06-101025 • •
City of Federal Way Demolition Permit #: 06-101025-00-DE
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: TWIN SHIN BUILDING
Project Address: 2020 SW 356TH ST Parcel Number: 252103 9050
Project Description: Demolition of an existing 1800sgft vacant service station
Owner Applicant Contractor
TWIN SHIN INC OMS CONSTRUCTION OMS CONSTRUCTION
32842 19TH AVE SW 6225 20TH ST E OMSC014991J2 4/15/07
FEDERAL WAY WA FIFE WA 98424 6225 20TH ST E
98023-6430 FIFE WA 98424
Additional Permit Information
CONDITIONS:
After final inspection is complete and approved,Please contact Kari Cimmer by e-mail at
Kari.Cimmer@ci.federal-way.wa.us to receive a refund of cash bond.
PERMIT EXPIRES Sunday, March 2, 2008
Permit Issued on Friday, March 3, 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: 5
3/
REIDEIVEr ./_ /Q��
arrOF `�k — 1 f I
Federal Way NAR 0 3 PERMIT I
COMMUMTYDEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP
333258^tSOUTH•POBOX 9778
FEDERALWAY,WA 98063-9718 )TY OFFA tCATION
TD
253-835-2607•FAX 253-835-2609 BU) r / 1( /
www attioffederrilwati com
The following is required information-an incomplete application will not be accepted. Please .rint legibly in ink)or type.
1 ■ PROPERTY INFORMATION
SITE ADDRESS . -''0_10 - 3 b S f S 11SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page]lengthy legal desenptian)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
d DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
L '/ 11 674 IP/cd 1_SI�y /�c.k Cif . 5:2-1-1/11-€ 5
PROJECT NAME(Name of Business or Owner Last Name) / s,,, , t, ; .5-X. 'n
U PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE Q
OWNER ,''c, SA'-fo••1 ( `-'d )3s L - /Q 2 /3
MAILING ADDRESS CITY,ST TE,ZIP 1 •/�, ,/ )f
CONTRACTOR COMPANY NAME /�y APPLICANT NAME OFFICE PHONE _
�/ !_ C3'27S ' 1i c.-7 - L)t, TE/ZPP 5106....4. ?op_i_r2 Cj)
ES6 -3�Q.T
MAILING ADDRESS S- }� - 3
tITY OF FEDERAL WiiY BUSINESS 1,10ENSE NUMBER EXPIRATION DATE FAX NUMBEI1 it5 r?
/`//Y
CONTRACTORS REGISTRATION NUMBER(cozy of card required with each application) �J; EXPIRATION DATE
OH5 ( 0 . - 4- 1LLIZ / 1
APPLICANT COMPANY NAME //APPLICANT NAME OFFICE PHONE �/y/�
MAILING ADDRESS j- u` , 'C2/,STATE,/P 5 (.CEL )NT -3642 3�V
E
�,4 )35` - - 9Y% 3
RELATIONSHIP TO PROJECT �• j /.�• FAX NUMB /
❑ Architect 0 Tenant 0 Agent aother(Describe) (..61;91-7-‘.-4-4)1.-
L j 3 / - GU,?
CONTACT NAM - PRIMARY PHONE / E-MAIL ADDRESS
LENDER . NAME `
MAILING ADDRESS CITY,STATE,ZIP / PHONE
) -
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ -
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
, 1
• •
1110
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. _ SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑ y
EXISTING rsorosm TOTAL. �..: 2, - 4#a' zn L`+7� R/
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture 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(commerci 1) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or 7ub/showarCombo) SHOWERS WATER CLOSETS Roo 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.
NAME/TITLE --L DATE .3 • Ci e•
(Signature) (Title)
RELATIONSHIP TO PROJECT q Owner ❑ Agent15 Contractor 0 Architect 0 Other
Bulletin#100—January 1,2006 Page 2 of 4 k\I-Iandouts\Permit Application
�} DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
•
F�'G� 'G� f24to 5t‘i 3c-pek
' (, r.j l r CE V E® 33325 8th Avenue South
,_ �./ PO Box 9718
CITY OF Federal Way WA 98063-9718
Federal Way MAR 0 3 2006 253-835-2607;Fax 253-835-2609
www.cityoffederalway.com
CITY OF FEDERAL WAY
BUILDING DEPT.
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.A : STOS BATEMENT 6. ELECTRICITY
(Copy of'.pprov.l orm and estos survey from Puget Sound Clean Air (Electricity to be shut off and meter removed) �.
Agenc Provided,
—.7 / (Puget Sound Energy)
(City o -.era!Way Building Official)
2. GAS SUPPLY ijO CM'4 c 7. FUEL STORAGE TANKS
1(Gas t :be s ut off,meter removed and final bill paid) (Above or below grade fuel tanks, have been pumped or removed
fie•' } i' t ?-I`i-c undertimeepaitsfiefit permit prior to any dismantle/excavation)
(Puget Soilnd Energy)
VCA (Federal Way Fire District#39)
X 3. SEPTIC SYSTEM 8.WATER- Public Source (Check applicable box)
(Tank to be removed or tank to be drained and filled) -*Meter to be removed and final utility bill paid
o Meter to remain and be protected
IJFt-KE tfAVE 0 U.:-F iu,T1
(King County Environmental Services) (Water Supplier)
******OR******
4.SANITARY SEWER (Check applicable box) 9.WATER- Private Well (Check applicable box)
o Sewer line capped at property line o Private well filled and capped
❑Existing sewer line to remain and be used by proposed new structure o Private well to be used for other purposes `
L1}0.4ti iF IJUT C-c) ,�64--, /0/4
(Sewer District) -TO (King County Environmental Services)
5. GARBAGE fs- �.�o.� .- z/c,� 40
(All household garbage disposed off and final bill paid)
r..)(Dt
(RST Disposal/Federal Way Disposal)
El Completed Construction Permit Application form
❑ Provide the following fees: 1. Demolition Permit Fee $65.50
2.Automation Fee 5.00
3. WA State Surcharge _4.50
4. Cash Bond Deposit 500.00 efundable upon Completed Final Inspection)
$575.00
Bulletin#I22—January 1,2006 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
4k • DEPARTMENT OF&UNITY DEVELOPMENT SERVICES
33325 8th Avenue South
CITY , PO Box 9718
Federal Way WA 98063-9718
FederFederal Way 253-835-2607;Fax 253-835-2609
al www.cityoffederalway.com
DEMOLITION PERMIT CONTACT LIST
This list of agencies may assist you in expediting the demolition permit process.Refer to the demolition permit
requirements for signature blocks.All applicable signatures are required prior to permit approval.
1. Asbestos Removal: Puget Sound Clean Air Agency
110 Union Street, Suite 500
Seattle,WA 98101-2038
206-343-8800—OR—800-552-3565
http://vvww.pscleanair.org
2. Electricity: Puget Sound Energy
Attn: Construction Coordinator
22828 68th Avenue South, Suite#102
Kent,WA 98032
888-225-5773
3. Gas: Puget Sound Energy
805 156th Avenue NE
Bellevue, WA 98004
888-225-5773
4. Telephone: Qwest Communications
801-962-2475(phone)/801-237-6491 (fax)
5. Water: Lakehaven Utility District Tacoma Public Utilities
Technical Service Division Customer Service
31623 First Avenue South —OR— 747 Market Street
Federal Way,WA 98003 Tacoma,WA 98402
253-941-2288 253-383-9600 or 253-383-2471
6. Garbage: Waste Management
655 Second NW
Auburn,WA 98071
253-833-3333 (residential)—OR—253-939-9792(commercial)
7. Sewer: Lakehaven Utility District
Technical Services Division
31623 First Avenue South
Federal Way,WA 98003
253-941-2288
8. Septic: King County Environmental Services
14350 SE Eastgate Way
Bellevue,WA 98007
206-296-4932
9. Fire Department: Federal Way Fire Department#39
31617 First Avenue South
Federal Way,WA 98003
253-839-6234
Bulletin#109—October 1,2004 Page 1 of 1 k:\Handouts\Demolition Permit Contact List
Feb-15-2006 09:11 From-PSE ELE C 1ST RESt>tPONSE1 it Sr
253 395 6820• 1-091 P.002/00?, F-265.
,
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
/` CJ
ede ( da j ' V 33325 8u'Avenue South
PO Box 9718
CITY OF IPIlklivoloe, Federal Way WA 98063-9718
Federal Way. 3 2006
J MAR 0 253-835-2607;Fax 253-835-2609
vr
FEDERAL WAY ww.citvoffederalway.com
CITY OF •
Ill r1INt i DEPT.
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 ii'the proposal exceeds thresholds that trigger an environmental review.An environmental review and
submittal ai'an environmental checklist may be required,which will extend the time period before a demolition permit can
• be issued.
0 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 simdstncl-dated_by the respective agency representatives.
' 1.ASBESTOS ABATEMENT 6. ELECTRICITY
(Copy of approval form and asbestos survey from Puget Sound Clean Air (Be '. ., be shut o nd meter removed)
Agency provided) / r, Ci% c2/775/0
(Puget Sound Ergyj
(Cary of Federal Way Building Official) S C ceF/2,
2.GAS SUPPLY 7.FUEL STORAGE TANKS
(Gas to be shut off,meter removed and final bill paid) (Above or below grade fuel tanks,have been pumped or removed
unde eFartaroent permit prior to any dismantle/excavation)
(Puget Sound Energy) • t _ (C)
{V`�- (Federal Way Fire District#39)
3.SEPTIC SYSTEM---' 8.WATER-Public Source (Check applicable box)
(Tank to be removed-or tank to be drained and filled) .-Meter to be removed and final utility bill paid
❑Meter to remain and be protected
( _ - ,e_ 0-01.1t -OK rt t fi 2 a/G1D
(IQng County Environmental services) Water Supplier)
******OR******
4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box)
o Sewer line capped at property line o Private well filled and capped
a Existing sewer line to remain and be used by proposed new.structure ❑Private well to be used for other purposes
LPr1-1-A 6AD L. 1 L1-r q'D t ,T"p - — o i5-r c>a 1J6c-
(sewer District) ... (ling County Environmental Services)
S.GARBAGE fCi , 1,10 4c,
(All household garbage disposed off and final bill paid)
(R:r Disposal/Federal Way Disposal).
❑ Completed Cunstruction Permit Application form
[7 Provide the following fees: 1.Demolition Permit Fee $65.50
2.Automation Fee 5.00
3.WA State Surcharge 4.50
4.Cash Bond Deposit 500.00 efundable upon Completed Final Inspection)
5575.00
6u11ctin#122—January 1,2006 Page 1 of 1 • k:IHandoutsTemolition Permit Requirements
Agency Case No. PUGET SOUND CLEAN AIR AGENCY '"Date Recei
110 Union Street,Suite 500 fb
200600276 • Seattle,WA 98101-2038 M t �� 3 %006
.tlT ilk:.:.:::::::...;.:.:::::.:::.:::::
::.. '"� , "K www.pscleanair.org
—""-"4"1"-_ NOTICE OF INTENT �.in AG -
�I.EAN
Agency Use Only •�'�•�'
Clean Air Agency Agenc �bnly
A. Project Type: 1. U Friable Asbestos Removal 2. CYFriable Asbestos Removal & Demolition 3 , jemolition Only
B.
Property Owner: (,..r: S CL. Phone: G 6 • 5S 4 (c �-
Mailing Address: 3 I 11 �'- j
k- 1.E City: -, �. _t i-t-\ State �C'- Zip: TiG
C. Asbestos PLEASE PR/.VT CLEARLY.THIS WILL BE YOUR RETURN ALA/LING LABEL.
Contractor: 'I= S- 4 C-r- S ._+'✓=ms ;s , / L,C • Owner/CEO: � c, J0 -\ (A: I I c-ti yj
Mailing Address: C -) 1 4 ` Au E �� 1 - Contractor
Phone: -� . l Job No.:
City: -• /!.,t I wP State: (-�C� Zip:, 1•
'I.-=)
/75 Fax 1 J : > ( X'�fj'
D. Site f
Address: --)-CD L S cam, `.77 �`� l < c X 1 �x '' S
City: Zip: /,! L.Z
Site
Manager: /_,, r,t- - C(_ C.77 l E
Local Phone: C 5 - / / / j
E. CS Asbestos Survey or No. of
/ Date of Asbestos Was Friable Asbestos Identified? ❑Yes �No
❑ Mat'l Presumed _ Structures: Survey: c / tS -1
/
Was Nonfriable Asbestos Identified? OYes ❑No
AHERA Buildinga
Certification,,: Attach a copy of the survey when friable asbestos
Inspector: -}/&-'1 C'/ Sc^nExp. Date: ,}L�l h�NQS (.) .0c 7has not been identified.
An AHERA Survey is required before all demolition projects u` t'
F. Demolition Start �1 No. of 1. ❑ Training Fire(List Fire Dept.)
Information: Date: ' /v1j/a6 aT ctrl-
Structures: 2. ❑ 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 aNo
Contractor: (;fc-S. r S/-7.-Le-<_t?..----. If yes, list type and qty. Note disposal requirements in Step 6(on back).
`
G. Friable Asbestos Work Days: M T W Th F Sa Su
Project Information: Start Date: Completion Date: Hours:
Will all friable asbestos ❑ Yes
Total Qty. to be Removed: Linear Ft. Square Ft. materials be removed? ❑ No
❑ Boiler\Furnace Insulation 0 Duct Insulation ❑ Pipe Insulation ❑ Fireroofing ❑ Paints U Plaster ❑ Textured Coatings
❑ Cement Board ❑ Cement Pipe ❑ Friable Flooring ❑ Friable tI rterial Other:
(ice
H. Asbestos/Demolition Project Categories: AMOUNT /0° ' Notification Period Project Demolition
1. Single-Family Residence(owner-occupied): CK• NO. /D ??
Fee Surcharge
A. Asbestos Removal Project Only �± NO -2 9,x. 7.' A.Prior Notice A. $25
B. tj Demolition Project(with or without asbestos removal!!A! t B. 10 Days* B. $50
*(Asbestos removal can begin upon notification;demolition must wait 10 days)
Note: If the single family residence is owned by one family who has been or will be using the residence r �ile, the above boxes
IA or IB may be checked. If this is not an owner-occupied residence, one of the categories listy d'i'ed instead. A single
family residence does not include rental ,ro,erty. multi-amilv units, or any mixed-use building.
2. *-4 All Other Demolitions(with no Asbestos removal or Nonfriable Asbestos l Q Acys 0 3 2006 100 J
only or less than 10 linear feet and/or 48 square feet of friable Asbestos) tY►l1n
Friable Asbestos Projects(other than Single Family Residence): Asbestos TIRAL WAY
3. U _> 10- 259 linear feet and/or>_48 - 159 square feet of asbestos Prior or j 4
L�({1�@,a�l`PT$100 5100
4. ❑ 260-999 linear feet and/or 160-4,999 square feet of asbestos 10 ays $200 $100
' 5. U >1,000 linear feet and/or>5,000 square feet of asbestos 10 Days $600 $100
6. ❑ Emergency Asbestos Project or U Emergency Demolition Project Prior Notice $50 Emergency Fee
(Single-Family Residences are exempt from emergency fee;however,property owners must provide a written emergency request)
I. I certify that the information contained in this notification&supplemental data is,to the best of my knowledge,accurate&complete. Agenc Jse Only
Signature ` i —<��
Representing Date Reviewed By//
Puget Sound Clean Air Agency Form No.: 66-160(Revised 2105)TS 3/� It4
The Puget Sound Clean Air Agency requijetdvance notification before any person clikences 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
III, 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 PLEASE PRINT CLEARLY. THIS WILL EYOU'R RETURN MAILING LABEL.
Contractor: �'�� Ccr 51-4-" l=—"w Owner/CEO: /26`.‘" 0
Mailing Address: 6 fi� s f Phone: t 6( •- �—C{ �T J b tractor's
LI City: State: `(---) Zip: 'I L4 Fax: 1 S (3"C 7 7
GUIDELINES FOR SUBMITTING AN ASBESTOS\DEMOLITION 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 project 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 fire. 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. Listtypes 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 8. For owner-occupied Single-Family Residential projects,, check BOX H1A for renovation projects or BOX H1B for
demolition projects (with or without asbestos Yemvvai):'-Asbestos-reinoval may be conducted after a complete notification is received,
but demolition activities can only begin on the le...day aftPTat,P ndtrl'rcation is received. Note:If the single family residence is owned
by one family who has been or will be using the residence as their domicile, boxes 1A or 1B 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 demonstrating the
need to conduct the project 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 S25.00 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.pscleanair.org.
For technical assistance call(206) 689-4058 and for administrative inquiries call(206) 689-4090.
Puget Sound Clean Air Agency Form No.: 66-160(Revised 2/05)TS
i •
ou
FS.&GS.
Services Inc.
•
3-1-06
Puget Sound Clean Air Agency
110 Union Street, Suite 500
Seattle, WA 98101
To Whom It May Concern:
RE: Asbestos Removal, 2020 SW 356th St., Federal Way, WA 98023
I am writing you this letter as a statement of completion, that the asbestos removal
work done at the above mentioned address was completed on 3-2-06. In accordance with
40 CFR subpart E, all asbestos material, as identified in the survey, has been removed
and properly disposed of. This project is now complete.
All closeout paperwork will be forwarded to OMS Construction as soon as possible.
Respectfully,
te7(Gordon Williams 4.211-6
President
Cc: OMS Construction
RECEIVED
MAR 0 3 2006
CITBF FEDERAL WAY
UUIL.DNG DEPT.
16214 57th Ave East, Suite A Phone: 253-548-1011
Puyallup, WA 98375 Fax: 253-536-8488
s •
Pre Demolition Asbestos Inspection
RECEIVED
1 Vacant Service Station MAR 0 3 2006
2020 SW 356th CITY
TBOF FEDERAL
E E LW,AY
1 Federal way, WA
1
1 Prepared for:
David Om Construction
6225 26° Street East
1 Fife, WA 98023
1 February 13, 2006
1
1
1 .
i
1 NOWICKI
1 VIRONMENTAL
ENVIRONMENT MANAGEMENT&COMPLIANCE
1 33516 9th Avenue South
Building#6
Federal Way,Washington 98003
1 Phone: (253)927-5233
Fax: (253)924-0323
info@nowickienvironmental.com
1
1 • • . .
NOWICKI
I PRE DEMOLITION ASBESTOS INSPECTION
Vacant Service Station, 2020 SW 356th Street, Federal Way XNVIRONMENTAL
I
PROJECT: Pre Demolition Asbestos Inspection ENVIRONMENTAL MANAGEMENT&COMPLIANCE
LOCATION: Vacant Service Station RECEIVED
I 2020 SW 356th Street
Federal Way, WA 98023
MAR 0 3 2006
CLIENT: David Om Construction
I
6225 20th Street East CITY OF FEDERAL WAY
Fife, WA 98424 BUILDING DEPT.
I SITE CONTACT: Philip So
Phone: (206) 356-3608
I PROJECT Identify asbestos containing materials (ACM) in this vacant former service station that
DESCRIPTION: will be impacted by planned demolition work.
EXECUTIVE This pre-demolition inspection was conducted at the subject property on Tuesday
I
SUMMARY: February 7, 2006. Locations from which the samples were collected are keyed to the
accompanying site sketch. The following items were identified as ACM:
I
Sample # Description Location Analysis Quantity
14 Asphalt Roofing Material Rear Shed 2% Chrysotile 200 SF
15 Black Roof Patch Material Rear Shed 4% Chrysotile 200 SF
I
A destructive inspection and sampling of the electrical and lighting systems was not
conducted as it could not be determined whether or not the electrical system was
energized. Electrical wiring and individual electrical system components and fixtures
Ishould be considered ACM until tested and proven otherwise.
BUILDING The building is vacant service station approximately 60' long by 30' wide with a 20'
I DESCRIPTION: wide by 60' long canopy over the area where fueling stations had been located and a
20' long by 10'wide wooden shed added on to the rear.
I The main structure and canopy appear to be constructed of 10 gauge or heavier
aluminum panels, the whole of which is bolted to a concrete slab or concrete piers.
The metal roofing system on the main structure and canopy is covered with what
I appears to be 1/2 - 3/4" of black bituminous coating material with a coat of rock
ballast. The wooden shed is covered with two layers of asphaltic roofing material
installed over the wood sheathing
IThe interior partition walls of the structure are made up of steel stud framing with
unfinished gypsum wallboard surfacing. 6"x6"ceramic tiles are found on the walls of
Ithe single restroom, adjacent to the office area.
Flooring consists of multiple layers of 12"x12" tile squares over the concrete slab in
the main retail area, 2"x2" glazed ceramic tile in a mortar bed over the concrete slab
Iin the office and restroom areas and bare concrete in the rear shed.
I 33516 9th Avenue South
Building#6
Federal Way,Washington 98003
Phone:(253)927-5233
IFAX:(253)924-0323
1 • • .
I Ceiling tiles have been removed throughout the structure allowing a clear view to the
metal roof above and the plastic wrapped fiberglass insulated ductwork that runs
throughout the building.
IInterior and exterior doors are a mixture of metal and solid or hollow core wood
units; most of the interior doors been removed from their frames.
IWindows and storefront are single glazed and /or laminated units that have been
broken or otherwise damaged to varying degrees since the site has been vacant.
I There was no insulation on any of the exposed plumbing lines and the heating system
appears to have been removed from the facility.
I
INSPECTION
DATE: On Tuesday February 7, 2006 Nowicki Environmental Services inspected the subject
property and collected the samples described in this report.
INSPECTOR (_,,,,,&-- -‘,
•ENDORSEMENT: � ��{,�,- ,
A lson
PROJECT r/.7-# 1 �%:II
REVIEW:
Walt Pich
ANALYSIS Polarized Light Microscopy
METHOD:
' PARMETERS: 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
Iinspector.
DEFINITIONS: ACM is subdivided into three types;
1 (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
Imembers or other materials on surfaces applied for decorative purposes.
(2)Thermal System Insulation (TSI): These materials are defined as those applied to
I pipes, fillings, boilers, tanks, ducts or other structural components to prevent heat
loss or gain.
I (3) Miscellaneous Materials: All other building materials that may be ACM but not
surfacing materials or TSI fall into this category.
SAMPLES Fifteen primary asbestos bulk samples and eight associated secondary samples were
1 EXTRACTED: extracted and analyzed for the purposes of this inspection.
Locations from which the samples were collected are keyed to the accompanying site
Isketch.
Pre-Demolition Inspection—Vacant Services Station,202 SW 356`h Street Federal Way, WA Page 2 of 3
I
Nowicki Environmental Services Project#06-0044—February 2006
• •
I Items that have been found to be asbestos containing are described and quantified in
the Executive Summary section of this report.
IThe following items were sampled, tested and found to be non-asbestos containing:
Sample # Description Location Analysis
I 0la 12"x12"tile, gray marbled pattern Retail Area Non-Detect
01b - associated tan mastic Retail Area Non-Detect
01c 12"x12"tile, beige marbled pattern Retail Area Non-Detect
0ld - associated yellow mastic Retail Area Non-Detect
I02a 12"x12"tile, orange marbled pattern Retail Area Non-Detect
02b - associated yellow mastic Retail Area Non-Detect
02c 12"x12"tile, dark gray pattern Retail Area Non-Detect
I 02d - associated yellow mastic Retail Area Non-Detect
03 Leveling compound Retail Area Non-Detect
04a 12"x12"tile, gray flecked pattern Office Non-Detect
I 04b - associated yellow mastic Office Non Detect
05 Orange mastic Office Non-Detect
06 Black cove base mastic Rear Hallway Non-Detect
I 07 Cove base mastic
Insulation backing Retail Area Non Detect
08a Retail Area Non-Detect
08b - associated pink insulation Retail Area Non-Detect
09 Dark cove base mastic Retail Area Non-Detect
10 Insulation backing Retail Area Non-Detect
11 Roofing Main Structure Non-Detect
1
12 Roofing Service Area Canopy Non-Detect
13 Roofing Rooftop Gazebo Non-Detect
LIMITATIONS: During demolition it is possible that additional suspect ACM may be discovered within
I wall, floor or ceiling sandwiches or other areas/systems not accessible 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
Inon-asbestos containing.
Nowicki Environmental Services is neither responsible for the classification of
materials that are not identifiable with reasonable diligence, nor for the identification
Iof materials beyond the scope for this project as we understand it.
The structure was not occupied at the time of this inspection however a destructive
I inspection and sampling of the electrical and lighting systems was not conducted as it
could not be determined whether or not the electrical system was energized.
Electrical wiring and individual electrical system components and fixtures should be
Iconsidered ACM until tested and proven otherwise.
No hard measurements were taken of this structure; all square/lineal footage figures
are approximate rough estimates to provide perspective and scope. Site sketches are
I
not to scale.
Disclaimer
I This report and its contents are limited to the scope and activities performed at the subject property as described,
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
I
guarantee is included or intended.
Pre-Demolition Inspection-Vacant Services Station,202 SW 356th Street Federal Way, WA Page 3 of 3
INowicki Environmental Services Project#06-0044-February 2006
.
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34004 9th 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@aol
Polarized Light Microscopy Test Report
I1
EPA Method 600/R-98/116
Client Nowicki Environmental Services, Inc. Date February 8, 2006
33516 9th Avenue South, Building#6 Page Page 1 of 3
Federal Way, WA 98003 Invoice 060608
Date Received February 7, 2006
IProject Client/Number David Om Construction/06-0044
Project Name 2020 East 356th
IClient Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatment Percent Type Fibers
IOla 60207-49a Gray Marble Pattern Ash ND - -
12"x 12"Vinyl Tile
IHomogeneous
O l b 60207-49b Tan Mastic Chloroform ND - Cellulose
Assoc. w/O l a
O l c 60207-49c Beige Marble Pattern Ash ND - -
12"x 12"Vinyl Tile
Assoc. w/O l a
I
O 1 d 60207-49d Yellow Mastic Chloroform ND - Cellulose
Assoc. w/O l a
I02a 60207-50a Orange Marble Pattern Ash ND - -
12"x 12"Vinyl Tile
Homogeneous
I
02b 60207-50b Yellow Mastic Chloroform ND Cellulose
Assoc. w/02a
I02c 60207-50c Dark Gray 12"x 12"Vinyl Ash ND - -
Tile
Assoc. w/02a
I02d 60207-50d Yellow Mastic Chloroform ND Cellulose
Assoc. w/02a
I03 60207-51 Leveling Compound - ND - Cellulose
Homogeneous
I 04a 60207-52a Gray Fleck 12"x 12"Vinyl Ash ND - -
Tile
Homogeneous
I 04b 60207-52b Yellow Mastic Chloroform ND - Cellulose
Assoc. w/04a
• s .
•
i 441 non Environmental Services
34004 9`h Avenue South • Building A Suite 5 • Federal Way,Washington 98003-6740
IWBE W2F5912535 Telephone Seattle(253)874-8118 •Tacoma (253)952-6717 • Facsimile(253)927-4714 *email ORION6717@aol
Polarized Light Microscopy Test Report
I EPA Method 600/R-98/116
Client Nowicki Environmental Services, Inc. Date February 8, 2006
1
33516 9th Avenue South, Building#6 Page Page 2 of 3
Federal Way, WA 98003 Invoice 060608
Date Received February 7, 2006
IProject Client/Number David Om Construction/06-0044
Project Name 2020 East 356th
IClient Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatment Percent Type Fibers
I05 60207-53 Orange Mastic Chloroform ND - Cellulose
Homogeneous
I06 60207-54 Black Cove Base Chloroform ND - -
Homogeneous
I 07 60207-55 Cove Base Mastic Chloroform ND - -
Homogeneous
a 08a 60207-56a Insulation Backing - ND - Cellulose
Assoc. w/08b Fiberglass
08b 60207-56b Pink Insulation - ND - Fiberglass
IHomogeneous
09 60207-57 Dark Cove Base Mastic Chloroform ND - Cellulose
Homogeneous
I10 60207-58 Insulation Backing - ND - Cellulose
Homogeneous
I 11 60207-59 Roofing Ash ND - Cellulose
Homogeneous
I 12 60207-60 Roofing Ash ND - Cellulose
Homogeneous
13 60207-61 Roofing Ash ND - Cellulose
1
Homogeneous
14 60207-62 Roofing Ash 2 Chrysotile Cellulose
Homogeneous
I
15 60207-63 Roofing Ash 4 Chrysotile Cellulose
Homogeneous
I
I
1 0 •
I •
`- '_ . pion Environmental Services
34004 9th Avenue South • Building A Suite 5 • Federal Way,Washington 98003-6740
1 WBE W2F5912535 Telephone Seattle(253)874-8118 •Tacoma (253)952-6717 • Facsimile(253)927-4714•email ORION6717@aol
Polarized Light Microscopy Test Report
I EPA Method 600/R-98/116
Client Nowicki Environmental Services, Inc. Date February 8, 2006
1 33516 9th Avenue South, Building#6 Page Page 3 of 3
Federal Way, WA 98003 Invoice 060608
Date Received February 7, 2006
IProject Client/Number David Om Construction/06-0044
Project Name 2020 East 356th
1 Client Orion Sample Asbestos Other
Number Number Stereo Scope Exam Treatment Percent Type Fibers
I
I
Dup: Laboratory QA/QC Duplicate;M;Mastic [(a),(b),(c),etc.]: Sample layers numbered from front to back.
Comments: For layered samples,each component has been analyzed separately. ND means 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 known to miss asbestos in a small percentage of samples that
I
contain asbestos. Thus negative PLM results cannot be guaranteed. This report may only be reproduced in full
with written approval of ORION Environmental Services.
I
IAnalyst ( /` ; )Lie Reviewed By0,0_, -tf,(1---6
1 onna McNeal Allen Clark
I
Laboratory Director, CEO Laboratory Analyst
1 Leading Environmental Compliance Consulting Into tfie 21's Century
I
1
I
I
I
1 • • _ .
Nowicki Environmental Services Inc.
ILaboratory Services ® Chain of Custody Form
Client/Name: PA')ib om I- 3 Project#/Name: Zoo E 6
Address: Date Sampled: 0:24,C 7 G 6
Sampled By: A O5CJ
Telephone: Laboratory ID: 0 c _ oQ zor
IFAX:
Cellular: Turn-Around Time (Please check appropriate box)
IE-mail: ❑ 4-hour* I 24-hour * ❑ 3-day
ISample # Description of Sample Analysis (check appropriate box)
Chi (,Qi r' cvE.g IE16:a Ie7.Xi2LOA/6T- tC 11-Asbestos ❑ Lead ❑ Mold
i
cam- pg;c (k;;- O--G- d/ E"Asbestos ❑ Lead ❑ Mold
C 3 1etAu61 com pjy,)0 0A) ccikici sl. IAsbestos ❑ Lead ❑ Mold
04
E> ri-EE- /2X/2---- Gt./M r/c IAsbestos ❑ Lead ❑. Mold
I oFiuk /�'' -,'tF (';'ii ) // is iC �; ice) Q'Asbestos ❑ Lead ❑ Mold
06 8 - J, 845E 4 ' E"Asbestos ❑ Lead ❑ Mold
I01 ti 00\1E 14$E 5-T10 I 'Asbestos ❑ Lead ❑ Mold
08 F/Ri Gr-A-65 th%5o ice` 1340/�;i,i6 E(Asbestos ❑ Lead ❑ Mold
I O`i aKCic � t`3�-5� i�, 1, i -lc (01,,D . A/05-71(1 Asbestos ❑ Lead ❑ Mold
i.i
0 36 50iA-77r,u 6 40/4 1A) D/Asbestos ❑ Lead ❑ Mold
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'Gr AjC- trz) rpt; 5-1-k,ch7 ;, P--Asbestos ❑ Lead ❑ Mold
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<z 15,. �1�,, �s; ,Dpv P'Asbestos ❑ Lead ❑ Mold
` H ca2 , '�-ilu,��,'71>C"d) ,lei .„ Li/Asbestos ❑ Lead ❑ Mold
IM: i, KZ 9/Asbestos ❑ Lead ❑ Mold
/6. *J4 frifilu6 ICs, ,.:K ,D, icco - LlAsbestos ❑ Lead LI Mold
I
Relinquished By: ;4, Relinquished By:
Signature: , ( _� ti. Signature:
I ' Printed Name: 4 & c ' Printed Name:
Company Name: „!2,0of i Company Name:
ITime r Z6 Date: 040-7/c4., Time: Date:
Notice: Samples must be enclosed in a sea/ed bag or Relinquished By:
I container. Unless otherwise requested all samples will be Signature:
disposed of five(5) working days after analysis. You will
be contacted if the sample is insufficient in quantity for Printed Name:
III analysis. Analysis method is in accordance with EPA Company Name:
Method 600/R-93-116 for Polarized Light Microscopy. Time: Date:
I *Additional charges apply for 4-hour and 24-hour sample analysis. Please contact Nowicki Environmental for further details.
33516 gth Avenue South, Building # 6, Federal Way, WA 98003
Phone: (253) 927-5233 FAX: (253) 924-0323
I
E-mail: info@nowickienvironmental.com Website: www.nowickienvironmental.com
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• THIS CARD IS TO ROIAIN ON-SITE
• y
CITY OF a�a�. ionium Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 06•-101025x•00-DE
Owner:
Address: 2020 SW 356TH ST
FEDERAL WAY, WA 98023-7255
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.
0 Final-Building(4050)
Approved
By G.. C.3 Date 4(-?i/— OP