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Home My WebLink AboutPermit D06-302 - Pederson Residence - DemolitionPEDERSON DEMOLITION 4230 S 150 ST D06 -302 Parcel No.: 0042000095 Address: 4230 S 150 ST TUKW Suite No: City o1' Tukwila Tenant: Name: PEDERSON RESIDENCE Address: 4230 S 150 ST, TUKWILA WA Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: cttukwila.wa.us Owner: Name: GREEN GARY R Address: 2732 ROOSEVELT, ENUMCLAW WA 98022, 98022 Phone: Contact Person: Name: TED PEDERSON Address' 14459 25 AV S, SEATAC WA, 98168 Phone: 206 - 947 -0638 Contractor: Name: PEDERSON'S CLASSIC HOMES INC Address: 14459 25TH AVE S, SEATAC WA 98168 Phone: (206)241 -9001 Contractor License No: PEDERCH973D4 DESCRIPTION OF WORK: DEMOLITION OF AN 875 SQ FT SINGLE FAMILY RESIDENCE. WATER DIST. 125 & VAL -VUE SEWER DIST. DEVELOPMENT PERMIT Expiration Date:03/24 /2007 Steven M. Mullet, Mayor Steve Lancaster, Director Permit Number: D06 -302 Issue Date: 08/11/2006 Permit Expires On: 02/07/2007 Value of Construction: $4,000.00 Fees Collected: $203.19 Type of Fire Protection: NONE International Building Code Edition: 2003 Type of Construction: Occupancy per IBC: 0022 doc: IBC- PERMIT **continued on next page** 006 -302 Printed: 08 -11 -2006 Public Works Activities: Channelization / Striping: N Curb Cut / Access / Sidewalk / CSS: N Fire Loop Hydrant: N Number: 0 Size (Inches): 0 Flood Control Zone: N Hauling: N Start Time: End Time: Land Altering: N Volumes: Cut 0 c.y. Fill 0 c.y. Landscape Irrigation: N Moving Oversize Load: N Start Time: End Time: Sanitary Side Sewer: N Sewer Main Extension: N Private: Public: Storm Drainage: N Street Use: N Profit: N Non - Profit: N Water Main Extension: N Private: Public: Water Meter: N Permit Center Authorized Signature: s permit and know the same to be true and correct. All provisions of law and ordinances governing this work will bebcfnpli ith, whether specified herein or not. I hereby certify that I have read and e The granting of this per it does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construc j 1 *Te p yrmance of work. I am authorized to sign and obtain this development permit. Signature: City Tukwila Print Name: /L01- / r a?) 37Z :O A) doc: IBC - PERMIT Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Fax: 206 -431 -3665 Web site: ci.tukwila.wa.us MVIA 01 A -I Steven M. Mullet, Mayor Steve Lancaster, Director Permit Number: D06 -302 Issue Date: 08/11/2006 Permit Expires On: 02/07/2007 Date: 0 I (1t`A Date: fi -7/-06 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. 008 -302 Printed: 08-11 -2006 CITY OF TUKV /11A DEPT. CF CGL::.:UXiTY o:': LO?t••:ENT 6300 C .U; H N LR CLVD. TUKWILA, WA 93188 PERMIT CONDITIONS 1: ** *BUILDING DEPARTMENT CONDITIONS*** PERMIT CENTER Parcel No.: 0042000095 Permit Number: D06 -302 Address: 4230 S 150 ST TUKW Status: ISSUED Suite No: Applied Date: 08/04/2006 Tenant: PEDERSON RESIDENCE Issue Date: 08/11/2006 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: 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. doc: Conditions * *continued on next page" 006 -302 Printed: 08 -11 -2006 CITY OF TUKvpiA DEPT OF CC' ' I Y 03':1Crt.'-NT 6300 5.:.,1111 CIA/0. TUKWILA, WA 93183 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: Print Name: doc: Conditions /; ,4 v o 4 ° P P' 17 CENTER Date: C17 D06 -302 Printed: 08 -11 -2006 E-Mail Address: Company Name: CITY OF TUKWILA Community Developmer' nepartment Public Works Departmeted Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 htto://www.ci.tukwila.wa.us eIR.IA" Ger 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 Address: 4 5 0 IS o Tenant Name: tj ere 4%.. Property Owners Name: --- ret eta (eta S Mailing Address: i44 S Scs Contact Person: E-Mail Address: Contractor Registration Number: Contact Person: E-Mail Address: Company Name: Mailing Address: Contact Person: E-Mail Address: QAAppliestionsWenns-Applicatiom On Line3-2006 - Permit Application doe Revised: 1-2006 bh King Co Assessor's Tax No.:004 ZOO -0 09 5— 0(p Suite Number: Floor: New Tenant: 0---. Yes rei ..No 5en -TAC_ cit lt1A- state State ci.S-1(oFs Zip 'CONTACT PERSON Name: Day Telephone: 2.06 CI - Mailing Address: Address: City State Zip Fax Number: 2-04 C E .. ?•-s ) GENERAL CONTRACTOR INFORMATION r (Contractor information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Mailing Address: Zip City Day Telephone: Fax Number: Expiration Date: I ARCHI'TECT OF RECORD All plans must be wet 'stamped by Architect of Record Company Name: Mailing Address: City Day Telephone: Fax Number: State ENGINEER OF RECORD - Alt plans must be wet stamped by Engineer of Record State Zip City Day Telephone: Fax Number: Zip Page I of 6 ID 1712 Valuation of Project (contractor's bid pnce): S 549#20 • Scope of Work (please provide detailed Information): Ablit Will there be new rack storage? ❑ ..Yes ❑.. No (If yes, a separate permit and plan submittal will be required) Provide All uildiag Areas,jn Squa Footage Below I" Floor 21° Floor 9lloor : °_" Floors Basement: - Accessory Structure* `. Attached Qrarage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck Existing 9375 Interior Remodel Addition to Existing - 'Structure New . Type of Gal9strt)cfion per IBC' Type of Occupancy per IBC PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area for accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: QMpplicadonsWomn- Application on Line\3 -2006 - Permit Application.doc Revised: 4-2006 • bh Existing Building Val : tion: $ a 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 ❑..No If "yes". attach list of materials and storage locations on a separate 8 -1/2 x 11 paper indicating 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. Page 2 of 6 Fixture Type: Qty Fixture Type: Qty Fixture Type: Qty Fixture Type: Qty Bathtub or combination bath/shower . Drinking fountain or water cooler (per bead) . Wash fountain -- • Gas piping outlets - Bidet Food -waste grinder, commercial Receptor, indirect waste Clothes washer, domestic Floor drain Sinks Dental unit, cuspidor Shower, single head trap Urinals Dishwasher, domestic, with independent drain Lavatory Water Closet Building sewer or trailer park sewer Rain water system — per drain (inside building) Water heater and/or vent Industrial waste pretreatment interceptor, including its trap and vent, except for kitchen type grease interceptors Repair or alteration of water piping and/or water treating equipment Repair or alteration of drainage or vent piping Medical gas piping system serving one to five inlets/outlets for specific gas Additional medical gas inlets/outlets — six or more PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: Mailing Address: City State Zip Contact Person: Day Telephone: E -Mail Address: - Fax Number. Expiration Date: Contractor Registration Number: i Valuation of Project (contractor's bid price): $ Scope of Work (please provide detailed information): Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: QMppliation,Wam4Applimione On LineU -2006 - Permit Applic.tion.doc Revised: 4-2006 6F Page 5 of 6 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 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. BUILDING 07101rRIZED AGENT: Signature: Date: 8 - 3 - t7 4. Print Name: 74E) "at:t n—SO/0 Day Telephone: 206 e Q t:{7 -0( Mailing Address: . PEW S °[ 2 5 At- So -5ce7f. L it/A R jai Zip city State Date Application Accepted: Date Application Expires: itials: Q WppliatiouWonns- Appliations On Line\3 -2006 - Permit Application.doc Revised: 4-2006 bh Page 6 of 6 City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 0042000095 Address: 4230 S 150 ST TUKW Suite No: Applicant: PEDERSON RESIDENCE Receipt No.: R06 -01248 Payment Amount: 124.92 Initials: JEM Payment Date: 08/11/2006 03:03 PM User ID: 1165 Balance: $0.00 Payee: PEDERSON'S CLASSIC HOMES, INC. TRANSACTION LIST: Type Method Description Amount RECEIPT Payment Check 4231 124.92 ACCOUNT ITEM LIST: Description Current Pmts BUILDING - NONRES STATE BUILDING SURCHARGE Account Code 000/322.100 120.42 000/386.904 4.50 Permit Number: D06 -302 Status: APPROVED Applied Date: 08/04/2006 Issue Date: Total: 124.92 8595 08/14 9716 TDTAL 124.92 doc: Receipt — _ Printed: 08 -11 -2006 City of Tukwila 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670 Parcel No.: 0042000095 Address' 4230 S 150 ST TUKW Suite No: Applicant: PEDERSON RESIDENCE Receipt No.: R06 -01185 Payment Amount: 78.27 Initials: BLH Payment Date: 08/04/2006 09:39 AM User ID: ADMIN Balance: 5124.92 Payee: PEDERSON CLASSIC HOMES INC TRANSACTION LIST: Type Method Description Amount Payment Check 4213 78.27 ACCOUNT ITEM LIST: Description Current Pmts PLAN CHECK - NONRES RECEIPT Account Code 000/345.830 78.27 Permit Number: D06 -302 Status: PENDING Applied Date: 08/04/2006 Issue Date: Total: 78.27 ...'." ^'!04 .7716 TOTAL doc: Receipt Printed: 08 -04 -2006 Project: 4 r / R-`5. Type of Inspection: 7 2 Address: 5' S /SO .s7 Date Called: Special Instructions: Date Wanted: nail': - mV —o( P.m. Requester: Phone No: roG 9f - 04.7p INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 i Approved per applicable codes. COMMENTS: Permit any/ 0-77 I pect r: Date: 2- O .00 REINSPECTION E REQUIRED. dor to inspection, fee must be id at 6300 Southcente Blvd., Suite 00. Call to sechedule reinspection. Receipt No.: !Date: Corrections required prior to approval. .... Project: - er /e ,.S OA/ Re s . Type o Inspection: »e Cows i t. /t em. i Address: 4'.230 s /SO s Date Called: Special Instructions: Date Wanted: �t a.m. �S /.> — O` Requester: Phone No: BO G- 94'7 - INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (2 s 6)431.36(70 ,pproved per applicable codes. Corrections required prior to approval. COMMENTS: or: Is ? 5 8.00 REINSPECT Iy1t1 FEE REQ ED. Prior to inspection, fee must be aid at 6300 Southcenter Blvd., uite 100. Call to sechedule reinspection. Receipt No.: t. .w 4 Dat x_15 'Date: H. Asbestos/Demolition Project Categories: QC No o 1. Single - Family Residence (owneroccupied): RCp D A. 0 Asbestos Removal Project Only r b0 B. f I� Demolition Project (with or without asbestos removal project) *(Asbestos removal can begin upon notification; demolition must wait 10 days) O Notification Period Project Demolition Fee Surcharge 17-1 Prior Notice B. 10 Days A. $25 B. $50 Note: If the single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes IA or 1B may be checked. If this is not an owner - occupied residence, one of the categories listed below must be used instead. A single family residence does not include rental property, multi family units, or any mixed -use building. 2. U All Other Demolitions (with no Asbestos removal or Nonfriable Asbestos only or less than 10 linear feet and/or 48 square feet of friable Asbestos) 10 Days 0 • Friable Asbestos Projects (other than Single Family Residence): Asbestos Demo 3. U ? 10 - 259 linear feet and/or 2 48 - 159 square feet of asbestos Prior Notice 10 Days $100 $50 4. U 260 - 999 linear feet and/or 160 - 4,999 square feet of asbestos 10 Days $200 $50 5. U >1,000 linear feet and/or >5,000 s uare feet of asbestos 10 Days $600 $50 6. U Emergency Asbestos Project or 01 Emergency Demolition Project (Single- Family Residences are exempt from emergency fee; however, property owners must provide a Prior Notice written emergency request) $50 Emergency Fee r _ , C. Asbestos PLEASE PRINT CLEARLY. THIS WILL BE YOUR RETURN MAILING LABEL Contractor: ID U..1 13 t rn.v " "'.. eiTY Owner /CEO OfTU u Mailing Address: Start Phone: AUG 0 4 2005 Contractor Job No.: City: State: I Zip: Fax: PONTCENTER F. Demolition Date of Asbestos Survey: 1 i - O Co Start AHERA Building. Inspector: Cow V 0,4 k s-Fy,c�, No. of 1. CI Training Fire (List Fire Dept.) U Cement Board U Cement Pipe U Friable Flooring A , U Friabir (Material Other: Information: z. Local Phone: Date: - 3 - (0 I Structures: 2. ❑ Ordered Demolition (attach copy of Order) Demolition Insert demolition contractor's mailing address on back Will nonfriable asbestos be left in place during demo? U Yes U No Contractor: Ow j G � If yes, list type and qty. Note disposal requirements in Step 6 (on back). E. El Asbestos Survey or CI Mat'l Presumed No. of Structures: j Date of Asbestos Survey: 1 i - O Co Was Friable Asbestos Identified? h9 Yes ❑No Was Nonfriable Asbestos Identified? ❑Yes RNo Attach a copy of the survey when friable asbestos has not been identified. AHERA Building. Inspector: Cow V 0,4 k s-Fy,c�, Certification #: 6-2_I - 0'1 Exp. Date: /DZ262�'I D. Site Address: L{Z. 3 O f(, S, ) S D -- Cit t . &A Total Qty. to be Removed: Linear Ft. ZipRgl s S Site Manager: U Cement Board U Cement Pipe U Friable Flooring A , U Friabir (Material Other: Pe DER_ SON z. Local Phone: ! y7"Oly 3 2 (CD G. Friable Asbestos Project Information: Start Date: Completion Date: Work Days: M T W Th F Sa Su Hours: Will all friable asbestos ❑ Yes materials be removed? ❑ No Total Qty. to be Removed: Linear Ft. Square Ft. ❑ Boiler\Fumace Insulation U Duct Insulation U Pipe Insulation Fi Fireproofing ❑ Paints ❑ Plaster U Textured Coatings U Cement Board U Cement Pipe U Friable Flooring A , U Friabir (Material Other: Agency Case No. 200600682 a Clean Air A PUGET SOUND CLEAN`„: AGENCY 110 Union Street, Suite 500 Seattle, WA 98 10 1 -203 8 www.pscleanair.org NOTICE OF INTENT RECEIVED AUG 0 2 2006 AlR 4f�FtJ('.Y A. Project Tyne: 1. 0 Friable Asbestos Removal 2. 0 Friable Asbestos Removal & Demolition 3. Demolition Only B. Property Owner: ----� 1 `:` 7 Pt ateaLS OA) Mailing Address: I 4 14,5 6 1 2 S A S o City :'.J E — t fc 2-00 - Phone: ?V/ - 06 3' StateW Pt Zin.R &t to g An AHERA Survey is required before all demolition projects fr Puget Sound Clean Air Agency Form No.: 66 -160 (Revised 8 /06) TS 1. I certify that the igfonnation contained in this notification & supplemental data is, to the best of my knowledge, accurate & complete. Z -o(.0 Signature Representing Date J. Demolition PLEASS PANT CLEARLY. MIS WILL BE YOUR RETURN NA/LINGLABEL Contractor: Owner /CEO: Mailing Address: - Phone: - Contractor's Job It: City: State: Zip: Fax: The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects (regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal and demolition projects involving materials and structures below the notification threshold are still subject to all other requirements of Regulation III. Article 4. After receiving a complete notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification. GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION NOTIFICATION Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring, cement asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles window putty and most roofmg materials. Step 2. Enter property owner information in Box B. Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential project, in Box C. Print clearly this is your return mailing label. Step 4. Enter the site address for all notifications in Box D. For multi- structure projects, attach supplemental sheet with a site map (include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure. Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the notification of a demolition project when only nonfriable asbestos or no asbestos is identified on the survey. Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition, check yes and list the type and quantity of material. Note: Demolition debris containing nonfriable asbestos materials must be labeled as "nonfriable asbestos-containing waste" and be deposited at an authorized waste disposal facility. Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc. Step 8. For owner-occupied Single - Family Residential projects, check BOX HlA for renovation projects or BOX HIB for demolition projects (with or without asbestos removal). Asbestos removal may be conducted after a complete notification is received, but demolition activities can only begin on the lo day after the notification is received. Note: If the single family residence is owned by one family who has been or will be using the residence as their domicile, boxes IA or III may be checked A single family residence does not include rental property, multi - family units, or any mixed -use building. For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 - 5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge (additional fee) in yourjpayinent. To file for an emergency asbestos or demolition project, check the appropriate box 1 -- 5 and the applicable 'emergency ; boifit 14. All emergency requests must be accompanied by a letter from the property owner demonstrating the need to conduct the proiect immediately in accordance with the requirements in Regulation HI. Section 4.03 (c). Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box I. Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for work schedule changes if the contractor is participating in the Agency work schedule fax program. A $25.00 processing fee is requited for all amendments. Puget Sound Clean Air Agency asbestos regulations and forms can be downloaded from the Agency web page at www.pscleanair.org. For technical assistance call (206) 689-4058 and for administrative inquiries call (206) 689-4090. Puget Sound Clean Air Agency Form No.: 66 -160 (Revised 8/06) TS Page 1 of 5 #260753 July 31, 2006 •✓ ASBESTO -TEST, INC. ASBESTOS SURVEY 4230 S 150m ST., TUKWILA, WA 98188 Ted Pederson 14459 25 Ave. S. Sea Tac, WA 98168 Ph: 206- 947 -0638 f 206- 241 -9387 On July 24, 2006 Asbesto-Test personnel conducted an Asbestos survey (per U.S.E.P.AJA.H.E.R.A. guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State) of the house (a? 4230 S 156 St., Tukwila, King County, Washington 98188. This survey purpose is to identify any Asbestos Containing Materials that may be present and will require professional removal prior to demolition or renovation. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The structure is a one story wood frame. The siding is wood. The composition and siding vapor barrier materials were sampled. INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior has been gutted. Remnant flooring and wall materials were sampled where located. The mastic materials were uniformly sampled. INSULATION: The insulation materials were sampled. ELECTRICAL SYSTEM: The "old" electrical wiring insulation was sampled. Any additional suspect electrical wiring insulation or any suspect TSI (Thermal System Insulation) found in, around, or behind any located fuse or breaker boxes should be considered to be ACM (Asbestos Containing Material), unless determined otherwise by laboratory analysis. CONTINUE TO PAGE 2 RECEIVED CITY OF TUKwtA AUG 0 4 2006 PERMIT CENTER 1429 Ave. D. PMB #187, Snohomish, WA 98290 ph: 206 - 914-5500 Si: 360- 563 -2469 page: 206-540-2401 PO& •3ot Page 2 of CB260753 Misc.: None. # of structures included in survey: one house Requested by: Ted Pederson Inspector, certified AH.E.RA. accred. #1022629 (Expires 6/21/07) continue to page 3 July 31, 2006 Asbesto-Test, Inc (206) 914 -5500 4230 S 15e St. Tukwila, King County, Washington 98188 HEATING AND VENTILATION SYSTEM: The heating and ventilation system are gone. The interior has been gutted. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None. .4 -T Page 3 of 5 CB260753 ANALYSIS ID 3.0 laminant mastic kitchen countertop 3.1 splash panel mastic kitchen July 31, 2006 Asbesto-Test, Inc (206) 914 -5500 4230 S 1M" St.. Tukwila, Xurg County. Washington 98188 Any and all materials identified as ACM or PACM in this report (and/or additional materials associated with the structure that may be discovered and later identified as ACM or PACM), must be professionally abated prior to demolition. ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES AND /OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION, AS LISTED QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY. SAMPLES 1 -2 ARE ASBESTOS CONTAINING MA TERLI LS ASBESTOS//TYPE/ /QUANTITY OTHER MATERIAL 1.0 SHEET VINYL REMNANTS yes // chrysotile // 35-40% non - fibrous materials, FRIABLE ACM cellulose Remnants in kitchen & scattered outside on lawn — color: yellow & green pebble Note: The asbestos is in the gray /white vinyl backing. The mastic is also ACM as it cannot be separated from the friable vinyl backing material. QUANTITIES OF ASBESTOS FOR ABATEMENT ASSESSMENT AND /OR PRICING FOR REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION. 2.0 SHEET VINYL FLOORING yes // chrysotile /1 35-40% non - fibrous materials, FRIABLE ACM cellulose Bathroom — color: green Note: The asbestos is in the gray/white vinyl backing. The mastic is also ACM as it cannot be separated from the friable vinyl backing material. APPROX. 25 SQ. FT. ON FLOORING FELT. THE FELT IS ACM AS IT IS CONTAMINATED WITH THE ACM VINYL BACKING. NOTE: Any additional colors or kinds of vinyl flooring and/or tile with any relating mastics/backings that were not discovered in this survey and may later be located in this structure are also presumed to contain asbestos unless tested otherwise by laboratory analysis THERE WAS NO ASBESTOS DETECTED IN ANY OF THE REMAINING SAMPLES 3.0 floor leveling NM) non -fibrous materials, dining room fiberglass NM) NM) continue to page 4 adhesive, cellulose adhesive, cellulose A -T Page 4of5 CB260753 4230 S 150 ' St. Tukwila, King County. Washington 98188 ANALYSIS ID ASBESTOSI/TYPE//OUANTITY 4.0 splash panel mastic bathroom shower stall 5.0 base cove mastic homogenous throughout 6.0 insulation "loose -lay" mineral wool fiberglass 7.0 "old" electrical wiring insulation 8.0 siding vapor bather material beneath wood siding exterior 9.0 composition roofing 9.1 roofing vapor barrier 10.0 drywall misc. & loose lay 10.1 drywall taping compounds SAMPLED PER AHERA PROTOCOL 10.2 surface paint homogenous throughout NAD NAD NAD NAD NAD NAD NAD NAD NAD NAD continue to page 5 July 31, 2006 Asbesto-Test, Inc (206) 914-5500 OTHER MATERIAL adhesive, cellulose adhesive, cellulose cellulose, fiberglass non - fibrous materials, cellulose, polymers cellulose, tar cellulose, tar fiberglass, non -fibrous materials cellulose, tar non -fibrous materials paint, gypsum non -fibrous materials, cellulose, fiberglass paint, cellulose A -T Page 5 of 5 CB260753 END OF REPORT July 31, 2006 Asbesto-Test, Inc (206) 914-5500 4230 S 150 St, Tukwila, Xing County, Washington 98188 Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials, as prescribed byA.H.E.RA. protocoL Samples taken are listed with their corresponding analyses. If asbestos is detected, those samples containing asbestos are listed first and noted with the initials "ACM ". If during demolition or renovation, any additional hidden or covered suspect materials similar to those identified in the survey are located [may include but not limited to: sheet vinyl flooring tile flooring wall or ceiling texturing: or paints, concrete siding or skirting, cement pipes, cement wallboard electrical cloth electrical wiring insulation, thermal paper, wallboard joint compounds, vinyl wall coverings, spackling compound% or any other suspect MS! (Thermal System Insulation)), they should be treated as Asbestos Containing Materials unless determined to be non - asbestos by laboratory analysis. Note: Asbesto-Test, Inc. does not guarantee approximations of quantities of ACM,which may be listed with the analyses. It is therefore recommended professional abatement price and/or disposal quotes be obtained by Inquiring as to fees per area of specific ACMmetenirl (La square or &tear foot, etc), or by on s to assessment. Any and all matesieh identified as ACM in this report must be abated prior to ACM dsnabance, renovation, or demolition. All materials identified as ACM neat beprofessionally abated by a licensed asbestos abatement contractor prior to any isiu bane Analytical test method: USEPA 600/R93/116" (PLM); WAC 296 -62 -07753 App. J JUL ACM signifies "Asbestos Containing Material" PACM signifies "Presumed Asbestos Containing Material" CAB signifies 'Concrete Asbestos Hoard" signifies 'less than" TSI signifies "Thermal System Insulation" HVAC signifies "Heating Ventilating Air-Conditioning" NM) signifies "No Asbestos Detected" "One percent is the USEPA regulatory limit for asbestos in bulk samples. PLM has been known to miss asbestos in small percentages of some samples, which contain asbestos, thus negative PLM results carmot be guaranteed. Floor tiles and wipes should be tested with SEM or TEM, to Sure analytical accuracy when reported in small Percentages. Asbesto-Test, Inc. claims responsibility for sample content only. A -T ACTIVITY NUMBER: D06 -302 DATE: 08 -04 -06 PROJECT NAME: PEDERSON DEMOLITION SITE ADDRESS: 4230 S 150 ST X Original Plan Submittal Response to Incomplete Letter #_ Response to Correction Letter #, Revision # before Permit Issued DEP S Building Di Is�ion Public Work ' PERMIT COORD COPY'` PLAN REVIEW /ROUTING SLIP '0(o DETERMINATION OF COMPLETENESS: (Tues., Thurs.) 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 E3?f Structural Review Required ❑ No further Review Required ❑ REVIEWER'S INITIALS: DATE: DUE DATE: 09 -5 -06 Approved ❑ Approved with Conditions Not Approved (attach comments) ❑ Notation: APPROVALS OR CORRECTIONS: 5(I M& It Fire Prevention Structural ❑ Incomplete ❑ mik Planning Division Permit Coordinator DUE DATE: 08 -8 -06 Not Applicable ❑ REVIEWER'S INITIALS' DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents/rouling slip.doc 2-28-02 License Information License PEDERCH973D4 Licensee Name PEDERSON'S CLASSIC HOMES INC Licensee Type CONSTRUCTION CONTRACTOR UBI 602277722 Ind. Ins. Account Id VICE PRESIDENT Business Type CORPORATION Address 1 14459 25TH AVE S Address 2 City SEATAC County KING State WA Zip 98168 Phone 2062419001 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 3/24/2003 Expiration Date 3/24/2007 Suspend Date Separation Date Parent Company Previous License CLASSH'026CS Next License Associated License Business Owner Information Name Role Effective Date Expiration Date PEDERSON, THEODORE F PRESIDENT 03/24/2003 PEDERSON, KATHY A VICE PRESIDENT 03/24/2003 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2 Washington State Department of Labor and Industries GenerallSpecialty Contractor A business registered as a construction contractor with L &I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date https: // fortress. wa. gov /lni/bbip /printer.aspx ?License= PEDERCH973D4 08/11/2006 Y 0 REVISIONS No changes shall be made to the scope c� WsEt vidthout prior approval of ' Division. rzqulre a new plan submittal and may include additional plan review fees. Permit Plan review approval Is subject to errors and omfsakM Approval of construction documents does not audw tae the violatien c; L -., - ccepced code or ordinance. Receipt of approve) �� onditions is acknowledged: By Date: City of Tukwila BUILDING DIVISION vas .,y �o '90 .111111'1�1��.�1��121 —I IIIII:III I�Th�L�I. �III�lIl1� ►1.111�1)1��L11 -l�iT" min 1/16 3 4 5 6 •� t t Ftv^ -.4r r � t.� n � 9II6 •.. V 6 E 4, 9 IIU .��Illlillll1IIIIIIIII�IILIZ : LLB: I1dii iiii O11 im 1i��► 1�VIII��i��l�l��l�l�� ►fll�lll��lllll�ll�lllll : t REVIEWED FOR CODE COMPLIANCE gyp• f, AUG 10 2006a RECE M CRY OF TUKWM A AUG 0 4 2006 PERMIT CENTER t . .Y City Of Tukwila C 0 (04W 5 BUILDING 0TVISION S1 V) r� Q v lo 1J Q c� gyp• f, r RECE M CRY OF TUKWM A AUG 0 4 2006 PERMIT CENTER t . .Y C 0 (04W 5 'y S1 V) r� Q v lo 1J Q c�