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Permit D05-401 - DOAK HOMES - DEMOLITION
DOAK HOMES 11640 EAST MARGINAL WY S D05 -401 Z W 6 J U:. O 0 co W =' W LL W 0 u Q D. • d. �_ Z F— O Z F- LLI UD .0 1— Lu - U. � H` - O: W ..Z — O. • Z City o. Tukwila S teven M. Mullet, Mayor Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: ci.tulavila.wa.us DEVELOPMENT PERMIT Parcel No.: Address: Suite No: 0733000030 11640 EAST MARGINAL WY S TUKW Permit Number: Issue Date: Permit Expires On: Steve Lancaster, Director DOS -401 12/08/2005 06/06/2006 Tenant: Name: DOAK HOMES Address: 11640 EAST MARGINAL WY S, TUKWILA WA Owner: Name: CEDAR GROVER PROPERTIES LLC Address: PMB 262, 3213 W WHEELER ST Contact Person: N Name: DARRYL DOAK SR Address: 11812 26 AV SW, BURIEN WA Contractor: N Name: DOAK HOMES INC. Address: 11812 26 AV SW, SEATTLE, WA Contractor License No: DOAKHI *092NZ Phone: Phone: 206 - 246 -6587 Phone: 206 246 -6587 Expiration Date: 08/08/2007 DESCRIPTION OF WORK: DEMOLITION OF OLD HOUSE AND REMOVAL OF ALL DEBRIS AND DEMOLITION OF 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 Flood Control Zone: N Hauling: N Land Altering: N Landscape Irrigation: N Moving Oversize Load: N Sanitary Side Sewer: N Sewer Main Extension: N Storm Drainage: N Street Use: N Water Main Extension: N Water Meter: N Number: 0 Start Time: Volumes: Cut 0 C.Y. Start Time: Size (Inches): 0 End Time: Fill 0 c.y. End Time: Private: Public: Profit: N Non - Profit: N Private: Public: Z Z z �w UO CO Lu J = H CO LL .w O 9 -1 LL ?. C0 d = W H Z �_O Z r_ W �o U O� 0 f_ w W LL O w z U =: O~ Z doc: IBC- Permit D05 -401 Printed: 12 -08 -2005 City 6. Tukwil Steven M. Mullet, Mayor Departmeitt of Commui ity Developmei :t 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206- 431 -3665 Web site: cOukwilammus * *continued on next page ** Steve Lancaster, Director doc: IBC - Permit D05 - 401 Printed: 12 - 08 - 2005 : Z QQ Z " u� D _3 C.) U O: CO) D W =. J SO U WO � Q _ CY. H W Z F- O Z F- WU D p. U CO. :O C) W UJ LL 0 111 Z . U =� O Z I+ �N r 1908 Permit Number: Issue Date: Permit Expires On: Permit Center Authorized Signature: Date Dy LD I hereby certify that I have read and x mih this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. City o. lukwila Department of Conunui :ity Development 6300 Southeenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206- 431 -3665 Web site: ci.tulnvila.tiva.ns Steven M. Mullet, Mayor Steve Lancaster, Director D05 -401 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 construction or the performance of work. I am authorized to sign and obtain this development permit. Signature: Date: Print Name: 7)1>41C — j'R 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 D05 -401 Printed: 12 -08 -2005 Z 1 Z W WS S UO CO 0 co W J = !r N tl W O 9 E L? � = W Z E- O. Z F- U� O U) D I— W �O tai co U N, p _ O F- Z i I�VILA, _ 0 • C t of Tula it w a Igoe Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 PERMIT CONDITIONS z Parcel No.: 0733000030 Permit Number DOS-401 W Address: 11640 EAST MARGINAL WY S TUKW Status: ISSUED j Suite No: Applied Date: 11/09/2005 v Tenant: DOAK HOMES Issue Date: 12/08/2005 0 0 U) UJI J = 1: ** *BUILDING DEPARTMENT CONDMONS * ** LL w� 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. CO D 3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to = w start of any construction. These documents shall be maintained and made available until final inspection approval is Z granted. — 4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary ZO g 5 sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other o excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of p C0 this requirement. W 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 presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila w z shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the v = O ~ Building Official from requiring the correction of errors in the construction documents and other data. z 6: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * ** 7: 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 -401 Printed: 12 -08 -2005 I �...Q C ity o f Tukwi l a CO Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Z Z �w u� 5 3 0. U) Ui N ~ W LL a` �d H= z �.. F— O Z I--. IIJ W U � O N. W UJ u- O ui z U CO! O H Z 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: / - R-Os Print Name: ZJ mac- C i doc; Conditions D05 -401 Printed; 12 -08 -2005 s .01A CITY OF TUKWILA' . Community Development Department Public Works Department Permit Center f 906 f 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 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.; * *Please Print" :SITE,OCATION King Co Assessor's Tax No.: 6,7 3 X0 0 Site Address: j/ tG 1 (0 A;i'_ 1-1VW i.?" 561- l Suite Number: Floor: Tenant Name: /0 0/t - I - e_ New Tenant: ❑ .... Yes (. ...No Property Owners Name I if Q� Xa�1el s fet_i'E:.= Mailing Address: 7X bf7e 5, rr e_,-?> City State Zip CONTACTPERSON Name: V . � -� Ss^ . Day Telephone: g o 6 z y G E Q-- Mailing a E -Mail Address: City State Zip Fax Number: 7 , y6-- ,5"9 GENERAL`CONTRACTOR INFORMATION (Mechanical Contractor mformAtion on back page) Company Name: - Jd!-tK e S 1,C , Mailing Address Z g /"1 - 6 1 /2-0 2. cJ City ceZI 2 o6 3k `3,1t12 — C Contact Person: y� �. / a- , Day Telephone: ;?_C)& el ;`7 E -Mail Address: Al Fax Number: U Contractor Registration Number: DO#/'�/V Ic M2 A17- Expiration Date: ©r R 0G' - 7 * *An original or notarized copy of current Washington State Contractor License must be presented at & tide 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 - All plans must be wet stamped by Engineer of Record Company Name: Z/ / �' �g tw eet -.Ark A cv Z ,0 " o "S 4, e0 t //-'y a ! /V Mailing Address: �,� l� os 5� �� (,ti��� in9 U I Ile 12 C / ?6 JZ City State Zip Contact Person: ?J J19 G y � C /7 Day Telephon& 4 0 : E -Mail Address: A Fax Number: 4 / q:k%p=its phuVcc chsngesIpertnil application (7.2004) Revised: 6.9-0S bb Page l n.n.v •+. r�¢ �rrnnra. �. �,.:; ggveafi' M+ 11MtufaMCnR�+. i, 7J�s Tt+' .�rtuN^�+'e�YaRMri:!MmRats!+n!,+k � Z W tY 2 �U UO N J = H NLL WO L¢ U� = �W Z F- F- O Z F- W U O� 0 F- W H W Z U= O Z BUILDS OR�YtA ION LX06= 431,3670 t Valuation of Project (contractor's bid price): $ 5 DG�G� Existing Building Va ion: $ Scope of Work lease provide detailed information): —1 P (P P � m Will there be new rack storage? [:]..Yes 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 Existin Remodel Structure New pet IBC IBC V Floor o0 2n Floor Vfloor: - 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 ova 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 ;Ell-No 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? [:1 .. Yes ❑ .. No If' yes ", attach list of materials and storage locations on a separate 8 -112 z 11 paper indicating quantities and Material Safety Data Sheets. gA\pcnnits plus %icc changes\permit application (7.2004) Revised 6-8-05 Page 2 gam, b Z '~ w D J 0 N CO W J = l— �U_ w 1�J W? N = W H Z� l— O Z F— W D U ON C3 I-- WW HF_ �- O Z W U= O Z P l imt•WORKS.PERMIT INF('RMATION' 206 = 4330179 y 4 _ Scope of Work (please provide detailed information): '.f Call before you Dig: 1- 800 - 424 -5555 Please refer to Public Works Bulletin #1 for fees and estimate sheet. Al .. Water District ..Tukwila .. Water District # 125 ❑ . ❑. Cl.. Highline ❑ ...Renton ! i ❑ ... Water Availability Provided 'j Sewer District ❑ ...Tukwila E] ... Va1Vue ❑ .. 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 ") 1 ❑...Technical Information Report (Storm Drainage) ❑ .. Geotechnical Report ❑...Traffic Impact Analysis l ❑ ...Bond ❑ .. Insurance El.. Easement(s) ❑ .. Maintenance Agreements) El ... Hold Harmless Proposed Activities (mark boxes that apply): ;, ❑ ...Right -of- -way Use - Nonprofit for less than 72 hours ❑ .. Right -of- -way Use - Profit for less than 72 hours . ❑ ...Right -of -way Use - No Disturbance ❑ .. Right -of -way Use - Potential Disturbance } ❑ ...Construction/Excavation/Fill - Right -of -way Non Right -of -way [...Total Cut cubic yards ❑ .. Work in Flood Zone ...Total Fill cubic yards ❑ .. Storm Drainage `� ❑ ...Sanitary Side Sewer ❑ .. Abandon Septic Tank ❑ .. Grease Interceptor ❑ ...Cap or Remove Utilities ❑ .. Curb Cut ❑ .. Channelization ❑ ...Frontage Improvements ❑ .. Pavement Cut ❑ .. Trench Excavation ❑ ...Traffic Controt E].- Looped Fire Line ❑ .. Utility Undergrounding ❑ ...BackfIow Prevention -Fire Protection " Irrigation " :{ Domestic Water " j ❑ ...Permanent Water Meter Size... WO# ❑ ...Temporary Water Meter Size.. WO# i []...Water Only Meter Size............ WO# ❑ ...Deduct Water Meter Size ........ ❑ ... Sewer Main Extension ............Public Private ❑ ...Water Main Extension ............. Public Private 4!�q 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: Ci State Zip Water Meter Refund/Billing: Name: Day Telephone: Mailing Address:: city State Zip q:llpermits plusticc changcstpermit application (744) Revisal: 6 -4.05 bh Page 3 14 Z iF- Z �W �U UO W= F- NLL WO LLQ D� = �W Z t-- Z� W W U� ON o1-- WW 2 f- H U. O 111 Z U= O~ Z c MECHA .NICAL`:PERMIT,INFORMATIOhI 206- 431;3670 ` MECHANICAL CONTRACTOR INFORMATION Company Name: 1 ��PJ�i Mailing Address: f ,� r Contact Person: !K E -Mail Address: Contractor Registration Number: 14 * *An original or notarized copy of curre Washing Valuation of Project (contractor's bid price): S Scope of Work (please provide detailed information): —' City Day Telepx State Zip Fax N ber: ;Dy Ex ration Date: /0 = �S State Contractor License ust be presented at the time of permit issuance ** � J Use: Residential: New ... Replacement.. . Commercial: New .... E] Replaceme ..... ❑ Fuel Tyne Electric.....❑ Gas..., er: Indicate type of mechanical work being installed a9d the quantity below: Unit Type.' Qty Unit Type: Unit Type: ' Boiler /Corn pressor: Q Furnace <100K. BTU Air Handlin nit >I0,000 Fire Damper 0 -3 HP /100,000 BTU CFM Furnace >100K BTU Evap oraldr Cooler Diffuser 3 -15 HP /500,000 BTU Floor Furnace Ventil ion Fan Connected Thermostat ( r \-30 HP /1,000,000 BTU to S' le Duct Suspended /Wall /Floor )�"` ti lation System / Wood/Gas Stove r 30 -50 P/1,750,000 BTU Mounted Heater Appliance Vent Hood and Duct Water Heater 50+ HP /1, 0,000 BTU Repair or Addition to Incinerator - Domestic Emergency Heat/Refrig/Cooling Generator System Air 1llandling Unit Incinerator - Comm/Ind Other Mechanical <I0,000 CFM Equipment PERMIT A ,LICATION NOTES ApplipableAo all permits in this application a 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 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER j PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. i BUILDING OWN OR UTHORIZE GENT: Signature: G 6 Date: � ce/ Print Name: c)y'? , ee, ( �l),�,�� �'.f -e Day Telephone: 2 O6 Mailing Address: 1 1 Z 2 - .2 6 Z A-r� ,Y 5', r_.() 1 ra v^f PiV �•(� I� �; ?/� /( City State Zip Date Application Accepted: Date Application Expires: Staff I tials: q.Upermus pluslicc changcApermit application (7.2004) Revised. 6."S Page 4 bh i I� Z J.- Z W aa JU UO CO CO W W = CO LL W } O } �J U_ Q N = F- W Z� F- Z� W � p U ON 0 l- W F- W Z 111 U= Z �J�W1LA, �'9S 4 J G) W tf�� ti �2 1908 Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 -431 -3665 SET RECEIPT Copy Reprinted on 12 -08 -2005 at 12:06:32 12/08/2005 Steve Lancaster, Director. RECEIPT NO: ROS -01756 Initials: BLH Payment Date: 12/08/2005 User ID: ADMIN Total Payment:628.00 Payee: DOAK HOMES, INC. SET ID: 1234 SET NAME: DOAK HOMES DEMOS SET TRANSACTIONS: set Member Amount D05 -398 107.56 D05 -399 107.56 D05 -400 107.56 ggtt���Q Qlz,!a 107.56 D�5 -402 90.20 D05 -403 107.56 TOTAL: 628.00 TRANSACTION LIST: 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 �' ...ate+ ,�.�'..�� J( "'h� le•ZM � z W JU UO N W = f N LL w 0 9 - L? � =w F- O w ~ W U� :0 N 0 F- w L —0 w z U= O z �. City of Tukwila lace 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 RECEIPT Parcel No.: 0733000025 Permit Number: DOS-401 ' Address: 11620 EAST MARGINAL WY S TUKW Status: PENDING Suite No: Applied Date: 11/09/2005 Applicant: DOAK HOMES Issue Date: i i Receipt No.: R05 -01637 Payment Amount: 66.99 Initials: SLH 'Payment Date: 11/09/2005 01:48 PM User ID: C 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 Z Z �W a � .3 C.) UO w 0 w= J S2 LL WO LL LLQ = CI �. W Z H O. w Ljj U� O N D 1— W U ll. ~O. .. Z W U= O F- Z f INSPECTION RECORD Retain a copy with permit INSPECTION N0. PEP643 CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (2 6 Project: Type of Inspection: 1 -7 j Address: �l O �&4 Date Called: Special Instructions: Date Wanted` p. m Requester: Phone N +- `it"�J Receipt No.: Date: Z �Z W JU U O o W= I` �LL W O 2� J U- co d = H W. _ ? f- Z O W �5 U� O- In I-- WW Ir— U LL. ~O �Z U =. O Z ` --I paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Sout,hcenter Blvd., #100, Tukwila, WA 98188 (206)431-3670 R oject- T f I Pection: Approved per applicable codes. Corrections required prior to approval. 1-1 COMMENTS: I Inspector: 6,AJ — 7e;,4 , lob I I Receipt No.: I Date: $58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Z W 0 00 CO a U) LLJ LU x J �— U) LL 0 U. ?. co C, LLJ z 0 z �— W LLJ 5 co 0 Ir— UJI U J X U. LL lL z co O z Address: a j I U Iko py:�V' Date Called: "8y [ Ce Special Instructions: Date Want- 7 T - C? p.m. equester. Phone No, U ;Eo (k - q31 - 9 cQ '7 Approved per applicable codes. Corrections required prior to approval. 1-1 COMMENTS: I Inspector: 6,AJ — 7e;,4 , lob I I Receipt No.: I Date: $58.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. Z W 0 00 CO a U) LLJ LU x J �— U) LL 0 U. ?. co C, LLJ z 0 z �— W LLJ 5 co 0 Ir— UJI U J X U. LL lL z co O z INSPECTION RECORD 1 5 E Retain a copy with permit INSPECTION NO. t�' PER NO T CITY OF TUKWILA BUILDING DIVISION. 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Pt Type Vnrection. f Address: - Date Called: Special instructions: qAte Wanted: a.m. Requestef: M e No: f C� -g-Approved per applicable codes. Corrections required prior to approval. f: � r Z �~ W 5 JU UO ND C0 W J = �LL W O L N = W H = Z F- WO W U� :O N C) !— W W HL) ti O W Z U= O Z s Dec 08 05 09:52a American Environmental Cc 206 522 4099 �►,�RrcAry Environmental Construction LLC Asbestos - Lead - Mold - Demolition 0 Telly & Darryl Doak Doak Homes Inc 11812 26 Ave SW Burien, WA 98146 December 8, 2005 I Via Us Mail - -- Letter of Completion - -- (AEC Job # 5495) P.1 P.O. Box 81005 Seattle, WA 98108 - 1005 Phone: (206) 267 -0746 Fax: (206) 267 -0753 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 - 523 -4441 if you have any questions or comments regarding this Letter of Completion. E Respectfully submitted, America Environmental Construction, LLC I Bellows — Ad inistr� ve Assistant CITY OF T DEC 07 2005 PERMIT CENTER J)GG LI'D z Z �w QQ JU UO Cl) 0 . J = CQ LL w o LL Q rn D. = �w z rr- z O W w U o cn. o� =U O wz co O z 4 ��.. 1 t�. luu7 y 4 .111 rtPl ��ncwr����nic� i �� z,,..�., .�.. ._,.� 1j t- 9.. �.....� M • �y Arnerican Environment : ' `r Sam Data Sheet age: "� � Job Location: 11 , Zd I -& Z (G '� �' ��g, �W S Job.: SX14' S ampled By: 90 :9 _ Date: � � - Gt '7 - TFrne: •- - Count. MicrascWe Field Area: 91an Ce ssettes : Rate: SW ._._ Fibm gate: End _ biters rflefd Fibers Average L mple ID. Location: wjAQ Ty Work Activity: .� ! A Y Observations: � � _ Q Lion: `f�, Worker. fs'Q r 1? ' z- SSat: b Celt# Off ! - 1 q C) ; ,..�... Tune: Start r �g Hate: smrt - Z, a r:mont: #: Time: End : 0j R ate: End Z Fitters Fibers Liters bold /a ,.__.2.. Mnums _. _ Average 7 m N LO l u; � 'erometion' Decon: _ Environrrient Purnp #: 50 Wor Ac L : Observatio A 1 I Worker. SS# - Cerw. -- Time Stare Rate: Start f z 1► tend f ; l,� Rate. End f M Fibers Fibers Liters /cc /cc Minutes = Average 11- Up .�� ple 1'0: YB Sp Ty C pecan: Environmenr� Hump t �0-� Location; 6 1 L work Activity: Oborvations: Worker. ---- • ---� -- 11me: Start 2,: Tait: End Minutes c SS#. Gert# Rate: Start / - Z Rate: End Fibers Fibers f Z Liters A Id /cc Smpla ID: 5 _ Location: - tC Sarnpte T ype: Work Activity: j -m Protection' demon: """. ObseN�itl0nS: � I / (�Iezi me: �r�`(Z{ � Worker. SSx: r90: Environment Pump #: ! Time: start �:.?� �' Time. End y Minutes = Rate: SW ._._ Fibm gate: End _ biters rflefd Fibers Average ° - Bitaftog zone A - Pts Awtemrit - CeArto ' CL - Gears= �i� • Irside Area H - HePA Exhauk 0 - Outside Are* HL - IGeM Blank b�rNCyd N - Hag Mask APR F - Ful Pam Mask ADR PAPR C4 - CoOnuaus Flow AIr PA - Presoute0era"Ak t7.S- Ovcon wi Shower H • KPA Vacuum O - r)w-n wfo Shower G • Giove* 1E - % i sliclosure FE - Kul! Z+nrlos%n AI �#(d r' P, . � I V L z Z �W dd JU UO U W = CU. O WO u- rn D 2 �W z� WO D0 U ON OH W �U u- 0 w z L) CO P_ O z Li UU ua uu: c98 rimer 1 can t_n 1 ranrnenta 1 l.Q CUb Ded 9•Uby , 5 A. .0 ►V. . Lvvi 'f. /LI 11v LAUVMIV1 %1L'J Iity uv. jJIL I . L America Environmental : "I Sam D ata Sheet ; - ��a «:, Of Job i.ocation1 �s f �� � !� C: uA l Ja #: r V175 Sampled ey: Fr A Date: 1 Z -07.. ~j 'rime: _._.... _. -Mank Count: Microscope Field Arcs: Bla Cassettes: -j Location: $ rr zd 0 Type P Work Activity: Q Actier %t, Observasti �,� o� 1 02 - ` ll C1 Tr Worke, SS#: CertlF: H � ronment: Time: Start g ., ? 9 Rate: Slant i U Fibers Fibers time: End . Rate: EP4 /0 Liters ftid I= e�- Minutes = Average /p &WILI Sample Type: A 2F1 Protection �fZ Decon: Ernrironment:__1�__ Pump #: 6 Location: OSF Work Activ � iz2t t?bseryatio ���..... Wormer - Time: St art Trine Er)d ' Min a rC / SS#: Rate: Start / b Rate: End l Liters Average f (� Firers Fibers !field lot Pie ID; 3 Location. Sample Type: VbrkAc lly: MOUTA •�� v '+ •`�� 1.� ,Ooi2 Protection: Observat1ons: y . .. _goy Decon:_ " YVorker Ad V ru Ai? A A, SSA Gertk: / T i me : St Rate: Start Z Envitnnrrtent: • z& — Fibers Fibers Pump #:_ j TI � Rate: En d ,,, Liters Maid /CC Mtnutas = Averag Sample IU:Stl Location: �cJ SE• ��to 3 �}' CJti /* �.. Sample Type: aeFjg Work Activity: - wr lr�• rn, >< c it-r .�.� . . _ Protection: Ob servations; )9 Nei S _ Decon: Worker. - SSO: ---- -- ---- -- Cert,* - . - . _.�.. Environme Ti S tar t ,�� Rate: Start Time End Ra te : End Fibers Fibers ' Fump * 50 f 2 5L $ Liters !field /cc } Minutes a Average �. 1 a • emathim Zono P . PivAbsUff nt RY a igz ION r►nn� ,,aaKti r�r - c4d1ty Ck- Clearance M - HallMalkAPR D.S. Dewnwi$hvwer H - HE'AVncvum `1 - huside Anne H 1 - HEPA ahaujl F - Full Flrob Mask APR D - Decon w/o Shower G - GiovatIag 0 - Outilda Aroe BL - FIlld Blank PAPR ME - KM i:nciowre CA - Contlnuous Fk = • FuP Enclosure .•�r PA - Pmsvrn DrvwV Air III ik+ + �+� ;'Jr� �:... ::. v:.... w.:.« a. t. cu.• sa... z:±:;: w: s... aau� :�.�3as+'.+�:<:t.G�.ta...._G �:, ;luJ»uw•�:.JaL:c:...:+i:W'u'.v ,3,'i..i�.:.iCyr �.�Sjo'st: Z �z �w 6 2 D UO to 0 CO F— �LL w J LL CO D = w ZO w Uj �O U 0 F— wW F=- N LIJ Z U) z Dec 08 05 09:53a American Environmental Cc 206 522 4099 P.4 549 AS N 4 ASBESTOS WASTE SHIPMENT 1R FP0RT' F'0% %1 Fro PLEASE PRINT OR TYPE! If you have questions, conmc: your local DEQ Regional Office in Portland at ( 229- a a 5364, Salem at (503) 378 -8240 ext •272, Medford at (541) 7 ?6.6010 ext. 235, or Bend at ;541) 385.6146 ext. 226, OR call (800) 452 -4011 for the location of your local regional DEQ office. WASTE GENERATOR: (Cuntrnctor, Fac"lity, or Cip- rator) t S. Transporter # 1: (Acknowledgment of receipt of materials; I . Asbestos removal site name and address Doak aiornes -Darryl Doak Company: D&B Trucking Address: '1905 East Lincoln Ave., T000me, WA 99421 Phone: 26 -383 -3860 416 20, 11638, 11640 E. Ma rgin _q �y South Seattle WA K ing — 9 E3168 - ^ Street Cit}vState County Zip Phone: g53. 363 -L8t30 Ccntact person: Darryl Doak _ Phone: 2 06.246.6587 DISPOSAL: (Certification of rcr.cipfof asbestos materials covered by this manifest, except as noted in item 11 bolow.! 2. Operator's name and addresv American Environmental Construction LLC _ Phone: 206- 267 -0146 fDtate: r , Signature: — 7417 -4 Avenue South Seattle, WA King 98148 Street OwState County Zip 3. Waste disposal site: Northern Wasco County Landfill Phone: 541- 993 -CC89 2550 Steel Road The Dallas, OR Wasco _ 97058 _ Street CitylSwte County 'L;p 4. Describe asbestos materials: lf0 1nA5' % I C.- lur J�?bE 1 el>,� 5. Containers: Number: 9 Aa i r �a, p5 _ 75d l h5 Ty pe: 6 'Total quantity (cubic yards): Z y d� ✓ - 7 . PERATOR'S CERTIFICATION: I hereby 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 respezts in proper'condition for transport 3ecarding to all government regulations, All movement of this asbesws- containing material is recorded on this Waste Shipment Record Form. Name: _Z Signature. LC TRANSPORTER(S): S. Transporter # 1: (Acknowledgment of receipt of materials; Agent: Company: D&B Trucking Address: '1905 East Lincoln Ave., T000me, WA 99421 Phone: 26 -383 -3860 Signature: Date: 9, transporter 0: (Acknowledgment of receipt of materials) Agcnt: Dover C om p any: NTSI 1 D&B Trucking �ddrnss: '• 905 East Lincoln Ave.. Tacoma, WA 98421 Phone: g53. 363 -L8t30 Signature: Date: DISPOSAL: (Certification of rcr.cipfof asbestos materials covered by this manifest, except as noted in item 11 bolow.! 10 Waste Disposal Site: Northern Wasco Co unty Landfill Name and Title: _ ,_. fDtate: r , Signature: — _ Phone: 11. DISCREPANCY SPACE: (Add anuchments us needed) _ _.•� (Rcvis:d 0, "ti'. .1. i.. ,,i.;, t;, ,.,'�r 'u- 4.,x�:.�x d.;.r.yu u.,ry..J:. • �i�::: �i�,. t1t'' � .�n;�N.Y.¢.u.rJc�'L+�. :s : :'. ULin.;:ii:�,7n"`'.G4�. "; �:linw�i ua'..." ab.- :r� ;d;.•Y�? :Skw «��.2e �, �4:... iN: ����. �+ w :F�.;a�.u�..3�_+.t�:dxt`N:ll;,t, Z Z �W UO D W= F- NLL W J LL j N = W Z f.. ZO �5 U :O Cl) 0 E- W _ F- H U- O . Z - W U= O t-- Z Dec 08 05 09:52a American Environmental Co 206 522 4089 P.3 r Agency Case No. SOiJi•JD CLEAN Agency ~ Data Re.eiv � ! AGENCY 200503701 1 10 Union Street, Suite 500 :. ��e- :,i�t Seattle, WA 98101 -2C33 www,pscleanair.org , t ` i dgane? Ul.: Owy Nt �Tl�� a� �T�` 1 .Igeme, We or /y 1 N. Project Tvng: _j. 0 -F-rinble Ash"- tat Removal 2. d Friahll A!ibes ReMnval & -M o ition 3. Uerrfaliti t}nI� R Property Owner D oak Hom Inc _ _ [ Phone: �06 .2 , 16.658 7 _ F M76ina.Addrnss: 11812 26th AVe SW V Icity: Burien .. � _ (state W A Z.iu. 98146 1' ac% 'am l�i,L;,!! C. Asbestos Centrnctor: Arnerican En viron ment al Coi LX _ o.yner/C.L J Ass elin �� ;:ontrac :or f 1 t ii :112 Address:_ PI Z). BOX $1005 Phone: (2C6 523- - lob No.: C.rv: Se attle Staff: WA Z i :98 1Q$ - :OCS Fax: (!C6 522 -1099 ; 5` 95 ; 08- 0. Site + Add r,«: 11620, 1163$, 11640 East Marginal Wa South �;�,. Seattle j z ip, 1 ._....- . _ t +tc Manarcr. Darryl Doak Lot al Phone: 206.372.2280 F .A Sooestos 5ur,'a�� or !! \o u; Date of Asbaero5 Was Friable Asbestos Identified? ! zs Q1 7 es Mat'l Prorttcd i Sln t ttlres: Sum�e:�_ _ 1 - 2 -05 1 Was Nonfriable Asbestos Identified? 9 cs ON AlIERA Building Certification 4: .4ttach acopy of the survey wlrznftiahle z he mos 1 ln.;pector: Carl Dy lestra -F-x . Date. 1016645(.6- 2* -C- has trot beer, fdent;6ed. 1 .t 1 . A ER{ o vrvcy a nq utrrd boors all de mcdam" p.. -vpe s F. Demoli :ion Start , TBp �/ of e er No. of 1. Training Fire (List Fire Qfpt.) i Informati i Date: rx�+ I Structures: 3 T Ordered Demo!aiar, ( atlarh eoo�� or o rd l Den :oaiion /WLr daM01111011Contractor's ntadtnraddreuaf bate, '1' Wili :ionfriable asbestos be left in place during demo? U Yes a Vo i Contractor: Darryl Dcak ! If y etI. list type and : Note disposal req tirements in St:p 6 (on back). C;. Friable Asbestos I Work Day;: i Sa Su Project Information: Start Date: Com letion Dat e: Hours: Will all friable asbestos U 4 i . Tots' 0m-. to be Rcrroved: Linear FL Square Ft. m terials be removed? Q No i LJ Dud;:r Insulation Due: Insulation i'Ipe Itsulation U Fireproofing U Paints LJ Plaster LJ T extured Coalin&s :nt Eoard Ll ;,crtcot Pipe Friable FloorinR Friable Rooting Mactrial other: + Ire. AVIL tosruemontion rrolect e:ategoriest Notification Period Project Oetualltion I 1. i1n,Ie•Fnmily Residence (owncr•occupi Lee � e Surchsre A Q Asbestos Removal Project Only A. ?6or Notice A. S25 S. Q Demolition Project (with or without asbestos removal project) H. 10 Gays" B. $50 j i--- •'Asbestc, removal c:tn bevin upon notitIcation: demoiition must wait 10 daysl _ J ote. /f (he ,, Iagfe fi rmdy residenca is owned by one faml4y ►rho .'hai' been or,-Pill be using the residence as their domici!e, the above 6axes d or 18 may be cAe6wci If this Is noe ast owner - occupied residence, one cf the categories listed below must be used instead Z single ';vnil asidance does net ,rtclude rental proverry midti- familt units, or an mixed. use buddin j 2. All Other Demolitions (with no Asbestos rcatovat or Nonfriablc Asbt tats lU Gays + uwv or 1• - ;s mart it) nnear Ices ana/cr ou square test of triable Asbcstas) j friable Asbestos Projects (other than Sin F amily Residence - iy Asbesto Demo L 3. U ! 0 - 259 linear .feet end /or Z 48 - 159 square feet of asb osto; I Friar Notice 10 Dws 3 100 4. 'J 260 . 999 linear feet andlor 160 •4.999 souara feet of asbastos fM > 1.000 linear feet and/or X5 .000 53 11 ITC feet of asbestos + 10 Days ; 10 Days X20 I S610 SI00 S! 00 i 6. Emergency Asbestos Project or Emergency Demolition Project i — tSinale.J"nm+ly Kevden:cs arc exem 1'r,rn emerrerov fee: h owevLn. property ati-,ntrs rou a raride : Prior Notice Hrtten errIM rcGt esa $SG = mergency Fee. ' Z . 1, 1 com f it the +rl'orrmuon con =1 c n this uctlGca:io:t d: sup ^Ietm:otnl dQU u, to Lse bat ei m} 0'0%414dge, Age .y 'St Il / -7 ' _ �J Arn erican Environ Construct L.LC � �? . 23.0 5 *� -`- ! / Sit,11titrre Racrcdrnune —�_ Dare _ r•.t �u.d , rwwwr.rr+rrr r Ptl&ct St. JnJ Clem At: AFe :ec =0011 Na. f6.160 (Itc- isec L9S) rS RECE IVED Obi: 02 M; Z Z �W 2 D JU UO O to III W= I.- �U. WO J W? � = W Z 1.. W W U� O� O F- WW FF- LL Z UI U= O Z a:i•1 :::+ :.Y :+x: n:�'.�: :-w: <M�.t '��,:.::r %.,vial•:wr,�5i5-.. sat.::::.:',. �Jw : :.ii1.:.iLa: :i�,w.ts?ivr.bma �JW . iu; ,Dec 09 05 09:52a American Environmental Cc 206 522 4099 p.2 C" � L Job Number 5455 - Labor and Industries v NOTICE OF Industrial Hygiene Compliance ASBESTOS ABATEMENT (Regional addresses and phone • numbers on page 2) , Today's Date �ov ember 28, 2405 } PROJECT THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 CALENDAR DAYS PRIOR TO THE START DATE COMPLETE ALL APPLICABLE BOXES — INCOMPLETE OR ILLEGIBLE NOTICES WILL NOT BE ACCEPTED MAIL OR FAX TO THE REGIONAL OFFICE — CIRCLE CHANGES ON AMENbEl) NOTICES Notice date: 11 128' 05 Ini I d mended ❑ Site Work Hours Su Mo Tu We Th Fr Sa Start date: 12 / 0 7105 On Ole Q Off Hold ❑ 8:00 M am X X i X� ?� X tc Completion: 12 /31105 ! Emergency ❑ pm 4:00 pm Project Dates and Werk Hours must be Exact CONTRACT ❑ Indoors Q O utdoors ❑ Fi PROPERTY OWNER Company Name ❑ Popcorn ceiling Name Neg. Ares. enclosure American Environm Construction LLC l ❑ CAB Doak H omes Inc - - Contrac r Certification Number D Sheet vinyl Owner's Agent _ 1338 (] Asbestos paper ❑ Other Quantity linear feet Darryl Doak a M anua l m ethods Other _ Regulated A rea in ur ❑ Cement asbestos pipe Company -_ ❑ Mudded pips ins. [' 'l, mask. APR Dnak Homes ix r�hfa Name f ❑Duct tape Address (❑ Type C pressure demand A ura Bell ❑ Other 11812 26th A SW P hone Number City _ State ZIP•+a (206) 523 -4411 Burien WA 9 8146 Job Site C.A.S. Photo number John Asselin ' (206) 372 -2280 ' JOB SITE ItACILI'I'Y Address Type �_ ! 11620 EastMarginal Wa South Residential Structure Building Name Room Age Size 40 Years nra Guy Seattle WA WA C Remodel ❑Demolition ❑Repair [21 Maintenance ZIP + 4 County ` 98168 King QUANTITY OF ASBESTOS TO BE: M 0 REMOVED ❑ ENCAPSUL.ATED Qu antity 310 square feet ❑ Indoors Q O utdoors ❑ Fi ❑ B onier insul CONTROL MEASURES ❑ Popcorn ceiling ❑ Duct paper Neg. Ares. enclosure ❑ Wrap & cut .` l ❑ CAB E3 VA (] Glove bag Q Wet methods D Sheet vinyl ❑ Roofing ❑ mini enclosure Q HEPA vacuum (] Asbestos paper ❑ Other Quantity linear feet ❑ Critical barriers ❑ Other _ a M anua l m ethods Other _ Regulated A rea ❑ Mag. pipe insulation ❑ Cement asbestos pipe RESPIRA PRO'T'ECT ❑ Air cell pipe insulation ❑ Mudded pips ins. [' 'l, mask. APR I — Type C contin fluty ❑ Ductinglduci insulation ❑Duct tape ❑ Full face APR (❑ Type C pressure demand E 1:3 Other ❑ Other ❑ PAPR ther F413- 025 -COG notice cf asbestos abatement project 11-0 1 For clean copies go to httpu /www.Ini,iva.gowforms i::': ii..i, r. ,` -,f ;:.i�:...:::a.. ".,L i:,— ..w,Nt,i l .:::.:::ar:'. Z '~ W J0 00 = W 1— �LL W LL 4 0 = F. W Z I-- t— O Z H W U 0� 0 1— WW - Z lli CO O Z w �d o il , ara � mw • omr fD 00 O to O O NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT. PERMIT COORD COPY PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: D05 -401 PROJECT NAME: SITE ADDRESS: DOAK HOMES DATE: 11 -09 -05 11640 EAST MARGINAL WY S X Original Plan Submittal Response to Correction Letter # Response to Incomplete Letter # Revision # After Permit Issued DEPART ft W h-. Bui g Division Public W � ►til I I Y5, Fire" Prevention Structural ❑ "cwt 00 Planning Division d Permit Coordinator ❑ fi ll DETERMINATI N OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 11 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: r TUES /THURS ROU NG: Please Route Structural Review Required ❑ No further Review Required ❑ i REVIEWER'S INITIALS: DATE: c s i APPROVALS OR CORRECTIONS DUE DATE: 1 2-08-05 Approved ❑ Approved with Conditions Not Approved (attach comments) ❑ Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documems/roufli% slip.doc 2.2M2 tt w t., `'•s ;`a1JM,k ;.1 .;:xii, .:�,.% «�f:. 9'k +�,.' �.A.0 a:�,twint S• (SiJisb� z i~ W 00 ND W = V1 U_ W 2� 9Q �d =w �_ Z F.. z I— �o U ON OH W W UO .z w 0 O z Look Up a Contractor, Electrir.ian 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 1 GENERAL Specialty 2 UNUSED Effective Date 8/9/1991 Expiration Date 8/8/2007 Suspend Date 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 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date Until #4 CBIC SC9910 08/01/2001 Cancelled 1 $12,000.00 08/01/2001 #3 1 CBIC SC9910 08/01/2000 08/01/2001 1 1 $6,000.00 Pagel of 3 https:H fortress. wa. gov /lni/bbip /printer.aspx ?License= DOAKHI *092NZ 12/08/2005 I Z Z 0: JU U CO co 11.1 �_ F- N LL Wo 2 QQ LLQ to = d F- W Z h- h- O Z f- W UC) ON o1-- = W, F- LL O W Z CO) bh =„ O Z File: D05 -0401 35mm Drawing #1 1 �r; k `4t`q l.� R rr ' r � '` �+�r� Prole >'k [ • a.p• f ti 3 r ER� �C� y �1� �F /' �, j � a F�' '' S '� 1 a - 7 4 �aa,111 ° '�•S j ~ , ��� -0 n` 't�- ' � : .ey'� ' i J ••Y. l P' 1 ' t aN J '�+ 1 • JF t .= p k �t�}',t�, K . ry h.. � � . y� j �:]ry' � •. r j' 3 � {i/.y;T� �i 31+ ? 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