20020004.pdfDATE IIICIIVIII//
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
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PERMITAPPLICATION. INDAYS I
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Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPUrANT Oil BEHALF OF HIS OR HEII SPOUSE, NEVIS. ASIABNS AND LCCESORS
Traffic Mitigation
IN INTEREST. AGREES TO INDIMNIF'K DIFEIID AND HOLD HARMLESS Till CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OFWHATEVE NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
FREDA THE ISSUANCE OF THIS PERNUER ISSUANC� OF THIS PERMIT SHALL NOT 89
D=rTOMODFY AIWE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Y THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I W THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN TION OF THE BO Cool OF THE STATE OF WASHINGTON 'I'LATING TO
FOR INSPECTI(
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"1771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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Recording Fee
City Surcharge
State Surcharge
Plan Chit Deposit
Receipt III
Total Amount Due
Receipt #
APPUCATION APPROVAL
This applisiAwn Is not a ponhil unit istinedbythe
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WALIM SPECULTY
CONSTRUCTION INC
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January 16,2001
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Raglewood Inc.
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'Home,,,
CmigReimer
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18607 Olympic View Drive
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RE: Aqbeslos Removal at 18725 94'h Ave West, Bilmondii, WA
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Please let this letter serve as verification that the following ACM materials have been i
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removed and disposed of in accordance with all regulatory agency rules und regulations.
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Puget Sound Clean Air Agency and Department of Labor & Industries Notifications, Air
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Monitoring and Waste klaniicst are herewith enclosed,
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As idcritified in survey by NVL Labs, dated 11/27/0 1:
Approximately 2.10 SF Sheet Vinyl Flooring/undorlayments in kitchen, 120 Sr;
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Sheet Vinyl Flooring/underlayments in rear entry bathroom, 4u SIT VAT in ftom
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entry, 180 8F VAT in master bedroom, I sink in kitchen and 120 SF non -friable
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roofing.
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Sincerely,
Linda Walker
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TABLE OF CONTENTS
Subject
Page
1.0 SCOPE OF WORK
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2.0 SURVEY METHOD
2
3.0 LABORATORY INFORMATION
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4.0 BUILDING DESCRIPTION
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5.0 FINDINGS
6-6
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6.0 CONCLUSIONS AND RECOMMENDATIONS,
7-8
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7.0 LIMITATIONS OF SURVEY
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APPENDICES
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Sample Locations (Map)
A
Laboratory Results
B
AHERA Certifications & Laboratory Qualifications
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18725 94th Avenue West, Edmonds, Washington
Project 9 2061-1125
1.0 SCOPE OF WORK
An investigative survey for asbestos containing materials (ACM) was conducted on a
residential structure located at 18725 94th Avenue West, Edmonds, Washington.
The inspection was conducted on November 21, 2001 by Lisa Kollasch, an AHERA certified
building inspector. This inspection was performed at the request of Craig Reimer of Eagle
Wood Homes.
The purpose of this inspection was to identify asbestos containing materials that would be
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impacted by the planned demolition of this structure.The northeast portion of the first floor of
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the house was excluded from this survey. It was inaccessible at time of survey.
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The garage affic was excluded from this survey. Access to this space was not available at time
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of survey.
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No visible damage was made during sampling, per request of Craig Reimer.
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The asbestos survey section is written to comply with the AHERA asbestos sampling
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procedure as stated in 40 CFR 763.86. This protocol is required for all asbestos surveys prior
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to a building demolition under the Puget Sound Clean Air Agency, (PSCAA), Regulation 111,
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Article IV, revised July 13, 2000.
The asbestos survey also satisfies the 'Good Faith" asbestos inspection requirements as
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stated in Washington Administrative Code (WAC) 296-62-07221(2), 'identification". As stated
in this regulation, the owner of a structure scheduled to be renovation/demolished must provide
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a contractor with a written report of the asbestos containing materials to be disturbed during
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renovation/demolition.
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The National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61
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requires a survey by an accredited asbestos inspector prior to demolition of a structure.
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A floor sketch indicating sampling locations has been included in Appendix A.
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NVL Laboratories, Inc., Page I
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 - Fx (206) 634-1936
18725 94th Avenue West, Edmonds, Washington
Project# 20OT-1 126
2.0 SURVEY METHOD
Asbestos Survey Method
A walk-through inspection of all accessible areas of this structure was performed to identify
potential asbestos -containing materials. The walk-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,
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roofing, wall materials, etc.) were obtained of each material to satisfy the requirements of the
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Asbestos Hazard Emergency Response Act (AHERA) rules and regulations. These samples
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were placed into plastic sample bags, numbered and recorded.
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Homogeneous Materials
Homogeneous materials are defined as an area of Asbestos -Containing Material (ACM) or
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Presumed Asbestos -Containing Material (PACM) which appears similar throughout in terms of
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color, texture, and date of material application. The report listing for homogenous materials will
appear as follows:
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Sample
Number
Material
Description
Location
Asbestos
%
Area
Friable
job#-01-01
whitefloortile
kitchen
job#-01-02
white floor tile
kitchen
job#-01-03
white floor tile
kitchen
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Under OSHA Guidelines, a minimum of three negative analysis of a single suspect
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homogeneous asbestos containing matedal is required to prove a negative result for surfacing
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materials and thermal system insulation.
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NVL Laboratories, Inc., Page 2
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 Fx (206) 634-1936
I.
1872�5 94th Avenue West, Edmonds, Washington
Project# 200i _1125
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, then subsamples of the components were analyzed
separately. All Bulk samples are analyzed using EPA Method 600/R-93/116 with the following
measurement uncertainties for reported % Asbestos (1 %=0-3%, 5%=> 1 -9%, 1 0%=5-15%,
20%=1 0-30%, 50%=40-60%). For samples containing more than one separable layer of
materials, the report will include findings for each layer (labeled Layer: 1, Layer: 2, etc.). The
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asbestos concentration in the sample is determined by visual estimation.
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Laboratory Accreditation
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Professional accreditations for NVL Laboratories, Inc., include the following:
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NVL Laboratories, Inc., is currently accredited by the National Institute of Standards and
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Technology (NIST) under the National Volunteer Laboratory Accreditation Program (NVLAP)
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program for bulk asbestos fiber analysis. NVLAP Lab Code 102063-0.
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NVIL Laboratories, Inc., is approved by the American Industrial Hygiene Association (AIHA)
Asbestos
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Analysts Registry (AAR) program for airborne asbestos fiber analysis. Counter ID
7412.
NVL Laboratories, Inc., is currently accredited by the American Industrial Hygiene Association
(AIHA) under the Industrial Hygiene Laboratory Accreditation Program (IHLAP). The IHLAP
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program is designed specifically for laboratories involved in analyzing samples to evaluate
workplace exposure. Certification Number 563.
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NVL Laboratories, Inc., Page 3
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 Fx (206) 634-1936
18725 94th Avenue West, Edmonds, Washington
Project # 2001-1125
4.0 BUILDING DESCRIPTION
General Building type:
This is a three story single family residence with a detached garage.
Primary
external components:
The primary external components of the house are wood shingles. The garage has concrete
and wood,
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Type of foundation:
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The house has a full concrete basement. The garage has a concrete slab foundation.
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Roofing materials:
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The house has wood shingles. The garage has built-up tar layers and 3-tab asphalt.
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Window types:
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The house has vinyl windows with no putty, wood framed windows without putty and wood
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framed windows with putty. The garage has wood framed windows with no putty. There are
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detached wood framed windows with putty behind the garage.
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Flooring:
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The first floor of the house has a concrete substrate. The second and third floors have a wood
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substrate with overlay areas of carpet, sheet vinyl and vinyl file.
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The garage substrate is concrete.
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Thermal systems w/insulation types:
The house utilizes electric baseboard heating. Blown -in insulation was noted in the attic. No
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suspect thermal pipe insulation was noted.
Finishing:
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The house has wood paneling, The garage has concrete.
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Page 4
NVL Laboratories, Inc.,
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 Fx (206) 634-1936
6.0 FINDINGS
inventory of Suspect Asbestos -Containing Materials
Material
Location
Asb stos
Area
Friable
Desert tion
%
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es1no)
I - b, sheet
kitchen floor
IND
vinyl:wn
2- g, y backing/
2:45
230
yes
yellow mastic
3- yellow vinyl
3:ND
4- vapor barrier
4:ND
nnnpr/ mastic I
1-2
11- brown sheet
living area, floor
IND
vinyl
2- gray backing/
2:45
allow mastic
1-tanlZ'x12"Vinyl
front entry, floor
file
2:ND
2- white mastic
40
no
3- brown vinyl file
3:3
4- black mastic
4:ND
2-2
1-tan12"x12"v1nyl
front entry, floor
1:ND
tile
2:ND
2- white mastic
3- brown vinyl tile
3:3
4- black mastic
4:ND
—
3-1
1- tan qN9" vinyl
master bedroom floor
1:3
180
no
tile
2- black mastic
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2*ND
3-2
1- tan 9114" vinyl
master bedroom floor
1:3
tile
2- black mastic
2:ND
4-1
1- white sheet vinyl
rear entry bathroom, floor
IND
2- gray backing/
g/
2:45
120
yes
yellow mastic
3- tan vinyl file
3:3
4- vapor barrier
4:ND
a a I at[
4-2
I-W ites It vinyl
re
IND
2-9 yb Ing/
2:45
yellow mastic
3- tan vinyl tile
3:3
4- vapor barrier
4:ND
a er/mastic
3
1
yes
5-1
black sink
kitchen
sink
undercoating
j4D - —None Detected
NVL Laboratories, Inc.,
4708 Aurora Avenue North. Seattle, WA 98103
Ph (206) 647-0100 - Fx (206) 634-1936
Page 5
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Sample
Material
Locat on
As%stos
Area
Fria a
Number
Description
(fe)
(yes/no)
6-1
white blown -in
attic
ND
insulation
6-2
white blown -in
attic
ND
insulation
7-1
vapor barrier paper
house roof, under wood
ND
shingles
7-2
vapor barrier paper
house roof, under wood
ND
shingles
8-1
vapor barrier paper
exterior, under wood
ND
siding
8-2
vapor barrier paper
exterior, under wood
ND
siding
9-1
window putty
house,east
ND
10-1
1- 34ab asphalt
garage roof, north
1:ND
2- vapor barrier
IND
paper
10-2
1- 34ab asphalt
garage roof, south
1:ND
2- vapor barrier
2:ND
paper
11-1
1- built-up tar
garage roof, northeast
1:ND
2- built-up tar
2:ND
3- built-up tar
3:5
120
no
1,11-2
built-up tar
qarage roof, southeast
ND
12-1
garage exterior
12-2
1(3arage exterior, north
I ND
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ND - None Detected
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Any suspect material(s) not identified above should not be disturbed, and tested immediately.
The suspect material must be t reated as asbestos containing until testing proves otherwise.
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NVL Laboratories, Inc., Page 6
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 Fx (206) 634-1936
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18725 94th Avenue West, Edmonds, Washington
Project: # 2001�1 126
6.0 CONCLUSIONS AND RECOMMENDATIONS
ASBESTOS
The following summarizes the homogeneous Asbestos -Containing Materials (ACM) and
Presumed Asbestos -Containing Materials (PACM) identified at the residential structure located
at 18725 94th Avenue West, Edmonds, Washington.
1. Brown Stone-Pattenned Sheet Vinyl: (material number 1)
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There is approximately 230 fl:2 of asbestos -containing brown stone -patterned sheet vinyl
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flooring in the kitchen and living area. The gray fibrous backing/yellow mastic tested positive
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for asbestos. The vinyl flooring below this brown she at vinyl in the kitchen did not test positive
for asbestos. The substrate is wood.
2. Brown Vinyl Tile: (material number 2)
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There is approximately 40 fe of asbestos -containing brown vinyl tile flooring in the front entry.
is below a layer of
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The associated black mastic did not test positive for asbestos. This material
tan I Z'x1 2" vinyl tile. The substrate is wood.
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3. Tan 9"x9" Vinyl Tile: (material number 3)
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There is approximately 180 1112 of asbestos -containing tan 9"x9" vinyl file flooring in the master
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bedroom. The associated black mastic did not test positive for asbestos. The substrate is
wood.
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4. White Stone -Patterned Sheet Vinyl: (material number 4)
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There is approximately 120 fl:2 of asbestos -containing white stone -patterned sheet vinyl flooring
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in the master bathroom. The gray fibrous backinglyellow mastic layer tested positive for
asbestos. The tan vinyl tile below this material also tested positive for asbestos. The substrate
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is wood.
6. Black S ink Undercoating: (material number 5)
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There is one sink with an asbestos -containing black undercoating in the kitchen.
6. Brown Sheet Vinyl: (mate rial number 11)
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There is approximately 120 It2 of asbestos -containing built-up tar layers on the eastern portion
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of the garage roof.
Approximations of square footage are offered as an added service to the client. These
numbers are not exact values and should be confirmed by the client and participating
contractors.
NVL Laboratories, Inc., Page 7
4708 Aurora Avenue North, Seattle, WA 98103
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Ph (206) 547-0100 - Fx (206) 634-1936
18725 94th Avenue West, Edmonds, Washington
Project # 2001 .1125
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 State Department of Labor and Industries and PSCAA require that the abatement
be performed using Certified Asbestos Workers under the direct on. -site supervision of a
Certified Asbestos Supervisor. 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 accessible during the time of surveying can
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sometimes conceal ACM. Thus, NVL recommends that an AHERA inspectorlproject manager
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be on site at the time of renovation/demolition to ensure that any potentially asbestos-
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containing materials uncovered during the process of renovation/demolition be dealt with
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properly.
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NVL Laboratories, Inc., Page 8
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 Fx (206) 634-1936
18725 94th Avenue West: Edmonds, Washington
Project 2001-1125
OF SURVEY
7.0 LIMITATIONS
The sole purpose of this survey report is to document asbestos -containing materials
discovered in the survey of suspect materials by NVL Laboratories personnel at the residential
structure located at 18725 94th Avenue West, Edmonds, Washington on November 21, 2001.
This site visit consisted of a thorough visual walk-through of the building for the purpose of
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vieviting and sampling potential ACMs. As hazardous material surveys are non -comprehensive
for destructive
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by nature, NVL Laboratories, Inc., cannot be held liable materials which r equire
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means to access, materials which are hidden from sight (e.g. materials hidden behind walls),
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materials which cannot be found due to their obscure nature, or which otherwise cannot be
discovered with reasonable diligence.
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This document is the sole property of NVL Laboratories and the property owner, or his agent,
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authorizing this survey.
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Inspected by: Reviewed by:
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Lisa Kollasch
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AHERA Building Inspector Benjamin T. Cook, HMM
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AHERA Certification No.: 998618 Hazardous Materials Specialist
AHERA Certification Expires on: April 27, 2002 Certified Hazardous Materials Manager
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Page 9
NVL Laboratories, Inc.,
4708 Aurora Avenue North, Seattle, WA 98103
Ph (206) 547-0100 - Fx (206) 634-1936
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE4*0-21—
PLANNING DIVISION DATE
PROJECT
SITEADDRESs
PERMIT #— Qc) C). 0C),?0 ADB# DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED b
A field inspection was conducted to determine fmal compliance with approved plans. Final approval
denotes that there are , no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
2. MICROFILM
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sign_
ocaprv1.doc.1:temp.-b1dg:fbnns 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wall ................
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Stab Insulation ..........
PLUMBING:
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Rough -in ...........
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HEATING:
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GasTest ................
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Equipment .................
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
IT
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ................
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