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TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 - YELLOW-' TOR
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PFIRTNER'S CLINSI M l-ax:2Ub-8ti2-(9-',b �;ep 2b 'U1 e:01 P. Us
Agency Cate NO. KJGET SOUND CLEAN A13L AGENCY Date Received
110 Union Stiom Suite 500
a SmWc�WA 98101-2038
........... -P 25 2001
2QG103036 www.psclea=.org S�-
A9--y U. 0* N017CE OF UMNT Ar-y UAd Nly
A. ProJect Tyw: —1 1. 0 Asbestos Rmayal 2. Asbestos Rinnovid & Datn-litio- 3. Ikomolitiost, No Asbestos Rmovd
Owner.
r- Asbestos FEMMUT cmoLt ma r"
Contractor Partners Construction, Inc
Owner/CEO! Danid R m.ffav
MailinsAAdress: 1313 Cea" Ave Soutb. Suite A
Phone: 2W57S-7429 -
Job No.:
City: vast —
I State: WA
ZiE, 98032m7409
Fax: 253.SS2-7936__
1273a
F. M A or
Mt?tus Survey
I Presumed
I No. of s Survey
I Shuctures: I was Conducted: 7-V�-I I
Was Friable Asbestos identified? 2gYes Lj No
was Nodriatite Asbestos rdentified? Nyes El NO
Attach a copy oftbe sumey, ifoonfliabla asbestos is
idernified or ifno asbestos is idendflod on survey.
AHERA Building Inspector. Balltancluiry
Certification No.; 546401589,03
1 Exp. Diue� 17-8-1
1 Sme! WA
-��Stftrt
of
I Dole, 10-12-1
Tmnmg ire DW.'
Ordered �-��92NJ,
F. :—M-
.
forsaad...
Demolitim ",-" 1,1� -11-11 'i-aft *W, -mb"d Will notiffi-hie asbestos be left in place during
C..: NorWcs Construction IfM list type and qry.
Fs --D at —e it - —s,— — Tom'PletionDam:
Asbestos PrAject
Wortsmition.
10-11-1
Work Diy,z� S. S.
Hem: 94
Total Ory. to be Rernoved: Linear Ft. 361 Souare
Thermal lefftenstelm UDiciltw UPipelm.
oo- Vermiculite insuistion
d Coatings
Oth-
u Pipe EJ-Fj��Flocffing cc Ptoofing Mid')
Othm
EL AsbcoosiDemmolitim Projft-t Catelones:
1. Single -Family. (Check box A & B for asbestos remmal & demolition)
A. 0 Asbestos ReflW&I Project
B. W Demolition Proicct
Notirkation PeAW
<ZLj;�, Notice
1_0 Days
ftlect Fee schedule
$ 25 Nan-ReftaWsbic
Fee Covers Asbestos
Remvsl & Demolition
2.
AD Other Demolitions With No Asbestos Rgmval EE&ct
1013ays
S150
a 10 - 259 linear ieCt or > 49 - 159 sq=c feet ofasbestos (Bw back)
10 Days
260 - 999 finear feet or 160 - 4,999 square lect ofasbegoa
IODays
$300
5.
1, - 49,999 ailumm fi�d of asbestog
, fed Or 5,000
10 Days
1 7 0 1
>ft9,999
lincar fed or > 50,000 square toot oftsbestos
10 Days
1 $2,000
7.
Emagency Asbestos Prolect or LI EmeMency Demolition PT ect
Pnor Notice
I Twice Proiect Fee]
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i=wwdek At PartnerS CARMT-4110MI-1-1kc- 9-2S-1
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PARTNER'S CONST INC Fax:206-852-7936 Sep 25 '01 7:01 P.04
The I>uger Sound Clean Air Agency requires itivance notification before any person. commenc-cs-a friable asbestos project
involving materials equal to or greater in size than 10 linear fed or 48 square feet and for all diantifition projects
(regardless ofasbostos content) involving structures with a pt�cjocted roofam greater than 120 square feet (Regulation III,
Article 4), All asbestos removal and demolition notifications must be submitted to the Agency on CwTcnt Agency forms.
Asbestos rmovaLand demolition Projects involvinit MMIM:JaI3 and smxtm betow the notification threshold = still
111- Article 4.
subioct to all oJbl;I.Mguircmcnts of RUWation
The Agency notification form must be used to submit a notification for an asbestos project. a combined asbestos and
demolition project and a demolition project where no asbestos removal is required prior to demolition. After receiving a
complete notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and
demolition contractor by mail. The returned copy will be your validated notification.
J. — r—.— ,
Oe" (A.) C S CQn S:r4,j r 7,-,)4
Ow—/CEO� J e::Cp 'Y' -A. -Je"
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Mailing Address: "i L/ � f'J.
417- 7 7 5 -5 S-Y1
Jccon`970"'
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city jL-Q�=D"
75p-
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GUIDELINES FOR SU0MrrnNG AN ASSESTOSXDEMOLI'nON NOTIFICATION
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Step 1. Check the appropriate project type in Box A.
In
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Step 2. Enter property owner information in Box B.
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Step 3. Enter the asbestos contractor or property owner iriftirmation, if the property owner is conducting a single-family residemW
project. in Box C. Print clearly this is your return mailing label.
C 2
Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with a site map
Ch
(include an address for each lite) and a list ofthe type and amount offriable asbestos to be removed from each structure,
0 -n
Step S. Check either asbestos survey or material presumed in Box Z. All demolitions require that an Asbestos Hazard Emergency
Response Ata (AHERA) sitbamos survey be conducted by a certified AHEPLA building Inspector. Attach s,�,opv ofthe siryev results i
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the notification jubmittal bir proiticts where - 'able asbestos
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Step 6. Enter the project information in Box F. and check the training fire or ordered demolition (a copy ofthe official order must be
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attached) if appropriate. All asbestos must be removed prior to conducting is training fire Additional training fire requirements are
contained in Regulation 1, Section 8.08. If any nonfiriable asbestos mat-Tuds will be left in place during demolitiom check yes and list
the W and quaritity ofmat".
Step 7. Enter asbestos Project information in Box G.
z
Step & For Singile-Family Residential projects, check BOX HIA for renovation projects. BOX H10 for demolition projects with no
BOX HIA HIB for asbestos removal and demolition projects The total Project fee for single-family
z3bcstos removal and and
(esidenuid projects is $25 regardless of category or categories chosen. Asbestos removal my be conducted after a complete
z
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tionfIcation is received, but demolition activities can only begin on the I& day after the notification is rectived.
For Commercial asbestos projects; check the project category H2 - 6 that matches the amount of friable asbestos that will be
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removed. The project category fee includes both asbestos removal and demolition. To Me for an emergency asbestos or demolition
project, check the appropriate box I - 6 and the applicable emergency box in HT All amtruengy reaurns must be accompanied by a
jencr ft= prgperty o-ner dcfnc)n=ina the nod to conduct the prQi= immediately in aicordsto.kth the reguLrements i
the
Regulation III- Section 4,03 (c)
Step 9. Plem certify the accuracy and completeness ofthe information provided by signing the notification in Box 1.
Mandatory amendments to the notification are required fbr changes that increase the project category, change the types of asbestos
materials to he removed and work schedule changes. No The is required fbr work schedule changes ifthe contractor is participating in
the Agency work schedule fax program. A fifty -dollar processing fee is required fbr all other amendments
Puget Sound Clean Air Agency asbestos regulations and forms can downloaded from the Agency web page at www.pscleanair.org.
For technical assisistire contact (206) 689-4058 and for administrative inquiries contact (206) 699�4090.
PS/,WA F— tJ.. 66-160 (R—d YAW) AM
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
WWI..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING*
�Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING � ..................
FIRST�fl_OOFI FRAMING...,
INSULATION ...................
Floor Insulation
Wall insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
fvl�
OCCUPANCY ..................
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DATE RECEIVED
Hill
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CITY OF EDMONDS Us
PERMIT
NUMBER 2001-07/9
08 SUITEIAPTIF
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CONSTRUCTION PERMITAPPLICATIOA JADDRESS,
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISIO1 NO.
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ENG. REVIEW FEES
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TIUFT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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FAX
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