HomeMy WebLinkAboutPermit D05-399 - DOAK HOMES - DEMOLITIONDOAK HOMES
11640 EAST MARGINAL WY S
D05 -399
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City a. Tukwila
Department of Commctnity Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 -431 -3665
Web site: ci.tulovila.wa.us
DEVELOPMENT PERMIT
Steven M. Mullet, Mayor
Steve Lancaster, Director
Parcel No.: 0733000030
Permit Number DOS -399
Address: 11640 EAST MARGINAL WY S TUKW
Issue Date: 12/08/2005
Suite No:
Permit Expires On: 06/06/2006
Tenant:
Name: DOAK HOMES
Address: 11640 EAST MARGINAL WY S, TUKWILA WA
Owner:
Name: CEDAR GROVER PROPERTIES LLC
Phone:
Address: PMB 262, 3213 W WHEELER ST
Contact Person:
Name: DARRYL DOAK SR
Phone: 206 - 246 -6587
Address: 11812 26 AV SW, BURIEN WA
Contractor:
Name: DOAK HOMES INC.
Phone: 206 246 -6587
Address: 11812 26 AV SW, SEATTLE, WA
Contractor License No: DOAKHI *092NZ
Expiration Date: 08 /08/2007
DESCRIPTION OF WORK:
DEMOLITION OF OLD HOUSE AND REMOVAL OF ALL DEBRIS AND
SEPTIC TANK
Value of Construction: $3,000.00
Fees Collected: $174.55
Type of Fire Protection:
International Building Code Edition: 2003
Type of Construction:
Occupancy per IBC: 0022
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
Fire Loop Hydrant: N Number:
0 Size (Inches): 0
Flood Control Zone: N
Hauling: N Start Time:
End Time:
Land Altering: N Volumes:
Cut 0 c.y. Fill 0 c.y.
Landscape Irrigation: N
Moving Oversize Load: N Start Time:
End Time:
Sanitary Side Sewer: N
Sewer Main Extension: N Private:
Public:
Storm Drainage: N
Street Use: N Profit:
N Non - Profit: N
Water Main Extension: N Private: Public:
Water Meter: N
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Department of Community Development
—r 6300 Southeenter Boulevard, Suite #100
N 2 Tukwila, Washington 98188
Phone: 206 - 431 -3670
" ti.N...NM "••• ,
isoa Fax: 206 - 431 -3665
Web site: ci.tukwila.wa.its
* *continued on next page **
Steven M. Mullet, Mayor
Steve Lancaster, Director
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doc: IBC- Permit D05 -399 Printed: 12 -08 -2005
Permit Number:
Issue Date:
Permit Expires On:
Permit Center Authorized Signature: ' Ujvl n1 nA Date: - WDZ J,a!�
I hereby certify that I have read and x i ed his permit and know the same to be true and correct. All provisions of law and
ordinances governing this work will be complie with, whether specified herein or not.
City ox``Tukwila
Departitieut of Coriunuuity Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: ci.t ukwila.wa,us
Steven M. Mullet, Mayor
Steve Lancaster, Director
DOS -399
12/08/2005
06/06/2006
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws
regulating con stuction or the performance of work. I am authorized to sign and obtain this development permit.
Signature:
Date: 2 ' 19
Print Name: ��`�L ,I '� — Tp
This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is
suspended or abandoned for a period of 180 days from the last inspection.
doc: IBC - Permit
Printed: 12 -08 -2005
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City of Tukwila
was
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
PERMIT CONDITIONS
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Parcel No.: 0733000030 Permit Number DOS -399
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Address: 11640 EAST MARGINAL WY S TUKW Status: ISSUED
Suite No:
2
Applied Date: 11/09/2005
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Tenant: DOAK HOMES Issue Date: 12/08/2005
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1: ** *BUILDING DEPARTMENT CONDITIONS * **
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2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the
Building Official.
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3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to
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start of any construction. These documents shall be maintained and made available until final inspection approval is
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granted.
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4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary
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sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other
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excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of
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this requirement.
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5: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of,
any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits
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presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila
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shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the
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Building Official from requiring the correction of errors in the construction documents and other data.
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6: Contractor shall notify Public Works Utility Inspector Mr. Greg Villanueva at (206)433 -0179 of commencement and
completion of work at least 24 hours in advance.
* *continued on next page **
doc: Conditions D05 -399 Printed: 12 -08 -2005
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City o f Tul -wl la
INS
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
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I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and ordinances
governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provision of any other work or local laws
regulating construction or the performance of work.
Signature:
Date: 1 '
Print Name: -Yc— k— - rw,
doc: Conditions D05 -399 Printed: 12.08 -2005
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Applications and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or by fax. Z
* *Please Print"
SITE:LOCATION
Site
Tenant Name: A ) L
no
Mailing Address: I / a/ 2- -
a e
King Co Assessor's Tax No.: 4 _
oec/-,!1 Number: T - Floor:
New Tenant: ❑ .... Yes [ - No
E -Mail Address:
City State Zip
Fax Number: i`, 4 / 6 -�'�
GENERAL CONTRACTOR INFORMATION: (Mechanical Contractor information on back page) I
Company Name: �I e,4 C S /A--
Mailing Address: 1 �� /.2 - 6 1 /� S': c J , �- . �.�✓ 11' $�1. �ZZ
City C e // 2 0 e ;
Contact Person: _ 2 y �� /� �� Day Telephone:
E -Mail Address: X)Ilf Fax Number: 2 U' 6
Contractor Registration Number: J)m .)� M21VZ Expiration Date: 0�
* *An original or notarized copy of current Washington State Contractor License must be presented at a ti a of permit issuance **
ARCHITECT OF RECORD - All plans must be wet stamped by Architect of Record
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
ENGINEER.: OF: RECORD .A II plans must be stamped by Engineer of Record'
/ / ti
Company Name: // / /V .tit r e6, -1 /VZ' , A N CP
Mailing A
Contact
E -Mail
gMpermits plus\icc changalpertnit application (7.2004)
Revised: 63.05
trh
Page t
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CITY OF TUKWILA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
S: 4 A 5� 9G" �n� is U i L° /V , /' c / 9`0 7z
City State Zip
'C 1 / 6, c',2_ Day Telephon "§'1 y g6 - _ /0 0 - -
j1,2 , Fax Number: Z V .Z. 5 z/ 1? 5 / D 8"
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BI�IL EPt�� 4 ,ORMAT�ON '206 431 3670. �;
Valuation of Project (contractor's bid price): $ Existing Building Valuation: $
Scope of Work (please provide detailed information): 141f U v
Will there be new rack storage? ❑ ,.Yes . JR No If "yes", see Handout No. for requirements.
Provide All Building Areas in Square Footage Below
Addition to Type of :. Type of
Interior Existing Construction Occupancy per.
Existing Remodel Structure New per IBC. IBC
2 ...Floor
3 ,:Floor
Floors `: thru
Basement
Accessory Structure*
Attached Garage
Detached Garage.
:Attached Carport -
Detached Carport
Covered.Deck':
Uncovered Deck
PLANNING DIVISION:
Single - family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling:
*Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence.
Number of Parking Stalls Provided: Standard: Compact: Handicap:
Will there be a change in use? ❑ ....Yes XNo If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
❑.. Sprinklers ❑ ..Automatic Fire Alarm one El. Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ ., Yes ❑ .. No
If yes ", attach list ojmaterials and storage locations on a separate 8 -112 x 11 paper indicating quantities and Material Safety Data Sheets.
q:\lpermits plusllce ehsngalpermit spplicstion (7.2004)
Revised 6.6.05 Page 2
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Call before you Dig: 1- 800 - 424 -5555
Please refer to Public Works Bulletin #1 for fees and. estimate.sheet.
Water District
❑ ...Tukwila El ... Water District # 125 ❑ .. Highline ❑ ...Renton
❑ ... Water Availability Provided
Sewer District
❑ ...Tukwila ❑... ValVue ❑ .. Renton ❑ ...Seattle
❑ ...Sewer Use Certificate ❑ ... Sewer Availability Provided ❑ .. Approved Septic Plans Provided
❑ ...Septic System - For onsite septic system, provide 2 copies of a current septic design approval by King County Health Department.
Submitted with Application (mark boxes which apply):
❑ ... Civil Plans (Maximum Paper Size -22" x 34 ")
❑ ...Technical information Report (Storm Drainage) ❑ .. Geotechnical Report ❑ ...Traffic Impact Analysis
❑ ...Bond ❑ .. Insurance ❑ .. Easement(s) ❑ .. Maintenance Agreements) ... Hold Harmless
Proposed Activities (mark boxes that_a
❑ ...Right -of -way Use - Nonprofit for less than 72 hours
❑ ...Right -of -way Use - No Disturbance
❑ ...Construction/Excavation/Fill - Right -of -way
Non Right -of -way _
g ...Total Cut cubic yards
ff ...Total Fill cubic yards
❑ ...Sanitary Side Sewer ❑ .. Abandon Septic Tank
❑ ...Cap or Remove Utilities ❑ .. Curb Cut
❑ ...Frontage Improvements ❑ .. Pavement Cut
❑ ...Trafl Control ❑ .. Looped Fire Line
❑ ...Backflow Prevention - Fire Protection "
Irrigation "
Domestic Water "
❑ ...Permanent Water Meter Size... WO#
❑ ...Temporary Water Meter Size.. WO#
❑ ... Water Only Meter Size............ WO#
❑ ...Sewer Main Extension ............Public Private
❑ ... Water Main Extension .............Public Private
❑ .. Right -of -way Use - Profit for less than 72 hours
❑ .. Right -of -way Use — Potential Disturbance
❑ .. Work in Flood Zone
❑ .. Storm Drainage
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
❑ ...Deduct Water Meter Size "
FINANCE INFORMATION
Fire Line Size at Property Line Number of Public Fire Hydrant(s)
❑ ...Water ❑ ...Sewer ❑ ...Sewage Treatment
Monthly Service Billing to:
Name: Day Telephone:
Mailing Address:
City State Zip
Water Meter Refund/Billing:
Name: Day Telephone:
Mailing Address: state Zip
q:Upermits pluslicc changeApermit application (7 -2004)
Revised: 6.8.03
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MECHANICAL PERMIT. INFORMATION — 20643 -
MECHANICAL CON TN
Company Name: ,"
Mailing Address: 2
E -Mail Address:
Contact Person:
R INFORMATION
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Y
Contractor Registration Number: FK I Xle I 15 Go
* *An original or notarized copy of current shington State Contractor
Valuation of Project (contractor's bid price): $ '7 40. .ea J
Scope of Work (please provid detailed information): f 4� >
Use: Residential: New ...X� R
Commercial: New .... ❑ R
Fuel Type Electric ..... ❑ Gas...
City
Day T
7` , //-'C
Slate Zip
R :6 - 3 - 9,Z.2 a. i
a umber: S Y d 3
piration Date: A2 - Z G - e
must be presented at the time of permit issuance **
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty
Boiler /Com pressor:
Q
Furnace <IOOK BTU
Air Handling J Vnit >10,000
Fire Damper
0 -3 HP /100,000 BTU
CFM
Furnace>IOOK BTU
Evaporato ooler
Diffuser
3 -15 HP /500,000 BTU
Floor Furnace
Ventilati Fan Connected
Thermostat
j
15 -30 HP /1,000,000 BTU
to Sin Duct
Suspended /Wall /Floor
Venti lion System
/
Wood/Gas Stove
r
30 -50 HP /1,750,000 BTU
Mounted Heater
Appliance Vent
I
Ho id and Duct
Water Heater
50+ HP /1,750,000 BTU
Repair or Addition to
I inerator -Domestic
Emergency
Heat/Refrig/Cooling
Generator
S stem
Air Handling Unit
Qncinerator — Comm/Ind
Other Mechanical
<I 0,000 CFM
Equipment
FM
Indicate type of mechanical work being installed a , � A the quantity below:
PERMIT APPLICATION NOTES Applicable to all permits in this application
Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject
to possible revision by the Permit Center to comply with current fee schedules.
Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation.
The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested
in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition).
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNE - RPTHORIZED AGENT
Signature: _ Date: (- `
Print NameD �9 �ek!Z J04/< Day Telephone: 2 O
Mailing Address: /1 _ 41, -e 15:, Gi>/ U,0^/ P/V 10
City State Zip
Date Application Accepted: Date Application Expires: Staff itials:
q.Npermits pluslice ehanges%permit application (7 -2104)
Revised 6.8.05 Page 4
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( c� Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
7908
Fax: 206 - 431 -3665
SET RECEIPT
Steve Lancaster, Director
Copy Reprinted on 12 -08 -2005 at 12:06:32
12/08/2005
RECEIPT NO: R05 - 01756
i
Initials: BLH
Payment Date: 12/08/2005
User ID: ADMIN
Total Payment: 628.00
Payee: DOAK HOMES, INC.
r
l SET ID: 1234
SET NAME: DOAK HOMES DEMOS
SET TRANSACTIONS:
Set Member
Amount
---- - - - - -- ------
D05 -398
- - - - --
107.56
[05399:
107.56
D05 -400
107.56
D05 -401
107.56
D05 -402
90.20
D05 -403
107.56
TOTAL:
i
628.00
i
TRANSACTION LIST:
i Type Method
Description
Amount
---- - - - - --
Payment Check
5095
628.00
TOTAL: 628.00
ACCOUNT ITEM LIST:
Description Account code Current Pmts
------------------------ - - - - -- ---------- - - - - -- ------ - - - - --
BUILDING - NONRES 000/322.100 601.00
STATE BUILDING SURCHARGE 000/386 27.00
TOTAL: 628.00
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. City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
RECEIPT
Parcel No.:
0733000025
Permit Number:
DOS -399
Address:
11620 EAST MARGINAL WY S TUKW
Status:
PENDING
Suite No:
Applied Date:
11/09/2005
Applicant:
DOAK HOMES
Issue Date:
Receipt No.:
R05 -01635
Payment Amount:
66.99
Initials:
BLH
Payment Date:
11/09/2005 01:47 PM
User ID:
ADMIN
Balance:
$107.56
Payee: DOAK HOMES INC
TRANSACTION LIST:
Type Method Description Amount
---- - - - - -- -- - - - - -- --------------------- - - - - -- ------ - - - - --
Payment Check 5083 66.99
ACCOUNT ITEM LIST:
Description Account Code Current Pmts
------------------------ - - - - -- ---------- - - - - -- ------ - - - - --
PLAN CHECK - NONRES 000/345.830 66.99
Total: 66.99
t
doc: Receipt Printed: 11 -09 -2005
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INSPECTION RECORD i
Retain a copy with permit INICK PERMI N0.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -367
Project'
Type of Inspection: /
_..; r
Address:
r �
Date Called:
Special Instructions:
Date Wanted: a
p.m
Requester:
Phone No:
Approved per applicable codes. El Corrections required prior to approval.
f"A�IL' \iTC.
Receipt No.: Date:
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u paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT N0.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Project:
B2(L
V4
Type of Inspection:
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Address:
Date Called: --/
Special Instructions:
Date Wanted:
9
m.
1 0 P.M.
Reauester:
Phone No:
r, - 931
Approved per applicable codes. Corrections required prior to approval.
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COMMENTS:
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Inspector: / Date: ?' J
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Receipt No.: Date: :1 —
$58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
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INSPECTION RECORD
Retain a copy with permit _ $(26)431-3670 3
INSPECTION N0. .
- CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 AA
P4�e/ct�:
Type of I
spe
ress. � � '-"°
Date Called:
�D4(te
Special Instructions:
Wanted: a.m.
,: 1 13 � m.
Requester:
P I�op a N -�37�
Receipt No.: Date:
M Corrections required prior to approval.
In tor: Date: , 2 l
8.00 REINSPECTI N FEE REQUIR . Prior to inspection, fee must be
aid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection.
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Dec 08 05 09:52a American Environmental Cc 206 522 4099 p.l
R/CArV' Box $, 005
i Seattle, WA 98108 - 1005
i Environmental Construction LLC Phone: (206) 267 - 074ft
1 Asbestos - Lead - Mold - Demolition Fax: (206) 267 -0753
December 8, 2005
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3
j Telly & Darryl Doak I '
Doak Homes Inc
11812 26 Ave SW
j Burien, WA 98146
Via Us Mail
- -- Letter of Completion - --
(AEC Job # 5495)
Re: Asbestos Abatement Services at: 11620, 11638, 11640 E. Marginal Way S., Seattle
This is to certify that American Environmental Construction LLC has removed all of the
asbestos containing materials from the above referenced address per the Asbestos
Survey conducted by Asbesto -Test Inc., dated November 10, 2005 and our Proposal &
Contract dated November 18, 2005.
Clearance Air Monitoring (Sample Type = CL) as reported on the attached Air Sample Data
Sheet indicates that the airborne asbestos level is below the EPA established standard of
.01 fibers /cubic centimeter for clean air after an abatement project. Accordingly, the work
area is safe, in regard to asbestos exposure, for re- occupancy and /or demolition.
Please call me at 206 - 5234441 if you have any questions or comments regarding this
Letter of Completion.
Respectfully submitted,
America Environmental Construction, LLC
ILabra Bellows - Adr inistr^ ve Assistant
i
CITY OF RECEIVED
DEC 0 7 2005
PERMIT CENTER
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Dec 08 05 09:53a American Environmental Co 206 522 4099 o.4
t; 549
AS 4 ASBESTOS WASTE SHIPMENT REPORT F'ORNL
PLEASE PRINT OR TYPE! If you have questions, contact your local DEQ Regional Office in Portland a: (503) 229-
a a !364, Sal at (503) 378.8240 ext •272, Medford at (541) 776.6010 exL 235, or Bend at i,541) 388.6146 ext. 226, 01l
call (E00) 452-40 11 for the location of your local regional DEQ office.
WASTE
GENERATOR: (Cunvwtor, Facility, or Opatitarl
�
i .
Asbestos r site name and address: Doak Homes - Darryl Doak
'
116 20. i 11640 E. Mg rgingil Way Sou Seattle WA
King
9!3168 -
Street GtylSmte
County
Zip
Ccntact person: _ Darryl Doak Phone:
2 06.246. 656 7
2.
Operator's name and address- American Environmental Construction LLC Phone:
206- 267 -01
7417 - din Avenue Soutt. Seattle, WA
Ki ng
98198
Street CityiState
County
'Lip
3.
Waste disposal site: Northern Wasco County Landfill Phone:
541- 993 -CC89
2559 Steel Road The Dallas, OR
Wasco
- 97058
_
Street CityiState
County
Z;p
4.
Describe asbestos materials: _ rYIAS % ! ClUE'r�f?�r7c�
4
S.
Contairars: Ntunber: Ae, S L. raps - 756J Type:
6.
Total quantity (cubic yards): Z V !IS
OPERATOR'S CERTIFICATION: I heroby declare that the contents of this consignment are fully and accurately
described above by proper shipping name and are classified, packaged, marked and labeled, and are in all respects in
proper condition for transport according to all government regulations, All movement of this asbestus- containing
material is recorded on this Wass e Rrco.d Form.
Name: C C= /`�L Q Company: Ame Environmental Constructio
Signature: Date: f��� G �% U
-C
TRANSPORTER(S):
S. Transporter k 1: (Acknowledgment of receipt of materials;
Agent: Company: D&B Trucking_
Address: t 905 East Lincoln Ave.. Tacoma, WA 93421 Phone: 25 -383 -3850
Signature: Date:
9. Transporter 92: (Acknowledgment of receipt of materials)
Agent: onva Company: NTSI I D&B Trucking
Address: '.905 East Lincoln Ave.. Tacoma, %NA 98421 Phone: Z,53 -3 63 - L�3E0
Signature: _ Date.
DISPOSAL: (Certification of rrecipl'of asbestos materials covered by tbb manifest, except as noted in item 11 b6ow.,
10 Waste Disposal Site: Northern Wasco Co unty Landfill
Name and Title: _ --_ _ Date:
Signature: _ Phone:
11. DISCREPANCY SPACE: (Add attachments us necdcd) _.• _
(Revisal 0103)
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Dec OED 05 09t52a
,agency Case No,
200503701
rigcrttp UtI Onty
i
American Environmental Co 206 522 4099
PUCaI"sT SGUiJD CT.L• At.
AGENCY
1 10 Union Street, Suite 500
MI.. A. Seattle, WA 98101.338
www.pscleanair.org
'NOTICE OF INTENT
F•:d
Data Bet civcd D`1 y
•tome: Use Only
A. Prniect Tenet 1. ❑,.,1'rinb_ le Ashcstas Rerrjovnl 2. d Frighig Al �o Removal & Q, mofitian 3. Demoliti f?nh
Proeerty Owner Doak homes In Phone: X06
rt * v —
�i inc 4��: mss: :161 6th Ave SW ci,. 8urien stste WA , z,a. 9816 I
�..+....
;4Stre5t05
Contractor:
%•t,.ilin2 Add 'J.C1. B oy 51005
�c Se attle
rllment Construction L.L.0 I OwnerlCE John Ass efin.
r �tmtrzcto.
Phone: (206) . 523 1 -4 44 1 - lob No.:
Sta(z WA Z i :9$108 -idO Fax: (.'- 6) 522-4099 i 5495
D. Site
A ddress : 1162,0, 11633, 1 East Marginal Way South
site
Dar �tanart:r Doak
City Seattle I Zip. 9F.68
[Local Phone: 206.372,2280
}w iu soestos `aurvev or No o
.7 1 Presurn J. StMtCt!1rcL. - -
A1-tE',',A Building
. r... lnspr,:tor; C3r......i vst
.In ANERA av rvcy rr nJl dundintirr p•
I F. Demolition Stan
1 Information-, Oatc; I BD
I Den :Uiltit}n JnTUr1 JJ,nOirrmp rontrctctar'1
Conuamor: Carryl Doak
Data cf Asbestos I Was Friible Asbestos Identitted'? I,.;1 a MN-,v !
Sttn,e• 1i -2-05 -1 Was Nonfriable Asbestos Identified? 9� es CINo
%eriificuion a:: attach a copy 'o the ;amr>> tivhen.6itsble 2snesJ0s
6x a 1016845j.1i- ?7 -t: +6 hos no beer. iden4 ied. l
o! k . tJr No. of :. 7 - ining Firc (List Fire Dttpt.)
� _ Structuces: ?. Ordered Dernolkior. (att'aeh copy of rde- ' 1
_7
ngaddre.rsan bo -m Wili nonfriable asbestos be let} in place during demo? Yes No
i If yes, list type and qty. Note disposal regArements in St.p 6 (on back).
C. Friable Asbestos
— Project Info rmation:
i ota, Vt�-. to be F ern•oved:
! i1u4l;:6Ft: l sulatiort t
I � :nt Eostd :;rsrtent
- - - - Work Days: JA it W Tilt It Sa Su
Start Date: Completion Date: Hours:
Will all friable asbestos 0 �'es
Linear Ft. S t:arc Ft. r,_teria!s be removed Q No
Duct I nsulation _Pipe Mutilation U Fireproofing Paints Ul Plaster - U T c:c , .t:red C:owings
Pipo Frt� 'able Floorlr,R W Friable Roofma MarerW Other:
H. AshestostDemolition Project Categoriest )_1otincation.Per•ied Project Demolition
!, aingla•Fnmily Residence (owner - occupied;: _Fj c Surcharge
A. C1 Asbestos Removal Project Only A• Mor Notice A. $25
B. 0 Demolition Projecr (with or without asbestos removal project) B. 10 D ays , 8. s5o
• ! Asbestc, removal can be>_t r_ ueon notitIcation: d emolition must wai: 10 days'+
vtc: 1J'lhe sia le,amdly residence is owned by one j' rmily ►rho ;has been or,will be using the residence as their domrci!ethe above beers S
l: t ar 1 may bu checke4 If this is not orr owner - occupied residerce, one of the categories //sled below mast be used instead..! single
!2niily rr_eic doer nor lrrelade renlel nroam+rry »nrltl.&Mily unite rrr nHV .++rn•� use .bui /dine_ ��•-"j=
Z All Other Demolitions (with no Asbestos removal or Nonfriable Asbestos 1
10 Days - - j — — - -- I
IQ ( I
1. t txrtfv 1 it I! a i r1*0mQuaa acn-•, t n 04 ncuficw.ion d: sup ^lemcntnl lots u, to 6c ! err of m k ca
y Moukdae, ac :ur� do rn�lato. Age 7 se Qn1
/ f / Am_ erican Enviro Construct L.I.C. -^ 111•23-0 -&Cl , o--
SiynQU:re ^ Recrttrnrrnp Dore
Pusct 5r�,n:l Cleyn ,�,' h>;c;cv cane Na. E6.16t) (Batiste JOB) TS
RECEIVE
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Dec 08 05 09:52a American Environmental Co 200 522 4099 p.2
�^ f L Job Numb 5 55 -1
Labor and Industries NOTICE OF
.Industrial Hygiene Compliance ASBESTOS ABATEMENT
(Regional addresses and phone M, -
N
H
numbers on page 2) "" PROJECT
Today's Date Nov ember 28, 2005
THIS N0; ICE MUST BE RECEIVED NO LATER THAN 10 CALENDAR DAYS PRIOR TO-THE START DATE
COMPLETE ALL APPLICABLE BOXES - INCOMPLETE OR ILLEGIBLE NOTICES W ILL NOT BE ACCEPTED
MAIL OR FAX TO THE RE, GIONAL OFFICE - CIRCLE CHANGES ON AMENbEf) NOTICES
Notice date: 11 / 18 i Q5 Ini I ❑ mended ❑ Site Work Hours Su Mo Tu We Th Fr Sa
Start datc: 12 /07,'05 On old Q Off Hold 0 8:00 am am X X ; X X X
Completion: 12 / 31 105 Emergency 13 pm 4: p m Project Dates and Were Hours must be Exact
CONTRACT
❑ Indoors Q O utdoors
❑ Fir
PROPERTY OWNER
Company Name
❑ Popcom ceiling
Name
Neg. pres. enclosure
American Environmental Construction LLC
1 Q CAB
Doak Homes I
- -
Contrac r Certification Number
r ❑ Sheet vinyl
❑ Asbestos paper
Owner's Agent
❑ Mini enclosure --
❑ Critical barriers
1338
Q uantity linear feet
Darryl Doak
✓❑ Other Regulated .area
i ur
❑ Cement asbestos pipe
Company
-~
'
[]✓ '/, mask APR
Doak Homes In
d Name i
❑ Duct tape
Address
— _
ura Bell
❑ Other,
11812 26th A
SW
P hone Number
1 (206)523
laity
_
State ZIP +4
- 4441
Burien
WA 93146
Job Site C.A.S.
Phone number
I
John Asselin
• (2 06) 3 72 -228D
JOB SITE
FACILITY - - �
Address
Type
11620 East Mar final Wa South
Residential Structure
Building Name
Room
Age Size
4 0 Years n/a
City
Seattle WA
WA
✓' Remodel ❑ Demolition
❑ Repair C1 Maintenance
ZIP + 4 County
` 98!68 King
QUANTITY OF ASBESTOS TO BE: REMOVED [] ENCAPSULATED
[ Quantity 310 s quare feet
❑ Indoors Q O utdoors
❑ Fir
❑ Boiler insulation
CONTROL MEASURES
❑ Popcom ceiling
❑ Duct paper-
Neg. pres. enclosure
[] Wrap & cut
1 Q CAB
0 VAT
❑ G lo v e bag
Q Wet methods
r ❑ Sheet vinyl
❑ Asbestos paper
0 Roofing
❑ Other
❑ Mini enclosure --
❑ Critical barriers
Q - vacuum
V M anual m ethods
Q uantity linear feet
❑ Other _
✓❑ Other Regulated .area
[] I4ag. pipe insulation
❑ Cement asbestos pipe
RESPIRATORY PROTECT
❑ Air cell pipe insulation
❑ Mu dded pipe ins.
[]✓ '/, mask APR
❑ Type C contin flow
❑ Ducting/duct insulation
❑ Duct tape
❑ Full face APR
❑ Type C pressure demand
❑ Other
❑ Other,
❑ PAPR
❑Other
F413. 025 -COG notice cf asbestos abatement project 11-0 1
For clean copies go to ht1p:! /www.lni.wa.gowfornts1
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NIOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEARfiHAN.
THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT.
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER D05 - 399
PROJECT NAME:
SITE ADDRESS:
DOAK HOMES
DATE: 11 -09 -05
11640 E AST MARGINAL WY S
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # After Permit Issued
DEPARTMENTS: hVI
Build E ion
i
P ublic Wo
11 1Q r
Fire Prevention
Structural ❑
P 4P ll-
Planning Division
Permit Coordinator ❑
DETERMINATION OF COMPLETENESS (Tues., Thurs.) DUE DATE: 11 -1 0 -05
Complete ❑� Incomplete ❑ Not Applicable ❑
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES/THURS ROU ING:
Please Route Structural Review Required
REVIEWER'S INITIALS:
❑ No further Review Required ❑
DATE:
AYYKUVALN UK % —UKKtL I IUN!)
Approved ❑ Approved with Conditions
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documenlshoutir% slip.doc
2.28 -02
DUE DATE: 12-08-05
Not Approved (attach comments) ❑
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Look Up a Contractor, Electric - or Plumber License Detail
Washington State Department of Labor and Industries
General /Specialty Contractor
A business registered as a construction contractor with L &I to perform
construction work within the scope of its specialty. A General or Specialty
construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
License Information
License
DOAKHI *092NZ
Licensee Name
DOAK HOMES INC
Licensee Type
CONSTRUCTION CONTRACTOR
UBI
601329337
Ind. Ins. Account Id
58243002
Business Type
CORPORATION
Address 1
11812 26TH AVE SW
Address 2
Impaired
City
SEATTLE
County
KING
State
WA
Zip
98146
Phone
2062466587
Status
ACTIVE
Specialty l
GENERAL
Specialty 2
UNUSED
Effective Date
8/9/1991
Expiration Date
8/8/2007
Suspend Date
1 CBIC
Separation Date
08/01/2001
Parent Company
Previous License
DOAKH* *10605
Next License
#3
Associated License
Business Owner Information
Name
Role
Effective Date
Expiration Date
DOAK, DARRYL E SR
01/01/1980
DOAK, ESTRELLA M
01/01/1980
Account
r-�
Bond Information
Bond
Bond
Company
Account
Effective
Expiration
Cancel
Impaired
Bond
Received
Bond
Name
Number
Date
Date
Date
Date
Amount
Date
Until
#4
1 CBIC
SC9910
08/01/2001
Cancelled
$12,000.00
08/01 /2001
#3
CBIC
SC9910
08/01/2000
[ :08/0 1/2001
$6,000.00
Pagel of 3
s:// fortress. wa. gov /lni/bbip /printer.aspx ?License= DOAKHI *092NZ 12/08/2005
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