18-104171 , - .
Demolition
City of Federal Way Permit #:18-104171-00-DE
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: CAMELOT SQUARE MFH SPACE 361
Project Address: 3001 S 288TH ST Parcel Number:042104 9155
Project Description: Demolition of existing manufactured home damaged by fire.
Owner Applicant Contractor
CAMELOT SQUARE INC JOSE MONTE OPICO OWNER IS CONTRACTOR
3001 S 288TH ST 3001 S 288TH ST UNIT 361
FEDERAL WAY WA 98003-8019 FEDERAL WAY WA 98003
, , ci .
Additional Permit Informati
Vdoer.
PERMIT EXPIRES Wednesda i Mail2019
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Permit Issued on Fridays• ember8
..
I hereby certify that the above information is • - • at the c ction on the above described property
and the occupancy and the use will be in a • - with the I , rules and regulations of the State of
I Washin r e Ci of I Way.
•iti
Owner or agent: �• Date: 0 9- 0v - /�
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THIS CARD IS TO REMAIN ON-SITE
Federal Way Construction Inspection Record
CITV Of 111/1
r•
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 18 104171 00 Address: 3001 S 288TH ST Space 361
Project: CAMELOT SQUARE INC FEDERAL WAY WA 98003-8019
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 SWM Precon Site Mtg(4400) Q Initial Erosion Control(4365) j 0 Interim Erosion Control(4370)
Approved To be done PRIOR to breaking ground Approved
By Date By Date L By Date
® Final Erosion Control(4375) 3❑ Final-Building(4050)
Approved Approved
By Date By Date
❑ Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
....„4...... RECEIVED PERMIT APPLICATION
CITY OF
SEP 7 + t' h Fl Way, 8003-6325
Federal Way0 r 2018 PERMIT 253 88C35-2607ENTER + FAX33325 253-835-2609S8AvenueSout+per+mitcenterlederacityoflederWA9alway.com
CrrY OF FEDERAL WAY
COM^'MUN D
PERMIT NUMBER I 8 _. 1 C� - 5 ` TARGET DATE
SITE ADDRESS SUITE/UNIT#
�I d P, 4F4- 1 ce ecczc 1Jl CSA ?b I
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$� COO M3 0 Lt 2 I 0 if _ 9 1 S 5
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL XDEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT CO�,y y 00`QL m ‘AP
PROJECT DESCRIPTIONl tmob,
o
Detailed description of work to ��ecn ak z n-6 c) u oo C�e o ci o b, (t1.
be included on this permit only
NAME __ _ % PRIMARY PHONE
6 WI M fi53 (pt 52, 1291
PROPERTY OWNER MAILING ADDRESS E-MAIL
300 l< S. _.‘,15r /14 S : c-j al60 (50e1 • s-•2$rt / 361
F,TY r Q Tv)) W . y Bu iA ZIP i ions .�.�-.L ��y OVA_
N EO W Y l r PHONE'7C5'3
MAILING ADDRESS � / E-MAH
CONTRACTOR 3 6, 5 • 2— 'j Si # 6/ '
CITY STATE . ZIP FAX
A STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME _ - PRIMARY PHONE-_
._
UwVIe r
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME me a s a�a�ei PRIMARY C q y 7
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
PROJECT FINANCING NAME /` 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,C AT ,ZIp/-� PHONE
(RCW 19.27.095) NYY
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. 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 cl•im arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to c'4 as a part of this application.
(------)
SIGNATURE: Adi DATE 69- ii) 5(
...- r
PRINT NAME: III a ,)
— -
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
9/7/2018 Approved Transaction
pscleanalr.org
Puget Sound Clean Air Agency
Single-Family Notification Case #: 201804173
This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspect
project or demolition site (Reg III, 4.03(a)(6)).
Fee Amount Paid $65.00
Credit Card Transaction # AQOFF9D199F9
Transaction Date 09/07/18
Owner's Name Jose Opico Montes Phone (253) 929-4247
Project Street Address 3001 S 288th Street#361
City Federal Way Zip 98003
Contact Person Jose Montes Phone (253) 929-4247
Mailing Address
This project includes a demolition.
Demolition Start Date 09/17/18 Completion Date 09/17/18
Demolition will be completed by the home owner
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.
COMMUNITY DEVELOPMENT DEPARTMENT
33325 Bch Avenue South
Federal Way,WA 98003
CITY OF �� 253-835-2607;Fax 253-835-2609
federal Way www.cityoffederalway.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.
C�Address of Demolition: 2i / - S ` -7' fq.- ttl E^( , 1436 I TX147- a,1 WA rrO(5,3
'❑ 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.
CI i completed Construction Permit Application form is also required.
1.ASBESTOS ABATEMENT
(Provide copy of Notice of Intent from Puget Sound Clean Air Agency 5. ELECTRICITY
and co of i spection report by AHERA-certified inspector)
CJ eb( Scouvie Jed 6PS_.
ity of Federa ay Building Official) (Puget Sound Energy/T c ma Power)
2. FUEL STORAGE TANKS 6. NATURAL GAS
❑ Under grade tank(s)is/are present Y v A
o Above grade tank(s)are present
❑Tank(s)has been pumped or removed under South King Fire& (Puget Sound Energy)
Rescue permit prior to any dismantling or excavation
outh King Fire and Rescue) 7.WATER- Public Source
NIA - MH PA-Wg... -S5gssisb 13 3 Li (2 l
eopronso.k-ct nIEz6-0-s
(Lakehaven Utility District)
3. SEPTIC SYSTEM DECOMISSIONING9kth 5?
Ail / 1
8.WATER- Private Well
(king County Environmental Services) /VIA A
Ning County Environmental Services)
4.SANITARY SEWER
Nfk- Nttk PLwn3 ti- c& brr.Prtrz Ta 13E cljt<er•WA)Er—Tal,
'R-gc.opsJ EC,16D (*nog- 'T3uu-D t06. I Pc.r. [3
p 1L.t ' 1`it) (Lakehaven Utility District) r4th
❑ Please Note: Erosion control measures must be in place during the demolition and through
completion of the site clean-up.
(Applicant)
Bulletin#122—March 16,2017 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
ASBESTOS NORTHWEST LLC SURVEY REPORT C d"' t
30620IORTHWESTF Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 941 4343 Fax:253 941 4175
Asbestos Northwest, LLC - Survey Report
30620 Pacific Hwy S, #103253.941, Federal Way, WA 98003
.4343
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Survey Location: 3001 S 288th St Space #36q Federal Wat WA
Prepared for: Jose Montes
Date: September 6th, 2018
Asbestos Northwest Batch Number: 201812379
Inspector: Sean Butler (#168124)
E-mail: seanb@asbestosnw.com
1
ASBESTOS NORTHWEST LLC SURVEY REPORT
,,„„ ASBESTOS
NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
Contents
1. Background Information and Scope of Work 3
2. Building Description 4
Structural System 4
Finishing Materials 4
Mechanical system 4
Electrical system 4
Insulation 4
Roofing 4
Outbuildings 4
3. Material Sampling Information 5
Definitions 5
Survey Methodology 5
4. Asbestos Containing Material 7
5. Conclusions 8
Appendix A—Certifications 9
Appendix B — Building Layout 11
Shed Area North Side 12
Looking to Front 12
Appendix C— Laboratory Report 13
2
ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS edam
'T
NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
1 . Background Information and Scope of Work
On September 6th, 2018 Asbestos Northwest, LLC conducted a survey of the mobile home
located at space #36, in the mobile home park at 3001 S 288th St in Federal Way WA.
AHERA-certified building inspectors Sean Butler (#168124) and Dan Lafley (#163509)
conducted the survey to determine the presence of Asbestos Containing Materials
(ACM's) prior to the demolition of the building to make way for redevelopment.
The single wide mobile home appeared to have dated to the 1960's or 1970's and had
been extensively fire damaged. The fire marshal had posted signage indicating that the
building is unsafe to enter, samples were only taken from the perimeter of the structure.
The majority of the building had been entirely consumed by fire, with only the rear portion
remaining somewhat intact.
There was evidence that the mobile home had undergone some remodel work, such as a
press board shed on the side along with a covered parking area, but for the purposes of
the survey the home was considered one homogenous area. Due to extensive fire
damage few suspect materials were accessible to the inspectors. Photos of the site can
be found later in the report.
Potential asbestos-containing materials were located and sampled from the perimeter of
the building site. See Appendix B for a detailed floor plan with sample locations.
Materials were located and sampled following AHERA protocol in 40 CFR 763.86, then
analyzed in-house at Asbestos Northwest per 40 CFR 763.86. See section 3 for detailed
sampling information.
3
ASBESTOS NORTHWEST LLC SURVEY REPORT ter!' .. ,
NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
2. Building Description
The building was a single wide mobile home dating to the 1960's or 1970's. It had been
extensively fire damaged and its original configuration and condition were difficult to
determine. In compliance with signage posted by the fire marshal the building was not
accessed directly, and samples were taken from the perimeter.
Structural System
The building was of wood-framed construction and was on a metal chassis. The overall
structure of the building appeared to be unaltered although a simple shed and carport roof
had been added to one side of the building.
Finishing Materials
The surviving interior walls of the building appeared to be drywall. No joint compound was
visible, seams between panels had trim strips in place instead. Fibrous painted paneling
material was also found, likely from the ceilings.
Mechanical system
A forced air furnace was located somewhere in the home, with galvanized under floor
ducting. No suspect wrap or tape materials were visible during the inspection process.
Some fiberglass insulation was noted.
Electrical system
The electrical system was disabled at the time of the inspection. The electrical panel was
inaccessible, and visible wiring remnants had rubber insulation.
Insulation
Visible insulation in the walls and ceilings of the building was all fiberglass. No vermiculite
or other suspect insulation products were seen.
Roofing
The residence had a peaked roof with asphaltic shingle over tar paper. The covered
parking area had a roof of rolled asphaltic shingles.
Outbuildings
There were no outbuildings on site, although there was a covered parking area on the side
of the home and a wooden shed to the rear.
4
ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS i
NORTHWEST
• 30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
3. Material Sampling Information
Asbestos survey work performed by Asbestos Northwest meets inspection regulatory
requirements enforced by federal, state, and local agencies, including Asbestos Hazard
Emergency Response Act (AHERA), WAC 296-62-077 (WISHA) and 40 CFR Part 61
(NESHAP) and 29 CFR Part 1926.1101 (OSHA)
Definitions
Homogenous— Materials with the same appearance, texture, color, and which were
applied during the same general construction period.
Surfacing Material — Material that has been sprayed-on, troweled-on or otherwise applied
to surfaces, such as acoustical plaster, texture and joint compound, and fireproofing
materials on structural members.
Thermal System Insulation — Material applied to pipes, fittings, boilers, breaching, ducts,
and other interior structural components to prevent heat loss or gain.
Miscellaneous Material — Building materials such as structural components, structural
members or fixtures not included in surfacing and thermal insulation.
Survey Methodology
Before sampling began, inspectors documented the total surveyed area. A sketch of each
space was created, and total square footage was roughly measured. The inspectors then
determined the extent of each visible homogenous material throughout the survey area.
Materials were classified as surfacing, thermal insulation, or miscellaneous material, and
friability was assessed according to AHERA specifications.
Materials were sampled according to 40 CFR 763.86. Depending on homogeneity, square
footage, and material type, the proper number of samples needed to accurately assess the
location and extent of asbestos was determined and collected. At the point of collection,
samples were placed in an appropriate container and labeled. Location was noted on the
building floor plan, and a description of the material was recorded with the label number.
Sampling tools were then wiped clean to prevent contamination between samples. Any
suspect debris was sealed. The samples were then counted, and their label numbers were
recorded on a chain of custody form. The inspector then signed and released the form to
the laboratory with the samples. Samples were analyzed in-house at Asbestos Northwest.
Below is a list of all materials sampled. Appendix C contains the laboratory report and
analytical results for each sample.
5
ASBESTOS ; �
ASBESTOS NORTHWEST LLC SURVEY REPORT
44V-
NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 941 4343 Fax:253 9414175
Description Material Type Sample Numbers and Locations
Fibrous Paneling Friable Miscellaneous 1- Debris South Side
Material
Texture on Drywall Friable Surfacing Material 2- Debris South Side
Asphaltic Shingle and Non-Friable
Tar Paper Miscellaneous Material 3- Debris North Side
Rolled Asphaltic Non-Friable
Roofing Miscellaneous Material 4- Debris North Side
6
ASBESTOS NORTHWEST LLC SURVEY REPORT
..ASBESTOS NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
4. Asbestos Containing Material
A homogenous material is considered ACM (Asbestos Containing Material) if one or more
samples of the material are found to have greater than 1% asbestos. Analysis can result in
both positive and negative conclusions in materials containing less than 10% asbestos, or
materials that have very fine asbestos fibers, have been hand mixed, or have asbestos
fibers tightly bound in the matrix; therefore, EPA recommends a minimum of three
samples be analyzed by PLM for these types of materials. All materials that were sampled
during the inspection were analyzed under PLM, EPA Method 6001R-931116.
Laboratory results show that none of the samples taken contained asbestos.
ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS ,_ ithivii
1 .
NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
5. Conclusions
None of the materials sampled contained asbestos. Given the extensive fire damage to
the structure large areas were inaccessible and samples could only be taken from the
perimeter of the site.
Other materials may be uncovered during the demolition process that would require
abatement, these should be tested as encountered.
The material that contains asbestos must be abated before remodeling may begin. A
Certified Asbestos Abatement Contractor must carry out abatement.
Different materials require different abatement processes depending on the friability, type
of asbestos, and amount of asbestos present. It is important that materials are treated by a
Certified Asbestos Abatement Contractor.
8
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ASBESTOS NORTHWEST LLC SURVEY REPORT
ASBESTOS
[NORTHWEST
•
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 941 4343 Fax:253 9414175
1900 W Nidwrsert,Ste 315 ®®
Seattle,WA 98119 1 t C,
(268)2854373
Assisemievi
This certifies that A^P,_p"
Sean T.Butler
has satisfactorily completed
4 hours of refresher training as an
AHERA Building Inspector
to comply with the training requirements of
TSCA Title ll,40 CFR 763(AHERA)
EPA Provider#1085
Inatruntar Date.Jun 20,2018 Epees in 1 year.
Cert.Nun 168124
1900 W.Nickerson,Seattle,WA99119 Ste 315 i i 4
(206)2854373 rr w ar>rrerra1111r
This certifies that Awn#i,.<: ,. i
Daniel J. Lafley
has satisfactorily completed
4 hours of refresher training as an
AHERA Building Inspector
to comply with the training requirements of
TSCA Title ll,40 CFR 763(AHERA)
trtetor tate.004,2017 Expires all year.
Cert,Num 163509
10
ASBESTOS NORTHWEST LLC SURVEY REPORT E TOSV"'"\
NORTHWEST• '
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 941 4343 Fax:253 9414175
Appendix B — Building Layout
Soot 9 ,)-ge-
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11
ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS/
NORTHWEST
•
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 941 4343 Fax:253 9414175
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Looking to Front
12
ASBESTOS NORTHWEST LLC SURVEY REPORT ASBESTOS "
NORTHWEST
30620 Pacific Hwy S Suite 103 Federal Way,WA 98003
Tel:253 9414343 Fax:253 9414175
Appendix C — Laboratory Report
IIORTHWtEStT + ii Asbestos NW Batch# 201812379
30620 Pacific Hwy S.6103,Federal Way,WA 98003
(253)941-4343 NYLAP Lab Code:200993-0
Bulk Samples Chain of Custody (EPA 60018-93/116)
NamelCompa� Jose MontesDate: 9/6/2018,.,.. �_. .__ .
. .............................._
Address: Phone: 206 929 4247
Email:
Project
Manager: Same Project#
Project
l Location: 3001 S 288th St#360 Federal Way WA Number of Samples 4
Turn around time: 24
# Sample ID Description Location/Comments
1 1 Fibrous Paneling with Paint Debris South Side
2 2 Drywall Paneling Debris South Side
3 3 Asphaltic Shingle and Tar Paper Debris North Side
4 4 Rolled Asphalt Roofing Debris North Side
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Print Sign Company Date Time
Sampled by Sean Butler " - Asbestos Northwest 9/6/2018 1:00PM
Relinquished by:
Delivered by: Sean Butler Asbestos Northwest 9/6/2018 2:00PM
Accepted by: Dan Lafley Asbestos Northwest 9/6/2018 2:00PM
Analyzed by: Cathy Butler 0141.1 rtt `- Asbestos Northwest 9/6/2018 2:45PM
13
ASBESTOS NORTHWEST LLC SURVEY REPORT
ASBESTOS - \
d Way,WA 98003
30620NPacificORHTwyHs WESTeE10S3 TFe Federal
Tel:253 941 4343 Fax:253 941 4175
„ASSESTOSiddliiiii
!NORTHWEST Ct\\-FWJAP
Asbestos Northwest,FIX: TESTiNG
NVI AP IASI COM 2.001'13.0
30620 Pacific Hwy S.#103,Federal Way,WA 98003
Ph:(253)941-4343 Fax:(253)941-4175 Batch Number: 201812379
PLM Analysis by EPA Method 600/M4-82-020 and 600/R-93/116
This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,or
any agency of the U.S.Government,
Attn: Date Received: 9/6/2018
Jose Monies Date Analyzed: 9/6/2018
Samples Received: 4
Samples Analyzed: 4
Location: 3001 S 288th St#360 Federal Way WA
Client Sample Lab Sample %Non-Asbestos %Asbestos Fibers
Layer Description Matrix
ID ID Fibers and Type
Brown fibrous material
1 Filler,Paint 90%Cellulose None Detected
with paint
Charred white powdery Binder/filler,
2 1 2%Cellulose None Detected
material with paint Paint
White powdery material
2 Filler/binder 10%Cellulose None Detected
with paper
White chalky material Fit lerlbinder,
3 15%Cellulose None Detected
with paper Gypsum/binder
Black asphaltic material Asphalt/binder, 20%Cellulose,
3 1 None Detected
with sand Sand Glass fibers.
Black asphaltic fibrous 10%Cellulose,
2 Asphalt/hinder one Detected
materialPolyethylene
Black asphaltic fibrous 10%Cellulose,
4 Asphalt/binder None Detected
material Polyethylene
5%Cellulose,
2 Black asphaltic material Asphalt/binder None Detected
Glass fibers
(
API
Analyzed by:Cathy Butler, Report Page 1
14