 4- 11ACW1m... Vial) c.,S4&-Q.,S Ryvt. S 136 Pb (Attach separate page for lengthy legal descron) OAK k , i • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL )(DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESC*IPTION(Provide cletailedidescription of,work inquded on this rmit onluJ DUYNC IA ,11 c4- g111■Cp ---0 \I r-- AivrL __, 6)-0 wi() PROJECT NAME(Name of Business or Owner Last Name) +It iclumank, . PEOPLE INFORMATION PROPERTY PRIMARY PHONE OWNER NAm -i-A-lievkctikot. SuLscin 94-rotdutvocuk (,)-63)9aG -9 cos CITY,STATE,ZIP SA6LTIG DRESIS0.31 iu()... (..0 ad I lay , LO Pt GI Et 0a3 CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE 4L[ii arasi U vcI r■is-1-.%IASI. lieu. TaitAikilt illicuicti (36b) Stcg -XIS 1 ING ADDRESS i ,STATE.ZIP CELL PHONE CITY STA 1)0 lio>c 1(0 Pi101 q WA qE33D (aa) 318 - 101 CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATIO DATE FAX NUMBER al-O (ie-J t2 2- eg1_ B L te / I 0 8 (300 ) 5b1 - Sq6k CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATILT DATE 0 tp, / 1 ' O& APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE ( ) - MAILING ADDRESS ¶ :1N O& CITY,STATE4IPr CELL PHONE G (1,00V opV (Aour (015 ) oi -5%o RELATIONSHIP TO PROJECT FAX NUMBER o Architect o Tenant n Agent k.Other(Describe) 0 V) 11 053)E-13 -DI 11-3-. TtaL,K,1-1.01J-uery\ct ( E-MAIL ADDRESS, _ Go D lhlone.con LENDER Per RCW 19.27.095: Lender information iS NAME required liprcdect value exceeds$5,000 A MAILING ADDRESS CITY,STATE,ZIP PHONE ( ) • DETAILED BUILDING INFORMATION EXISTING USE PROPOS' 1 -: EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? o YES • NO FIRE SUPPRESSION SYST— • • !a ED/REQUIRED? 0 YES 0 NO WATER SERVICE PRO .I P — o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(WEL SEWER SERVICE •ROVIDER o LAKEHAVEN o HIGHLINE n PRIVATE(SEPTIC) , • • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PRO' • 2 TOTAL SQ. FT. 0..FT. SQ.FT. BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT EXISTING PROPOSED TOTAL TOTAL EXIST IRO SP TOTAL PROPOSED ED TOTAL S► NUMBER OF F **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do no . bide existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EV •.••TIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(Commercial) WOODSTOVES BOILERS FIREPLACE ■: • RANGES MISC(Describe) COMPRESSORS FURNA ' GAS WATER HEATERS DUCTS G• •IPE OUTLETS PLUMBING BATHTUBS(orThb/Shower Combo) SHOWERS WATER C Crone) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNT GAS PIPE OUTLI.IS SUMPS RAINWATER SYST WASHING MAC..'-++ URINALS HOSE BIBBS LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the nformation furnished by me is true and correct to the best of my knowledge,and further, that I am authorized by the owner of the above p ises to perform the work for which the permit application is made. 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 of Federal Way,but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application. ' 1� n ✓ NAME/TITLE \ —'�.)l tx [U ©Wf n lQ�f DATE (Signature) (Title) R ELATIONSHI PROJECT Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other FOR OFFICEUSE,ONLY ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? ❑YES ❑NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application • • DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES • � 33325 8�'Avenue South CITY OF �.� P9 Box 9718 Federal Way WA 98063-9718 Federal Way 253-835-2607;Fax 253-835-2609 www.cityoffederalway.com 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.ASBE S ABATEMENT 6. ELECTRICITY (Copy of ap7aval form and asbestos s ey from Puget Sound Clean Air (Electricity t off nd met r removed) Agency pro e. Sound Energy) (Puget 9Y) /( • of Federal Way Building Official) 2.GAS 7. . - i ORAGE TANKS (Gas to be shut off oved and final bill paid) (Above or below • , have been pumped or removed under Fire D •• ent permit pri• • :- ■' , antle/excavation) (Puget Sound gYr (Federal Way Fire District#39) 3,-SEC SY 8.WATER- Public Source (Check applicable box) (rank to be remov-• •i'tank to be drained and filled) ❑Meter to be removed and final utility bill paid ` Meter to remain and be protected ring County Environmental Services) (Water Supplier) c --f O( ******OR****** 4.S ER (Ch- :•plicable box) 9. - - Private Well(Ch- ••p icable box) ❑Sewer line capped - : ••- -.- ❑Private well thief •-• • ❑Existing - me to remain and be uses •' • .:_- • new structure ❑Private well t• •- • -• for o • ..ses (Sewer District) (King County Environmental Services) 5.GARBAGE (All househ I arbage d- is sed off and final bill paid) (RST Disposal/Federal Way Disposal) ❑ Completed Construction Permit Application form 5' ❑Provide the following fees: 1.Demolition Permit Fee $6 .50 2.Automation Fee 5.00 3.WA State Surcharge 4.50 4.Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection) $573.00 Bulletin#122—March 9,2005 Page 1 of 1 101-Iandouts\Demolition Permit Requirements 06-14-2006 03:36 From-EKING 4253437671i T-566 P.002/002 F-641 Jun OE Q6 24:5Sp Ts olderman • 253 W5.900g p. 2 DEPARTMIXT OF COMMUNITY DEvrLnPAISIVT SB1t ca a 33335 811 Avenue South CITY O! PC]8oz 97I3 Federal Way Federal �y, A 4$855.2719 233 835-2507:Fax 253-835-1609 ww w.oityotTede rlIviey.00m DEMOLITION PERMIT REQUIREMENTS A demolition permit ire required to remove any;structure or structures on a subject property-Cheek with the City's FIanning Di*vision to see if the proposal exceeds threshold&that trigger en on vironn cntati review_An eenvitnstmentai review and submittal of en a rvirontaeatel checklist may be required.which will extend the tiro.period before a demolition portrait sash be issued, 0 PAM'.tO Submitting itting a demolition permit,the following line(as applicable)must be signed by the respective agency(Fee attached Demolition Permit Contact Lbz). NO7B7'p APPLICANT.' Untiaias shall ba diseorareeaeel cord service= if appaieaple,Nino to Wnattee of rho drmo?faa perArrr.All applicable trees below are to be .v,d ina.d by the respective agemy reprrsrnnttives. 1.A Be3TOe$ABATEMENT 0 (easy or approver fermi and asbestos survey f to i Puget sound Clean kW ,: e� - n q r Agency provided)) , i re/ d'J''I L 1 1 n way (-ugeesosnd Budding ) = - Z.GAS SFiipRLlf "�" -- ,,. 19E TAN/CS Mae to be ante orr -ta rveet an Om bin paid) (Above or b n • _. _ • - - n have been pumped or removed under Pyre '.-• • ant peon or. .. .L antle/eteeavadon) pun a o ( 0y re n 9'c M=SYSTEM S.WATER-aublc Sown* (Chock applicable bee) (Tank to be removed or tank to be drained and Medi o Meter to be r ertaaved and fired alit,bill paid • me to remain and be protected (king County E rennienril dowel) �► `T ter Supp er)�FJ Obe este, OR....,e. R [ •p rcaeta not) 0. - - -Iterate Well(Ch o Sewer One�p• ( p nob a boa) v 6dsel i r to remain and be -4,••• ... - -- ra Private we MI new n�ra a Private well t• •• gwer l•,`*. a., Tyr='1'r:temente -- 3.GARBAGE • (Ai!hd prM and final bill p l/Feele-al Way'Dis sal) G!Completed Construction Permit Application form Cl Provide the following tees: 1.Demolition Permit Fed $63.50 2.Automation Fee S.00 I WA,State Surcharge . 4-50 4.Cash Bond Deposit 500.00 Nerzen4able:won Compiceed Thal tospecdim) $573.00 Benign#122_Miuth S.2110$ Pest a or 1 V -- leltaedeamtbanoRilton Perron Elinquirerean Received Jan-OE-2006 04:55am Frain-251 925 1005 Tv-PIE Page on • MAY-24-2006 22 52 P.01/01 PRGh7 . SOUND ENGINEERING,INC. t ri ri Nu. • J. e:a� ..2 1,1 GJ+4a °',. ° ���.. _,�-,_ '• • .[ y' x .,rvyY�,.,•iY Ati%, Durag'.forrorCoMM4riTrit 1, , ' - 1. ' 190ii'`• ;,:', , •., b,; ci/V OF redeJrgN. ai`•1.-c': :.',,' • `i)'4 + ". Federal ItItay GT3•a7S1 .'i.. Y,L 1.• `Y,1°;,•V��n. „ti�.,):5 PERMIT REQUIREMENTS , DEMOLITION PE .; ` ,g .�R �.)'rte rernave unicorn or structures on a subject property.Check wit,illti i tter'n, ►""'' A demolition permit is required to any environmental review.An environmis i „ , ;';- ` Division to see if the proposal woods thresholds that trigger which will extend the time period before a darr011on.' .'.�' CcaR .� ,a7,r submittal of in eavflnrt*netrral checklist maybe required, ��,• be Issued. . ,A9 °i kM;:5; y. the following items(pa applicable) be by�B a :;; �',` '°,, Q Prior to submitting a demolition permit, „ agency(see attached Demolition Permit Contact List). 'i ;:; °: MAW shall bt die 'ed dad sewlrss perjCroted(f spplicabb•prior to EnuarICSQfdieda�(ththraperIli 4 PllC'Ia'•' ,' ":t ; . . reams u be br:ne'rol a Ul Pepr'esenlotivel. ?j :� ry!` tirrtf0 •,•" ;, J'j ABATEMENT 6.ELECTRICITY and motor nelnowl(0 L ASS y,,� from Puget Sound C$r Air t , city to be shut Off r,.' ';i Vl(''3p;,' ,i. .;, (Cow *prowl 1411111 Gwmaw-'."'•'! xI: '. �." -1.`. 4 ,,�I. eBour Provided) Puget 3'. a�: , 4F CV Way a ;- '`a-! '' ° y.FUEL STORAGE TANKS ':..m‘' `,::!,:i'',,::.• 2.$to SUPPLY I fuel tanks 17� . d, :, ' -. be shut off,meter removed and final bill paid? (Above or below t r )'^';, : +._a;,•,Y;, :•(tit to undue Fire Department Admit txior W'ahY� ��,' .,` ', .--- ;�: a. it 4i�; fir Sou �Tt7 Way i�ra D�tot'a39) „, ; , ,,, .,; . fi.WATiR-Pvbric source tcheck'fp0liOiala,,ov q.. . ,., 1•° : 3.SEPTIC SYSTEM be drained old fImo) o muter to be ns final%OW be vnd ^i' ?.f.7,',-'•,i- auk tiD Or tank et remelt P , }}1- !` arse` .t':',•,,1,i,? ' ;',-1 (1C111QC(It+rll5' mono. , Y'� :''�$t. .' , p.WATER■Private WEN(Check«pplicable::be -.` ,.,'. • •{.,'63,'., ,a't 4.'3w line SEWER (Check oppueabte box) !Paled Mid peed o sewer line c+�Ppad at pn 1Y e a Rivets u+e . . o Bddi Sewer Inc to remain and be used by propoaad now e 0 Private well to he used for other purposes .y ., .}; (SDI( t ur(t1r Brivioonmenial lrtiervkeef { ,;u, S. A MGE a ',r<<� ..;, nouseho+d g �.X:!• .2. . py, .. .Y �II` -- _ - ... „_ • 1 J.: 1� \as1 n .I. ter, �4';•�i,��.,k..aa-• /� 1L •. ...-'fir' _.777, -•— ❑Completed Construction Permit Application forge � '`" •°' 1.Demolition Permit Pee $63.50 1 : ❑Provide the following 5.00 '< 2.Automation i. •s: :' , 3.WA State Surcharge 0.00 (Re[eadatsle moo Comptelar'E+irl' ...,; :',.ar<; ,'3 �.Cash Bond Deposit 509• Page 1of1 k.AilafrdOWADIZAditrus PIN Rrgulru • dz'1; .,=,' TOTAL P.01 06/07/2006 15:01 FAX 206 689 4073 FS CLEAN AIR 21001 MAY-16-2006 12146 PM C0wSFIC Ytdb 4 esr•-i r-ooa - I Case Na, PUUh l'SOUND Ci A11tAI,il.NCY ` ire lttaoelved ASHY r� +� 110 Union swot.Suite 500 PSAl�4 pl[4 i 16 2006 2 0 0 6 0 2 1 G. Scettie,WA 91101.203g r� _ "r a wenv,pscleartair,org Elie ally a,r NQTI Agency CE OF INTENT Ageow use OnRY A r2 t Tyne: 1. LI Yriebla_Asbestes Removal L ✓ Friable , Property Owner: Sultan Haldeman Phone: 253477-5960 Manful,Address, 30157 16`"Ave>t SW : Federal Slate WA 95029 C. Asbestos Contractors Crown Delta .. tors LI.0 Owner/ ED: Kirk Baker Cotlffactor Man..: Address: 12218 518' South ' Phone: 206-763- : Job No.! IMMIN State: W Mill Fax:206-163-2S79 '.„ .64 D. Site Address: 30156 16°6 a SW Ci :Federal Wa Zi.: 99023 Site Manager: Susan kloldetxtt an Local Phone: 53-677-5960 1y, Asbestos 'urvey or No.of Date of Asbestos Was Friab e ,bestoe I....,;•e•. Yes UNo ❑ ,__t'l Presumed • ,oarres: 1 r4" ►.:/ ►. WM Moldable Asbestos Identifted7 /Yes ON° AMEBA Building Certificat i on a- I a.6a4S Attach a copy of the survey when friable asbestos Inspectors Carl Dykstra Exp.Date:06/22/06 has not been tdenttf`tsd. Aa AHEM 3wr.oy la regal i before ail daneetirlerr projeaa --_ F. Demolition I Start No,of 1.a Training Fire eat Fire Dept:) Infornistlen: I Date: 05/30/06 Oros: 1 2.Gi Ordered Demolidon ttach co of Order a � f7emolition leant thro t:lien ee-7.ealer a marring address an back. Will nonftiabre-rsreltos be left in p ax during ern-4?-1J1 Yes 1 No Contractor: If yes,list type and qty. Note disposal requirements in Step 6(on back). ISD G. Friable Asbestos Work Days; 1'eoloet in( rmation: I start dates. _ 05/25/06 Action Date: ?5/30/06 Houw 1!00 A.M.- :30 R. . ' Will all friable asbestos J rtes Total ,to oe Removed: I.incar Ft, 1500 9 uare Ft. rI s be ram ved? Boiler umi mutation Dual Insulation Pi a Insolation ' Fireproofing Paints Plaster Terture Cam' Cement Board Q Cement Pipi 1 Friable Floods Friable Rooting Material -. Gtrr IL A,sbaetasaktmolilion Project Categories: NOt1Wcation_kstriod f Project Minn 1, Single-Pamily Residence(owner-vicettpled): { Em $fie A U Asbestos Removal Project Only A.Prior Notice A. 821_H ',Demolition Project(wik or without asbestos removal project) Days*B. 10 JZi_ "Asbestos removal can be l in u.. notitication•demolition most wait 10 de Nate:If the single amity residence is owned by one family who has been or will be using the residence as t snot kite,the above bozos IA or 1 B may be checked. ((this is not an owner.occupicl reridartca,one of the celgorles listed below dnasstt be sued instead. A single esidence does no i cl de rental .ro• ,multi-amts units.or an mixad•ure budding;,,,^-_ 100 2. >s All Other De 1101.4 ens(with no As 4 stos removal or '�a ', • Asbestos 10 Days onlvyass than 10 linear eat and/or 48 .•tsars fist of friable Asbestos Friable As t ..toe Pro ects • is ,•.r. 'stray ' ,dense,): Asbestos Demo 3, • • - 9 'i a:feet d/or 48-159 -tare set of as egos Prior N••: a 1* "11 k 5100 _1_, 4. 0 260-999 linear feet sadlor 160.4 999 s•uare t i. as•eatos 10 Da $200 100 5. a >1 000 list.. . t-- .,.- or',.5 Ili wars feet of.tglistos 0 rl a 86011 $100 6. * Emergency Asbestos Project or Emergency Demolition Project Prior Notice 550 Emergency Fee (sunk-anew ucsise+ces era ruse eraencyf +owwar,Pro— owns%must wrenen emir,l,- . A. L 1 testify th the area wntaUead its:Wes notittcetton&sueniementat data ill,u►inc beat of my knowledge.accurate&compeer. -f/MO ! Y ., ► . � . _ . C _ .. . '6 tJr n,rerus Net Sound Clean Air Agency Form No,: 66-160(atvised MS)T5 AU0931iy1 0 ' i . - .e 1 111► M • A-T ASBESTO-TEST, INC. ASBESTOS SURVEY 30156 161-21 AVE. SW, FEDERAL WAY, WA 98023 Page 1 of 6 #260427 April21,2006 Susan or Tim Holderman 30157 16th Ave.SW Federal Way,WA 98023 Ph: 253-677-5960,253-307-2246 susan holdermanna,comcast.net On April 12,2006 Asbesto-Test personnel conducted an 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)of house na,3015616`h Ave.SW,Federal Way,King County, Washington 98023. This survey purpose is to identify any Asbestos Containing Materials that may be present and will require professional removal prior to demolition or renovation. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The structure is one story wood frame. The siding is wood. The composition roofing and siding vapor barrier materials were sampled. INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS:The interior is drywall and wood. The drywall/taping materials were sampled. The tile and vinyl flooring with relating backings and mastics were also sampled per each located homogenous area. The mastic materials were sampled where applicable. The popcorn ceiling materials were uniformly sampled. INSULATION: The insulation material was sampled. ELECTRICAL SYSTEM: The electrical wiring insulation did not appear to be of the kind to be ACM. The power may have been"on"at the time of the survey,thus sampling was not safe. Any suspect electrical wiring insulation or any suspect TSI(Thermal System Insulation)found in, around, or behind any located fuse or breaker boxes should be considered to be ACM (Asbestos Containing Material), unless determined otherwise by laboratory analysis. CONTINUE TO PAGE 2 1429 Ave.D.PMB#187,Snohomish,WA 98290 ph:206-914-5500 fax:360-563-2469 page:206-540-2401 • Page 2 of 6 April 20,2006 CB260427 Asbesto-Test,Inc. (206) 914-5500 3015616a Ave.SW,Federal Way,King County, Washington 98023 HEATING AND VENTILATION SYSTEM: There is baseboard electric heating with a complimentary fireplace insert in the structure. There was no visible suspect ACM located associated with the electric heating units.Note:It was not possible to dismantle the electric heating units to locate and/or evaluate any additional suspect ACM which may be concealed, inside the units, or associated in hidden areas. It is our opinion any further handling of the heating units should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect materials are located prior to and/or during any demolition or renovation, any and all additional related suspect materials should be considered to be ACM (Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. Misc.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None. #of structures included in survey: one structure Requested by:Susan& Tim Holderman Carl Dykstra Inspector,certified A.H.E.R.A accred.#1016845(Expires 6/22/06) continue to page 3 A-T • Page 3 of 6 April 20,2006 CB260427 Asbesto-Test,Inc. (206) 914-5500 3015616!—"Ave.SW, Federal Way,King County, Washington 98023 Any and all materials identified as ACM or PACM in this report(and/or additional materials associated with the structure that may be discovered and later identified as ACM or PACM),must be professionally abated prior to demolition.ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION,AS LISTED QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY. SAMPLES 1-6 ARE ASBESTOS CONTAINING MATERIALS ANALYSIS ID ASBESTOS//TYPE//OUANTITY OTHER MATERIAL 1.0 SHEET VINYL FLOORING yes//chrysotile//35-40% non-fibrous materials, FRIABLE ACM cellulose Den—color: brown pebble Note: The asbestos is in the gray/white vinyl backing. The mastic is also ACM as it cannot be separated from the friable vinyl backing material. APPROX.575 SQ.FT.on wood 2.0 SHEET VINYL FLOORING yes//chrysotile//35-40% non-fibrous materials, FRIABLE ACM cellulose Master bathroom surface layer—color: cream 2.1 SHEET VINYL FLOORING yes//chrysotile/135-40% non-fibrous materials, FRIABLE ACM cellulose 2"d layer—color: tan pebble Note:The asbestos is in the gray/white vinyl backing. The mastic is also ACM as it cannot be separated from the friable vinyl backing material. APPROX.30 SQ.FT.on bottom layer Non-ACM sheet vinyl 3.0 FLOOR TILE yes//chrysotile//2-5% non-fibrous materials ACM Center bedroom-color: off white w/gray streaks 3.1 BLACK MASTIC yes//chrysotile//2-5% adhesive,cellulose MASTIC AND TILE IS NON-FRIABLE ACM APPROX. 100 SQ.FT.on wood 4.0 LINOLEUM FLOOR TILE yes//chrysotile//2-5% non-fibrous materials NON-FRIABLE ACM cellulose,tar SW bedroom—color: brown Note: The asbestos is in the hard tile surface material. 4.1 MASTICBACKING NAD adhesive,cellulose,tar APPROX. 140 SQ.FT.on wood continue to page 4 Efal Page 4 of 6 April 20,2006 CB260427 Asbesto-Test,Inc. (206) 914-5500 3015616`—"Ave.SW,Federal Way,King County, Washington 98023 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL NOTE:Any additional colors or kinds of vinyl flooring and/or tile with any relating mastics/backings that were not discovered in this survey and may later be located in this structure are also presumed to contain asbestos unless tested otherwise by laboratory analysis 5.0"POPCORN"CEILING yes//chrysotile//2-5% non-fibrous materials, FRIABLE ACM cellulose,foam Family room-APPROX.560 SQ.FT. 6.0 TEXTURED CEILING PAINT yes//chrysotile//2-5% non-fibrous materials, FRIABLE ACM cellulose,foam Living room&hall areas-APPROX.360 SQ.FT. THERE WAS NO ASBESTOS DETECTED IN ANY OF THE REMAINING SAMPLES 7.0 sheet vinyl flooring NAD non-fibrous materials kitchen surface layer—color: tan&white design 7.1 mastic NAD adhesive 7.2 sheet vinyl flooring NAD non-fibrous materials, 2°d layer—brownish gray cellulose 7.3 mastic NAD adhesive6 8.0 sheet vinyl flooring NAD non-fibrous materials, hall bathroom—color:tan&brown sandy cellulose,fiberglass 8.1 mastic NAD adhesive 9.0 sheet vinyl flooring NAD non-fibrous materials, master bathroom bottom layer—color: off white cellulose,fiberglass (beneath surface ACM vinyl layers) 9.1 mastic NAD adhesive 10.0 sheet vinyl flooring NAD non-fibrous materials, laundry—color: tan cellulose,fiberglass 10.1 mastic NAD adhesive 11.0 drywall NAD non-fibrous materials all areas except entry,hall,living room paint,gypsum 11.1 drywall taping compounds NAD non-fibrous materials, SAMPLED PER AHERA PROTOCOL cellulose,fiberglass 11.2 surface paint homogenous throughout NAD paint,cell continue to page 5 • • Page 5 of 6 April 20,2006 CB26042 7 Asbesto-Test,Inc. (206) 914-5500 3015616L'Ave.SW,Federal Way,Kind County, Washington 98023 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL 12.0 drywall NAD non-fibrous materials entry,hall,living room paint,gypsum 12.1 drywall taping compounds NAD non-fibrous materials, SAMPLED PER AHERA PROTOCOL cellulose,fiberglass 12.2 surface paint homogenous throughout NAD paint,cellulose 13.0 splash panel mastic NAD adhesive,cellulose bathroom shower stall 14.0 insulating material NAD non-fibrous materials, on underside of kitchen sink cellulose,polymers 15.0 laminant mastic NAD adhesive,cellulose kitchen countertop 15.1 splash panel mastic NAD adhesive,cellulose kitchen 16.0 base cove mastic NAD adhesive,cellulose homogenous throughout 17.0 insulation NAD cellulose,fiberglass mineral wool fiberglass 18.0 siding vapor barrier NAD cellulose,tar material beneath wood siding exterior 19.0 composition roofing NAD cellulose,tar fiberglass, non-fibrous materials • 19.1 roofing vapor barrier NAD cellulose,tar continue to page 6 • .1110 Page 6 of 6 April 20,2006 CB260427 Asbesto-Test,Inc. (206) 914-5500 3015616th Ave.SW,Federal Way,King County, Washington 98023 Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials,as prescribed by A.H.E.R.A.protocol. Samples taken are listed with their corresponding analyses.If asbestos is detected,those samples containing asbestos are listed first and noted with the initials"ACM". If during demolition or renovation,any additional hidden or covered suspect materials similar to those identified in the survey are located[may include but not limited to:sheet vinyl flooring,tile flooring,wall or ceiling texturings or paints,concrete siding or skirting,cement pipes,cement wallboard,electrical cloth,electrical wiring insulation,thermal paper,wallboard,joint compounds, vinyl wall coverings,spackling compounds,or any other suspect TSI(Thermal System Insulation)],they should be treated as Asbestos Containing Materials unless determined to be non-asbestos by laboratory analysis. Note:Asbesto-Test,Inc.does not guarantee approximations of quantities of ACM,which may be listed with the analyses.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 on 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. Analytical test method:USEPA 600/R93/116**(PLM);WAC 296-62-07753 App.J Kew ACM signifies"Asbestos Containing Material" PACM signifies"Presumed Asbestos Containing Material" CAB signifies"Concrete Asbestos Board" < signifies"less than" TSI signifies"Thermal System Insulation" HVAC signifies"Heating Ventilating Air-Conditioning" NAD signifies"No Asbestos Detected" **One percent is the USEPA regulatory limit for asbestos in bulk samples. PLM has been known to miss asbestos in small percentages of some samples,which contain asbestos,thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM or TEM,to insure analytical accuracy when reported in small percentages. Asbesto-Test,Inc.claims responsibility for sample content only. END OF REPORT ArLynn Hammond,Pres. Analytical Chemist,B.Sc. AIHA proficient A-T