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07-101343 City of Federal Way Dhmo!ition Penh t #: 07-101343-00-D'E 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: FEDERAL WAY TOWNHOMES Project Address: 31408 28TH AVE S Parcel Number: 092104 9142 Project Description: Demolition of(1) residence & (1) fish hatchery on a 1.69 acre site Owner Applicant Contractor SOUTH FORK HOMES LLC SOUTH FORK HOMES LLC GRIMSTAD CONSTRUCTION INC PO BOX 930 PO BOX 930 GRIMSCI002RF(1/4/09) SUMNER WA 98390 SUMNER WA 98390 21842 148TH AVE S KENT WA 98042 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 Friday, March 13, 2009 Permit Issued on Wednesday, March 14, 2007 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,th City of Federal Way. Owner or agent: Date: THIS CARD IS TOAIN ONSITE «.Y of immunity DevelopmX Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 07-101343-00-DE Owner: SOUTH FORK HOMES LLC Address: 31408 28TH AVE S FEDERAL WAY, WA 98003-5003 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 _ C Date 7_� 1 / ?o 'PIPE FACILITY: ° Warehouse and Residential House a ADDRESS: ° 31408 28th Ave South Federal Way, WA 98003 • INTENT OF SURVEY: The intent was to identify immediate or potential asbestos health hazards for building renovation or demolition. Sampling was done on all accessible suspect building materials. • DESCRIPTION OF BUILDING: On February 2, 2007, F.S. & GS. Services, Inc. performed an asbestos survey on a vacant warehouse and house. The warehouse is mostly cinder block construction with a concrete slab floor. There is sheet vinyl and ceiling tile in the office portion of the warehouse. No asbestos was detected The house is a rambler with wood siding and a brown 3-tab roof. The flooring is mostly hardwood with sheet vinyl in the kitchen and bathroom. Both structures have. assumed asbestos containing vermiculite in the attics. The following samples contained asbestos: 013 EXTERIOR°ERIOR WINDu i s ',WINDOW P°.-mi A Puget Sound Clean Air Agency permit is required to obtain a demolition permit. 9 ALL MATERIALS IDENTIFIED AS ASBESTOS, ° • CONTAINING 1% OR GREATER, MUST BE REMOVED PRIOR TO DEMOLITION OR RENOVATION ° • ESTIMATED COST OF REMOVAL:PLEASE SEE PROPOSAL • • • , II. frp. , , EPA AND LABOR & INDUSTRY XTRACTS Current federal regulations (NAT AL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTAIS,NESHAPS, CFR 40, PART; 61, SUBPART M [REVISED SUBPART B])require that no renovation or demolition activity release asbestos fibers to the environment. Therefore, all affected asbestos containing materials must be removed by a certified asbestos contractor prior to remodel or demolition. WAC 296-62-07707, Identification, requires an owner to perform a good faith inspection to determine whether materials to be worked on or removed contain asbestos. LIMITATIONS In accordance with your request, F.S. & GS. Services, Inc., has conducted an A.H.E.R.A. type survey. F.S. & GS. warrants that the survey was performed with the usual thoroughness and competence of this profession, and within the limits of accessibility to materials. The survey was conducted within the guidance provided by 40 CFR Part 763, Subpart E, appendix C. F.S. & GS. Services is not responsible for materials, hidden from sight, that cannot be found with reasonable diligence, such as materials in foundations or slab floors. We are providing this information for the express use of South Fork Homes, LLC and we make no warranty of sufficiency of data to any other parties. This survey and demo permit will need to be submitted to the Puget Sound Clean Air Agency prior to renovation or demolition activity. LABORATORY CREDENTIALS All suspect materials were analyzed by Orion Environmental Services in accordance with 40 Code of Federal Register Chapter 1, Part 763, Subpart F. AIHA Bulk Asbestos Analytical Testing Program (102911). • Charles Jobe O AHERA INSPECTION EXPIRES CERTIFICATION NUMBER#1022509 6-14-07 • • • • II • 411. 'v. “ 1 -, • • °RI-01r Environ -rental Services • An Environmental Com.liance Consulting Firm Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client P.S. & GS Services, Inc. 16214—57th Avenue East, Suite A Date February 5, 2007 Puyallup, WA 98375 Page Page 1 of 3 Invoice 070465 Project Name 07048 Date Received February 5, 2007 Unit Address South Fork Homes, LLC—Warehouse & Residential House @ 31408—28th Avenue South Federal Way, Washington Client Orion Number Number Stereo ne ScoExam Sample Asbestos Other Treatment Percent Type Fibers Warehouse CJ-Ola 70205-74a Ceiling Tile - ND - Cellulose Homogeneous CJ'-01 b 70205-74b Brown Glue Dot Chloroform ND Cellulose Assoc. w/CI-01a CJ-02a 70205-75a Joint Compound _ Assoc. w/CJ-02b ND Cellulose CJ-02b 70205-75b Gypsum Wallboard ND Cellulase Homogeneous 1 CJ-03a 70205-76a Joint Compound Assoc. w/CJ-03b ND Cellulose CJ-03b 70205-76b Gypsum Wallboard - ND Homogeneous Cellulose CJ-04 70205-77 Gypsum Wallboard - ND - Cellulose Homogeneous kesideni al House CJ-05 70205-78 Gypsum Wallboard Homogeneous ND - Cellulose 34004 - 9th Avenue South • Suite 5 • Federal Way, Washington 98003-6740 • Tacoma (253) 952-6717 • Seattle(253) 874-8118 • Facsimile (253) 927-4714 • Email Info@OrionES_net W13E W2F9219763 4 II 41 41 I Aea awes , .11'40 aS t Chi ,`0�7 41 :31111t/NJIS ,S2iOlD3dSNI 41 3WI1/31b'a :A8 a3AIJ3a21 JNII0021 8`d1-£ NM0218 30021 21OI2131XJ T T T T D A.LLfld MOGNIM MOC1NIM 210Ri31X3 OT OTD 1ANIA 139HS NJV18 W0021H1V8 NP kJ 6 600 1ANIA 133HS NM0218 NJHJIIN NIVN 8 800 (31IS0dNOJ) CMV0811VM Wf1SdAJ AVMT1VH NPN L L00 (31IS0dN0J) a2ivO811vM Nf1SdAJ NO02i JNIAII NIVN 9 900 (31ISOdNOJ) a2IVOST1VM Nf1SdAJ W0021 JNIAT1 NIVN S SOD ISfOH (31ISOdNOJ) a21VO8T1VM 14f1SdAJ 3JVdS 3JI3d0 NIVW 17 17OD (31IS0dWOJ) adVOSTIvM Wf1SdAJ 3DVdS 3JId30 NIVk1 £ £00 (31IS0dNOJ) a2Id0811VM 1411SdAJ 3JVdS 3JI330 NIVN Z Z0D _LOCI 3f119 GNV TILL ONI1I3J 3JVdS 3JId30 NPN T T0D JSllOH3•WM 1vR131vW 3O 3dAl V121y 210013 OlOHd #31d1ANS Zi7086 VM '1uaN £0086 VM 'AeM leaapad 3S any 418i7T ZI78TZ :SS311aad 1-11noS a"v u18Z 80b1£ :SS3baan JT 'sawoH >pod 41noS :31011/N 1N3I1D asnou •say pue asnogaJeM :MANN 9NI01If18 81'OL0 #1.33CO2ld S310N 31dWVS aNV 901 31dNVS LOOZ-ZO-ZO :31ya SOIS39S1/ 88t'8-9£S-£SZ #XVd SL£86 VM dflllVAfld TTOT-817S-£SZ #131 V alms 1seJ *any ,SLS-i1Z9T DNI S3DIA213S 'SD IS 'S'3 1 . . • . ORIOir Environmental Services An Environmental Compliance Consulting Firm ■ Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client F.S. & GS Services, Inc. Date February 5, 2007 16214—57th Avenue East, Suite A Page Page 2 of 3 Puyallup, WA 98375 Invoice 070465 Date Received February 5, 2007 Project Name 07048 Unit Address South Fork Homes, LLC—Warehouse & Residential House @ 31408—28th Avenue South Federal Way, Washington Client Orion Sample Asbestos Other Number Number Stereo Scope Exam Treatment Percent Type Fibers CJ-06a 70205-79a Joint Compound - ND - Cellulose Assoc. w/CJ-06b CJ-06b 70205-79b Gypsum Wallboard - ND - Cellulose Homogeneous CJ-07a 70205-80a Joint Compound - 2 Chrysotile Cellulose Assoc.w/CJ-07b CJ 07b 70205-80b Gypsum Wallboard ND - Cellulose Homogeneous CJ-07c 70205-80c Joint Compound & - <1 Chrysotile Cellulose Gypsum Wallboard Composite Assoc. w/CJ-07b CJ-08 70205-81 Brown Vinyl Sheeting w/ - ND - Cellulose Black Felt Backing Homogeneous CJ-09 70205-82 Black Vinyl Sheeting w/ - ND - Cellulose Black Felt Backing Homogeneous 0 CJ-10 70205-83 Window Putty Crush 2 Chrysotile Cellulose 0 Homogeneous CJ-11 70205-84 Black/Brown 3-Tab Ash ND - Cellulose Roofing • Homogeneous • 34004-91h Avenue South . Suite 5 • Federal Way, Washington 98003-6740 4111 • Tacoma (253) 952-6717 • Seattle(253) 874-8118 ♦ Facsimile(253)927-4714 • Email lnfo@OrionES.net • WBE W2F9219763 REc96 . •• CITY OF . MAR 1 4 207 ', L/17-00-7 - c o 1 3 •2/-,5: Federal Way PERM j,ITY OF FEDERAL WA SF MF CO ME EL PL (�E EN FP COMMUNITY DEVELOPMENT SERVICE �ILDING DEPT. �-/ 333258P' AL WA ,WA 98H•PO BOX 9;B,. AP P LI CA 1� FEDERAL WAY,WA 98063-9718 253-835-2607•FAX 253-835-2609 The following is required information-an incomplete application will not be accepted. Please print legibly(in in a .• 40(3 IN PROPERTY INFORMATION SITE ADDRESS 31 L'`V '�E ✓ cx1 SUITE/UNIT# ASSESSOR'S TAX/PARCEL# G p1 2U 1-1 - 9 LOT SIZE(sf) I. 67 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) ?TN AA 1x 5 I/,a L3Ly OF ST y (Attach separate page for lengthy legal description) J C �'`—c, P ('s • PROJECT INFORMATION J i`(� TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit onto) t�eer)0 ;an 0+ I resp v.c42_ a I -Fist (4-4.- ,t ©n c L ( A PROJECT NAME(Name of Business or Owner Last Name) O 11 El PEOPLE INFORMATION PROPERTYNAM �^ PRIMARY PHONE qG _ OWNER O I'ocV tk��5 LL-C (0-53)( I -7! l lj!J MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS oril CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE (3( CriSkaCK CvnS4codciorN Ron Gcc-r1 S .rl (gs3)(o3 I ?19t) MAILING ADDRESS CITY,STATE,ZIP CELL PHONE 1.4 D. I u$}h �.ie- S 1 -� ' (AY4- 9W'-L (Dao) CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER (�53 ) (039 - 48s� COPY of card required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS with each application / ��!\ .�J� (�sc .�... �ac� �= / — - off APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE Safr,e cs D L-3 - MAILING ADDRESS CITY,STATE,ZIP CELL PHONE RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect 0 Tenant o Agent ..Other Oi..3Y19.0 ( ) - PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS CONTACT L.1 kin) . A �� (953)3r a DD. LENDERNAME Per RCW 19.27.095: FCEOr j e.('���K Lender information is required if project value exceeds$5,000 MAILING ADDRESS CITY,STATE,ZIP PHONE 4\cc Ae Sot,. 4 R O (a53)-( -(430k • DETAILED BUILDING INFORMATION i EXISTING USE 0 c c, c..(1� s4-ocCLc PROPOSED USE PIOtk-; .r- FcN_1(. EXISTING ASSESSED/APPRAISED VALUE $ DSO' U O/r---,�V VALUE OF PROPOSED WORK $ 9 rn f (I 1 h b'1 SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? YES 0 NO WATER SERVICE PROVIDER ICtLAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL) SEWER SERVICE PROVIDER ` HAVEN o HIGHLINE ❑ PRIVATE(SEPTIC) ti '" • PROJIiCT FLOORjAREAS AREA DESCRIPTION VEXISTING PROPOSED TOTAL ' BASEMENT SQ.FT. SQ.FT. SQ.FT. n ti. � _ o d 0 FIRST a A Lr SECOND `T f) Li 9 Co Lint �%K. un1A &se ( 3k THIRD (3 00( unli, (001-1 600 y ADDITIONAL FLOORS(DESCRIBE) ® Q 0 0 DECK('COVERED OR ilit UNCOVERED?) D 9 9 7 GARAGE 0.- CARPORT a n Y* Sia sCa NUMBER OF FLOORS F.7CISTTNt: PROSE]) IS TOTAL TINGTOT PROING SF POS TOTAL SF -77 _ i�rN1 SF /�N� **NEW HOMES ONLY** NUMBER OF BEDROOMS oC ESTIMATED SELLING PRICE $ d 7s, 000 • 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 orrkk $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tob/Shower Combo) LAYS(Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSE'S(Toilet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE 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 ' B" ' A TL Z4. DATE 3- J£ 07 (Signature) (Title) RELATIONSHIP TO PROJECT ❑ Owner KAgent 0 Contractor ❑ Architect 0 Other FOR OFFICE USE ONLY ❑NEW ❑ADDITION ❑ALTERATION a REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? a YES ❑NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? ❑YES ❑NO PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application • IIP • aT)EPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8`h Avenue South PO Box 9718 CITY' OF = " Federal Way WA 98063-9718 253-835-2607;Fax 253-835-2609 Federal Way www•07;Fffederal35-26 9 DEMOLITION PERMIT REQUIREMENTS -�o 311-to Fs � r-h- A.�e_ S �ote..a .� LOwi 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. ID 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.ASBESTOS ABATEMENT 6. ELECTRICITY (Copy of approval form and asbestos survey from Puget Sound Clean Air (Electricity to be shut off and meter removed) Agency provided) (Puget Sound Energy) (City of Federal Way Building Official) 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 under Fire Department permit prior to any dismantle/excavation) (Puget Sound Energy) (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) o Meter to be removed and finalutility bill paid *Meter remand be tec d-t c !x 5."1- t (King County Environmental Services) (Water Su ier) ******0 ****** 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 o Existing sewer line to remain and be used by proposed new structure o Private well to be used for other purposes (Sewer District) (King County Environmental Services) 5.GARBAGE (All household garbage disposed off and final bill paid) (RST Disposal/Federal Way Disposal) ❑Completed Construction Permit Application form 0 Provide the folloyving 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#122—March 9,2005 Page I of I k:\Handouts\Demolition Permit Requirements • .(2 • • 410111 ,• / ge„„, ( (107 • _ DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8th Avenue South 4111,ki PO Box 9718 CITY OF Federal Way WA 98063-9718 f era 253-835-2607;Fax 253-835-2609 vo,yw.ciiyotTederalway,A.:pin DEMOLITION PERMIT REQUIREMENTS 4'0 30-1018- #ar-h-• LOt,ts 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 he disconnected and services performed,if applicable,prior to issuance of the demolition permit.All applicable items below are to be siggiea 0,31,g4fgetby the respective agency represematives. 1.ASBESTOS ABATEMENT 6. ELECTRICITY (Copy of approval form and asbestos survey from Puget Sound Clean Air (Electricity to be shut off and meter removed) Agency provided) (Puget Souno Energy) (City of Federal WayBuilding Officai) 2. GAS SUP1,1' / 7. STORAGE TANKS be ( (0, bit paid) (Above or below grade fuel tanks, have been pumped or removed under Fire Department permit prior to any dismantle/excavation) - Puget Sound,er ercy) (Federal Way Fire District#39) 3.SEPTIC SYSTEM 8. WATER-Public Source (Check applicable box) (Tank to be removed or tank be drained and filled) a Meter to be removed and final utility bill paid a Meter to remain and be protected (King ounty Environmental Services) (Water Suppber) .*****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 a Private well to be used for other purposes (Sewer District) (King County Environmental Services) 5.GARBAGE (All household garbage disposed off and final bill paid) (RST Disposalth.deral Way asposat) Completed Construction Permit Application form O Provide the following fees: 1.Demolition Permit Fee $ti3.50 2.Automation Fee 5.00 3.WA State Surcharge 4.50 4.Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection) $573.00 Baca!,#122--March 9,2005 Pap:. I oil 1.,,\Haidottlh‘Detnulit ion NI ni it RCLIU ing I lenh J`HIY-UC-CJl7b ie:4+� I-rom: 2535297206 41.2533832572 P. 1/1 01`/02/,2007 11:40 FAX 25358. AHBL INC 000z . t 5 t a. t DP:PARTMENT OF COMMUNITY DEVELOPMENT SER VICES 33325 8th Avcnue South • 111116. CITY OF � ewers: , PO Sox 9713 Federal Way F835-! Way FaWx 98063-9718835 253-835-2607;[Saz 253835.2609 www.cityoffederalway.c:i.n n DEMOLITION PERMIT REQUIREMENTS A demolition permit is reciuire:l to remove any structure or structures on f.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 atplicable)must be signed by the respective agency (see attached Demolition Permit Contact List). ,voTr rn ArrIc4&T. Utilities shall he disconnected and services performed, if applicable:prior to issuance of the demolition permit.All appticuble hems below are to be filmed 4Gi61 dated by the respective agency represcnrarivvc. 1.ASBESTOS ABATEMENT 6. ELECTRIt71T'Y (Copy of approval form and asbestos:urvoy from Puget Sound Clean Air (Electricity to br shut off and meter rernoveri) Agency provided) (City of Federal Way Building Official) (Puget Sound Energy) 2.GAS SUPPLY 7. FUEL STIIJFtAGE TANKS (Gas to be shut off, meter removed and final bill paid) (Above or beim grade fuel tanks, have been um under Fire Department r Ped or removed (Puget Sound Energy) P permit prior to any dismantle/excavation) Na i r1�k 1..AiTW iter r7-10. 2cf are ( I Way Fire District#39) ` Feder 3.SEPTIC SYSTEM 8. WATER- .4ublic Source (Cheek applicable box) J 1'02-e 7 (Tank to be removed or tank to be drained and filled) ❑Meter to be rtrnoved and field utility bill sold LI Meter to remain and be protected (King County Envirormental Services) (Water Supplier) ****** OR*****. 4.SANITARY SEWER (Check applicable box) 9. WATER- 'Private Well (Check applicable box) o Sewer line capped at property no n Private well fl kid and capped u Existing sewer line to remain and be used by proposed hew structure er Private well to be used for other purposes Sewer District --'- (King County Environmental Service) 5.GARBAGE (All ho hc4I g rbage disposed off and final bill paid) (RSIf`Dip sal/Federal Way Disposal) ❑ Completed Construction Pa-mit Application form CD 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 owl erin ok122-[nisch 9,2005 Parc 1 of 1 k\Nvndourvalcmolitlon Permit Regnirrar,cnu 01/02/07 TUE 11: 50 [TX/RX NO 75701 : 0 '21/2007 ncy WED ase 14;31 FAX 25388 FS & GS ServicesII 001/002 AgeCNo. Date Received PUGET SOUND CLEAN AIR AGENCY j cl,,,A iti`dlgcrcy 110 Union Street,Suite 500 p;c:oor:air.or9 Seattle,WA 9c101-2038 Agency Use Only Agency Use Only NOTICE OF INTENT Type or print clearly A.Pro ect i e: 1. U Friable Asbestos Removal 2. 54 Friable Asbestos Removal&Demolition 3. ❑ Demolition ON B. Property Owner: South Fork Homes LLC Phone: 253-631-7996 Mailing Address: 21842 148th Ave.SE .4.• City: Kent State WA Zip: 98042 C. Asbestos Contractor: F.S.&GS.Services,Inc. Owner/CEO: Gordon L.Williams Contractor Mailing Address: 16214-57"'Ave.E. Suite A. Phone: 253-548-1011 Job No.: City: Puyallup _ State: WA Zip: 98375 Fax:253-536-8488 07063 31404 D. Site Address: ,3-14-2f1 28th Ave.So, City: Federal Way Zip: 98003 Contact Person: Local Phone: E. la Asbestos Survey or No.of Structures:2 Date of Asbestos Survey: Was Friable Asbestos Identified? Yes ONo ❑ Mat'I Presumed , 2-2-07 Was Nonfriable Asbestos Identified? j Yes ❑No. AHERA Building Inspector:Charlie Jobe Certification#: I022509 Exp.Date:6-14-07 AIIIIIIIIIMINI An AI IBk4 Survey is required before all demolition projects F. Demolition Start Date: 3-2-07 No.of Structures: 2 1. U Training Fire(List Fire Dept.) Information: 2. U Ordered Demolition(attach copy of Order Demolition Insert demolition contractor's mailing address on back. Will nonfriable asbestos be left in place during demo? Cl Yes ❑No Contractor: Don Olsen Constnaetion If yes,list type and qty. Note disposal requirements in Step 6(on back). -G. Friable Asbestos Work Days: IW Th F Sa Su Project Information: Start Date: 2-27-07 Completion Date:2-28-07 Hours: 8 am-4 pm Will all friable asbestos Yes Total Qty.to be Removed: Linear Ft. 1900 Square Ft. materials be removed? ❑ No II. Asbestos/Demolition Project Categories: Notification Period Project Demolition L Single-Family Residence(owner-occupied): Fee Surcharge A. ❑ Asbestos Removal Project Only A.Prior Notice A. $25 B. U Demolition Project(with or without asbestos removal project) 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 as their domicile, the above boxes JA or 113 may be checked. If this is not an owner-occupied residence,one of the categories listed below must be used instead. A single famil 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 $50 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 $50 $50 4-73 260-999 linear feet and/or 160-4 999 s'ware feet of asbestos 10 Da . 5 11 t 5. • >1,000 linear feet and/or>5,000 s uare feet of asbestos 10 Days ' ,10 $50 6. Emergency Asbestos Project or Emergency Demolition Project Prior Notice $50 Emergency Fee (Single-Family Residences arc exempt from emergency fee;however,property owners must provide a written emergency request) I. I certify that the information contained in is notification&supplemental data is,to the best of my knowledge,accurate&complete. Agency Use Only Aud&.ok Old Services Inc. 211 6/Q 7 Signature Representing Date vrmminmw 66-160 ~-1. !:L f ,•r ISS F.0.-Ie.-91), 1:45am 02/21/2007 WED 14:32 FAX 25 488 FS & GS Services1111) 002/002 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'linear feet or 48 square feet and for all demolition projects (regardless of asbestos content) involving structures with a projected roof arca.Beater than 120 square feet (Regulation III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. As•- •, r ,Bova' and demolition •ro'ects involvin .n g jiajs and structures below the notification threshold are still subject to all other requirements or'Rcg elation III,Article 4. J. Dcmohtion Contractor: Don Olsen Construction Owner/CEO: Don Olsen Mailing Address: 21842 148th Ave.SE Phone: 253-631-7996 Contractor's Job#: City: Kent State: WA Zip: 98042 Fax: GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION 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 suiyev to the notificasipn Qf a de:11?olition project when only nonfriable asbestos ox jasbestos 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. 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 IIIA for renovation projects or BOX FHB for demolition project(with or without asbestos removal). Asbestos removal may be conducted after a complete notification is received, but demolition activities can only begin on the 10th day after the notification is received. Note:If the single family residence it owned by one family who has been or will be using the residence as their domicile, boxes IA or IB may be checked: A single family residence does not include rental property,multifamily 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. Al - - .-, -•nests must be accom anie. • .•s- i . .e .ro.- owner demonstrating the need to conduct the project immediately in accpx anee with the requirements in Regulati IJSeCeetion 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 fhx 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 Intent(Revised 11/06)ISS • 03/02/2007 FRI 13:21 FAX 25‘488 FS & GS Services ?001/001 , t—r"—IT=7 411) . Services inc. 3-2-07 Puget Sound Clean Air Agency 110 Union Street, Suite 500 Seattle, WA 98101 To Whom It May Concern: RE: Asbestos Removal,31408 28th Ave. So.,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 3-1-07. 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 South Fork Homes LLC as soon as possible. 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