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Home My WebLink AboutPermit D09-243 - GONZALEZ RESIDENCE - RESIDENCE DEMOLITIONGONZALES DEMOLITION 13264 38 AV S D09 -243 Parcel No.: 7340600920 Address: 13264 38 AV S TUKW Suite No: Tenant: Name: GONZALES DEMOLITION Address: 13264 38 AV S , TUKWILA WA Cityillf Tukwila Owner: Name: GONZALEZ SIDNEY P Address: 13264 38TH AVE S , SEATTLE WA 98168 Phone: Contact Person: Name: HARLAN PERKINS Address: 21211 25 CTS , KENT WA 98031 Phone: 206 - 396 -4351 Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Inspection Request Line: 206- 431 -2451 Web site: http: / /www.ci.tukwila.wa.us Contractor: Name: HI -LINE HOMES Address: 11306 62ND AVE E , PUYALLUP WA 98373 Phone: 253 - 840 -1849 Contractor License No: HJLINH *983BD DESCRIPTION OF WORK: DEMOLITION OF 1900 SQ FT FIRE DAMAGED RESIDENCE. PROPERTY ON VALLEY VIEW SEWER AND WD #125 WATER. PUBLIC WORKS ACTIVITIES INCLUDE EROSION CONTROL. Value of Construction: Type of Fire Protection: Type of Construction: doc: IBC -10/06 $18,522.00 V -B DEVELOPMENT PERMIT * *continued on next page ** Permit Number: D09 -243 Issue Date: 12/08/2009 Permit Expires On: 06/06/2010 Expiration Date: 11/08/2011 Fees Collected: $713.01 International Building Code Edition: 2006 Occupancy per IBC: 0022 D09 -243 Printed: 12 -08 -2009 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N City a*TTukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.ci.tukwila.wa.us Permit Number: DO9 - 243 Issue Date: 12/08/2009 Permit Expires On: 06/06/2010 Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: Hauling: N Start Time: End Time: Land Altering: Volumes: Cut 0 c.y. Fill 0 c.y. Landscape Irrigation: Moving Oversize Load: Start Time: End Time: Sanitary Side Sewer: Sewer Main Extension: Private: Public: Storm Drainage: Street Use: Profit: N Non - Profit: N Water Main Extension: Private: Public: Water Meter: N Permit Center Authorized Signature: 10:1 _ to u � Date: 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 pe % 't does not pr- ume to give authority to violate or cancel the provisions of any other state or local laws regulating construction • e = `o ce • o I am authorized to sign and obtain this development permit. Signature: Date: /g- Print Name: %l"'' 1t %.<, n S 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 -10/06 D09 -243 Printed: 12 -08 -2009 Parcel No.: 7340600920 Address: Suite No: Tenant: 1: ** *BUILDING DEPARTMENT CONDITIONS * ** 8: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * ** doc: Cond -10/06 13264 38 AV S TUKW • City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us GONZALES DEMOLITION PERMIT CONDITIONS Permit Number: Status: Applied Date: Issue Date: D09 -243 ISSUED 11/17/2009 12/08/2009 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: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the Cityof Tukwila Permit Center. 6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building Department (206- 431 - 3670). 7: 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. 9: The applicant must notify the City Project Inspector at (206)433 -0179 upon commencement and completion of work at least 24 hours in advance. All inspection requests for utility work must also be made 24 hours in advance. A demo permit from Puget Sound Clean Air Agency is required prior to proceeding with demolition activities. 10: Any material spilled onto any street shall be cleaned up immediately. 11: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation off-site or into existing drainage facilities. 12: From October 1 through April 30, cover any slopes and stockpiles that are 3H:1 V or steeper and have a vertical rise of 10 feet or more and will be unworked for greater than 12 hours. During this time period, cover or mulch other disturbed areas, if they will be unworked more than 2 days. Covered material must be stockpiled on site at the beginning of this period. Inspect and maintain this stabilization weekly and immediately before, during and following storms. 13: From May 1 through September 30, inspect and maintain temporary erosion prevention and sediment at least monthly. All disturbed areas of the site shall be permanently stabilized prior to final construction approval. 14: The site shall have permanent erosion control measures in place as soon as possible after final grading has been D09 -243 Printed: 12 -08 -2009 doc: Cond -10 /06 • 0 City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us completed and prior to the Final Inspection. 15: SEWER CAPPING PERMIT SHALL BE OBTAINED from Valley View Sewer District and signed -off before Public Works final inspection. 16: Water capping shall be coordinated with Water District #125. 17: ** *PLANNING DEPARTMENT CONDITIONS * ** 18: Any other structures on the property, including the shed located in the southwestern corner of the site, must be removed or demolished prior to final inspection of the demolition work. * *continued on next page ** D09 -243 Printed: 12 -08 -2009 • City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and 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 construction or the performance of work. Signature:/ , Date: /4-,—. 7 '','"'- Print Name: doc: Cond -10/06 D09 -243 ordinances governing or local laws regulating Printed: 12 -08 -2009 CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us Tenant Name: TT Property Owners Name: Si t- (\Z� W l& e Z Mailing Address: '42 l- 6 (D City Name: /la ikon_ • Mailing Address: 71211 � 1 21 1 � . G� E -Mail Address: 1 2k JO rfrl aSf . 4g"t Company Name: Ili/ m e- /Io Plef Mailing Address: //3 Dr; 62. NO A ye, E Contact Person: AV.1'Y' Ale/1.0 id E -Mail Address: jil/ W ir e / e 5. 6471 Contractor Registration Number: 1 I iN0 N' 98 3 `i31) Company Name: 14-7. Iiv t \k rh. tS Mailing Address: I I3oC CZhd Av tlil[t Contact Person: ct 4 c4 l O k 0 Ct U AI ro(A S E -Mail Address: W QV) rO W S& h t 1 21 o me S. (_-o vh Company Name: 140 f M Z S i AC, Mailing Address: 113 62 net. Pr-ve Contact Person:10 AtirouvS E -Mail Address: W G1 b CO k. S @ k S FLApplications\Fonns- Applications On Line\2009 Applications \1 -2009 - Permit Application.doc Revised: 1 -2009 bh Building Permit No. Mechanical Permit No. Plumbing/Gas Permit No. Public Works Permit No. Project No. Aar -)) (For office use only) Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *Please Print ** SITE LOCATION i _ King Co Assessor's Tax No.: 7 3 Y b b ob 920 Site Address: / 3 2 6 3 g �",4 -vim f / 606 441 i1 64/11 Ag Suite Number: Floor: Pu ya //c9 City New Tenant: ❑ Yes ❑ ..No State Day Telephone: 2_66-'3/6" CONTACT PERSON - who do we contact when your permit is ready to be issued Xe✓17 4 9/0 3 City State Zip Fax Number: ?...57 - 52) -39 7g GENERAL CONTRACTOR INFORMATION - (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) A/A, 95'377 State Zip Day Telephone: 25 - 1 °) 129 Fax Number: 7...C3 -56 4 - 814-141 Expiration Date: I `/' /1 1 ARCHITECT OF RECORD - All plans must be wet stamped by Architect of Record 'Pck k %AR W/4- 98'371 City Day Telephone: 2c1- 770 -22'44 X 112_ Fax Number: ZS3 ` 4- g ENGINEER °OF RECORD - All plans must be wet stamped by Engineer of Record ?(A-I/4, l iv") l/UA • 6373 City State f Zip Day Telephone:`2S3 �]7 0 ,2 ,'T X al- A4+- X 1� Fax Number: 2S3 264 O vq9 Page 1 of 6 • BUILDING PERMIT INFORMATION - 206 -431 -3670 � 4242 Valuation of Project (contractor's bid price): $ / Existing Building Valuation: $ 0 Scope of Work (please provide detailed information): De 'o O4 : (Air n ed.. 8.06, d n Arco •^ i4v it,►.; ldi, .. ruts/ kovje 0y■ loi- Will there be new rack storage? ❑ Yes 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: -7 Lot Area (sq ft): I D, D Floor area of principal dwelling: C._/T tL 1 3 Floor area of 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: Will there be a change in use? ❑ Yes . No If "yes ", explain: FIRE PROTECTION/IIAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes %i No If "yes', attach list of materials and storage locations on a separate 8 -1/2 "x 11 "paper including quantities and Material Safety Data Sheets. SEPTIC SYSTEM ❑ On -site Septic System - For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:\Applications\Forms- Applications On Line \2009 Applications \1 -2009 - Permit Application.doc Revised: 1 -2009 bh eJ _ ❑.. No If yes, a separate permit and plan submittal will be required. Handicap: Page 2 of 6 Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC 1 Floor ICCOO V-14%.' 2nd Floor 3` Floor Floors 1 thru 1 Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck • BUILDING PERMIT INFORMATION - 206 -431 -3670 � 4242 Valuation of Project (contractor's bid price): $ / Existing Building Valuation: $ 0 Scope of Work (please provide detailed information): De 'o O4 : (Air n ed.. 8.06, d n Arco •^ i4v it,►.; ldi, .. ruts/ kovje 0y■ loi- Will there be new rack storage? ❑ Yes 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: -7 Lot Area (sq ft): I D, D Floor area of principal dwelling: C._/T tL 1 3 Floor area of 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: Will there be a change in use? ❑ Yes . No If "yes ", explain: FIRE PROTECTION/IIAZARDOUS MATERIALS: ❑ Sprinklers ❑ Automatic Fire Alarm None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes %i No If "yes', attach list of materials and storage locations on a separate 8 -1/2 "x 11 "paper including quantities and Material Safety Data Sheets. SEPTIC SYSTEM ❑ On -site Septic System - For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:\Applications\Forms- Applications On Line \2009 Applications \1 -2009 - Permit Application.doc Revised: 1 -2009 bh eJ _ ❑.. No If yes, a separate permit and plan submittal will be required. Handicap: Page 2 of 6 PERMIT APPLICATION NOTES — Applicable to all permits in this application Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. BUILDING 0 Building and Mechanical Permit 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). Plumbing Permit The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 Uniform Plumbing 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. AUT ZED Signature: Print Name: IM r ti ,o ✓/5-41l Mailing Address: 7 12 I I 4, 5 ` C+ $ /5 2 n 14v4- Date Application Expires: V Date Application Accepted: it _ 17`07 H:\Apphcanons\Forms- Apphcanons On Lme\2009 Applications \1 -2009 - Permit Application.doc Revised: 1 -2009 bh City Date: / // , 3 / / d Day Telephone: 20 C _�9(� -- 4 1 3 5 r IA/A. I8o7 / State Zip Staff Initials: Page 6 of 6 Parcel No.: 7340600920 Address: 13264 38 AV S TUKW Suite No: Applicant: GONZALES RESIDENCE Receipt No.: R09 -01834 Payee: PERKINS REMODELING ACCOUNT ITEM LIST: Description BUILDING - NONRES PLAN CHECK - NONRES STATE BUILDING SURCHARGE • City of Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 -431 -3665 Web site: http://www.ci.tukwila.wa.us Initials: WER Payment Date: 11/17/2009 01:29 PM User ID: 165S Balance: $0.00 TRANSACTION LIST: Type Method Descriptio Amount Payment Check 1006 713.01 Authorization No. Account Code Current Pmts 000.322.100 000.345.830 640.237.114 RECEIPT Total: $713.01 Permit Number: D09 -243 Status: PENDING Applied Date: 11/17/2009 Issue Date: Payment Amount: $713.01 429.40 279.11 4.50 PAYMENT RFCE . VED doc: Receipt -06 Printed: 11 -17 -2009 Project: ( o,241 .S .n6 Type of Inspection: F / / A dress: �22GV 389vS Date Called: Special Instructions: ' .. Date Wanted: Requester: Phone No: 3 9;- 4 '/35 ) INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 `Approved per applicable codes. PERMIT NO/ D. (206)431 -3670 Corrections required prior to approval. Z ' COMMENTS: Pr n,7 frie / 2Aml Inspec .00 REINSPECTIO FEE REQUIR D. Prior to inspection, fee must be aid at 6300 Southcen er Blvd., S Ite 100. Call to schedule reinspection. Receipt No.: Date: —/ —/ Date: Project: 6 #9.dCFS ii-- Type of Inspection: Ptiel• — Cows"! — o Address: /32 5/ 3J' io$T Date Called: Special Instructions: . 1 6 6 1 4 // g4 C5_778.5 o/ Date Wanted; ,O p.m. Requester: Phone No: :z0‘-Yi -4351 I pa INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 b 2 1/3 PERMIT NO. (206)431 -3670 COMM 5: Date: .00 R NSPECTION FEE REQUI • ED. P for to inspection, fee rt►Gst be d at , 00 Southcenter Blvd., Suite 10'. Call to schedule rein pection. Receip . ' o.: Date: proved per applicable codes. El Corrections required prior to approval. . COMMENTS: ((14 d I IIr kt r 1 t4 I e 1v l'.',144(Iv' / EA 5LvJ ri 41) 17 0 It (F 1 ^ l) pwna� (pp i i / dic.z, "?J Ui i' L< i 5 u r -4' <1 •v /. l I } r . °E l 6v rr! 16 ( ,-.1 le) J• 1• fi c,- 1 /7 if ! k. if - ., i I Z iti 77 Special Instructions: .' 0 a? 05 -0 / 4 l Requester: Phone No: -.3 VSS / Project d ,-�^ /� `JV /�/� l /` ti.J°� 0 Type of Inspection: /-="-- kAA/4V /n/!o Address: /3 ' i / 35 4 5 Date Called: Special Instructions: .' 0 a? 05 -0 / Date Wanted: / -- /9- /v �.my Requester: Phone No: -.3 VSS / zy 5 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Approved per applicable codes. Corrections required prior to approval. Inspector: 7GIrLIle Date: I It I 0 lei El $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. (Receipt No.: 1Date: oject: i Type of Ins ctio Address: °� 1 3=q62 4 5 �Q • �a " "''t S7, Date Called: / i5 O Special Instructions: - r Date Wa // " a.m p.m. Reque , P (30NC — 3Cge - 4-35 t INSPECTION NO. INSPECTION RECORD Retain a copy with permit 6A) PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Approved per applicable codes. Corrections required prior to approval. COMMENTS: /MP -/LAtAW thOo a' • Date: /Pr a Inspector: I:" $60.00 REINSPECTION FEE-REQUIRED. Prior to inspectiofS, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: Project: Zr,� Type of In ction: i -PCvl Address: 3, y a d S Date Call O / /U S'09 Special Instructions: �/� Y / w" '" r u or ` �-Imi° . ( � "4} Date Wanted: esi , (a I v I (.5.nfi'. �• Requester: i Phone No: a06 316 Y3.$7 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 ❑ Approved per applicable codes. Corrections required prior to approval. COMMENTS: P �Z..�Cvn cowl Auc.A-Pdl Ov\ - Site _ Inspector: ID5 Date: 1 1 re (i0 El $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: 'Date: D evv-, ci 1'L. Pl UAL'\ PLANNING APPROVED • No changes can be made to these plans without approval from the Planning Division of DCD Approved B Date: leavi* 12 . a 1 scA,1:6 By Date: _1 /8 to y • tn M t--• , P'-- --- -----* City Of 1lkwila BUILDING DIVISION FILE C •; PI( Permit No... Plan review approval is subject to errors and omissions. Approval of construction documents does not authorize the violation of any adopted code or ordinance. Receipt nt approved Fiel. .. is admowledged: REVISIONS No changes shalt be made to the scope of work without prior approval of Tukwila Building Division. NOTE: Revisions will require a new plan submittal and may include additional plan review fees. X09- 213 Go el ZN Le-2 ?'U Je c+ L/U --Peat \As weft 2 - I2- I t e4- K -t - t,w4 No3 CA, j- eeis r ( 4 'Pe 11Z v' (2 2 - 396 - 41-35 S i 4-e AAA ces r< /32_64 30,ve5 1 I,v ll�c v � - pa- v^ 44 I 06)0 zz -- REVIEWED FOR E CODE CO APPROVED DEC 0 3 2009 A- A City of Tukwila BUILDING DIVISION RECEIVED NOV 17 2009 PERMIT CENTER J Billings, MT • Helena, MT • Missoula, MT • Seattle, WA October 27,2009 Mr. Harlan Perkins Perkins Remodeling 21211 95 Court Kent, WA 98031 RE: Dear Mr. Perkins: Overview of Building — - i2.s�r� INDUSTRIAL HYGIENE, IPAC. Final Report Asbestos Limited Inspection 13264 38 Ave. South, Tukwila,WA NIH Project Number 299 -195 215 SW 153 St. Burien, WA 98166 Phone: 206- 988 -1746 FAX: 206 - 988 -1978 REVIEWED FOR CODE COMPLIANCE APPROVED DEC 0.3 2009 City of Tukwila BUILDING DIVISION This report provides the . summarized results of the asbestos inspection performed by Jude Cummings (AHERA Certified Inspector 10303513) of Northern Industrial Hygiene, Inc. (NIH) on October 22,2009 at the above referenced site. The inspection was performed to identify potential asbestos containing building materials (ACBM) that may be present in this burned out residential building. This inspection included the suspected asbestos content on interior wall and ceiling systems, surfacing materials on walls and ceilings, flooring systems materials, electrical wiring insulation, thermal building insulation, exterior roofing and siding materials and materials in the debris pile in the southwest area outside the structure. This burned out residential building is a two story structure with a peaked roof, one interior staircase, a small accessible attic and front and side porches. The original construction is of wood on wood support beams on a concrete block foundation with a 1980's wood constructed addition on a concrete foundation. The exterior of the building is finished with wood siding. The ground level is comprised of center and rear bathrooms, an entryway, a staircase to the second floor, kitchen and access to the 1980's addition comprised of 2 bedrooms a living room and side porch with a wood burning stove in this area. The second floor contains 2 bedrooms, 2 closets, a hallway and access to the roof of the side porch. The floors on the second level are of wood with a small piece of carpet in the closet in the west bedroom. No carpet mastic is evident. The roof limited access is via the second floor doorway on the south side of the structure. Asbestos samples were taken from the interior wall and ceiling systems, the ceramic and vinyl systems, felt under exterior wood siding, thermal insulation in the walls and ceilings, wiring insulation, the roofing system, fiberboard and felt under wood siding. There was no visible caulking around the windows. There is no evidence of a central heating or cooling system. RECEIVED NOV 1 2009 Asbestos • Lead -Based • Paint • Industrial Hygiene • Indoor Air Quality h O9 - 2,L1'; PERMIT CENTER Mr. Harlan Perkins 21211 95 Court ,Kent, WA 98031 Asbestos Inspection Procedures Sampling Procedures The asbestos survey was performed using the applicable portions of the currently recognized standard protocol developed for schools under AHERA, as promulgated in Title 40, Code of Federal Regulations (40 CFR), Part 763 and as amended in the Federal Register. Since the primary concern for this investigation was to identify potential asbestos hazardous materials of the building, the NIH representative visually inspected existing conditions considering each construction, addition, or renovation date as separate. Laboratory Analysis of Bulk Samples Bulk samples obtained during the inspection were assigned bulk sample numbers and entered on sample summary/chain -of- custody forms. The samples were transported to the laboratory in person under standard chain -of- custody procedures. The asbestos analysis was performed in accordance with EPA Method 600/R- 93/116, which employs polarized light microscopic techniques with dispersion staining for identification of mineral forms of asbestos. The quantification of asbestos in the sample is intended to be an estimate only and the limit of detection for this method is approximately 1% by volume. Asbestos Inspection Findings Building materials included linoleum, ceramic tile, wallboard systems and fiberboard, electrical wire insulation, building insulation, roofing materials and felt under siding as the suspect materials of concern for the purpose of this inspection in this structure. One out building is present at this site but not in the scope of this inspection. Suspect materials were sampled following sample collection requirements outlined under the EPA, AHERA legislation and State of Washington regulations. Laboratory results revealed that no asbestos was detected in any of the building materials sampled. Building materials sampled where No Asbestos was Detected: M16.1 Felt M16.2 Felt M17.1 Building Insulation M16.3 Fiberboard M16.4 Paper M3.1 Wallboard System M11.1 Wire Insulation M16.5 Orange Ceramic Tile System M3.2 Wallboard System M11.2 Wire Insulation M3.3 Wallboard System Northern Industrial Hygiene, Inc. NAD NAD NAD NAD NAD NAD NAD NAD NAD NAD NAD Under Exterior Siding ( original structure) Under Exterior Siding (1980's addition) South Side at Porch (1980's addition) Around Stove Pipe Penetration In Debris Pile On Ground In Debris Pile on Ground and In Kitchen Entry Way at Electrical Outlet At Front Door, Throughout First Floor Front Entry Hall First Floor Addition Kitchen 2 Mr. Harlan Perkins 21211 95 Court Kent, WA 98031 Building materials sampled where No Asbestos was Detected (continued) M16.10 Off -white Ceramic Tile System M16.6 Off -white Ceramic Tile System M16.7 Vinyl Flooring M16.8 Off -white Ceramic Tile System M16.9 Blue Ceramic Tile System F1.2 Off -white Vinyl Flooring M1.1 Roofing System M1.2 Tar NAD = No Asbestos Detected Northern Industrial Hygiene, Inc. NAD NAD NAD NAD NAD NAD NAD NAD Conclusions No asbestos containing building materials were found. Limitations First Floor, Rear Bathroom Floor First Floor, Rear Bathroom Wall First Floor, Rear Bedroom Floor First Floor, Center Bathroom Floor First Floor, Center Bath Wall Around Tub First Floor, Center Bath, Floor Around Toiler Roof, South Side — Entire Roof Roof, Around Stack Penetration This asbestos survey report was prepared based on information obtained during our on -site observations and the interpretation of the laboratory results of bulk building material samples collected during the survey. The conclusions of this report are professional opinions based solely upon our visual site observations and interpretations of laboratory analyses and field data as described in our report. This report has been prepared to provide information concerning the various types of asbestos - containing materials present at this site. It includes only those materials that were visible and accessible at the time of our inspection. We did not remove any permanent building enclosures or disassemble any equipment. This inspection and report is intended to identify asbestos - containing materials. It is not intended to be used for the purpose of obtaining bids for its removal by abatement contractors. The scope of services performed by NIH may not be appropriate to satisfy the needs of other users, and any use or re -use of this document, or the findings presented herein, is at the sole risk of the user. Our opinions are intended exclusively for use by Mr. Harlan Perkins. The opinions presented herein apply to the site conditions existing at the time of our investigation. Therefore, our opinions may not apply to future conditions that may exist at the site that we have not had the opportunity to evaluate. 3 Mr. Harlan Perkins 21211 95 Court Kent, WA 98031 It was a pleasure to assist you with this project. Please call if you have any questions on our report, or if you need any additional assistance. Respectfully submitted, NORTHERN INDUSTRIAL HYGIENE, INC. r Ms. Jude Cummings Certified AHERA Asbestos Inspector Certification Number 10303513 Attachments: Laboratory Analysis Report NVLAP Certification Inspector Credentials Invoice Northern Industrial Hygiene, Inc. 4 10/26/2009 Jude Cummings Northern Industrial Hygiene, Inc. 215 SW 153rd Street Seattle, WA 98166- RE: Bulk Asbestos Fiber Analysis; Batch # 09 -00724 Project Location 13264 38th Ave. S., Tukwila, WA Dear Jude Cummings, Thank you for choosing Northern Industrial Hygiene, Inc. as your laboratory. Enclosed you will find analytical results for the bulk samples submitted to the laboratory. Northern Industrial Hygiene is accredited by NVLAP Lab Code: 200511 -0. Accreditation by NVLAP does not indicate endorsement by NVLAP or any other government agency. All bulk samples are analyzed in accordance with U.S. EPA method 600 /R- 93/116 (July 1993), "Method for Determination of Asbestos in Bulk Building Materials "(NESHAP, 40 CFR -Part 61) protocol. Analysis is cross checked through our inter or intra laboratory quality assurance program for verification. The percent values reported are based on calibrated visual estimates by volume unless verification by Point Count is indicated. Test results reported relate only to the samples submitted by the customer to Northern Industrial Hygiene, Inc. Trace amounts of asbestos are below the limit of detection and asbestos fibers with diameters below approximately 0.25 micrometers are not detectable with the Polarized Light Microscopy (PLM) analytical procedure. A trace amount of asbestos is defined as one to five fibers in three slide mounts. Asbestos found in this amount will be reported as "< 1.0 %" by PLM analysis. I his report is highly confidential and shall not be reproduced without your written approval and the written approval of Northern Industrial Hygiene, Inc. Samples are archived for thirty (30) days following analysis. Please contact us if samples need to be archived longer than the standard holding time. Thank you for using Northern Industrial Hygiene, Inc. If you have any questions or concerns please contact us. Sincerely, fv Jude Cummings Laboratory Manager Enclosure: Bulk Sample Results INDUSTRIAL HYGIENE, I NC. 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 EMAIL: jcummings @bridgeband.com NVLAP Lab Code: 200511 -0 I Northern Industrial Hygiene, I 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. Asbestos Fibrous Components: No Asbestos Detected Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings INDUSTRIAL HYGIENE, INC - Bulk Asbestos Analysis Report nc. S., Tukwila, WA White and pale yellow loosely compressed fibers with charred residue Non - Asbestos Fibrous Components: 1% Cellulose 95% Mineral Wool and Beads (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 NIH Batch Number: Client Job Number: Turn Around Time: Samples Analyzed: 09 -00724 299 -195 5 Day 19 Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.1 Dark Brown Felt Paper Under Exterior Siding - North Side Lab Sample Number: 09- 00724.0001 Checked If Sample Not Analyzed ❑ Dark brown fibrous papery material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 35% Cellulose Non - Fibrous Components: 65% Asphalt Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.2 Dark Brown Felt Paper Under Exterior Siding, West (1980's addition) Lab Sample Number: 09- 00724.0002 Checked If Sample Not Analyzed Dark brown fibrous papery material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 40% Cellulose Non - Fibrous Components: 60% Asphalt Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M17.1 Building Insulation At Porch (south, 1980's addition) Lab Sample Number: 09- 00724.0003 Checked If Sample Not Analyzed ❑ Non - Fibrous Components: 4% Miscellaneous Materials Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.3 Fiberboard Around Exhaust Pipe Opening (South) Lab Sample Number: 09- 00724.0004 Checked If Sample Not Analyzed ❑ Jude Cummings, Laboratory Manager Page 1 Northern Industrial Hygiene, I 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. INDUSTRIAL HYGIEraE, INC. Bulk Asbestos Analysis Report nc. S., Tukwila, WA 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 NIH Batch Number: 09 -00724 Client Job Number: 299 -195 Turn Around Time: 5 Day Samples Analyzed: 19 White fibrous compressed powder Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 12% Fiberglass Non - Fibrous Components: 88% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.4 Paper On Ground in Debris Pile ( South) Lab Sample Number: 09- 00724.0005 Checked If Sample Not Analyzed ❑ Charred tan and white papery material Non - Asbestos Fibrous Components: 95% Cellulose Asbestos Fibrous Components: No Asbestos Detected Non - Fibrous Components: 5% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M3.1A Joint Compound In Debris Pile (East) Lab Sample Number: 09- 00724.0006 Checked If Sample Not Analyzed ❑ Layer 1 Charred white paint Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: Non - Fibrous Components: 100% Paint Layer 2 Charred tan paper and off -white powdery residue Asbestos Fibrous Components: Non - Asbestos Fibrous Components: 75% Cellulose 2% Fiberglass No Asbestos Detected Non - Fibrous Components: 23% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M11.1 Wire Insulation Entry Wall at Electrical Outlet Lab Sample Number: 09- 00724.0007 Checked If Sample Not Analyzed ❑ Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 Jude Cummings, Laboratory Manager Page 2 Client Sample Number: M16.5 Client Sample Description: Orange Ceramic Tile Client Sample Location: Floor at Front Door Sample Comments: Lab Sample Number: 09- 00724.0008 Checked If Sample Not Analyzed ❑ Layer 1 Orange Ceramic Tile Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected Non - Fibrous Components: 55% Aggregate 45% Filler and Binder Layer 2 Gray gritty material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected Non - Fibrous Components: 60% Aggregate 40% Filler and Binder Layer 3 Off -white fibrous compressed hard material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 12% Cellulose 5% Fiberglass Non - Fibrous Components: 83% Filler and Binder Northern Industrial Hygiene, I 215 SW 153rd Street Seattle, WA 98166- Project Location: 13264 38th Ave. Layer 1 Charred white non - fibrous flexible material (outer layer) on wire Asbestos Fibrous Components: Non - Asbestos Fibrous Components: Non - Fibrous Components: No Asbestos Detected 100% Filler and Binder Layer 2 Gray non - fibrous flexible material (inner layer) on wire Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 1% Cellulose Non - Fibrous Components: 99% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M3.2 Wall Board System Wall - Front Entry Lab Sample Number: 09- 00724.0009 Checked If Sample Not Analyzed ❑ Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings INDUSTRIAL HYGIENE, INC. Bulk Asbestos Analysis Report nc. S., Tukwila, WA (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 c 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 NIH Batch Number: Client Job Number: Turn Around Time: Samples Analyzed: 09 -00724 299 -195 5 Day 19 Jude Cummings, Laboratory Manager Page 3 Client Sample Number: M11.2 Client Sample Description: Wire Insulation Client Sample Location: First Floor Electrical Outlet Sample Comments: Lab Sample Number: 09- 00724.0010 Checked If Sample Not Analyzed ❑ Layer 1 Black rubbery material (outer layer) on wire Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected Non - Fibrous Components: 100% Filler and Binder Layer 2 White straight fibers Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 100% Synthetic Non - Fibrous Components: Layer 3 White papery material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 98% Cellulose Non - Fibrous Components: 2% Filler and Binder Layer 4 Blue non - fibrous material (inner layer) on wire Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected Non - Fibrous Components: 100% Filler and Binder Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings Northern Industrial Hygiene, Inc. 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. S., Tukwila, WA INDUSTRIAL HYGIENE, INC. Bulk Asbestos Analysis Report NIH Batch Number: Client Job Number: Turn Around Time: Samples Analyzed: (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 09 -00724 299 -195 5 Day 19 Layer 1 Black charred material Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: 10% Cellulose Non - Fibrous Components: 90% Filler and Binder Layer 2 Charred brown material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 5% Cellulose Non - Fibrous Components: 95% Filler and Binder Layer 3 Charred tan and white paper and white compressed powder Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: 15% Cellulose 2% Fiberglass Non - Fibrous Components: 83% Filler and Binder Jude Cummings, Laboratory Manager Page 4 Northern Industrial Hygiene, Inc. 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. S., Tukwila, WA Layer 5 Red non - fibrous material (on wire) Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: Non - Fibrous Components: 100% Filler and Binder N __3...x,.1.$. .. _....:F.+.. INDUSTRIAL HYGIENE, INC. Bulk Asbestos Analysis Report 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 NIH Batch Number: Client Job Number: Turn Around Time: Samples Analyzed: 09 -00724 299 -195 5 Day 19 Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M3.3 Wallboard Kitchen Wall Lab Sample Number: 09- 00724.0011 Checked If Sample Not Analyzed ❑ Off -white and tan paper and white compressed powder Asbestos Fibrous Components: Non - Asbestos Fibrous Components: 18% Cellulose 2% Fiberglass No Asbestos Detected Non - Fibrous Components: 80% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.10 Ceramic Floor Tile Bathroom, Rear of Home Lab Sample Number: 09- 00724.0012 Checked If Sample Not Analyzed ❑ Off -white ceramic tile Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: 1% Cellulose Non - Fibrous Components: 60% Aggregate 39% Filler and Binder Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings Client Sample Number: Client Sample Description: Client Sample Location: Bathroom Wall, Rear of Home Sample Comments: M16.6 Ceramic Tile Lab Sample Number: 09- 00724.0013 Checked If Sample Not Analyzed ❑ (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 Jude Cummings, Laboratory Manager Page 5 Northern Industrial Hygiene, Inc. 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. S., Tukwila, WA INDUSTF:UAL HYGIENIE, BHC- Bulk Asbestos Analysis Report Layer 1 Off -white ceramic tile Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: Non - Fibrous Components: 60% Aggregate 40% Filler and Binder Layer 2 White compressed powder Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 2% Cellulose Non - Fibrous Components: 98% Filler and Binder Layer 3 Tan paper and white compressed powder Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 40% Cellulose 2% Fiberglass Non - Fibrous Components: 58% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.7 Flooring Back Bedroom, First Floor Lab Sample Number: 09- 00724.0014 Checked If Sample Not Analyzed ❑ Layer 1 Asbestos Fibrous Components: No Asbestos Detected White vinyl with white fibrous backing and tan residue Non - Asbestos Fibrous Components: 20% Cellulose Non - Fibrous Components: 35% Filler and Binder 45% Vinyl Filler and Binder Layer 2 White fibrous compressed material Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: 18% Cellulose Non - Fibrous Components: 82% Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M16.8 Ceramic Floor Tile Center Bathroom, First Floor Lab Sample Number: 09- 00724.0015 Checked If Sample Not Analyzed ❑ Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 ' NIH Batch Number: Client Job Number: Turn Around Time: Samples Analyzed: 09 -00724 299 -195 5 Day 19 Jude Cummings, Laboratory Manager Page 6 Northern Industrial Hygiene, Inc. 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. S., Tukwila, WA !INDUSTRIAL HYGIENE, INC. 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 Bulk Asbestos Analysis Report NIH Batch Number: 09 -00724 Client Job Number: 299 -195 Turn Around Time: 5 Day Samples Analyzed: 19 Layer 1 Off -white ceramic tile Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: Non - Fibrous Components: 55% Aggregate 45% Filler and Binder Layer 2 Gray gritty compressed material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 1% Cellulose Non - Fibrous Components: 60% Aggregate 39% Filler and Binder Layer 3 White fibrous compressed material Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: 22% Cellulose Non - Fibrous Components: 78% Filler and Binder Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 Jude Cummings, Laboratory Manager Page 7 Client Sample Number: MI6.9 Client Sample Description: Ceramic Tile Client Sample Location: Center Bathroom around Tub Sample Comments: Lab Sample Number: 09- 00724.0016 Checked If Sample Not Analyzed ❑ Layer 1 Bright blue ceramic tile Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected Non - Fibrous Components: 40% Aggregate 60% Filler and Binder Layer 2 White gritty compressed material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 2% Cellulose Non - Fibrous Components: 60% Aggregate 38% Filler and Binder Layer 3 White fibrous compressed material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 22% Cellulose Non - Fibrous Components: 78% Filler and Binder Northern Industrial Hygiene, Inc. 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. S., Tukwila, WA !INDUSTRIAL HYGIENE, INC. 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988 -1978 NVLAP Lab Code: 200511 -0 Bulk Asbestos Analysis Report NIH Batch Number: 09 -00724 Client Job Number: 299 -195 Turn Around Time: 5 Day Samples Analyzed: 19 Layer 1 Off -white ceramic tile Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: Non - Fibrous Components: 55% Aggregate 45% Filler and Binder Layer 2 Gray gritty compressed material Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 1% Cellulose Non - Fibrous Components: 60% Aggregate 39% Filler and Binder Layer 3 White fibrous compressed material Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: 22% Cellulose Non - Fibrous Components: 78% Filler and Binder Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings (Sample results continued on next page.) 10/22/2009 10/23/2009 10/26/2009 Jude Cummings, Laboratory Manager Page 7 Northern Industrial Hygiene, In 215 SW 153rd Street Seattle, WA 98166 - Project Location: 13264 38th Ave. S. Sampled by: Jude Cummings Received by: Jude Cummings Reviewed by: Jude Cummings Bulk Asbestos Analysis Report c. , Tukwila, WA Client Sample Number: Client Sample Description: Client Sample Location: F1.2 Vinyl Flooring Center Bathroom Floor around Toilet Sample Comments: Materials distinguishable but inseparable Lab Sample Number: 09- 00724.0017 Checked If Sample Not Analyzed ❑ Off-white vinyl with white fibrous backing and off -white residue Asbestos Fibrous Components: Non - Asbestos Fibrous Components: Non - Fibrous Components: 40% Filler and Binder 45% Vinyl Filler and Binder No Asbestos Detected 12% Cellulose 3% Fiberglass Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M1.1 Tan Shingles Roof, South Side Lab Sample Number: 09- 00724.0018 Checked If Sample Not Analyzed ❑ Layer 1 Tan and orange pebbles and black fibrous asphalt Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 15% Fiberglass Non - Fibrous Components: 40% Aggregate 45% Asphalt Filler and Binder Layer 2 Black fibrous asphalt Asbestos Fibrous Components: Non - Asbestos Fibrous Components: No Asbestos Detected 40% Cellulose Non - Fibrous Components: 60% Asphalt Filler and Binder Client Sample Number: Client Sample Description: Client Sample Location: Sample Comments: M1.2 Tar Roof, around Stack Opening Lab Sample Number: 09- 00724.0019 Checked If Sample Not Analyzed ❑ Charred opaque flexible material Asbestos Fibrous Components: No Asbestos Detected Non - Asbestos Fibrous Components: Non - Fibrous Components: 5% Synthetic 95% Filler and Binder 10/22/2009 10/23/2009 10/26/2009 215 SW 153rd Street Burien, WA 98166 OFFICE: (206) 988 -1746 FAX: (206) 988-1978 NVLAP Lab Code: 200511 -0 NIH Batch Number: Client Job Number: Turn Around Time: Samples Analyzed: 09 -00724 299 -195 5 Day 19 Jude Cummings, Laboratory Manager Page 8 T Instruct° EPA Provider Cert. Number: 1085 rttttc;t Argus Pacific, Inc. • 1900 W Asbestos uil iI iio t5 to certifp that us Am Curnmin bec zatizfactoriCp compCeteb 4 ijour of refre0er training a5 an to comply With tfje training requirement5 of Q2i Z tie 311 / 40 eff3R 7G3 (zmeiazo Certificate Number: 10303513 D ARNERLsom n TRAINING•CONSULTING n 41' S I t Ins ector Jan 14, 2009 Date(s) of Training Exam Score: NA Expiration Date: Jan 14, 2010 Nickerson, Suite 315 • Seattle, Washington • 98119 • (206) 285.3373 • fax (206) 285.3927 aM �� •li � � .J�'+.'�..+y.n -� '� t��t�" >•y9 ,nzY.,Lsc��av�3� -�"� �i�� United States Department of Commerce National Institute of Standards and Technology Certificate of Accreditation to ISO/IEC 17025:2005 is accredited by the National 1 Laboratory Accreditation Program for specific S'enliC.f:S. ilS.tud on the &op.- of Accreditation, for: BULK ASBESTOS FIBER, ANALYSIS This laboratory fs accredited in accoru'ance with the recognized International Standard /.30//EC 17025:2005, This accreditation demonstrates technica! c., for a defined scope and the operation of a laboratory quality management system (refer to joint ISO-ILAC-1AF Communique dated 18 June 2005). Gr 70,4r ■7( ( s , Effective dates 2M9-01-01 through 2009-12-31 N% LAP LAB ( 'ODE: 200511-0 Northern Industrial Hygiene, Inc. Buncn. WA For the National In (cite of Standard and Technoiogy Nvl. AP-01C (REV. 2i800 13; Approved Transaction pscleanair.org Puget sound • Agency Single - Family Notification Case #: 200902753 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $75.00 Credit Card Transaction C VTHF4CCOA36F Transaction Date 12/03/09 Owner's Name Sidney P. Gonzalez Project Street Address 13264 38 th ave s City Tukwila WA. Contact Person Harlan Perkins Mailing Address 12242 46th ave so Tukwila , WA 98178 Create Another Notification • • If you have questions, contact us at asbestos @pscleanair.org or 206.689.4058. Phone (206) 920 -2614 Zlp 98168 Phone (206) 396 -4351 certify that: 1) This Is a single- family residence project. The structure is used by one family who owns the property as their domicile. 2) The information I have provided is to the best of my knowledge accurate and complete. 3) I understand the fee for this Notification is nonrefundable. Page 1 of 1 This project includes a demolition. Demolition Start Date 12/07/09 Completion Date 01/31/10 Demolition will be completed by a demolition contractor This is an emergency project. The emergency reason: The project must proceed to avoid Imposing an unreasonable burden. RECEIVED DEC 0 4 2009 PERMIT CENTEF https: / /secure.pscleanair.org /Asbestos /Approved.asps 1 2/3/2009 ACTIVITY NUMBER: D09 -243 DATE: 11 -17 -09 PROJECT NAME: GONZALEZ DEMOLITION SITE ADDRESS: 13264 38 AVE S X Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # Revision # After Permit Issued EPART ENTS: C) Woq Budding ivlsion Fi re reve tion Inning Division P Works DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 1 1 -1 9-09 Complete 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 Approved Notation: Documents/routing slip.doc 2 -28 -02 • o PE 11 PLAN REVIEW /ROUTING SLIP REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: Structural Incomplete Structural Review Required Approved with Conditions n n No further Review Required DATE: Permit Coordinator Not Applicable DUE DATE: 12 -17 -09 Not Approved (attach comments) n REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status HILINH*981BT HI LINE HOMES CONSTRUCTION CONTRACTOR GENERA UNUSED 1/30/2002 2/10/2010 ACTIVE CREATDB101QM CREATIVE DESIGN BUILDERS CONSTRUCTION CONTRACTOR CARPENTRY /FRAMING CABINET AND MILLWORK 11/14/1990 11 /7/1994 ARCHIVED CREATDB066QG CREATIVE DESIGN BUILDERS INC CONSTRUCTION CONTRACTOR GENERAL UNUSED 11/7/1994 11/7/2003 INACTIVE Name Role Effective Date Expiration Date SUNDBY, WILLIAM G PRESIDENT 01/04/2002 Bond SUNDBY, CHERYL E SECRETARY 01/04/2002 Account Number Untitled Page • • General /Specialty Contractor A business registered as a construction contractor with Lai to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name Phone Address Suite /Apt. City State Zip County Business Type Parent Company HI -LINE HOMES 2538401849 11306 62ND AVE E PUYALLUP WA 98373 PIERCE Corporation CREATIVE DESIGN BUILDERS INC UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 601584067 ACTIVE HILINH *983RD CONSTRUCTION CONTRACTOR 1/4/2002 11/8/2011 GENERAL UNUSED Other Associated Licenses Business Owner Information Bond Information Page 1 of 3 https: // fortress .wa.gov /lni/bbip/Detail.aspx 12/08/2009 Bond Bond Effective Expiration Cancel Impaired Bond Received Bond Company Name Account Number Date Date Date Date Amount Date 3 OHIO CAS INS CO 3 720885 11 /07/2001 Until Cancelled $12,000.0011 /05/2001 2 AMERICAN ARB006917 11 /07/1996 Until 12/13/2001 $6,000.00 11/13/2001 RELIABLE Cancelled Untitled Page • • General /Specialty Contractor A business registered as a construction contractor with Lai to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name Phone Address Suite /Apt. City State Zip County Business Type Parent Company HI -LINE HOMES 2538401849 11306 62ND AVE E PUYALLUP WA 98373 PIERCE Corporation CREATIVE DESIGN BUILDERS INC UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 601584067 ACTIVE HILINH *983RD CONSTRUCTION CONTRACTOR 1/4/2002 11/8/2011 GENERAL UNUSED Other Associated Licenses Business Owner Information Bond Information Page 1 of 3 https: // fortress .wa.gov /lni/bbip/Detail.aspx 12/08/2009 • • REGISTERED AS PROVIDED BY LAW AS CONST CONTR GENERAL REGIST. # • EXP. DATE CC01 PERKIRS952K7 6/5/2011 EFFECTIVE DATE 5/27/2005 PERKINS REMODELING SERVICE 21211 95TH CT, KENT WA 0 1 / / k tic,t I>. 1 >1.1'. \1:1 \)(N.1 OI I \}U R AND I`Itl'tiTI II ``.