20040421.pdfP
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERIIT APPLICATION
P9 7AME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
I CITY
NAME
zip TELEPHONE
TELEPHONE
PERMIT EXPIRES
USE PERMIT
ZONE -1
NUMBER
JOB SUITE/AP
ADDRESS 1�7 x
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street use Permit Roq'd
EXISTING — PROPOSED Inspection Required
Sidowilk Required
Underground
REQUIRED DEDICATION- FT Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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PLUMBING MECH
ADDITION
..AIRES'IDENTIAL
COMMERCIAL
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SIGN
FENCE
�OADIKIG
REMARKS
OWN ERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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SIDE SEWER MUST 811 CAppFZ 4jT
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
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AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN I no DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
12 IN INTERES17, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcrty OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOI BE
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT 1HE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENI OF
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULAI ING CONSTRLIC-
TION; AND IN DOING THE WORKVUHQRIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA13OR E �F THE STATE OF WASHINGTON RELATING TO
WORKMEN'S/COMOENSATiON IN§ AN E AND RCW 18.27. j t
(OWNER R AG� �DA IIGN7
CHECKED BY
OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANI
LOAD
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REGI'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording ee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Base Fee 04:T
Plan Chk. Deposit
Receipt 0
Total Amt. Due 't f
Receipt # Z
APPLICATION APPROVAL
This application is not a PCIRIR Until signed by tile
Building Official or his/tier Deputy: and Friesife paid, and
receipt is acknowledged in space provided.
OFFICiALSPIGNAT UBE DATE,
RFLFASFD BY DATE
INT'ON I tyv I I
I TNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A� L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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Fax;425AHC34 May 20 2CO4 7;18 P.02
Limited Survey
to locate and Identify
Asbestos Containing Building Materials (ACBM's)
Subject prope rt ; Demo SFR Submifted lo: Joe Schnious
20130 Maplewood Dr Classica Homes
Edmonds VNIA 98026 745 Edmonds St
Edmonds WA 08020
(206) 972-0028, fax: (425) 771-7829
Labanalyelsby: EK0,lnc.
2000 70" PINE Property owner; Same
Marysville WA 98271
(360) 651-939D !nspection date , May 19, 2004
WCO WCS WC.1 WW WC11 Ww WC% W(V KAX MCI WCZ MXX WC* WW WCO WC1 VOW WCO VXX
Puripose
The above address was inspected to locate asbestos In accordance with federal and state laws.
The sampling methods specIfled in 40 OFR 763,88, a sub -section of the Asbestos Hazards
Emergency Response Act (AHERA), were employed with the following specific purpose in mind
Safety - Intended operations present the potential for dIsturbance of an ACBM, This
report was prepared to facilitate employee's safe performance of normal activities.
71 Removal. Specifically this survey anticipates :
Renovation. This may not Include use of destructive search methods (I,@,, -
breaking into walls, etc.) unless expressly directed by client In writing.
Demolition, Destructive search techniques are highly recommended and may
be Implied by statutes which require identification of all suspected ACBMs
prIor to demolition, [as 1.140 CFR 763.85 (a)(4)(1)]
Management, Information heroin w1!I be used by the property owner to develop an
appropriate Operations & Management (O&M) policy to reduce the likelihood of
exposure to building occupants for ACBM's which will be left In place.
Property $ale - Public buildings, including commercial and IndusWal facilities are
required to use an accredited inspector (see the Asbestos School Hazard Abatement
Reauthorization Act (ASHARA)I. Private buildings may be inspected to compliment an
appraisal.
MWods
Currently only persons having the AIHERA BuIldlng Inspector training are considered acceptably
accredited by all governmental agencies,
Mandated AHERA procedures are.,
training (for the inspector)
examining (materials which the inspector suspects)
identify (by sampling or by assuming material j2 an ACS"
assessing (friability, condition and potential for darnage)
documenting (the above with locations)
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Fa,(;42K03OE34 May ZO 2CO4 7;18 P.03
Procedures for sample collection often seem complicated to the layperson. What appears to be
the same material located In dIfferent areas, may, or may mot, require additional samples,
depending on the usage of each area. Sprayed and troweled on materials require at least three
tests to confirm they are = ACBM. Dlffering quantities of suspect homogeneous materials also
affect the number of samples needed.
Analysis of samples must be done by an accredited laboratory,
Assessing friability is done per the EPA definition that the material can be crumbled to a powder
using hand pressure. Neither the forces expected to act on any material or differing local regulatory
consensus can be anticipated by this Inspector,
An accredited Asbestos Management Planner should be consulted for assessments of condition
or potential for disturbance,
Estimated quantities are given as a courtesy and should not be relied on for bid purposes. An
accredited-Asbestoz ProiectDA"kner Is reguired for gUilatifying ACBM's.
The inspeotor who prepared this report hereby certifies by signature below, that
has received training pursuant to 40 CFR Part 783, Sub -part E, Appendix 0
has had at least ten (15) years professional experience In the asbestos abatement field
used his/her best efforts in locating suspect ACSIVI's
-Pzap 5a-Pa" 1005580 July 15, 2004
Bill Schroeder Certification Expiration Date
7
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to
M. 1)(!� is to rertifp that
Bill Schroeder
hag; sarigtartari1v ramplw-b
4 baur:� of rL-frrober training; ao an
Asbestos Building Inspector
tD rnnipip wab tbe training reqtij-,rmtntjf ot
Z*Ul Title 131 / 40 C-13X 703 (910C13,M)
".Prtificate Number 1003580
1 U)
Exarnswre: N/A
Expiration Date% Jul I a, 2004
A�ltw VuUie, E— - !ON 14. Ni6fmr, Sua, 3 �.q . EA ilia. WAI li
Limitaticol
Destructive methods 9 were were not (check one) employed 'in collecting samples for
laboratory analysis.
Sampling location drawings are not to scale.
Samples are believed to be representative of similar materials found throughout the areas
inspected.
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Fax-425203OC34 May 20 2CO4 7;19 P-04
Reasonable discovery efforts were used In preparing this report, Standard Industry practices
recognlze that every square Inch of a building cannot reasonably be exposed during the survey
process, especially in occupied structures. Wall interiors, underground pipes, septic tank Ilners,
every area under carpets or bum debri, we all examples of this, Consequently, some materials
may remain concealed which are not Identiffed In this report, Materials not addressed in this
report should be assumed to contain asbestos untill determined otherwise by an accredited
professional. The results of such analysis Must be incorporated by addends into this report prior to
disturbance of these materials. A copy of this report must remain onsite during such activities.
This report can be expected to become outdated as regulations, building improvements and
Intended usage of this information may onange over time.
Most demolition projects must submit this raport with their "Notice of Intent to Remove or
Encapsulate Asbestos" form required by local air pollution agencies. Typically these are filed by the
abatement or demolition contractor. Permit filings are not Included with preparation of this report.,
however, the permit forms may be attached herein.
Items not attached to structures are not normally addressed by this type of report.
Structures
A survey of I structure(s) occurred on the date listed In the head of this report. This is a single
story residence which has a basement and an attached carport,
H'stgrical
Historical records El were I X were not (check one) examined for use in this survey, This home
was likely built In the 1940;s.
General _NgJM
Following is a description of the construction materials examined at this address.
Roofing - This roof has asphaltic 3-tab shingles over a tar paper vapor
barrier. Sealant wwo not observed.
Ceilings & walls, Interior - Moo', wall and ceiling substrates are a typical smooth sheetrock
with taped joints systern. Asbestos was found In the joint
compound of the wall system, but not in the sheetrock. Wood
planks, wood paneling and fabric covers some walls. Ceiling
tiles have been stapled to the living room ceiling. A texture
material was added to all other ceilings and a few walls. Some
walls in the bathroom have ceramic tiles attached,
Wall surfaces, exterior - Siding is lopped wood products over a tar paper vapor barrier.
Floors Much of the home is carpeted which has been applied directly
to a hardwood substrate, Sheet vinyl found in the kitchen
has been conflrmed to contain asbestos. The bathroom floor
is ceramic tiles.
Insulation, structural The attic has blown -in cellulose insulation. Walls and floors are
un-insulated,
Host sources - A newer oil burning furnace found in the basement was the
primary heat source for the home. There is also a wood stove In
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Fax-425'1:030634 May 20 2004 7;10 P.05
the living room,
Insulation, thermal system - The wood stove flue Is not Asbasto-Vent". water pipes are not
Insulated. New ducts were installed with the newer furnace, and
these were partly wrapped In fiberglass insulation. A small
quantity of older ducts were found disassembled and discarded
In the NE corner of the craMspace under the living room, These
older duct remnants are wrapped In asbestos paper.
Glazing compounds - Windows are mostly wood framed types which do have glazing
compounds attached. A few aluminum framed cranking type
windows were also discovered, and these do not have glazing
compounds attached.
Wiring - Wiring has plastic sheathing only.
Doors - Doors are wood, glass or wood and glass.
Adhesives - Adhesives were not discovered. Cove base is wood,
Functional Spoon
Functional spaces are identified In order to determine a sampling plan which will be
representative of the materials found In areas of similar usage. The functional spaces identified at
this location have been deemed are (nominally) :
I indoor areas
0 , Outdoor areas
S-uspect Materials
Materials commonly suspected to bei ACBM's which were found during this Inspection are:
Doors
Floor coverings
insulation, structural
insulation, Thermal System
Mastic (adhesive)
17 Mortar or grout
Z Putty (or caulking)
1Z Roofing
El Sealants
Siding material
Vapor barrier membrane
Wall & ceiling finishes
Wiring Insulation
Homogengous Areas sity of products
Suspect materials are listed as shown below in order to determine the homogen
discovered. These are materials which are similar In age, color and texture. This property
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Fax.42520301334
contained the following materials which appeared homogeneous:
May 20 2004 7;21 P.06
1
Due paper
2
Coiling tile
3
Glazing putty
4
Joint compound
5
Roof shingle, 3-tab
6
Sheetrock
7
Tar paper
8
Texture
ID
Vinyl sheet goods
FIndimSe
Materials c*ntalning greater than 11% asbestos WERE discovered.
The table on the following page summarizes suspect materials Identified during this inspection.
Characterization of each material as surfacing, TSI or miscellaneous is made for the express
purpose of developing a sampling strategy and may not accurately reflect the product's designation
for abatement project design purposes.
10
Type
FS
HA
I
FrI
Description ILocation
ACBM
Oty
1.08
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1 1
Y
Duct paper
Crawl under living roo; 'NE Nomer
Y
20 of
US
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0
J 3
N
Glazing putty
Most windows
N
N/A
.0-48
3.0-49
Surf
I
1_8
Y
Texture
I Most Calling$, some wall$
N
N/A
-MC.-Oa
Nee
1
9
Y
Sheet vinyl
Klitchem
Y
126 of
$.Oa&b
Mlso
I
4M
Y
Wallboard system
Wall & Ceiling substrates
N
N/A
.on
a a Ots
MISC
1
2_
Y
Ceiling tile
Living room
N
N/A
7.08
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N
Roof shlngle, red 3-tab
All roof areas
N
N/A
a Oa
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7
N
Terpoper
Under roofing & siding
_N
NIA
Legend
AWO
TS1
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Thermal System Insulation
Surf
Surfacing (troweled or sprayed on)
Miso
miloallemeous
0
Amumed ACOM
Abbre Defin
ACSM Asbestos Con-alning Building Material
Fa Functional Space
HA Homogenous area
Fri Fdable
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P(Gied: WR damo
20130 Uaple%� Dr
Edawds WA 98M
Job#:
Bulk Sample Analysis for Asbeskm Fibers
Cbetd: Classico Homes Sarnping date - 06-19,2004 10-,30 Lab: EKO. Inc.
Address; .7Z Edmonds St Ely: Idl —Sdroeder Address: 20M 70th PINE
E-dmond3 WA 9WW Oeliveted by: INI S&neder ftwyAvile WA 9=1
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Doke: 06-19-2004 11A6 RUM (2 bout):
Tarp : 64 *F Ba": 40619a
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ZQZ 4
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT A —I
SITE ADDRESS- 2013412 D/2.
PERMIT #_Z_0 �14 12-J—ADB#_______----DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
e- lei,
A field inspection was conducted to determine 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
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE' given to owner/contractor by inpector
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:1emP:b1dg:r6rms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wall ..................
Pier/Porch . .................
*,Rdt�ining Wall .... ......
Slab Insulation ..........
PLUMBING:
Underground ............. ..
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
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
OCCUPANCY ..................
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