16-101974City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (263) 835-2607 Fax: (253) 835-2609
Project Name: LUNA
Project Address: 32009 21ST AVE SW
Project Description: Demolition of fire -damaged office structure.
4 $
Demolition
Permit #: 16 -101974 -00 -DE
Inspection Request Line: (253) 835-3050
Parcel Number: 132103 9036
Owner
Ag lin cant
Contractor
JAVIER LUNA
JAVIER LUNA
OWNER IS CONTRACTOR
31108 50TH PL SW
31108 50TH PL SW
FEDERAL WAY WA 98023-2009
FEDERAL WAY WA 98023-2009
Additional Permit Information
Demolition Valuation.............................................1200
PERMIT EXPIRES Wednesday, April 25, 2018
Permit Issued on Monday, April 25, 2016
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
a"e_qty of Federal Way.
Owner or agent: Date: _
THIS CARD IS TO REMAIN ON-SITE r
Cl" Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 16 -101974 -00 -DE Address: 32009 21 STAVE SW
Project: JAVIER LUNA FEDERAL WAY, WA 98023-2501
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.
E]
SWM Precon Site Mtg (4400)
Initial Erosion Control (4365)
Final - Building (4050)
Interim Erosion Control (4370)
Approved
Approved
By
To be done prior to breaking ground
By
Approved
By
Date
By
Date
By
Date
E]
Final Erosion Control (4375)
Final - Building (4050)
Approved
Right of Way
Approved
By
Approved
By
Date
Date
By
Date
Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
ReCENED
A•2 5 PERMI APPLICA
CITY OF ����
Federal Way CITY OFFMERALWAY
CDS (�
PERMIT NUMBER _ 0_ 7
v / ���eee C� TARGET DATE
TION
SITE ADDRESS
SUITE/UNIT #
VALUATION
ZONING
ASSESSOR'S TAR/PARCEL
/PROJECT
TYPE OF PERMIT
El BUILDING ❑PLUMBING ❑ MECHANICAL EMOLITION E]ENGINEERING ElFIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY 11HONE
/
PROPERTY OWNER
MAILING ADDRESS
-MAIL
JA 3 -3 /
CITY
�AjTE
!li// '0
ZIP
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE N
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
EMAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. 1 certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
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 totia—cift as apart of th' plication.
SIGNATU DATE
PRINT NAME:,
L
Bulletin #100 — February 22, 2016 Page I of 2 k:\Handouts\Permit Application
• 0
41k
CITY OF
Federal Way
COMMUNITY DEVELOPMENT DEPARTMENT
33325 8`h Avenue South
Federal Way, WA 98003-6325
253-835-2607; Fax 253-835-2609
www.ciiyoffederalwa +� com
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure on a subject property. Demolition of separate
structures may require separate permits.
❑ Address of Demolition: 3aoc3 z -� / 5 f d/% L11-7 G(
❑ Prior to submitting a demolition permit, the following items must be signed by the respective agency
or their approvals attached. Items not applicable to your project should be marked N/A.
❑ A completed Construction PerinitAppiication form is also required.
i. ASB STOS ABATEMENT
(Provi opy of Notice oflntentfrom Puget Sound Clean Air Agency 5. ELECTRICITY
an of inspection repo RA- rtified inspector)
of FleddrhMiy Suffiding ) 1
j� (Puget Sound Energy)
2. FUEL STORAGE TANKS
❑ Under grade tank(s) is/are present
❑ Above grade tank(s) are present
❑ Tank(s) has been pumped or removed under South King Fire &
Rescue permit prior to any dism ntling or excavation
(South Ki g Fire and Rescue)
6. GAS SUPPLY
f,�
(Puget Sound Energy)
7. WATER - Public Source
14flA fJOvFJ
(Water Supplier) �I�
3. SEPTIC SYST M �'
+ c. c.L Lc � 4rli
S. WATER - Private II
(King County Environmental Services) n
�7 G�l� v'Ltl� W L4% v'Y i7U'vL/Lli'C `C-I•� G(
(King Coufity Environmental Services)
4. SANITARY SEWER
(Lakehaven Utility District
IJO"1' CO�J�JCC-icl�'
Bulletin # 122 — May 13, 2015
a
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Page 1 of 1
k:\Handouts\Demolition Permit Requirements
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Contractor Registration #AAADNDN883KB
Asbestos Contractor #1541
RRP #1016
ASBESTOS SURVEY REPORT
Project Location: 32009 2111 Ave. SW
Federal Way, WA. 98023
Inspection Date: April 21, 2016
Report Date: April 22, 2016
Prepared For: Javier Luna
Email: javluna3311@gmail.com
Phone: 206-941-9021
Inspected By: Michael Neureiter
AHERA Certified Building Inspector
Certification # 3509-15-09-5009
Expiration Date: 9/28/2016
0
Prepared By: AAA & D NW Environmental Services, Inc.
3632 49th Ave. SW
Seattle, WA 98116
Phone: 253-217-2537
Fax: 360-275-2939
Email: aaadnwinc@yahoo.com
ASBESTOS SURVEY REPORT
AAA & D NW Environmental Services, Inc. Page l of 7 Project #016-168
32009 21" Ave. SW ASBESTOS SURVEY REPORT
Federal Way, WA. 98023
REGULATIONS: In the event of anAsbestos Removal or Demolition Project, Regulation III
Article 4 of the PSCAA Asbestos Control Standards should be consulted. This Regulation is
available at the following WEB Address: http://www.pscleanair.org/reg3/reg3.pdE
This survey provides the information required in order to meet the AHERA sampling protocol as stated
in 40 CFR 763.86 National Emission Standard for Hazardous Air Pollutants (NESHAP). This sampling
protocol is required for all Asbestos Surveys prior to Demolition or Renovation of a building under
Puget Sound Clean Air Agency Regulation III Article 4. This survey also assists the building owner
in meeting the "Good Faith" Asbestos Inspection requirements stated in WAC 296.62.07721, requiring
the owner of a building to be demolished or renovated to furnish contractors with a written statement
whether the material to be disturbed contains Asbestos. Current Asbestos Regulations require this report
be kept on the site throughout Asbestos Abatement and/or Demolition or Renovation of building
structures on the property.
This Asbestos Survey Report complies with the AHERA sampling protocol stated in 40 CRF 763.86
Puget Sound Clean Air Agency, Regulation III, Article 4.
SURVEY PROTOCAL
Asbestos Survey Protocol
The AAA & D NW field inspector is an Asbestos Building Inspector, certified under the requirements
of the United States Environmental Protection Agency (EPA) Asbestos Hazard Emergency Response
Act (AHERA) regulation 40 CFR 763, Subpart E. A copy of this certificate is provided in the
Appendix.
The AHERA Guidelines state the following:
The inspector must determine homogenous areas, which are defined as an area of Thermal System
Insulation, Surfacing Material, or Miscellaneous Material that is uniform in texture and color.
Once homogenous areas have been determined, the inspector determines whether or not material is
friable or non friable. Friable is defined as a material, when dry, can be crushed, pulverized, or reduced
to dust using hand pressure. Non friable material is defined as material, when dry that cannot be
crushed, pulverized or reduced to dust using hand pressure. Materials normally defined as non friable
can become friable by definition if sufficiently damaged. Friability is determined at time of inspection.
Demolition, renovation or abatement may affect friability of material.
AAA & D NW Environmental Services, Inc. Page 2 of 7 Project #016-168
•
32009 21st Ave. SW
Federal Way, WA. 98023
•
ASBESTOS SURVEY REPORT
Once friability has been determined, the materials suspected of containing asbestos are divided into one
of three categories: Thermal System Insulation (TSI), Surfacing Material (SM), or Miscellaneous
Material (MM). TSI and SM are considered to be friable, with the exception of TSI where the
structural integrity of the insulation is intact and the protective wrap is undamaged.
Materials are divided into one of these categories and samples are collected in the following manner:
Friable Thermal System Insulation:
Inspector shall collect three (3) randomly distributed samples;
2. Inspector shall collect a minimum of one sample of each TSI material that appears to have
been used as a patch, as long as the patch is less than six linear feet or six square feet;
3. Inspector shall collect sufficient samples from areas of TSI applied to
fittings, tees, and joints.
Friable surfacing material:
1. Inspector shall collect surfacing material samples in a statistically random manner as follows:
a. Collect three bulk samples from an area believed to be homogeneous (defined as a
material that appears to be the same or similar and was installed at the same time) that
is 1,000 square feet or less in size;
b. Collect five bulk samples from an area believed to be homogeneous that is greater than
1,000 square feet in size, but less than 5,000 square feet in size;
c. Collect seven bulk samples from an area believed to be homogeneous that is greater
than 5,000 square feet.
Miscellaneous Materials:
Inspector shall collect sufficient samples to determine if the material is asbestos -containing
or not.
Non -Friable Materials:
1. Inspector shall collect sufficient samples to determine if the material is asbestos containing
or not.
AAA & D NW Environmental Services, Inc. Page 3 of 7 Project #016-168
32009 21St Ave. SW
Federal Way, WA. 98023
•
ASBESTOS SURVEY REPORT
On April 21, 2016 an AA A & D NW Inc. AHERA Certified Building Inspector conducted a Good
Faith Asbestos Survey per U.S EPA A.H.E.R.A guidelines as designated and specified by Puget Sound
Clean Air Agency and Washington State of a single family home located at 32009 21 sc Ave. SW.
Federal Way, Washington 98023 for the purpose of identifying any Asbestos containing materials that
may be present and may be impacted prior to Demolition or Renovation.
NARRATIVE: The subject property is a one story, 1,300 sq. ft. wood framed single family home with
a pitched composition roof, wood siding and a cement foundation with crawl space. The structure was
damaged by fire and had been completely gutted prior to my Inspection. There were no interior walls, no
interior ceiling, a wooden floor, no wiring, no heating system, no insulation, no cabinets, no fixtures,
some PVC plumbing, no windows. It had been condemned by the City of Federal Way who, according
to the owner, will demo Project and back charge owner for Demolition. New owner states he recently
purchased property as is.
SUMMARY.
The summary of sample test results indicates no presence of Asbestos > 1% which is subject to
regulation. The owner is advised to have a Certified AHERA Building Inspector present during the
entire demolition in order to identify any possible suspect materials for determination of ACM or
PACM.
Any and all materials identified as ACM or PACM in this report (and/or additional materials associated with the
structure that may be discovered and later identified as ACM or PACM), must be professionally abated prior to
demolition or renovation. ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES
AND/OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION, AS LISTED
QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY
AAA & D NW Environmental Services, Inc. Page 4 of 7 Project #016-168
•
32009 21St Ave. SW
Federal Way, WA. 98023
C�
ASBESTOS SURVEY REPORT
Some sample analysis listed may be representative analysis of individual and separate samplings and
analysis of homogenous materials, as prescribed by A.H.E.R.A. protocol.
If, during demolition or renovation, any hidden or covered suspect materials are located {may include
but not limited to: sheet vinyl flooring, tile flooring, wall or ceiling texturing or paints, concrete siding
or skirting, cement pipes, cement wallboard, electrical cloth, electrical wiring insulation, thermal paper,
wallboard, joint compounds, vinyl wall coverings, spackling compounds, or any TSI (Thermal
System Insulation) }, they should be treated as Asbestos Containing Materials unless determined to
be non -asbestos by laboratory analysis.
Any and all materials identified as ACM in this report must be abated prior to ACM disturbance,
renovation, or demolition. All materials identified as ACM must be professionally abated by a Licensed
Abatement Contractor prior to any disturbance.
Wallboard Systems (sheetrock) containing <1% Asbestos must meet the removal requirements found
In Washington Labor & Industries Regional Directive 23.30 which may require the presence of a
Certified Asbestos Supervisor during removal.
Analytical test method: USEPA 600/R93/116** (PLM): Wac 296-62-07753 App.37
Key: ACM signifies "Asbestos Containing Material"
PACM signifies "Presumed Asbestos Containing Material"
CAB signifies "Concrete Asbestos Board"
< signifies "Less than"
> signifies "Greater than"
TSI signifies "Thermal System Insulation'
ND signifies "None Detected"
**One percent is the U. S. EPA regulatory limit for asbestos in bulk samples. PLM has been known to
miss asbestos in small percentages of some samples which contain asbestos, thus negative PLM results
cannot be guaranteed. Floor tiles and wipes should be tested with SEM or TEM, to insure analytical
accuracy when reported in small percentages.
The conclusions in this report resulted from a visual walk through determining the collection of samples
of suspect materials. AAA & D NW, Inc. cannot be held liable for materials requiring destructive
measures to access or materials which were hidden and could not be found with reasonable diligence.
AAA & D NW Environmental Services, Inc. Page 6 of 7 Project #016-168
32009 21st Ave. SW
Federal Way, WA. 98023
•
ASBESTOS SURVEY REPORT
Within the limitation of scope, schedule, and budget, our services have been executed in accordance
with generally accepted practices in this area at the time this letter was prepared. No other hazardous
material/waste was investigated. No other conditions, expressed or implied, should be understood.
AAA & D NW Environmental Services Inc. claims responsibility for sample content only.
Sincerely,
i AHERA Certified Building Inspector
#3509-15-09-5009
AAA & D NW Environmental Services, Inc.
AAA & D NW Environmental Services, Inc. Page 7 of 7 Project #016-168
)9ertirleatf or tompfetion
PRESENTED BY:
COLE AND ASSOCIATES, TRAINING AND CONSULTING, INC.
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THIS IS TO CERTIFY THAT
MICHAEL B. NEUREITER
3632 49TH AVE. SW. SEATTLE, WA 98116
HAS SUCCESSFULLY COMPLETED THE STATE OF FLORIDA APPROVED
AHERA BUILDING INSPECTOR REFRESHER
TRAINING COURSE
AS REQUIRED BY 40 CFR 763, SUBPART E, APPENDIX C
PROVIDER NUMBER 0003574
ATTENDED BETWEEN MONDAY, SEPTEMBER 28, 2015 AND MONDAY, SEPTEMBEI
EXAMINIATION DATE: MONDAY, SEPTEMBER 28, 2015
Cole and Associates, Training and Consulting Inc, 8657 S. 190th St.
Kent, WA 98031 (425) 793-5505 Fax (425) 793-5552
1 -8n -455 -BEAR and 14388414-M
www.ctcbearcom
444
Training Administrator
Training irector
3509-15-09-5009
9/28/2016
Certification Number
Expiration Date
Cole and Associates, Training and Consulting Inc, 8657 S. 190th St.
Kent, WA 98031 (425) 793-5505 Fax (425) 793-5552
1 -8n -455 -BEAR and 14388414-M
www.ctcbearcom
-eruiw �.i Pwuveo 1 ransac➢on
psdeanair.org
Puget Sound +!: A:r Agency
`Single -Family Notification Case *: 201601941
This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available
for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)).
Fee Amount Paid $65.00
Credit Card Transaction # ASOFE314BDEE
Transaction Date
04/22/16
Owner's Name
Javier Luna
Phone (206) 941-9021
Project Street Address
32009 21st Ave. SW
City
Federal Way
Zip 98023
Contact Person
Javier Luna
Phone (206) 941-9021
Mailing Address
This project includes a demolition.
Demolition Start Date 04/25/16 Completion Date 05/03/16
Demolition will be completed by a demolition contractor
This is an emergency project. The emergency reason:
The project must proceed to avoid imposing an unreasonable burden.
I certify that:
(1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile.
(2) The information I have provided is to the best of my knowledge accurate and complete.
(3) I understand the fee for this Notification is nonrefundable.
Create Another Notification
If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058.
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