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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS DR HER SPOUSE, HEIRS. ASSIGNS N SU CES RS
ENG. INSPECTION FEE
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TOTALAMOLNTDUE
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I HEREBY ACKNOWLEDGE
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- e No. PUGET SOUND AIR POLLUTION CONTROL AGENCY Date Received
-�g—y Cas I to Union Street. Suite 500, Seattle, WA 98101-N38
NOTICE OF INTENT
"'.,-y I., -, TO PERFORM:
' .4-Project Type: 1 1, � Nsbestos Removal 1 2. Ll .45bestos Removal & Demolition 13. 12 Demolition. No Asbestos Removal I
'* ""';�Steve Pond 2P6.955.6999
Prop"ay Owner'M n
Mailing Add.,,F- %.,JBox 6072/ Edrno6ds, WA. 90,QW6 1,1.:
C. ASI-1- ConuMWC Or
Owner/CEO:
Contractor
Nfailina Address:
Phone; I
Job No.:
Cirv: State: ZiD:
Fax�
P"oject Manager or
rn—df P&,tnn-
insDector Name:
F, Dernolift
Worras so I
., one Star,,
Structures: I Daul:
Training Fire (List Fire Dept. as demolition contractor below)
Ordered Demolition (attach copy of Orde,
Demolition
Contractor:
Phone: I
C. Asbestos Pro 0. of S.1n,'grureV. Start Compludurt ys: M T W Th F So Su
Informatio .. t.c. 1) Date, Wl'...."
..?"t I N� Date:
'e Yes
Total Ouannry to be R oved� Linear Ft- Imam Ft. I rW� 0 No
ThffmalSvstcmlnsuiation: I Boilcr\F=ac- . U 1).0 Ins. LJ Pipe Ins.
I Oth,.
I Surfacing Mat'l: I U Fireproofing LJ Faints U Plaster U Texturod Coatings
2aa'.
L��Maf'l: I W cement Hd W cement Pipe U Flooring Mat'l L3 Roofingflfat'l
AsbostosA)emoiitionProj'ectCattgorim;
U Owner-Occaupied Residential Asbestos Removal Project
Q Owner-Oc"pied Residential Asbestos Removal & Demolition Project
d Residential Demolition Project. No Asbestos Removal
Notification Wallin
Proiect Fe
NON-REFUNT)AB
Effi9d
Prior Notice
$25
2, All Other Demolitions With No Asbestos Removal Pro cct
10 DaYs
$150
3. 10-2591ineir et or 48 - 159 sguare feet (see back ofform for options)
3 Days
$150
4. 260 - 999 linear feet or 160 - 4,999 sqnart; feet
10 Days
"I
L=311=11-
5 1000 - 9 999 linear feet or:j UUU - 49 999 Stmare felt
10 Days
6 Ll 30.000 - 49,999 'near feet or M.000 - 9 . 99 square feet
IID �
ay,
15
7' W 5U.0ou - 99.999 linearr et or RX0.000. 149.999 square feet
av
10 !L-
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9' W IOD.000+ linear fee[ or 150.00G+ sauarc feet
10 Days
Slo.000
�9 L, Emereenev Asbestos Proiector W E
: Project I=
Irm Alternate means or comoUance for fria
! Project Fee
11. -.J Alternate means or Comuliance for nonfliable asbestos materials
I Concurrent with I'miect
I T,i,- Proiect Fee
1. 1 do hemby cwufy that the Inforowdon coatidned inthIs notifleation. md supplemental dois dosaibed he"h Is (a the b�,' of mv krawlotge
,wv� d —Plow. I A.11 not all.. y bus praj,ot � d--fifi-o scn,,id- - bosrin ..fil th. pp.ps. wdual; pi.d has
el2psed.
—D-
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Al— W, 0�&
PSAPCA F-- N.. 66-160 (R—M o196) ANI
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To: Mr. Steve Pond
PO box 6072
Edmonds, WA. 98026
INFORMATION ABOUT SURVEY FOR ASBESTOS IN BUILDING MATERIALS
ir Background Information and Scope of Work:
ADDRESS: 19019- 80'h West/ Edmonds, WA.
OWNER: Steve Pond PSAPCA Case #
An,
INSPECTED and SAMPLED: March 08, 2000.
AREAS SURVEYED7 most of entire house except for: concealed/ hidden/ inaccessable
M, AREAS EXCLUDED� NOT SURVEYED: concealed/ hidden/ inaccessable locations
LDAITATIONS7 did not look inside all wall & ceiling voids, cavities, crawlspaces & attic
or underneath piled debris due to burned out nature ofbuilding.
AFTER SURVEY: planned —demolition,
Building Description:
BUILDING TYPE: single-family residence.
SPECIAL FEATURES: 2BR, approx. I 100 SqFt on concrete foundation, hip roof, 21ayers
of three tab asphalt roof, vent flue block type chimney.
CONSTRUCTION DATES: built about 1940's, renovation dates unknown, new walls &
ceilings 1992 according to owner.
MUCTUR SYSTEM: wood framing, I floors, on concrete foundation.
MECHANICAL SYSTEM: electric(independant wall unit) heating system/ removed.
ROOFING SYSTEM: asphalt 3 tab shingles, 2 layers, over tarpaper. Some repaired B.U.
NONSTRUCTURAL SYSTEMS 7 (not inherent to building
Building Inspector and Laboratory:
INSPECTOR: Gordon Crawford, dba GCC, ABERA Asbestos Building inspector
certification #916190604, expiring 05/25/00,
phone 206-723-7972.
-OR ClaytonEnvironmental Consultants,
LABORATORY: Blue Sky Testing Labs, Seattle
Seattle, NVLAP #101106-0.
Survey Methodology:
PROCEDURE: ABERA sampling protocol in 40 CTR 763.86
SCOPE: destructive sampling within accessable areas
LOCATIONS SAAVLED: homogeneous areas
SAMPLING METHODS: teaspoon size, into 2x2" plastic bags.
ACCESS TO HODEN AREAS hidden or inaccessible areas likely to be disturbed:
Plumbing pipe in walls/ crawlspace/ floors
Asbestos Identification Process:
E MATERIAL LOCATION ELAN: (2)Functional spaces/ levels 1-2 /(19)HSA's
,5;
RESULTS: No listed ACBMs, PACNTs or ACM positives. Samples taken are
summarized in in the accompanying 2-page (T.O.R.)TABLE OF RESULTS
"TABLE OF RESULTS" AS "SURVEY #030800SP", cover letter.
Notice to Renovation or Demolition Contractors:
CONCEALED AREAS: inaccessable crawlspace under building, concealed plumbing
insulation PACM (Presumed Asbestos Containing Materials) & wiring insulation PACM or
material under/ around/ in burned debris PACM.
HIEDDEN AREAS: wall & ceiling voids
HAZARDOUS AREAS: Non Asbestos Hazards (structural fire & water damage)
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GCC
927- 21 Ave. E.
Seattle, WA 98112
April 6, 2000
CONTACT: Mr. Steve Pond
PO box 6072
Edmonds, WA. 98026
re: Asbestos survey #030800SP
Dear Mr. Pond,
A completed order for an AHERA asbestos survey for purpose at demolition of house structures At Premises
address of 1 gol 9 So" West/ Edmonds, WA. was received by us 03/08/00.
please find the ancloged entitled: "Information About Survey For Asbestos In Building Materials, "Table Of
Results (a 3 page a9b0gtOS survey tables describing physical assessment, field data summary tables, ate.). Also
included ate some PSAPCA forms which may be Completed for you by the building contractor, ia: notice Of
intent and instructions. our agreement includes a provision for m . a to provide you with the Completed survey
when I am paid in full.
Information reviewed: Built 1940's renovated dates 1992, Walls/ ceilings/ plumbing, according to owner.
Scope of work: The enclosed list Of materials were sampled assessed and analyzed. TWO functional spaces
were defined by floor level and the roof. The ground level and Main floor considered (1) as well as foundation Of
house, the roof designated as (2). Nineteen (19) HSRS, (HOMOQOneOur Sampling Area's) ware defined, (0)
were proven positive by destructive sarnpring over (22) Samples necessarily taken and employing testing
laboratories listed in the two copies of enclosed entitled "information About Survey For ArbagtOg In Building
Materials- . one copy should be posted in a conspicuous area at the site prior to activities.
Findings: of the two functional spaces in survey# 080300SP where (22) samples were taken from (19) HSA's,
there were (a) materials certifiably proven positive (>1 %asbestos) of which (o) is considered friable ACBM. In
addition Homogeneous Area# (112 & 114 describes burned and charred debris from fire which hag devastated
the premises
CONCEALED AREA
Wall cavities, ceiling 6 floor voids which May Contain Old decommissioned PACM insulated water plumbing pipes
and electrical wiring. However I found none. Due to the nature of the premises being structurally compromised
by fire with remaining debris, this hag unavoidably imposed limitations in the survey as called out in the survey
information "Information About Survey For Asbestos In Building Materials".
HAZARDOUS ARE No asbestos hazards are present
Further:
enclosures:
A) Notice of Intent for abatement project may be completed by owner or contractor according to enclosed
PSAPCA rules and guidelines enclosed.
B) PSAPGA Homeowners guide enclosed
ds
Regar >
Gordon Crawford
AHERA Carl.# 916190604
206.723.7972
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TO: Mr. Steve Pond
PO box 6072
Edmonds, WA. 98026
INFORMATION ABOUT SURVEY FOR ASBESTOS IN BUILDING MATERIALS
Background Informatto andScopeorWork:
ADDRESS. 19019- go' West/ Edmonds, WA.
OWNER: Steve pond PSAPCA Case
INSPECTED and SAMPLED: March 08, 2000.
AREA—SUR : most ot entire house except for: concealed/ hidden/ inaccessable
SSUR—VEYED
�D- NOT 9 iYED: concealed/ hidden/ inaccessable locations
AREAS EXCLUD URVE crawlspaces & attic
ED - �N-Ly� "� u t%v r & ceiling voids, cavities,
L_INUTATIONS: did not look inside all wall
or underneath piled debris due to burned out nature ofbuilding.
AFTER _SURVEy.. planned jemolition.
Building Description:
BUILDING T)[RE-7 single-family residence.
SPECIAL FEATURES: 2BR, approx. I 100 SqFt on concrete foundation, hip roof,
2 layers of three tab asphalt roof, vent flue block type chimney.
S: built about 1940's, renovation dates unknown, new walls &
CONS, LUCTION DATES:
ceilings 1992 according to owner.
STR13CTUR SYSTEM, wood framing, I floors, on concrete foundation.
� VS—TEM: electric(independant wall unit) heating system/ removed.
MECHANICAL - tarpaper. Some repaired B.U.
ROOFING SYSTE alt 3 tab shingles, 2 layers, ovei
NONSTRUCTUR—AL SYSTEMS: (notidnt t
Building Inspector and Laboratory:
INSPECTOR7 Gordon Crawford, dba GCC, AHERN Asbestos Building inspector
certification 4916190604, expiring 05/25100, phone 206-721-7972.
LAB ATORY: Blue Sky Testing Labs, Seattle -OR Clayton Environmental Consultants,
Seattle, NVLAP 4101106-0.
Survey Methodology: sampling protocol in 40 CFR 763.96
PROCEDURE: AIIERA
SCOP : destructive sampling witrun accessable areas
LOCATIONS SAMPLEID- homogeneous areas
SAMPLIN N_MTHODS: teaspoon size, into 2x2" plastic bags.
le areas likely to be disturbed:
ACCESS TO "IDDEN AREAS: hidden or inaccessib
Plumbing pipe in walls/ crawlspace/ floors
Asbestos Identification Process:
MATERtAL LOCATION P—LAN: (2)Functional spaces/ levels 1-2 /(19)HSA!s
re
RESULTS: �o A�isied ACWs, PACM`s or ACM positives. Samples taken a
summarized in in the accompanying 2-page (T.O.R.)TABLE OF RESULTS
"TABLE OF RESULTS" AS ,SURvEy #030800SP", cover letter.
Notice to Renovation or Demolition Contractors:
CONCEALED AREAS: inaccessabie cTawlspace under building, concealed plumbing
insulation PACM (Presumed Asbestos Containing Materials) & wiring insulation PACM or
material under/ around/ in burned debris PACM.
HIDDEN AREAS: wall & ceiling voids
HAZARDOUS AREAS: Non Asbestos Hazards (structural fire & water damage)
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Gordoa Cra%fwd AHERA Cut. #9161906G4 Sheatl
927. 21 Ave. E.
Scattle,W.k 98112
2D6.723.7972
AHERA Sway 0030800SP for demolition: Table of—ult, 19019- 80 Wvni Edmon&, WA
Material Desc. Material Location HSA# Sample # Pos.% Asbestos Friable YIN Amount Damage Disturb.
It
SIDING& EXTERIOR SURFACING
SIDING& EXTERIOR SURFACING
#
#
SURFACING MATERIALS:
SURFACING MATERIALS:
#
#
SURFACING:
- ROOF SURFACING
- ROOF SURFACING
0
#
ROOFING
ROOFING
lAsphaftcomp.&B.8�,
�nlaer�j-
East ever portch
2D1
030611.11SP
no
no
I 500sqft
no
no
2
Asphalt comp. & B. =g (layer
Eastover portch under the above
201
030BI 1.2SP
no
no
1500sqft
no
no
3
White painted (Asphalt comp. roofing layer 1)
S.E. gable pairded white
202 030810.16P
no
no
same
no
na
4
Roofing layer 2 (Asphalt cornpositiDn)
Under the above
202 03DB10.2SP
no
no
same
no
no
5
Rooling layer 3 (Asphalt composition)
Under the above
202
030810.3SP
no
no
some
no
na
6
Asphalt tar patch
Typical me
�
203
030815SP
no
no
spots
no
M
. MASONRY & SURFACING
VM1.20- E—SUNFACING
#
#
7
Chimney block
Rooftop
204
030812SP
no
no
2DaH27
no
na
8
1 Masonry cNimnev 11 or
Rooftop
205
030813SP
no
no
same
no
no
9ITapping
layer at chimney cap
Rooftop
206
030814SP
no
no
spots
no
no
10IMasonry
bobbing lay r
Extedor foundation wall N. side @ vent
107
03DO18SP
no
no
spots
no
no
11
Exboriargy ok sheathing
Exterior N.E. wall under siding
108
030907SP
no
no
12ODsqft
no
no
12
Exborior 2D# building fatt
Over the above
109
030808SP
no
no
same
no
na
. FLOORS & INTERIOR SURFACING
- FLOORS & INTERIOR SURFACING
#
#
13
17 X 17ficortile
Kitchen & utility
110
0308WASP
no
no
lostift
no
no
14
Adhesive under the above
KAchan & utility
111
0308M.2SP
no
no
350 sqft
no
no
15
XiF —dobns on floor
Bathroom floor burned out material
112
030809SP
no
no
259qft
no
nQ
- WALLS; & CEILINGS
- WALLS & CEILINGS
#
#
16
G;ypsum wallboard and texture
Utility @ N. soderior vall
113
030801SP
no
no
80sqft
no
no
17
Gypsum mliboard and ceiling debris
Burnad out W. front rooms on floor throughout
114
030805SP
no
no
18
Gypcel bird
Utility room & center taped joint
115
030802SP
no
no
120sqft
no
no
19
Gyposil & Joint & texture
S.E. bedroom @ joirot
116
030803SP
no
no
120sqft
no
no
20
Gypoell & joint & topping
E. adjoined bedroom
117
030EI04SP
I no
no
2009qft
no
no
- INSULATION:
INSULATION:
1��
d
21
;!t�baolt=
'iy N.E. exterior %vall
UL
lie
030515SP
no
no
1120Dsqft
no
—rw--
22
9.E. bedroom wifing
1 119
030817SP
I no
no
111 00sq1t
no
no
Page 03 of 04 MURATEG VF108011 'From:MLIRATEC UF100011 Sun Apr 9 03:21:55 Z0.
MRR-28-2000 15:26 CLAYTON GROUP SERVICES 206 763 4169 P.03/04
Log # 25695
Client- GCC job / P0 0 030800SP10322001201
U.,
L on. None Givers
ocat!
...
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SAMPM01308050
'd
No Asbestos Detect""
tioMOGENEC)IJS
Asbestos '/h X_iZ I
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No Asbestos Detected
0 -n
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Asbestos Asbestos %
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0 giplion: White palut over b1Rck25PhR1t1c fibers
-c
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Note:
. ...... ...... i .... .
am.
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No Asbestos Detected LAYER2
Z
non-mbestoo %
Asbestos % fibe M ...
In
'RIM
Asbesto 3
Asphalt Pillar & Binder 60
Mi.,ral Fillar & Binder 40
""";I
Description; Whit. ad red pabbi... bliek asphaltic runterill
Note:
ANALY7,M)TAY:
plimlihmARYREPORT Tracy Perkins
the maiL
ON 3/2812009
Labvlafv'YDaigShvelLfo,lbmmmdfa-dpsoA
Vertned by:e
Page 04 of 04 MUHATEC UF1800/t From:MURATEC LIF1080/1 Son Apr 9 63:2Z:3Z Z009
Mo AMs b��� FR 3
e"stos Detected LAY
Asbestos
Asbestos %
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717
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Note-
pRELyNnNARY REPORT ATMLYZED BY!
Laboratory Data Skew Isfor tab nsg andfaxing only. Thefmd report wittfollow in the malL M.L7 P.kin.
ON 1128/2000
TOTAL P.04
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CITY OF EDMONDS GARY HAAKENSON
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
February 15, 2000
Steve Pond
P.O. Box 6072
Edmonds, WA 98026-0072
Dear Mr. Pond:
The purpose ofthis letter is to inform You Of the latest status concerning the land use complaint
that had been submitted against your Property at 19019 — 80d' Ave. W. in Edmonds. Originally,
the complaint was concenung nuisance items being kept illegally on site. Today the City of
Edmonds needs to address an issue conceming a dangerous building as well as any nuisance
items being kept on the site illegally. Your land use complaint had been assigned to enforcement
case file numbered ZE-99-55.
According to the Dangerous Building Code, it is illegal for a single-family residence to remain
that has become an attractive nuisance and dangerous building in the City of Edmonds. Onjune
7, 1999, You were notified that the building was required to be completely reconstructed with a
valid building permit or removed by December 31, 1999. Since then the City ofEdmonds has
not received notice of your intentions or been able to verify progress towards correction. Asa
result, I am notifying you that you have 30 days to submit a building permit application to
reconstruct your residence or completely remove the house and all nuisance items from the site.
In order to comply with the code, you must take corrective action by March 15, 2000. Ifthe City
of Edmonds has not received your application for the reconstruction of your residence or an
application for the demolition of your residence, then on March 16, 2000 a Notice of Civil
Penalties will be issued. The Notice of Civil Penalties begins fines of $100 daily until this issue
has been resolved.
if you have any questions, comments or concerns then please contact me at (425) 771-0220.
Thank you for your cooperation in this matter.
Sincerely,
OAWII�f�
Jeannine Graf —
Building Official
Incorporated August 11, 1890
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RECORD OF INSPECTIONS
DATE APPROVED
INSPECTOR
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
pier/Porch ............ a:
Retainirig Wall ...........
Stab Insulation .......... -4
PLUMBING:
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EXTERIOR SHEATHING
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Ceiling Insulation ....... -------
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SHEETROCK NAILING
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ICS NA=�
ANG ADDRESS
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YES 0 NO
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REMARKS
'WI—ONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
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VARIANCE OR CU
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VALUATION FEE
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BUILDING
PLAN CHECK NO: IVESTED DATE
PLUMBING
MECHANICAL
H,S.pERglT AUTP�O'VAIZBS .1,111 THE WORK NOTED. THIS PERMIT COVERS WORK TO
E E PRGPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
WAY ) WILL REQUIRE
_��OMAW CUR11, SIDEWALKS. ORIVI S, MAROUIES, 'TC,
PERmIssla 4.
STATE SURCHARGE
—SEPARATE
PERMIT APPLiCATIDN: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P PLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOR
OF
[N. ILI.ITI.ANY.THECIT
ENG. I.SPECTI? I N FEE
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13 N NTEREST. AGREES TO INDEM141 DEFEND AND HOLD HARMLESS THE CITY
I 'ANY AND
FROM
LANDSCAPING
EDMONDS. WASHINGTON,tTSOFFICI LS, EMPLOYEES. AND AGENTS
ALL CLAIMS FOR DAMAGE OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT 11EC1111
I D E.ED TO MODIFY. WAIVE 0 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
I E PROVISION.'
0 Y'S ABILITY TO ENFORCE ANIORDINANCE
RECEIPT
TOTAL AMOUNT DUE
F4��6�7
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL J"T
I HEREBY ACKNOWLEDGE
GIVEN IS CORRECT. AND THAT I A. THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
P� ..d
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AUTHOPIZED THEREBY. N
TION. AND IN DOING T o PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
-It `71"p` - 2`p
IN VIOLATION OF ,"EW.RK
E LABOR CODE OF THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW IS 27
OFFICIAL 'SIG E
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,IGNATy,p!��NER OR ADEN I I E SIGNED
(425)
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771-0220
RELEASED
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G OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDiN 771-0221
INSPECTION HAS KEN MADE AND APPROVAL OR A CERTIFI,
ORIGINAL FILE - YELLOW INSPECTOR
A FINAL
HAS BEEN GRANTED. UBC SECTION 109
FAX.
PINK -OWNER - GOLD ASSESSOR
CATE OF OCCUPANCY
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