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07-102035
City of Federal Way 0 Dem li Community Development Services o tion Perm#. 07-102035-b -� P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 8355-30550 Project Name: HARTNELL Project Address: 30305 6TH AVE S - Parcel Number: 064310 0130 Project Description: Demo 1939 sq/ft fire damaged single family residence. \ Owner Applicant Contractor ANN M HARTNELL ALLEN STAFFORD KLEENSWEEP CONSTRUCTION SERVICES 30305 6TH AVE S KLEENSWEEP CONSTRUCTION SERVICES INC FEDERAL WAY WA 98003 INC KLEENCS982M4(7/24/08) PO BOX 611 PO BOX 611 MILTON WA 98354 MILTON WA 98354 • Additional Permit Information` PERMIT EXPIRES Thursday, April 16, 2009 Permit Issued on Tuesday, April 17, 2007 I hereby certify that the abo - information is correct and that the construction on the above described property and the occupancy and the -.- will be in a dance with the laws, rules and regulations of the State of Washington � .i• •= , of Federal Way. Owner or agent Date: LI /17/C)7 f` NNW ® THIS CARD IS TO UMAIN ON-SITE- J t ommunity Developmrfit Inspection Record ecordcQTY OF Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 07-102035-00-DE Owner: ANN M HARTNELL Address: 30305 6TH AVE S FEDERAL WAY, WA 98003-4014 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. El Final-Building(4050) Approved By C.,.......a.J Date s--„as-,a7 A , CITY OF � P • Federal Way PERMIT ® — COMMUNITY DEVELOPMENTSERVICES J R A "I 2c1� SF MF CO ME EL PL EN FP 33325 8TM AVENUE SOUTH•PO BOX 9718 ' L I C A T I O N _ __ 11eu. FEDERAL WAY,WA 98063-9718 TD 253-835-2607•FAX 253-835-260V-1)r 53.835-260T OF1pEo ALwww.d. deralwacom .M BUILDING G DEP+p r � __ �� The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION 2 5 b '� AVS SITE ADDRESS J 0 3 C� � YK'Q67.414L;�,.,n� SUITE/UNIT# ASSESSOR'S TAX/PARCEL# D & Irt 3_ O - O 3 O LOT SIZE(4) LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) ■ PROJECT INFORMATION - TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCPTION(Provide detailed description of work included on this permit only) D PROJECT NAME(Name of Business or Owner Last Name) C`I k r 4 ri%1 l • PEOPLE INFORMATION PROPERTY NAME PRIMARY PHONE OWNER I/ YNh w �ti,r lc. kW'� t I 3 )5 9&.- loll MAILING ADDRESS CITY,STATE,ZIP . E-MAIL ADDRESS 3030,5 tv ciVt S I e kk wr:j wlk J/j i3c 3 CONTRACTOR COMPANY NAME (CANT NAME OFFICE PHONE • Ik�.eeyn5Wee0 C St -zrG s� d1C (A.5 ) ' ). -). ..1a MAILING ADDj2 GI it CITY,kTAT IP CELL PHONE - CITOF FEDERAL WAY BU$INE35 LICENSE NUMBER 'VW\ t^►ti q6 51 0,53 )aGe t R - 3 7 EXPIRATION DATE FAX NUMBER ao ak,.,- 100c-15$-ci&- 11/1007 D.53)95), -(0).7C CONTRACTOR'S REGISTRATION NUMBER t r EXPIRATION DATE E-MAIL ADDRESS. -( ICL�ehLS )� 7/19 /0g • APPLICANT COMPANY NAME i APPLI.. NT NAME OFFICE PHONE k-1e-tv‘5tareof cd"6 t, .1 era 5kK4 ( 33)/.3 -.).a(1 MAILING DDR S CITY,STATE,ZIP CELL PHONE RELATIO 0IP TO P?.)t'OJEC L` iv\t I Iv v� vac, (.153)�, 1 - i 73 t FAX NUMBER ❑ Architect ❑ Tenant 0 Agent Other C-0 Vt.V TrAc,}d r Q.51)9S� -C.).74_ PROJECT NAM ,,,,. [ PRIMARY PHONEG E-MAIL ADbRESS CONTACT �l ere_V J¶G. Okre (. 3 ) aal_- 1 737. LENDER NAME LT,/ ^ Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 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 F .SU RESSION SYSTEM PROPOSED/REQUIRED? ❑•YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN . 0 HIGHLINE 0 PRIVATE(SEPTIC) • PROJECT FLOOR AREAS ry AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ. FT. SQ.FT. SQ. FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 EXISTING PROPOSED TOTAL TOTAL ERfSTINO SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF :EDROOMS STIMATED SELLING PRICE $ • FIXTURES Indicate number of each type of fixture to be installed or relocated as part of th• roject. Do not include existing fixtures to remain. MECHANICAL , Value of Mechanical Work $ (A COPY OF BID OR ESTIMAT MUST BE INCLUDED WITH APPLICATION) • AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS ANS GAS WATER HEATERS MISC(Describe) BOILERS •EPLACE INSE• ' HOODS(Commercial( COMPRESSORS F 'NACES RANGES DUCTS GAS ►I G S REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/Shower Combo) •VS(eathroo•.sinks( URINALS MISC(Describe) DISHWASHERSRAINWATERS ,T VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toner( ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS • SIGNATURE I certify under penalty of perjury that the informatio 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,/rform the work for which the permit application is made. I further agree to hold harmless the City of Federal Way as to any claim ii ding costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim),which may be made by any perso• in- ff ing the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the reliance •4 the ci „^� i . ;- • • employees,upon the accuracy of the information supplied to the city as a part of this application. / ir/ NAME/TITLE t ' v DATE /17 107 Ignaur. (Title) RELATIONSHI, 'O v;JECT ❑ Owner a Agent ,6ontractor ❑ Architect 0 Other r o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES o NO BASIC PLAN? . o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application 0 ' ' , a . , Aiiii‘. DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8th Avenue South rr PO Box 9718 CITY OF 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. 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 siEned and dated by the respective agency representatives. 1.ASBESTOS ABATEMENT 6. ELECTRICITY (Cop of approval form and asbestos survey from Puget Sound Clean Air (Electripty to be shut off and meter removed) iency .) u-vha►✓e& Ck1 4-;(vim, ok N,rL •• (Puget Sound Energy) (City of Fed ral Way Building Offidal) 2.GAS SUPPLY 7. FUEL STORAGE TANKS (Gas to be shut off,meter r9moved and final bill paid) (Above or below grade fuel tanks, have been pumped or removed under Fire Department permit prior to any dismantle/excavation) (Pu et Sound Energy) Al d4 (Federal Way Fire District#39) i 3.SEPTIC SYSTEM 8.WATER-Public Source (Check applicable box) (Tank to be removed or tank to be drained and filled) `o Meter to be removed and final utility bill paid Is A Meter to remain and be pledied ii To t k '--orit le,A0 Lc SQ. (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 --Na Ekting sewer line to remain and be used by proposed new structure o Private well to be used for other purposes (Sewer District) (King Cg6nty Environmental Services) 5.GARBAGE (All household garbage disposedff and final bill paid) i\ A (RST Disposa/Federal Way Disposal) ❑ 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 (Refundable upon Completed Final Inspection) $575.00 , Bulletin#122—January 1,2006 Page 1 of 1 k:\Handouts\Demolition Permit Requirements DEPARTMENT O•MMUNITY DEVELOPMENT SERVICES 33325 8th Avenue South PO Box 9718 CITY OF Federal Way WA 98063-9718 Federal Way 253-835-2607;Fax 253-835-2609 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 9:101-2038 206-343-8800 , A s ' - Ps C ON A/w , I'LL— http://www.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 04/17/2007 TUB 13:19 FAX 25 368488 FS & GS Services ...I./1001/002 s Prajec Case No:•=== • -~. • kt et Sound Clean Air Agency = - l�atesRi ceiii�": ::::`;.: lctil�Ii „ 1904 314 Ave Stc 105 i 91gcncy, Seattle,WA 98101-3317 • G --_ - _ ---• pf.clA""" "9 206.343.8800 1.800.552.3565 �206.343.4073 - - -- _-- :`iAgency:US0%Only:;w z. Notice of Intent Type or print c/curly A.Pr ject Type: 1. 0 Friable Asbestos Removal 2. ❑ Friable Asbestos Removal&Demolition 3. titDemolition Only B. Property Owner: Ann Maric HartnellPhone: 253-606-9605 Mailing Address: 30305 6th Ave So City Federfll Way City 98375 State WA Zip 9800 C. Asbestos Contractor: F.S.&GS.Services,Inc, Owner/CEO: Gordon L.Williams Phone:253-548 1011 Contractor No.: 07088 Zip: 98003 Was Friable Asbestos Identified? biZYes ❑No Was Nonfrinble Asbestos Identified? OYea No Mailing Address: 16214-57th Ave.E.Suite A. City Puyallup State: WA Fax:253-536-8488 D. Site Address: 30305 6th Ave South City: Federal Way contact Person: al Phone: 1C. Asbestos Survey or No.of Structures: 1 Date of Asbestos Survey: ❑ Mat'l Presumed 1-9-07 AI'IERA Building Inspector Charlie Jobe Certification#: 1022509 Exp.Date:6-14-07 An AHEM Survey is required before all demolition projects F. Demolition Start Date: 4-1-07 No.of Structures: I 1.l.) Training Fire(List Fire Dept,) Information: 2. ❑ Ordered Demolition(attach copy of Ordcr) Demolition Wert demolition contractor's mailing address on back Will nonfriablc asbestos be left in place during demo? ❑ Yes ❑No Contractor: Kleenawrep t urpururiud If yes,list type and qty. Note disposal requirements in Step 6(on buck). G. Friable Asbestos Work Days: M T W Tb F Sa Su Project Information: • Start Date: Completion Date: Hours: 8 am-4 pm Will all friable asbestos Yes Total Qty.to be Removed: Linear Ft. Square Ft. • materials be removed? No 13. Asbestos/Demolition Project Categories: Notification Period Project Demolition 1. Single-Family Residence(owner-occupied): Fee Surcharge A. ❑ Asbestos Removal Project Only A.Prior Notice B. Demolition Project(with or without asbestos removal project) B. 10 Days* •(Asbestoa removal can begin upon notification;demolition must wait 10 days) 4:1t) Note:If the single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes IA or IB may be checked. If this is not an owner-occupied residence,one of the categories listed below must be used instead. A single fami//residence does not include rental property,multi-family unite,or any mixed-use building. 2. U All Other Demolitions(with no Asbestos removal or Nonfiablc Asbestos 10 Days $50 only or less than 10 linear fcct and/or 48 square fcct of friable Asbestos) Friable Asbestos Projects Lather than Single Family Residence): Asbestos Demo 3. Cr>10-259 linear fcct and/or>48- 159 square feet of asbestos Prior Notice 10 Days $50 $50 4. ❑ 260.999 999 linear fcct and/or 160-4,999 square fest of asbestos 10 Days $200 $50 $50 5. U >1,000 liner fcct and/or>5,000 oars fest of aebcstos 10 Days $600 6. ❑ Emergency Asbestos Project or Emergency Demolition Project Prior Notice $50 Emergency Fee (Single-Family Residences arc exempt from emergency fcc;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. • '_ �� F.S.&GS Services_Inc. 31/6/d� __----- Y v Signature Representing Dole =_••_ =- wt ''�^-'_ rA x � I/ 66-160 Notice of Intent Rev.2/1/07 ' % � ii�3� © 1 04/17/2007 TUE 13:19 FAX 2568488 FS &, GS Services4110. 4002/002 The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project involving materials equal to or greater in size than.10 Iinear feet or 48 square feet and for all demolition projects (regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation 111, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal and demolition projects involving materials and elutes below the notification threshold are still sl jeet to all other requirements of RegulationArticle 4. • J. Demolition Contractor: Klee nsweep Curportaion Owner/CEO: Mailing Address: P.O.Box 611 Phone: 253-606-9505 Contractor's Job a: City: Milton State: WA Zip: 98354mss' GUIDELINES FOR SUBMITTING AN ASBESTOSWEMOLITION 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. lNgnfriable 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 leu in place during demolition, check yes and list the type and quantity of material. Note: Demolition debris containing nonfriable asbestos materials must be labeled as"nonfriable asbestos-containing waste"and be deposited at an authorized waste disposal facility. Step 7. Enter asbestos project information in Box G. List types of Friable asbestos material to be removed:surfacing material such as popcorn ceilings or plaster,sheet vinyl flooring,duct and pipe insulation,cement asbestos board siding or pipe,etc. Step 8. For owner-occupied Single-Family Residential projects, check BOX HIA for renovation projects or BOX 111B for demolition projects'(with or without asbestos removal). Asbestos removal may be conducted after a complete notification is received, but demolition activities can only begin on the 101°day after the notification is received. Note:Ifthe single family residence is owned by one family who has been or will be using the residence as their domicile,boxes 14 or lB may be checked A single family residence does not include rental property,multi-fluidly units,or any mixed-use building. For Commercial asbestos projects(or projects that do not qualify as Single Family Residential);check the project category 112- 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 paymentTo file for an emergency asbestos or demolition project, cheek the appropriate box 1 —5 and the applicable emergency box in 116. wn the need to conducj the project immediately in accordance with the ieggireznents in Regulation III_Section 4.03(c). Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box I. Mandatory amendments to the notification are required for changes that increase the project category,'change the types of asbestos materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for work schedule changes if the contractor is participating in the Agency work schedule fax program. A$25.00 processing fee is required for all amendments. Puget Sound Clean Air Agency asbestos regulations and forms can be downloaded from the Agency web page at www.pscleanair.org. For technical assistance call (206) 689-4058 and for administrative inquiries call (206) 689-4090. • 66-160 Notice of Intens Rev.2/7/07 RUN 04/04/2007 WED 15:21 FAX 253 8488 FS & GS Services 2002/002 Y Q� Fs . Services Inc. 4-4-07 Puget Sound Clean Air Agency 110 Union Street, Suite 500 Seattle,WA 98101 To Whom It May Concern: RE: Asbestos Removal,30305 6th Ave South,Federal Way,WA 98003 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 3-26-07. 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 Ann Marie Hartnell as soon as possible. Respectfully, 0441-OCIVKA Gordon Williams President Cc: Ann Marie Hartnell • 16214 57th Ave East,Suite A Phone: 253-548-1011 Puyallup,WA 98375 Fax: 253-536-8488