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04-102209City of Federal Way Demolition Permit #: 04 - 102209 - 00 - DE Community Development Services 33530 1 st Way S Federal Way, 00 Fax:253.68003-62 Inspection request line: 253.835.3050 Ph:253.661,4000 Fax:253.661.4129 Project Name: WEST HYLEBOS CREEK RESTORATION Project Address: 36317 PACIFIC S Parcel Number: 292104 9021 Project Description: Demolish dilapidated accessory structure and miscellaneous other foundations on site. Owner Applicant Contractor GOLDMAX INC JANSEN, INC *GRANT JANSEN * JANSEN, INC *GRANT JANSEN 1101 S ORANGE AVE 801 ORCHARD DR SUITE 1 801 ORCHARD DR SUITE 1 NEWARK NJ BELLINGHAM WA 98225 BELLINGHAM WA 98225 07106-1509 (360) 715-0071 PERMIT EXPIRES November 30, 2004. Permit issued on June 3, 2004 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: „ Date: FINAL INSPECTION REQUIRED UPON COMPLETION OF THE WORK. TO SCHEDULE CALL (253) 835-3050 INSPECTION CODE 4050 C/3/0L/ 06/01/2004 15:45 FAX 3G07150078 JANSEN INC Z 002/013 RECEIVE �,\4-OA3 COMMUNr1Y DEVELOPMEh7 SER VICES COY Rr Federal Way J U N 0 3 zPERMIT APPLICATION 33530 FIRST WAY SOUTH • PO DOX 971E FEDERAL WAY, WA 98063-9718 2531616�191 er15366J14129 iyQ(fa , w i �': CiF,' ;'IIY'ti 'r,�i'. j� iifS i �•v� ...,... r;� , ... ' i ,+SI �� it tt i' �{I" i [ iiti .[,'� [ ��1 � .� '3�[1�II ,;�n+i}. 1 :;r � �.' I:, �• I:'. ME i,. .r� �� � -, . ' i[ ..0 i.�if�' . The ftlMupf► a fa ►aaafmd {TLPo77R.ation - all incomolete apvUeation uAlf not be accepted. Please Artnt te4ib$1 Nn Ink) or twos. SITE ADDRESS, I- (` dO A c '4L, 4 `� . P c�C1 a-k [,f SUITE/APT # ASSESSOR'S TALC/PARCEI, #: L A 4IC,0 � (_ SQUARE FOOTAGE OF LOT: )-�q 0 LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1) a-t4Z"u�cl (Attach, separate page for lengthy legal description) TYPE OF PERMIT ('Phis Appllcatlon): ? BUILDING ? PLUMBING ? MECHANICAL C DEMOLITION? ? ELECTRICAL ? ENGINEERING? FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide) detailed description of work' included on This permit only): r� ey) cl Je rzk?a w1 1d 1';-M G L� 6"L) o c"l o 'a"61 5_l%�' u,�C (ohuu—t.0 �tJ { i✓cf%Gl 20� PROJECT NAME (Narne of Business/Owner Last Name): PROPERTY N E: OWNER: (-1LJ1 d fyw-)( Inc. MAILING ADDRESS (STREET ADDRESS;I: I I� I S . c�Yttih toe— CONTRACTOR. - LENDER: p! )—p-1 vd.. r 040001 APPLICANT: PRIMARY PHONE: ( 1) 1-3 ) 1)19 4 - CrI-Y' S't rs, 'L(N N e 4-) CL✓ic I t-i S 70 +-1 O (e NAMF, COMPANY OPP E PK0KE: MAILINO ADDRESS IE`STRL'ET ADD Pk 11 b lot w' Arc I1t 111� )r• -:I;-I Or-, Y, STATS. ZIP kin. INZ>a G&GL PHONn (3(CO ) �Jcl11 V-J-4 5 J1)7 CITY OF FEDERAL WAY BUSINESS LICENSE TIUMaER: XPIRATION DATE: PAX NL'MRAQ: CONTRACTOR'S RF.O(STRAT(ON NUMBER; 6XV1RA1'10N 1)A'1 6; (copy of card requlr d with eaah application) --T R N 5 C' 1 '� ( / ( ) l /U':j NAM& DAYTIME PHONE: MAILING ADDRESS (STREET ADDRESS;]: CITY, STATE, ZIP NAME: �VA�� �Gc c1SE�� COMPANY CL$'1S�?y� I✓I �- OPFICC PH NE: ( Pv) (�J - CC) MAILING ADDRESS (,STREET ADDRESS(: .13 r : CITY, STATE, ZIP 8c I [ .,� i�a ,., , w a s EVENING PHONE: (_?ca u ) 302, RELATIONSHIP TO PROJECT: ? Architect ? Tenant ? Othcr (Describe): �Z-yl- ✓u C'f-D — FAX NUMBER' (& a )'T15 - EXISTING USE: —04; r4t o v1 ed PROPOSED USE: a (a,, -- EXISTING ASSESSED/APPRAISED VALUE is VALUE OF PROPOSED WORK: $ A) 0. SPRINKLERED BUILDING? ? YPIS ? NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ? YES ? NO WATER SERVICE PROVIDER: ? LAKEHAVEN ? HIGHLINE ? TACOMA ? PRIVATE (WELL) SEWER SERVICE PROVIDER: ? LAKEHAVEN ? RIGHLINE ? PRIVATE (SEPTIC) 06/01/2004 15:45 FAX 3607150078 JANSEN INC PROJECT FLOOR AREAS fa 003/013 AREA DESCIZIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL BASEMENT FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED?) GARAGE/CARPORT HOW MANY FLOORS? { • AL 6 iro I''I',' � uli pig' il;l ?1 sso• I „, �!f' i 'i11i Ili ' ��!11; : 1 ;'' I s ,1i;,)pa�rnq'uao?R9we�p' ('�' li�� I i I, � �,,;'� ;�� ' � I!li,���l.:• ,,,, �, °°NEW HOMES ONLY°° NUMBER OF BEDROOMS: RSTIMATED SELLING PRICE; $ IndicaLe number of each type MECHAAUCAL Value of Mechanical Work S AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS PLUMBiNO IV ((� ure that is to be installed or relocated as part of this project. Do not L'i I A - EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS PIPE OUTLETS BATHTUB$ (0rTu5/ehOW-C-1..) SHOWERS DISHWASHERS SINKS GAS PIPE OUTLETS SUMPS WASHING MACHINES URINALS LAVE omhroom sink VACUUM BREAKERS GAS LOGS HOODS (C�—W) RANGES GAS WATER HEATERS WATER CLOSETS (Toaeh DRINKING FOUNTAINS RAINWATER SYS KOSE BIBBS ELECTRiC WATER HEATERS existing fixtures to Train. _ REFRIG, SYSTEMS WOODSTOVES MISC (Describe) MISC (Describe) l certify under penalty of perjury that the information furnished by me is true and correct to the beat of my knowledge, and further, that ! 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' feear incurred in the investigation and defense of such claim) which may be made by any person, including the undersigned, and flied against the City of Federal Way, but only wheys such claim arises out of the reliance of the city, including Its offtcern and employees, upon the accuracy of the information supplied to the city as apart of this application. NAMEITITLE: G' C / ' .C.4�7 -S9k DAT1W: (Slgnatum) M' 161 RELATIONSHIP TO PROJECT: ? Property Owner ? Applicant oxxtxaat Architect r c2 ll �O ?au'[ �� 'a ' � ee �} �yy 'i' � I; j;5 "C :9 .�A.If, i�. I ,�' 'i ii:"�'I', • r� .t i ry�d !; y I v>, "'I i I I•ti I .. t �y ��((,, �71!!. ! ,i:+ �!i:• •iF!: il�' ;' 'r . i %; a �!}:.. '�,; �:rT:.'� ���xr � � ' •�' ��'b �a��[��p,'y7��}a�j'yj'�""�r^I�� '�:I���: ;� "f�ili'; °.,�.• ��r" �!,.:. i : �rii•�i" !;'E:i�l�; li 'c M .. '•' �I; L � �4";�E' 7" ;I,�: °i ry., :� ~ftz�s . � • �x��¢r: . N.� ' r.. ZTTiTt .�i`C fnLtiTli iIINuu tt 1 F YES. "' 51 !! !p'.F, p',_*; Bulletin #100 - January 13, 2004 Page 2 of 4 k:\Handouts - Rcviscd\Pcmiit Application 06/01/2004 15:46 FAX 3607150078 05/,20/2004 11122 FAX 2536614,r JANSEN INC City of Federal Way a 006/ 013 2 003/003 CITY OF 4A Federal Allay DEPARTMENT OF COMMUNITY DEWELOYMENT SERVICES 33530 First 'Way South PO Box 9718 Federal Way WA 99063-9718 253-661-4115; Pax 253-661-4129 w'ww.eitY9ffc de�~alw�yy, c vm 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 followu 9 items (as applicable) must be signed by the respective agency (see attached Demolition Permit Contact List). NOTETOAPPLIClNT? Utilities shall be disconnected and serviem performed, ifapplicable, prior to issuance ofthe demolition permit, All applicable items below are to be s1g,44dgAdd=dby the respective agency representatives, 1. ASBIESTOS ABATEMENT (Copy of approval form and asbestos survey from Puget Sound Clean Air Agency provided) L t (City or federal way 6ulidingOffidiil) 2. GAS SUPPLY (Gas to be shut off, meter removed and final bill paid) (Puget Sound Energy) 3. 51EPTIC SYSTEM (Tank to be removed or tank ta,be drained and filled) 110 (King County Environmental 58rv1Ces) 4. SANITARY SEWER (Check applicable box) o Sewer line capped at property line a F-45dnTg� �sewer ling to remains and be used by proposed new stucture }J 46tVLIA In W(-JN-d< (Sewer District) 5. GARBAGE (All household cgarbage disposed off and final bllf paid) _ 1iIn Disposal/Federal Way DlWosal) 6. ELECTP-Wr Y (Electricity to be shut Off and meter, removes is 1'Pca rci scyi/l CC — (Puget Sound Energy) 7. FUEL STORAGE TANKS (Above or below grade fuel tanks, have been pumped or removed under Fire Department permit prior to any dismantle/excavation) eras Way Rre Dlstrkc ;ff§�— S. WATER - PublicSouree (Check applicable box) o Meter to be removed and final utility bill paid ❑ Meter to remain and be protected rj (Water Supplier) s*****OR ■**x*x 9. WATER - Private Weil (Check applicable box) ❑ Private well filled and capes o Private well to be used flor other purposes Cfgng County Environmental Services) ❑ Completed Construction Permit Application form. ❑ Provide the following fees. A. Demolition Permit Fee S61.00 2. WA. State Surcharge 4.50 3. Cash Bond Deposit 500.00 (Refundable upon Completed Final inspection) $56! 50 Bulletin #122 — Pebruary 5, 2003 pa9e 1, of 1 k:\Handouts — Revised�Demolltlon Permit Requirements 06/03/2004 09:18 FAX 3607150078 JANSEN INC Z 003/005 06/03/2004 06:06 FAX 206 689 ' '3 PS CLEAN AIR Z 002 QH/'0''2/0Q4 16:bI hAK :ibl)fIOL( 1 JANSt:N tNU 101,1 U Z/0'4 _ .ggency Case No. PUGET SOUND CLEAN. aR r' l7l7 o AGENCY 1 7 5 AtSi:{' ` ti� i;� i u� l 1p Union 5ueet, 5uire 500 III W " '' SCILVIC. WA 98101.203 5 J U N 0 2 2004 ~^"'i^��IPLhHM1,lltsrl r: a+vww.pyoleaRalT'.org 7geraey Ua2 on(v NOTICE OF INTENT A.1"ro1&0Tyi L__1,_13 JET allogAbeaxor3Removal 2. ® Pr11leAsbestosRemnvrL&Demolition 3.,CI'TlemolitinnQnly B, Proparty Owner: �!� Vl lLt ?L 1tiL . I'Zone: "� �3 46� `.•`IO(a C ... 1ia litl ct,rl�— State IJ S zi .: C; I �4 L. AS•beAlft '' - ry14x41 rlukr t;r.r.e rul r. 71u.7+v1ili-M• rrJUA AP:1111tre H,Ur. 114r r.1 d&fG - Contracta, . ow:.t:r/CE,O: Mnilin Address: Pho.le. Job No.- City: slaw zi 1 FFm � D. Site Addrtss; 3 Ci G1 r- 5 city: F� =wa-zip. Site //�� _ Maaagcr: �I var.� e , Local Phone: J 4) C l 0 3, - 0 L 1 J E. Asbestos Survey or No, or )Date of A9bcsto�r WaFriable Asbestos ldarti Ord`' Ycs :`c CI Mill Pre un d Struotures: 1 Sur+J .'-� uy' wft, Nonfrit+.ble A,sbesio; ldcn[ifed7 Ye; 1i'1( AHEPA Building Cerdfieation 4: 071P - A1iT'1a4•0" 4 4.rra :h a copy of rite survey when fi-lahle ashesros InypaetOT: DO-VLVaMt. 1� CCd Ex . Date: sa 131 a5 hos for been identified Am AjTV i&4 81irk4 "s r•r vrredbefoev all elt!rnolifionprdjeces F. Detolition Start Ito, of 1, Tra�ininS klire (List fire Depi.) fa e" C 3 Strucrt mv, 2-0 Ordered Demolition (attach cope of Orde: . Demolition lnsaY+ arNo111iaa aorurwfal 's nt>allktgaddress on back_ Will nonfrinble asbestos I ,e IQ R in place during den) o'l Yes L -1- N G(7t1tYACtut, L Cs'1 �y1 C . �$ee �ztJlll t�'ct+C� Ryas, list typt end qcy, G. Friable Asbestos Work flays: M T W Th F sm -Su Project Information: Start bate; Com ]etion Date; Hours; Will all friable asbestos AV YsS 1'ofal to be Remo-, IL Linear Ft, 5 uam Y t. materials be removed; Vc Eloilcr\Furnaoe lnsu,lariwi LAD= Insulation Pipe Insulation F•ireprobfins l? link Plaster f exrured Coanr, -C,t:merlt Hoard U Ctmcnt Pipe friable. Flooring mtlble Roofing Ivlaserlal 01 lee: rs H. .Asbesto9rDemolition Project Categories., Vir a tfott Prai[1 � Project Dernolitiotl . Single -Family Rexidcncct (owner-occupled); A6�I0UNT �O + Fee Surrharpc ,4- © Asbestos Rcmovtll Project Only y}��. (;rDeniolition �' A. Pvfor Notice A $25 B, Prcljcct (with or without aabesro8 removal prZ�KAIMO 8��Days" 73, $60 Asbestos renloval can begin 11 on notification- demolition a ?rote: ffthe single faHuly residence is 0--l"n rd by orta f:am:ly who has been or W11 be using 1hd r&siri mea as then- domicile, the above boxes 1,4 or 1.8 may be Checked, If fkis is nor art t7imar-ocenpied residence, orre of elf Categories Bored helots rrudsf bu wsedI A stride fom!i',- fist r cr dons not include pon'ral rp E xtulri- wnLIZ wnies. nr en mixed -use buildbl , - ---� 2. P All Other Demolitions with no AsbmWs minoval or Nonfrieblel Asbestos lb Divs ScOC�- onlY F'ridble Asbestos PF9jeut-s.Qt1!jLJLiap Single Fatufl►+ Residence): s<+slo Lstas D I119 w 3 0 - 5 l ear feet anchor ;t 48 - 159 s uwe feat of axsbost4s Prio Notice 10 IDays $100 $100 4` Ll 260 - 999 linear feet anchor 160 - 4.999 square feet of asbwos 10 -Mays S200 S 100 5. 71.000 linear feet andlor>5.000 s uare feet ofacbe9eos 10 DA s sus❑ 0 b, Fntergancy Asbevo& Project, pr F✓met-�ency Demolition Project Prior Notice i wi,ca PrGJect Fee � She le-Famii Residences ore cxem t frarn cincr i,.ii ry fea; however, =P&W 0,4ner9 must TirbVi& a WraKe + c+ner .rnav acscl 1. l Comity thatZ11a Information aolltoltled 'W, thit nolirCGlian & fupplemcntal data is, to the best ofn1v knowlcdg�, ncurate A complete. Age Se 11. r J St,cnarur� Re resenJin� rJoro �lv wclC Pager Sound Cleet+ /sir Aawy Corm Nd,! 60-160 (Reviried 10%) TS �a 06/03/2004 09.18 FAX -0607150078 JAHSEN I-W 06/ 03/2004 08, 08� FAQ 206n 689u 1 '3 pS„innEA A R a 004/005 14 003 i0oo'9/014 '1lva V_uget Sound Clears Air Agency roquires advdtl0e notification before any per: ou commences a friable asbestos project kivolving materials equal to or greater in size than 10 linear feet or 49 squire ftnt and for all demolition projects (-egardless of asbestos content) irlyolving structures with a projected roof area treater than 120 square feet (Regulation i[I, Article 4), All asbestos removal and demolition notifications must be subr fitted to the Agency on current Agency forms. Asbestos rs-. oya and demolition to dots lwolyir'l mate rial. 5trtS4t' ice be w t .e rtCltificatit]n threshold al'e ll siabioct to al I other re uirernents of Rc ]anon M. Article 4. kftar seeaivinR a complete notifict�tian with the appropriate project fee, the Ag ency wilt review the form and return a copy to the asbestos and demolition contractor by mail-. The rcrurned copy will b( your validated noti.fioation, D CM blirj 1)r, "' 'tit' ' Contractor: GW1SCn it'1C. Owner/Cl o. Mailing Addr:,ss; �b I �� l��VtLL� ( Phone: ?Co U I Cj L'O / •'� actor's Job C�t1+: Yu�'rl SCRto: 1/1f Fi Zip; VI d %-� �� FRK: � � — 00�- GUIDELINES FOR SUFRMl 7 NCR AN ASSESTOSIDEMOLIT ON NOTIFICA710N Step 1. Check ncc appropriate project type in Box A. Friable asbestos tacludes popeom r _iling material•, abeec vinyl flooring, cement asbestos board siding, and duct iamulationo f5 normally found in vinyl floor tiles, window putty and moat roofing materials. Sitep Z. Pater proptny owner inforrn.ation in Sox B. 54ep 3. Enter the asbestos 00r1traCtOr or property owner information, if the property ow icr is conducting a sin(;ld family residential project, in box C• Print clearly this is your return mailing label. Si,ep 4, Enter the site address for all notifications in 13ox D, For multi -structure project , a9tach supplemental sheet with a site map (include air address for each site) and a list ❑rthe type and amount of friable asbestos to bt removed from each structure• Sirep S. Check either asbestos survey or material presumed in Box E. All demolitions i equire thta an Asbestos Hwzard Emergency R.imponsc Act R4; asbestos survey be conducted by 3 OCrtiiidd AHERA brdilding lr Spector. Attach a cony of rite survey, to the auiificaficn of dem i ro' e t %v e n o as bt to i cat if ed an rliz _Slu-vim. - Srep 6, Enter the project information in Box F. and check the training itre or ordered c emolition box if appropriatc (a espy of the ol'flcial order must be attached), All aabnstos must be removed prior m corcluctirtl a training fire. Additional training fire mquirements arc nenenined ill Rsguletiorl 1, Section S,08 If any nonfriable asbestos mate -Ws will be left in place during demolition, cheek yes and list the type and quantity of material. Step 7. Enter asbesms project information in Box C. List types of,_ is lza5bestos mated J to be removed; surfacing material such as p,poorn eeiling3 or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos ooard siding or pipe, etc. Step a. For owner -occupied Single -Family Residential projects, oheck BOX K1,A i ar rencivntion projects or BOX MH for darmolitrnn projeett (with, or wirhouc asbestos removal), AsbGSWS TCMOVal may be :onducted afti;r a complete notification is rercivvd, brut demolition activitles can only brain on die 106' day after the notificatia i is recelvrd. Nom_, if ill singly fnnitly reridente is olvned by a+:efaodly who has been or will be using the re.9iderrce as rftefr Fie *Hello, boors' JA or 1B many br rhrrk4d A s!r rgle fattal(y rasr derzae does not include renral property, hrulfLfamtly 11ra11,Y, or a►ty 014ve• !curd butlding Fc! Commercial asbestos projects (or projects thRt do trot qualify as Singiv Fw,nuy R sidendal)_ check the project category H2 - 5 that matches the amount of friable aFbestns that will be removed. If a demolition is i •ivolvcd, include this appropriato surcharge (additional feel in your payment. To Me for erl ernr;,rgeaey asbestos or demolition proje t, check the appropriate box 1 -, 5 aricl the applicable emergency box in H6. All emergency requests must be aticgrnnariiud by a lgi frntn the l�ron�y 4Yhlc�dernc�ns ratio,' the i i ate ��r1 ' accordance with the re u%ternsnts in Fcc ul ti ,r ,M $=�Aiun 4.03 (c), Sriip 9_ Ploaee ccnify the 2auTwacy and completanas5 vfthe information provided by signi rg the notification in Box 1. Mandatory nmcnL-nents to the nori'•tication are required for changes that Increase the pro ecL eacegar;y, change the types of asbestos materials to be razoved un,d changes to start date, completion slate end work schedule % r asbestos projects, No fee is required for wtuk schedule chertges if the contractor is participating in the Agency work schedule •F'ax procrani. ,A �25.00 processing fee is required for all amendments, Puget Sound Clean Air Agency asbestos regulations and fnrFn_3 can -be dewr►lotded froze th s Agency well page at www,psoleanair.org. For technical assistance call (206) 689-4056 and for adrninlstracive inquiria grill (206) 689 AD90. Pugct Sound Clwn Air Agcncy Fnrut Nis.' 66.160 (daviaed 1/04) TS 06/01/2004 15:46 FAX 3607150078 JANSEN INC [a00a/013 ORIONEnvironmental Services ,An Euvironmcntal C,'o,mpliance C'onsuIting Firm 3=40414 911' Avenile. Soiah, Sairo A-S in Federal Way. Washington Phone (253) 952-6717 Facsimile (253) 927-4714 o-Mail OHION671Ti. AOL.com REPORT Date: May 28, 2004 Jansen Inc_ 801 West Orchard Drive, Suite 1 Bellingham, WA 98226 Attu: ,Heather Mans Wsr W21+s912535 Executive Summary RE: Asbestos and Metals Report fof Various Building Sites Associated with the Hylebos Creek Restoration Project, Dear Ms. Marts: On May 25, 2004 ORION Environmental Services performed an asbestos and lead survey on the buildings and debris piles associated with West Fork Hylebos Creek Restoration Project near the corner of S. 359th Street and Pacific Highway South In Federal Way, Washington; Orion Project #041162_ The purpose of this specific investigation was to ascertain the location of asbestos and lead containing materials that would be impacted during demolition and clean- up activities at the site, This investigation was performed by an accredited AHERA Building Inspector and EPA, Certified Lead Inspector, Donna McNeal AHERA (I/MP-NAI.04-014; Expiration Date February 13, 2005). Results of this investigation are as noted in the remarks below. Asbestos Three (3) bulk samples were homogenized, collected, processed and analyzed for asbestos content_ From the fourteen types of non -homogeneous suspect materials, five (5) bulk samples (including layered samples) were collected and analyzed for asbestos. Building materials that contain asbestos fibers In the amounts greater than 1 percent (1 %) arm regulated by the Dopartment of Labor and Industries and by the Puget Sound Clean Air Agency. - West Fork Hylebos Federal Way, Washington page 1 of 3 Zon'd d50cZ0 if0!Z0J90 bISZ� ZZ9 S9Z S(�S ItOINdWNOai(�Na NOIZ! 06/01I2004 15:46 FAX 3GO7150078 JANSEN INC Z 009/012 ORION' Environmental Services An Environmental Compliance Consulting Firm 34004 91" Avonuc Soull►, Sultt A-5 in irederill Witty, Wushinuton Phone (253) 9S24i717 FttcHiftfile (253) 927-4714 a -Mail ORION0717(6-AOL.com Material IdentfflGatioa7 MateriahDescriptlon Roofing Material 1 (RM1) Multi Layered Composite Roofing; Rust Material, Blue with associated Felt. Debris Pile 3 Northeast of the Garage Roofing Material 2 (RM2) Multi Layered Composite Roofing; Black with Associated Felt. Debris Pile 4 Noltllwest of the Garage Roofing Material 3 (RM3) Composite Roofing; Rust with Associated Felt. Located on the Shed Northeast of the House 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 this office space were non -detect for containitg asbestos, (See Attached Orion Report 041070) Meta! For the purpose of this investigation, lead -based paint Is defined as paint or other surface coatings (stain, shellac, or vamish) applied prior to 1978 and containing lead equal to or exceeding 1.0 milligram(s) per centimeter or 0.5 percent lead by weight in a dried state, unless your city or state requires a more strict Interpretation. The property was tested for lead -based paint using portions of the inspection protocol of Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead -Based Paint Hazards In Housing '(1997 Revrsion)_ HUD guidelines were implemented for prnt®ctioh of residents. In addition, Washington State's Department of Labor and Industries defines lead -based paint as paint with any detectable concentratlons of lead are regulated, thus creating the requirement for implementing worker, and in same cases, environmental protection, tabor and Industries guidelines were implemented for contractor'and worker protecton. Also, the Washington State's Department of Ecology requires that wastes from demolition or renovation activities that exhibit toxic Characteristics be analyzed by using Toxicity Characteristic Leaching procedure (TCLP) (40CFR 281.24). TCLP analysis is used to determine if lead associated with constituents are below the allowable regulatory threshold, of 5.0 ppm (milligrams/liter) of lead in leached solution. TCLP testing should be carried out when a waste stream can be determined from the soope of work. - West Pork Hylebas Federal Tray, Waslibigron Page 2 o f 3 eme ' d d90 I Zm toel Te/so tZ2_t1 LZ9 9SZ 9hs 11C11.N3WNg td 1 6N3 Nn I �1❑ 06/01/2004 15:47 FAX 3607150078 JANSEN INC a 010/013 OIUON ]Environmental Services An Environmental Compliance Consulting Firm 34004 9"i Avenue South. Suite Afi in Foilerul W.iy, Washington Phone (253) 952-4717 Fucrimile (253) 927-1714 a-MAH1 ORION6 717rq�AOL.cwn The purpose of this report is limited to providing the client an evaluation concerning potential lead -based paint, specified in the report, and evident at the site at the time of the evaluation. It Is also understood that the report will pertain only to the subject property. Use of the report and data contained therein for other purposes, is at the sole risk and responsibility of the user. There was no suspect painted component collected and analyzed for total lead_ Lead analysis was performed on one composite sample to determine if the waste stream anticipated from this project would be above the regulatory threshold for disposal. Analytical results show that the concentrations of lead was < 6.0 ppm (See Attached Report) which does not exceed the maximum concentration levels for toxicity characteristics as defined by Washington State Department of Ecology's Dangerous Waste Regulations. Any waste containing contaminants which occur at concentratlons at or abova the Dangerous waste threshold, shall be designated Dangerous Waste. Questions conceming this Executive Summary may be addressed to the undersigned. Professionally Yours, [ Environmental Services (�Donna Mcmeal AHERA Building Inspector 3 Encl, Attachment 1 — Asbestos Laboratory Report Attachment 2 — Inspector's Accreditation h7est fork Hylebos Federal May, Washington Page 3 of 3 t�p'd dS��ZO ��1T0/9m tiTLt LZG esz SAS 1W-LN2WNMJI6NZ NGIJQ 06/01/2004 15:47 FAX 360715007E JANSEN INC R 011/013 Orion .:,Environmental Services 34004 9 h Avenuc South ♦ DiWding A Suire 5 • Federid War, Washiugton 9SW3-4740 WE C W2r5912535 Telephone Seattle (253) 874-8118 • Tacoma (253) ys;Z-,y17 * Facsimile (253) 927-4714 +cmull ORION6717gx41 Polarized Light Microscopy Test Report EPA. Method 600/R-98/116 Client Jansen, Inc, Date May 28, 2004 801 West Orchard Dr. # 1 Page page 1 of 2 BellillghaTo, WA 98225 invoice 041162 ,Aim Heather Date Received May 25, 2004 Project Number N/A Project Name West Fork Hylebos Client Orion NUMr NumbIr Steag scogy Exam WFH-01a, 40528-70a Ruat Composite Roofing Homogeneous WWi3-O l b 40528�70b Blue Composite Roofing Assoc- with WFH-0la WITH-01c 40528-70c Roofing Felt Assoc. with WFH-Ota VVTR-02a 40528-71 a Rust Composite Roofing Homogcacous NVFH-02b 40528-71b Blue Compositea Roofing Assoc. with WFH-02a WFH.02c 40528-7% Roofing Felt Assoc, with WFH-02a - WFH-03a 40528-72a Slack Composite Roofing Homogeneous WFH-03b 40528.72b Rust Composite Roofing Homogeneous WFH-04a 40528-73a Rust Composite Roofing Homogeneous WFH-04b 4052R-73b Roofing Folt Assoc, with WFH-04a Sample Asbestos 'X`rcatmcr)t Au s t Tie Ash ND - Other .Fibers cellulose Ash ND Fiberglass Cellulose Ash ND - Cellulose Ash ND - Fiberglass Ccllulosc Ash ND - Cellulose Ash ND - Cellulose Ash WD - Fiberglass Cellulose Ash ND - Cellulose Ash ]viz - Cellulose Ash ND - Cellulose Soo • d JS0 o Z0 to/ Z0/90 -t7tiL,b 2-Z5 SSZ sr�S 7V1N2WNMJ 1 e"NS No 1 JO 06/01/2004 15:47 FAX 3GO7150078 JANSEN INC fa 0 12/0 13 OrI011 Environmental Services NOW 9 h Avcnuc South + Building A Suite 5 ♦ Fedeml 'Way, VWashingwu 9800-'�-6740 WHE W2F5)12535 Telephone Seattle (253) 8744118 *Tacoma (253) 952-6717 • Ficilmile (253) 9274714 ♦crosQ OR10NG717(�eol Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client JanSen, Inc- 901 West Orchard Dr. # 1 Bellingham, WA 98225 Attn: Healher Project Number NiA Project Name West Fork Hylebos Client Orion Number Npm „fir Stereo Scans Exam Date May 28, 2004 Page Page 2 of 2 Invoice 041162 Date Received May 25, 2004 Sample Asbestos Other TreatmCnt -Percent Tvne Faber WF14-05a 40528.74a Rcd Composite Roofing Ash ND - Cellulose Homogeneous WFH-05b 40528-74b Roofing belt Ash ND - Cellulose Assoc. with WFH-05a bup: LaboMory QA/QC Duplicate; M; Mastic [(a), (b), (c), etc.): Sample layers numbered from front to back. Comments: For layered esmples, each compoa=t has been analyzed separately- ND uimns non-4cteet for asbestos fibers by EPA t4 eMod. 600M-98/116. Diwlaiwers: PLM has been 1gown to miss asbestos iu a small percentage of samples that contain asbesto ,. Thus noga6vc PLM results cannot be gua=eod_ This report may only be mproducul in full witb wiittcn approval of ORION Envlronmentid Saxvices, Orion samples are analyzed according to LPA McThod 600/R-98/116 by AIHA Hulk Asbestos Analytical Testing Program (102911) proficient analysts. Reviewed By - '20,5�� Donna ,IV><cNeal Leading Em ironrnentafOb7nphanze (,'artsufti g Arneo tf:a 21" Ca'ritury Laboratory Director 900 ' d d90 i Z0 ib'0r doi50 -V14t LZS SSZ ShS 1101"nWN0?d i (1Nn No i ao 06/01/2004 15:47 FAX 3G07150078 JANSEN INC 16013/013 =r Q0 io CL 0 c 5 -- x— — mr W Q c 1 o w 2-001d dsOoZp tiSLti 4Z6 SSZ SnS 7d1N3WNOJIi,N3 NOlaO King County Dept. of Finance Treasury Operations - Property Tax Information Pagel of 3 1 King County -EXIN Finance and Businessg Operations Division jam ' ��j �u• � Ep i'�f31�%irl r r'ii ?rfj Tax Account Number 292104902104 (This account is active.) Tax Payer Name GOLDMAX INC 3N2677 Annual Statement Requested by Parcel Number 2921049021 Mailing Address C/O KWON E.K. 9 LEDGEROCK CT MORRIS PLAINS NJ 07950 Amount Due: $ 1,674.19 Second half amount if paid by October 31, 2004 . It is not necessary to have a tax statement to make your payment. Please write the account number on your check and make it payable to and mail it to: King County Treasury 500 4th Ave, #600 Seattle, WA 98104 If the mailing name or address is incorrect and you want to make a change, please click on the following link: Tax Info FAQ If you would like an official printed tax statement mailed to the mailing address listed above, click on the REQUEST PRINTED TAX STATEMENT button. REQUEST PRINTED TAX STATEMENT 2004 Tax Information Tax Amount: $ 3,261.67 Other Information FEES und Value: $ 267,0001 SURFACE WATER $ 83.77' provement Value: $ 100 NOXIOUS WEED $ 2.94• Status: Taxable; Total Billed: $ 3,348.38 Levy Code: 1205 Paid: $ 1,674.19 Interest: $ 0.00 Penalty:. $ 0.00 Amount Due: $ 1,674.19 =i3 1 ■ Tax Amount: $ 3,128.98 Other Information FEES Land Value: $ 252,000, SURFACE WATER. $ 83.77' Improvement Value: $ 1001 NOXIOUS WEED $ 2.94. Status: Taxable. Total Billed: $ 3,215.6911 Levy Code:I 1205 Paid: $ 3,215.69 http://www.metroke.gov/finance/treasury/kctaxinfo/taxinfo.aspx?pareel_id=2921049021 &s... 6/2/2004