12-105709` '
Applicant
Contractor
IV Demolition
City of Federal Way
Community &Econ. Dev. Services
33325 8th Ave S
T M POHLMAN CONSTRUCTION INC
,
Permit #:
12 105709 00 DE
Federal Way, WA 98003
(253) 835-2607 Fax: (253) 835-2609
s l._ y
Inspection Request
Line: (253
) 836050Ph:
Project Name: CASEY, C.
Project Address: 3113 SW 300TH PL Parcel Number: 416710 0155
Project Description: Demolition of existing single family residence.
Owner
Applicant
Contractor
CECELIA T CASEY
T M POHLMAN CONSTRUCTION INC
T M POHLMAN CONSTRUCTION INC
321 FAIRFIELD AVE S 150
PO BOX 183
TMPOHC1097BT (6/21/14)
DEVON PA 19333
CARBANADO WA 98323
PO BOX 183
CARBANADO WA 98323
Additional Permit lnformation
Demolition Valuation............................................A200
PERMIT EXPIRES Saturday, December 27, 2014
Permit Issued on Thursday, December 27, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the u e will be in acc nce with the laws, rules and regulations of the State of Washington
City of Federal Way.
Owner or agent: Date:
/ 0;/ 1
F�k,�uca 11, 3/►s
THIS CARD IS TO MAIN ON-SITE
CITY �,°F Construction In ection Record
Federal Way INSPECTION REQ TS: (253) 835-3050
PERMIT #: 12 -105709 -00 -DE Address: 3113 SW 300TH PL
Project: CECELIA T CASEY FEDERAL WAY, WA 98023-2328
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 - Buildii
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
` an or
Federal Way
COMMUNITY DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
a.�u. rtuojjederoluae�. coni
'OPERMIT
APPLICATION
- /mss 7O'�7
S MF CO ME PL DE EN FP
SITE ADDRESS /
,2/,13 _-5, X30(3 (GJ
SUITE/UNIT M
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/ARCF�L -7/ D -
I/ - W„ -
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
OLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
,
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
'
MAILING ADDRESS
E-MAIL
ti % Chi
CI
TE
ZIP
NAME `� -�
PHO&E0"
�.
MAILING
L
CONTRACTOR
ax Za
CITY
STATE
ZIP
F
WA STATE CONTRACTOR'S LICENSE M
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME ��=
PHONE
(The individual to receive and
respond to all correspondence
MAILING ADDRESS
concerning this application)
CITY
STATE ZIP
FAX
ALTERNATE CONTACT NAME: PHONE
EMAIL
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5,000 or more
(]?CW 19.27.095)
MAILING =TY, STATE, ZIP
PHO -
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. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. 1 understand that the
issuance o- 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 def of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such cli arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to a city as apart of application.
SIGNATURE: DATE
PRINT NAME:
Bulletin # 100 -January 1, 2011 Page 3 of 3 k:\Handouts\Permit Application
�2
CRITICAL AREAS ON PROPERTY?WATE PIIRVEYOR S PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTINGIPREVIOUS USE LOT SIZE (In S aze Feet) ERISTING FIRE SPRnWLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
o Yes ❑ No a Yes o No
PROPOSED I TOTAL
e3asmo I FROFOSM
# OF BEDROOMS
FOR OFFICE USE
Area Construction # of
AREA DESC N �� Occupancy Group(s) Additional Information
VALUE OFMECRAMCAL WORK $
(a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
_ AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (commercial)
BOILERS
FURNACES HOT WATER TANKS �c
COMPRESSORS
GAS LOG SETS REFRIGERATION S T
hWCTING
GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this pr ject. Do not include existing fixtures to remain.
BATHTUBS (-Tnb/Sho—C—bo)
LAVS (11—dS;.,,-q TOILqfS WATER PIPING
DISHWASHERS,
RAINWATER SYSTEMSU ALS OTHER (Describe)
DRAINS
SHOWERS CUUM BREAKERS
DRINKING FOUNTAINS
SINKS pciah—/uwiry) WATER HEATERS (Freec,:�)
HOSE BIBBS - __-
SUMPS WASHING MACHINES 'ls.
CRITICAL AREAS ON PROPERTY?WATE PIIRVEYOR S PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTINGIPREVIOUS USE LOT SIZE (In S aze Feet) ERISTING FIRE SPRnWLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
o Yes ❑ No a Yes o No
PROPOSED I TOTAL
e3asmo I FROFOSM
# OF BEDROOMS
FOR OFFICE USE
Area Construction # of
AREA DESC N �� Occupancy Group(s) Additional Information
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
Federal Way, WA 98003-6325
CITY OF 253-835-2607; Fax 253-835-2609
Feter ay www.cityoffeticralway.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.
❑ 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. A11 applicable
items below are to be signed and dated by the respective agency representatives.
2. GAS SUPPLY
6. ELECTRICITY
(Electriaty t be shut off and neter removed)
i
(PuQetpund Energy)
7. FUEL STORAGE TANKS
(Gas to b,"hut off,,Tter removed and final bill paid) (Above or below grade fuel tanks, haye Pepumped or removed
under Fire Department permit r ntle/excavation)
(Pu tSound Energy)
(South King Fre and Rescue)
3. SEPTIC SYSTEM
(Tank to be removed or t# to be drained and filled)
111;114
( KiO tounty Environmental Services)
4. SANITARY SEWER (Check applicable box)
❑ $ewer line capped at property line
,il: Cjsting sewer line to remain and be used by proposed new structure
(Lakehaven Utility District)
S. GARBAGE
(All household garbage dispo d nal bill paid)
(Waste ana ent/Other Company)
0 Completed Construction Permit Application form
8. WATER - Public Source (Check applicable box)
❑ Met a removed and final utility bill paid
rl-Meter to remain and be protected
(Water Supplier)
****** OR ******
9. WATER - Private Well (Check app7blebox)
❑ Private well filled and capped
❑ Private well to be used for other po
(King County Environmental Services)
❑ Provide the following fees: 1. Demolition Permit Fee Based on valuation. See table on pg 4 of the construction permit application.
2. Automation Fee $6.00
3. WA State Surcharge $4.50
Bulletin #122 —January 1, 2011 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
DEPARTMENT OF COUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
Federal Way, WA 98003-6325
253-835-2607; Fax 253-835-2609
w,,N-Nv. ci tvoffederaltivay.coin
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
www.pscleanair.org
2. Electricity: Puget Sound Energy
Tacoma Public Utilities
Attn: Construction Coordinator
Customer Service
22828 68`h Avenue South, Suite #102 —OR—
747 Market Street
Kent, WA 98032
Tacoma, WA 98402
888-225-5773
253-383-9600 or 253-383-2471
3. Gas: Puget Sound Energy
805 156`h 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: South King Fire & Rescue
333258 1h Avenue South
Federal Way, WA 98003
253-946-7248
Bulletin #109— January 1, 2011 Page 1 of 1 k:\Handouts\Demolition Permit Contact List
Approved Transaction
0
pscIeanair.org
Puget Sound Ci,,.in Air Agency
Single -Family Notification Case #: 201203710
https://secure.pscleanair.org/Asbestos/Approved.aspx
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 # VU3FA3170BC8
Transaction Date 12/24/12
Owner's Name Cecelia Casey Phone (610) 687-5069
Project Street Address 3113 SW 300 PL.
City Federal Way Zip 98023
Contact Person Tryge Pohknan Phone (253) 332-2104
Mailing Address P O Box 183
Carbonado, WA 98323
phis project nclades a demolition.
)emolition Start Date 01/07/13 Completion Date 02/07/13
)emolition will be completed by a demobion contractor
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.
REPORT Date: December 18, 2012
TM Pohlman Construction
PO Box 183
Carbonado, WA 98323
Attention: Tryge Pohlman
RE: Asbestos Report for Remediation
Dear Mr. Pohlman:
•
WBE W2F5912535
Executive Summary
On December 14, 2012 NOW Environmental Services performed a limited asbestos survey on
the interior of the building located at 3113 SW 300'h PI, Federal Way, Washington; NOW Project
#ON12-0521. The purpose of this specific investigation was to determine the presence or
absence of asbestos in the building that would be impacted during demolition activities. This
investigation was performed by an accredited AHERA Building Inspector, Allen M Clark of
NOW; Accreditation number: BIR -NES -0118-12-01.
Results of this investigation are as noted in the remarks below.
Asbestos
Ten homogeneous suspect asbestos -containing materials were identified and collected for
analysis from the building. From the homogeneous sample, (15) sixteen bulk samples were
homogenized, collected, processed and analyzed for asbestos content. Building materials that
contain asbestos fibers in the amounts greater than 1 percent (1%) are regulated by the
Department of Labor and Industries and by the Puget Sound Clean Air Agency.
Negative for Asbestos Table:
Material Identlilcation
Material Description
Vinyl Sheeting (VSI)
Vinyl Sheeting, Cream with Blue Flowers.
Tan Mastic 1 (Misc. 1)
Tan Mastic associated with Cream Vinyl Sheeting
Vinyl Tile (VTI)
Vinyl Tile, Gray
Wallboard (WS 1)
Wallboard
Texture (Misc. 3)
Texture associated with Wallboard
Insulation
Attic Insulation
Composite Roofing
3 Tab Composite Roofing, Porch
Rolled Roofing
Rolled Roofing most of House
Roofing Mastic
Associated with Rolled Roofing
Window Putty
Associated with Nine Windows
House Insulation
Under Plastic Siding
NOW Project N12-0521 Page 1 of 3
Pohlman, 3113 SW 300'' Pl, Federal Way, WA December 18, 2012
•
Based on the field inspection, the homogenization of materials, and the results of the laboratory
analysis, all of the suspect materials that were sampled and analyzed associated with house were
non -detect for containing asbestos. (See Attached ORION Report 126256)
Inaccessible Locations
NOW Environmental Services cannot make statements as to the potential presence or absence of asbestos
containing materials in inaccessible areas or areas not considered.
Disclaimer
NOW Environmental Services has conducted a survey for asbestos containing materials of the
residential structure located at 3113 SW 3001h PI, Federal Way, Washington in conformance
with the requirements established by the United States Environmental Protection Agency and
the Occupational Safety and Health Administration prior to the engagement of renovation or
demolition of the building. The sampling strategy and analytical method employed conform to
existing and enforceable standards and methods.
This Executive Summary of the investigation performed at the subject site is intended to
describe asbestos containing materials with the potential of being impacted. 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 guarantee is included or intended.
The opinions presented herein apply to the site conditions existing at the time of our
investigation, and interpretation of current regulations pertaining to asbestos containing
material. Therefore, our opinions and recommendations may not apply to future conditions that
may exist at the site we have not had the opportunity to evaluate. Future regulations pertaining
to these materials may impose stricter restrictions on renovation or demolition work. The
regulations should always be verified prior to any work involving these materials. The inspector
is not held responsible or liable for any repairs or replacements with regards to this property,
systems, components, or the contents therein. The acceptance of this report by the client
acknowledges the client's agreement to all of the terms and conditions of the inspection
contract.
NOW retains active copies of reports for a period of not less than one year. Retained copies of
reports, field data, field notes, laboratory test data, calculations, estimates, and other documents
prepared by NOW as instruments of service, shall remain the property of NOW.
NOW Project N12-0521 Paee 2 of 3
Pohlman, 3113 SW 304th PI, Federal Way, WA December 18, 2012
•
Other than the Client, other agencies of the U.S. Federal Government, and the Owner, reports
submitted with respect to services performed under this contract may not be extended to third
parties without prior written consent.
Questions concerning this Executive Summary may be addressed to the undersigned.
Professionally Yours,
NOW Environmental Services
Allen M. Clark
AHERA Building Inspector
2 Encl.
Attachment 1— Laboratory Report Asbestos
Attachment 2 — Inspector's Accreditation
NOW Project N12-0521 Page 3 of 3
Pohlman, 3113 SW 300`h Pl, Federal Way, WA December 18, 2012
ORION Environmental Services
34004 Ninth Avenue South, Suite Al2, Federal Way, WA 98003
Phone: (253) 952-6717 e Fax: (253) 927-4714
Email: info@oriones.net a Web: www.oriones.net
WBE W21`9219763
Polarized Light Microscopy Test Report
EPA Method 600/11-98/116
Client: TM Pohlman Construction Inc.
Address: PO Box 183, Carbonado, WA 98323
Attention: Tryge Pohlman
Project Name: 3113 SW 300th PL
Project Number: N12-0521
Rpt. Date: 12/18/2012
Page: 1 of 2
Invoice: 126246
Date Rcvd: 12/14/2012
I %
Asbestos
Client I Orion Material r Sample Asbestos Other
Containing
Sample ID Sample ID Description Treatment ' Material Type i Fibers
la 20121214-33 Vinyl Sheeting w/Felt Backing ND cellulose
lb
l
Mastic
I
chloroform
ND
cellulose
2a
120121214-34
Fiber Layer
ND 1
cellulose
2b -
i Wallboard
!
ND
I cellulose
3
20121214-35 Wallboard
ND
cellulose
14a
I
20121214-36 Fiber Layer
�
I
ND
cellulose
4b
} Wallboard
ND
cellulose
5
20121214-37 Vin Tile
chloroform
ND
f
6
20121214-38 Insulation
ND
I fiberglass
7a
20121214-39 . Composition Roof
ND i
I cellulose
j 7b
Composition Roof
ash
ND
cellulose
8a
l
20121214-40 I Rolled Roof
I ash
�
I ND I
I
cellulose
8b
Mastic
ND
cellulose
+ 9
20121214-41 Window Putty
I
i ND I
i
cellulose
�
i._10.
20121214-42 Insulation
i
ND
0
i 0
Polarized Light Microscopy Test Report (cont.)
Client: TM Pohlman Construction Inc.
Address: PO Box 183, Carbonado, WA 98323
Attention: Tryge Pohlman
Project Name: 3113 SW 300th PL
Project Number: N12-0521
Rpt. Date: 12/18/2012
Page: 2 of 2
invoice: 126246
Date Rcvd: 12/14/2012
i
% i
Client Orion i Material i Sample I Contini�ng Asbestos Other
Sample ID Sample ID Description Treatment i Material Type Fibers
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 fibers by
EPA Method 600/R-98/116.Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain
asbestos. Thus, these laboratory results represent due diligence, however negative or <1 % PLM results can not be guaranteed.
Per EPA guidelines samples will be archived for 30 days then will be disposed of. This report may only be reproduced in full with
written approval of ORION Environmental Services.
Analyzed By (Print) Date
Reviewed By (Print) Date
Dennis Rauschenberg 12/18/2012
Donna McNeal 12/18/2012
Analyzed By (Signature) Time
d By (Signature) Time
/J
Cet �t
k /�Ki_
19