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Permit D03-026 - DOAK HOMES - DEMOLITION
D03 -026 DOAK HOMES, INC. 4058 So. 148t'' St. SEE ALSO: L02-.024 MI02 -131 Z Q • Z W -J O 0 CO CI W= J H WO u.< =• d � W Z0 w w U� - O a F- W W H U LL ~O .. Z U= O~ z Public Works Activities: doe: Devperm City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 0040000955 Address: 4058 S 148 ST TUKW Suite No: Tenant: Name: DOAK HOMES INC Address: 4058 S 148 ST, TUKWILA WA Owner: Name: DOAK DARRYL E SR Address: 11917 4TH AVE SW, SEATTLE WA Contact Person: Name: DARRYL DOAK SR Address: 11812 26 AV SW, BURIEN WA Contractor: Name: DOAK HOMES INC. Address: 11917 4TH AVENUE S.W., SEATTLE, WA Contractor License No: DOAKHI *092NZ DEVELOPMENT PERMIT DESCRIPTION OF WORK: DEMOLISH EXISTING 1,000 SQ FT SINGLE FAMILY RESIDENCE. CLEAN UP SITE FOR CONSTRUCTION OF NEW HOME. HAUL AWAY DEMOLITION MATERIAL. WATER DISTRICT 125 AND VAL -VUE SEWER DISTRICT. Value of Construction: $6,500.00 Fees Collected: $51.50 Type of Fire Protection: N/A Uniform Building Code Edition: 1997 Type of Construction: V -N Occupancy per UBC: 0007 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 Sanitary Side Sewer: N Sewer Main Extension: N Storm Drainage: N Street Use: N Water Main Extension: N Water Meter: Channelization / Striping: Start Time: Private: N Private: N ** Continued Next Page ** D03 -026 Permit Number: D03 -026 Issue Date: 02/10/2003 Permit Expires On: 08/09/2003 Phone: Phone: 206 - 372 -2280 Phone: 206 246 -6587 Expiration Date: 08/01/2003 End Time: Public: N Public: N Printed: 02 -10 -2003 ..+r,:n:: U,r�,::w.i;; ::;s:...,'`i ..si?;d »a xvc:i.: +.:c:`riw r ,.- •w,U:u�.�`::a.iF:ti�;.:' Signature: Print Name: doc: Devperm City of Tukwila Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Permit Center Authorized Signature: k 7.h614L,14 . ) Date: — / D`D 3 I hereby certify that I have read and examined 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 construction or the performance of work. I am authorized to sign and obtain this development permit. r ma /.. 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. D03 -026 Date: `Z D /o Printed: 02 -10 -2003 Parcel No.: 0040000955 Address: 4058 S 148 ST TUKW Suite No: Tenant: DOAK HOMES INC 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division. 3: Electrical permits shall be obtained through the Washington State Division of Labor and Industries and all electrical work will be inspected by that agency (206- 835 - 1111). 4: All permits, inspection records, and approved plans shall be available at the job site prior to the start of any construction. These documents are to be maintained and available until final inspection approval is granted. 5: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997 Edition) as amended, Uniform Mechanical Code (1997 Edition), and Washington State Energy Code (1997 Edition). 6: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations 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 ordinance of the jurisdiction. No permit presuming to give authority to violate or cancel the provisions of this code shall be valid. 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: ate..�lizz��. -j Date: Print Name: it`'J1 ay/ . c',z; doc: Conditions City of Tukwila D03 -026 PERMIT CONDITIONS Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Permit Number: D03 -026 Status: ISSUED Applied Date: 01/22/2003 Issue Date: 02/10/2003 Printed: 02 -10 -2003 Payee: DARRYL DOAK ACCOUNT ITEM LIST: Description doc: Receipt BUILDING - NONRES STATE BUILDING SURCHARGE City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 RECEIPT Parcel No.: 0040000955 Permit Number: D03-026 Address: 4058 S 148 ST TUKW Status: APPROVED Suite No: Applied Date: 01/22/2003 Applicant: DOAK HOMES INC Issue Date: Receipt No.: R03 -00148 Payment Amount: 51.50 Initials: KAS Payment Date: 02/10/2003 02:10 PM User ID: 1684 Balance: $0.00 TRANSACTION LIST: Type Method Description Amount Payment Check 2775 51.50 Account Code Current Pmts 000/322.100 47.00 000/386.904 4.50 Total: 51.50 44 0.2.'':11 :? 71.5 i O i - Af. 51. 50 Printed: 02 -10 -2003 COMMENTS: 0 00 SR-- 1 S 9 () n -e - 1V\":„ 'V e V ■\1 t C 0 iM `‘t-tr i 0 kc - to C ‘ r`CA Special Instructions: , c=e Date Wanted: --k'` -e c r r a r -P 1_S S4 t, () 0-1 , v, A; roc 1 Proj t: H OGi I� Il o ' o Type of Inspe '.. �7� Address: 4 /055 S / ST— Date Called: /9- -D3 Special Instructions: , c=e Date Wanted: a.m. Requestee: Phone No: v aD6 ,'27,- ,22.6P0 k +i4it':J,S;1�ai+":.."iA?.'rp;a Nis- ^C;ift+:i�3 _ i;,: •�I:'.;as:,v",ai:c «'.'.�.s,: -+: INSPECTION NO. Approved per applicable codes. Inspector: I I J ) INSPECTION RECORD Retain a copy with permit PERMIT CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Corrections required prior to approval. /1,94- Date: R 0-0 "5 El $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: Project.` __)0C11/ 14 Ann -4' 4 1 Type of Inspection. -rcr - mo Address: 1- 10 �c< S 3 ) s Date Called: 2- II - 03 Special Instructions: Date Wanted: 2. I 1-6 a Requester: It f Phone No: j INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 Approved per applicable codes. Corrections required prior to approval. COMMENTS: Date: El $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: FILE COPY Prepared By: Building Inspector Cert. #: Expiration Date: Date Inspected: Project #: L A B S HAZARDOUS MATERIALS SERVICES Asbestos Survey 4058 South 148 Street Seattle, WA Date Prepared September 26, 2002 Prepared for: Mr. Darryl Doak Doak Homes Inc. 11917 4 Avenue Southwest Seattle, WA 98146 Margaret Poe 1002308 May 29, 2003 September 19, 2002 2002 -460 DO3 ft 02& NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT. _. I TABLE OF CONTENTS Subject Page 1.0 SCOPE OF WORK 1 2.0 SURVEY METHOD 2 3.0 LABORATORY INFORMATION 3 4.0 BUILDING DESCRIPTION 4 } 5.0 FINDINGS 5 -6 6.0 CONCLUSIONS AND RECOMMENDATIONS 7 7.0 LIMITATIONS OF SURVEY 8 APPENDICES Sample Locations (Map) A Laboratory Results B AHERA Certifications & Laboratory Qualifications C 4058 South 148 Street, Seattle, WA Project # 2002 -460 1.0 SCOPE OF WORK An investigative survey for asbestos containing materials (ACM) was conducted on a residential structure located at 4058 South 148 Street, Seattle, Washington. The initial inspection was conducted on August 13, 2002 by Lisa Kollasch, an AHERA certified building inspector. This inspection included the detached garage and the residence was excluded due to accessibility. A follow up inspection was conducted on the residence on September 19, 2002 by Margaret Poe, an AHERA certified building inspector. These inspections were performed at the request of Darryl Doak, of Doak Homes Inc. The purpose of this inspection was to identify asbestos containing materials that would be impacted by the planned demolition of this structure. The asbestos survey section is written to comply with the AHERA asbestos sampling procedure as stated in 40 CFR 763.86. This protocol is required for all asbestos surveys prior to a building demolition under the Puget Sound Clean Air Agency, (PSCAA), Regulation III, Article IV, revised July 13, 2000. The asbestos survey also satisfies the "Good Faith" asbestos inspection requirements as stated in Washington Administrative Code (WAC) 296 -62- 07221(2), "identification ". As stated in this regulation, the owner of a structure scheduled to be renovation /demolished must provide a contractor with a written report of the asbestos containing materials to be disturbed during renovation /demolition. The National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61 requires a survey by an accredited asbestos inspector prior to demolition of a structure. A floor sketch indicating sampling locations has been included in Appendix A. NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 1 '•, , i ; �.ti }.r...., to+�v.t , ne a r �. �Y. "r '4 ih4 't! 3;: 0 K} t+., �..,- ,i:f } r`4y�.Rnw87.na.i_t dL: y itA °'t4, Sample Number Material Description Location Asbestos % Area (ft Friable (yes /no) job# -01 -01 white floor tile kitchen job# -01 -02 white floor tile kitchen job# -01 -03 white floor tile kitchen 4058 South 148 Street, Seattle, WA Project # 2002 -460 2. 0 SURVEY METHOD Asbestos Survey Method A walk- through inspection of all accessible areas of this structure was performed to identify potential asbestos - containing materials. The walk- through inspection included a review of the internal and external aspects of this structure. The locations and types of potential asbestos containing materials were noted. Sufficient bulk samples of building materials (vinyl floor tile, roofing, wall materials, etc.) were obtained of each material to satisfy the requirements of the Asbestos Hazard Emergency Response Act (AHERA) rules and regulations. These samples were placed into plastic sample bags, numbered and recorded. Homogeneous Materials Homogeneous materials are defined as an area of Asbestos - Containing Material (ACM) or Presumed Asbestos - Containing Material (PACM) which appears similar throughout in terms of color, texture, and date of material application. The report listing for homogenous materials will appear as follows: Under OSHA Guidelines, a minimum of three negative analysis of a single suspect homogeneous asbestos containing material is required to prove a negative result for surfacing materials and thermal system insulation. NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 2 4058 South 148 Street, Seattle, WA Project # 2002 -460 3.0 LABORATORY INFORMATION Laboratory Analysis — Asbestos Samples are analyzed in our laboratory using polarized light microscopy (PLM) with dispersion staining. If samples are not homogeneous, then subsamples of the components were analyzed separately. All Bulk samples are analyzed using EPA Method 600 /R- 93/116 with the following measurement uncertainties for reported % Asbestos (1 % =0 -3 %, 5 %= >1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). For samples containing more than one separable layer of materials, the report will include findings for each layer (labeled Layer: 1, Layer: 2, etc.). The asbestos concentration in the sample is determined by visual estimation. Laboratory Accreditation Professional accreditations for NVL Laboratories, Inc., include the following: NVL Laboratories, Inc., is currently accredited by the National Institute of Standards and Technology (NIST) under the National Volunteer Laboratory Accreditation Program (NVLAP) program for bulk asbestos fiber analysis. NVLAP Lab Code 102063 -0. NVL Laboratories, Inc., is approved by the American Industrial Hygiene Association (AIHA) Asbestos Analysts Registry (AAR) program for airborne asbestos fiber analysis. Counter ID 7412. NVL Laboratories, Inc., is currently accredited by the American Industrial Hygiene Association (AIHA) under the Industrial Hygiene Laboratory Accreditation Program ( IHLAP). The IHLAP program is designed specifically for laboratories involved in analyzing samples to evaluate workplace exposure. Certification Number 563. NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 3 !y;iii,:J�;F `•''. ;i�t tiL 4 :e >-�%:{c ?i::iti +.ii;:.: ic�s..:i.uwsa. , • 4058 South 148 Street, Seattle, WA Project # 2002 -460 4.0 BUILDING DESCRIPTION General Building type: This is a one story single - family residence with a detached garage. Primary external components: The primary external components are vertical wood shingles. The garage has horizontal wood shingles. Type of foundation: There is a post and pier foundation. The garage has a concrete slab. Roofing materials: There are asphalt shingles. The garage has 3 - tab asphalt shingles. Window types: There are wood framed windows with putty and aluminum framed windows without suspect putty. The garage has wood framed windows with putty. Flooring: The first floor substrate is wood with sheet vinyl and carpet. The attic substrate is wood with linoleum. Thermal systems w /insulation types: No central heating system was noted in this residence, rather baseboard electric heat was noted. Fiberglass insulation was noted in the attic and crawl space of this residence. Finishing: There are painted gypsum drywall partitions. The garage has wood paneling. NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 4 Sample Number Material Description Location Asbestos ( %) Area (ft Friable (yes /no) 2002 -460- 1. 3 -tab asphalt Garage roof 1:ND 1 -1 2. 3 -tab asphalt 2:ND 2002 -460- 1. 3 -tab asphalt Garage roof 1:ND 1 -2 2.3 -tab asphalt 2:ND 2002 -460- Window putty Garage ND 2 -1 2002 -460- Window putty Garage ND 2 -2 2002 -460- 1. white sheet vinyl bathroom floor at 1:ND 3 -1 2. grey backing with mastic doorway 2:ND 3. white sheet vinyl 3:ND 4. grey backing with mastic 4:ND 2002 -460- 1. white sheet vinyl bathroom floor at 1:ND 3 -2 2. grey backing with mastic doorway 2:ND 3. white sheet vinyl 3:ND 4. grey backing with mastic 4:ND 2002 -460- 1. painted clay tile bathroom shower 4X4 1:ND 4 -1 2. white mastic inch tile 2:ND 3. yellow mastic 3:ND 2002 -460- 1. painted clay tile bathroom shower 4X4 1:ND 4 -2 2. white mastic inch tile 2:ND 3. yellow mastic 3:ND 2002 -460- 1. white ceramic tile bathroom shower 2X2 1:ND 5 -1 2. white mastic inch tile 2:ND 3. yellow mastic 3:ND 2002 -460- 1. white ceramic tile bathroom shower 2X2 1:ND 5 -2 2. white mastic inch tile 2:ND 3. yellow mastic 3:ND 2002 -460- 1. white sheet vinyl kitchen floor at entry to 1:ND 6 -1 2. grey backing with mastic living room 2:ND 2002 -460- 1. white sheet vinyl kitchen floor at entry to 1:ND 6 -2 2. grey backing with mastic living room 2:ND 4058 South 148 Street, Seattle, WA Project # 2002 -460 5.0 FINDINGS Inventory of Suspect Asbestos - Containing Materials ND - None Detected NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 5 Sample Number Material Description Location Asbestos ( %) Area (ft Friable (yes /no) 2002 -460- 7 -1 1. white sheet vinyl 2. grey backing with mastic entry at front door 1:ND 2:ND 2002 -460- 7 -2 1. white sheet vinyl 2. grey backing with mastic entry at front door 1:ND 2:ND 2002 -460- popcorn ceiling living room ceiling at 3 192 yes 8 -1 texture corner of bath 2002 -460- popcorn ceiling living room ceiling at sample not 8 -2 texture middle of west wall analyzed 2002 -460- popcorn ceiling living room ceiling at sample not 8 -3 texture entry way analyzed 2002 -460- Window putty west living room ND 9 -1 window 2002 -460- Window putty south living room ND 9 -2 window 2002 -460- 1. brown vapor barrier south under exterior 1:ND 10 -1 paper 2. black vapor barrier paper siding by kitchen window 2:ND 2002 -460- 1. brown vapor barrier south under exterior 1:ND 10 -2 paper 2. black vapor barrier paper siding by kitchen window 2:ND 2002 -460- multi layered black SW roof corner 3 960 no 11 -1 asphalt shingles with grains 2002 -460- multi layered black SW roof corner 4 11 -2 asphalt shingles with grains 2002 -460- 1. paint with texture east wall dining off 1:ND 12 -1 2. gypsum wallboard kitchen 2:ND 2002 -460- 1. paint with texture west wall of bedroom 1:ND 12 -2 2. gypsum wallboard NW 2:ND 2002 -460- 1. paint with texture living room south wall 1:ND 12 -3 2. gypsum wallboard by entry 2:ND 2002 -460- 1. fiberglass insul. dining room wall east 1:ND 13 -1 2. grey blown -in insul. 2:ND 2002 -460- 1. fiberglass insul. attic at access in living 1:ND 13 -2 2. grey blown -in insul. room 2:ND 4058 South 148 Street, Seattle, WA Project # 2002 -460 Inventory of Suspect Asbestos - Containing Materials- continued ND - None Detected Any suspect material(s) not identified above should not be disturbed, and tested immediately. The suspect material must be treated as asbestos containing until testing proves otherwise. NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 6 ,...1.?..: �Y� ,; 7:....,....:: in::• 41.a.C;thU,Sssi; '2' `. `u?',ir: s;:iay.:Y 146 AIY 4058 South 148` Street, Seattle, WA Project # 2002 -460 6.0 CONCLUSIONS AND RECOMMENDATIONS ASBESTOS The following summarizes the homogeneous Asbestos - Containing Materials (ACM) and Presumed Asbestos - Containing Materials (PACM) identified at the residential structure located at 4058 South 148 Street, Seattle, Washington. 1. Popcorn Ceiling Texture: (material number 2002 - 460 -8) There is approximately 192 ft of asbestos - containing popcorn ceiling texture associated with the living room of this residence. This material is on gypsum wallboard. 2. Asphalt shingles: (material number 2002 - 460 -11) There is approximately 960 ft of asbestos - containing asphalt shingles associated with the roof of this residence. The substrate is wood. Approximations of square footage are offered as an added service to the client. These numbers are not exact values and should be confirmed by the client and participating contractors. If discovered, all ACMs that will be disturbed as a natural part of renovation /demolition and are required to be removed and disposed of in accordance with Washington State Regulations. Washington State Department of Labor and Industries and PSCAA require that the abatement be performed using Certified Asbestos Workers under the direct on -site supervision of a Certified Asbestos Supervisor. Further, NVL suggests that an AHERA inspector review this property after abatement to ensure all ACM has been removed by the contractor. Hidden wall and ceiling cavities that are not accessible during the time of surveying can sometimes conceal ACM. Thus, NVL recommends that an AHERA inspector /project manager be on site at the time of renovation /demolition to ensure that any potentially asbestos - containing materials uncovered during the process of renovation /demolition be dealt with properly. NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 Page 7 The sole purpose of this survey report is to document asbestos - containing materials discovered in the survey of suspect materials by NVL Laboratories personnel at the residential structure located at 4058 South 148 Street, Seattle, Washington on August 13, 2002 and z September 19, 2002. re w QQ � J U O 0 • o J • w w 0 u- j N d � �/� z � 2 LL! � U � O N O 1— w • w • O w z U � 01— 0 4058 South 148 Street, Seattle, WA Project # 2002 -460 7.0 LIMITATIONS OF SURVEY This site visit consisted of a thorough visual walk- through of the building for the purpose of viewing and sampling potential ACMs. As hazardous material surveys are non - comprehensive by nature, NVL Laboratories, Inc., cannot be held liable for materials which require destructive means to access, materials which are hidden from sight (e.g. materials hidden behind walls), materials which cannot be found due to their obscure nature, or which otherwise cannot be discovered with reasonable diligence. This document is the sole property of NVL Laboratories and the property owner, or his agent, authorizing this survey. Inspected by: Lisa Kollasch AHERA Building Inspector AHERA Certification No.: 1002070 AHERA Certification Expires on: April 24, 2003 Inspected by: Margaret Poe AHERA Building Inspector AHERA Certification No.: 1002308 AHERA Certification Expires on: May 29, 2003 Reviewed by: NVL Laboratories, Inc., 4708 Aurora Avenue North, Seattle, WA 98103 Ph (206) 547 -0100 • Fx (206) 634 -1936 John Terrill Senior Project Manager Page 8 z z EC 2 Ui W _i O 0 (/) W W w 0 u_ I-- m • in Z 0 Z 1- W w • 0 C.) w O — 0 • w I Lii L I: 0 O CD I= O 1- Z r - L „J _ j I v_...._ _ 1 NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE IT IS DUE TO THE QUALITY OF THE DOCUMENT. I H • Z • W O 0 COO CO W W -J CJ) LL w LI- < HO w z z w w 0 D I- W w I W L I 0 0 U) o Z NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Lisa Kollasch Project Location: 4058 S 148th, Seattle, WA Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Lab ID : 22090687 Client Sample #: 2002 - 460 - 1 - 1 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: Asphalt shingle with granular coating Non - Fibrous Materials: Other Fibrous Materials:% Asphalt /binder,Sand Cellulose 6% Glass fiber 22% Layer 2 of 2 Description: Asphalt shingle with granular coating Non- Fibrous Materials: Other Fibrous Materials:% Asphalt /binder,Sand Cellulose 8% Glass fiber 23% Lab ID : 22090688 Client Sample #: 2002 - 460 -1 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: Asphalt shingle with granular coating Non - Fibrous Materials: Other Fibrous Materials:% Asphalt /binder,Sand Cellulose 5% Glass fiber 20% Lab ID : 22090690 Client Sample #: 2002 - 460 -2 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Tan formed cementitious material with painted surface Non - Fibrous Materials: Other Fibrous Materials:% Sampled by: Client Analyzed by: John Terrill Reviewed by: Munaf Khan Clay /binder,Mineral /binder,Paint Cellulose 2% #102063 Batch #: 2211796.00 Client Project #:2002 -460 Samples Received: 4 Samples Analyzed: 4 Method: EPA /600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Layer 2 of 2 Description: Asphalt shingle with granular coating Non - Fibrous Materials: Other Fibrous Materials:% Asbestos Type: % Asphalt/binder,Sand Cellulose 8% None Detected ND Glass fiber 20% Lab ID : 22090689 Client Sample #: 2002 - 460 -2 -1 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Tan formed cementitious material with painted surface Non - Fibrous Materials: Other Fibrous Materials:% Asbestos Type: % Clay /binder,Mineral /binder,Paint Cellulose 2% None Detected ND Asbestos Type: % None Detected ND Date: 08/14/2002 Date: 08/14/2002 Munaf Khan, Laboratory Director Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0 -3 %, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. 4ri (01,R4VORFORV PVIA40nm -ArtrA W!.rse titmrrm: 5 , rvmav ^A,ur, "Ittr.JOrpx0 ,!!! Page 1 of 1 I Condition of Package: u 'iooa u uamagea (no spiliage) u Severe aamage (spillage) i `Seq. I Lab ID Client Sample Number Comments A/R 1 US -- 01( �.'L'�- 7 1- 1--)1 (� Received by 12 )-1, Z'i � Cl VP- ' 4)1 -- IQ QO 3 GI ' 4 Results Called by 7' . Results Faxed by • - l 8 9 1 10 11 12 13 14 L 15 Sampled by USIA K r j / j1s( `0 ��i N VL ; - p Lab O 41. i t i Jr` . Relinquished by US -- 01( �.'L'�- ►_.... .41 1--)1 (� Received by ' ( A / / •,G� 3 � Cl VP- ' 4)1 -- IQ QO Analyzed by GI 0) Results Called by :::- . Results Faxed by • - NVL Laboratories, Inc. • 4708 Aurora Ave N, Seattle, WA 98103 f el: 2156.547.0100 Emerg. Pager: 206.344.1878 1.888.NVL.LABS (685.5227) Client NVL Field Services Division Seattle, WA 98103 6516 ?roject Manager 1.1.34A .J o') fS ' " Project Location 405 S . / 9 8 " D Other Types of Analysts METALS Total Metals ❑ TCtP Address 4708 Aurora Ave. North S ��- -� Phone: (206) 547 -0100 Fax (206) 634 -1936 Print Below S CHAIN of CUSTODY .. SAMPLE LOG NVL Batch Number Client Job Number ? T) o (0 0 Total Samples C �=y BATCH ID 2211796 Turn Around Time 0 1-Hr ❑ 24 -Hrsf ❑ 4 Days ❑ 2- Hrs ,3ays 0 5 Days ❑ 4 -Hrs ❑ 3 Days ❑ 6 to 10 Days Please cal for TAT less than 24 His Email address 10 Asbestos Ak 1 ❑ PCM ( NIOSH 7400) ❑ TEM (NIOSH 7402) ❑ TEM (AHERA) ❑ TEM (EPA Level II) ❑ Other bestos Bulk P (EPAP600/R- 93/116) ❑ PLM (EPA Point Count) ❑ PLM (EPA Gravimetry) . ❑ TEM Bulk L Limit ❑ ppm (AAS) ❑ ppb (GFAA) Matrix ❑ Air Filter ❑ Paint Chips ❑ Drinking water ❑ Paint Chips (Area) 0 Dust/wipe ❑ Waste Water RCRA Metals ❑ Arsenic (As) ❑ Barium (Ba) ❑ Cadmium (Cd) ❑ Chromium (Cr) ❑ All 8 ❑ Lead (Pb) ❑ Mercury (Hg) ❑ Selenium (Se) ❑ Silver (Ag) Other Metals ❑Alt3 Copper (Cu) ❑ Nickel (Ni) ❑ Zinc (Zn) ❑ Fiberglass ❑ Nuisance Dust ❑ Rotometer Calibration ❑ Other (Specify) ❑ Silica ❑ Respirable Dust Mold/Fungus (Please use Mold COC) Time I Special instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after analysis. . 'lease stop at first positive with the exception of roofing and wall materials. With egard to multiple layered flooring, please analyze all layers. sxy;:Ax( ^Y Y RFC NVL Laboratories, Inc. Lab ID : 22098067 Client Sample #: 2002 - 460 -3 -1 Location: 4058 S 148th, Seattle, WA 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Margaret Poe Project Location: 4058 S 148th, Seattle, WA Layer 1 of 4 Description: Layer 2 of 4 Description: Layer 3 of 4 Description: Layer 4 of 4 Description: Lab ID : 22098068 Client Sample #: 2002 - 460 -3 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 4 Description: Off - white sheet vinyl Non - Fibrous Materials: Vinyl /binder Layer 2 of 4 Description: Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Layer 3 of 4 Description: White sheet vinyl Non - Fibrous Materials: Vinyl /binder Layer 4 of 4 Description: Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Lab ID : 22098069 Client Sample #: 2002 - 460 -4 -1 Location: 4058 S 148th, Seattle, WA (Sampled by: Client Analyzed by: Wei Long Tai Reviewed by: Nick Ly Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Off -white sheet vinyl Non - Fibrous Materials: Vinyl /binder Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder White sheet vinyl Non - Fibrous Materials: Vinyl /binder Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Date: 09/23/2002 Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Other Fibrous None Other Fibrous Materials:% Detected ND Materials:% Cellulose 65% a�aas #102063 Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Date: 09/23/2002 Nice,ff; T- hnic. e ' =or J Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: None Detected ND J Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk • s are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1%=0-3%, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. Page 1 of 7 IMO NVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Margaret Poe Project Location: 4058 S 148th, Seattle, WA Layer 1 of 3 Description: Brown hard brittle material Non - Fibrous Materials: Binder /Filler Layer 2 Layer 3 Layer 1 of 3 Layer 2 of 3 Layer 3 of 3 of 3 Description: White mastic Non - Fibrous Materials: Mastic /binder of 3 Description: Yellow brittle material Non - Fibrous Materials: Binder /Filler Lab ID : 22098070 Client Sample #: 2002 - 460 -4 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 3 Description: Brown hard brittle material Non- Fibrous Materials: Binder /Filler Layer 2 of 3 Description: White mastic Non - Fibrous Materials: Mastic /binder Layer 3 of 3 Description: Yellow brittle material Non - Fibrous Materials: Binder /Filler Lab ID : 22098071 Client Sample #: 2002 - 460 -5 -1 Location: 4058 S 148th, Seattle, WA Description: White hard brittle material Non - Fibrous Materials: Binder /Filler Description: White mastic Non - Fibrous Materials: Mastic /binder Description: Yellow brittle material Non - Fibrous Materials: Binder /Filler Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Other Fibrous None Other Fibrous Other Fibrous Materials:% Cellulose 2% Other Fibrous None Other Fibrous Other Fibrous None Other Fibrous Materials:% Detected ND Materials:% Cellulose 3% Materials:% Detected ND Materials:% Cellulose 3% Other Fibrous Materials:% Cellulose 2% Materials:% Detected ND Materials:% Cellulose 4% Other Fibrous Materials:% Cellulose 2% awdaf #102063 Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: None Detected ND Asbestos Type: % None Detected ND Asbestos Type: None Detected ND Asbestos Type: None Detected ND Asbestos Type: None Detected ND r Sampled by: Client Analyzed by: Wei Long Tai Date: 09/23/2002 Reviewed by: Nick Ly Date: 09/23/2002 Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1%=0-3%, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. Page 2 of 7 -- 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com NVL Laboratories, Inc. Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Margaret Poe Project Location: 4058 S 148th, Seattle, WA Lab ID : 22098072 Client Sample #: 2002 - 460 - - Location: 4058 S 148th, Seattle, WA Layer 1 of 3 Description: White brittle material Non - Fibrous Materials: Binder /Filler Layer 2 of 3 Description: White mastic Non - Fibrous Materials: Mastic /binder Layer 3 of 3 Description: Yellow brittle material Non - Fibrous Materials: Binder /Filler Lab ID : 22098073 Client Sample #: 2002 - 460 - - Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White sheet vinyl Non - Fibrous Materials: Vinyl /binder Layer 2 of 2 Description: Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Lab ID : 22098074 Client Sample #: 2002 - 460 - - Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White sheet vinyl Non - Fibrous Materials: Vinyl /binder Layer 2 of 2 Description: Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Lab ID : 22098075 Client Sample #: 2002 - 460 -7 -1 Location: 4058 S 148th, Seattle, WA Sampled by: Client Analyzed by: Wei Long Tai Reviewed by: Nick Ly Bulk Asbestos Fibers Analysis By Polarized Light Microscopy t VWf }+"h"^H�'(': + <mv.nT'+•.y.t.. Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 3% Other Fibrous Materials:% Cellulose 2% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Date: 09/23/2002 Date: 09/23 /2002 Ni aVaaf #102063 J Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1%=0-3%, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. J Page 3 of 7 r NVL Laboratories, Inc. a�aL D 4708 Aurora Ave. N., Seattle, WA 98103 #102063 L Te1. 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Margaret Poe Project Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White sheet vinyl Non - Fibrous Materials: Vinyl /binder Layer 2 of 2 Description: Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Lab ID : 22098076 Client Sample #: 2002 - 460 -7 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White sheet vinyl Non - Fibrous Materials: Vinyl /binder Layer 2 of 2 Description: Gray fibrous backing with mastic Non - Fibrous Materials: Binder /Filler, Mastic /binder Lab ID : 22098077 Client Sample #: 2002 - 460 -8 -1 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Tan lumpy foamy material with paint Non - Fibrous Materials: Other Fibrous Materials:% Synthetic foam, Binder /filler Cellulose 5% Lab ID : 22098078 Client Sample #: 2002 - 460 -8 -2 Lab ID : 22098079 Client Sample #: 2002 - 460 -8 -3 Lab ID : 22098080 Client Sample #: 2002 - 460 -9 -1 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Gray brittle material with paint Non - Fibrous Materials: Binder /Filler, Paint Sampled by: Client Analyzed by: Wei Long Tai Reviewed by: Nick Ly a Date: 09/23/2002 Date: 09/23/2002 Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 65% Nip ��+ ec - ector Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % Chrysotile 3% SAMPLE NOT ANALYZED SAMPLE NOT ANALYZED Other Fibrous Materials:% Asbestos Type: % Cellulose 3% None Detected ND Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0 -3 %, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. Page 4 of 7 ' NVL Laboratories, Inc. Client: Address: Attention: Project Location: Lab ID : 22098081 Client Sample #: 2002 - 460 - 9 - 2 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Gray /white brittle material with paint Non - Fibrous Materials: Binder /Filler Lab ID : 22098082 Client Sample #: 2002 - 460 -10 -1 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: Brown fibrous material Non - Fibrous Materials: Binder /Filler Layer 2 of 2 Description: Black asphaltic fibrous felt Non - Fibrous Materials: Asphalt /binder, Binder /filler Lab ID : 22098083 Client Sample #: 2002 - 460 -10 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: Brown fibrous material Non - Fibrous Materials: Binder /Filler Layer 2 of 2 Description: Black asphaltic fibrous felt Non - Fibrous Materials: Asphalt /binder, Binder /filler Lab ID : 22098084 Client Sample #: 2002 - 460 -11 -1 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Multi -layer black asphatic material with sand Non - Fibrous Materials: Asphalt /binder, Sand Lab ID : 22098085 Client Sample #: 2002 - 460 -11 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 1 Description: Multi -layer black asphatic material with sand Non - Fibrous Materials: Asphalt /binder, Sand 4708 Aurora Ave. N., Seattle, WA 98' Tel: 206.547.0100, Fax: 206.634.74 www.nvIlabs.com 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 ww.nvllabs.com NVL Field Services Division 4708 Aurora Ave. North Seattle, WA 98103 6516 Ms. Margaret Poe 4058 S 148th, Seattle, WA Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Other Fibrous Materials:% Cellulose 2% Other Fibrous Materials:% Other Fibrous Materials:% Other Fibrous Materials:% Other Fibrous Materials:% Other Fibrous Materials:% Cellulose 17% Glass fibers 14% Other Fibrous Materials:% Cellulose 17% Nick aav #102063 Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Asbestos Type: % None Detected ND Asbestos Type: % Cellulose 70% None Detected ND Asbestos Type: % Cellulose 50% None Detected ND Asbestos Type: Cellulose 70% None Detected ND Asbestos Type: % Cellulose 50% None Detected ND CI •.TriS fo Asbestos Type: Chrysotile 3% Asbestos Type: % Chrysotile 4% Sampled by: Client Analyzed by: Wei Long Tai Date: 09/23/2002 Reviewed by: Nick Ly Date: 09/23/2002 J Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0 -3 %, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. Page 5 of 7 .,'e. f lt!des:¢isVry;•.SUN•.v'ce+?Se . • • '� h�R: ��n�y. a, , awv :.+<m.�«em:.�:c;.., <m,,,. ,., « n.,. , b r, +.,,.. _ . ». ... r ..... r.r;.en.+ io' w+w.�e,posrvw.rrtro NVL Laboratories, Inc. - 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Margaret Poe Project Location: 4058 S 148th, Seattle, WA Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Lab ID : 22098086 Client Sample #: 2002 - 460 - 12 - 1 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White compacted powdery material with paint Non - Fibrous Materials: Binder /Filler, Paint Layer 2 of 2 Description: White chalky material with paper Non - Fibrous Materials: Gypsum /binder, Binder /filler Lab ID : 22098087 Client Sample #: 2002 - 460 -12 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White compacted powdery material with paint Non - Fibrous Materials: Binder /Filler, Paint Layer 2 of 2 Description: White chalky material with paper Non - Fibrous Materials: Gypsum /binder, Binder /filler Other Fibrous Materials:% Other Fibrous Materials:% Other Fibrous Materials:% Other Fibrous Materials:% Lab ID : 22098088 Client Sample #: 2002 - 460 -12 -3 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: White compacted powdery material with paint Non - Fibrous Materials: Other Fibrous Materials:% Binder /Filler, Paint Cellulose 5% Layer 2 of 2 Description: White chalky material with paper Non - Fibrous Materials: Gypsum /binder, Binder /filler Lab ID : 22098089 Client Sample #: 2002 - 460 -13 -1 Location: 4058 S 148th, Seattle, WA Layer 1 of 2 Description: Brown fibrous material Non - Fibrous Materials: Other Fibrous Materials:% Binder /Filler Cellulose 50% Synthetic fibers 35% (Sampled by: Client Analyzed by: Wei Long Tai Reviewed by: Nick Ly Date: 09/23/2002 Date: 09/23/2002 Other Fibrous Materials:% Vsi '1F+, %hMhYrttl'!3 ?t45gAi`�, �r�:v:�t C.r.wgN.1.. Glass fibers 14% KIVaa,J #102063 J Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Asbestos Type: % Cellulose 4% None Detected ND Asbestos Type: % Cellulose 27% None Detected ND Asbestos Type: Cellulose 4% None Detected ND frti Nick L' technical P or Asbestos Type: % Cellulose 27% None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % Cellulose 27% None Detected ND Asbestos Type: % None Detected ND Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samp es are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0 -3 %, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. i Page 6 of 7 1 eNVL Laboratories, Inc. 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvllabs.com Client: NVL Field Services Division Address: 4708 Aurora Ave. North Seattle, WA 98103 6516 Attention: Ms. Margaret Poe Project Location: 4058 S 148th, Seattle, WA Layer 2 of 2 Description: Gray fibrous material Non - Fibrous Materials: Binder /Filler Lab ID : 22098090 Client Sample #: 2002 - 460 -13 -2 Location: 4058 S 148th, Seattle, WA Layer 1 of 5 Description: Gray fibrous material Non - Fibrous Materials: Binder /Filler Layer 2 of 5 Description: Silver paper Non - Fibrous Materials: None Detected Layer 3 of 5 Description: Layer 4 of 5 Description: Layer 5 of 5 Description: Tan paper Non - Fibrous Materials: Binder /Filler Black asphaltic mastic Non - Fibrous Materials: Asphalt/binder Yellow fibrous material Non - Fibrous Materials: Binder /Filler Bulk Asbestos Fibers Analysis By Polarized Light Microscopy Sampled by: Client Analyzed by: Wei Long Tai Date: 09/23/2002 Other Fibrous Materials:% Other Fibrous Materials:% Cellulose 80% Other Fibrous Materials:% None Detected ND Other Fibrous Materials:% Cellulose 80% Other Fibrous Materials:% Cellulose 3% Other Fibrous Materials:% Glass fibers 80% aVaaV #102063 Batch #: 2213219.00 Client Project #:2002 -460 Samples Received: 24 Samples Analyzed: 22 Method: EPA /600R- 93/116 Asbestos Type: % Cellulose 80% None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND Asbestos Type: None Detected ND Asbestos Type: % None Detected ND A Reviewed by: Nick Ly Date: 09/23/2002 Nic IM0 -- hnic_ re -- or Note: If samples are not homogeneous, then subsamples of the components were analyzed separately. All bulk samples are analyzed using EPA 600 /R- 93/116 Method with the following measurement uncertainties for the reported % Asbestos (1 % =0 -3 %, 5 % =1 -9 %, 10 %= 5 -15 %, 20 %= 10 -30 %, 50 %= 40 -60 %). This report relates only to the items tested. If sample was not collected by NVL personnel, then the accuracy of the results is limited by the methodology and acuity of the sample collector. This report shall not be reproduced except in full, without written approval of NVL Laboratories, Inc. It shall not be used to claim product endorsement by NVLAP or any other agency of the US Government. Page 7 of 7 Seq. # Lab ID Client Sample Number Comments AIR 1 (EPA Point Count) ?CO ? ylop' -f PLM (EPA Gravimetry) Analyzed by 2 /R- 93/116) • PLM " • TEM Bulk METALS 3 Matrix C H 1 RCRA Metals /f /��./ 4 Other Metals "1 -z • Total Metals 5 • Air Filter 6'i • Arsenic (As) 6 Lead (Pb) l -Z All 3 7 i -I • Drinking water El Paint Chips (Area) 8 Barium (Ba) (P . Mercury (Hg) • 9 • 1'1 • ppb (GFAA) • Dust/wipe 10 • 7-7 • Selenium (Se) 11 Nickel (Ni) g -1 12 • Other R' Chromium (Cr) • 13 • ( F'3 14 fri 15 • 6/-7i • Fiberglass • Silica ❑ Nuisance Dust • Respirable Dust • Asbestos Air • PCM (NIOSH 7400) • TEM (NIOSH 7402) • TEM (AHERA) ❑ TEM (EPA Level II) • Other ,4 e.- ' ,e �,Lf /o_e_ _ • �..._.._.._. - - � —/ <.___.--- Asbestos Bulk I &PLM (EPA/600 f : 61e g -eve, /� (EPA Point Count) Received by PLM (EPA Gravimetry) Analyzed by Results Called by /R- 93/116) • PLM • • TEM Bulk METALS Det. Limit Matrix r _7,e____ RCRA Metals /f /��./ All 8 Other Metals • • Total Metals • pp (AAS) • Air Filter • Paint Chips • Arsenic (As) • Lead (Pb) • All 3 • Drinking water El Paint Chips (Area) • Barium (Ba) • Mercury (Hg) • Copper (Cu) • TCLP • ppb (GFAA) • Dust/wipe • Waste Water • Cadmium (Cd) • Selenium (Se) • Nickel (Ni) • Soil • Other • Chromium (Cr) • Silver (Ag) • Zinc (Zn) • Other Types of Analysis • Fiberglass • Silica ❑ Nuisance Dust • Respirable Dust • Rotometer Calibration • Mold /Fungus • Other (Specify) Sampled by Au Q,r.¢ -- / o ___ mar a,l-.0 At_ ,4 e.- ' ,e �,Lf /o_e_ _ • �..._.._.._. - - � —/ <.___.--- V -- Nki- I ki D IIM f ' .� G " f : 61e g -eve, /� Relinquished by Received by 7f f ,_ ,.1_. Analyzed by Results Called by / "iL� r Results Faxed by r _7,e____ / ' /'�.����'° /f /��./ Fl NVL Laboratories, Inc. • 4708 Aurora Ave N, Seattle, WA 98103 w Tel: 206.547.0100 Emerg. Pager: 206.344.1878 1.888.NVL.LABS (685.5227) Client NVL Field Services Division Street 4708 Aurora Ave. North Seattle, WA 98103 6516 Project Manager Margaret Poe Project Location _Mo5S , 19 cc 5coutk'I.t,, Wfr Phone: (206) 547 - 0100 Fax: (206) 634 - 1936 Print Below Sign Below ;rrAr x.+X+q.r CHAIN of CUSTODY SAMPLE LOG Client Job Number Total Samples Turn Around Time Email address Condition of Package: ❑ Good ❑ Damaged (no spillage) ❑ Severe damage (spillage) BATCH ID 2213219.00 NVL Batch Number 2eoz --Li too 2 cf ❑ 1 -Hr ❑ 24 -Hrs ❑ 4 Days ❑ 2 -Hrs [g2 Days ❑ 5 Days ❑ 4 -Hrs ❑ 3 Days ❑ 6 to 10 Days Please call for TAT less than 24 Hrs margaret.p @nvllabs.com Cell: (206) 909 -4576 Home: (425) 793 -1523 Comoan Date .' Time Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after a 0..ea.. 5+oe at tr,�' posi-five w/ .exc,epfid-cc e i ooP�v�c vv ;p It. I a r 2d r; K -- . at4149 eag allysis 14(040'16L-05 Seq. # Lab ID Client Sample Number Comments AIR 1 /R- 93/116) • PLM (EPA Point Count) 70 (00 — /0 - 1 Relinquished by i • 2 Det. Limit • pp (AAS) • ppb (GFAA) (0 -1 6,e' Other Metals 3 • Total Metals 1, - I • Arsenic (As) • Lead (Pb) • All 3 • Drinking water • Paint Chips (Area) • Barium (Ba) • Mercury (Hg) • Copper (Cu) • TCLP 5 • Cadmium (Cd) • Selenium (Se) /Z-1 • Soil • Other 6 • Zinc (Zn) I Z Z- Wm `` MINA:MIMI • Other Types of Analysis 7 • Nuisance Dust • Rotometer Calibration • Respirable Dust • Mold /Fungus (Z 8 13 - , A 9 iii-C____ 13 -Z ; ?A..-. 10 11 12 13 14 15 • Asbestos Air • PCM (NIOSH 7400) • TEM (NIOSH 7402) • TEM (AHERA) • TEM (EPA Level II) • Other , re PD gAsbestos Bulk iPPLM (EPA/600 /R- 93/116) • PLM (EPA Point Count) • PLM (EPA Gravimetry) • TEM Bulk Relinquished by i • METALS Det. Limit • pp (AAS) • ppb (GFAA) Matrix 6,e' Other Metals RCRA Metals • All 8 • Total Metals • Air Filter • Paint Chips • Arsenic (As) • Lead (Pb) • All 3 • Drinking water • Paint Chips (Area) • Barium (Ba) • Mercury (Hg) • Copper (Cu) • TCLP ❑ Dust/wipe • Waste Water • Cadmium (Cd) • Selenium (Se) • Nickel (Ni) • Soil • Other • Chromium (Cr) • Silver (Ag) • Zinc (Zn) Wm `` MINA:MIMI • Other Types of Analysis • Fiberglass • Silica • Nuisance Dust • Rotometer Calibration • Respirable Dust • Mold /Fungus • Other (Specify) Sampled by ij , re PD r .0,4v N i/. ` N' /P ' . y' Relinquished by i • O , r i ' ''; ...; 6,e' /1.1U1i V DA MV !VIM" Received by (I/ S Analyzed b Wm `` MINA:MIMI . Results Called by Results Faxed by , A iii-C____ ; ?A..-. NVL Laboratories, Inc. 4708 Aurora Ave N, Seattle, WA 98103 Tel: 206.547.0100 Emerg. Pager: 206.344.1878 1.888.NVL.LABS (685.5227) Client NVL Field Services Division _.J • Street 4708 Aurora Ave. North Seattle, WA 98103 6516 Project Manager Margaret Poe Project Location Phone: (206) 547 -0100 Fax: (206) 634 -1936 CHAIN of CUSTODY SAMPLE LOG NVL Batch Number Total Samples Turn Around Time Email address Cell: (206) Condition of Package: ❑ Good ❑ Damaged (no spillage) 0 Severe damage (spillage) Client Job Number 700? - 1Lo Print Below Sign Below Comoan `11 L AB S ' N AAAI,ous .AIIAIAU <IWI<II ❑ 1 -Hr ❑ 24 -Hrs ❑ 4 Days ❑ 2 -Hrs ❑ 2 Days ❑ 5 Days ❑ 4 -Hrs ❑ 3 Days ❑ 6 to 10 Days Please call for TAT less than 24 Hrs margaret.p @nvllabs.com 909 -4576 Home: (425) 793 -1523 Date Time Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after italysis. IN\VIL) Building Inspector Certifications & Laboratory Qualifications 41,1 s. r r 10 ` t A C C �� y a+lLS.rrr:Gfl Igg X1 1, ^•;vs�r .rhf rN dV � et x x catiaiWicavaiixr 1h:iif YirL.tiru7rhYLtira 3. P. certificate of Complition Trai ng Ad , tration AHERA Certifi: • M09907012 i5 to certifp that Margaret E Poe 1ja dtlfACtDritp COYtTptEtEb 4 Tjuurt of refres'ber gaining an Asbestos Building Inspector to comply uitij the training requireinent5 of Tfie i Effie 311 / 40 ell& 763 (ZIK?Q 3R•2I) Certificate Number 1002308 ARGUS D n SAFETY • TRAINING • INDUSTRIAL HYGIENE n May 29, 2002 Date(s) of Training Expiration Date: May 29, 2003 Argus Pacific, Inc. • 1900 W. Nickerson, Suite 315 • Seattle, Washington • 98119 • (206) 285. •t '�•:•!Ya, u�7+�u4.w�71j/ , y ,.. ,t:tt�;NJ7� (x•41,1, 01.1�1)'i . 1. i � J `* 1 I, • .I It 1 c � i u ,� • ••I,1.1.1 .4ttltti /1�` \ fin �Rt t4'.YSW�ogri.. 1 \ Kt /4„, 1 ` !r' t�/ 4 41. 11 • t. !• '•Q:i4411 1,1 • V t!i / 31 1 11 1 11', , ' ..j`1 'e r �'+'Cr 1 j i �� • r'iC'��1ti� s ar 7111 toy," r>i� \�I 1 y /� % 4 .0(4,0 �l ll �'r:, � r•• .. ; Z11'If 111j���a.. a •��I yP 1 YR 1s + !rli:Y'ru 11 srGSrs Y's'. V rr n '!lr r�;rrrsvrs �U U lr VU 1 111\ Iit�iY -- !(' Yi ♦ I I �• S.Y t f r/ Vslie • Ys „ � / Y 1 J .)i 1 ` u±l U `\ // . 3373 • fax (206) 285.3927 4 tltR:!St4.VUt4.!tr ^Ar�i.1 -rl•%/ 1 1 ``{Sttr�SlSr,r.Yt:LgA };1 ?.� 1ur p' • 1 �;., e.r X41 N�• F t.:SS •1•��... •rte:\ Z W JU O 0 W W J = W J IL cn = F W — _ Z �.. W O � Q U co 0 W W W z U= O F- Z 4 ktl...Tundviv_2701 , , '414 AID =KIVA 73 WIWI . l4it W1 CI' In MPS *HIM 1,i$ t77.RNVIiM • arM tireettetriOmIllrin't SliMt tfittlfitIS I41 +7017/6S:iWitrahfathhiti.rig■NIZataviiilli)fitsNASI.torbilliftts.i oilak th - owaliriArf,priElr;77.-APWrIVM - ,at 1 ;!:r WAk Yft A ": ( vI N...7 ( Ifa l \ PAW% vrriirykmirrariA: %awl% ( cate utrp ■(401) ‘„45 • fax (206)285.3927 < • I I j— Z CL O 0 U) 0 ('‚ Ui ILI CO IL L i 0 Li_ a 52 0 I-- m ill Z '— ‚-0 Z u j 2 0 n 0 O (12 • 1- LL1 I ^ 0 z w I= 0 I ■ National Institute of Standards and Technology ISO/IEC 17025:1999 ISO 9002:1994 BULK ASBESTOS FIBER ANALYSIS NVLAP-01S (06.01) September 30, 2003 Effective through Scope of Accreditation NVL LABORATORIES, INC. 4708 Aurora Avenue N. Seattle, WA 98103 Mr. Nghiep Vi Ly Phone: 206-547-0100 Fax: 206-634-1936 E-Mail: munaf@nvllabs.com URL: http://www.nvllabs.com National Voluntary Laboratory Accreditation Program 0, to F o 0* -cfe 4 gr. 1. 4 4u o 0 to ` O * " Page: 1 of 1 NVLAP LAB CODE 102063-0 NVLAP Code Designation 18/A01 EPA-600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Insulation Samples Pow '4) roa,otim4.1,a,1_, For the National Institute of Standards and Technology _Ty 40 , exaa lm..eitts0 4. United States Department of Commerce National Institute of Standards and Technology ISO /IEC 17025:1999 * '•� * ISO 9002:1994 Certificate of Accreditation - Q S TATES OF P NVLAP-01C (06 -01) is recognized by the National Voluntary Laboratory Accreditation Program for satisfactory compliance with criteria set forth in NIST Handbook 150:2001, all requirements of ISO /IEC 17025:1999, and relevant requirements of 1S0 9002:1994. Accreditation is awarded for specific services, listed on the Scope of Accreditation, for: September 30, 2003 Effective through NVL LABORATORIES, INC. SEATTLE, WA BULK ASBESTOS FIBER ANALYSIS Oa.i ».l ratotoi- For the National Institute of Standards and Technology NVLAP Lab Code: 102063 -0 . *�" OF cot, ti r Z W tY 2 JU 0O too ui I-- WO 2 g a co = d F-W Z � I— 0 Z I— U 0. O N O I-- W W - r 0 w O 1— z MERICA N Environmental Construction LLC P.O. Box 81005 Seattle, WA 98108 -1005 Voice: (206) 267 -0748 - Fax: (206) 267 -0753 Billing Address Doak Homes, Inc. 11812 - 26th Avenue SW Burien, WA 98146 THANK YOU FOR YOUR BUSINESS Job Address 4058 South 148th Street Tukwila, WA 98168 Invoice Date 11/11/2002 AEC Job No. 2245 Please make all checks payable to: American Environmental Construction, LLC., and send to: P.O Box 81005 Seattle, WA 98108 -1005 Questions? Voice: 206 -267 -0746 or 800 -357 -2760 Fax: 206 - 522 -4099 WA Contractor # AMERIEC996MB Member of the Better Business Bureau P.O No. Description Asbestos abatement per Proposal & Contract dated: October 17, 2002 ArayT p/z 53, 5 .Nn " ... : 3 2002 Estimator HH Subtotal Total Terms Net 30 Amount .1,180:00T $1,180.00 Sales Tax (8.8 %) $103.84 $1,283.84 Payments /Credits $0.00 Balance Due $1,283.84 iGWd::id+ • r:..' G+: Yi. h. 23i. ri�S' L: kdvi .ISl3+'S�'�u t.rll:w'LY.i:tJta.J Site Address: 4/0 S S / 5 ✓ — Tenant Name: --�� Property Owners Name: Mailing Address: Name: I* f7 Mailing Address: / Doak Homes, Inc. E -Mail Address: Company Name: Mailing Address: Contact Person: E -Mail Address: Contact Person: E -Mail Address: lapplicationslpennit application (1 -2003) 1/2003 CITY OF TUKWILA Community Development Department Public Works Department Permit Center 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** Doak Homes.,jJ c: 11812 26th Ave—, .) Burien, WA 98146 1t11 Ave SW Burien, WA 98146 'GENERAL CONTRACTOR° INFORMATIO :_;061c Homes, Inc. 11812 26th Ave SW Burien, WA 98146 Page 1 Building Permit.+lVo pJ : ' d2 Mechanical Permit No Public Works Permit No . (Folk oJJlce use .'only) ' King Co Assessor's Tax No.: ✓b 9 000- oc- i = 07 Suite Number: ----- Floor: City Day Telephone: % 06 3 72- -.2 2 )6 City State Zip Fax Number: O( ,2, e-/6 - 65 7 City New Tenant: 0 .... Yes [] ..No State State Zip Zip Day Telephone: ;2,C)6 5 7 - 2 - 2 g Fax Number: .Z06' 2 cL-/6 — 6. 5 - 8 7 Contractor Registration Number:D 0 y,. /I; Expiration Date: 0 3 -C 23 * *An original or notarized copy of current Washington State Contractor License must be presented a the time of permit issuance ** All plans must be wet stamped .by Architect. of Record Company Name: Mailing Address: Zip City Day Telephone: Fax Number: ENGINEER OF RECORD - All plans must be wet stamped by Engineer of Record State Company Name: /1 //) ;: r/1) y��c r ° ,,-, „� Mailing Address: , (? . J3 f -1- 2 4 l L /i 2,- .., -�f�r it 6- G �9� ti - city Contact Contact Person: / / %y1 c? "7 L / $c/I is/ r E -Mail Address: - Fax Number: S✓973-2-e• State Zip Day Telephone: BUILDING PERMIT _ ON . 206 -431 -3670 Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): /LI /!"fi1OI / /GJr Will there be new rack storage? ❑...Yes o If "yes ", see Handout No. 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): /7;,0/2 0 Floor area of principal dwelling: /D,f'O /= / 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 No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑ .. Sprinklers ❑...Automatic Fire Alarm ❑...None ❑ .. Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes If "yes ", attach list of materials and storage locations on a separate 8 -1/2 x I I paper indicating quantities and Material Safety Data Sheets. 'applications\pennit application (1 .2003) 12 103 UTILITY DISTRICTS: Note: If the utility district is not City of Tukwila, you must provide written verification and approval from that utility district at the time of permit application. Water ❑ .. City of Tukwila Water District ©Water District #125 ❑... Highline Water District ❑...City of Renton Water District Sewer ❑ .. City of Tukwila Sewer District Er. Val Vue Sewer District ❑...City of Renton Sewer District ❑...City of Seattle Sewer District ❑ .. Septic System (If property is served by a septic system, 2 copies of approved septic design from King County Health Department must be submitted at the time of permit application) Page 2 jC '�� Existing Building Valuation: $ 4 / 5 j e' 1 - YJ i ; Y': /:? rr.- /Z i2 Dili & for requirements. r.er . ir ..rrwr.. Existing Interior Remodel Addition to Existing Structure New Type of Construction per UBC Type of Occupancy per UBC 1" Floor 2 Floor 3 Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage ; Attached Carport Detached Carport Covered Deck Uncovered Deck • - BUILDING PERMIT _ ON . 206 -431 -3670 Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): /LI /!"fi1OI / /GJr Will there be new rack storage? ❑...Yes o If "yes ", see Handout No. 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): /7;,0/2 0 Floor area of principal dwelling: /D,f'O /= / 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 No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑ .. Sprinklers ❑...Automatic Fire Alarm ❑...None ❑ .. Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ .. Yes If "yes ", attach list of materials and storage locations on a separate 8 -1/2 x I I paper indicating quantities and Material Safety Data Sheets. 'applications\pennit application (1 .2003) 12 103 UTILITY DISTRICTS: Note: If the utility district is not City of Tukwila, you must provide written verification and approval from that utility district at the time of permit application. Water ❑ .. City of Tukwila Water District ©Water District #125 ❑... Highline Water District ❑...City of Renton Water District Sewer ❑ .. City of Tukwila Sewer District Er. Val Vue Sewer District ❑...City of Renton Sewer District ❑...City of Seattle Sewer District ❑ .. Septic System (If property is served by a septic system, 2 copies of approved septic design from King County Health Department must be submitted at the time of permit application) Page 2 jC '�� Existing Building Valuation: $ 4 / 5 j e' 1 - YJ i ; Y': /:? rr.- /Z i2 Dili & for requirements. r.er . ir ..rrwr.. .,PUBLIC- WORKS.PERMITIM . MATION. 206- 433=0179 Scope of Work (please provide detailed information): r 2. %, � �9 /. r /}- y en. 5 G9k evP.r l�lei () ,'%ti) °/' YI43Ne ( e)44/4' Please refer to Public Works Bulletin #1 for fees and estimate sheet. Str t Use: Street Use ❑...Channelization /Striping Lan A1[erin or Haft' Land Altering: ❑...Cut cubic yards 0... Fill Storm Drainage: . 0 .. Storm Drainage ❑...Flood Control Zone ❑ .. Water Main Extension ❑ .. Private ❑ .. Water Meter /Exempt: ❑ .. Water Meter Permanent #: ❑ .. Water Meter Temporary #: ❑ .. Fire Loop/Hydrant (main to vault) #: Monthly Service Billing to: Name: Mailing Address: \applications\pennit application (1.2003) 1/2003 Water ... Water Meter Refund /Billing: Name: Mailing Address: Doak Homes, inc. 11812 26th A 81 Burien, WA 98146 Sewer ... ❑ Doak Homes, Inc. 11812 2Rth Ave SW Burien, WA 98146 Call before you Dig: 1- 800 - 424 -5555 ❑...Curb cut/Access /Sidewalk Page 3 City Sewage Treatment City cubic yards i Hauling RIE.4tvt i If >50c Sewer Information: ❑ .. City of Tukwila Sewer District .. Val Vue Sewer District 0... City of Renton Sewer District ❑ .. City of Seattle Sewer District ❑ .. Sanitary Side Sewer ❑ .. Sewer Main Extension ❑ .. Private ❑ .. Public Water Information: ❑ .. City of Tukwila Water District ' Water District #125 0... Highline Water District ❑ ... Public Size(s): Size(s): Size(s): ❑ .. Est. Quantity: ❑... City of Renton Water District ❑ .. Deduct ❑ ... Water Only Size(s): ❑ .. Landscaping Irrigation gallons ❑ .. Miscellaneous: Day Telephone: (2 — 3 72 - z Z en Day Telephone: 2, 0 6 3 7 2 �b TI (t ov A t' 1 : State Fire Line .... State Zip Zip Unit Type: Qty Unit Type: Qty Unit Type: Qty : Boiler /Compressor: Qty Furnace <100K BTU Air Handling Unit >= 10,000 CFM Other Mechanical Equipment 0 -3 HP /100,000 BTU • Furnace >100K BTU Evaporator Cooler 3 -15 HP /500,000 BTU Floor Furnace Ventilation Fan 15 -30 HP /1,000,000 BTU Suspended /Wall/Floor Mounted Heater Ventilation System 30 -50 HP /1,750,000 BTU Appliance Vent Hood 50+ HP /1,750,000 BTU Heat/Refrig/Cooling System Incinerator - Domestic Air Handling Unit <= 10,000 CFM Incinerator — Comm /Ind iMECHANICAL PERMIT . .206= 431 =3670• MECHANICAL CONTRACTO NFORMATION Company Name: Mailing Address: Contact Person: Day Telephone: Z E -Mail Address: Fax Number: i Z Contractor Registration Number: Expiration Date: re * *An original or notarized copy of current Wa.hington State Contractor License must be presented at the time of permit issuance ** D J U 0 co 0 W = t-- Valuation of Project (contractor's bid price): Scope of Work (please provide detailed info ,S1 ,: V.. Use: Residential: New .... Replacement Commercial: New ....0 Replacement •...❑ Fuel Type: Electric Gas ....E Oth r: Indicate type of mechanical work being installed and the quantity below: BUILDING OWNE OR AUTHORIZED AGENT: Signature: ` Ali Doak I Inc. 11812 26th Ave SW Print Name: Mailing Address: \applications \permit application (I -2003) 1/2003 Burient, WA 98146 rl anon): C-sj Page 4 City City Stale Zip .., PERMIT APPLICATION NOTES — Applicable to all p �`an `tl 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 extend the time for action by the applicant for a period not exceeding 180 days upon written request by the applicant as defined in Section 107.4 of the Uniform Building Code (current edition). No application shall be.extendedhnibi once. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICAA[ON'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. Date: 2 Day Telephone: 0‘ 5 7? 2 3'V State Zip Date Application Accepted: / —Z2 — c. � Date Application Expires: '7 -zz -c3 Staff _Iuitials: i , "�I:SiF.14:iria >. ti: 14i6i::' aaii:4riit,ti46 W O L.L. to Id � Z = I O Z I- al • 0 O • - O E— W W. I F- u- O Z W U= O~ Z PERMIT NO.: DC) " 024. BUILDING PERMITS INSPECTIONS ❑ I Progress Inspection Status ❑ 2 Pre - construction ❑ 3 Investigation ❑ 4 OK to Occupy ❑ 5 Remove Stop Work Order ❑ 6 Follow -up ❑ 7 Pre -Move Inspection ❑ 50 WSEC Residential ❑ 60 WA Ventilation/Indoor AQC ❑ 70 NLEA inspection /Modular Struct ❑ 71 Mobile Home Tie Down Insp ❑ 7 / Marriage Lines ❑ 90 Rested ❑ 95 Footing Drains ❑ 100 Foundation Footings ❑ 200 Foundation Walls ❑ 250 Foundation insulation ❑ 300 Concrete Slab /Slab Insulation ❑ 350 Crawl Space ❑ 400 Shear Wall Nailing ❑ 450 Plywood Wall Sheathing ❑ 500 Roof Sheathing Nailing ❑ 525 Plywood Deck Nailing ❑ 550 Exterior Wall Sheathing ❑ 600 Masonry Chimney ❑ 610 Chimney Installation/All Types ❑ 700 Framing ❑ 750 Roof /Ceiling Insulation ❑ 800 Floor insulation ❑ 801 Wall insulation ❑ 802 Exterior Roof Insulation ❑ 803 Glazing inspection ❑ 815 Lighting and Controls ❑ 900 Suspended Ceiling ❑ 1000 Interior Wallboard Fastening ❑ 1001 Exterior Wallboard Fastening ❑ l 110 Pre -Move inspection 1 115 Motor Inspection 1120 Pre -Demo 1140 Pre - reroof 1400 Final -Fire 1700 Final - Building 1900 Final - Reroof ❑ 3100 Site Visit ❑ 4000 Special- Concrete ❑ 4001 Special -Bolts in Concrete ❑ 4001 Special- Mom/Resist Conc Frame ❑ 4003 Special -Reinf Steel Prestress ❑ 4004 Special- Welding ❑ 4005 Special -High- Strength Bolting ❑ 4006 Special - Structural Masonry ❑ 4007 Special -Reinf Gypsum Concrete ❑ 4008 Special - insulating Conc Fill ❑ 4009 Special -Spray Fireproofing ❑ 4010 Special - Piling, Piers, Caissons ❑ 4011 Special- Shotcrete ❑ 401 Special- Grading, Excav /Fill ❑ 4013 Special- Retaining Wall ❑ 4014 Special- Panels ❑ 4015 Special -Smoke Control System TENANT NAME: CONDITIONS 6 ' 10001 No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division aii 10002 Plumbing permits shall be obtained through King Co 10003 Electrical permits obtained through L & I 10004 All mechanical work shall be under separate permit 10005 All permits, insp records & approved plans available ❑ 10006 All structural concrete shall be special inspected ❑ 10007 All structural welding shall be done by WABO certified inspector ❑ 10008 All high- strength bolting shall he special inspected ❑ 10009 Bolts installed in concrete shall be special inspected ❑ 10010 When special inspection is required...notify Tukwila Building Division ❑ 1001 1 The special inspector shall submit a final signed report ❑ 10012 Any new ceiling grid and light fixture installation ❑ 10013 Partition walls attached to ceiling grid ❑ 10014 Readily accessible access to roof mounted equipment ❑ 10015 Engineered truss drawings & calcs shall be on site ❑ 10016 Any exposed insulation backing material shall have ❑ 10017 Subgrade preparation including drainage, excavation ❑ 10018 A statement from the rooting contractor verifying tire retardant class of roof o f , 10019 All construction to be done in conformance w /approved plans ■ &TL Devv‘e) ❑ 10020 Structural observation shall be provided for this project ❑ 1002I All food preparation establishments must have King Co ❑ 10022 Fire retardant treated wood shall have flame spread of ❑ 10023 Notify Building Division prior to placing any concrete ❑ 10024 All spray applied fireproofing shall be special inspected ❑ 10025 All wood to remain in placed concrete shall be treated 10026 All structural masonry shall be special inspected 10027 Validity of Permit 10028 Rack storage requires separate permit ❑ 10030 No occupancy of building until final insp by Bldg Div ❑ 10031 Comply with requirements of TMMMC 16.04 ❑ 10032 Remove all weeds, concrete, stone foundations, flat concrete ❑ 10034 Removal of septic tanks require approval and compliance with King Co Health Dept. ❑ I0035 Contact PW Div to obtain insp for water /sewer connect ❑ 10036 Manufacturers installation instructions required on site ❑ 10038 A C of O will be required for this permit ❑ 10039 Final approval for all T1 w /in the limits of the SC Mall ❑ 10040 AU construction noise to he in compliance with 8.2 TMC ❑ 10041 Ventilation is required for all new rooms & spaces ❑ lOt)42 Fuel burning appliances ❑ 10043 Appliances, which generate ❑ 10044 Water heater shall be anchored ❑ 10045 Reroof ❑ "Anchoring — All new construct and substantial improvement shall be anchored to prevent flotation" Plan Reviewer: Permit Tech: At\ Date: Date: 1 Z, ACTIVITY NUMBER: D03 -026 DATE: 01 -22 -03 PROJECT NAME: Doak Homes - L- SITE ADDRESS: 4058 S 148 St St Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Is Issued DEPARTMENT: Building Divisio Approved ❑ Notation: Documents/routing slip.doc 2.28.02 a Public Works '041 h A � o PLAN REVIEW /ROUTING SLIP 5)0 Ilam' Fire Prevention Structural DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete \/ Incomplete n APPROVALS OR CORRECTIONS: Approved with Conditions 0 C L I-Z3 - Planning Division Permit Coordinator 0 DUE DATE: 01-23-03 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 ROUTING: Please Route Structural Review Required n No further Review Required REVIEWER'S INITIALS: DATE: DUE DATE: 2-20 -03 El Not Approved (attach comments) n REVIEWER'S INITIALS: DA TE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: 21` vuf Y 6 CORNER LEGAL DESCRIPTION I" I v 1 N NORTH I CORNER I ` --' SECTION 22 T23N R4E W M FOUND CONCRETE Cr Cr LL Lu X O O (Nj M O N M � o cn I a) 30 ‘1/4 MONUMENT & CASE (VISITED MAY , 2302) ROS V28 P6 SOUTH LINE OF N , NW SEC. 22, T23N, R4E. WM EXISTING FIRE HYDRANT I J U v CENTER OF SECTION 2 M (CALCULATED POSITION) - 4 ROS V.28— — O 18 LOT 1 CITY OF TUKWILA SHORT PLAT NUMBER L96 -00040 ACCORDING TO THE SHORT PLAT RECORDED UNDER RECORDING NUMBER 9703050537, RECORDS OF KING COUNTY, WASHINGTON 10' EASEMENT FOR, SEWER LINE REC NO. 911120006 EXISTING POWER POL 30' EASEMENT FOR INGRESS, EGRESS AND UTLITIES REC# 9703650537 15' UTILITY EASEMENT, REC# 9609260137 SS P EXISTING SANITARY SEWER GRAPHIC SCALE so (INFO') inch == 30 ft i i • in 0 ti I I 120 S8 7 %34'2 71 587'43'091 95 -0' 2652 07' (MEAS.) 2650.11' (CALC) S87°43 128 79 N87°4 W 128 78 - _ i I _ ! . - TURN- AROUND I r r i III,_ I T EXISTING ASPHALT N87 °47'30"W N88'09'19"W 2644.34' (CALC. EXISTING STORM DRAIN (r( (^ i rL El r a I P3rmit No. 0 -Y2) J I— U � e I CO to I 0' 0 0 !.1 ) If C82 R „ 51-7W 848:17' (tf�l - }. _ • txb Lila A CB9 FiLc C O S 144TH ST. S 146TH ST. e Stan that the Plan Check approvals are s' ;?. t errors and omissions and approval of p: c - des not authorize the violation canon of any adopted code or ordinance Receipt of con - tr aCOer's copy of approved plans acknowledged. _ I , Pj Gate qe, EXISTING BLOCK WALL LOT 2 8113 SOFT 128.78 10' DEDICATED TO PUBLIC REC.# 9703650537 i 128.80 (PLAT) 128.7$ jCALC4 x_14 — � r I E (24 ") : 248 ` 1E08') 252 56 EXISTING FIRE HYDRANT • 1 1 4 f ,.--- NORTHEAST ; CORNER Tom` -- SECTION 22 T23h R4E W M J'1 FOUND BRASS ROC IN 2 u ��� CONCRETE 0 .4ONUMENT IN CASE (VISITED MAY. 2002) PROS V 28 P6 25' \J S e - S let 's rh' ' '' ' , s i 1 -- ? CP I ‘C''' '''''*. .,.9A- ' 1 ,. - ..-j k ' th ,,-,,,,.. , - : 0:* L,. 25' W Q ' C z 1 C ' N '''f Tt ylrti f •99rJ! ` ;. FEB 7', a _L =J LEGEND p SET 4 x 24" IRON ROD WITH YELLOW CAP STAMPED ALIJANT 22594 (CALC) CALCULATED BEARING AND /OR DISTANCE (MEAS) MEASURED BEARING AND /OR DIST"`J'iCE (PLAT) ADAMS HOME TRACTS VOt. 1 1. PAGE 31 (REC) RECORD DATA FP', REC# 9203650` :17 (HD) RECORD JF SURVEY IN V L 2p. PAGE 6 REC.# ,j 106239006 (KCCS) K' COJN1Y CONTROL SURVEY MERIDIAN: RECORD OF SURVEY IN VOL. 28, PAGE 6 REC.# 8106239006 DATUM: KCCS NORTH a CORNER SECTION 22, T23N, R4E, W.M BASIS OF BEARINGS. HELD NORTH H LINE OF NORTHEAST CORNER OF SEC. 22, T22N, R4E W.M SITE ADDRESS: 4058 -S 148TH ST TAX LOT NO. 004000- 0095 -07 NOTE: 1. INSTRUMENTAT1'ON FOR THIS SURVEY WAS A NIKON TOTAL STATON DTM A -10. SERIAL NO 540312 2. PROCEDURE;; USED WERE FIELD TRAVERSE. ANGLE AND COMPASS RULE ADJUSTMENT 3. PRECISION FOR THIS SURVEY EXCEEDS STANDARDS SET BY WAC -332- 130.090 4 THE LAND SHOWN ON THIS SURVEY MAY BE SUBJECT "O EASEMENTS, COVENANTS OR RESTRICTION OF THE RECORD NOT SHOWN HEREON. 5 EXISTNG HOUSE LOCATION PER REC.# 970365050537 FOUND PUNCH IN BRASS DISK IN CONCRETE MONUMENT IN CASE (VISITED MAY, 2002) ., - REC# 9703650537 „; DS ;;��� ,IAN 2 `. 441113 (0.20 WEST & 0.04 SOUTH OF 1/16 CORNER) NOT HELD FOR POSITION. PECEIVED COY Y OF TUKWILA PERM ?T CENTER EAST i CORNER SECTION 22, T23N, R4E (CALCULATED POSITION) ROS V 28. P6 P.O. Box 2598 WOODINVILLE, WA 98072 (425) 485-1083 DOAK SHORT PLAT NE 1/4 OF NW 1/4 OF SECTION 22, T23N, R4E, WM CITY OF TUKWIILA FILE NO. DATE JOB NO. 6/18/2002 96018 D0-02.10 SHEET 2 OF 2 1