20040032.pdfr
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 15
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
B e Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SiDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
1 Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
_j
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt 0
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1141S PERMIT SHALL NOT BE
LandscapeInsp.
Total Amt. Due
93 R REDUCE ANY REQUIREMENT OF ANY CIPY ORDINANCE
DEEMED TO MODIFY, WAIVE 0
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0 NOR LIMIT IN ANY WAY THE cl ry-S ABILITY TO IENFORCE ANY ORDINANCE PROVISION
xi
Recording Fee
Receipt if
,ell
I HEREBY ACKNOWLEDGE THAT I HAVE READ 1111S APPLICATION. THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
I hisapplication e, not a pUfnlil Until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF IIIE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Budding 01ficial or tusiher Deputy. and Fees are paid, and
tecuipt is acknDwIedged if, space provided
IN V61-ATION OF THE LABOR CODE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27
OFF1 Cs SIGNAIURF [)AT E
SIGNATURE (OWNFIJ 0
DATE SIGNED
(425)
771 0220
DAlt
RFLFASED BY
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK 0%1�141:fi GOLD - ASSESSOR
09;03 PRESS HARD -YOU ARE MAKING 4 COPIES
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12/24/2003 08:27 FAX 206 689 4073 PS CLEAN AIR
sent dy: WALKER SPEC CONST; Q001
To: PSA;,p # 4' 4258087383; Dec-l-q-03 4:05PM;
At: 92066894073 Page I
AgT61C `T� - PUGET SOUND CLEAN A�', AGENCY Date Received
290 110 Union strect, Suite 500
1 19 2003
A "101-2039
www.pseleanair.org
48dticy um Only NOTICE OF TNTENT Agency Use unty
Friable Ashett-n- Dentolitign 3, 1)elijolitlon Only
A, Proimt Type- Friable Asbestos Removal
Property Owner: Voetmann c/o Tom Braaten Constrtiction Phone: (425)637-2663
L��ia Address: 3443 Evergreen PoInt Rd Ci�: Medi, ia State WA I Zip. 98039
E—A�bestw
C ontractor, Walker Specialty Construction, Inc. Owne -/CEO: Bill Walker
Contractor
Mailillp, AddroSS: PO Box 469 _thont : (425).806-7377 Job No.:
Zip: 98291 1 Fax: (jU5 806-7383 A2542
Snohomisb State; WA -TCity: Ednonds Zip. 980io
A-Adren- 18916 Sound Viuw Place
Site
Manager: Torn Braaten Local Phone: (425)637-2663
E. I—Asbenos Survey or I i�ol' of Date of Asbestos Wag P-riable Asbestos identified? Eyes oNo
—j3 Mat'l Presumed ictwes: I Survey 1-1-IBLQ Was -14onfriable Asbestos Identified? MYes oNo
AHM-3LA Building Certification CLAYS327 Atrac h a copy ofthesu"ey whonfriable asbesrav
4
Inspector ArLyrn Hammond Exp, Date 8/12J04 Lhaus P or been idgntiflecL
An AHNRA Survey ig required Ware 211 clemolitifin jwujeea No. of 1.3Training Fire (List Fire Dept.)
information: I Date: 1/5/04 Structures: 1 2. :1 Ordered T)arnolition (attach cop
F. Demolition Start _y of Ordeo_
Demolition Will tionfriabic asbestos b, left in place during demo? o Ycs M No
4' ontraccor; Goodnight Construction Ifyes, list type and qty.
VVoTk Days-., M T W Th F Sa .9 u
F. � - -�w-
rolect Information. --F;t7aTt Daie: 12J29/03 Completion Date- 114/04 Mum- '60
G, Friable Ajbe6tos
Wi
It all :' �Ie�s e'sos to Yes
Tota: Qty. to beRcrnoved: Linear Ft 26 Square Ft. materials be removed? N 0
Thermal Sytitem Insulation: I LJEloileAlFurnaceins. U Duct Ins. U Ilip� Ins. 01�.Cr:
Surfilcing al'l: LJ Improofing U LJ piaswr LJ Textured Coatings ober:
Cemcrit lid. U Cemcnt Pipe M FriobIc Floaring or RocifingM.Pel Ot cr:
Misc. ma!i]
1,11. Asbestos/Demolition Project Categories: itirication Period p5Ak��! Detnlition
I , Slngle-Faml)y Residence: Fee rcharve
A, f Asbestos Removal Project Only A. Pxior Notice & $25
B. iDeniolition Project (with or without asbestos removal project) B. 10 Days*
J. C�-
'(Asbestos removal can begin upon notificatim demolition must wait 10 dW)
Notur.- If Mesinglefamily residgnce Is ownedbyonefamily who has been or will he using I ie residence as their-domicil-0, the 00 Ve boxes
1A or ]Bmav he checked. - A si"Ie am It amitv anhs. or an mLud-usebudding.
y tesidence does not Lnclude rgnialpropero, mui'14
2. U AR Other Demolitions With No Aabestos Removal Proiect 10 DMs
Friablo Asbestos Projects (other than Single Family Residcritca): Asb mtos Derno
Lit >— 10 .259 linear feet and/or ��: 48 - 159 saRre feec of asbcatos Pric r Notice 10 Days $150 sloc
$200 $too
4. - 999 linear 1'eet and/or 160 - 4,999 square fectof asbestos 10 Days
5. 0 >1,000 linear feet and/or >5,000square feet of asbesto3 10 Days $750 $250
�—T U Emergency MbdStOSProject or LJ Emergency 1)emolition Project Prior Notice Twicc Project Fee
I (Siagle-FaMBY Reskiences arc exempt from emergency vido A writi in emergency rcqutso
I Certify I
itio Wbrrnation c4intaincd in this notAcOiDn & suppierriental daLa Is, to the h"L uriny knawledg) accurate & cornpIctc. Ag
Walker Specialty Constrixtion, In, 12/19/03
Signatun ewedAIV
Pugi.-t Sound Cicnn Ait AgcnL-y rorm No.: 66-160 (Ravi6ad 9/03) TS 4V-��/� y
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ReoelVed: 12/24/03 9:36AM;
12/24/2003 08:28 FAX 206 689 4073
OeNt. MY: WALKLM Sl-tt; UUNS I
206 68P
4073 ->.WALKER SPEC CONST; Page 2
PS CLEAN AIR
4258067383; DeC-19-03 4:06PM;
1?1002
Page 2
Thit Puget Sound Clean Air Agency requires advance notification before any persot cornmence�s a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square fee and for all demolition projects
(rej!,ardless of asbostos content) involving strucuires with a projected roof area gri am than 120 square. feet (Regulalion
111, Article 4). All asbestos removal and demolition notifications must be submh:ed to the Agency on current Agency
forms. Alihgg -me L
.2s removal a d demolition proiects hivolving materials and sp turt below the notificAticialbreshold are
�L_
stil! subiect to all 9gho_r_req_4J[prnents of R lation M Article 4. Site Address: 18 ? 16 Sound View Pl, Edmonds
After recaiving a complete notification with the appropriate project fee, the Ageizy will review the form and return a
copy to the asbestos and demolition contTactor by mail. The returned copy will be,,our validated notification.
J. Demolition
Co
Mailing Address: PO Box 1347
State: WA I Zip: 98272
C011tVactor's
11honc: (360)194-6220 1 Job#:
GUIDF-LINES FOR SUBMITTING AN ASBESTOSIDEMOLITIC -N NOTIFICATION
Step 1. Check Lho appropriate -project type in Box: A. Friab sabasto includes popcorn cei ing material, sheet. vinyl flooring, cemulit
asbestos board siding, and duct insulation. Nonfr ible aahegqug isnormally found in vinyl fl or tiles, window putty and. most roofing
macerials.
Step 2. Enter proporty owner inforTnation in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the propeTty own,:r is conducting a single-family residential
prcject, in Box C. pript clear ly thi3 is your rcturn mailing label.
Stk,p 4. Enter the site address for all notifications i * n Box 1). For multi -structure projects. amch supplemental sheet with a site map
(include an uddress for each sitc) and a list of the type and amount of ftiable asbestos to be t -moved from each structure.
Stup 5. Check either asbestos survey or material presumed in Box E. All demolitions rt quire that an Asbestos Hazard Frnergency
Reiponso Act (AHERA) asbestos survey be conducted by a certified AHSRA building InE -tector. AttacILa- copy of the survey To the
estos or no asbestos is,identlH LMALsurvey.
Stop 6. Enter the project information in Box F. and check the training fire or ordered di molition box it'appropriate (a copy of the
offlcial order must be attached). All asbestos mint be removed prior to conducting a training fire. Additional training rire
requirerneaEs arc contained in Regulation 1, Section 8,08. If any nonbriable asbestos niatei;als will be left in place during demolition,
chuck yes and list the type Hnd quantity of material.
Swp 7. Enter asbestos project information in Box G. List types of �riable asbestos matairia to be removed: surfacing material such as
popeorn ceilinp or plaster, sheot vinyl flooring, duct and pipe insulation, cement asbestor, h,)ard siding or pipe, etc.
St ;p 8. For Single-FamilY Residential projects-, check BOX H1A for renovation projects Box q1B for demolition projects with or
wiliout asbesioB rctnovaj. Asbestos removal may be conducted after a complete notificati, in is received, but demolition activitin ran
unly begin on the I O'h day after the notification is received, Note: ff the shWk family i midence is owned by one fondly who has
bezn or will be using the residence as their domicile, baxes 1A or III may be checked. , I singlefamitv residence does not include
reital property, multi -family units, or any mlted-use building.
For Commercial asbestos projects (or projects that do not qUSlify R5 Single Family R isidential); check the project category H2 -
5 -hat matches the amount of friable asbestos that will be removed. If a demolition is iavolved, include the appropriato surcharge
(additional fee) in your payment. To file for an emergency asbestos or demolition projei t, check the appropriate box I — 5 and the
applicable emergency box in H6. All emeralgiry. roquests Mast be agsi2Wpanicd by a 10 ftoalhq. - -
negA' toa ents In e i ti n 111,Seghgn 4_0S L�),
Sitap 9. Please certify the accuracy and complewness or the information provided by siguir g the notification in Box 1.
Mandatory antendrneriLs to the notification are required for changes that increase the prc Icct catc6ory, change the typcs of asbestos
m-iterials to be removed and changes to start date., completion date and work schedule fi r asbestos project- No fee is required for
work schedule cl=ges Ir the contractor is participating In Jha Agency work schedule fax pi ogram. A $25.00 processing f" is required
fw all amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can, downloaded from th; Agency wcb page at www.pseleaftaLr.org,
For technical assistance cuntact (206) 689-4058 and for 2dministrative inquirics coutact (2116) 689-4090.
PLrCL Sotii%d Cleall Air Agrney Farrn Nu., 66. 160 (Reviscd 9/01)'173
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DEC 29 2003 2:20PM HP LASERJET 32.0.0
AIR SAMPLE DATA SHEET
WALKSU
NPML&Lvv Page Of
TAS C"STSECT1101111111 Job Number
P.O. Box 469, SNOHOMISH. WA 952911 -0469 Client Job Number
(206)3614913,(360)505-0354, FAX (425)806-7383 Number of Samples
GCNWALKESCO54LO,, Asbestos Cert. #011198 AbatementFirm:
Client: 10
I Q4 Results to:
Location: I
Blank Cassettes:
Date: Blank count:
Sampled by: (AVG.)
Company: Date:
R ived b
eceived by:t Date:
Analyzed by:
Microscope filed area: or 37mm
ilter size: (circle one) 5m
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Sample iD:A � 2Sq 2 V I t IJJ
Location: e- "A
qObservatlions:
Sample Type: W Cert #: 1? 2-14 �—,4
%Norker:64 SS#:
Protection: Time. Sta ate: Start Fibers] Fibers/
Decon: Time: Start .2-9- End Liters Fields cc
Environment: End Average
Pump L Minutes
Sample ID:^',L�
Sample TypeL.__�.
Protection:
Decon:
Environment' —
Pump
Sample ID:)4---,;
Sample Type:4�
Protection:
Decon:
Environment: —
Pump #: —
Sample ID: _
Sample Type,
Protection:
Decon:
Environment:
Pump
Sample ID: _
Sample Type:
Protection:
Decon:
Environment:
Pump ft:
LOMI
Observations: SB#: Cert #:
Worker Rate: Start Fibers/ Fibers/
Time: Start End Liters Fields cc
End
Minutes
_Ljr— Average
—J_jLocation:
Observations:
Worker: .
—Time: Start —
End
Minutes =
Location:
Observations:
Worker:
Time: Start_
End
Minutes =
Location:
Observations:
Time: 9tan_
End
Minutes = —
--Sample Types`
B-Breathing Zons p-pre Abatemeni
TWA CL-clearance
A -Area X-AGgressive
I -Inside r6g 2F92 H-HEPA exhaust
o-outside rea aroa c-CellIng
BL.Fleld Blank
SS#: Cert #:
Rate: Start Flhers/ Fibers/
End Liters Fields cc
Average =
SS#: Cert #: —
Rate: Start Fibers/ Fibers[
End Liters Fields cc
Average =
SS#: Cert M.
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End
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..**Control Choices-*
ResplrAQU-RMWf&= Dmailtmtallam EindmMeaL
PA -Pressure Demand Air D,s-Decon w/Shower H-HEPA Vacuum
CA-ContInUCU5 Flow Alf D-Decon w/o Shower N-Negative Air
PAPR G-Glovebag
F-Full Face Mask APR
M-1-121f Mask APR
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WSC Job #A kAtMNCO Cont #
'*'V'VS
PSCAA # 3 WASTE SHIPMENT RECORD
1. Waste Generated Site Name and Address:
71
CV 9.4 C /0
0 rs Name:
&
Owners Phone No.:
'ni -
�- (
� Z-�)P 7 43
2, Operators Name and Address:
Operator's Phone No.:
WALKER SPECIALTY CONSTRUCTION, INC.
(206) 361-8913
PO BOX 469, Snohomish, WA 98291-0469
3. Waste Disposal Site WDS) Name and Address, and Physical Site Locations: WDS Phone No.:
RABANCO REGIONAL LANDFILL
1-800-927-5641
500 Roosevelt Grade Rd.
Roosevelt, WA 99356
4. Responsible Local, State or EPA Agency Name and Address:
PUGET SOUND CLEAN AIR AGENCY
110 Union Street, Suite 500, Seattle, WA 98101
5, Description of Waste Materials:
6. Containers
7. Total QuantRy
No. Type
M3 (yd')
Asbestos Containing Materials kzjz� V, 0
-I- F1'o-korak— Calk,
-TI i q -'\ I
V.
8, Special Handling Instructions and Additional Informationj
DOUBLE BAGGED & LABELED.
9. OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully accurately described
above by proper shipping name and are classified, packed, marked and labeled, and are in all respects In proper
condition for transport by highway according to applicable International and government regulations.
Printed/Typed Name
Signature
Z�
Month
Day
Year
10. Transporter 1 Acknowledgment of Receipt of Materials &Z'
Printed/Typed Name b-)l I:W)o
Signor re Inr
Mon)h
I L
�Jly
2
'y r
11. Transporter 2 Acknowledgment of Receipt of Material.
PrInted/Typed Name Signature Month Day Year
Rabanco Trander
2733 3rd Ave. S.
Seattle, WA 206-646-2565
12. Discrepancy Indication Space
Waste Disposal RRLC
13. Authorized Waste Disposal Site Owner or Operator: Certification of receipt of asbestos materials covered by this manifest except
as noted in item 12
:o
Printed/Typed Name IR E: Month Day Year
FEB 8 2004
101
WHITE: Return to Operator
UC;VEZLV['fV1LN1 UIrl.
CITY OF EDMONDS
YELLOW: Waste Site
PINK: Transporter
WHITE: Operator
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: MAU SM FIRE DEPARTMENT DATE--------
IVISION DATE—LD-�- 2 --Iz
ENGINEERINGI)
PLANNING DIVISION DATEL-------
MAN SMN
PROJEC
SITE ADDRESS
Z' ADB#-----------PATE.INSPECTED�—.--�'-.,1-71
PERMIT #
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval,
denotes that there are no objections from the above signed Department to the release of
ONDS and the granting of
]PERFORMANCE �B
__,\L_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAMED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector.
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvi.doc.l:tenip:bldg:fonnsIO/OI
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qECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...........
FOUNDATION:
Footing . ..............
Wall..........................
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 FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR 44/7
OCCUPANCY ..................
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