HomeMy WebLinkAboutPermit D11-285 - JACKSONS STORE - DEMOLITIONJACKSONS DEMOLITION
13138 INTERURBAN AV S
D11 -285
City olkukwila
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.TukwilaWA.gov
DEVELOPMENT PERMIT
Parcel No.: 0003000108
Address: 13138 INTERURBAN Alt S TUKW
Suite No:
Project Name: JACKSONS DEMOLITION
Permit Number: D11 -285
Issue Date: 03/05/2012
Permit Expires On: 09/01/2012
Owner:
Name: PACWEST ENERGY LLC
Address: 3450 COMMERCIAL CT , MERIDIAN ID 83642
Contact Person:
Name: CARYL MATTSON
Address: 18215 72 AV S , KENT WA 98032
Contractor:
Name: EVERGREEN ENVIRONMENTAL SERVICES INC
Address: 17108 9 AV SE , MILL CREEK WA 98012
Contractor License No: EVERGES061J5
Lender:
Name:
Address:
Phone: 425 656 -1063
Phone: 425 - 787 -8987
Expiration Date: 01/14/2014
DESCRIPTION OF WORK:
DEMOLITION OF EXISTING 2296 SF CONVENIENCE STORE /CAR WASH AND 1478 SF CANOPY. PUBLIC WORKS
ACTIVITIES INCLUDE EROSION CONTROL, CAPPING/DISCONNECTING OF TWO (2) WATER SERVICES (DOMESTIC &
IRRIGATION) AND SEWER SERVICE PLUS ABANDONMENT /REMOVAL OF EXISTING (2) TWO MONITORING WELLS PER
D.O.E. STANDARDS.
Value of Construction: $10,600.00 Fees Collected: $846.04
Type of Fire Protection: N/A International Building Code Edition: 2009
Type of Construction: VB Occupancy per IBC: 0019
Electrical Service Provided by: SEATTLE CITY LIGHT
* *continued on next page **
doc: IBC -7/10
D11 -285 Printed: 03 -05 -2012
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
Fire Loop Hydrant:
Flood Control Zone:
Hauling:
Land Altering:
Landscape Irrigation:
Moving Oversize Load:
N
N
Number: 0 Size (Inches): 0
Start Time:
Volumes: Cut 0 c.y.
End Time:
Fill 0 c.y.
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:
Permit Center Authorized Signature:
N
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 pr • sions of any other state or local laws regulating
construction or the perform. • e of work am am authorized to sign a • a 's dev- •p 1�' permit and a• ee to the conditions attached
to this permit.
Signature: 114L4.
Print Name: z_
This permit shall become null and voi • Or 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.
g
PERMIT CONDITIONS:
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the
Building Official.
3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to
start of any construction. These documents shall be maintained and made available until final inspection approval is
granted.
4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary
sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other
excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of
this requirement.
5: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the City of Tukwila
Building Department (206- 431 - 3670).
6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building
doc: IBC -7/10
D11 -285 Printed: 03 -05 -2012
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.
8: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * **
9: The applicant or contractor shall call Public Works at least 48 hours in advance to schedule a mandatory
pre - construction meeting with Public Works Project Inspector.
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.
10: Contractor shall notify Public Works Project Inspector at (206)433 -0179 of commencement and completion of work at least
24 hours in advance.
11: Work affecting traffic flows shall be closely coordinated with the City Project Inspector.
12: Permit is valid between the weekday hours of 7:00 a.m. and 3:30 p.m. only.
13: Any material spilled onto any street shall be cleaned up immediately.
14: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation
off -site or into existing drainage facilities.
15: From October 1 through April 30, cover any slopes and stockpiles that are 3H:1V 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.
16: 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.
17: The site shall have permanent erosion control measures in place as soon as possible after final grading has been
completed and prior to the Final Inspection.
18: Abandoned side sewers shall be capped at the main.
19: Disconnected side sewers which will be reconnected in the near future shall be capped at the property line.
20: Sewer and water utilities shall be plugged at the mains if they are to be abandoned. If they will be used again in the
near future for a new building, they shall be capped at the property line and at the water meter respectively.
21: Applicant or contractor shall notify Tukwila Public Works Department at (206)433 -0179 immediately if contaminated soils
are encountered.
22: Two existing monitoring wells shall be abandoned and/or removed per D.O.E. standards. A licensed drill contractor shall
apply for Notice of Intend with Department of Ecology to decommission well(s) and submit proof of completed abandonment
prior to permit final- sigh -off.
doc: IBC -7/10
D11 -285 Printed: 03 -05 -2012
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
SITE LOCATION
Site Address:
BCE #14700
Building Permit No.
Mechanical Permit No.
Plumbing /Gas Permit No.
Public Works Permit No.
Project No.
(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 **
yak otA1101.\
King Co Assessor's Tax No.: 0003000108
13138 Interurban Avenue South (@ 48th Avenue S.) Suite Number:
Tenant Name: Jacksons Store No. 631
Property Owners Name: PacWest Energy, LLC
Mailing Address: 3450 East Commercial Court
Floor:
New Tenant: ❑ Yes ..No
Meridian, Idaho
83642
City
State
Zip
CONTACT PERSON - who do we contact when your permit is ready to be issued
Name: Ms. Caryl Mattson, Design Engineersarghausen Consulting
Mailing Address: 18215 - 72nd Avenue South, Kent 98032
E -Mail Address: cmattson @barghausen.com
Engineers, Inc. 425 656 -1063
Day Telephone: Inc. , 425)
Kent, Washington
City State
Fax Number: (425) 251 -8782
98032
Zip
GENERAL CONTRACTOR INFORMATION -
(Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5))
Company Name: TBD
Mailing Address:
Contact Person:
E -Mail Address:
Contractor Registration Number:
City
Day Telephone:
Fax Number:
Expiration Date:
State
Zip
ARCHITECT OF RECORD - All plans must be stamped by Architect of Record
Company Name: N/A
Mailing Address:
Contact Person:
E -Mail Address:
City
State
Zip
Day Telephone:
Fax Number:
ENGINEER OF RECORD - All plans must be stamped by Engineer of Record
Company Name: Barghausen Consulting Engineers, Inc.
Mailing Address: 18215 - 72nd Avenue South
Contact Person: Patrick A. Taitano, P.E.
E -Mail Address: ptaitano @barghausen.com
H:\ Applications \Forms-Applications On Line \2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
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Kent, Washington
City State
Day Telephone: (425) 251 -6222
Fax Number: (425) 251 -8782
98032
Zip
14700 -F -APPL- DEMO - 2011- 08- 23.pdf
Page 1 of 6
BUILDING PERMIT INFORMATION — 206 -431 -3670
Valuation of Project (contractor's bid price): $ 10,600.00 Existing Building Valuation: $ 209,197.24
Scope of Work (please provide detailed information): Demolish existing 2,296- square -foot convenience store /car wash
building and existing 1,478 square foot canopy.
Will there be new rack storage? ❑ Yes
O.. No If yes, a separate permit and plan submittal will be required.
Provide All Building Areas in Square Footage Below
PLANNING DMSION:
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 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: Handicap:
Will there be a change in use? ❑ Yes m 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 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\Fonns- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
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Page 2 of 6
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
1st Floor
2,296
V -B
B & M
2nd Floor
3rd Floor
Floors thru
Basement
Accessory Structure*
1,478
I I -B
M
Attached Garage
Detached Garage
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
PLANNING DMSION:
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 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: Handicap:
Will there be a change in use? ❑ Yes m 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 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\Fonns- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
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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 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 OWNER 0
Signature:
Barghausen Consulting Engineers, I
Print Name: Caryl Mattson, Design Engineer
AUTHORIZED AGENT:
Mailing Address: 18215 - 72nd Avenue South
Date Application Accepted: II'
Date: S �� D-0/(
Day Telephone: (425) 656 -1063
Kent
WA 98032
City
Date Application Expires:
H:\ApplicationsWonns- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
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0247-2,10-
State Zip
Staff Initials:
Page 6 of 6
Ci, 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
SET RECEIPT
RECEIPT NO: R12 -00906
Initials: JEM
Payment Date: 03/05/2012
User ID: 1165 Total Payment: 11,325.70
Payee: PACWEST ENERGY LLC
SET ID: 1017 SET NAME: JACKSON STORES
SET TRANSACTIONS:
Set Member Amount
D11 -285 652.40
D11 -286 6,892.55
D11 -287 1,798.15
EL11 -0791 505.30
EL11 -0792 212.90
M11 -118 553.55
PG11 -126 710.85
TOTAL: 652.40
TRANSACTION LIST:
Type Method Description Amount
Payment Check 0007347 11,325.70
TOTAL: 11, 325.70
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
BUILDING - NONRES
ELECTRICAL PERMIT - NONR
GAS - NONRES
MECHANICAL - NONRES
PLAN CHECK - NONRES
PLUMBING - NONRES
PW BASE APPLICATION FEE
PW LAND ALT PERMIT FEE
PW PERMIT /INSPECTION FEE
PW PLAN REVIEW
STATE BUILDING SURCHARGE
000.322.100
000.322.101.00.0
000.322.103.00.0
000.322.102.00.0
000.345.830
000.322.103.00.0
000.322.100
000.342.400
000.342.400
000.345.830
640.237.114
TOTAL:
5,947.70
718.20
63.00
538.85
14.70
647.85
250.00
89.50
2,992.40
50.00
13.50
11,325.70
CifP 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
SET RECEIPT
Copy Reprinted on 08 -23 -2011 at 14:59:02 08/23/2011
RECEIPT NO: R11 -01842
Initials: JEM
Payment Date: 08/23/2011
User ID: 1165 Total Payment: 4,593.29
Payee: BARGHAUSEN CONSULTING ENGINEERS, INC.
SET ID: S000001558 SET NAME: JACKSON STORE 631
SET TRANSACTIONS:
Set Member Amount
D11 -285 193.64
D11 -286 2,756.50
D11 -287 1,165.87
EL11 -0791 126.33
EL11 -0792 53.23
M11 -118 120.01
PG11 -126 177.71
TOTAL: 193.64
TRANSACTION LIST:
Type Method Description Amount
Payment Check 29585 4,593.29
TOTAL: 4,593.29
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
ELECTRICAL PLAN - NONRES
PLAN CHECK - NONRES
PW BASE APPLICATION FEE
000.345.832.00.0
000.345.830
000.322.100
TOTAL:
179.56
4,163.73
250.00
4,593.29
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
1)/ 1-2AS
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION Y'
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -367
Permit InspectioriRequest Line (206) 431 -2451
Project: .
fr/ f K.564 /�0AC h f
Type o Inspection.:
i i- / i✓,t L
ss:
/3/ g _ ,ui w, /M' j
Date Called:
Special Instructions:
I.
Date Wanted: .
Requester:
Phone No:
►`
Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Dat :
ri El - PECTION FEE REQUIRED. ior,to next inspection, fee must be
pa' • at 6300 Southcenter Blvd.. Sui 100. Call to schedule reinspection.
DIN -2 EDS
•
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
N_33/
CITY OF TUKWILA BUILDING DIVISION
6300 Southeenter Blvd., #100, Tukwila. WA 98188 r_ (206) 431-3670
Permit Inspettion Request Line (206) 431-2451
Prole . _ .: . ..c, I
a
Type of Inspegion:
N.,, -r7e
Address: 5 .4 a.„3.0,,,,,.64pate
ddr
Called:
Special Instructions:
. , (I T%
. I 0 A v■-•A
0 Al■ A tAa. dvc(
Date Wanted:.
P.m.
Requester:
hone No:
P .2._
- 4 3°8- 3Z,
.L
ixtApproved per applicable codes.
Corrections required prior to approval.
COMMENTS:
IiIspee* witA,
mAi „,„
Date.
..... c,
Rff1SPEcTtON FEE REQUIRED. P r to next inspection, fee must be
paid at 6300 •Southcenter Blvd.. Suite 100. Call to schedule reinspection.
. •
.s1
•
•
:',.:INSPECTION RECORD •
'Retain a copy with permit
INSPECTION NO :: PERMIT NO.
.D11 -$5
• CITY. OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspectiori•Request Line (206) 431 -2451
Project: • ;
aac•-ksvns
•uimv
Type of Inspection:
40 Flnv.l
peot . -kr-, V-1;101/4,1,e04
Address: • .
1313 IS -I.1
. -
, .
Ade 5
Date Called:
3 Iai I i g-
i
Speciall Instructions: :
•
•
•
C 5 eiv cc-re4 _ Aspin,�,,' 4- Ie'G+ i pIec e.
Date Wanted:) f .
Vim;
i �p -r'ii
Requester:
Phone No:
•
i
LO. Approved per applicab
oitip
Corrections required prior to approval.
COMMENTS: ,:. •
peot . -kr-, V-1;101/4,1,e04
- Ftied
- C P A . -4 oak) (Mile{ 4- if'f CQ/1/ieG47;,1
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• r(rd..tecol .
Inspector:
D5
Date:
'5 2- ((
ri REINSPECTION•FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
•
1
INSPECTION NUMBER
INSPECTION RECORD
Retain a copy with permit
ply -
1 s` -
PERMIT NUMBERS
CITY OF TUKWILA FIRE DEPARTMENT
444 Andover Park East, Tukwila, Wa. 98188 206- 575 -4407
Project:
Z-Ar- ,sows
11
S }vr' -e � . 6 3 I
Tye of Insp ction:
H 9i0, �-t0,i0k�
i,.
+o
Address: 13133
Suite #:
--SAS
Contact Person:
04,14. -47- L....
Occupancy Type:
Special Instructions:
f
Phone No.:
LO - 6s17- /063
i
\Appyoved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Sprinklers:
,
Hood & Duct: _
Monitor:
Pre -Fire:
---7`
Occupancy Type:
DI I • a 6 5" b.12.."-►o
co.,,,ide,
Pre e SU r-c 7---P S\
4
V g• t^'k. pr o a a love,
S O i x
oK
Needs Shift Inspection:
Sprinklers:
Fire Alarm:
Hood & Duct: _
Monitor:
Pre -Fire:
Permits: ..
Occupancy Type:
Inspector: /!e^-
Sm., C2--
. •
Date: sill/ Z
Hrs.:
(
•.
$100.00 REINSPECTION FEE REQUIRED. You will receive an invoice from
the City of Tukwila Finance Department. Call to schedule a reinspection.
Billing Address
Attn:
Company Name:
Address:
City:
State:
Zip:
Word /Inspection Record Form.Doc
6/11/10
T.F.D. Form F.P. 113
•
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•2
•
•
p
• .i
41
FILE COPY
Permit No.,
ASBESTOS SURVEY
1"uk ocla✓
Wins f 4 N 1 -285
REVIEWED FOR
CODE COMPLIANCE
APPROVED
OCT 2 8 2011
City of Tukwila
BUILDING DIVISION
13138 INTERURBAN AVE S., TUKWILA, WA 9811:
Page 1 of 4
#2110323
March 28, 2011
Jacksons Food Stores
3450 E Commercial Ct.
Meridian, ID 83642
Attn: Jack Davis
c.c. Daniel B. Goalwin
425 - 656 -7441; c: 206 - 396 -8589
dgoalwinabarghausen.com
ECEI VED
OCT 20 2011
TUKWILA
On March 21, 2011, Asbesto -Test personnel conducted an Asbestos survey (per PUBLIC WORKS
U.S.E.P.A. /A.H.E.R.A. guidelines as designated and specified by Puget Sound Clean Air
Agency and Washington State) of the convenience store and fuel stop (a. 13138 Interurban
Ave S., Tukwila, King County, Washington 98168. This survey purpose is to identify any
Asbestos Containing Materials that may be present and will require professional removal
prior to demolition.
Note: This store was occupied and In full use at the time of the survey. Thus destructive sampling was limited. THIS IS A LIMITED
SURVEY DUE TO RESTRICTED SAMPLING AND OCCUPANCY. There may be asbestos containing materials present In the structure
that were not discovered In this inspection. If there are any additional suspect Asbestos Containing Materials located prior to or
during demolition (including, but not limited to those materials listed in the last page of this surny report), the material(s) are
PALM unless tested otherwise by laboratory analysis. It is our opinion that an AHERA certified building inspector must be on site
during demolition to ensure there are no additional hidden' suspect asbestos containing materials present in the structure.
NARRATIVE OF FINDINGS
BASIC CONSTRUCTION: The structure is one story metal and wood frame on a concrete
slab. The siding is metal. The roofing is metal and torch down. The roofing was not sampled at
the time of this inspection as to not compromise the integrity while it is in use. The torch
down/built up roofing and any roofing penetration/sealant materials are PACM unless tested
otherwise by laboratory analysis. We recommend a return trip for roofing sampling once the
structure is vacant.
BBB
MEM
CONTINUE TO PAGE 2
1429 Ave. D. #187, Snohomish, WA 98290 425-489-4040; c 206 -914 -5500; f 775. 665 -0420
e mail Asbestotest emsn.cont ; web: www.asbestotest.cont
RECEIVE�p
CITY OF TUKWILA
OCT 172011
PERMIT CENTER
L R #CORRECTION �- ptt 215
Page 2 of 4
CB2110323
March 28, 2011
Asbesto -Test, Inc. 425 -489 -4040
13138 Interurban Ave S., Tukwila. King County, Washington 98168
INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior is wood,
concrete, and drywall. The drywall/taping materials were representatively sampled. The tile
flooring materials, with relating backings and mastics, were uniformly sampled. The misc. mastic
materials were sampled. The masonry tile and relating mortar /mastic materials were also
uniformly sampled. The acoustic ceiling panels were also sampled.
INSULATION: The insulation materials were sampled.
ELECTRICAL SYSTEM: The electrical wiring insulation did not appear to be of the kind to
be ACM. The power was "on" at the time of the survey, thus sampling was not safe. Any 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.
HEATING AND VENTILATION SYSTEM: The HVAC is a newer vintage gas rooftop
unit. There was no visible relating suspect ACM located. Note: It was not possible to dismantle
the heating unit to locate and/or evaluate any additional suspect ACM which may be concealed,
inside the unit, or associated in hidden areas. It is our opinion any further handling of the HVAC
should be coordinated by the project manager and /or abatement contractor. If any additional
relating suspect materials are located prior to and /or during any demolition or renovation, any
and all additional related suspect materials should be considered to be ACM (Asbestos
Containing Material), unless determined to be otherwise by laboratory analysis. Any TSI that
may be present inside or outside the HVAC system including but not limited to all gaskets, joint
compounds, sealants, and/or insulations, are PACM unless tested otherwise by laboratory
analysis.
MISC.: None.
ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None. The canopy
is attached.
# of structures included in survey: one convenience store & canopy
REQUESTED BY: Daniel B. Goalwin
Carl Dykstra
Inspector, certified A.H.E.R.A.
accred. #1067045 (Exp. June 2, 2011)
continue to page 3
1429 Ave. D. #187, Snohomish, WA 98290 425- 489 -4040; c 206 -914 -5500; f 775 - 665 -0420
e mail Asbestotest(amsn.conl ; web: www.asbestotest.con,
Page 3 of 4
CB2110323
March 28, 2011
Asbesto -Test, Inc. 425- 489 -4040
13138 Interurban Ave S., Tukwila, King County, Washington 98168
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 USTED QUANTITIES ARE NOT GUARANTEED AND
ARE AN APPROXIMATION ONLY.
ANALYSIS ID
SAMPLE #1 IS ASBESTOS CONTAINING MATERIAL
ASBESTOS //TYPE/ /QUAN'T'ITY OTHER MATERIAL
1.0 FLOOR TILE yes // chrysotile // 2%
TILE IS NON - FRIABLE ACM
Throughout retail area — color: light gray &off white intermixed
APPROX. AREA 800 SQ. FT.
2.0 mastic
Beneath previous sample listed
non - fibrous materials
NAD cellulose, adhesive
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 base cove mastic NAD adhesive, cellulose
homogenous throughout
4.0 masonry tile NAD non - fibrous materials
Restroom floor
5.0 mortar /mastic NAD adhesive, cellulose,
beneath previous sample listed non - fibrous materials
6.0 masonry tile NAD non- fibrous materials
Restroom wall
7.0 mortar /mastic NAD adhesive, cellulose,
beneath previous sample listed non - fibrous materials
8.0 drywall
NAD non - fibrous materials
paint, gypsum
9.0 drywall taping compounds NAD non - fibrous materials,
SAMPLED PER AHERA PROTOCOL cellulose, fiberglass
EiBB
continue to page 4
1429 Ave. D. #187, Snohomish, WA 98290 425 -489 -4040; c 206 -914 -5500; f 775 - 665 -0420
e mail f.sbestotest(0msn.conl; web: www.asbestotest.com,
Page 4 of 4
CB2110323
March 28, 2011
Asbesto -Test, Inc. 425- 489 -4040
13138 Interurban Ave S.. Tukwila, Kinj County. Washington 98168
ANALYSIS ID ASBESTOS //TYPE/ /QUANTITY OTHER MATERIAL
10.0 acoustic ceiling panels
suspended
11.0 insulation
NAD cellulose, paint
NAD cellulose, fiberglass
Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous
materials, as prescribed by ALH.E.R.A. 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 texturings or paints, concrete siding or
skirting, cement pipes, cement wallboard, electrical cloth, electrical wiring insulation, thermal paper, wallboard, joint compounds.
vinyl wall coverings, spackling compounds, or any other suspect TSI (Thermal System lrtsulation)]. they are presumed Asbestos
Containing Materials unless determined to be non - asbestos by laboratory analysis.
Note: Asbesto -Test, Inc. does not guaran tee 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
ACM material (i.e. square or linear foot, etc.), or by on site assessment.
Any and all materials identified as ACM and /or PACM in this report must be abated prior to disturbance in renovation or demolition.
Analytical test method: USEPA 600/R93/116 ** (PLM); WAC296 -62 -07753 App. 1
Kw ACM signifies "Asbestos Containing Material"
PACM signifies "Presumed Asbestos Containing Material"
CAB signifies "Concrete Asbestos Board"
< signifies less than"
TS, signifies "Thermal System Insulation"
HVAC signifies "Heating Ventilating Air- Conditioning"
NAD 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 cannot be guaranteed. Floor tiles and wipes should be tested with SEM (scanning electron microscope) or
TEM (transmitting electron microscope), to insure analytical accuracy when asbestos is reported in small percentages.
ArLynn Hammond, Pres.
Analytical Chemist, B.Sc.
AIHA proficient
END OF REPORT
1429 Ave. D. #I87, Snohomish, WA 98290 425 .489 -4040; c 206-914 -5500; f 775 - 665 -0420
e mail Asbestotest(msn.cont ; web: ?vww.asbestotest.com,
INSTRUCTION AND INFORMATION SHEET FOR SF 180, REQUEST PERTAINING TO MILITARY RECORDS
1. General Information. The Standard Form 180, Request Pertaining to Military Records (SF180) is used to request information from
military records. Certain identifying information is necessary to determine the location of an individual's record of military service. Please
try to answer each item on the SF 180. If you do not have and cannot obtain the information for an item, show "NA," meaning the
information is "not available." Include as much of the requested information as you can. To determine where to mail this request see Page 2
of the SF180 for record locations and facility addresses.
Online requests may be submitted to the National Personnel Records Center (NPRC) by a veteran or deceased veteran's next of kin using
eVetRecs at http: / /www.archives.gov /veterans /evetrecs /.
2. Personnel records and Service Treatment Records (STR). Personnel records of military members who were discharged, retired, or
died in service less than 62 years ago and STR's are in the legal custody of the military service department and are administered in
accordance with rules issued by the Department of Defense and the Department of Homeland Security (DHS, Coast Guard). STR's of
persons on active duty are generally kept at the local servicing clinic, and usually are available from the Department of Veterans Affairs
approximately 40 days after the last day of active duty. (See item 3, Archival Records, if the military member was discharged, retired or
died in service over 62 years ago.)
a. Release of information: Release of information is subject to restrictions imposed by the military services consistent with
Department of Defense regulations and the provisions of the Freedom of Information Act (FOIA) and the Privacy Act of 1974. The
service member (either past or present) or the member's legal guardian has access to almost any information contained in that
member's own record. An authorization signature, of the service member or the member's legal guardian, is needed in Section III of
the SF180. Others requesting information from military personnel records and/or STR's must have the release authorization in
Section III of the SF 180 signed by the member or legal guardian. If the appropriate signature cannot be obtained, only limited
types of information can be provided. If the former member is deceased, surviving next of kin may, under certain circumstances, be
entitled to greater access to a deceased veteran's records than a member of the general public. The next of kin may be any of the
following: unremarried surviving spouse, father, mother, son, daughter, sister, or brother. Requesters must provide proof of death,
such as a copy of a death certificate, letter from funeral home or obituary.
b. Fees for records: There is no charge for most services provided to service members or next of kin of deceased veterans. A
nominal fee is charged for certain types of service. In most instances service fees cannot be determined in advance. If your request
involves a service fee, you will be notified as soon as that determination is made.
3. Archival Records. Personnel records of military members who were discharged, retired, or died in service 62 or more years ago have
been transferred to the legal custody of NARA and are referred to as "archival" records.
a Release of Information: Archival records are open to the public. The Privacy Act of 1974 does not apply to archival records,
therefore, written authorization from the veteran or next of kin is not required. However, in order to protect the privacy of the
veteran, his/her family, and third parties named in the records, the personal privacy exemption of the Freedom of Information Act (5
U.S.C. 552 (b) (6)) may still apply and preclude the release of some information.
b. Fees for Archival Records: Access to archival records is granted by offering copies of the records for a fee (44 U.S.C. 2116 (c)).
You will be notified if there is a charge for photocopies of documents contained in the record you are requesting.
4. Where reply may be sent. The reply may be sent to the service member or any other address designated by the service member or other
authorized requester.
5. Definitions and abbreviations. DISCHARGED -- the individual has no current military status; SERVICE TREATMENT RECORD
(STR) -- The chronology of medical, mental health and dental care received by service members during the course of their military career
(does not include records of treatment while hospitalized); TDRL — Temporary Disability Retired List.
6. Service completed before World War I. National Archives Trust Fund (NATF) forms must be used to request these records. Obtain
the forms by e-mail from inquire @nara.gov or write to the Code 6 address on page 2 of the SF 180.
PRIVACY ACT OF 1974 COMPLIANCE INFORMATION
The following information is provided in accordance with 5 U.S.C. 552a(e)(3) and applies to this form. Authority for collection of the information
is 44 U.S.C. 2907, 3101, and 3103, and Public Law 104 -134 (April 26, 1996), as amended in title 31, section 7701. Disclosure of the information
is voluntary. If the requested information is not provided, it may delay servicing your inquiry because the facility servicing the service member's
record may not have all of the information needed to locate it. The purpose of the information on this form is to assist the facility servicing the
records (see the address list) in locating the correct military service record(s) or information to answer your inquiry. This form is then retained as a
record of disclosure. The form may also be disclosed to Department of Defense components, the Department of Veterans Affairs, the Department
of Homeland Security (DHS, U.S. Coast Guard), or the National Archives and Records Administration when the original custodian of the military
health and personnel records transfers all or part of those records to that agency. If the service member was a member of the National Guard, the
form may also be disclosed to the Adjutant General of the appropriate state, District of Columbia, or Puerto Rico, where he or she served.
PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT
Public burden reporting for this collection of information is estimated to be five minutes per request, including time for reviewing instructions and
completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of the collection of
information, including suggestions for reducing this burden, to National Archives and Records Administration (NHP), 8601 Adelphi Road,
College Park, MD 20740 -6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. SEND COMPLETED FORMS AS INDICATED
IN THE ADDRESS LIST ON PAGE 2 OF THE SF 180.
City of f 7°u ila
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
January 10, 2012
Caryl J. Mattson
Barghausen Consulting Engineers, Inc.
18215 72nd Avenue S
Kent, WA 98032
RE: Request for Application Extensions
Jacksons Store Number 631 —13138 Interurban Av S
Dear Ms. Mattson,
This letter is in response to your written request for extensions to Permit Application Numbers
D11 -285, D11 -286, D11 -287, M11 -118, PG11 -126, EL11 -0791, and EL11 -0792. The Building
Official has reviewed your letter and considered your request. It has been determined that the
City of Tukwila will extend the permit application expiration dates an additional 90 days,
through May 18, 2012.
If you should have any questions, please contact our office at (206) 431 -3670.
Sincerely,
File: Permit No. D11 -285 through 287
M11 -118, PG11 -126, EL11 -0791, and EL11 -0792
W:\Pennit Center\Extension Letters \Applications\2011'ELl 1 -0972 Application Extension.doc
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
Bill Rambo, Permit Technician
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite 100
Tukwila, Washington 98188
January 5, 2012
RE: Request for Extension of Application
Jacksons Store No. 631
13138 Interurban Avenue South, Tukwila, Washington
Our Job No. 14700
Dear Bill:
CIVIL ENGINEERING, LAND PLANNING, SURVEYING
In response to your letters dated January 3, 2012; and on behalf of PacWest Energy, LLC (d.b.a.
Jacksons Food Stores, Inc.), we respectfully request the maximum 90 -day extension of our permit
application starting from February 19, 2012 for the following permits:
1. D11 -285:
2. D11 -286:
3. D11 -287:
4. PG11 -126:
5. M11 -118:
6. EL11 -0791:
7. EL11 -0792:
Demolition Permit
Building Permit — Store
Building Permit — Canopy
Plumbing Permit — Project
Mechanical Permit — Store
Electrical Permit — Store
Electrical Permit — Canopy
We request the extension of these permits at this time to allow us to coordinate the financing and GC
selection. We expect the permits to be picked up well within this time frame.
Thank you for the notifications of the pending application expiration date. If you have any questions in
regard to this extension request, please contact me at 425.656.1063 or by email at
cmattson @barghausen.com.
CJM /ps
14700C.008
enc: As Noted
cc: Jack Davis, Jacksons Food Stores
Sincerely,
Caryl J. Mattson
Design Engineer
tA,
18215 72ND AVENUE SOUTH KENT, WA 98032 (425) 251 -6222 (425) 251 -8782 FAX
BRANCH OFFICES • OLYMPIA, WA • CONCORD, CA • TEMECULA, CA
www.barghausen.com
RECEIVED
env OF'TUKWIILA
hJAN :0.5 2012
PERMIT CENTER
01 -03 -2012
CARYL MATTSON
18215 72 AV S
KENT WA 98032
City of Tukwila
A
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
RE: Permit Application No. D11 -285
JACKSONS DEMOLITION
13138 INTERURBAN AV S TUKW
Dear Permit Applicant:
In reviewing our current application files, it appears that your permit applied for on 08/23/2011, has not been
issued by the City of Tukwila Permit Center. Per the International Building Code, International Mechanical Code,
Uniform Plumbing Code and /or National Electrical Code every permit application not issued within 180 days
from the date of application shall expire and become null and void. Your permit application will expire on
02/19/2012.
if you still plan to pursue your project, a written request for extension of your application must be submitted to the
Permit Center at least seven (7) days before it is due to expire. Address your extension request to the Building
Official and state your reason(s) for the need to extend your permit application. If it is determined that an
extension is granted, your application will be extended for an addtional 90 days from the expiration date and you
will be notified by mail.
In the event that we do not receive your written request for extension or request was denied, your permit
application will expire, become null and void and your project will require a new permit application, plans and
specifications, and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
Bill Rambo
Permit Technician
File: Permit File No. D11 -285
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
•
City of Tukwila
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
September 21, 2011
Caryl Mattson
Barghausen Consulting Engineers Inc
18215 72 Av S
Kent, WA 98032
RE: Correction Letter #1
Development Permit Application Number D11 -285
Jackson's Demolition —13138 Interurban Av S
Dear Ms. Mattson,
This letter is to inform you of corrections that must be addressed before your development permit can be
approved. All correction requests from each department must be addressed at the same time and
reflected on your drawings. I have enclosed comments from the Public Works Department. At this time
the Building, Fire and Planning Departments have no comments.
Public Works Department: Joanna Spencer at 206 431 -2440 if you have questions
regarding the attached comments.
Please address the attached comments in an itemized format with applicable revised plans,
specifications, and /or other documentation. The City requires that four (4) sets of revised plans,
specifications and /or other documentation be resubmitted with the appropriate revision block.
In order to better expedite your resubmittal, a `Revision Submittal Sheet' must accompany every
resubmittal. I have enclosed one for your convenience. Corrections /revisions must be made in person
and will not be accepted through the mail or by a messenger service.
If you have any questions, please contact me at (206) 431 -3670.
Sincerely,
c
Bill Rambo
Permit Technician
end
File No. DI1 -285
W:\Pemiit Center\Correction Letters \2011\D11 -285 Correction Letter #1.doc
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
•
PUBLIC WORKS DEPARTMENT COMMENTS
DATE: September 19, 2011
PROJECT: Jackson Demolition
13138 Interurban Ave S
PERMIT NO: D11 -285
PLAN REVIEWER: Contact Joanna Spencer (206) 431 -2440 if you have any questions regarding the
following comments.
1) Please submit copy of Asbestos Survey /Demolition approval from Puget Sound Clean Air
Agency.
2) Add note that the City shall be notified immediately if contaminated soil is encountered.
3) Verify if the property has a fire sprinkler system. If not please delete fire sprinkler
plugging/capping in note 7 on sheet CO3.
4) Sewer and storm drainage pipes shall be capped at the property lines since the property will be
redeveloped. I have attached old gas station plans for your use and reference. Please verify
utilities location, since these are not "As- Builts ". Show location of utility cappings.
W:Other/Joanna /D 11- 285.doc
�ERMIT CORD COPYr
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D11 -285 DATE: 10/1/11
PROJECT NAME: JACKSONS DEMOLITION
SITE ADDRESS: 13138 INTERURBAN AV S
Original Plan Submittal Response to Incomplete Letter #
X Response to Correction Letter # 1
Revision # after Permit Issued
DEPARTMENTS:
Building Division Fire Prevention
',unlit Works Structural
Planning Division
❑ Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 10/20/11
Complete 71..
Incomplete
Not Applicable
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
f . .
TUES/THURS ROUTING:
Please Route Structural Review Required No further Review Required ri
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 11/17/11
Approved Approved with Conditions Not Approved (attach comments) ❑
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center. Use Only .
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents /routing slip.doc
2 -28 -02
IWERMIT COORD COP'S
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: D11 -285 DATE: 08/23/11
PROJECT NAME: JACKSONS DEMOLITION
SITE ADDRESS: 13138 INTERURBAN AV S
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # after Permit Issued
D P TMENTS: o
ll
ng I ivisio �
W.
Fire Prevention
Structural
Planning Division
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete
Comments:
Incomplete
DUE DATE: 08/25/11
Not Applicable
n
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
REVIEWER'S INITIALS:
No further Review Required
DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions
Notation:
REVIEWER'S INITIALS:
DUE DATE: 09/22/11
Not Approved (attach comments) a
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections:
■
Bldg ❑
Fire ❑ Ping ❑ PW1Sr Staff Initials:
Documents /routing slip.doc
2 -28 -02
City of Tukwila
REVISION
SUBMITTAL
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Web site: http: / /www.TukwilaWA.gov
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: 10/17/2011 Plan Check/Permit Number: D11-285
Response to Incomplete Letter #
Response to Correction Letter # 1
Revision # after Permit is Issued
Revision requested by a City Building Inspector or Plans Examiner
Project Name: Jacksons Food Stores #631
Project Address: 13138 Interurban Avenue South, Tukwila, WA 98168
Contact Person: Ms. Caryl Mattson
Phone Number: (425) 656 -1063
Summary of Revision:
Public Works Responses:
1) A copy of the Asbestos Survey is attached, PSCAA approval is in process.
2) "Demolition Notes" have been added to sheet C3.0
3) The project does not currently have a fire sprinkler system; note 7 has been revised.
4) Refer to note 2. of the Demolition Notes added to sheet C3.0
Sheet Number(s): C3.0
R1r nC ThI.�
OCT 17 Z011
eERMIT CENTER
"Cloud" or highlight all areas of revision including date of revision
Received at the City of Tukwila Permit Center by: %'
L�(I Entered in Permits Plus on 1 1
H:Wpplications \Fors- Applications On Line \2010 Applications \7 -2010 - Revision Submittal.doc
Revised: May 2011
Contractors or Tradespeople Peer Friendly Page
a
General /Specialty Contractor
A business registered as a construction contractor with L &I to perform construction work within the scope of
its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name EVERGREEN ENVRNMENTAL SVCS INC UBI No. 601540547
Phone 4253553028 Status Active
Address 17108 9Th Ave Se License No. EVERGES061J5
Suite /Apt. License Type Construction Contractor
City Mill Creek Effective Date 4/25/1994
State WA Expiration Date 1/14/2014
Zip 98012 Suspend Date
County Snohomish Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
ther Associated Licenses
License
Name
Type
Specialty 1
Specialty
2
Effective
Date
Expiration
Date
Status
NORTHTE083MLTANK
NORTHWEST
/ENVIR
SVCS INC
Construction
Contractor
Tanks /Tank
Renovation
Demolition
7 /13/1992
4/5/1994
Archived
NORTHTT099JS
NORTHWEST
TANK TESTING
Construction
Contractor
Tanks /Tank
Renovation
Demolition
4/10/1991
4/5/1992
Archived
EVERGCS961N5
EVERGREEN
CRANE SERVICES
INC
Construction
Contractor
General
Unused
8/31/2004
8/31/2006
Out Of
Business
Business Owner Information
Name
Role
Effective Date
Expiration Date
HINES, JOHN
President
04/25/1994
Amount
Bond Information
Page 1 of 2
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
4
DEVELOPERS SURETY
Ft INDEM CO
856831C
12/15/2001
Until Cancelled
$12,000.00
01/14/2002
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
15
EVEREST
INDEMNITY INS
CO
EF4ML00098091
12/15/2008
12/15/2012
$2,000,000.0012
/14/2011
14
EVEREST
INDEMNITY INS
CO
4000007192071
12/15/2007
12/15/2008
$2,000,000.0012
/11/2007
13
HUDSON
SECIALTYINS
CO
FEC6110300
12/15/2006
12/15/2007
$2,000,000.0012
/14/2006
12
EVEREST
INDEMNITY INS
CO
40000016780
61
12/15/2005
12/15/2007
$2,000,000.0012
/04/2006
Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx
03/05/2012
10
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• :DEMQIITION:PLAN.: •
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-r-
EXISTING RETAINING CURB TO
REMAIN ALONG NORTHEAST
PROPERTY LINE; NEW EGRESS
WALK WILL BE FLUSH WITH TOP
PLANNING APPROVED •
No changes ban be made to these
plans without approval from the
Planning Division d DCD.
Approved By:,
Date:,
7
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LEGEND
EXISTING STORM DRAIN
EXISTING WATER LINE
EXISTING GAS LINE
EXISTING OVERHEAD POWER
SAWCUT LINE
CATCH BASIN PROTECTION
w
SD
FI.15 ifPifiso
Permit No. t"'
P1Rn review approval is subject to errors and omlaslons.
AT-3:3val of construction documents does not authothe
– – wtk 436A..ion of any adopted code or ordinance. Receipt
oV •
Lpproveci Fist conditions
TEMPORARY CONSTRUCTION FENCE
CLEARING LIMITS
SILT FENCE
P(OH)
X X X X
X X X
By
Dar
City Of Tukwila
BUILDING DIVISION
GENERAL DEMOLITION NOTES:
1. CONTRACTOR SHALL ASSURE THAT ALL NECESSARY PERMITS HAVE BEEN
OBTAINED PRIOR TO COMMENCING WORK, INCLUDING DEMOLITION AND ANY SEWER
CAPPING PERMITS. FIRE PROTECTION DEMOLITION PERMIT IF REQUIRED, IS ISSUED
BY FIRE DEPARTMENT. SEPARATE PERMITS ARE REQUIRED FOR EACH BUILDING AS
WELL AS SEPARATE SEWER CAPPING PERMIT
2. DISASSEMBLE AND REMOVE INTERIOR OPERATIONAL EQUIPMENT FOR SALVAGE
AS DIRECTED BY OWNER
3. DISMANTLE AND DEMOLISH BUILDING STRUCTURES. DEMOLITION DEBRIS AND
•MATERIALS TO BE STOCKPILED AND DISPOSED OF AT AN APPROVED SITE.
FOUNDATIONS. BELOW SLAB AND BELOW ADJACENT SURFACES WILL REMAIN.
REMOVE ALL STEM WALLS, ANCHOR BOLTS, ETC. TO LEAVE THE AREA FREE FR
ANY PROTRUSIONS (STRUCTURAL OR UTILITY).
4. ANY HAZARDOUS • SUBSTANCES AND/OR MATERIALS ENCOUNTERED SHALL BE
HANDLED AND DISPOSED OF BY QUALIFIED PERSONNEL ACCORDING TO COUNTY,
STATE AND. FEDERAL REGULATIONS.
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EXISTING OIL WATER
SEPARATOR & --BASIN TO
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arks have been reviewed by the Public
0 y Ls 0-epartment for conformance with current
4' s1/4) y standards. Acceptance is subject to errors and
,or
4z• .‘„„\ rnkOions which do not authorize violations of
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,,- ..ktYacrivted standards or ordinances. The responsibility
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designer. Additions, deletions or revisions to these
(-) ,. › drawings after this date will void this acceptance
„
' i resubmittal i
b '4, and will require a resubmttal of revised drawings
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FIRE
Final acceptance is subject to field inspection by
the Public Works utilities inspector.
Date: 13y:
I VeZ -
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EXISTING I.D. SIGN w
EASEMENT FROM CITY
SEATTLE-CITY LIGHT
DEPARTMENT
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REVISIONS
No changes shall be the to the scope
M of work without prior approval of
Tukwila Building Division.
NOT: Revisions will require a new plan submittal
and may include additional plan review fees.
5 ANY ENCOUNTERED UNDERGROUND TANKS, VAULTS, ETC., SHALL BE REMOVED
PER COUNTY/STATE REGULATIONS. CRAWL SPACES, TUNNELS, TANK HOLES, ETC.,
SHALL BE BACKFILLED AND COMPACTED PER SOILS ENGINEERS RECOMMENDATIONS.
6. DISCONNECT ALL POWER, TELEPHONE, GAS FROM BLDG. CONTRACTOR SHALL
CONTACT AND COORDINATE WITH THE FIELD ENGINEER AND ANY APPROPRIATE
UTILITY COMPANIES ON REQUESTING DISCONNECTION'S, REMOVALS AND/OR
RELOCATION OF EXISTING SERVICE. CONTRACTOR SHALL COORDINATE WITH THE
OWNERS ENGINEER, AND APPROPRIATE UTILITY PURVEYORS TO VERIFY SERVICE
LOCATIONS. TO EXISTING BUILDING. CONTRACTOR IS CAUTIONED THAT PERIMETER
UTILITIES OUTSIDE OF THE BUILDING ARE TO REMAIN OPERATIONAL. THE
CONTRACTOR. WILL BE SOLELY RESPONSIBLE FOR ANY DAMAGES AS A RESULT OF
A DISRUPTION OF UTILITY SERVICE ASSOCIATED WITH AND/OR DUE TO HIS
ACTIVITIES.
7. CONTRACTOR SHALL CONFIRM AND VERIFY WORK SCOPE ITEMS AND BUILDING
UTILITY SERVICES TO DEMOLISH WITH THE OWNERS AUTHORIZED REPRESENTATIVE.
DEMOLITION SCHEDULE
EXISTING BUILDING TO BE DEMOLISHED AND
DISPOSE OF. OFFSITE.
EXISTING. BUILDING & CANOPY OVERHANG TO BE
DEMOLISHED AND DISPOSE OF OFFSITE.
REMOVE EXISTING SIGN. FOUNDATION TO
GRADE AND 'DISPOSE OF OFFSITE
EXISTING 1 -INCH WATER METER TO REMAIN
REMOVE EXISTING CONCRETE SIDEWALK AND
DISPOSE OF OFFSITE
DEMOLISH EXISTING CONCRETE CURB AND
DISPOSE OF OFFSITE
REMOVE EXISTING SHED AND DISPOSE OF
OFFSITE
0, REMOVE EXISTING CONCRETE PAD AND
DISPOSE OF OFFSITE
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PRIOR TO COMMENCING WITH
DEMOLITION
A "pre-demo inspection" is required.
Contractors shall provide documentation that
an "asbestos survey" has been completed. If
needed, abatement procedures per "Puget
Sound Clean Air Agency" shall be completed
and documentation of compliance shall be
provided at time of final inspection.
REMOVE EXISTING ASPHALT AND DISPOSE
OF OFFSITE
O EXISTING MONITOR WELL TO BE ABANDONED AND OR
REMOVED PER D.O.E. STDS. A LICENSED DRILL
CONTRACTOR TO APPLY FOR N.0.1. W/D.O.E. TO
DECOMMISSION WELL AND SUBMIT PROOF OF
COMPLETED ABANDONMENT PRIOR TO
OCCUPANCY/PERMIT FINAL
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DEMOLITION NOTES
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1. NOTIFY CITY -lerb?-UKWILA AND ENGINEER IMMEDIATELY IF CONTAMINATED SOILS ARE
ENCOUNTERED.
2. ALL SEWER AND STORM PIPES SHOWN TO BE ABANDONED OR REMOVED SHALL BE
CAPPED AT THE PROPERTY BOUNDARY.
EXISTING MONITORING WELL TO REMAIN
AND BE PROTECTED.
12 REMOVE EXISTING CONCRETE HANDICAP
RAMP AND DISPOSE OF OFFSITE
SEE SHEET Cal FOR EROSION
AND SEDIMENTATION CONTROL
MEASURES
SPECIAL NOTE:
ALL CONSTRUCTION SHALL CONFORM TO THE CITY OF
TUKWILA STANDARD SPECIFICATIONS.
GRIND AND REMOVE EXISTING PARKING
STRIPING
SEPARATE PERMIT
REQUIRED FOR:
ethanical
riffIectrical
irhumbing
(Was Piping
City of Tukwila
StALDNG DIVISION
REMOVE EXISTING BOLLARDS AND DISPOSE
OF OFFSITE
REMOVE EXISTING SEWER RV DUMP
STATION AND DISPOSE OF OFFSITE.
REMOVE EXISTING CONCRETE DISPENSER
ISLANDS, DISPENSERS & CANOPY COLUMNS
AND DISPOSE OF OFFSITE
REVIEWED FOR
CODE COMPLIANCE
APPROVED
OCT 28 2011
City of Tukwila
BUILDING DIVISION
REMOVE EXISTING HORIZONTAL PROPANE TANK
AND APPURTENANCES AND DISPOSE OF OFFSITE.
REMOVE EXISTING LOT LIGHT AND
APPURTENANCES AND DISPOSE OF OFFSITE.
EXISTING AIR/WATER UNIT W/BOLLARDS TO
REMAIN AND BE PROTECTED.
REMOVE EXISTING OIL WATER SEPARATOR AND
APPURTENANCES AND DISPOSE OF OFFSITE.
EXISTING VAULT TO REMAIN AND BE
PROTECTED. ADJUST RIM TO NEW GRADE.
RECEIVED
CITY OF TUKVVILA
OCT 1 7 2011
PERMIT CENTER
CORRECTION
LTR#. 1
•RECEIVED
OCT. 202011
TUKWILA
PUBLIC WORKS
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CALL BEFORE YOU DIG:
1-800-424-5555
UTILITY CONFLICT NOTE:
THE CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION, DIMENSION, AND DEPTH
OF ALL EXISTING UTILITIES WHETHER SHOWN ON THESE PLANS OR NOT BY POTHOLING THE
UTILITIES AND SURVEYING THE HORIZONTAL AND VERTICAL LOCATION PRIOR TO CONSTRUCTION.
THIS SHALL INCLUDE CALLING UTILITY LOCATE @ 1-800-424-5555 AND THEN POTHOLING
ALL OF THE EXISTING UTILITIES AT LOCATIONS OF NEW UTILITY CROSSINGS TO PHYSICALLY
VERIFY WHETHER OR NOT CONFLICTS EXIST. LOCATIONS OF SAID UTILITIES AS SHOWN ON THESE
PLANS ARE BASED UPON THE UNVERIFIED PUBLIC INFORMATION AND ARE SUBJECT TO VARIATION.
IF CONFLICTS SHOULD OCCUR, THE CONTRACTOR SHALL CONSULT BARGHAUSEN
CONSULTING ENGINEERS, INC. TO RESOLVE ALL -PROBLEMS PRIOR TO PROCEEDING WITH
CONSTRUCTION.
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