05-103820 • • ar
City of Federal Way Demolition Permit #: 05 - 103820 - 00 - DE
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-305(1
Project Name: OTTO
Project Address: 1240 SW 296TH Parcel Number: 062104 9047
Project Description: Demolish existing single family residence preparatory to construction of new residence.
Owner Applicant Contractor
RAY&CAROL OTTO RAY&CAROL OTTO RAY&CAROL OTTO
1240 S 296TH ST 1240 S 296TH ST 1240 S 296TH ST
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(253)944-4271
PERMIT EXPIRES August 15,2007.
Permit issued on August 15,2005
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: ,, / f Date: t V40.
THIS CARD IS TO "EMAIN ON-SITE
CITY OF `--� tommuni Develo m nt Inspection Record
tY p p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-103820-00-DE
Owner: RAY & CAROL OTTO
Address: 1240 SW 296TH ST
FEDERAL WAY, WA 98023-3410
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 ...e..di Dates - 24(i.6.37
•
,
a-.,Ak- nEcEMILDD .
0
Federal Way PERMIT - g `-
COMMUNriyDEVELOPMENfSERVICES�G 1 2005SF MF CO ME EL P DE EN FP
33325DRLWAY,E EOUTH•Po ' APPLICATION
FEDERAL WAY,FAX
53-898063-9718-260fr. I
253-835-2607•FAX 253-835.4609 /
www.cituoffederalway.com I OF FEDERAL WA',
BUILDING DEPT.
The ollowi • is 'aired in orntation—an incom•lete a..lication will not be acce•ted. Please •rant le•ibl (in in or •e.
J. ®V (t• PROPERTY INFORMATION • .
SITE ADDRESS 12,4 -tZ' "�i --S.-freer SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 ( A / 0 'I- 9 0 ( LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
IN PROJECT INFORMATION
• . TYPE OF PERMIT 0 BUILDING 0 PLUMBING D MECHANICAL -
XDEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
d1 iii 4.4--a4.4.
o
o;
PROJECT NAME(Name of Business or Owner Last Name) 6770
PEOPLE INFORMATION
PROPERTY NAME „ r I�
��[IL,/Jn✓ e$C' �t--��O PRIMARY PHONE
OWNER (J l I (200) Le5- 3 1
'4..V.) MAILING ADDRESSCITY,STATE,ZIP
rzxw s z �� �J e Ide ,,/ ',Jail iw 4 e b'oe3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
}'�a�1 ( ) -
- _ M MAILING ADDRESS� CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER (F )
EXPIRATION DATE FAX NUMBER
/ / ( ) _
-gL
I CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
_\A
^1 (��csr. PLICANT COMPANY NAME ,p APPLICANT NAME OFFICE PHONE
t O MAILING ADDRESS ( )
CITY,STATE,ZIP - CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( )
ft. CONTACT NAME PRIMARY PHONE
l'1 G-t 4 o- - C ( Z-�( ) 14.5C1 - 32.-4: e� z l c r
E-MAILE MAI)fLADDRESS y
r LENDER �'1:., 0i-o'f'
, y ,
nls€'�� NAME
1 MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
•
Jr PROJECT FLOOR AREAS \ J !
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
BASEMENT r
FIRST
SECOND
THIRD
FOURTH •
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED • " TOTALL%ISrDiO BR`- %`'��OT PROPOSED 9R §.R a," ' orAL eR:,5�'
NUMBER OF FLOORS 04,14,4= .. °., �A3 a, , ��
**NEW HOMES ONLY** NUMBER OF BEDROOMS TED 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(comm,rciat) 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 crone) 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 attorneysfees 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 0,172 �7 DATE g/ L/ ✓
(Signature) / (Title)
RELATIONSHIP TO PROJECT e'Owner 0 Agent 0 Contractor ❑ Architect 0 Other
a t 4� Ab1) ON i �7 'IjERA. e N �ratAII2' � �� 0 M Nx �
.� ..� � ,�® � � rr�err. e»^ �s '°x''' xr ronz,^ m�^� �+�«m
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Bulletin#100—Januaiy 7,2005 Page 2 of 4 k\Handouts\Permit Application
le •
`�/c DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
r RECEIVED 33325 8th Avenue South
PO Box 9718
1 2 Z005 Federal Way WA 98063-9718
AUG253-835-2607;Fax 253-835-2609
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 TOAPPLICAtvT.: 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.
I.ASSES • EMENT 2,,6050050 6. ELECTRICITY
(Copy o>;•..rov,•I form)nd c§begos safvyrom Puget Sound Clean Air (Electricity to be shut off and meter removed),,,f/
Agency provide•► tiyil� �}V"
�^` (Puget Sound Energy)
�••,._ (City of oic
-deral Way Building Official)
2. GAS SUPPLY 7.FUEL STORAGE TANKS
(Gas to be shut off, meter remove and final bill paid) (Above or below grade fuel tanks, have been pumped or removed
C6 SL t t+l k under Fire Depa ment permit prior to any dismantle/excavation)
-
(Puget Sound Energy) 71a
(Federal Way Fire District#39)
J)SEPTIC SYSTEM 8. WATER- Public Source (Check applicable box)
(Tank to be remov or tank to be drained and filled) n Meter to be removed and final utili bi paid
el to rem • 'and be protected/
1
(King County Environmental Services) :r= .•ier)
******OR ******
4.SANITARY SEWER (Check applicable box) 9. WATER- Private Well (Check applicable box)
o Sewer line cap at property line o Private well filled and capped
)(Exist g sew lin to remain a used by proposed new structure o Private well to be used for other pur es
72 47
( r ' trio) (King County En ronmental Services)
GARBAGE
05 Chard
(All household garbage disposed off and final bill paid)
I ead -=O 12- '6/5 see c,tle,(t d
(RST Disposal/Federal Way Disposal)
❑ Completed Construction Permit Application form
❑Provide the following fees: 1.Demolition Permit Fee $63.50
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#I22—March 9,2005 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
Agency Case No. PUGET SOUND CLEAN " ` , 1 1L
AGENCY VET)
110 Union Street,Suite 500
200500590 ..............m.„...,,,.,....-.;./..,..........,.„,,...
4Seattle,WA 98101-2038 JUL 0 6 2005
wry-.v.pscleanair.org
NOTICE OF INTENT Ni'ifik—S 63E5ILEpe1t
_i_�u11i Ahjtyfk
A.Project Type: 1. L3 Friable Asbestos Removal 2. F.3 Friable Asbestos Removal&Demolition 3. I(1 Demolition Only
B. /� � t ,c� ' ^
Property Owner: CLI( 4 lo'c'o l O�TV 2�(F l J —3�(p
'/ j f Phone: q
Mailing Address: t 24 �,% 2 ��� S - City: {`e? �Ccl �"l �- to Lf Zip: I�122 ' A
C. Asbestos " ' '. C""7' ', ' "I :, 'c,.777:07)712cn
Contractor: Vil Owner/CEO:
Contractor
Mailing Address: Phone: Job No.:
City:
. State: p: Fax.
D. Site ) G �+ p
Address: 1 Lef o L, G2– SVP - J f le t+ City: �1.1 1-1Gvc/1°4 Zip: ( o'z-3
Site �„ •
Manager: L1lcr 1 1 G f 1 Local Phone: LG?c'�!{54-32- 1
E. l.7 Asbestos Survey or No. of 1 Date of Asbe tos Was Friable Asbestos Identified? LI Yes ®<
CIMat'l Presumed Structures: Survey: to 1 /c5 Was Nonfriable Asbestos Identified? ❑Yes [ N
AHERA Building et?,l�ii:•ecl fitsgtes Sat.rvic/ Certification 4: /Gr/232z, Attach a copy of the survey when friable asbestos
Inspector: "'dyed 64.0.4 ,GLi4Exp.Date: /ff./pp 5- has not been identified.
An AHERA Survey is required before all demolition prbjects
;< �F. Demolition Start � No. of 1. LiTraining Fire(List Fire Dept.)
-7///.5--/05-
Information: Date: S O5- d f ca r Structures: I 2. Li Ordered Demolition attach co of Order)
Demolition Insert demolition contractor's mailing address on back. Will nonfriable asbestos be left in place during demo? Yes U No
Contractor: i,., 1,9e th'Kt Yrl,7,_e / if yes,list type and qty. Note disposal requirements in Step 6(on back).
,
G. Friable Asbestos Work Days: T W Th F Sa Su
Project Information: Start Date: /1 M
Completion Date: Hours:
Will all friable asbestos ❑ Yes
Total Qt . to be removed: Linear Ft. Ssuare Ft. materials be removed? ❑ No
• Boiler\Furnace Insulation 111 Duct Insulation ■ Pipe Insulation . Fireproofing II Paints ■ Plaster ■ Textured Coatings
U Cement Board LI Cement Pipe U Friable Flooring U Friable Roofing Material Other.
H. Asbestos/Demolition Project Categories: Notification Period Project Demolition
1. Single-Family Residence(owner-occupied): Fee Surcharge
A.,❑ A stos Removal Project Only A.Prior Notice A. '.25
B. .'Demolition Project(with or without asbestos removal project) B. 10 Days* - $ 0
*(Asbestos removal can begin upon notification;demolition must wait 10 days) Hi $
Note:If the single farniiy 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
family residence does not include rental property, multi family units, or any mixed-use building.
2. n All Other Demolitions(with no Asbestos removal or Nonfriable Asbestos 10 Days $100
only or less than 10 linear feet and/or 48 square feet of friable Asbestos)
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 $100 $100
4. U 260-999 linear feet and/or 160-4,999 square feet of asbestos 10 Days $200 $100
5. Li >1,000 linear feet and/or>5,000 S uare feet of asbestos 10 Days $600 $100
=0 Emergency Asbestos Project or lJ 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)
L I certify that the information contained in this notification&supplemental data is,to the best of my knowledge,accurate&complete. Agese my
(1-1tD-e-- (let 7//A5- ___teL.-T. i
Signature Representing Date
Reviewed By
Puget Sound Clean Air Agency Form No.: 66-160(Revised 2/05)TS 7/76
AMOUNT TO
CK. NO. (oat{
RCPT IMO_ _ ct,Z 36
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w, t
•
Certified Asbestos Survey
P 25744 135th Place S E
Kent,WA 98042
Phone 253 630 3996
June 30,2005
Mr.and Mrs.Ray Otto
1240 Southwest 296th Street
Federal Way,Wa 98023
Dear Clients,
On June 17,2005 a survey for asbestos contained in the construction materials that will be disturbed in the
demolition of the home located at 1240 Southwest 296th Street,Federal Way,WA 98023 was completed.
The owners are Mr.and Mrs.Ray Otto phone 253944 4271 and the home will be demolished.
Asbestos greater than 1%was detected in sample:
Sample#061705-2A,Joint compound,contained Chrysotile asbestos @ 2.4%PC
The survey was done without limitations.
No hidden or inaccessible areas were found.
All area measurements are approximate.
International Asbestos Testing Labs, 16000 Horizon Way Unite 100,Mt.Laurel,NJ,08054 conducted the
analysis by Polarized Light Microscopy(PLM)and Point Counting(PC).The survey was done by Certified
Asbestos Survey,25744 135th Place S E,Kent,WA 98042 phone 253 630 3996.Michael Bastanchury,
AHERA building inspector certification#1012322 expiring November 3,2005,did the survey in
accordance with sampling protocol outlined in CFR 763.86 by PSAPCA Reg. III Article 4.
Sincerely
Michael Bastanchury
Certified Asbestos Survey
' S S
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. .4 : 28 PM 8/01/2005 • 600 FEDERAIOAY-RESI
Salesperson 451 Residential Account
Date created 8/11/2004
Account : 600-23761 Billed to: 600-23761
OTTO, RAY & CAROL OTTO, RAY & CAROL
1240 SW 296 ST 1240 SW 296 ST
FEDERAL WAY WA 98023-3410 FEDERAL WAY WA 98023-3410
Contact : Contact:
Phone: 253-661-0563 Phone: 253-661-0563
Purchase order: Bill cycle: RQ1 RESIDENTIAL QTRLY ADV 1, 4, 7, 10
Comments:
Routes : 4301 4707 4603 8888
Days : THU THU THU
Equipment : S35
Services Occurs
1 T51 1-35 GAL CART MSW Total due: $ . 00
1 REC RECYCLE PER UNIT (DFU) 0 Current : $ . 00
1 G91 1-96 GAL CART YDW 06-30-05 : $ . 00
1 HAR HAZARDOUS WASTE FEE 05-31-05 : $ . 00
04-30-05 : $ . 00
Standard monthly charge: $19 . 43 03-31-05 : $ . 00
/g 4-1/
4i/frrL
�ripa/Va9 (iF
• 4 : 32 PM C�tomer Biographical Inform on 8/01/20'05
Customer Number: 600-231 Customer Id: 00006-44Mir-35009 Created 08/11/2004
Service Address
Nai'ae OTTO, RAY & CAROL
Contact
Addr 1240 SW 296 ST
C/S/Z FEDERAL WAY WA / 98023-3410
Phone 2536610563 Fax #
E-Mail
Billing Address
Name OTTO, RAY & CAROL
Contact
Addr 1240 SW 296 ST
C/S/Z FEDERAL WAY WA / 98023-3410
Phone 2536610563 Fax #
E-Mail
Current balance : . 00
Last billed: 07/01/2005 62 . 28 Last payment : 06/24/2005 62 . 28-
F3=Exit F2=Service History F5=Refresh F7=Billing Information F8=Services
F12=Previous F13=Balance Inquiry F24=More keys
Aug-14-2005 06:48 From-PSE ELEC 1ST RESPONSE 253 395 68240 T-525 P.002/002 F-357
��� r �� -ace r-uu7/UU4 r^drib
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dtammh_
DE?AtTMF.rr ov CDMIHUNrlY1EY
33F251 OP81EANvi us o-rpthc
i)i•�i,y.'fPOSPx 9718CITY OF
Feder-HI Way WA 98063-e718
Federal Way
293-S35-2607;Fax 3S3•H35-2609
www_o itvo I fed era lw Rv_cor7r
DEMOLITION PERMIT REQUIREMENTS
A rlemolitien pentlit is required to remove any ylructure or structures on a subject property. Check with the City's Planning
Division to see if the propoSai exceeds thresholds that trigger an environmental review_An environmental review and
Stibmittai of an environmental checklist may be required,which will extend the time period before a demolition permit can
be issumd.
I-1 Prior to submitting a demolition permit,the following items(as applicable) must be signed by the respective
agency(see attached Demolition Permit Contact List).
Nair7OApeirrilrg7, Wallies shall be eliaconi7arraei g zd,rerulcdrperformed, rfapp(hcnblc_pr,pr to issuanc70 efte denmolirir .n perrnir.Ail applicable
ire,u. bclaw are iv be penelArr(,rlcded by the per/me/Aid agency represapautives.
t.ASBESTOS ABATEMENT 6 ^�
(Copy of approval form and asbestos survey from Puget Sound Clean Air fElo•4, I RIC�TY /
Agency oratd v1) y - shut off and meter removed)
r J (City of Federal Way 9t p i O pl) (Pug Sound Energy)
GA' SUPPLY
(Geta to ;. , 74 FUEL STORAGE TANKS
k e/•,er removed and final bill paid) (Above or below grade fuel ta.nk5, have been pumped or removed
- .4P Under Fire Department permit prior to any dismantle/excavation)
( uget SOUn d Ener9Y)
(Federal way Fire District#29)
SEPTIC SYSTEM 8.WATER-Public Source (Check applicable box)
Clank to pe removed or tank to be drained and filled) ri Meter to be removed aria final utility bill paid
❑Mater to remain and he protected
(King County Env rronmental Services) (Warr SWApiler)
NLSEWER (Check applicable box) Y 4***0%CR f.gara�
4.sATARY
❑Sew Ie capped at fo 9.WATER- Private Well (Check applicable box)
p perry line ❑Private well filled and capped
❑Existing sewer Ilse to remain and be used by proposed new structure n Private well to be used for other purposes
(Sew®r Distri -• (lung C❑only Environment l Services) '
5. GARBAGE
(All housemaid garbage disposed off and final bill paid)
(i:' , 7/;)
(RSTb�spcsal/Federal way oisposal ))( r0 6( .z1
❑ Completed Construction Permit Applic=ation,form S/v
❑Provide the following fees: I.Demolition Permit I+'ec $63.50
2..Automation Fee 5.00
3. WA.State Surcharge 4.5U
4.Cash Bond beposit _5[1Q_00 (Refundable upon completed Final lnspocnIon)
5573.00
num-tali/tdZ• nl,srro 9.2Qfl ---- ,_
Pegs 1 of 1 klHundoufb1peruoliliAn Pamir Requirtmanii