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04-101880 1. I • • • , ,. +►. City of Federal Way Demolition Permit #:04 - 101880 - 00 - DE Community Development Services 33530 1st Way S Federal Way,WA 98003-6210 Ph:253.661 4000 Fax 253.661.4129 Inspection request line: 253.835.3050 Project Name: REYNOLDS-WALSH Project Address: 30210 23RD SW Parcel Number: 012103 9005 Project Description: Demolition of existing above-ground structure and leaving foundation and basement Owner Applicant Contractor KATHY REYNOLDS &JEAN WALSH SWEATMAN YOUNG INC SWEATMAN YOUNG INC 30210 23RD AVE SW SWEATMAN YOUNG INC SWEATMAN YOUNG INC FEDERAL WAY WA 98023 PO BOX 7105 PO BOX 7105 BONNEY LAKE WA 98390 CONDITIONS: • After final inspection is complete and approved by City Inspector,please contact Kari Cimmer by e-mail at Kari.Cimmer @ci.federal-way.wa.us OR fax at 253-661-4129,to receive refund of cash bond. PERMIT EXPIRES November 10,2004. Permit issued on May 14,2004 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: IL (tceis Date: ''i ' w/ 14 oLI w ? . • 4, . 41411%, THIS CARD IS TO REMAIN ON SITE CITY of COMMUNITY DEVELOPMENT INSPECTION Federal Way IVR INSPECTION REQUEST PHONE#(253)835-3050 PERMIT#: U y'(013 Yo(JO PROJECT NAME: et /2v oS_ to (5k. ❑TEMP.EROSION CONTROL(4365) ❑FOOTING/SETBACKS(4110) ❑FOUNDATION WALLS(4115) To be done prior to breaking ground Approved to place concrete Approved to place concrete By Date By Date By Date ❑DRAINAGE/DOWNSPOUT(4040) ❑RE-STEEL 44 tip-I5 D GROUNDWORK PLUMBING(4190) Approved to backfill Approved to place concrete or grout Approved to cover By Date By Date By Date ❑SLAB ON-GRADE(4255) ❑UNDERFLOOR(4285) ❑FLOOR SHEATHING(4105) Approved to place concrete Approved to sheath floor Approved to install flooring By Date By Date By Date ❑SHEAR WALLS(4245) ❑ROOF SHEATHING(4220) ❑ELECTRICAL ROUGH-IN(4225) Approved to install siding Approved to install roofing Approved By Date By Date By Date ❑PLUMBING ROUGH-IN(4230) ❑MECHANICAL ROUGH-IN(4165) ❑GAS PIPING ROUGH-IN(4125) Approved Approved Approved to release test By Date By Date By Date ❑FIRE STOPPING(4095) ❑FRAMING(4120) Approved NOTE: Approved to insulate Prior to framing inspection,all rough-in& Unstopping sign-offs must be approved. By Date IBC 109.3.4/UBC 108.5.4 By Date ❑INSULATION(4150) ❑GYP.WALLBOARD NAILING(4130) ❑SUSPENDED CEILING GRID(4265) Approved to install wallboard Approved to mud&tape Approved to drop tile By Date By Date By Date ❑FINAL-FIRE(4060) ❑FINAL-PLANNING(4070) ❑FINAL-PUBLIC WORKS(4080) Approved Approved Approved 1 By Date By Date B Date ❑FINAL-S.W.M(4375) ❑FINAL-ELECTRICAL(4090) FINAL-BUILDING(4050) Approved Approved Approved By Date By Date By / i Date / 4 /!'" • Re ilic Federal Way / _ / 0 / o E D COMMUNITY DEVELOPMENT SERVICES ,,� L SF MF CO ME EL P DE N FP 33530 FIRST WAY SOUTH•PO BOX 9718 A p p L I e � �^ y �/ FEDERAL WAY,FAX 98063-9718 1-419 TD / FEDERAL 253-661-4115.FAX 2 6 www.dtgo/jederalwaU.com r. ur n NG P �'la�� The ollowin• is re.uired in ormation-an inco •lete a..lication will not be acce•ted. Please •rint le•ibi (in ink)or . PROPERTY INFORMATION SITE ADDRESS —' ( 0 2; f I - Q- SUITE/UNIT# ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal desoiptior) • PROJECT INFORMATION • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTIONide detailed description of work pcluded on this permit onlq) -- mac; PROJECT NAME(Name of Business or Owner Last Name) '' 1J - w@- I PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER �j /Ad C J 1' - l�L t o 4 2 (Zr) )?1Y -©223 MAILING ADDRESS A CI/gTIP 0,7 1f. q 3 i CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE `eo(1--Kl ) S1A C- (,t,( Sva ..k�.ti (L53 ) 8`3 - 3 78 6 MAILING ADDRESS U CITY,STATE,ZIP CELL PHONE F0I 130.1c, 7loS uQ c. l ?837b (. sue )t.o' -- /4(? 1q- -L7 - BL• OF FED AY BU/SIINESS LICENSE,,, ,Be, EXPIRATION DATE (,� FAX NUMBER gq g I �/I /0(1 tr3 ) 8 / -zZrb CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE S49Eit-t"9r cgs-BR 0/ / o/ 1°S APPLICANT COMPANY NAME ppAPPLICANT NAME OFFICE PHONE fin, MAILING ADpREgs s > IA.., ,n_J, Sew e•ti. ('LS3)aG?'�l D0 �1 �CIITY,STATE,ZIP CELL PHONE t`o YS©K 7/Q � c LI.0•c 4y age 1 W4- P83Po ( 25 ) 6 - /CO RELATIONSHIP TO PROJECT i FAX ❑ Architect ❑ Tenant ❑Agent Qther(Describe) y+xL (Z4-3 )NUMBER f Z z 7s a CONTACT N E PRIMARY PHONE E-MAIL ADDRESS P I lk e4+1AA.c (253 )404".14 f 9 $1(f co ,.,.....y ,Caw LENDER Per RCW 19.27.095: Lender information is NAME required if project value exceeds$5,000 144,... - MAILING ADDRESS CITY,STATE, IP DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) • PROJECT FALOOR AREAS AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.E:. TOTAL BASEMENT FIRST SECOND THIRD • FOURTH ADDITIONAL FLOORS(DESCRIBE) — DECK(COVERED?) GARAGE/CARPORT HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL ERISTDYO AND PROPOSED **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 not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(Commercial) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS troikt) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information 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 premises 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. o NAME/TITLE t..0• > � ' DATE g /471.15V (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent CContractor ❑ Architect ❑ Other FOR OFFICE USE ONLY a NEW a ADDITION 0 ALTERATION o REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a YES a NO ZONING DESIGNATION CHANGE OF USE? a YES o NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? a YES a NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES ❑NO Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application MAY-12-2004 17:1°' FROM:SWEATi Yar-o_3 INC ,;i3.891 wEPE 0:9240223 _ P.2 Ilk\ PI ''' - . isrmoreff rrOFCoanamerYDEvaLOnwrrSEavICES 33530 Pint Way South PO Box 9718• CITY OF 1111111 Federal Way WA 98063-9718 Federal Mfay 25346141f S;Fax 253-651-4129 BeiNsc tYaffed,__wa r_m RECEIVED DEMOLITION PE M I REQUIREMENTS MAY 1 4 2004 CITY OF FEDERAL WAY A demolition permit is required to remove any structure or structures on a subject property.ChecAlliagaiiirffilitlanning 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. • t • �r to submitting a demolition permit,the following Items(as applicable)must be signed by the respeetiw agency(see attached Demolition Permit Contact List). NOfs roAI'P CCUir Utilities shall be disconnected and services polarised Vapplicabi,poor to ioymnce auto demo1idat permit All applicable teems below are to be, m/and dated by the rowecthy agency repre entatiwts• , 1. `'_ $• ABATEMENT V 6. -1444 r• 4,py, , ,,�; and �...w •-surveyfivmpugetscum men .41,,1. s ,•t. , :mdarremNg0 p •" it : l • :ri.,i it... . l e 1 . _ .. r, , .: ..) � 'r 2.GAS Y 7.FUEL TANKS . b. (Gas to ,mater bTrl removed ;(� under Fire Despa do AJd m ntll/oxavatlon) O (Federal Way District#39) 3.5E Stf51'EM 8.WATER-Public Source (Check applicable box) to bt removed or tank to be drained and used) in Pieter bo be removed and final ut ty bi paid . Xdleter to remain and be protected • (king txtY ErMronmentai Services" ervices) (Water Sup ) OR s•asa. 4. Y SEWER (Check appil . • 9.WATER vats Well(Glee• ,x) a Sewer line •—•-. at• •..•. o Private well '%.-- -•• .,••- a bitting super r,,. . - - • .. • --• • •..••._• new structure o Private well to be Sewer Dish** (fang County llinrkortmentol Services) S.CARBAO (Ail household •• i •• ••-_• •• • • , tilt pa (•. ,--r-rr _ . way en-.77 O Completed Construction Permit Application form. O Provide the following fees: L Demoltion'Permit Fee 56L00 2.WA State Surcharge 4.59 • 3.Cash Bond Deposit 500.00 (Refiradable open Completed Final Inspection) 5565.50 • Buff n#122—February 5,2003 Page 1 of 1 kWandouts—R evised)em itbn Permit Requirements MAY-1.,.,-,22004 17:19 FROM:5WEAT VOL.ia INC 253-891-2280 9240223 P.1 ai/Y% aV.i►L rA i.7.1U DAaai i, .? 1 Li. *Alit.1t iv1, �m+.+�+ Babbitt Septic Design,Inc. May 12,2ECEI VED 25113 90th Stmt East Buckley,Washington 98321 MAY 1 4 2004 Bill Sweatman CITY OF FEDERAL WAY BUILDING DEPT, Re:Remodel project at 30210 23'4 Avenue SW,Federal Way,Washington_ Dear Mr. Sean, Currently,my company is in the midst of replacing the on-site sewage disposal system for the above referenced property. As part ofthe septic installation permit which has been issued by the King County-Health Department,Permit# ON0065387,the existing septic tank is being i deeonnnissioned. Within the next week I will have the new septic system completed and ready for use. There is no separate septic tank decommissioning permit or documentation issued by the King County Health Department for any project outside of the above referenced permit If you need any other information please contact me at(253)862-4307. S-1...-54 , / i! .,/1711,' sib 7 r' ► • 1'I.', ,;i Design alai. r t : Mark Babbitt.President ;^ ± Certified Designer lD#5100246 "?{4\,,'�� , Certified Installer King County ID#MI144 .:-.1 At , . ill 11 F tea " r • • HMMed 1nvesdgaOn and Assessment Single Family Residential Unit 30210 23'1 Avenue SW Asbestos Survey Report Prepared for: Kathy Reynolds 30210 23rd Avenue SW Federal Way, Washington Prepared By: ORION Environmental Services 34004 9th Avenue South ♦ Building A, Suite 5 Federal Way, Washington 98003 Project Number: 040804 Deliverable Date: April 27, 2004 Role AHERA Building Inspector Nati* Lara Linde Otte . April 27, 2004 Stogy Rye. Reviewer Nth* . Nelson B. Miles Ill bate . . April 27, 2N4 ORION retains active copies of reports for a period of not less than one year. Retained copies of mss,field data,field ORION.tR NeEtilisep s calculations,estimates,and other documents pared by ORION as instruments of service,shae remain the property of ���eY Other than the Client,other agencies of the U.S. Federal Government, and the Owner, reports submitted with respect to servt , tits contract without Pia °0! 1` . t CITY OF FEDERAL WAY K.. BUILDING DEPT. ti .P '.e �+�+y�v�■, C t'xd �,i r{�/y.' (y,���1}i n•wnf ...n r>W:s7 xr...tovr..:� Vt::g;.`.-ro!'+ty*:aa.n.•'`*/`al'M:"_ Ta +s'•t...,3'`ai An Environmental Compliance Consulting Firm WBE W2F5912535 Report Date: April 27,2004 Executive Summary Ms. Kathy Reynolds 30210 23'"Avenue SW Federal Way, Washington l : Asbestps Survey litopprt Dear(yl#. �y�olds: pn April 16, 2004 f g9rnmflt, e rTfPflaMfOr T)f P fllf Fi 9 afP * iNrvey rding psi !o�ii ,sSOcl i with 9 3, S r00il rn it fs Mt?� location. t r reaue0, q irp4 0��hi� . P W�l #liceIt*in the a l t of as estos Q?n# ining m i l €Ni � Pprcyl r9 quad itlgs. Thu tuy I 09 �1tC9Ofp(' ncf e cods outlined in applicable fe rei, , 1 Fp9u a Q(►!' Investigatinp Team The representative conducted the field inyp: j i pnt fi f43 cp1l1►4 f, tlil�) �f�, irfs Port review for this survey. All bulk samp,gs f9 fj 19r yel off 4 i1 py an ArpA accredited Building Inspectpr 'ri kp jfl ■ i ppm! 1 1! P ' Fr10919• 411'1'11E0r rpgardin9 the representative is provided below: Pair! S. s .' r.1, , r r @f% . • Wuilding Inapuolcif 1 hPIT ! ge,r 41,11919910-BM-02 41! T i�SH 582E Building information • Estimate Date of 1950s w/1970 ? qti ing e14�A4 1i Construction: add onsage • Type of!Spiting; Gas Roller 1 F?Lndation Masonry • Type Lighting: . Incandescent& • Susp Vinyl flooring, Wallboa , Fluorescent Materials Piaster, Ceiling Tiles, Sink Caulking, Ceramic Tile & Grout, Insulation, Thermal Systems Insulation, Slip Sheeting, Roofing, and Carpet Mastic Investigating Protocol and Findinfis, • All samples were homogenized, collected, processed, and analyzed for Conte RQ ( R D Light Microscopy. AHERA protocol provides guidance for the number of sa� J�ei` MAY 42004 CITY OF FEDERAL WAY BUILDING DEPT. r ir', y{,.', d .. r.. i .,/y.a- ,.. wr�;i: An Environmental Compliance tianc e Consulting Firm materials to be collected depending on its' category and amount of material present. The goal of AHERA is to ensure statistically reliable data and it accomplishes this by requiring or suggesting a minimum number of samples to be collected, and in some cases, by using random sampling OFOnigues to determine sampling locations. However, in every case, AHERA relies on the judgment of the inspectors who are experienced in AHERA methodology and the type of facilities being inspected. Building materials that contain asbestos fibers in the amounts 1 rce (1%) is regulated by state agencies, which include the Department of Lat and lndcr rigs ( .W) and Puget Sound Clean Air Agency. AU suspect►ne ' ics i ffssociat with this survey were us ��rl� �+�f' � found non-detect or containing < 1% for corij199 Il1S' fl (fie *WOO i4Pg mQry PLVII Certificate of Analysis). Rlo.! note shalt !hOu additional materials Opt e► ! 'in phis report) a discovered as a resylt of continua Mplition, they are to 0? re r�e1 If cs ant ilia ig ttnless subsequent 1 sampling py an a� ited inspector prcrs R) Se• tg#cc eased paint • Vane Ford netts (i11 error and exterior walls,windows, etc.) were found painted with various colors. 0 de read py federal a04 #1110 m Nlatip9s.Ty detectable concentration for a given metal are regulated and motes the requirerr ent for implementing worker, end In some cases, are presumed to envirgrl I p�r�otec � qn !s rr>fqrrrla , � painted � Rre "'� be lead-co irr , therefore compli rice nieasuhes may t i lle' '�ponen$ are being im a ct rt Ff to skyey. 1 The TCLP is a waste extraction �gcedu 4 .60 to 00-mine if a waste is hazardous. It simulates conditions that cause ''ar j'in'( 'nc fll . Th w is considered hazardous if the extract or leachate contains a ll c q 9p'�, r e I i 1'FAf trrtion that exceeds the maximum contaminant concentration. r $ p i e were/ collected fOr determining waste stream characterization. 1 . Silica Concrete and masonry components were observed and may contain silica. silica as regulated by the state indudes the speciation of Quartz, Cristobilite, and Tridymite, thus creating the requirement for implementing worker, and in some cases, environmental protection. No samples were collected as a part of this survey Inaccessible Locations ORION Environmental Services cannot make statements as to the potential presence or absence of concealed asbestos containing materials. However, the inspector believes that all suspect materials were identified for this location. Disclaimer y ORION Environmental Services has conducted a survey for asbestos containing materta nce with the requirements established by the States AT the subject in conformance equ Ni 4 2004 CITY OF FEDERAL WAY :; , -,;,,,,,0-1,,,t41, ...,., , BUILDING U DN G DEP T I . �..E,r ,.+ .r+4.r ..a? •"C:. -ia F;,,,..:x,,,, r.+yc T.^... y ,i' ;.• ..,g.r' • l 4 . 0 _ s try •.,. �ta ices • An Environmental Compliance Consulting Firm Environmental Protection Agency and the Department of Labor and Industries after the engagement of demolition of the building. The sampling strategy and analytical method employed conform to existing and enforceable standards and methods. This Executive Summary of the investigation performed at the subject sites is intended to describe asbestos containing materials with the potential of being impacted. We represent that our services were performed within the limits prescribed by applicable regulations and in a manner consistent with the level of care and skill ordinarily exercised by other professional consultants under similar circumstances. No other representation is made to the client, expressed or implied, and no warranty or guarantee is included or intended. The inspector is not held responsible or liable for any repairs or replacements with regards to this property, systems, components, or the contents therein. The acceptance of this report by the client acknowledges the client's agreement to all of the terms and conditions of the inspection contract. Q stions concerning this Executive Summary may be addressed to me directly or Donna ) eal, CEO. Thank you for the opportunity to serve you. I hope we can be of assistance to A Op future projects. If there is anything additional I can do to expedite your operation, please do not hesitate to let me know. Professionally Yours, ORION Environmental Services nit--, ,tt Nelson B. Miles III Field Support Manager, AHERA BI, MP, PD Enclosure -2 AHERA Certification Laboratory PLM Certificate of Analysis RECEIVED MAY 1 4 2004 ,.!:; . _ ,,,.N,.;, CITY OF FEDERAL WAY BUILDING DEPT. • • ,--,, ., ,-, _. ___ .....„..... , • lion Environmental Services 34004 9a'Avenue South•Building A Suite 5•Federal Way,Washington 98003.6740 WBE W2F5912535 Telephone Seattle(253)874-8118 •Tacoma (253)952-6717•Facsimile(253)927-4714*email ORION6717(4ol Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client Kathy Reynolds Date April 27, 2004 30210 23`d Ave SW Page Page 1 of 4 Federal Way, WA Invoice 040804 Date Received April 19, 2004 Project Number NA Project Name 30210 23rd Ave South, Federal Way Client Orion Sample Asbestos Other Number Number Stereo Scone Eiai , Treatment Percent Type U1 R-01 40419-1 Black Slip Sheeting Ash ND - Cellu Homogeneous R-02 40419-2 Wallboard ND - Cellulose Homogeneous R-03a 40419-3a Wallboard - ND - Cellulose Homogeneous R-03b 40419-3b Joint Compound - ND - Cellulose Assoc.with R-03a R-04a 40419-4a Wallboard - ND - Celltlose Homogeneous R-04b 40419-4b Joint Compound - ND - CeItgi •sc Assoc. with R-04a R-05 40419-5 Plaster - ND - Cellulose Homogeneous R-06 40419-6 Plaster - ND - Cellulose Homogeneous R-07 40419-7 Plaster - ND - Cellulose Homogeneous R-08 40419-8 Suspended Ceiling Tile Ash ND - Fiberglass 2'x4' Homogeneous R-09 40419-9 Taping Mud on Ceiling - ND �C 1��® Homogeneous R-10 40419-10 Tongue and Groove Ceiling Ash ND MAY 1t5 Q Tile 1'x3' Homogeneous CITY OF FEDERAL WAY BUILDING DEPT. • I , •` : -, Orion Environmental Services 4 34004 9'h Avenue South•Building A Suite 5 4 Federal Way,Washington 98003-6740 WBE W2F5912535 Telephone Seattle(253)874-8118*Tacoma (253)952.6717•Facsimile(253)927-4714*email ORION6717 @aol Polarized Light Microscopy Test Report EPA Method 6001R-981116 Date April 27, 2004 I Client Kathy Reynolds Page Page 2 of 4 30210 23' Ave SW g Federal Way, WA Invoice 040804 Date Received April 19, 2004 Project Number NA Project Name 30210 23'Ave South,Federal Way Sample Asbestos Other Cheat Orion Treatment Percent N N Stereo Scone Treatment ha FikLs R-11a 40419-11a White Vinyl Sheeting - ND - Cellulose w/Grey Felt Backing Homogeneous R-1 lb 40419-11b White Mastic - ND - Cellulose Assoc.R-1 la R-12 40419-12 Sink Caulking - ND - Cellulose Homogeneous R-13 40419-1.3 Wallboard - ND - Cellulose Homogeneous R-14 40419-14 Ceramic Tile and Grout - ND - Cellulose Homogeneous R-15 40419-15 Surface Material - ND - Cellulose Homogeneous R-16a 40419-16a 12"x12"Self-Adhesive Ash ND - Cellulose Vinyl Tile Homogeneous R16-b 40419-16b White Mastic Chloroform ND - Cellulose Assoc. with R-16a R-17 40419-17 White Fluff From Above - ND - Cellulose Boiler Room Homogeneous R-18a 40419-18a Wallboard - ND - Cellulose Homogeneous R-18b 40419-18b Taping Mud - ND REC E I v(Etose Assoc.with R 18a MAY 1 4 2 CITY OF FEDERAL WAY BUILDING DEPT. MAY-05-2004 04 :39 PM REYNOLDS-WALSH 253 924 0223 P. 02 " - () • non Environmental Services 34004 9*Avenue South•Building A Suite 3*Federal Way,Washington 98003-6740 WBE W2F5912535 Telephone Seattle(253)874-8118*Taming (253)952-6717*Fralmfe(253)927-4714*email ORION6717@aol Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client Kathy Reynolds Date April 27, 2004 30210 23' Ave SW Page Page 3 of 4 Federal Way, WA Invoice 040804 Date Received April 19, 2004 Project Number NA Project Name 30210 2314 Ave South,Federal Way Client Orion Sample Asbestos Other &mks Nn SICISLUSICAULM Treatment Percent 1111C Fibcrrl R-19 40419-19 White Vinyl Sheeting - ND - Cellulose w/White Felt Backing Homogeneous R-20 40419-20 White Ducting Tape - ND - Cellulose Homogeneous R-21a 40419.21a Tan Speckle Vinyl Sheeting - ND - Cellulose vv/Grey Felt Backing Homogeneous R-21b 40419.2lb Tan Mastic Chloroform ND - Cellulose Assoc.with R 21a R-21c 40419-21c White Padding - ND - Cellulose Assoc.with R-2 la R-22 40 419-22 Carpet Mastic Chloroform NI) - Cellulose Homogeneous R-23 40419-23 White and Blue Streak - ND - Cellulose Vinyl Sheeting w/Black Pelt Backing Homogeneous R-24 40419-24 Brown Vinyl Sheeting - ND - Cellulose w/Black Felt Backing Homogeneous R-25a 40419-251 Yellow Insulation - ND - Fiberglass w/Paper Backing Homogeneous R-25b 40419-25b Dark Mastic Chloroform ND �� Assoc.with R-250 D MAY 1 4 2004 CITY OF FEDERAL WAY BUILDING DEPT. MAY-05-2004 04 :39 PM REYNOLDS-WALSH 253 924 0223 P.01 • I Y_� � _^ .._ • r!~�' :: o Environmental Services 34004 9"Avenue South•Building A Suite S•Federal Way,Washington 98003.6740 WBE W2F591253S Telephone Seattle(233)874-8118*Tacoma (233)932-6717•Facsimile(253)927-4714♦email ORION67177ael Polarized Light Microscopy Test Report EPA Method 600/R.-98/116 Client Kathy Reynolds Date April 27, 2004 30210 23rd Ave SW Page Page 4 of 4 Federal Way, WA Invoice 040804 Date Received April 19, 2004 Project Number NA Project Name 30210 23'd Ave South, Federal Way Client Orion Sample Asbestos Other N unb r Number Stereo Scone Exani Treatment Percent DIM Eikta R-26 40419-26 Pink Insulation ND - Fiberglass Homogeneous R-27 40419-27 Black Slip Sheeting Ash ND - Cellulose Homogeneous R-28 40419-28 Black Roofing Material Ash ND - Cellulose Homogeneous R-29 40419-29 Surihce Material - ND - Cellulose Homogeneous R-30 40419-30 Surce Material - ND - Cellulose Homogeneous gyp:Laboratory QA/QC Duplicate;M;Mastic[(a),(b),(c),etc.]: Sample layers numbered from front to back. Comments: For feted samples,each component has been analyzed separately.ND means non-detect for asbestos fibers by EPA Method 600/R-98/116. Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus negative PLM recaps cannot be guaranteed. This report may only be reproduced in ful with written approval of ORION Envirotunental Services, Orion samples are analyzed according to EPA Method 600/R-98/116 by AIHA Bulk Asbestos Analytical Testing Program(102911)proficient analysts. r Reviewed By IIA,.Y) ; } Donna McNeal Leafing T'nvinmme stu(Cbmpfatice Consulting IMEQE '`Iaiboratory Director MAY 14 ' CITY OF FEDERAL WAY BUILDING DEPT Agency Case No. • PUGET SOUND CLEAN AIIIII AGENCY Date Received 200400458 r A PR 2 3 2004 HO Union Street,Suite 500 �rll!'t . ,4. : -rv' Seattle,WA 98101-2038 www.pscleanair.org Agency Use Only Clean Air A:enc NOTICE OF INTENT Agency Use Only A. Project Tyne: 1. ❑ Friable Asbestos Removal 2. Friable Asbestos Removal& Demolition 3. ❑ Demolition Only B. Property Owner: JFA•u P1091-S H "w l/1�7/ R1'tic QS , Phone: 25/ -12 Y- a"L 3 Mailing Address: 30 Z! o Z 3 '� 1`'t 14-1/4- ,St../ City:/ -/Oil;:-"M4.- Y State 1'1'4 Zip gOZ 3 C. Asbestos PLEASE PRINT CLEARLY,Tills WILL BE YOUR RETURN MAILING LABEL. Contractor: Q W A/ " G Owner/CEO: Mailing Address: 3oZ(p 13 "''° v� S Contractor a Phone: 25-3 - /2-`11-612 Z d Job No.: y: FE.L *."-VIA L G./>�j , State: G i4 Zip: J6'O Z-3 p� Fax: _ Sf/4lT D. Site Address: 02-/0 Z "''� Site 3 E S w City: f- D,�n� wA v , Zip: ,ea Z 3 Manager: Local Phone: E. krAsbestos Survey or 1 No. of / Date of Asbestos Was Friable Asbestos Identified? .dyes ❑No ❑ Mat'l Presumed Structures: Survey: /lye,/ ZOt9V Was Nonfriable Asbestos Identified? ❑Yes ❑No AHERA Building Certification#:W 8E Attach a copy of the survey when friable asbestos Inspector: O/VDA( E`N r t d/I I n G�N T i 1 L Exp.Date: W£ 59/Z sitf has not been identified. An A HERA Survey,is required before all de olition projects F. Demolition Start o.of Information: I Date: .2-�y or_ o-A i y / 1. ❑ Training Fire(List Fire Dept.) e 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? ❑ Yes,.0+ No Contractor: ‘,t/OGF LG LvKST24e7re.v INL. If yes,list type and qty. • G. Friable Asbestos j Project Information: I Start Date: L//2.3/O �t� SJ7/1 y Work Days: M T W Th F Sa Su I r y Completion Date: l Total Qty.to be Removed: Will all friable asbestos 0 Yes Linear Ft. 1 �f3c 0 Square Ft. materials be removed? ❑ No U Boiler\Furnace Insulation U Duct Insulation ❑Pipe Insulation 1J Fireproofing ❑ Cement Board ❑ Cement Pipe p g Ot Paints U Plaster Textured Coatings p ❑ Friable Flooring ❑ Friable Roofing Material Other: H. Asbestos/Demolition Project Categories: ; ' ''.1 d : Notification Period Project Demolition 1. Single-Family Residence(owner-occupied): a A. U Asbestos Removal Project Only �0• Fee Surcharge B...14%'Demolition Project(with or without asbestos rem y ( toe 76 7.'1- B. 10 Days* • a 5t *(Asbestos removal can begin upon notification;demplit p J s B. 10 Days* CB- tg7 ttti,/wait 10 days- Note:If the single family residence is owned by one family°iv'ho7tas Been or wr eTiusiing theesidence as their domicile, the above boxes IA or lB may be checked. If this is not an owner-occupied residence,one of the categories listed below must be used. A single family residence does not include rental property, multi-family units,or any mixed-use building. 2. ❑ All Other Demolitions with no Asbestos removal or Nonfriable Asbestos 10 Days $200 only Friable Asbestos Projects(other than Single Family Residence): Asbestos Demo 3. ❑ >_ 10-259 linear feet and/or?48- 159 square feet of asbestos Prior Notice 10 Days S100 $100 4. ❑ 260-999 linear feet and/or 160-4,999 square feet of asbestos 10 Days $200 5. L3 >1,000 linear feet and/or>5,000 s uare feet of asbestos S 150 10 Days $750 5250 6. ❑ Emergency Asbestos Project or 0 Emergency Demolition Project Prior Notice Twice Project Fee (Single-Family Residences arc exempt from emergency fee;however,property owners must provide a written emergency request) e r IVED (. I certify that the information contained in this notification&supplemental data is,to the best of my knowledge,accurate& p Age Age r y Use e O On com lete. n 97-----' 0-, 110vw1e owt^Q r- it 4/4) ejV Signature V /� �_::.B Representing Date Revie ed B Puget Sound Clean Air Agency Form No.: 66-160(Revised 1/04)TS MT C % • WAY r G a"T• B $ E " fit^, �� a : 7 Ny - �5k33 .b�.d'I,Y� GENERATOR Work site name: Location: 4.z!o 1 -4) , ,1f a°.a " Mailing Address: ---"s 4 / :8.1,77 1.+ County '"v �: Owner's name: --r , ;5/' '-7( - ,s•' Owner's Phone: %w3 Q,,�e ,c) x 2.3 Operator's name: Contractor I.D. Number: • Mailing address: ,, t" ' v Contact Person: Operator's Phone: • Waste disposal site (WDS) DESTINATION: Name: .r A,.c ,-",,,-' WDS Phone: 5 Mailing address: /64 y S ,Z,¢Z$ ¢ Sty' 1144,4,c V,/ ` I 14,44. t'Agji WDS Address/location: �"v' t/3 1 Name,and address of responsible agency(Local,District or EPA Office where demolition/renovation notification was sent): X47 91 e,C �9' Special handling instructions and additional information: OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked and labeled,and are hall respects in proper condition for transport by highway according to applicable international and government regulations. (Obtain signature in Item 10 before taking Gold sheet for receipt) t ' r 3 • Print:. •e•Na e 1 Title Signature Date(MM/DD/YY TRANSPORTER Transporter 1 (Acknowledgement of receipt of materials) Name Phone: Address: j � --� � � r . - ,;.k'ti>i.S4 / /=. a sy q. / it) / 0 fJ,� Printed/typed Name Title Signature ._s' Date(MM/DD/YY) Transporter 2 (Acknowledgement ement of receipt of materials)) Name: Phone: ',, , Address: 1_-/ •1. Printed/typed Name Title Signature Date(MM/DD/YY) WASTE DISPOSAL SITE Discrepancy indication space: ° f c,,,) 4 t,,,,,,,,,t„,,,,c,,„.„.„,,„„„.„,A.,„„„.,,,,,,?“..,...,,,,,,....,,„,,.- ., ,,,,., ..... " 13 WASTE DISPOSAL SITE CERTIFICATION: I hereby that the above named material has . , eptedand to the best of my knowledge the foregoing is true accurate and complete excep : noted in the in Item 12. , MAY 1 fir a} '/4; , F1 ,444:.- f ,.� /{ ' ,c, f{` Printed/typed Name Title Signature era, j P• Y) Atli Upon transfer:Owner/operator retains GOLD,Transporter retains PINK;WDS retains YELLOW and sends completed WHITE cop e.:rator in item 2. s SOD