Loading...
HomeMy WebLinkAboutPermit MI2000-106 - KALCHIK RESIDENCE - DEMOLITIONCity of Tukwila (206) 431 -3670 Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188 MISCELLANEOUS PERMIT WARNING: IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRE_, APPLICANT IS PROCEEDING AT THEIR OWN RISK. Parcel No: 725520 -0215 Address: 14261 53 AV S Suite No: Location: Category: DEMO Type: MISCPERM Zoning: LDR Const Type: Gas /Elec.: Units: 001 Setbacks: North: Water: N/A Wetlands: Contractor License No .0 South: Sewer: N/A Slopes: Y Permit No: Status: Issued: Expires: MI2000 -106 ISSUED 06/02/2000 11 /29/2000 Occupancy: DWELLING U8C: 1997 Fire Protection: East: .0 West: .0 OCCUPANT STANISLAV KALCHIK 14261 53 AV S, TUKWILA, WA 98168 OWNER KALCHIK STANISLAV & LYUDMILA 14261 53RD AVE S, TUKWILA WA 981684423 CONTACT LYUOMILA KALCHIK 14430 58 AV S, TUKWILA WA 98168 * kkkk* kkk* kkk* k* kkk* kkk kk. tAkk *kkkkk *kkkk *kkk*k*kkkkkkkk kkkkkkkkkkk * * *kk *kk *kk*kkkkk Permit Description: DEMOLISH EXISTING RESIDENCE - DUE TO FIRE. * Ak, A• k* k- k*** A*•* kA*** Ot* kkk•#- kkk*A* kkkkk* kk, kkk** k* k* hkkkk* kkk •k•k *k*kk*kk4*k4kkk*4 *k*hAk.4* Construction Valuation: S 15,000.00 PUBLIC WORKS PERMITS: k(Water Meter Permits Listed Separate) Eng. Appr: Curb Cut /Access /Sidewalk /CSS: N Fire Loop Hydrant: N No: Size(in): .00 Flood Control Zone: N Hauling: N Start Time: End Time: Land Altering: N Cut: Fill: Landscape Irrigation: N Moving Oversized Load: N Start Time: End Time: Sanitary Side Sewer: N No: Sewer Main Extension: N Private: Storm Drainage: N Street Use: N Water Main Extension: N Private: Public: kkk******* kkkkk k*** Akk 4Akk *4kkwkkAk**4AkkAk*kAkkkAkAkkA* 4AkkkAAAAAk4kl *AA *Akkkkkkk TOTAL DEVELOPMENT PERMIT FEE=: $ .1.50 444 * 4444* 444* 4444* 44444k4444444444 4444 4AAk444444AAk4444444444AAA4444k4444444444 444 Streams: 1 Phone: Phone: 206 243 -8004 Phone: 206-234-7004 Public:: Permit Center Authorized Signature :_ ` Y Date :ul"2.— a!_ 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 provision of any other state or local laws regulating construction or the performance of work. I am authorized to sign for and obtain this development permit. Signature:--- 44215.1.= ____ fir....*''` Print Name :.. irdzi l L N ` / 'ACe;E44.,. _ _ _ ........ 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 i$ suspended or abandoned for a period of 180 days from the last inspection. Date d' c CITY 'OF TUKWILA dress : 14261 53 AV S Permit No: MI2000-106 Suite ' Tenant: Status: ISSUED Type: mrscpERm Applied: 05/16/2000 ,Partcel I: '25520-0215 Issued: 06/02/2000 **4*********************************** **** **************************** k * Permit Conditions: 1, No changes will be made to the plans unless approved by the Engineer and the Tukwila Builcding Division. •2. 'Validity of Permit. jhe:issuhde ofa,p*rmit or approval of plans, specificattO44-and computations*ihatI not be con- strued to be 840944t for, 01,r 'an i0proval, of„'.any,violation i •4.,,viof any of the4roirisdbi a .the building;:code 7ofa7,,,, •other ordinitYmO of4h -' A iiiAl %''' N :, rOilt,prAtiming to give avtildt-fey tiiV\61,ate or,cancelAhe Or kris:0ns of this code shaill-;:uevaliti. . e k CONTR, xe- TOR SHALL NOTIFY pipeCtc'woRKs U A TILTIYNSPECTOR p;\ . GREG/VILLANUEVA 0-it206)4331d179 Or :,COMMENCEMENT AN1j,-, 4pF WORK AT4EASV24 'loos IN ADVANCE%'- '"', 'm 50'cy of7,Soils or :other materials requires .., for a Hauripp p#Mit prior to any asso,c1119: w,l, l' -.40,,, i 4 ' - ,,„ , , / 14 , ., 0 „i ', ,, , i P 4 ; / ') ' t i • .4+,1 1 ''K 4 / '-'1''' , 0i ) a 4.. * 0 Ois ' yt,, .., ‘ , ; 1 , ' V , 1"1't/fl 1‘f 1 #L t I i I f 4, f 11 ;I, , .. : . : . , 4,-.i, — . - •.:!': :,-) - : .:-‘ "V: • • , 1 ,;...,,.'','0 • .. -- .:.: 0 • : V, • - : i : 4 - . . - : 414 . 4 : 0. :, i:.4, A' ''''' .:: '' : • : :4,./: it+ 0 4 A't CITY OF TU.. t)NILA Permit Center 6300 Southcenter Boulevard, Suite 100 Tukwila, WA 98188 (206) 431 -3670 Project 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/Ten�igt( a ‘A \c; 0,0 7t # (c. f\ l l V ue I5 onstru�ct}'to ©� wiELirsierimil Site Address �t �bt 5?) (viz T A Cit State/Zi.: ' • '' v(.' Owner: c 7 LProperty . ., r �. Cl' ' (L Phone: ( JC(,.) ) L(� - f3- -44�(. Street Address: 14. l S It . S `s , City State/Zip: I 68 Fax #: (,T/ , ) �ct 3 _ , Lq,pc� Contractor: Phone: ( ) Street Address: City State/Zip: Fax #: ( ) Architect: Phone: ( ) Street Address: City State/Zip: Fax #: ( ) Phone: ( ) Street Address: ,.;; , City State/Zip: Contact Person: � Q 1 Phone: (► `' .) l 3 -� 7 00(1 Street Address: -r • , C City 5tat / ip: of f 4i Fax #: ( •) a i{ - 6-0-0"f MISCELLANEOUS PERMIT REVIEW AND APPROVAL RE a (JESTED: (TO DE FILLED OUT RV APPLICANT) Description of work ci.e tM O T(4P. -w 110. to be 1 I 1 done (please be specific): t 0t -btu_ ks)uQ• �.Q. . • S•.4044.. . t4 . t•t.t.. 1 W t5 Ti. ' a S , • OuT Will there be storage of flammable/combustible hazardous material in the building? ❑ yes ❑ no Attach list of materials and story a location on se crate 8 t/2 X t I n er lndlcatin uantlties & Material Wet Data Sheets Above Ground Tanks Antennas/Satellite Dishes Bulkhead/Docks Commercial Karoo( Demolition ❑ Fence ❑ Manufactured Housineeplacement only Parrking. Lots 0 Retalnlne_IIs ❑ Tem era Facilities U Tree Cuttin APPLICANT RE UEST FOR MISCELLANEOUS PUBLIC WORKS PERMITS Channelization/Strlping t_! ❑ Flood Control Zone ❑ Landscape Irrigation ❑ Storm Drainage ❑ Water Meter /Exempt 11 ❑ Water Meter /Permanent # ❑ Water Meter Temp #_ ❑ Miscellaneous Curb cut/Access/Sidewalk ❑ Fire Loop/Hydrant (main to vault)N :, Sings): C3 Altering: 0 Cut cubic yards 0 Fill cubic yards 0 sq. ft,grading/cloaring ❑ Sanitary Side Sewer N: ❑ Sewer Main Extension Private 0 Public ❑ Street Use. ❑ Water Main Extension 0 Private 0 Public Size(s): 0 Deduct 0 Water Only Sings): Slugs): Est, quantity: gal ❑Moving Oversized Load/Hauling Schedule: MONTHLY SERVICE BILLINGS 10: Name: i a wi tf a -- Ity /Sta Phon t.3/ IR: (I 7S ''& O. Address: l7 / 1 6-3 _' A (i,(4 , tJ Water . Sower ;'Metro 0 Standby WATER METERDEPOSIT/REFUND BILLING: Name: Address :,C 1 S ewe S off(/ 3 - •s &pL aQ'l'Vr� Gity /Stat Value of Construction • In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review • Applications for which no permit is Issued within 180 days following the date of application shall expire by limitation. The building official may extend the time for action by the applicant for a period not exceeding 180 days upon written request by the applicant a; defined in Section 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once. Date applf ar • ted:.. 1 9/9/99 udscpnu.doc Date ppl'cati of ;':- .;• Ap aken by: (initials) All MISCf1LANFOU' ' RMIT APPU(ATIONS MIST BL SUB TED WITH THE LOLLOWINC: > ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN • BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED D ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT > STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED STRUCTURAL ENGINEER D 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 ". 'Uti Rh ''Ownii'1Authorlsad A8ent If the applicant is_other` hi ii the owner, registered architect engineer, or contractor; 1j is b � o Sfato of Weshin ton, a notarized letter from' the ro erty owner authdrixin the agent to submit this liar,'„;1., , , !Icntion and.`ootain.tho ormit will be re uirod as ` ar of his submittal. g p � .Bbd P I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER /4M.■l,YU. PENALTY /eF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. i'BUILDI G t)RNtll API', I( /TION AND REQUIRED ( HI( KI 1ST', IOR PERMIT REVIEW 'A boke!:Gtolind Tanks/Water Tanks - Supported directly upon grade Submit checklist No: M -9 e t eeding 5,000�gallons and a ratio of height to diameter or width which fekereeds'21`. ' ri zAntenrias /Satellite,Dishes Submit checklist No: M -1 O yy= giilkhdad /DbcSC :: , " y1 hi. .h ,T �= r .� 'M. , Submit checklist:* No: M -10 �Gtreyiftii eYYcy ial t Roroo, ! 1 Submit checklist No: M -6 ... efa iDblfon _ Submit checklist No M -3 0 (pv , tioo ! er: 6' 661. in' "Height .; Submit checklist . No: 'M -9 • 0 Land Aitering/Grading/PreIoads Submit checklist No M -2 ri tM1ice11ifeous,Public Works Permits ,Submit checklist No: 1+9 0 'M�titifaictui'ed Nbiising (RED INSIGNIA ONLY)'.:_,}Y. 1.. (. 71 « Submit checklist Not M -5 0 M VAk Ot'ertli ed L'oad/Hauling :0A t 'Submit checklist, NO Mi5 El SP Iftki litiL,5tJ t ,s{ : Submit checklist : No: M 4 =-.. O Rbthifiittg wauk • Over 4,feet in height ; .,_ r , Submit checklist Not M -1 4TTrhpt ary racilitie i Submit checklist No: M=7, T7eer,CUttiftg L:T+. { 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 ". 'Uti Rh ''Ownii'1Authorlsad A8ent If the applicant is_other` hi ii the owner, registered architect engineer, or contractor; 1j is b � o Sfato of Weshin ton, a notarized letter from' the ro erty owner authdrixin the agent to submit this liar,'„;1., , , !Icntion and.`ootain.tho ormit will be re uirod as ` ar of his submittal. g p � .Bbd P I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER /4M.■l,YU. PENALTY /eF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. i'BUILDI G iSS�.��1��, 161111;101191 � � 1, m/ %..t, Date: „ , r_» Phone: (,r wi. ....(3.00 Fax #: , (, ) 4' ,, ( y Address: 1 S —R I s City /State/gip: 1 6t ( t f�3 1 .. 9!9/99 mlwpm(.doc CITY OF TL "(WILA Permit Center 6300 Southcenter Boulevard, Suite 100 Tukwila, WA 98188 (206) 431 -3670 M -3 Submittal Checklist Miscellaneous Permits DEMOLITION ✓ Site Plan Requirements II •tance between structures and property lines ✓, immummumnamm Working Drawings 1511 0• or i fisting landscaping Building location and total square footage High water mark of river if within 200 feet of shoreline • ter or recei • t to verif above conditions have been met b • um • in . service • entif current sewer /water billin , account number m- IA Ed Identify water meter size III Foot print and location of structures to be removed • Temporary/permanent erosion control plan • Two (2) foot contours on site no ni INocate Points of access for demolition activities Limits of area to be disturbed by demolition activities existing sanitary side sewers and points to be .1 ,, ed/ca • ed at •ro•ert line i'ocate existing water meters, identify existing meters to be removed by City Public Works staff. Identify existing water services to be ca • • ed b demolition contractor. III ilLocation MI Identify existing side drain: modify and /or capped of slopes 20% or greater, wetlands, watercourses and their buffers III Additional Requirements Asbestos Abatement: Obtain approval from Puget Sound Air Pollution Control Agency prior to proceeding with demolition If structure to be demolished is over 4000 sq. ft., SEPA checklist Is re uired _ Construction debris to be taken to debris facility (Kin Count informational handout available at Permit Center) Foundation must be completely removed Abandonment of Saptic Tank for residential re • ulres the followin , conditions be met: -um ► tank em •t ._ A III with Sand Dismantle /destro ca • • ter or recei • t to verif above conditions have been met b • um • in . service • entif current sewer /water billin , account number Mauling re•uirements must be met if over 50 cubic ards of material is to be taken to or from site Fire Protection System Demo ( issued throw h Fire De artment An inspection prior to demolition will be made and again at mid•demolition and after work is completed. BOND • A bond must be made in amount equal to the cost plus 1O% and must be posted prior to issuance of permit. (Bond may be made in the form of surety or secured by a deposit in cash in the amount specified with a banking or escrow agent acceptable to the City, and conditioned as in the case of a surety. A surety shall be in form joint and several, shall name the City as obligee. This bond is required to be done in order to comply with all the conditions of demolition permit.) Title 16 City of Tukwila Ordinance 1393, 1986 7/96 Puget Sound Air Pollution Control A � e Agency 110 Union Street, Suite 500 • Seattle•WA•98101 -2038 (206) 343 -8800 Guidelines for Application to Perform a Demolition Who must file for a demolition permit? Any property owner who is going to burn or demolish structure, including, but not limited to, commercial buildings, or abandoned structures on private property. The purpose of the permit is to certify that the building is asbestos-free prior to demolition. Why must I file for a demolition permit with PSAPCA? I already filed one with the building department. Building departments do not regulate asbestos. Federal law requires the filing of a demolition permit with the Puget Sound Air Pollution Control Agency, and removal of all asbestos, What should I do first?' You must hire art Environmental Protection Agency (EPA) accredited inspector to survey. your structure for asbestos. A copy of this survey must be available for inspection during demolition You cannot demolish a building with any asbestos still present. Look for qualified inspectors in the yellow pages under Asbestos Removal, Laboratories Analytical, Building Inspection, Asbestos or Environmental Consulting and Testing. What if the inspector finds asbestos in the building? If there is asbestos in the building, it must be removed prior to demolition. You must hire a .certified asbestos abatement contractor for removal. What do I need as far as paperwork is concerned? m A completed Application to Perform a Demolition c $25 check payable to PSAPCA. ® Copy of survey stating the structure has been inspected and no asbestos was found, or an Application to Perform an Asbestos Project filed by an asbestos contractor to remove any asbestos in the building. Please include all of the required paperwork with your application or a permit cannot be issued. • How long will it take? You May begin demolition on the 11th- working day after you have provided us with the required information. Your approved Demolition Permit will be mailed to you within 10- working days after receipt by the Agency. PSAPCA Form No. 66- 181(5/94) jrs oil I =:a A;* 4** A #s +4 i411t d4 #` 4 sl s% ***40* sI x1. �4 •I h A '4 M •1 /Ir A frr h A Jl k A A h A4 # *:fit 1F s1 J� �1 k' ` :• u'Ki�ZLA, W ( rP trl X11 T A4************ A i ±k�� i A*h. t4 4`DFJ4i'aF004**i4*** A A41( 1` ******A r >' t NSMXT tomb r : ' P900029! Antc,uritts • rL.SO 0002/00 icripi, ' ty;man tM r`bhutl "'.CA3N t4ota ions i3TNNt9LI W ICf ).CHI 1111tc .TLU W 1, ... 44' *444 wa i. N W S ' w ai es' 1 k of al o n aa, as as / 1 r I : w. w 4. ti ass at r s. M$ or as a. as a. ri O. / s r w 1. r a , r as 11 wawa. w, a1 s . NW r i.1 ras • , a. S.S. .. P0. .I t Na x • A12000-106 Typal MIlCPERM M /9CELI_AN1 »At.15 I'I UMrr . f�ttrci.I Nla: .7, 1i C0 -0215 .ta AcicI 'tauu t 14261 53 AY I ki`9 tt:. Pkiy 'tent 151.50 Tutk1 ALL Put t+ . 11 0 • Oa1ArleHJ . .00 ..f1,t!t4' 4t4 .*A4, ; kA*#+ 414A- 0kA. A* 14. 4* AkAJ,4#kA14Aii*OA01,#AktiiFAWAk *AAkAk satin °;.44)40 Ua �:r i pt lu�� Amount O(R / l22. po . I1U 1 ;01ND 110HkCII 47,00 OO /3,06.90 tIATL : FU.I1.I)XNG OURGNARI ;l 4.50 it a a1s _ Aa' * a w r 1. M ON 001.: - lie r 1.. r` as IN /I f M w •t 1 • __I i a..0 a a• tr. was, r w r r .I ,., r w .n /1a r. a• 0.04 r+ f1+ . t r• i+ r r ax 1* 44 INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 9818 PERMIT NO. (206)431 -3670 Project: Type of Ins. on: .orr, Address: , Date called : Special instructions: /a: AMMINIUMMONNIMO r34 "Date wanted: Requester: Phone: V'4 Approved per applicable codes. Corrections required prior to approval. COMMENTS: tossomtmirmriabim J $47,00 REINSPECTION F . rr QUIRED, Prior to inspection, fee must be paid at 6300 Southcenter Blvd, S ' ite 100. Call to schedule reins section. Receipt No: Date: s... / iM:•. . �.u....1.,.�.JirsaW:+..;s ---' -` �-dl..w.••_ - - _ . L. Aasj A INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 9818 Prole . ' ' ,� , /G.' Type of fiction: 1 ,� —,pie ,, Addre . ' ate called: Special instructions: Date wanted: a.m. • .m. Requester: Phone: d, J'�. $47,00 REINSPECTIO FEE REQUIRED, Prior 10 inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cali 10 schedule reins ' ection. Receipt No: Date: Approved per applicable codes. J Corrections required prior to approval. COMMENTS: 4- .ate J'�. .r/ / .41 Lair re e , .1 ,.!t I / IflLw_. $47,00 REINSPECTIO FEE REQUIRED, Prior 10 inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cali 10 schedule reins ' ection. Receipt No: Date: INSPECTION RECOR Retain a copy with permit INSPEC?ION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 do —/o6 PERMIT NO. (206)431 -3670 Project; !_ T p • f Insppti •1s Addr ;s4 y /__ r / eu,e, 5 • Date called: 6o Special instructions: Date wanted: # a.m. ,• •.m. kiiiiiMMSINI Phone: Approved per applicable codes. COMMENTS: Corrections required prior to approval. Inspector: G�7 Date: .' Q $47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Cali to schedule reins s ection. Receipt No: Date: INSPECTION RECORLCD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 PERMIT NO. (206)431-3670 - Projec : ■ eh/ Type of Inspection: 41 Address: Date called: Special instructions: Date wanted: a.m. . an. Requester: Phone: Approved per applicable codes. COMMENTS: Corrections required prior to approval. Inspector: Date: $47.00 REINSPECTION FRE REQUIRED. Prior to Inspection, f must be paid at 6300 Southcenter Blvd. Suite 100. Call to schedule reins ection. Date: :••• ;;;;...; INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd, #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit 00-lab PERMIT NO. (206)431 -3670 Protect: chi 1` �% Type of inspection:, r . . iV Address: 112 53r6 ► Ave date called; 4_23-00 Special instructions: Date wanted: Requester: `ucla Kal 1 .1, Phone: 206 254-700 Approved per applicable codes. Corrections required prior to approval. COMMENTS: Inspector: $47.00 REINSPECTION NE REQUIRED, Prior to inspection, fee must be paid r at 6300 Southcenter Blvd. Suite 100. Call to schedule reins ' action, Receipt No; Date: gent by: NVL LASONATCATFS INC. • 206 634 1936; Asbestos Survey C4/25/00 1:66141;lethiL_M3A4;Paoe 2 14261 53rd Avenue South Tukwila, WashInston Date Prepared April 25, 2000 Prepared kr: Pontious liddipwayCanetutial 311116Woodla ta ndlhdavwaCaliCt Sied110,WateglontS103 Prepared flys bulking bupector Celt is Expiration Date: Dare Imputed; Proiert Prudy Stoncit.IVicRut 093155 November 2, 4000 April 21, 2000 8000412 NV1.1.00eriionek JAt, 47011 A u en re Avg. N., esatile, WA 91111031 Mont (2126) $474)100 • Fs* (206)63449M ' litveo cnr F,TLIKWILA WAY 1 7 2000 PERMIT CENTER too 111.21) co Sent by: NVL LABORATORIES /NC. 1.0 SCOPE OF WORK Zoe 634 1936; 04/25/00,,.1 :56PM;• 13e4;Pape 4/11 1 An investigative survey for asbestos containing materials (ACM) was conducted on a residence located at 14261 53rd Avenue South, Seattle, Washington. The inspection was conducted on April 21, 2000 by Prudy Stoudt•Mcrtea, an AHERA certified building inspector. This inspection was performed at the request of 8i11 Pontious of 8ridgeway Construction Contparty. The purpose of this inspection was to identify asbestos containing materials that would by impacted by the planned renovation of this structure. The asbestos survey section is written to comply with the Al 'ERA asbestos sampling procedure as stated in 40 CFR 763.66, "ibis protocol is required for all asbestos surveys prier to a building demolition under the Puget Sound Clean Air Agency, (PSCAA), Regulation 171, and revised February 12, 1991. The asbestos survey alto satisfies the "Good Faith" asbestos► inspection requirements u stated ire Washington Adnidnistratfve Coda (WAC) 296.6207221(2), 'identification ". As stated in this regulation, the owner of a struct u. scheduled to be renovation /demolished must provide n contractor with a written report of the asbestos containing materials to be disturbed during renovation/demolition The National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61 requires a survey by an accredited asbestos inspector prior to demolition of a structure. A floor sketch indicating sampling lecithins has been included in Appendix A. 1426153rd Awmue South, Tukwila, WA 1'aae 1 Sent by: NVL LA©OnATOnres INC. 2. 0 SURVEY METHOD 206 834 1038; 04/25/00 :58PM; ras 0/384;P *g.5/i t Asbestos Survey Method A walk - through inspection of all accessible are 01 this structure was performed to identify poundal asbestos containing materials, The walls- through inspection included a review of the internal and external aspects of this structure. The locations and types of potential asbestos containing materials were noted. Sufficient bulk samples of building materials (vinyl floor tile, roofing, wall materials, etc.) were obtained of each material to satisfy the requirements of the Asbestos Heard Emergency Response Act (AHERA) rules and regulations. These samples were plated into plastic sample bags, numbered and recorded. Homogeneous Materials Homogeneous materials are defined as an area of AsbestorContaining Material (ACM) or Presumed Asbssros.Containtng Material (PALM} which appears similar throughout in tom of color, texture, and dale of material application. The report listing for homogenous materials will appear as follows: an le ■ starlet Location . . n Ain MY Asbestos iL Ales its Pliable aa/no 1 -01 b,,„ flgmtile kitchen 142 ■■ 1... loor tUe„ kitchen .� l•W . , its floor ti kttchan INIUNIMPI Under OSHA Guidelines, a minimum of then negative analysis of a single suspect homogeneous asbestos containing material is required to prove a negative result for surfacing materials and thermal system insulation. NVL. • 1426153rd Avrnuir South, Tukwila. WA Paw 2 Sant by NVL LABOAA70AIES INC. 208 884 1236; 04/25/O01 :58PM; j(j`131s4;Page 6/11 3.0 LABORATORY INFORMATION Laboratory Analysis -- Asbestos Samples are analyzed in our laboratory using polarized light microscopy (PLM) with dispersion staining. if samples are not homogeneous, that subsamples of the components were analyzed separately. Ail Bulk samples are analysed wing EPA Method 600 /R- 93/116 with the following measurement ncertainties for reported % Asbestos (1% =0-31/4, 5%r .1.9%, 10%•5- 15%, 20%0110-30%, 50%s40-60%), For samples contain more than one separable layer of materials, the report will include findings for each layer (labeled Layer: 1, Layer: 2, etc.). The asbestos concentration in the sample is determined by visual estimation. Laboratory Accreditation ProfeMioral accreditations for NVL Laboratories„ Inc., include the following: NVL Laboratories, Inc., is currently accztdited by the National Institute of Standards and Technology (MIST) under the National Volunteer Laboratory Accreditation Program (NVLAP) program for bulk asbestos fiber analysis. NVLAP Lab Code 102063-0. NVL Laboratories, Inc., M approved by the American Industrial Hygiene Association (AII4A) Asbestos Analysts Registry (AAR) program for airborne **beams hber analysis. Counter ID 2412. NVL Laboratories, Inc., is currently accredited by the American Industrial Hygiene Assnriation (ARIA) under the Industrial Hygiene Laboratory Accreditation ?rodram (IHL1P). The 1HLAP presrani is designed speciticatly for lwbotetorles involved in analyzing samples to evaluate workplace exposure. Certification Number 563. 14261 53M AWi11w $v 7yiiwiia, WA Parr 3 Sint by: NVL LAHOAAYCAYE8 ANC. 208 834 19315; 4.0 BUILDING DESCRIPTION 04125/00 1,:57P0I; j 0364 ;Page 711 1 General lui!ding type: This is a aingk- family residence with 5 bedrooms and 3 bathmorns Primary external component:: Th. primary external components are vinyl aiding and brick Type of foundation: The foundation is a concrete basement. Roofing materials: The roof is 3•tab asphalt shingles with vapor barrier paper. Window types: These are vinyl window frames with no glazing. Floorings The aubatrat+e Is a wood deck, with carpets, sheet vinyl to the kitchen and ceramic Was in the bathrooms. Thermal systems wtinsulation types: The forced air headng system utilises electricity; than is fiberglass insulation on ducts. Finishing Thew aro painted gypsum drywall panfduna. • 1426153rd Avenue South, Tukwila, WA Past 4 $.rit by: NVL LAPORA"f ORIE8 INC. 206 634 103e; 04/25/00 1:bitM;JIjg 3e4;Page 5/11 5.0 FINDINGS Inventory of Suspect Asbestos- Containing Materials Sample MatsrMI �Nwnbrr Desatsiptlon 0000412 1- brown 3-tab 1-1 asphalt 2- black 3✓tac asphalt 3.asphalt paper 0000412 1 • brown 3•4ab 1-2 asphalt halt >aaoor 0000412 1- brown 3•tab $.etalion 1.3 asphalt asphalt paper 1- vapor barrier 9000412 2.1 0000412 1- vapor barrier $Outhwestside of house ND southwest comer of prop roc Asbestos ND ND N13 southwest comet dt house roof ND north tenter of houao roof north side dhotis* ND ND ND ND w • Area Friable ift31 eaMe1 2-2 ir 12 1• vapor barrier oast side of prep 0000412 1- gypsum wallboard cent., ceiling, basement 3-1 3 2 1• gypsum wallboard larnlly room, main floor 3.2 0000412 1. gypsum waUboerd bedroom 1, 2nd floor 3.3 1- irisutatlon west side of attic r•A IA .•. NAINI 1- mastat; 1 • Mask 1•grou 3000412 1• grout 6- 11000412 6-3 ND • Norr Demme main floor bathroom basement bathroom 2nd floor bathroom worm ten, main fluor bathroom NV1. basement bathroom and floor bathroom 14361 53rd Avenue South. Tukwila, WA SAES Paws ' 8ant by NVL LAS0NAT0RIE8 /NC. Ailb04101 - continued ample umber 8000412 7-1 8000412 8-1 8000412 8-2 %MA 208 834 1938; On 04/25/00 t:bveNaleifatc_S30402ego 9/11 1- brown cetantc kitchen well 1- white sheet vinyl center of kitchen floor 2- gray backing a•lilliii0101111.11111111MMO 1- white sheet vinyl 2. pay b.ckMl aL mastic ND. Nan Dammed Aa 4 beetai Are north center of kitchen floor "IA NO ND Any suspect Insterial(s) not identified above *tumid not be disturbed, and tested burnediately. 'rho suspect material must be treated u asbestos containing until tesdng proves otherwise. NV1, t4, 14361 33rd Avenue South, Tukwila, WA Page 6 Sant by: WL LABORATORIES INC. 206 634 1636; 04/25/00 1:137PMAINFAis 130403w 10/11N,‘H •. . 6.0 CONCLUSIONS AND RECOMMENDATIONS ASBESTOS No Asbestos-Containing Materials (ACM) or Presumed Asbestos-Containing Materials were (PACM) identified at the residence located at 14261 53rd Avenue South, Tukwila, Washington. If discovered, all ACMs that will be disturbed as a natural part of renovation/demolition and are required to be removed and disposed of in accordance with Washington State Regulations. Washington Stow Depart:tient of tabor and Industries and PSCAA require that the abatement be performed using Cerdfied Asbestos Workers under the direct on-site supervision of a Certified Asbestos Superviior. Further, NVL suggests that an AHERA inspector review this property after abatement to ensure all ACM has been removed by the contractor. Hidden wall and ceiling cavities that are not accesaibla during the time of surveying can sometimes conceal ACM, 'thus, NVL recommends that an A r:MA ittspector/project manager be on lite at the lino d rerovation/demolition to ensure that any potentially asbestos - containing materiels uncovered during the precise of resiovation/demohtion be dealt with PraPetlY. Dit 14261 b3rd AV1111141 South, TukwiI, WA P.IP 7 44. mint by: NVL LANHA1OHTE8 INC. • 206 634 1938; 04/26100 1 : 57PM; 3fgL,M364 ; P ge 11/11 7.0 LIMITATIONS OP SUR'V'EY Th• sole purpose of this survey report is to document asbestos- containing materials discovered in the survey of suspect materials by NVL Laboratories personnel st the residence located at 1426153rd Avenue South, Tukwila, Washington on April 21, 2000. This site visit consisted of a thorough visual walk- through of the building for the purpose of viewing and sampling potential ACM,. As hazardous material surveys are non -co prehen sivr by nature, NVL Laboratories, Inc., cannot be held liable for materia s which require destructive means to WWCl6r, materials which are hidden from sight (e.g. materials hidden behind walls, materials which cannot be fowid due to their obscure nature, or which otherwise cannot be discovered with reasonable diligent, This document is the sole property of NVL Laboratories and the property owner, or his agent, authorizing this survey. Inspected by: Reviewed by: Prody Staudt-McRae AHERA Building Inspector AHERA Certification No.: 993155 AHERA Certification Expires on: Nov. 2, 2000 NVL 3enjamin T. Cook, C,HMM Hazardous Materials Specialist Certified Hazardous Matenols Manager • 1426153rd Avenue South, Tukwi:e• WA Page 6 iva 4*E. N .04( LU car • RECEIVED CITY. OF TUKWILA MAY 1 6 2000 PERMIT CENTER A CITY OF 1'UI(W1U1 .) ,,a, APPROVI D .r JUN 0 2 2000 A'; Clti!is s standards. pied stands ra dsdo e adcquacy of net ditto std: 7t Public W I";UIL f i bro T t12 r, ) n 114 1 wafer r] K4cfer o,c etmo 5 10 40 50 60 cuss by bject to errors ' orize -' stations T' St., 'il t rc he J —ring b tic: MIME filkitdsi Of. Or 9' 5 Mlzoco-ia40 SITE P I'd ig PEJVIT COORD COPY PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: MI2000 -10.6 PROJECT NAME: STANISLAV KALCHIK SITE ADDRESS: _-142.61_5.3 _ V S ,,,,A, %� Original Plan Submittal Response to Correction Letter # # After Permit Is Issued DATE: a 516 -2000 Response to Incomplete Letter #_,____ (PARTMENTS: Building Division 14 Frhk -� Works P ( W ii NCO Fire Pre ention Structural Planning Division A? 6114a) Permit Coordinator DETERMINATIO OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 5.18 -200 Complete Incomplete ❑ Not Applicable EI Comments: TUES/THURS ROUT Cs Please Route Structural Review Required REVIEWER'S INITIALS: No further Review Required DATE: APR®_YALS OR CORR €CTIONS: (ten days) Approved ❑ Approved with Conditions REVIEWER'S INITIALS: O O D N ONs Approved E Approved with Conditions REVIEWER'S INITIALS: DUE DATE _E15:1020_ Not Approved (attach comments) DATE: DUE DATE Not Approved (attach comments) Ej DATE: at