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Permit D05-402 - DOAK HOMES - GARAGE DEMOLITION
DOAK HOMES 11640 EAST MARGINAL WY S D05 -402 City Tukwil Steven 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.titktivila.wa.us DEVELOPMENT PERMIT Parcel No.: 0733000030 Address: 11640 EAST MARGINAL WY S TUKW Suite No: Permit Number: Issue Date: Permit Expires On: Steve Lancaster, Director DOS -402 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: 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 GARAGE AND REMOVAL OF ALL DEBRIS Value of Construction: $2,000.00 Fees Collected: $145.91 Type of Fire Protection: International Building Code Edition: 2003 Type of Construction: Occupancy per IBC: 0026 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 doc: IBC - Permit D05 -402 Printed: 12 -08 -2005 Z ;Z Z �w QQ J0 0 0 to 0 CO LU Nw w 0 9-j wQ 0 �_ Z H- I O Z E- W U ON 0 t— w w U U Z� U= O Z w ±, wqs City a. 'Tukwila ar „ .. ....... o y Department of Community Development — 1 6300 Southcenter Boulevard, Suite #100 O Tukwila, Washington 98188 Phone: 206- 431 -3670 1908 Fax: 206 -431 -3665 Web site: ci.tulovila.wa.its * *continued on next page ** Steven M. Mullet, Mayo?- Steve Lancaster, Director Z if- Z LU JU UO NO W = W O. U- Q N D' _ d W Z F— O 2 5;. U U O C& :D H" W W' tl. O 111 Z CO P :C O Z OI �Z 1908 City oX Tukwila Depart»tettt of Contnttti ty Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Fax: 206 - 431 -3665 Web site: ci. tukwila. wa. its Permit Number: Issue Date: Permit Expires On: Steven M. Mullet, Mayor Steve Lancaster, Director- DOS -402 12/08/2005 06/06/2006 Permit Center Authorized Signature: ,, ;J ( Date: U —bilv� I hereby certify that I have read and x mite 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. 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 Qw4stxitction or the perfo rmance of work. I am authorized to sign and obtain this development permit. Print Name: � -�-�G I) DAkc UP, Date: I Z -P-a.57 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 -402 Printed: 12 -08 -2005 Z i� Z . W D. O, CO ) o co) LLJ J = H CO) WO L L N � Ir- _ Z 11--O Z 11-- w w U� O co o ff w ti O ..Z w O Z � x %ul -, Q City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 PERMIT CONDITIONS Parcel No.: 0733000030 Address: 11640 EAST MARGINAL WY S TUKW Suite No: Tenant: DOAK HOMES Permit Number: Status: Applied Date: Issue Date: DOS -402 ISSUED 11/09/2005 12/08/2005 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the Building Official. 3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to start of any construction. These documents shall be maintained and made available until final inspection approval is granted. 4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of this requirement. 5: Removal of septic tanks require approval and compliance with permit and inspection requirements through the Seattle /King County Department of Public Health (206/296- 4722). 6: 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 shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the Building Official from requiring the correction of errors in the construction documents and other data. * *continued on next page ** z i� '~ w JU 00 ND J ~ DLL w 9 J LL co =w z� H O z�— U� O co 0H wW w z w co OH z doc: Conditions D05 -402 Printed: 12 -08 -2005 City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 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: - L Date: 2 - dl - Print Name: doc: Conditions D05 -402 Printed: 12 -08 -2005 Z SZ LU D UO U � CO J � CO L W } J ULQ (D = O. W zF H O Z F- W 2 = Do O �. WW W � —O 111 Z CO) O~ Z { ILA CITY OF TUKWILA �} z Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 SITE :I:OCATION 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 ** 1 King Co Assessor's Tax No.: © 7 3>3 (9000 p Site Address: / tt" 0' 90 Suite Number: Floor: Tenant Name: ,) L A) e New Tenant: ❑ .... Yes [�..No Property Owners Name: - L•�c74_1< NC,0 Q2 � /* jy e r Mailing Address: // / — P 6 Z,-` e S' <c 6d City State Zip CONTACT`PERSON e-, 2 ell ( 5 7 2 Name: c l )�lc'�2 cr� , ���z�%' �� . Day Telephone: Y 9 -- E t"Q2;Z Mailing Address: I / a/ 2 — 0 E -Mail Address: City State Tip Fax Number: 2 , dti� a2 '/6- -a 'GENERAL CONTRACTOR:INFORMATION - (Mechanical Contractor information on back page) Company Name: S »G , Mailing Address: LSD /2 — 2 6 hLo _S', c:J , 9 rx!, - City ee // 2 j a �2 Contact Person: / �-• Day Telephone y(�-- s7 E -Mail Address: Fax Number: 2 ,gP 6 Contractor Registration Number: 7) 06}'/ 1V7_ Expiration Date: * *An original or notarized copy of current Washington State Contractor License must be presented at t e tirde 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 OFRECORD -'All plans -must be.wet stamped by Engineer of,Record .. . Company Name: /-f f / Mailing Address: P,01 Contact Person: E -Mail Address:_ J;ri A- 4 �Nj�/1,C`'F /?,e W q Mpemits W\iiee changeApermit s lication (7-2004 Revised: 6.1.05 bh Page 1 h R r 7 14 e v LX I- i All City State Zip Day Telephone � y g /O 01 Fax Number: '/,Z 5 4 /1? 5 �a3. w��.:. r. r.': v�,. ua :.�iu'tiu•Aura&.,7.w«:�Gn+1+25 ' i�u'i�rw aiv„w"iY.tnS::'.u'.'+*tmi: +i.+:ikrA; e�fHiikwttisa'kl:+r.��k++��. Z 3:Z W ¢¢ JU UO N W = H �LL WO 2 aa LLQ �D = �W Z t— t— O Z t- W W U� ON 0H W H~ LL w Z U= O Z �U IO N 206 - 413670 9 Valuation of Project (contractor's bid price): $ dG > Existing Building Valuation: $ Scope of Work (please provide detailed information): 2 eZZe , ;J Will there be new rack storage? []..Yes JR'No If "yes ", see Handout No. for requirements. Provide All Building Areas in Square Footage Below 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 PJ No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑.. Sprinklers ❑ ..Automatic Fire Alarm one ❑ . Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes ❑ .. No If' yes ", attach list of materials and storage locations on a separate 8 -112 x I I paper indicating quantities and Material Safety Data Sheets. gMpermits phis \ice changes\permit application (7.2004) RevisW 6-MS Page 2 I\ Z Z �W QQ JU UO UU J = H U) U. WO UQ to = f.. W Z Z� W �5 U� ON ID F- W LL H� —0 Z W co O� Z E xistin Interior Remodel Addition to Existing Structure New T ype of Construction per IBC Type of Occupancy per IBC 1" Floor >?. 2 ..Floor 3 .:Floor. Floors thou 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 PJ No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑.. Sprinklers ❑ ..Automatic Fire Alarm one ❑ . Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes ❑ .. No If' yes ", attach list of materials and storage locations on a separate 8 -112 x I I paper indicating quantities and Material Safety Data Sheets. gMpermits phis \ice changes\permit application (7.2004) RevisW 6-MS Page 2 I\ Z Z �W QQ JU UO UU J = H U) U. WO UQ to = f.. W Z Z� W �5 U� ON ID F- W LL H� —0 Z W co O� Z ! 1 1 i �1 S r i i i i i f •.I h LIC WORKS PERMIT.INFOR.MATIOI Scope of Work (please provide detailed information): 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 E] ... 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 Agreement(s) ❑ ... 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 _ ...Total Cut cubic yards ...Total Fill cubic yards ❑ ...Sanitary Side Sewer ❑ ...Cap or Remove Utilities ❑ ...Frontage Improvements ❑ ...Traffic Control ❑ ...Backflow Prevention - Fire Protection _ Irrigation Domestic Water ❑ .. Right -of -way Use - Profit for less than 72 hours ❑ .. Right -of -way Use — Potential Disturbance ❑ .. Work in Flood Zone ❑ .. Storm Drainage ❑ .. Abandon Septic Tank ❑ .. Curb Cut ❑ .. Pavement Cut ❑ .. Looped Fire Line ❑ .. Grease Interceptor ❑ .. Channelization ❑ .. Trench Excavation ❑ .. Utility Undergrounding ❑ ...Permanent Water Meter Size... WON ❑ ...Temporary Water Meter Size.. WON ❑ ... Water Only Meter Size............ WON ❑ ...Deduct Water Meter Size " ❑ ...Sewer Main Extension ............Public Private ❑ ... Water Main Extension .............Public Private FINANCE INFORMATION Fire Line Size at Property Line _ ❑ ...Water ❑ ...Sewer Monthly Service Billing to: Name: Day Telephone: Mailing Address: City state zip Water Meter Refund/Billing: Name: Day Telephone: Mailing Address:. Ci State Zip clAkpcnnits plwlicc changes%pennit application (7 -2004) Revised: 6.8 -05 Page 3 I1 Number of Public Fire Hydrant(s) ❑ ...Sewage Treatment Z �Z '~ W 5 UO C/) C0 LLI J = F— NW WO U- to _ CY �W Z— = H Z� W W U� C/) C3 I— Ww H F- It O W Z U= O Z MECHANICAL.PERMIT:,INFORMATION 206 431- 3670 MECHANICAL Company Name: N Mailing Address: Contact Person: k E -Mail VT RAC R INFORMATION '© e Contractor Registration Number: !�- FK l T k 2 * *An original or notarized copy of current Wash Valuation of Project (contractor's bid price): Scope of Work (please provid detailed information): State Contractor Li City State Zip Day elephone: 9 :!S - 3 ` ?-Z- aZ F xNumber: Expiration Date: /0 - Z L - OS e must be presented at the time of permit issuance ** s Use: Residential: New ... � R Commercial: New .... ❑ R Fuel Type Electric ..... ❑ Gas... FA M IBM Indicate type of mechanical work being installed " the quantity below: Unit T e. Q Unit Type: Qty Unit Type: Boiler /Com pressor- Q Furnace <IOOK BTU Air Handling nit >I0,000 Fire Damper _Qty 0 -3 HP /100,000 BTU CFM Furnace >IOOK BTU Eva rat Cooler Diffuser 3 -15 HP /500,000 BTU Floor Furnace Ventil on Fan Connected Thermostat 15 -30 HP /1,000,000 BTU to Si le Duct Suspended /Wall /Floor Ve tilation System / Wood/Gas Stove ( 30 -50 HP /1,750,000 BTU Mounted Heater Appliance Vent nod and Duct Water Heater 0+ HP /1,750,000 BTU Repair or Addition to Incinerator - Domestic Emergency Heat/Refrig/Cooling Generator System I/ I I Air Handling Unit Incinerator — Comm/Ind Other Mechanical <I0,000 CFM I I Equipment PERMIT :APPLICATION NOTES Applicable :to all permits in this applicat>ton 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. BUILDIN( Signature: i ? L�IY�'p L Date: /I/ ` I F - O 5 r I CC le' - , - 2,6> C, - 3 !T . Z ;Z ;1, 3 Print Name0 �, �,�.�1� �"� Day Telephone: 2 D E Mailing Address: JkV 2 .2 l Z Z Au � t L - ) i to w1 012 to /� 5' ;V. 4 1 � City State zip Date Application A cepted: Date Application Expires: Sta Initials: gMpermits plus \ice changes�permit application (7 -2004) Revised. 6.8.05 Page 4 bh V� ?.�'�1+✓14M xv. I�. Z J~ w W� UQ W= h— tL WO J cL U CY = W Z HO Z 1— W �p U ON 0 F_ W u. O W Z U= O Z { i i i i i NN.. ... l . its of 1 j kWi l a Steven M. Mullet, Mayor t Department of Communi Development Steve Lancaster, Director a us f�0 6300 Southcenter Boulevard, Suite #100 ., Tukwila, Washington 98188 Phone: 206- 431 -3670 rsoa Fax: 206 - 431 -3665 z W. SET RECEIPT _3 U UO Cl) J = H Copy Reprinted on 12 -08 -2005 at 12:06:32 12/08/2005 CO U_ W O � 5 RECEIPT NO: ROS -01756 U _ N d Initials: BLH Payment Date: 12/08/2005 ~ _ User ID: ADMIN Total Payment:628.00 ? �' HO z �- Payee: DOAK HOMES, INC. W UJ U� O N C1 F- SET ID: 1234 SET NAME: DOAK HOMES DEMOS = U SET TRANSACTIONS: LL- p set Member Amount -- Z. ---- - - - - -- ------ - - - - D05 -398 107.56 v _ ~ D05 -399 107.56 D05 -400 107.56 z D05 -401 107.56 54. 90.20 605 -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 000/386.904 27.00 TOTAL: 628.00 � -1, K' 4 . Cit of Tukwila race Y 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 0733000025 Address: 11620 EAST MARGINAL WY S TUKW Suite No: Applicant: DOAK HOMES RECEIPT Permit Number D05 -402 Status: PENDING Applied Date: 11/09/2005 Issue Date: Receipt No.: ROS -01638 i Initials: BLH User ID: ADMIN Payment Amount: 55.71 Payment Date: 11/09/2005 01:48 PM Balance: $90.20 4 Payee: DOAK HOMES INC TRANSACTION LIST: Type Method Description Amount --- - - - - -- -- - - - - -- --------------------- - - - - -- ------ - - - - -- Payment Check 5083 55.71 ACCOUNT ITEM LIST: Description Account Code Current Pmts PLAN CHECK - NONRES 000/345.830 55.71 Total: 55.71 gj.6_l. 1.1. 9 716 TOTAL 390. doc: Receipt Printed: 11 -09 -2005 z Z . W JU U0 ND C0 W J = N U., W 0 LL Q' cl) d = W H- 0 zz F-- G 5 U� Oc � H WW s E- u- O .. z U Cl) S OE-. z I INSPECTION RECORD Retain a copy with permit INSPECTION NO. j 6 W 6)431-i6 0 CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 Project: Type �pe c ti n: Address: Date Called: Special Instructions: J Hate Wanted: a.m Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: Inspecto . - Date: Receipt No.: Date: I f� Z - Z IXW 2 JU U N0 to LU J H �U. w O LQ =a F. W Z H F- O Z H U� O — o�- WW U- Z 111 U= O Z 1--1 paid at 6300 Southcenter Blvd., Suite 100. Call to sechedule reinspection. INSPECTION RECORD b <' Retain a copy with permit �-- INSPECTION NO. 42 0)"31-3670 CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 l ect: Type of I pection: ' � w A dr ,t 4af at Called: V � Special Instructions: Wanted: a.m. a O Requester: Pho e N Approved per applicable codes Z Z �W Q D JU UO Cj) C0 LU J = Cl) LL,' W LLa ND = F- W Z = H Z O W LIJ D p. U ON 0 I•- = U. ILL LLI Z U= O Z . M Corrections required prior to approval. S Dec 00 05 09:52a American Environmental Cc 206 522 4099 p.l P.U. Box 81005 Seattle, WA 98108 - 1005 FHRZ Environmental Construction LLC Phone: (206) 267.074Eo Asbestos - Lead - Mold - Demolition Fax: (206) 2E7.0753 December 8, 2005 Telly & Darryl Doak Doak Homes Inc 11812 26 Ave SW 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 a This is to certify tftat 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, Amer4A Environmental Construction, LLC — AdMinis stant RECEIVED CITY OF TUKWILA DEC 0 7 2005 PERMIT CENTER z '~ w 6 2 , JU UO Co o J = CO U - 0 LL co) a = w z� F— O W F- W U o C0. 0 E- W W u.. O w z U N� o� z y_- � Vim• ••-• 11111V 1 • VO11 L.11 11 V1 (1111i'11 Vfi .L .JV •wV V C. c- - 1 V V V r �t�, !, �UV) V 4 :�r'Al 6' V L LhOUPH,L,l1I :11� American Environmental : ' `r Sample Uata, Sheet �. ° gels: -.� Ur Job Location:1��z� Sampled By: '�SC -S _ Date: z - G1 Time: +la Cou Microscope Field Area: Stank C Sample lDi r Loca Type: �, Work Activily' tr, j A Lion: Observations: c -' o r ✓ U Q _..... Worker. G-A b v - 1Z #' SSa: Z Cert# Time: Start ;fig Rate: Sta ltrt - Z, nmont: Fibers Fibers _ �.,. #:. Tkne: End ..s. 55 - Rate: End Z. _ Liters Aeld hx ti- NGnures Average ' z M Location: f r� LO 1D. -_ G Location: N Yp e:. _ C( Work fttivi , j C; rrocectian' O bservati o ns: �,�,�; ' Demon: Worker — - — Envirvnrne Time: Slant J /: 3 � y / Purnp #: 5 l "*. End I - _ Minut = .WM Sample Type: Pra#ectlon:� Decon: Environment Pump*. MWA� :.l Location: Wbtk Activdy: observations: - Worker. ----- •-•- -- r 11me: Start / 2•' S Three: En Minutas SSA: Gert#: -- Rate: start Rabe: End j L Liters Average ! Z f ZL1 G r bars Fibers wars /cc 3 t o o - CL.Qa• Swnpte ID: r _ Location: f Rate: Start ! Sample T ype: � Rot End � _ / .. "� Fibers Fibers Liters d Ix 0 Average 4A- :.l Location: Wbtk Activdy: observations: - Worker. ----- •-•- -- r 11me: Start / 2•' S Three: En Minutas SSA: Gert#: -- Rate: start Rabe: End j L Liters Average ! Z f ZL1 G r bars Fibers wars /cc 3 t o o - CL.Qa• Swnpte ID: r _ Location: f G /l Sample T ype: � 1Notk AcLvity; O r 0A cJ2 C uA� l P �3� OtSgNOnS: ('� t� (d/r: - � /�1C' <^1L�' Oecon: -----� Worker. su C90 - ---- 6 nvironmen t•. Time: &tan - 3 7 Rate: SW Pump It: 1 Time — End z Ll _ f Rate: ate: Et�d Flt Fibers _ f.fters 1tleid Icc Minutes = Averaga ° • BrvOu g Zone P - Pre Abotvmat - Celina '� CL • Clearsnrs • Inside Area H • HEPA ExhsuM 0 - Outsde Area 8L - Field Stank ,•rl.�,ne M - HaI Mask APR F - Put Pam Mask APR PAPR CA - Continuous FlowA1r PA - Pressure Dom" Ak a.$• 0c= wi Shcwsr H • HEPA Vacuum D - Dwm wlo Sherrer G - Olow+bag ME - hwl Enclosure FE . Ful! L'ndo-,rre :+ . U N .UL, IYWOs' P,e 1L , , w+x.s.+.�.....- �.......... +........«... «..- ...... �UW4. LWlitu.+ .. .. � ..1 (ra,.iv`L«. =ii'� �'� � 1 . v' sLd ,l1.i..:rM+tiiSLdil'v.S.l� ��� ` z �z �w QQ D U O 07 0 J = H CO L w 9Q rn s �w zP W O �5 U� c) o t— wW F- u- O z U= O z uec uu uo ub:0 mmericen tnvlroninennal GO Cub z) e. e 9•ui:i:/ p, o �•�. �vv� 't•ierm IVVL t,nukPnnIVniea ,iii rev+ 1Jrt �+ t American Environmental "i S Data Sh Of Job Locat r�� 1144 e ry r4 Job #: � /UJ Samp 8 Y: f Date: fZ -07- U 5 'rime: w ank Co unt: Microscope Field Arcs Bla Cas neftes: j Location: 0 ,Type: P✓ 6 Work Activity: _ .._ U4 CD +:ctier: Observati ) j S 4 - a Worker. ' SS#: � Cortt T1me: Start t: b'`t d y X "�' ronmsnt:� �' Rae : 3 9 _ _ , F" I,*.— Tme: End Rate: End Fibers Fibers P. , !l1 #: � � �,.�� ! O Liters IBsld /cc ro Y— Minutes _ Average j p Owl I .v A1D: - 's, amp►e Tyne: j? f protection++ - __ I � decon: Ernrlronrlent:� Pump Location: 0SF Work ia f�E •tiic> ct Observations: � � i: .-,� Worker, - Tirne: S Time: Fmd Minutes e SS#. Ca Rota: Sham r hers Fibers Rate: End 1 4 _ _ - -_ Utffs /field kx Average ple IU; Location. Sample Ty pe: ,ql ,eF Sample Type: 1 7 Work Act'ri(ty: O bservations; Lig. N6 o S Decon: Protection: _ Observatbns. �. � �2.4 1 C, _ Decor: Worker l( A9ADid c8rt# S� / Environment: Time: Sta Rate: Start Z Pump # _' -- Timis: End_ � -- Rate: End ,� Fi6cn; Fibers Liters field /CC Mlnirtes = Averag S ample 1D: - 5L1 L ocatio n: pC l SE l�G 3 k Sample Ty pe: ,ql ,eF Work Acti Protection: % O bservations; Lig. N6 o S Decon: Worker. - - — $S *: ----- ---- -- Cert* --- --•- -- I Entironment: TkT*: Start f0; f yr Rate: Start Fume #: Time. End ate End Fibers Fibers • 5�� $ Liters !field /cc J Minutes Average l i m oll 011 1 w sa • Breathft Zone P . ProANUM',it CL - C1et+nnoe `r - 1-wide Arta • H - HEPA IF -Asuil 0 - Outside Ares 81.. Field Blank r�r.xi M - Half K%sk APR F - FU11F**M39kAPR PAPR CA - Continuous F'bw Ak PA - Pttm rs Dciw 0 Air D.S. Deccn wi 5howN H . HE! AVnrj +mm D . Dawn wto Shovrur G • CrbvstW ME • Km Ert*wre ='E - Ful! Endrwr + .- +..4.. .�..... ..w.,... _ i.t'�:✓.re.a..:6a.�:4:.a. 4u.S::a:�; c:f:v,i,v:nw .z. :i+.7k:.Y.ti�iSJA.�:k; ante: �. l+; �! .•'ltcil�bh.,rst' "w ��ic�+.: ' . Y .... t � . r z ,r— w UQ W= t— �U- w LL CJ)d =w z� ZO W w U� O� o t— wW w U= O z Dec 08 05 09:53a American Environmental Cc 206 522 4099 v.4 r C: 549 ASN 4 ASBESTOS WASTE SHIPMENT R14,PORT F 0101 PLEASE PRINT OR TYPE! If you have questions, contact your local DEQ Regional Office iit Portiand at (503) 229• a a 5364, Salem at (503) 378 -8240 ext •272, Medford at (541) 176 -6010 ext. 235, or Bond at ;541) 388.6 ext. 226, OR call (800) 452 -401 l for the location of your local regional DEQ office. WASTE GENERATOR: (Cuntractor, Fac;lity, or Operator) t I. Asbestos removal site name and address: Doak Homes Darr Doak r 16 20. 1 11640 E. Ms r_gl_ng l Way ; outh Seattle WA Kina 98168 - Street City/state County Zip Ccntact person: Darryl Doak Phone: 206. 7 46.658 7 2. Operator's name and address : American Environmental Construction LLC Phone: 206- 267 -0746 7417 - atrt Avenue South Seattle, WA _ _ _ King 9810153 Street CitY %State County Zip s. Waste disposal site: Northern Wasco County Landfill Phone: 541- 993 - GC89 25W Steel Road _ The Dallas, OR Wasco - 97058 i Street Citylstate Cwnty 'L;p 11 4. Describe asbestos materials: _ find 7 C IuF 5. Contair.:rs: Number: / Ad 5 r_a s - 7.56165 Type: > i J � 6. Total quantity (cubic yards): Z V d5 7. OPERATOR'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 respects in proper condition for transport according' to all government regulations. All movement of this asbestus- containing material is recorded on this Wes:e Shipment Reco :d Form. Name: _Z Signature: Company: American Environment C onstructio n Date: _ / z/ - O ? U t _ TRANSPORTER(S): S. Transporter #I: (Acknowledgment of recel t of materials, Agent: _ Company: D&B Trucking Address: 1 .905 East Lincoln Ave.. Tacoma, WA 93421 Phone: 26 - 333 -3850 i Signature: Date: 9. 'transporter rr2: (Acknowledgment of receipt of materials) ! Agent: Driver Cornpany• NTSI I D&B Trucking Address: 1305 East Lincoln Ave.. Tacoma, WA 98421 Phone: g53- 363 -38150 Signature: _ Date: DISPOSAL: (Certification of rcceipt'of asbestos materials covered by this manifest, except as noted in item 11 b0owd W Waste Disposal Site: Northern Wasco Co unty Landfill !game and Title: DLte: Signature: _ Phone: _ - 11. DISCREPANCY SPACE: (Add anachmenis as necdcd) _.._ (Rcyistd 6103) rl+ - •r.,+o.�,.a•., .. wrr: ci...•.ma••w�..tva 1vtu�icAra k,x:,'r'4 +•,.;..+. d.M: 4+t.;awl+,�,t.�::ce1 =r�i. =.uk.: Z iH- Z �W 00 (1) C3 W = H U) LL WO 9-1 LL N� = l.-W Z Z� W W U� O� 0H_ W 2 H H LL O W Z U= O� Z Dec 08 05 09352a American Environmental Co 206 522 4099 P -3 (� Agency CaT 3U7 ;� PUGET SOUND CLEAN A� ! Uatr. Rzccived ' AGENCY 200 5 0370 1 1 10 Union Sheet, Suite 500 1 V V lJ r `, :'; Seattle, WA 98101.:03 ' . '• - : :• :•a•. :rrl,�.,_ anvw.pscleanair.org a nc: n/ I rieCltc.J ("J. Only 'NOTICE OF INTEN t �... e��� Lot a. Pre'ect Tyner, 1. Q „Friab)e A hcstns Remnval 2. Q E ahle Ashes Rtrnnva i r)tolition 3, Dernolit(on Qni ! Property Owner D oak Homes Inc r Phone: X06 .246.658 7 r ,, ✓�i :int; Addnnss: 11612 26th A\,re SW � ci;\t: Burien 1 State W A zi :�: 981 �6 i 1. r/^ t... �wr�ww.. �Y�. MM�r�wrM�PrMwl .OriwA�r+�rw�YY1M �rrlr YI aYw�--1•Mwi���i �•.•.�Yr1Y C. Asbestos r .t.. t ntn!'t.Lattl.r, w• u!, u. in rna VJR tut r. _ Ccnrrm Arnerican Enviro nmental Construction LX OwneriCE John Ass ? : iiin2 Address: P 13 OX 81 005 I Fi:onc: (GC6 ) 523_4 lob Nc.: cues: Seattle i State: WA 7 0$-:a05 F8x: (211 522 -4099 i 5495 D. Si m I A ddress: 11620, 11638, 11640 East M arg hal Wa South c; Seatt(e zi : 98.68 i Sile manat ur: OBI' ,aak Local Phone: 20b.372,2280 1”. .fall Toescos aumev or No. of Dare of Asbestos etas Friable Asbestos Identified? :3 Nlat'1 Presum Stcuctltres: Sun 11-L - 1 Wes Nonfriable Asbestos Identified? 1dYes L.1itio , A iERA Building Gatification r:: 1 4tlach a cop}•• qf the ;urvey wher, 0able rive rro: In,pe :tor: Carl Dykstr Exr.. Date; -22-061 has trot beer VeniTled. 1 413 7HERA a a reputred belDre ab de nWaron propeu F. Demolition Start ,,, r / p " mr a.4 to No. of I. Training Firc Mist 5-re Dttpt,) Information-, ; Date: ' �� �. . tr ., uctures: 3 2. Q Ordered Demol -dar ( ac'h coo _t'_ Oro �Den;o:ition iwiwdimnratoucont 'lntadingoYdreaon bac4 µ/11l :lprtfTial)Ie 35�C5to5 be left in jliSCe during dCmO 1t! :4n t I Contt=or: parry! Doak If yes, list type and qty. Note disposal mglirements in S 6 (on back). f C. Fri:tble Asbestos t � _ Work Days: iA 1 W VIt V Sa Su i t PI-ajcct lttformstion; Start Date: Comple Dat Hours: Will all friable r,sbestos Q N'es c�c�tn! Removed: Linear Ft. Square Ft, rnttteria!s be removed? Q No ! Lt iiude6Fc lrsulatiot W Due: Insulation U Plpd ltuuiadon U Mreproofing U Pants J Plasttr Tez :ered Coatings (_J Curr.:nt U Cement Pipe Friable Floorlr,A Friable Roo ring Material Other: H. Ashrstosi Demolition Project Chtegoriest Notincatian Period Froject netuolition 1.:iin,-N- Fntnily Resilience (owner- occupied;: F te Surchstrr ( A. Q Asbestos Removal Project Only A. ?Tior Notice A. 525 1 B, Q Demolition Project (with or without asbestos removal project) B. 10 Gays B. $50 I ! •f Asbestc. remevul can beitin uoon notification: demolition must wait 10 da lvsl _ { l e)(a. - 1J't lte single.,arnrfy residence is owned by orieJamily who. has been or,will be using the residence as their domici!e, the above balers i i s t or 18 may be checkect If this i not an owner - occupied residence, one of the categories listed below mus be used instead. ,! single f ! !itmily esidwice does not !rtclude rental xotwty, naull fcmil'; units, or any misdd use budding. ?. ' All Other Demolitions twith no Asbestos removal or Nonfriable Asbestos I 10 i a0v or iess than 10 linear feet andlcr 4 8 square feet of friable Asbestos) I I ,_l Friable Asbescos Projects (other than Sinele F amiiv R esidence): Asbestos D rn I �� ! 0. 359 linear feet ::ndlor 46.159 sgttnre feet of asb estos I Prior Notice 10 Gays 5 !00 lQ0 i 4 6 0.999 linear feet andlor 160 -4,999 square feet cf asbestos ! 10 Days 3200 5 i 00 1 U %1.000 lincru' feet and/or X5.000 s ware feet oif asbe _ l0 oxys, S6 ,10 5100 6. U Emergency Asbestos Project or LJ Emergency Demolition Project Prier Notice r S50 Emergency Fee ' (Sinatc.rnmNV Itesteen -." arc exenrna: G;wn cmtrecrev (cc: howcve,, prcinyiv otvnxrs must armt•ide a urttim emaamncy r tG —SS � L ( rttti"f tt the trtbrmsaon ccn:.t !' n this sccnfica;ioa d supptamcntni d a, to ttx :xst of m) knoafcdge, x.uraic At carn Aft y�`s1t (nth✓ Arn eriean Enviro Constrtset LIC f 'Ll� 7 ,� t $iyuYUrre Xerrcrrfnunp Date _ F.:r .red r' Puset S% 0cah At. Apr•.cv =amt No. F6.160 (Reaisce M TS RECE 1V�D Z Z �w UO CO D J Co U_ W o� U_ co = W H z� W UJ U� ON 01-- W W H� LL O Z UJ U= H� Z Msnsme+ aenwa�w�aysyr• r�rxA 'tfis5trriwawwre:enar:�+aq.. .•t�•.c. n.. rw.• k+'• '+•k•^vuvrra+awns±wt�rtvnraM+.r gar. �+^, r/ fiayltksx7K,`? 4y�K'+ ibrkta�Nt .1Y?7:N.c`^H'�39�Jtitl�fAbt�4 N I� Ilea 08 05 09:52a American Environmental Cc 206 522 4099 p.2 �^ f L� Job Numb 5 95 -1 Labor and Industries ,,, NOTICE OF Industrial Hygiene Compliance ASBESTOS ABATEMENT (Regional addresses and phone • numbers on page x) Today's Date iNovember 28, 2005 PROJECT THIS NO T ICE MUST BE RECEIVED NO LATER THAN 10 CALENDAR DAYS PRIOR TO THE START DATE COMPLETE ALL APPLICABLE BOXES — rNCOMPLETE OR ILLEGIBLE NOTICES WILL NOT BE ACCEPTED MAIL OR FAX TO THE REGIONAL OFFICE — CIRCLE CHANGES ON AMEigbED NOTICES Notice date: I 1 / 28 r' 05 IT mended ❑ Site Work Hours Su Mo Tu We Th Fr S a Start date: 12 1 07 1 OS 1 On Off Mold n B:OD am am �� X X X� X X F -- tc - ---- -- rocnpl 12 / 31 105 Emergency ❑ pm 4:00 r pm Project Dates and Wer< Hours must be Exact i 1 CONTRACT ❑ Indoors 0 O utdoors ❑ Fir PROPERTY OWNER CONTROL MEASURES ❑ Popcorn ceiling ❑ Duct paper- Neg. pres. enclosure Compwiy Name ❑ CAB Name ❑ G love bag American E nvironmental Construction LLC ❑ Sheet vinyl ❑ Roofing ❑ Asbestos paper ❑ Other Q uantity linear feet Doak Homes I - - Contra c r Certification Number ❑ Cement asbest p Owner's Agent ❑ Air cell pipe insulation 1338 [] %a mask. APR Darryl Doak ❑ Ducting/duct insulation i ur ❑ Full face APR Company _ ❑ Other ❑ PAPR =Other Doak Homes In /Pole Name -� Address VL$ $allo 11812 26th Ave SW hone Number City State ZIP++ 1 (206)523-4441 Burien W A 9 3146 Job Site C.A.S. Phone number _ _ Jadn Asselin ' (206) 372 -2280 JOB SITE FACILITY Address Type i 11620 East Mar final Wa South Residential Structure j Building Name Room Age Size " 40 Years nla City Seattle WA WA ' Remodel [3 Demolition [ ❑ Repair ❑ Maintenance Z IP + 4 County ` 98468 King QUANTITY OF ASBESTOS TO BE: [] REMOVED ❑ ENCAPSUL Q uantit y 310 s quare fe ❑ Indoors 0 O utdoors ❑ Fir ❑ Boiler insulation CONTROL MEASURES ❑ Popcorn ceiling ❑ Duct paper- Neg. pres. enclosure ❑ Wrap & cut ❑ CAB Q VAT ❑ G love bag Q Wet methods ❑ Sheet vinyl ❑ Roofing ❑ Asbestos paper ❑ Other Q uantity linear feet ❑ :Mini enclosure - Cj Critical barriers ❑ Other _ �— [ � i] - H - EPA vacuum t M anua l m ethods Q Other Regulated A rea [] Mag. pipe insulation ❑ Cement asbest p RESPIRATORY PROTECT ❑ Air cell pipe insulation _ I ❑ Mudded pipe its. [] %a mask. APR ❑ Type C contin flow ❑ Ducting/duct insulation ❑ Duct tape ❑ Full face APR ❑ Type C pressure demand ❑ Other ❑ Other ❑ PAPR =Other F413-025-COO notice of asbestos abatement project 11-01 For clean copies go to htip:/ /www.Ini,vva.goviforms' Z }�-- Z �W QQD UO CO O W= H �LL WO u- (D D = �. W Z H t— O W ~ W U� O� 01-- W UJ 111 Z U= o Z PERMIT COORD COPY PLAN REVIEW /ROUTING SLIP i i i ACTIVITY NUMBER: D05 -402 PROJECT NAME DOAK HOMES DATE: 11 -09 -05 SITE ADDRESS 11640 EAST MARGINAL WY S X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued DEPARTMENTS 11-'1102 7 05 Bui ng Division 1 P blic W rks 1� inn xz, Fire Prevention Structural ❑ DETERMINATION OF COMPLETENESS (Tues., Thurs.) Complete d Incomplete ❑ Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: 0 1 _1H< Planning Division d Permit Coordinator ❑ DUE DATE: 11-1 0-05 Not Applicable ❑ TUES/THURS ROUT NG: Please Route Structural Review Required ❑ No further Review Required ❑ REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS DUE DATE: 12-08-05 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: Documents/routing slip.doc 2.2M2 tia. . ?:�tSA^F.':.J ° ;7i�" ;�a :,A. „ 1�^r� ^'.t ntm }.i "';tm �'�1�.lsi:.n. , r4wv+tA.3r:5Ji:?�v. 'ie::: D iu'' a' t�N .k +e�s�S+�Y,�•��<•; z �w QQ JU UO U) W_ �w w LL.? � =w z� 1— O W ~ w U� O C, � F- wW u. O .z w U= O z Look Up a Contractor, Electric .mil or Plumber License Detail Page 1 of 3 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 cant' 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 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 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 I SC9910 08/01/2001 Cancelled 1 1 $12,000.00 08/01/2001 #3 1 CBIC SC9910 08/01/2000 08/01/2001 1$6,000.0 0 https:H fortress. wa. gov /lni/bbip /printer.aspx ?License= DOAKHI *092NZ 12/08/2005 i Z = Z JU UO NO J F- NU- W F }O0 �J LL a = W 1— O Z h-. 5 U� 0 - � f- W 111 F- F= L L11 Z CO) O Z PF File: D05 -0402 35mm Drawing #1 � �,ag • T P "� t . ��y <� ,,, . 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