HomeMy WebLinkAboutPermit D19-0190 - JUSTIN RESIDENCE - DEMO HOUSE AND FOUNDATIONJUSTIN RESIDENCE
DEMOLITION
6404 S 143RD ST
D19-0190
Parcel No:
Address:
�~^�xx m�� Tukwila
^~U~� x�n v 0�m"mm�va
Department of Community Development
630U6outhcen»erBoulevard, Suite #1V0
Tukwila, Washington 9818g
Phone:3O6'431'3670
Inspection Request Line; 286'438'9350
Web site: http://www.TukwilaWA.gov
DEVELOPMENT PERMIT
3365901940 Permit Number: D19-0190
Project Name: JUSTIN RESIDENCE - DEMOLITION
Issue Date: 6/18/2019
Permit Expires On: 12/15/2019
]U8lN]AK4ESL+GA|LANN
Address:
Contact Person:
Address; 628SBRAND0NST,SEA7TLE WA,
98108
Contractor:
Name:
License No:
Lender:
Name:
Address:
B0YCECONSTRUCTION INC
628SBKANDONST'SEATTLE WA,
9@108
8OY[EO066QQ
JA[NE5JUIT|N
' Phone: (206) 264- OO5
Expiration Date: 1/21/2020
DESCRIPTION OF WORK:
DEMOLITION 1000SF HOUSE AND FOUNDATION. FILL VOID WITH DIRT, CAP WATER AND SEWER. DISPOSE OF
DEBRIS ATCERTIFIED SITE.
Project Valuation: $15,522.75
Type ofFire Protection: Sprinklers:
Fire Alarm:
Type ofConstruction: V8
Electrical Service Provided by: TUKWILA
Fees Collected: $97I.82
Occupancy per IBC: R-3
Water District: TUKVV|LA
Sewer District: TUKWILA
Codes adopted by the City of Tukwila;
International Building Code Edition:
International Residential Code Edition:
International Mechanical [ode Edition:
Uniform Plumbing Code Edition:
International Fuel Gas Code:
2015
20152015
2015
2015
National Electrical Code:
WA Cities Electrical Code:
VVA[Z96-468:
Code:
ublic Works Activities:
Channe|badon/Striping:
Curb Cut/Access/Sidewalk:
Fire Loop Hydrant:
Flood Control Zone:
Hau|ing/OversizeLnad:
Land Altering:
Landscape Irrigation:
Sanitary Side Sewer:
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Water Meter:
Permit Center Authorized S[gna
Volumes: Cut: O Fill: 8
Number: O
No
�-/����
Date: ��—/� ` /
I hearby certify that I have read and examined this permit and know the same to be true and correct. All
provisions oflaw and ordinances governing this work will becomplied with, whether specified herein ornot.
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other
state orlocal laws regulating construction nrthe performance ofwork. |amauthorized *: sign and obtain this
development pg,�mitand agree tothe conditions attached tothis permit.
PdntName:
This permit shall become null and void if the work is not commenced within 180 days for the date of issuance, or if
the work is suspended or abandoned for a period of 180 days from the last inspection.
PERMIT CONDITIONS:
I: 'PUBLIC WORKS PERMIT COND[O0NS**~
2: Call to schedule mandatory pre -construction meeting with DaveStuck|e, Public Works Inspector, (206)433'
Ol79.
3: The applicant orcontractor must notify the Public Works Inspector at(2O6) 43]-0179upon commencement
and completion ofwork atleast Z4hours inadvance, All inspection ,eqve,tsfor utility work must also be
made Z4hours inadvance.
4: Prior to construction, all utilities in the vicinity shall be field located. NOTE: For City of Tukwila utility
locates, call 811 or 1-800-424-5555,
5: Permit is valid between the weekday hours of 7:00 a.m. and 5:00 p.m. only. Coordinate with the Public
Works Inspector for any work after S:OOp.m.and weekends.
0: No work under this permit during weekend hours without prior approval by Public Works. Coordinate with
the Public Works Inspector.
7: Work affecting traffic flows shall be closely coordinated with the Public Works Inspector. Traffic Control
Plans shall be submitted to the Inspector for prior approval,
A: Flagging, signing and coning shall beinaccordance with K4UTCDfor Traffic Control, Contractor shall
provide certified flagmen for traffic control, Sweep orotherwise clean streets tothe satisfaction ofPublic
Works each night around hauling route (No flushing allowed). Notify Public Works Inspector before 12:00
Noon nnFriday preceding any weekend work.
9: Any material spilled onto any street shall hecleaned upimmediately,
10: Temporary erosion control measures shall be implemented as the first order of business to prevent
sedimentation off -site or into existing drainage facilities.
11: 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.
12: 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.
13: From May 1 through September 30, inspect and maintain temporary erosion prevention and sediment at
least monthly. All disturbed areas of the site shall be permanently stabilized prior to final construction
approval.
14: 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.
15: ***BUILDING PERMIT CONDITIONS***
16: All permits, inspection record card and approved construction documents shall be kept at the site of work
and shall be open to inspection by the Building Inspector until final inspection approval is granted.
17: 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,
18: 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).
19: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila
Permit Center.
20: 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.
21: ***PLANNING PERMIT CONDITIONS***
22: Tree protection measures shall be installed and inspected prior to the start of work. Please contact project
planner Jaimie Reavis at (206) 431-3659 or Jaimie.Reavis@TukwilaWA.gov to schedule an inspection of tree
protection measures.
23: All existing trees on site shall be retained and protected during construction. Any tree removals shall first
be reviewed and approved through submittal of a tree removal permit to the Department of Community
Development.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1700 BUILDING FINAL**
5200 EROSION MEASURES
5210 EROSION MEASURES FNL
1500 PLANNING FINAL
0101 PRE -CONSTRUCTION
1600 PUBLIC WORKS FINAL
5160 PUBLIC WORKS PRE -CON
5070 SANITARY SIDE SEWER
5130 WATER METER - PERM
CITY OF TUK
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
Building Pet:It No. NCA''' 0
Project No.
Date Application Accepted:
Date Application Expires:'
(For eke use only)
610
CONSTRUCTION PERMIT APPLICATION
Applications and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or by fax.
**Please Print**
SITE LOCATION
Site Address: 6404 -SOO
r517
King Co Assessor's Tax No.: 33 (0.5" 19 110
Suite Number:
Floor:
Tenant Name: New Tenant: E] Yes 0.. No
PROPERTY OWNER
Name: Sii41E-.4 / &A)l_ .7-10 *1)
Address: 3 1 to No i - ve-
city:vbef. State: to 4
Zip:
is?
CONTACT PERSON - person receiving all project
communication
Name: •—‘73 -kttivi, tjaskio‘iteN
Address:
City
erAkNe. State.sic\
Zip%01
Phone:\z) sekt.si,..t.M4x:
Email: -S)NAUNNE.t4 0 r?=1ZNit
0
GENERAL CONTRACTOR INFORMATION
Company Name:%0.sitia Czc‘sk-futMuNiMc.c..
Address:L9.1
:I a(
City State State4vm Zip
Phonetory.44A, : • 64
Contr Reg NottswitenvaEtate: vi4vu
Tukwila Business License No.:%x),%.... oCkOk\11%501
ARCHITECT OF RECORD
Company Name:
Architect Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
ENGINEER OF RECORD
Company Name:
Engineer Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
LENDER/BOND ISSUED (required for projects $5,000 or
greater per RCW 19.27.095)
Name: "S'ome.s "Ss4s.kk,c‘
Address:
City:—
\ Cd•C1rN 0%_ StateNAcx
ZipSC4.16"
H:lApplicationskForms-Applications On Line \ 201 2 Applicationaemiit Application Revised - 2-7-12.docx
Revised: February 2012
bh
Page 1 of 4
BUILDING PERMIT INFORMATI - 206-431-3670
Valuation of Project (contractor's bid price): $ (Y6- :A'S Existing Building Valuation: $
Describe the scope of work (please provide detailed information): .1..) Ql.katkioc•
4eNtilNitIOC-1. Nrae‘r \ 60c . Q oR N440Ae—e" Or•6, Stet./tr .4--‘‘SiOlt—
&"\OCLS Oc\- C_t2t3t:kS\
Will there be new rack storage? LJ ....Yes
o If yes, a separate permit and plan submittal will be required.
Provide All Building Areas in Square Footage Below
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
l't Floor
2"d Floor
3rd Floor
Floors thru
Basement
Accessory Structure*
Attached Garage
Detached Garage
Attached Carport
Detached Carport
Covered Deck
Uncovered Deck
PLANNING DIVISION:
Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches)
*For an Accessory dwelling, provide the following:
Lot Area (sq ft): Floor area of principal dwelling: Floor area 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? 0 Yes El No If "yes", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
.......Sprinklers Automatic Fire Alarm None 0.. .... Other (specify)
Will there be storage or use of flammable, combustible or hazardous materials in the building? El Yes 0 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:kApplicationsTorrns-Applications On Line \20I2 ApplicationslPerrnit Application Revised - 2-7-12.docx
Revised: February 2012
bh
Page 2 af 4
PUBLIC WORKS PERMIT INF e/ATION 206-433-0179
Scope of Work (please provide detailed information):
Call before you Dig: 811
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
.. Tukwila 0 ...Water District #125
.. Water Availability Provided
Sewer District
.. • Tukwila
.. Sewer Use Certificate
o
0 ...Valley View
...Sewer Availability Provided
0... Highline
... Renton
Renton
O... Seattle
Septic System:
0 On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department.
Submitted with Application (mark boxes which apply);
0 .. Civil Plans (Maximum Paper Size — 22" x 34")
.. Technical Information Report (Storm Drainage)
.. • Bond 0... Insurance 0... Easement(s)
Proposed Activities (mark boxes that apply):
o .. Right-of-way Use - Nonprofit for less than 72 hours
O . Right-of-way Use - No Disturbance
o .. Construction/Excavation/Fill - Right-of-way 0
Non Right-of-way 0
o .. Total Cut cubic yards
o .. Total Fill cubic yards
o .. Sanitary Side Sewer
0 .. Cap or Remove Utilities
Frontage Improvements
o .. Traffic Control
Backflow Prevention - Fire Protection
Irrigation
Domestic Water
o .. Permanent Water Meter Size (1)
o .. Temporary Water Meter Size (1) 71
.. Water Only Meter Size
O .. Sewer Main Extension Public 0
1:3 .. Water Main Extension Public El
D..
O..
D..
57
0... Geotechnical Report
0...Maintenance Agreement(s)
.. Traffic Impact Analysis
0.. Hold Harmless — (SAO)
.. Hold Harmless — (ROW)
D... Right-of-way Use - Profit for less than 72 hours
0... Right-of-way Use — Potential Disturbance
0... Work in Flood Zone
El... Storm Drainage
. Abandon Septic Tank
.Curb Cut
. Pavement Cut
. Looped Fire Line
17
0... Grease Interceptor
... Channel ization
El...Trench Excavation
D... Utility Undergrounding
WO # (2) " WO # (3)
WO # (2) " WO # (3)
WO # .. Deduct Water Meter Size
Private 0
Private 0
" WO #
" WO #
FINANCE INFORMATION
Fire Line Size at Property Line
Number of Public Fire Hydrant(s)
o .. Water 0 .. Sewer 0 .. Sewage Treatment
Monthly Service Billing to:
Narne:
Day Telephone:
Mailing Address:
City State Zip
Water Meter Refund/Billing:
Name:
Mailing Address:
Day Telephone:
State
Zip
City
HAApplicationsTorms-Applications On Line \2012 ApplicationsTermit Application Revised - 2-7-12.docx
Revised: February 2012
bh
Page 3 of 4
e"\
PERMIT APPLICATION NOTES —
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 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).
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 OrysiER OR AU7ITIZED AGENT:
Signature: yi447--- 2-- 44.Wii
Print Name: -IA 41g, 1-
Mailing Address: 3110 ivnerli &tie -
Date: Inv .4e :201f
Day Telephone: 6126-17/2
City State Zip
H:\Applicton\Forms-AppHctions On Lin02012 Applications\Pertnit Application Revised - 2-7-12.doex
Revised: February 2012
bh
Page 4 of 4
Cash Register Receipt
City of Tukwila
Receipt Number
DESCRIPTIONS
PermitTRAK
ACCOUNT QUANTITY
PAID
$265.00
D19-0190 Address: 6404 S 143RD ST
Apn 3365901940
$265.00
DEVELOPMENT
$15.00
PW PERMIT ISSUANCE/INSPECTION FEE
R000.342,400.00.00
0.00
$7.50
PW CONSTRUCTION PLAN REVIEW
R000.345.83000.O0
0.00
$7,50
PUBLIC WORKS
$250.00
BASE APPLICATION FEE
TOTAL FEES PAID BY RECEIPT: R17929
R000.322.100.00.00
0.00
=
$250.00
$265.00
Date Paid: Tuesday, June 18, 2019
Paid By: BOYCE CONSTRUCTION INC
Pay Method: CHECK 30687
Printed: Tuesday, June 18, 2019 3:50 PM 1 of 1
YST MS
Cash Register Receipt
City of Tukwila
DESCRIPTIONS ACCOUNT QUANTITY
PermitTRAK
PAID
$706.82
D19-0190 Address: 6404 S 143R0 ST Apn: 3365901940
$706.82
DEVELOPMENT
$686.22
PERMIT FEE
R000.322.100.00.00
0.00
$411.95
PLAN CHECK FEE
R000.345.830.00.00
0,00
$267.77
WASHINGTON STATE SURCHARGE
8640.237.114
0.00
$6.50
TECHNOLOGY FEE
$20.60
TECHNOLOGY FEE
TOTAL FEES PAID BY RECEIPT: R17876
R000.322.900.04.00 0.00
$20.60
$706.82
Date Paid: Wednesday, June 12, 2019
Paid By: BOYCE CONSTRUCTION
Pay Method: CHECK 30679
Printed: Wednesday, June 12, 2019 2:04 PM 1 of 1
5YSTEM5
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 438-9350
Project:
-)1-)51-114 RXE,S'i D fa/
_
Type 01 Inspection:
Li)/ NG- Fi Net Z---
Address:
6'14:95/ Se''3RP
-Date
Called:
Special Instructions:
P'/140 77
Date Wanted:
A ft v-)?
a.m.
p.m.
Requester:
AAJ 'a isiG V ISA1
Phone No:
cfvo- (of ene)
proved per applicable codes.
Corrections required prior to approval.
COMMENTS:
n pector:
Date:
-/42
REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
Project:
U "ZL 1 Gry
Type of Inspection:
Address: T
6L Oy 1414
fl to Called:
'Special Instructions:
Date W nted:
i
/ q
a.m.
p.m.
g j CCU
Reque ter:
Phone No:
EjApproved per applicable codes.
Corrections required prior to approval.
COMMENTeArA,S;
i'
Ra&tvi
.E
S
L I REI VSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit b‘ck 000
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 438-9350
Project:
Type of spec n:
Address:
/04014
I
Date Called:
-Special Instructions:
-bate
Wanted:
b 2-L9- 19
a.m.
P. •
Requester:
b cotkd
Phone No:
2-47(4, 7.471
,
ElApproved per applicable codes.
Corrections required prior to approval.
g---- 77 if
co2OE
,--
to
F
InspectorT:cS2/2 CT
)
Date:
REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Customer:
Customer
Project Number:
Project Name:
Project Address:
PO Number:
Sample Date:
Total Samples:
James Justin
6406 Somh14]rd
Tukwila
mm 98168
None Given
��m�� ���������� xnxxxx o.vx��������������x�x Inc.xxv
Bulk Sample Analysis Report
RECEIVED
Demo
5404South »43rd Street
Tukwila
wAg8168
None Given
U�� ���uw�D
�"w/n v � w
TUPWILA
PUBLIC WORKS
Sample Analyzed for this report:
22-APn'19 Laboratory |oNumber
z 2019-04'0397
Pacmmmumben
Report Number:
Date Received:
Date(s) Analyzed:
Tumammndrime:
Report Date:
Report By:
Page: 1ofZ
2019.0137
2019-G4-0307
4/Z3/lO19
4/30/2019
3-5 DaVs
4/30/2U19
William [GpUoway
William F. Golloway
The bulk sample submitted was analyzed for asbestos content using Polarized Light Microscopy (PLM).
Analysis was performed in accordance with Appendix E to Subpart E of 40 CFR Part 763 and EPA/600/R93/116.
The test results pertain only tothe sample submitted for analysis. Unless otherwise noted, the sample was
inhomogeneous; subsamples of components were analyzed to achieve representative analysis. Separate layers of
layered samples were analyzed and reported separate|y. Unless otherwise stated, asbestos content was quantified
by calibrated visual estimation (CVES). CVES concentrations are reported in two to three percent ranges for
fiber concentrations ranging from one toten percent, and usually five percent ranges for concentrations greater
than ten percent. Samples in which asbestos is not observed are reported as "None Detected". RECE|\/EED
CITY 0,_ TUK\V/LA
Limitations and Uncertainty:
�
Factors such assample quality, sample size, interfering matrix material,fibr size, andOber E N T E R
contribute to the uncertainty in asbestos concentration estimates in bulk materials. Relative errors exceeding
100%may occur \nsamples containing less than ten percent asbestos. Relative errors are typically below
thirty percent in samples having greater than ten percent asbestos, and app[oach zero as asbestos concentrations
approachlDO%.
11
Asbestos fibers with diameters less than approximately 0.25 microns are n I 0-Mete le by
diameters may not be visible if obscured by interfering matrix materials. These extremely fine fibers may occur in floor
tiles, adhesives, products with cement binders, and other non -friable or semi -friable materials.
be overcome using alternate analytical methods, such as Transmission Electron Microscopy (TE
The sample was provided bythird parties not subject tocontrol bvPacific RimEnvimnmenta
makes no representation regarding sample collection techniques or procedures.
This report cannot be represented by the customer to claim product endorsement by the
Accreditation Program (NVLAP), or any agency of the United States government. This report
except in full without written permission from Pacific Rim Environmental, Inc.
NVLAP Accredited Lab#: 101631-0 Report
Samples Submitted by: Third Party Reviewed by:
�
0,
P ilili 4)
his-- - -- — --
bODE COMPLIANCE
ADWVED
Inc.
Jvmon
����� ���«����
so
ational Voluntary
all no0ftYG0f0TUk*1a
BUILDING DIVISION
Z/, -7,::),/�
lApprovedSianotmry)
Pacific ximEnvironmental, mcas10
WINW.ciacrimemcom nre @oammen.com t206/244-8965
This report can not be reproduced except in full without written permission from Pacific Rim Environmental, Inc.
Pacific Rim Environmental Inc.
Bulk Sample Analysis Report
Customer: James Justin
Customer Project Number: None Given
Project Name:
Sample Date:
Report Date:
Report By:
Demo
22-APR-19
4/30/2019
William F. Galloway
PacRim Number:
Report Number:
Date Received:
Date(s) Analyzed:
Analyst(s):
NVIA
Tapting
11'1-LIP Lab Coda 101631.0
Page: 2 of 2
2019.0137
2019-04-0387
4/23/2019
4/30/2019
William F. Golloway
Customer
Sample Number: 01
Lab ID: 2019-04-0387
Lab Sample Description
Light brown and silver, loose
vermiculite with loose fibers
Customer Sample Description: Customer Sample Location:
Insulation Attic
As111)(pePt
Actinolite <1%
Non -Asbestos Fibers
Cellulose <1%
Synthetics <1%
Fibrous Glass <1%
Animal Hair <1%
Spider Silk <1%
Analyst: WFG
Analysis Date: 4/30/2019
Non -Fibrous Materials
Vermiculite, Mineral
Aggregate, Binder,
Refractory (Brick Fragments),
Metal (Nail), Plant Remains,
Wood Fragments, Gypsum,
Tar
Pacific Rim Environmental, 6510 Southcenter Boulevard, Suite 40 Tukwila, WA 98188
www.oacrimenv.com ore@acrimenv_com (206)244-8955
This report can not be reproduced except in full without written permission from Pacific Rim Environmental, Inc.
Chain of Custody for
Laboratory Analysis
9
Client
440 - '
PacRim ob Number:
Client Project
Number
_)d Li( I , L.) 1 -, 1
Address
64,06 soor# /0 0.3),
City
'-' if..i/L 4Name
Client Project
State
Zip
• ,
Client Project
Location
64/09- x, /4:3 RP
truALV144, Wi yet67
Contact
Phone
266._ - 1742
Email
„ro• A) i, 4
Please Choose Sample Type
Please Choose Turnaround Time
X
Asbestos Sample (Method EPA/600/R-93/1 16)
Same Day ($70.00*)
Lead Sample
, ,
.
24 Hour 060.001
Other PCM, Tem, Mold, etc. (Please contact
office for pricing and turnaround times)
..-:,
i:,,:,,
3 Working Days ($50.00*)
5 Working Days ($40.00*)
Samples received after 4:00 pm will be calculated from 8:00 am the following morning.
Please include payment; PacRim accepts all major credit cards or check.
*Samples include up to 3 layers, additional layers are charged at $5.00 per layer.
Sample Date
Sample #
Sample Description/Comments
4- p2,- ZOI9
i47‘..:' irvolfDAj
.
,
Special Instructions:
Released by
Signature
pc
, ,
PrintName
jorue6 4, ,
T/A/
Date
Time 61 '
Received By
Signature
-1)(2
clLiti,k
Print Name
ti-thulit ,
ol---,
Date
Time
Lab Received
.- •
y/
A14/
Print Name
Date
/.....70 -/
Time
Mail to: Pacific Rim Environmental, 6510 Southcenter Blvd. Suite 40, Seattle, WA 98188
Phone: (206) 244-8965 Fax: (206) 244-9096 Email: pre@pacrimenv.com
pscleanair.org
Puget Sound Clean Arr Agency
Single -Family Notification Case #: 201902480
This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection
at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)).
Fee Amount Paid $65.00
Credit Card Transaction # AQOFFEE3ABFD
Transaction Date 05/21/19
Owner's Name James Justin
Project Street Address 6404 South 143rd St.
City Tukwila
Contact Person Diane Nguyen
Mailing Address 3110 North Gove
Tacoma, WA 98407
Phone (206) 660-7712
Zip 98168
Phone (206) 264-8085
RECEIVED
JUN 1 3 2019
TUKWILA
PUBLIC WORKS
This project includes a demolition.
Demolition Start Date 07/01/19 Completion Date 07/12/19
Demolition will be completed by a demolition contractor
I certify that:
(1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile.
(2) The information I have provided is to the best of my knowledge accurate and complete.
(3) I understand the fee for this Notification is nonrefundable.
Create Another Notification
View History,
If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058.
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RECEI,ED
CITY OF TUKWIL.:-
PERMII CENTER
REV1EWED FOR
CODE COMPLIANCE
APPROVED
JUN 17 2019
City of Tukwila
BUILDING DIVISION
Page 1 of 9
March 26, 2019
M2190312
Jim Justin
206-660-7712
6406 S. 143rd St.,
Tukwila WA 98168
iustinilmsn.com
1429 Ave. D. #I87, Snohomish, WA 98290
425-489-4040
www.ashesmiesi.com. infoQasbestolestcom
ASBESTOS SURVEY
6404 S. 143" St., Tukwila, WA 98168
LE
RECEIVED
JUN 1 3 2019
TUKWILA
PUBLIC WORKS
On March 18, 2019, Asbesto-Test personnel conducted an Asbestos survey (per
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 house 6404 S. 143'1 St, Tukwila, Kinjz County,
Washington 98168. This survey purpose is to identify Asbestos Containing Materials that
are present and will require professional removal prior to demolition.
NARRATIVE OF FINDINGS
BASIC CONSTRUCTION: The house is a single -story wood frame on a crawlspace
foundation. The siding is pressboard over wood. The siding vapor barrier under the wood siding
was sampled. The roofing is composition. The composition roofing materials and roofing vapor
barrier were sampled.
INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior is wood,
and drywall. The drywall and taping materials were sampled. The tile and vinyl flooring with the
associated backings and mastics were sampled. The misc. mastic materials were sampled.
INSULATION: There is *vermiculite present in the attic. The vermiculite is PACM.
The vermiculite insulation is PACM (Presumed Asbestos Containing Material). The vermiculite
material taken from the "Libby, Montana mine" could be contaminated with substantial
quantities of Tremolite Asbestos. In the mining, heating, and milling of the vermiculite
material, the vermiculite becomes reduced to very small particulate matter, some of which is
below the detection limit using polarized light method (Analytical test method: USEPA
600/R93/116** (PLM); WAC 296-62-07753 App. J). Asbesto-Test, Inc. therefore presumes all
vermiculite material to be PACM, unless determined otherwise by a laboratory using SEM or
TEf4cqnn4nfj ar transmittinq electron microscopy). For more information, please visit
OR
CODE COMPLIANCE
APPROVED continue to page 2
JUN 17 2019
City of Tukwila
BUILDING DIVISIO
'aro it /9. bi 70
BBB
RECEIVED
CiTY OF TUKWILA
JU 1 2 20i9
PERMIT CENTER
Page 2 of 9
M2190312
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 143"1 St., Tukwila, WA 98168
ELECTRICAL SYSTEM: The electrical wiring insulation did not appear to be the kind to
contain ACM. 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: Heating throughout is baseboard / wall
electric. There was no visible suspect ACM located associated with any of the electric heating
units. It was not possible to dismantle the electric heating units to locate and/or evaluate any
additional suspect ACM which may be concealed, inside the units, or associated in hidden areas.
It is our opinion any further handling of the heating units should be coordinated by the project
manager and/or abatement contractor. If any additional relating suspect ACM is located prior to
and/or during any demolition or renovation, those materials are PACM (Presumed Asbestos
Containing Material), unless determined to be otherwise by laboratory analysis.
MISC.: None,
ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: None.
# of structures included in survey: one house
Requested by: Jim Justin
Certificate of Completion
.1 • new* eel
Matthew G. Hutson
.leart Or., so an
AHERA &WIN trtspezIcr
rennitor..
ISCA o. t$N76114.1k,
Matthew Hutson
Hutson
Inspector, Certified A.H.E.R.A.
Accred. #167808 EXP. May 30, 2019
continue to page 3
1429 Ave. D. 11187, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www,qsbestoreacom; info@pshiesiotesi,com
Page 3 of 9
M2190312
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 143'd St., Tukwila, WA 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.
ANALYSIS ID
SAMPLE #J0.0 IS PRESUMED ASBESTOS CONTAINING MATERIAL
ASBESTOS//TYPE//OUANTITY OTHER MATERIAL
0.0 VERMICULITE INSULATION PACM
NOTE: THE VERMICULITE INSULATION IN THE ATTIC IS PRESUMED ASBESOTS CONTAINING
MATERIAL (PACM).
AS PACM, THE VERMICULITE MUST BE PROFESSIONALLY ABATED (REMOVED) PRIOR TO
DEMOLITION.
The vermiculite insulation is PACM (Presumed Asbestos Containing Material). The vermiculite material token from the "Libby,
Montana mine" could be contaminated with substantial quantities of Tremolite Asbestos. In the mining, heating, and milling of the
vermiculite material, the vermiculite becomes reduced to very small particulate matter, some of which is below the detection limit
using polarized light method (Analytical test method: USEPA 600/R93/116" (PLM); WAC 296-62-07753 App. J). Asbesto-Test, Inc.
therefore presumes all vermiculite material to be PACM, unless determined otherwise by a laboratory using SEM or TEM (scanning or
transmitting electron microscopy). For more information, please visit http://www.labcor.net/
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
1.0 mastic NAD adhesive, cellulose
kitchen holding white (w/specks) laminate on countertops & backsplash
2.0 insulating material NAD non -fibrous materials,
kitchen on underside of sink cellulose, polymers
3.0 floor tile NAD non -fibrous materials
kitchen floor — wood pattern
3.1 mastic NAD adhesive
beneath previous sample
4.0 sheet vinyl flooring
kitchen 2nd layer — color: tan mosaic
4.1 mastic
beneath previous sample
NAD
NAD
continue to page 4
non -fibrous materials,
cellulose, fiberglass
adhesive
1429 Ave. D. #187, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www.as•besrorest,cam; info@ashiesiotestcorn
Page 4 of 9
M2190312
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 143'd St., Tukwila, WA 98168
ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL
5.0 mastic NAD adhesive, cellulose
bathroom holding white laminate on walls around shower/tub
5.1 white mastic NAD adhesive, cellulose
bathroom holding gray base cove
6.0 sheet vinyl flooring
bathroom — color: white
6.1 mastic
beneath previous sample
NAD
NAD
7.0 vapor barrier NAD
beneath hardwood flooring throughout — color: brown
8.0 drywall/taping compound/paint
walls & ceilings throughout sample 1 composite
8.1 drywall/taping compound/paint
walls & ceilings throughout sample 2 composite
8.2 drywall/taping compound/paint
walls & ceilings throughout sample 3 composite
9.0 textured paint material
kitchen
9.1 textured paint material
living room
9.2 textured paint material
bathroom
9.3 textured paint material
east bedroom
9.4 textured paint material
west bedroom
NAD
NAD
NAD
NAD
NAD
NAD
NAD
NAD
continue to page 5
non -fibrous materials,
cellulose, fiberglass
adhesive
cellulose
non -fibrous materials,
cellulose, gypsum
non -fibrous materials,
cellulose, gypsum
non -fibrous materials,
cellulose, gypsum
paint, cellulose,
non -fibrous materials
paint, cellulose,
non -fibrous materials
paint, cellulose,
non -fibrous materials
paint, cellulose,
non -fibrous materials
paint, cellulose,
non -fibrous materials
1429Ave. D. #187, Snohomish, W.4 98290
425-489-4040; f 775-665-0420
www.asbestorest,com• jnfo@asbrestoest.com
Page5of9
M2190312
ANALYSIS ID
COMMON AREAS:
10.0 composition siding
11.0 vapor barrier
beneath previous sample
12.0 insulation
in exterior walls — color: brown
paper faced
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S.143rd St., Tukwila, WA 98168
ASBESTOSIITYPE//QUANTITY OTHER MATERIAL
13.0 vapor barrier
material beneath particle board siding
14.0 composition roofing
first layer
15.0 composition roofing
2nd layer
16.0 mastic
holding composition roofing
17.0 vapor barrier
beneath composition roofing
BBB
NAD cellulose, tar,
non -fibrous materials
NAD cellulose, tar, fiberglass
NAD cellulose
NAD cellulose, tar
NAD cellulose, tar,
non -fibrous materials
NAD cellulose, tar,
non -fibrous materials
NAD cellulose, adhesive
NAD cellulose, tar, fiberglass
continue to page 6
d_T
1429 Ave. D. 6187, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www.ashestotes(.com' info@,astnes(otest.com
Page 6 of 9
M2190312
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 143'd St., Tukwila, WA 98168
continue to page 7
C"7"..")
1429 Ave. D. itl87, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www.ashesioiesi.com- info@asbiesrmiesi.com
Page 7 of 9
M2190312
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 143' St., Tukwila, WA 98168
continue to page 8
1429 Ave. D. N187, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www.asbesroresecom; info@asbtestotest.com
Page 8oj9
M2190312
BBB
Ealage
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 143"i St., Tukwila, WA 98168
FLOOR BOARD IN ATTIC
VERMICULITE UNDER FLOOR BOARDS IN ATTIC
FLOOR BOARD IN ATTIC
continue to page 9
1429 Ave. D. h187, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www.oshestotest.com• info@ashtesuxest.com
Page 9 of 9
M2190312
March 26, 2019
Asbesto-Test, Inc. 425-489-4040
6404 S. 14314 St., Tukwila, WA 98168
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".
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. guideline.
If, during demolition or renovation, any additional suspect asbestos containing materials 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)), those materials are presumed Asbestos Containing Materials unless determined
to be non -asbestos by laboratory analysis.
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 (L.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.
PLM (polarized light microscopy) 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
Analytical test method: USEPA 600/R93/116" (PLM); WAC296-62-07753 App. 1
•'One percent is the USEPA regulatory limit for asbestos in bulk samples.
xey:
'FRIABLE" signifies "Easily Airborne"
ACM signifies "Asbestos Containing Matenar
PACM signlies Presumed Asbestos Containing Materiar
CAB signifies 'Concrete Asbestos Board"
< signifies "less than"
TSI signifies Thermal System Insulation"
HVAC sign' eating Ventilating Air -Conditioning"
NAD nlfles "No Asbestos Detected"
r yn mmoniT • re , B
Analyt cal Chemi A proficient
Inspector, certified A.H.E.R.A.
accred.#168598 (Expires July 18, 2019)
BBB]
RT
1429 Ave. U. 11/87, Snohomish, WA 98290
425-489-4040; f 775-665-0420
www.asbesroiesicam- info@oshtesloteii.com
ERMIT COORD COP?
PLAN REVIEW/ROUTING SLIP
PERMIT NUMBER: D19-0190
PROJECT NAME: JUSTIN RESIDENCE - DEMOLITION
SITE ADDRESS: 6404 S 143RD ST
X Original Plan Submittal
Response to Correction Letter #
Revision #
DATE: 06/12/19
Revision #
before Permit Issued
after Permit Issued
DEPARTMENTS:
(Q(31 VI 04
Fire Prevention
Building Division
Structural
cp
PRELIMINARY REVIEW:
Not Applicable
(no approval/review required)
REVIEWER'S INITIALS:
APPROVALS OR CORRECTIONS:
Approved
Corrections Required
(corrections entered in Reviews)
Planning Division
Permit Coordinator
DATE: 06/13/19
Structural Review Required
DATE:
Approved with Conditions
Denied
(ie: Zoning Issues
DUE DATE: 07/11/19
Notation:
REVIEWER'S INITIALS:
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg El Fire 0 Ping 0 PW El StaffInitials:
12/18/2013
Ho] Contact
Safety & Health Claims & Insurance
41111Ik Washington State Department of
Labor & Industries
A-Z 'Index tiLlp My MI
Workplace Rights Trades & Licensing
BOYCE CONSTRUCTION INC
Owner or tradesperson
Principals
BOWELL, ROBERT
BOWELL, SHERI
Doing business as
BOYCE CONSTRUCTION INC
WA UBI No.
601 538 339
628 SOUTH BRANDON STREET
SEATTLE, WA 98108
206-264-8085
KING County
Business type
Corporation
Governing persons
ROBERT
A
BOWELL
SHERI LUCILLE BOVVELL;
Certifications & Endorsements
OMWBE Certifications
No active certifications exist for this business.
Apprentice Training Agent
Registered training agent. Check their eligible programs and occupations.
License
Verify the contractor's active registration / license / certification (depending on trade) and any past violations.
Construction Contractor Active.
Meets current requirements.
License specialties
GENERAL
License no.
BOYCECI066Q4
Effective — expiration
11/18/1994— 01/21/2020
Bond
DEVELOPERS SURETY & INDEM CO
Bond account no
178017C
$12,000.00
Received by L8,1 Effective date
12/07/2001 11/18/2001
Expiration date
Until Canceled
Insurance
..„ ....
WESTERN NATIONAL MUTUAL INS $1,000,000.00
Policy no.
CPP119931300
Received by L&I Effective date
Help us improve
11/13/2018
11/1812018
Expiration date
11/18/2019
/1—N\
Insurance history
Savings
No savings accounts during the previous 6 year period.
Lawsuits against the bond or savings
No lawsuits against the bond or savings accounts during the previous 6 year period.
L&I Tax debts
No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts
may be recorded by other agencies.
License Violations
No license violations during the previous 6 year period.
Workers' comp
Public Works Requirements
Workplace safety and health
LT:jt Washington Slate Dept. of Labor & Industries. Use of this site is subject to the laws cf the state ot Washington.
Help us improve
m
0
w
0
4
0
c
0
.0
a
0
0
PLANNING APPROVED
No changes can be made .tothese
plans without approval from the
Planning Division of DCD
Approved B, 4L t
Date:
Fire Vault
SEPARATE PER
RE UIRED FOR:
Mecbanicel
[/ Electrical
Plumbing
[/Gas Piping
City of Tukwila
9UILDING DIVISION
Street Access
c
0
a
0
0
Line
Sewer
Driveway
Fire Sprinkler Line
6404 South 143rd St,
Demo House
860-Sq, Ft,
32'..4„ x 26'-6"
tD. GPYO
Perron No.
Plan review approval a orbit:to errors
nmans Approval of donsmNion doC IV 1 ass
or autP Jut: violation of anv adopted mole or
ardinan Receipt of aporoved Field Coy and
Co 'lions
By
Date;
Scale in
City or T"
IttDiNG DNISION
20.25.30
REVISIONS
No changes snail be made to the scope
of won; wnnout Prior approval of If>e
Tukwila Building Division
NOTE: Revisions will require a new plan
submittal and may Include additional plan revel
West Property Line
Gas Line to 6406 Bldg,
East Property Line
These plans have been reviewed by the Public
Works Department for conformance with current
City standards. Acceptance is subject to errors and
omissions which do not authorize violations of
adopted standards or ordinances. The responsibility
for the adequacy of the design rests totally with the
designer. Additions, deletions or revisions to these
drawings after this date will void this acceptance
and will require a resubmittal of revised drawings
for subsequent approval,
_Final--aKeptanee is-subject°to field inspectiorb _..,. r_____ .._..
the Public Works utilities inspector.
Date: By:
6406 South 1431d St.
Bldg. 40' x 160'
REVIEND FOR
CODE COMPLIANCE
APPROVED
JUN171019
City of Tukwila
BUILDING DIVISION
Demo of House at:
6404 South 143rd St.
Tukwila, WA.98168
RN 131919
TUKWILA
PUBLIC WORKS
Property Owners
James L. & Gail AJustin
3110 North Gove
Tacoma, WA. 98407
Contact Phone: 206-660-7712
North
North Property Line
RECEIVED RECEIVED
CITY OF TUKWILA
j;!Ilt�
PERMIT CENTER