HomeMy WebLinkAboutPermit MI02-142 - HAGGARD RESIDENCE - DEMOLITIONHAGGARD RESIDENCE
DEMOLITION
11540 EAST MARGINAL
WAY S
EXPIRED
MI02 -142
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 0733000005
Address:
Suite No:
MISCELLANEOUS PERMIT
Permit Number: MI02 -142
Issue Date: 12/27/2002
Permit Expires On: 06/25/2003
Tenant:
Name: HAGGARD RESIDENCE
Address: 11540 EAST MARGINAL WY S, TUKWILA WA
Owner:
Name: HAGGARD WILLIAM J
Address: 11532 40TH AV S, SEATTLE WA 98158
Contact Person:
Name: BILL HAGGARD
Address: 11532 40 AV S, TUKWILA WA
Contractor:
Name: OWNER AFFIDAVIT ON FILE
Address: ,
Contractor License No:
Phone:
Phone: 206 - 910 -0957
Phone:
Expiration Date:
DESCRIPTION OF WORK:
DEMOLISH EXISTING 1,140 SQ FT SINGLE FAMILY RESIDENCE. CAP WATER & REMOVE SEPTIC, IF EXISTING.
EROSION PREVENTION AND SEDIMENT CONTROL.
Value of Construction:
Type of Fire Protection:
Type of Construction:
$2,000.00
Fees Collected: $76.50
Uniform Building Code Edition: 1997
Occupancy per UBC: 0007
Public Works Activities:
Curb Cut/Access /Sidewalk/CSS: N
Fire Loop Hydrant: N Number: 0 Size (Inches): 0
Flood Control Zone: N
Hauling: Y 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
Water Main Extension: N Private: Public:
Water Meter:
Channelization / Striping:
** Continued Next Page **
City of'tikwila
•
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Permit Center Authorized Signature:
Date: / 2- d'71-7i
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 w. h, whether specified herein or not.
The granting of
regulating c
Signatur
Print Name:
permit d
ion
not i resume to
rform nce o
authority to viol
I am authorized
e or cancel the provisions of any other state or local laws
sign and obtain this mechanical permit.
Date:
This permit shall become null and void :7' ork 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.
City of tkwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 0733000005
Address:
Suite No:
Tenant: HAGGARD RESIDENCE
PERMIT CONDITIONS
Permit Number: M102 -142
Status: ISSUED
Applied Date: 09/03/2002
Issue Date: 12/27/2002
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division.
3: All permits, inspection records, and approved plans shall be available at the job site prior to the start of any
construction. These documents are to be maintained and available until final inspection approval is granted.
4: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997
Edition) as amended, Uniform Mechanical Code (1997 Edition), and Washington State Energy Code (1997 Edition).
5: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations shall not be
construed to be a permit for, or an approval of, any violation of any of the provisions of the building code or of any
other ordinance of the jurisdiction. No permit presuming to give authority to violate or cancel the provisions of this
code shall be valid.
6: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * **
7: Contractor shall notify Public Works Utility Inspector Mr. Greg Villanueva at (206)433 -0179 of commencement and
completion of work at least 24 hours in advance.
8: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation
off -site or into existing drainage facilities.
9: 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.
10: Any material spilled onto any street shall be cleaned up immediately.
11: Any septic tanks in the area shall be pumped empty and removed or filled with sand. A copy of the documentation from
the business that performed the pumping shall be provided to the City Utilities Inspector.
12: Water utility shall be plugged at the main if it is to be abandoned. If it will be used again in the near future for a
new building, it shall be capped at the water meter.
13: Work affecting traffic flows shall be closely coordinated with the City Utilities Inspector. Traffic Control Plans
shall be submitted to the Inspector for prior approval.
14: A copy of the Certificate of Insurance Coverage (minimum of $1,000,000 naming the City of Tukwila as additionally
insured).
15: A $2,000 bond made out to the City of Tukwila for possible property damages caused by activities.
16: A map which shows the haul route.
17: Permit is valid between the weekday hours of 7:00 a.m. and 3:30 p.m. only.
18: Flagging, signing and coning shall be in accordance with MUTCD for Traffic Control. Contractor shall provide certified
flagmen for traffic control. Sweep or otherwise clean streets to the satisfaction of Public Works each night around
hauling route (No flushing allowed). Notify City Inspector before 12:00 Noon on Friday preceding any weekend work.
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 s.ecified herein or not.
The granting of thi
regulating const
it does t resume to , - authority to vi • .te or cancel the provision of any other work or local laws
or t = 'ror nce of
Signatur // , �� Date:
r A /
CITY OF UKWILA
Permit Centf:,
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
,:FOR STAFF USE ONLY
Project Number:
Permit Number:
-
Miscellaneous Permit Application
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
Project Name/Tenant: z ro , ` n thu 5�
Description of work to be done (please be specific): rj
.
%Y) i`it) r`3rai, » r a' re- -- re m o VC Om }'fro?e C
(/- Muu JG
Value of Construction: tom
Site Address : / 4
l /SzID5� /I��i� G�'G 1 ~%wf1�
city �Stat Y
Tax Parcel arccelumber:
`jDbD0�5
Property Owner: /1 /
y / r/ -� /-{a ����
5
Phone: (z,�/ ) 2 /( 1 �i i
Street Address:
v -17)
City St to /Zip:
Fax #: ( )
e ..--20 . x-60 i t..
Contractor:
0 Metro
0 Standby
Phone: ( )
Street Address:
City State/Zip:
Fax #: ( )
Architect:
Phone: ( )
Street Address:
City State/Zip:
Fax #: (
Engineer:
Phone: ( )
Street Address:
City State /Zip:
Fax #: ( )
Contact Person:13i J/
i7L6 j, n i4
Phone: (i7) )9/0 0.757
Street Address %/5, z
, /O Aye
City State/Zip:
q
Fax #: ( )
MISCELLANEOUS PERMIT ;REVIEW AND'APPROVAL- REQUESTED: (TO BE FILLED OUT BY APPLICANT)
Description of work to be done (please be specific): rj
.
%Y) i`it) r`3rai, » r a' re- -- re m o VC Om }'fro?e C
(/- Muu JG
Will there be storage of flammable/combustible hazardous material in the building? ❑ yes ® no
Attach list of materials and stora e location on separate 8 1/2 X 11 aper indicating quantities & Material Safety Data Sheets
❑ Above Ground Tanks Antennas /Satellite Dishes Bulkhead /Docks ❑ Commercial Reroof
® Demolition ❑ Fence ❑ Manufactured Housing - Replacement only
❑ Parking Lots ❑ Retaining Walls ❑ Temporary Facilities ❑ Tree Cutting
APPLICANT, REQUEST.FOR:M ISCELLANEOUS.PUBLIC WORKS'PERMITS
❑ Channelization /Striping
❑ Flood Control Zone
❑ Landscape Irrigation
❑ Storm Drainage
❑ Water Meter /Exempt #
❑ Water Meter /Permanent #
❑ Water Meter Temp #
❑ Miscellaneous
❑ Curb cut/Access /Sidewalk ❑Fire Loop /Hydrant (main to vault) #: Size(s):
❑ Land Altering: 0 Cut_ cubic yards 0 Fill_ cubic yards 0 sq. ft.grading/clearing
❑ Sanitary Side Sewer #: El Sewer Main Extension 0 Private 0 Public
❑ Street Use ❑ Water Main Extension 0 Private
Size(s):
Size(s):
Size(s): Est. quantity: gal Schedule:
CRAtioving Oversized Load /Hauling
0 Deduct
O Public
O Water Only
MONTHLY SERVICE BILLINGS TO:
Name:
Phone:
Address:
City /State /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER;.METER:'DEIOSI T /REFUND ,BILLING:..
Name:
Phone:
Address:
City /State /Zip:
Value of Construction - In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed
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
building official may extend the time for action by the applicant fora period not exceeding 180 days upon written request by the
in Section 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once.
Date application accepted:
and is subject to
by limitation. The
applicant as defined
Date application expires:
Appli
n to en by: (initials)
ALL MISCELLANEOUS PER '7,APPLICATIO NS MUST BE SUBMITT VITH ,M FOLLOWING:
• ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
• BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
• ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
• STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED
STRUCTURAL ENGINEER
i CIVIUSITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER (P.E.)
❑ Current copy of Washington State Department of Labor and Industries Valid Contractor's License. If not
available at the time of application, a copy of this license will be required before the permit is issued, unless the
homeowner will be the builder OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ".
Building.Owner /AuthorizedAgent; If the applicant is other thn 'the owner, registered architect/engineer, or contractor
licensed by the State of Washington, a notarized letter: from the property owner authorizing the agent to submit this
permit application and obtain the-permit will be required as part of this submittal.
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS F THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING. NEB!
SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR
Above Ground Tanks /Water Tanks - Supported'directly upon grade
exceeding 5,000 gallons and a ratio of height to diameter or width which.
exceeds 2:1
PERMIT REVIEW
Submit checklist No: M =9
❑
Antennas /Satellite Dishes
Submit checklist. No M'1 '
0
"'Bulkhead /Dock;
Submit checklist; No M =10'
0
,Commercial Reroof:,.
Submit checklist: No M =6
O
Demolition
Submit checklist , . No M=3 •; "; .'
❑
Fences - Over 6, feet in Height'
Submit!checklist No M -9
a
Land Altering /Grading/Preloads
Submit checklist No : M -2
O
Miscellaneous Public' Works Permits
Submit checklist. No H-9
Manufactured Housing(RED',INSIGNIA ONLY)
Submit checklist . No .M -5
❑
Moving Oversized' Load /Hauling
Submit checklist :No: M -5
❑
:Parking Lots 'i.i, ;
Submit checklist No: M -4
❑
'Retaining ,Walls ° - Over 4'feet in height
Submit checklist No M,1
❑
Temporary Facilities'
Submit checklist No M -7
❑
Tree Cutting
Submit checklist No: M -2
❑ Current copy of Washington State Department of Labor and Industries Valid Contractor's License. If not
available at the time of application, a copy of this license will be required before the permit is issued, unless the
homeowner will be the builder OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ".
Building.Owner /AuthorizedAgent; If the applicant is other thn 'the owner, registered architect/engineer, or contractor
licensed by the State of Washington, a notarized letter: from the property owner authorizing the agent to submit this
permit application and obtain the-permit will be required as part of this submittal.
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS F THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING. NEB!
TH ZED • GENT:
Date: 7./3 O —2_
/ J r
Fax Fax #: ( )
Signatures %/
i
/e
�f
Print name: °
;mil
11/i/J i
Phone: (20( )
r�
Address: /S ?2_
[ _Lf% ,/J//0r
City /St �gC & /,,
City of'tikwila
•
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 0733000005
Address:
Suite No:
Applicant: HAGGARD RESIDENCE
RECEIPT
Permit Number: MI02 -142
Status: APPROVED
Applied Date: 09/03/2002
Issue Date:
Receipt No.: R020001798 Payment Amount: 76.50
Initials: KAS Payment Date: 12/27/2002 11:32 AM
User ID: 1684 Balance: $0.00
Payee: HAGGARD
TRANSACTION LIST:
Amount
Type Method Description
Payment Check 5743 76.50
ACCOUNT ITEM LIST:
Description Account Code
Current Pmts
BUILDING - NONRES
INSP FEE - UTILITY
PLAN CHECK - UTILITY
STATE BUILDING SURCHARGE
000/322.100
000/342.400
000/345.830
000/386.904
47.00
15.00
10.00
4.50
Total: 76.50
r, rws ry[ C'I
)C
1
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
INSPECTION RECORD
Retain a copy with permit
112' 11-1Z
PERMIT NO.
ProjtPCOU A
Type of Inspection: P t 1 4� r
W ` tom,
Address:
s (O(�,Ff
w7(
Date Called:
NA"-:
Special Instructions:
JJ QRA
U
Date Wanted:
a.m.
p.m.
Requester:
Phone No:
ElApproved per applicable codes.
ElCorrections required prior to approval.
COMMENTS:
JNti�
1 I/ I,*
I 1 J) t
IV I
1
(c
1_
(itAiJ (p-LtA
Inspector:
Date: 111017
El $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
Mtioi, —I42
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Proje t' G
04
Type of Inspection:
Q li L�
Address: '
Date Called:
Special Instructions:
UUUUUU
Date Wanted:
a.m.
P.m.
Requester:
Phone No:
Approved per applicable codes. ❑ Corrections required prior to approval.
COMMENTS:
IJb
�zSC
c�sv.c
5 -11;),„ l i A,..--
G
Iii
cia,0 f A-0-f`l►4
540,,a
" (-64,- is,--ei . N/A
Inspector:
t9V
Date:
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. CaII to schedule reinspection.
FILE C
anderstand!that the Plan
abject to erlors and omissi
ans does npt authorize the
dopted code or ordinan
actor's copy of a • proved
By
Date
Permit Nip:
PY
eck appro
ns and a
violatio
•
•
s'rr G 1-[ou9
RECEIVED
c, :s . -99-2-4F SEP 0 5 2002
PUBLIC W RKS
404
co it.
cflao&L,f.•
1
eve
R ��.r
Ct���F��VED
its.? 13
VeSt
RECEIVED
CITY OF TUKWILA
SEP 0 3 2002
PERMIT CENTER --
-These plans hair
Works Departme
City standards. A
omissions which . F
adopted standards {Fir or
for the adequacy q; the
been
t for
cept
not
d
viewed 'by th
�nformance '
e is subject
thorize vio
ances. Th
ign rest
the c
o eirro
lions- of
respoxi ib
totally wi
designer. Additions, eletioi s or revisions to th
drawings after this will void this acceptance
and - re -a • bmittai '-of revised
for subsequent ,app
Final acceptance is s bject to fief
the Public Works u ?'ties ins
1 Date:
1)(2
DRi (s)v4'(
loy8'�`a8�
,4,�6.i4.3o4+ 6 8 0
2-E' 869.
406031799
LOT28
O
1 q10 oq
• p
143-
s3- 312 t1 q .ZOO
• V :J MAC 7:0 M 72:9 /_ , o �, "a1'1_,_\,‘..;:',1.
\`
.�f7, ~OiY. .` AC r •Z& Sv/�7' —_ ..� V ds)••y -�•••E �7! :L''y \
.___:.
t: ,40 y,Z_ FLOC =— ^� i „c►�Op�"�r � • • • oD 4niF. l/lGtl�i S 7' r "e :.�, i ,`�'�: ~J •c. •
',� l , y000Q
DUW/\j\ijJ H
e ^Xsa 8 s
81.- 53,
l47%ax.... oc.
WWI E
OCt 2 3 2007
;' 41 829. 2. 2
0
tiN
I--
9103 e4
90i. g3
8 r — o
KCSP 386043
4 87.02121114
d
U Lo r /. 47,/8 qc•
�•O /GO o
3o' ?Yr. Ro. Esry7
1 14TH.
P9S JBd•o / -oos
•- 2.Zd 47.48 Si A �i
W 75 -„,¢ _ t7o
_ 38
1.7.0.6 A�
V
c4
w
w on `. •
0
o
g
o.
.3.I
co
4:1- L 0 T 3 G 1
,I p
0
i • P
-,4O o 38p °.j4.•
0,7 s
7" 90.36
tot. •16
114 •
o '7
;ooh.
•
o' o
z3.
s0
• I�o10
r ' •7 L1 T �o
t {-7"!-r7•r— — 5
A
fr I
•8)
I• q I 7'+''•
5°'°' D
9 0',,5 905°° 01 1
00 70 5
12'8 /.i?8
rc?o�h •KC
.� es P8/: ff -00 Par. 6 •
\.
5° •
1 -'"
jo � Y
5 10.4%1'
;iL •
OCT 23 2007
RECEIVED
CITY OF TUKWILA
SEP 0 3 2002
PERMIT CENTER
RECEIVED
SEP 0 5 2002
TUKWILA,
•
ASBESTO m TEST
BULK ANALYSIS
8003 156th St SE • Snohomish, WA 98290
(425) 489-4040
Seattle: (425) 523-5117
Pager: (425) 996-6128
"GOOD FAITH" ASBESTOS SURVEY
brown structure ii 11540 E. Marginal Way
Seattle, WA 98168
Page 1 of 4
IN #210828
August 22, 2001
Bill Haggard
11532 40th Ave. S.
Seattle, WA 98168
Ph: 206- 910-0957
RECEIVED
CITY OF TUKWILA
SEP 0 3 2002
PERMIT CENTER
Note to PSCAA: This is an old wooded structure. There is no heating system. There are no vinyl or
tile flooring materials. The roofing, window glazing, and drywall/taping materials were sampled.
There was no asbestos detected in any of the samples taken. If there is any additional located suspect
ACM prior to or during demolition (such as, but not limited to, those materials listed on page 4), that
was not discovered in this survey, the material(s) must be PACM unless tested otherwise by laboratory
analysis.
INTRODUCTION
On August 21, 2001, Asbesto -Test personnel conducted a "good faith" asbestos survey (per
U.S.E.P.A. /A.H.E.RA. guidelines as designated and specified by Puget Sound Clean Air
Agency and Washington State) of the brown structure na 11540 E. Marginal Way, Seattle,
lane 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 of the
structure.
NARRATIVE OF FINDINGS
BASIC CONSTRUCTION (including siding and roofing types) The one story structure is
wood frame on a post and beam foundation. The exterior siding is wood. There was no suspect
ACM located beneath the wood siding exterior. The flat tar roofing was sampled.
ATTIC /WALL INSULATION: There was no relating suspect ACM located.
PLUMBING SYSTEM: There was no relating suspect ACM located.
CONTINUE TO PAGE 2
• •
Page 2 of 4 August 22, 2001
IN#210828 Asbesto -Test, Inc. (425) 489 -4040
brown structure (a, 11540 E. Marginal Way. Seattle, King County, Washington 98168
*INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior is
drywall and wood. The drywall and taping materials were uniformly sampled. There were no
vinyl or tile flooring materials located inside the structure. All of the floors are wood.
ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM and
was not 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.
HEATING AND VENTILATION SYSTEM: There is no heating system inside. The heating
stoves have been removed. There was no visible suspect ACM TSI located associated with any
heating system. Note: It was not possible to dismantle the furnace and ducting 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 furnace /ducting
system 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..
Misc.: The window glazing was sampled.
ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None.
# of structures included in survey: one
Requested by: Bill Haggard
red Schneider
Inspector, certified A.H.E.R.A.
accred.#996405 (Expires 11 /01 /01)
CONTINUE TO PAGE 3
• •
Page 3 of 4 August 22, 2001
IN #210828 Asbesto-Test, Inc. (425) 489-4040
brown structure (a,11540 E. Marginal Way. Seattle. Kinz County. Washinntgn 98168
THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN
ANALYSIS ID ASBESTOS//TYPE/ /OUANTITY OTHER MATERIAL
1.0) drywall NAD
1.1) drywall taping compounds NAD
SAMPLER PER AHERA PROTOCOL
2.0) composition roofing
over front entry
3.0) fiat tar roofing
over main structure
4.0) window glazing
NAD
NAD cellulose, tar, fiberglass,
non - fibrous materials
NAD non - fibrous materials,
cellulose
non - fibrous materials,
cellulose, fiberglass,
Paint, (gypsum)
non - fibrous materials,
cellulose, fiberglass
cellulose, tar, fiberglass,
non - fibrous materials
continue to page 4
Page 4 of 4 August 22, 2001
IN#210828 Asbesto-Test, Inc (425) 489.4040
frown structure (a 11540 E. Maruinal Way. Seattle, Sing County. Washington 98168
Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of
homogenous materials, as prescribed by A.H. E. R.A. protocol.
Samples taken are listed with their corresponding analyses. !f 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 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 ACM material (i.e. square or linear
foot, etc.), or by on site assessment.
Any and all materials identified as ACM in this report must be abated prior to ACM disturbance,
renovation, or demolition. All materials identified as ACM must be professionally abated by a licensed
asbestos abatement contractor prior to any disturbance.
analytical test method: USEPA 600/R93 /116'• (PLM)
' ACM signifies "Asbestos Containing Material"
PACM signifies "Presumed Asbestos Containing Material"
CAB signifies "Concrete Asbestos Board"
< signifies "less than"
TSI 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 or TEM, to insure analytical accuracy when reported in small percentages.
Asbesto -Test, Inc. claims responsibility for sample content only.
111 '('eider
cal Chemist, B.Sc.
proficient
END OF REPORT
(Irk EMT
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: M102 -142 DATE: 09 -03 -02
PROJECT NAME: BROWN HOUSE -v DEMO
SITE ADDRESS: 11540 EAST MARGINAL WAY
X Original Plan Submittal
Response' to Correction Letter
Response to Incomplete Letter #
Revision #' After Permit Is Issued':
DEPARTMENTS:
X, 66 -4-�D2
Builc i gn Diviis on e
Public Works
T34111/1 ALOCA-l2 -OL
51z niti q-5�
Fire Prevention
Structural
c.P_ P4 61-S-o2.
Planning Division
Permit Coordinator
ffr
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete Er.
Comments:
Incomplete ❑
DUE DATE: 09-05-02
Not Applicable ❑
Permit Center Use Only
INCOMPLETE LETTER MAILED:
LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: 'Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:''
TUES/THURS ROUT G:
Please Route Structural Review Required p No further Review Required
REVIEWER'S INITIALS:
DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions
Notation:
DUE DATE: 10-03-02
Not Approved (attach comments) ❑
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only
CORRECTION LETTER' MAILED:
Departments issued corrections:
Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
PERMIT COORD COPY
CITY OF T•WILA
Permit Center
6300 Southcenter Boulevard, Suite 100, Tukwila, WA 98188
Telephone: (206) 431 -3670
r
•
H -4
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON
ss.
COUNTY OF KING
/7 fIQttJ ` , states as follows:
1. I have made application for a building permit from the City of Tukwila, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code Washington, a copy of which is printed on the reverse side of this Affidavit. I have
read or am familiar with RCW 18.27.090.
3. I understand that prior to issuance of a building permit for work which is to be done by any
contractor, the City of Tukwila must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Tukwila of my compliance with this requirement, I hereby
attest that after reading the exemptions from the registration requirement of RCW 18.27.090,
consider the work authorized under this building permit to be exempt under No. 1 2- , and
will therefore not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might o ,'rwise have u • er state la
engage an unregistered contractor to perform construction
A" LICANT
\Ge. A. DE9...,
�= �. \StON /- It, � Signed and sworn to before me this
„ NO y m. �; 27th day of December
i PUBLIC •
`��.,,,,,,,.,.,,, NOTARY PUBLIC in and f r the State of Washington,
residing at Kir)9 County.
Name as commissioned: Alice A. Deacy
My commission expires: 6'l6 -04
,20 02 .
1 ti.L/.UyU exemptions. i nis chapter snail not appiy to:
1. An authorized representative of the nited States
Government, the State of Washington, or any
incorporated city, town, county, township, irrigation
district, reclamation district, or other municipal or
political corporation or subdivision of this state;
2. Officers of a court when they are acting within the
scope of their office;
3. Public utilities operating under the regulations of the
utilities and transportation commission in
construction, maintenance, or development work
incidental to their own business;
4. Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground
mine or mineral deposit when performed by an owner
or lessee;
5. The sale or installation of any finished products,
materials, or articles of merchandise which are not
actually fabricated into and do not become a
permanent fixed part of a structure;
6. Any construction, alteration, improvement, or repair
of personal property, except this chapter shall apply
to all mobile /manufactured housing. A
mobile /manufactured home may be installed, set up,
or repaired by the registered or legal owner, by a
contractor licensed under this chapter, or by a
mobile /manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW;
7. Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any site
or reservation under the legal jurisdiction of the
federal government;
8. Any person who only furnished materials, supplies, or
equipment without fabricating them into, or
consuming them in the performance of, the work of
the contractor;
9. Any work or operation on one undertaking or project
by one or more contracts, the aggregate contract
price of which for labor and materials and all other
items is Tess than $500, such work, or operations
being considered as of a casual, minor, or
inconsequential nature. The exemption prescribed in
this subsection does not apply in any instance
wherein the work or construction is only a part of a
larger or major operation, whether undertaken by the
same or a different contractor, or in which a division
of the operan n is made into contracts of amounts
less than $500 for the purpose of evasion of this
chapter or otherwise. The exemption prescribed in
this subsection does not apply to a person who
advertises or puts out any sign or card or other
device which might indicate to the public that he is a
contractor, or that he is qualified to engage in the
business of contractor;
10. Any construction or operation incidental to the
construction and repair of irrigation and drainage
ditches of regularly constituted irrigation districts or
reclamation districts; or to farming, dairying,
agriculture, viticulture, horticulture, or stock or poultry
raising; or to clearing or other work upon land in rural
districts for fire prevention purposes; except when
any of the above work is performed by a registered
contractor;
11. An owner who contracts for a project with a
registered contractor;
12. Any person working on his own property, whether
occupied by him or not, and any person working on
his residence, whether owned by him or not but this
exemption shall not apply to any person otherwise
covered by this chapter who constructs an
improvement on his own property with the intention
and for the purpose of selling the improved property;
13. Owners of commercial properties who use their own
employees to do maintenance, repair, and alteration
work in or upon their own properties;
14. A licensed architect or civil or professional engineer
acting solely in his professional capacity, an
electrician licensed under the laws of the state of
Washington, or a plumber licensed under the laws of
the state of Washington while operating within the
boundaries of such political subdivision. The
exemption provided in this subsection is applicable
only when the licensee,. is operating within the scope
of his license; :' ; ; ; -
15. Any person who engages in`•the activities herein
regulated asan employee, of a registered contractor
with wages as his.solWcompensation;
16. Contractors on highway projects who have been
prequalified as required by chapter 13 of the Laws of
1961, RCW 47.28.070 with the department of
transportation to perform highway construction,
reconstruction, or maintenance work.