20040492.pdf8
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CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALI. CLAIMS FOR DAMAGES OF WHATEVER NAI URE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMI1 SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
19 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Description
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Receipt # 7
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, rIIAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AMTHE OWNER, 08 THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAI
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S,90NVIE,�SATION INSURANCE AND RCW 18,27.
OFFICIALS71GN
I (7A UREI DATE
DATE SIGNED -7
LSIGNATURE ER 0 (425)
(OWNER 0 AGENT)
i.". 771-0220 'RELEASED BY'
�ATE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BU I LDI NG OR STRUCTURE UNTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCLI- ORIGINAL - FILE YELLOW INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD-ASSrSSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
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k1UUE'F SOUND CLEAN AIR AGENCY Date Received
110 Union Street, Suite 500 RECEIVED
Seattle, WA 98101-2038
200300690 www.pscleanair.org JUL 15 M
NOTICE OF INTENT ru
I M 0 UMR M mi ywo
k, Project Type: 1. Q Friable Asbestos Removal 2. Friable Asbestos Removal& Demolition 3. a Demolition -Only
PLEASEPRINrCLF-4fiLr. MISMU BE Y0UR-RtTUR-'VA41UVGL48E1-
Asbestos
Contractor:
I
Owner/CEO:..
-Contractor
4ailing Address:
C% Li �-7,
Phone: — - V 1 1,�2
Job No.:
RGPT.
Ity:
State:
Zip:
1 Fax:
1. Site
Address: City: 5- ip:
C6
Site 111-16 - Va 96,5:3 c'ell
Manager: -ro/v Y DAdAyrt1.Z-' 1A Local Phone: /;L 5- 6
)i3 Asbestos Survey or No. of Date of Asbestos Was Friable Asbestos Identified? Uyes ZNo
El Mat'l Presumed Structures: QAA:5- Survey:. 6�- '1-03 Was Nonfriable Asbestos Identified? E]Yes'Wo
HERA Building NVL- C Ccrfification #: AWY-060 Attach a copy ofthe survey unlessfriable asbestos
Inspector: LTo6i*Terr;11 Exp.Date: is identified
i 4HERA Survey is required before all demolition projects
Demolition Start No. of 1. Ll Training Fire (List Fire Depi.)
Information: I Date: Structures: 2. Q Ordered Demolition (attach copy of Order)
Demolition 44TV911110 contractr 1 mailin addres an back I Will nonfriable asbestos be left in place during demo? U Yes W No
y
Contractor:.,-,. If yes, list type and qty.
1. 1 L011 ---,A. I - L- i , I I - -
Friable Asbestos
Project Informad
Start Date:
Completion Date:
Work Days: M T W Th F Sa Su
Hours:
Will all friable asbestos Q Yes
!s
materials be removed? No
)tal Qty- to be Removed: Linear Ft.
Square Ft.
st type(s) of material to be removed:
Asbestos[Demolition Project Categories:
Notification Period
Project Demolition
Single-Farnily Residence:
Fee Surcharpe
C] Asbestos Removal Project Only
A. Prior Notice
A. T2 5
1. C3 Demolition Project (with or without asbestos removal project)
B. 10 Days*
B. $50
*(Asbestos removal can begin upon notification; demolition must wait 10 days)
)te: If the singlefamily residence is owned by onefamily who has been or will be using the residence as their domicile, the above boxes
I or 1B may be checked. A singlefamily residence does not include rental prope muld-family units, or a mixed -use bu��
-21 All Other Demolitions With No Asbestos Removal Project
10 Days
S200,)
Friable Asbestos Projects (other than Single Family Residence):
Asbestos Demo
U �: 10 - 259 linear feet or �t 48 - 159 square feet of asbestos
Prior Notice 10 Days
$150 $50
260 - 999 linear feet or 160 - 4,999 square feet of asbestos
11—
10 Days
$300 SIM
U 1.000 - 9.999 linear feet or 5,000 - 49,999 square feet of asbestos
10 Days
$750 $250
[I > 1-0,000 linear feet or > 50,000 square feet of asbestos
10 Days
S2,000 $1,000
El Emergency Asbestos Project or U Emergency Demolition Project
Prior Notice
I
Twice Project Fee
I
(Single -Family Residences are exempt from emergency fee. however, property owne must provide a
written cmergenc request)
I certify that the information contained in this notification & supplemental data is, to the best of my knowledge, accurate & complete. Agency Use Onl
Representing Date Reviewed BY
et Sound Clean Air Agency Form No.: 66-160 (Revised 3/03) TS
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The Puget Sound Clean Air Agency requires advance notification before any person commences a ftiable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
M, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on cur -rent Agency
forms. Asbestos removal and demolition projects involving materials and structures below the notification threshold are
still subject to all other requirements of Regulation HL Article 4.
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.
GUIDELINES FOR SUBMITTING AN-ASBESTOS\DEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring. cement
asbestos board siding, and duct insulation. Nonfriable asbestos is non-nally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-fan-dly residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with a site map
(include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure. .
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a col2v of the survey to the
notification of a demolition 12roject w en only nonfriable asbestos or no asbestos is identified on the survey.
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire
requirements are contained in Regulation 1, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition,
check yes and list the tv
. pe and quantity of material.
Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as
popeom ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc.
Step 8. For Single -Family Residential projects; check BOX HIA for renovation projects, BOX HIB for demolition projects with or
without asbestos remoyal. -*Asbestos removal -may-be conducted after a complete notification is received, but demolition activities can
only begin on the 10h day after the notification is received. Note: If the singlefamily residence is owned by onefamily who has
been or will be using the residence as their domicile, boxes 1A or 1B may be checked. A singlefamily residence does not include
rental property, m ulti-family units, or any mixed -use building.
For Commercial asbestos projects (or projects that do. not qualify as Single Family Residential); check the project category H2 -
5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
',additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box I — 6 and the
ipplicable emergency box in HT be aFcompa*d by a letter from the propegy owner demonstrating the
-,ieed to conduct the oroiect immediately in accordance with the reguirements in Regulation III, Section 4.03 (cl
3tep 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box 1.
Aandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
-natcrials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
.York schedule changes if the contractor is participating in the Agency work schedule fax prograrn. A $25.00 processing fee is required
-'or all amendments.
3uget Sound Clean Air Agency asbestos regulations and fornb1can downloaded from the Agency web page at www.pscleanair.org.
-or technical assistance contact (206) 689-4058 and for administrative inquiries contact (206) 689-4090.
luget Sound Clean Air Aecncv FnrmNn - 6i�-1 A() lRevi"(' 11nil T'Z
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1.5111IJ �4W�
FUUET SOUND CLEAN AIR AGENCY
Date Received
110 Union Street, Suite 500
RECEIVED
Seattle, WA 98101-2038
200300690
www.pscleanair.org
JUL 15 2M
NOTICE OF RqTE novi
r L'V'0gM=4
I
k. Protect Type: 1. 13 Friable
Asbesto3 Removal 2. Q
Friable Asbestos Removal & Demolition 3. Demolition Only
6
Property Owner: I-4AIV
A :'P1
Phone: qA9-4C111- 546.311Z714z-
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4ailingAddress: city: State Wl� zip:Y�Oa-26
V% !!'� -I U 1k
PLEAMPRINTCLEARLr, MIS KLL BE! YOUR RETURNMAILING LABEL.
Asbestos
Contractor: Owner/CEO:...,.,,I-r
-Contractor
lailing Address: Phone: Jo No.:
RUT. n.
:ity: State: Zip: Fax:
1. Site City: Q)
Address: _M0A W, zip:
M _�t
Site I-C6 - q 7-1 - j96 673 c: el
Manager: -ro Iq Y L) o rn Local Phone: J/;L -e, - 6 91 "
a.4 AAYY
V Asbestos Survey or T—No. of Date of Asbestos Was Friable Asbestos Identified?' LlYes W(
0 NIat,i Presumed I Structures: Survey: 6� -1,V -0.3 Was Nonfriable Asbestos Identified? 0Yes *Qqc
.HERA Building AWL 4,4� Certification #: 1,009r,060 Attach a copy of the survey unlessfilable asbestos
Inspector: LTokr,*Ter/-;/i Exp.Date: J.-�4-0j4 is identified.
,,4 HERA Survey is required before all demolition projects
Demolition Start No. of 1. LJ Training Fire (List Fire Depi.)
Information: Date: I Structures: 2. Ll Ordered Demolition (attach copy of Order'
Demolition ittiog contractor. In �aj a wt back- I Will nonfriable asbestos be left in place during demo? LJ Yes W No
.Mr r4l�zn ddress).
ContractorLP,VA/K)q 2-A-1 If Yes, list t3w and qty.
V 14 C KN6, =&AV�VL
Friable Asbestos, 10
Project Info—ati
Start Date:
Completion Date:
Work Days: M T W Th F Sa Su
Hours:
Will all friabld asbestos Yes
materials be removed? Q No
)tal Qty. to be Removed: Linear Ft.
Square Ft.
st type(s) of material to be removed:
Asbestos[Demolition Project Categories:
Notification Period
Project Demolition
Single -Family Residence:
Fee Surchare
0 Asbestos Removal Project Only
A. Prior Notice
A. $25
1. C3 Demolition Project (with or without asbestos removal project)
B. 10 Days*
B. $50
*(Asbestos removal can begin upon notification; demolition must wait 10 days)
I
I
)te: If the singlefamily residence is owned by onefamily who has been or will be using the residence as their domicik, the above boxes
I or JB may be checked. A singlefamily residence does not include rental prope 'muld-family units, or a mbced-use build'
JA All Other Demolitions With No Asbestos Removal Project
-10-Dlys.
$200�)
Friable Asbestos Projects (other than Single Family Residence):
"Auu, I:- I IM11[if-I
U �: 10 - 259 linear feet or �: 48 - 159 square feet of asbestos
PriorNotici . I�Pays
$150 $50
U 260 - 999 linear feet or 160 - 4,999 square feet of asbestos
J U tLo t)4sluu-i
$300 sloo
—1.000 - 9,999 linear feet or 5,000 - 49,999 square feet of asbestos
rjd
$750 $250
LJ > 10,000 linear feet or> 50,000 s inre feet of asbestos
rl O;Ai'�*Q'NDS
2,000 $1,000
Emergency Asbestos Project or mergency Demolition Project
7:T-
Prior Notice
Twice Project Fee
(Single-Farmly Residences are exempt from emergency fee: however, property owners must provide a
written emergeni , request)
I certify that the infort-nation contained in this notification & supplemental data is, to the best of my knowledge, accurate & complete. Agency Use OnI
17
J
Sih-atuAl Representing Date Reviewvd Bv
et Sound Clean Air Agency Form No.: 66-160 (Revised 3/03) TS
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The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(rega7idless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
IM, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency
forms. Asbestos removal and demolition 12roiects involving materials and structures below the notification threshold are
still subject to all other requirements of Regulation M, Article 4.
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.
PLWEPRWTCL_r,4)tLY. rit[SWILLOEYO(IARETEMV.tL4iUvOLANEI-
J. Demolition
Contractor. T Ile-
Owner/CEO:
Contractor's
Mailing Address:
Phone:
Job
City,
State:
Zip:
Fax:
GUIDELINES FOR SUBMITTING ARASBESTOS\DEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring,, cement
asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner infon-nation, if the property owmer is conducting a single-family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with a site imp
(include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure. .
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire
requirements are contained in Regulation 1, Section 8.08. If any nonfriable asbestos materials will be left in pjace during demolition,
check yes and list the ty
. pe and quantity of material.
Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as
popeom ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc.
Step 8. For Single -Family Residential projects; check BOX HiA for renovation projects, BOX HIB for demolition projects with or
without asbestos remoyal. -,Asbestos removal -may -be conducted after a complete notification is received, but demolition, activitics c=----
only begin on the 10th day after the notification is received. Note: If the singlefamily residence is owned by onefamily who has
been or will be using the residence as their domicile, boxes IA or IB may be checked. A singlefamily residence does not include
rental property, multi -family units, or any mixed -use building.
For Commercial asbestos projects (or projects that do. not qualify as Single Family Residential); check the project category R2 -
6 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
ladditional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box I — 6 and the
�pplicable emergency box in HT All emergency reguests must be accompanied by a letter from the property owner demonstrating the
aeed. to conduct the proiect immediately in accordance with the reguirements in Regulation III, Section 4.03 (c).
3tep 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box 1.
Vlandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
.vork schedule changes if the contractor is participating in the Agency work schedule fax prograrri. A $25.00 processing fee is required
.or all amendments.
?uget Sound Clean Air Agency asbestos regulations and forms can downloaded from the Agency web page at www.pscleanair.org.
-or technical assistance contact (206) 689-4058 and for administrative inquiries contact (206) 689-4090.
luRct Sound Clean Air Auencv Fnrm Nn - (1(1_lAn lRi.vicoli IMIN TC
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TABLE OF CONTENTS
Subject
1.0 SCOPE OF WORK
2.0 SURVEY METHOD
3.0
LABORATORY INFORMATION
4.0 BUILDING DESCRIPTION
5.0 FINDINGS
6.0 CONCLUSIONS AND RECOMMENDATIONS
7.0 LIMITATIONS OF SURVEY
APPENDICES
Sample Locations (Map)
Laboratory Results
AHERA Certifications & Laboratory Qualifications
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SCOPE OF WORK
An Investigative survey for asbestos containing materials (ACM) was conducted on a
residential structure located at 8017 238th Street SW, Edmonds, WA.
The Inspection was conducted on April 14, 2003 by John Terrill, an AHERA certified building
inspector. This inspection was performed at the request of Tony DiPangrazio, property owner.
The purpose of this Inspection was to Identify asbestos containing materials that would be
impacted by the planned demolition of this structure,
The asbestos survey section is written to comply with the AHERA asbestos sampling
procedure as stated in 40 CFR 763.86. This protocol is required for all asbestos surveys prior
to a building demolition under the Puget Sound Clean Air Agency, (PSCAA). Regulation III,
Article IV, revised July 13, 2000.
The asbestos survey also satisfies the "Good Faith" asbestos inspection requirements as
stated In Washington Administrative Code (WAC) 296-62-07221(2), "identification". As stated
In this regulation, the owner of a structure scheduled to be renovationidemolished must provide
a contractor with a written report of the asbestos containing materials to be disturbed during
renovation/derriolition.
The National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61
requires a survey by an accredited asbestos Inspedor prior to demolition of a structure.
A floor sketch Indicating sampling locations has been included in Appendix A.
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8017 238th Weet SW, Edmonds, WA
PrQ)W # 20D3-176
2.0 SURVEY METHOD
Asbestos Survey Method
A walk-through Inspeaon of all accessible areas of this structure was performed to identffy
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,
roofing, wall materials, etc.) were obtained of each material to satisfy the requirements of the
Asbestos Hazard Emergency Response Act (AHERA) rules and regulations. These samples
were placed Into plastic sample bags, numbered and recorded.
Homogeneous Materials
Homogeneous materials are defined as an area of Asbestos-ContaInIng Material (ACM) or
Presumed Asbestos -Containing Material (PACM) which appears similar throughout In terms of
color, texture, and date of material application. The report listing for hamogerious materials will
appear as follows:
Sample
Number
matedall
Description
Location
Asbestos
%
Area
(W)
Friable
(yesino)
Job#-01 -01
white floor tile
kitchen
Job#-01-02
whttefloortile
kitchen
Job#-01-03
1while floor file
kitchen
Under OSHA Guidelines, a minimum of three negative analysis of a single suspect
homogeneous asbestos containing material Is required to prove a negative result for surfacing
materials and thermal system Insulation.
NVL LabDratorles, Inc.,
4708 Aurom Ayenue North, Seattle, WA 98103
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Page 2
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8017 23ft Street sw, Edmonds, WA
Projed 0 2003-175
3.0 LABORATORY INFORMATION
Laboratory Analysis — Asbestos
Samples are analyze� in our laboratory using polarized light microscopy (PLM) with dspersion
staining. It samples are not homogeneous, then subsamples of the components were analyzed
separately. All Buk sampWs are anallmed using F-PA Method 600/R-931116 with the following
measurement uncertainties for reported % Asbestos (110/9-0-3%, 5%=>1-9%. 1 0%=5-15%.
20%=10-30%,50%=40-80%). For samples containing more than one separable layer of
materials, the report vAll Include findings fbr each layer (labeled Layer 1, Layer. 2, etc.). The
asbestos concentration In the sample Is determined by visual estimation.
Laboratory Accreditation.
Professional accreditations for NVL Laboratories, Inc,, include the flollowing:
NVL Laboratories, Inc., is currently accredited by the National Institute of Standards and
Technology (NIST) under the National Voluntew Laboratory Accreditation Program (NVLAP)
program for bulk asbestos fiber analysis. NVLAP Lob Code 102063-0.
NVL Laboratories, Inc., Is approved by the American Industrial Hygiene Association (AJHA)
Asbestos Analysts Registry (AAR) program fbr airborne asbestos fiber analysis. Counter ID
7412.
NVL Laboratories, Inc., is currently accredited by the American Industrial Hygiene Association
(AlHA) under the Industrial Hygiene Laboratory Acc4-editation Program (111-ILAP). The IHLAP
program is designed specifically for laboratories involved in analyzing samples to evaluate
workplace exposure. Certification Number 563.
NVL LaboratoriGs, Inc., Page 3
4708 Aurora Avenue North, Seattle, WA 98103
Ph OAR% 4,17-nInn . Vv MAI $M.-WaA
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8017 2386 Street SW, Edmonds, WA
Project # 20M-175
4.0 BUILDING DESCRIPTION
General Building type:
This is a single story, wood framed, single-family residence with a full parlially finished
basement.
Primary external components:
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The primary external component is wood siding.
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Type of foundation:
The house Is constructed on a full, partially belomi grade, concrete basement,
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Roofing materials:
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Roofing Is asphalt shingles.
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%ffindow types:
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Windows are wood framed with glazing compounds.
Flooring:
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Flooring is primarily hardwDod. There Is sheet vinyl In the kitchen and bathrooms.
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Thermal systems wlinsulation types:
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There Is a forced air heating system without suspect thermal Insulation.
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Finishing:
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Partitions, walls, and lids are gypsum wallboard,
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NVL Laboratorles, Inc.,
4708 Aumrs Avenue North, Seattle, WA 98103
Mh llng% s;A7-nlr%n . =� OAM FVXA_i01A
8017 238th Street SW, Edmonds. WA
Project # 2003-175
5.0 FINDINGS
Inventory offtspect Asbestos -Containing Materials
sample Material Location Asbestos
Number Description - M
2003-175 1: sheet vinyl flooring back entrance in 1: ND
-1-1 2: fibrous basement 2: ND
Area
2003-175
1: sheet vinyl flooring
back entrance in
1: ND
-1-2
2: Cbrous
basement
2: NO,
backinqlmastic
2DO3-175
bricklmortar
maln, Chimney
ND
-2-1
2003-176
1: sheet vinyl flooring
kitchen flooring
1: NO
-3-1
2: fibrous
2: NO
3: sheet vinyl flooring
3: NO
4: fibrous
4: ND
backing/mastic
5: linoleum
5: ND
6: fibrous backing
6: NO
2003-175
1: sheet vinyl flooring
kitchen flooring
1: ND
-3-2
2: fibrous
2: ND
3: sheet vinyl flooring
3: ND
4: Obrous
4: ND
backing/mastic
5: linoleum
5: ND
6: fibrous backing
6: ND
2003-175
1: sheet vinyl flooring
bathroorn flooring
1: ND
-4-1
2: fibrous
2: ND
3: sheet vinyl flooring
3: ND
4: fibrous
4: ND
backing/mastic
5: felt backing
5: ND
2003-175
1: sheet vinyl flooring
bathroom flooring
1: ND
-4-2
2: fibrous
2: NO
3: sheet vinyl flooring
3: ND
4: fibrous
4: NO
backing1maslic
5: fell backing
1 5: NO
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NL) - mne betectec
* This material is less than 1% asbestos If It Is considered as a component of the composited sample.
Please refer to the end of the next section for Information on materials containing less than % asbestos.
NVL LaborQWBS, Inc.,
4708 Aurora Avanue North, Seattle, WA 98103
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Page 5
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8017 238th Street SW, Edmonds. WA
project # 2003-175
Sample
Material
Location
Asbestos
Area
Friable
Numbw
Oescription
_119_
(W)
(yesino)
2003-175
splash guardfadhesive
around kitchen
NO
-5-1
counter
2003-175
splash guard/adhesive
around bathroom
NO
-6-1
shower * -
2003-175
1: paint
living room wall
1: NO
not
-7-1
2: joint compound
2: 2*
quantified
no
3: gypsum wallboard
3: NO
2003-175
1: point
north bedroom wall
1: NO
-7-2
2-- Joint compound
2: 2*
2003-175
1: painLqoint compound
-i6dt—hbedroom wall
—i-.- 2 *
-7-3
2: joint compound
2: 2*
3: gypsum wallboard
3, NO
2003-175
Window glazing
laundry room window
NO
-8-1
compound-_
2003-175
thermal Insulation
attic crawl space
NO
.9-1
batting-
20D3-175
thermal insulation
attic crawl space
NO
.9-2
battlina
2003-175
1: thermal Insulation
attic crawl space
1: NO
-9-3
batting
2: residual roofing felt
2: NO
2003-175
1: roof shingles
roofto-p
1: NO
-10-1
2: roofing felt
2: NO
2003-175
1: roof shingles
rooftop
1. NO
-10-2
2: roofing felt
2: NO
2DO3-175
vapor barrier
underneath exterior
NO
-11-1
siding_
2003-175
vapor barrier
underneath exterior
NO
-11-2
1
siding -
NU - None U8D8C1eQ
This material is less than 1 % asbestos It It is considered as a component of the composited sample.
Please refer to the end of the next section for Information on materials containing less than % asbestos.
Any suspect material(s) not identified above should not be disturbed, and tested
Immediately. The suspect material must be treated as asbestos containing until testing
proves otherwise.
NVL Laboratories, Inc.. Page 6
4708 Aurora Avenue North, Seattle. WA 98103
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BO 17 238th Street SW, Edmonds, WA
Projeet # 20M-11 76
6.0 CONCLUSIONS AND RECOMMENDATIONS
ASBESTOS
The following summarizes the homogemous Asbestos -Containing Materials (ACM) and
Presumed Asbestory-Containing Materials (PACM) Identified at the residential structure located
at 8017 238th Street SW, Edmonds, WA on April 14, 2003.
1. Joint Compound: (material number 2003-175-7)
There Is an undetermined quantity of asbestos -containing joint compound associated with the
gypsum wallboard system throughout the structure, This material is less than 1% If it is
considered as a component of the wall system. Please refer to the and of this section for
information on materials containing less than 1% asbestos.
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,
If discovered, all ACIVIs that will be disturbed as a natural part of renovallorVdemolition and are
required to be removed and disposed of In accordance with Washington State Regulations.
Washington State Department of Laborand 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 ACIVI has been removed by the contractor.
Hidden wall and coiling cavities that are not accessible during the time of surveying can
sometimes conceal ACIVI. Thus, NVL recommends that an AHERA inspector/project manager
be on sfte at the time of renovation/demolibon to ensure that any potentially asbestos -
containing materials uncovered during the process of renovation/demolition be dealt with
property.
NVL Laboratories, Inc., Page 7
4708 Aurora Avenue North, Seattle, WA 98103
Ph /)MR% 447-ninn - cr� i-onRN AV-101A
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8017 23 Bth Street SW, Edmonds, WA
IR-Yoject # 2003-175
Materials Containing 1 % Asbestos or Less
The OSHA asbestos standard(s) regulate occupational exposure to asbestos, Including
asbestos containing material (ACM). Please see (a) Scope and Application and (b) Definitions
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for 'Asbestos* and wAsbwdos Containing Material," for the General Industry, Construction and
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Shipyard asbestos standards. In the OSHA Construction Standard, work Involving materials
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containing 1 % or less asbestos would be considered unclassified. Unclassified asbestos
operations cover employees likely to be exposed In excess of the permissible exposure limit
(PELs). and who are performing operations not covered by Class I through IV. For
construction work involving unclassified asbestos the applicable requirement will include; an
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exposure assessment. use of vacuum cleaners equipped with HEPA fifters, use of wet
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methods and prompt cleanup of debris, use of respirators.and protective clothing, training and
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record keeping
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Further, If a negative exposure assessment cannot be made, air monitoring would be required
as part of the exposure assessment.
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NVI- Uiboratodes, Inc., Page 8
4708 Aurora Avenue North, Seattle, WA 98103
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8017 238(h Street SW, Edmonds. WA
Projedil 2003-175
7.0 LIMITATIONS OF SURVEY
The sole purpose of this survey report is to document asbestos -containing materials
discovered In the survey of suspect materials by NVL Laboratories parsonnel at the residential
stuckire located at 8017 238th Street SW, Edmonds, WA on April 14, 2003.
This site visit consisted of a thorough visual walk-1hrough of the building for the purpose.of
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viewing and sam ling potential ACMs. As hazardous material surveys are non -comprehensive
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by nature, NVL Laboratories, Ina, cannot be held liable flor materials which require destructive
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mans to access, maborials which are hidden from sight (e.g. materials hidden behind walls),
materials which cannot be found due to their obscure nature, or which otherwise cannot be
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discovered wfth 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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Inspecteg by:
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John Terrill
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AHERA Building Inspector
AHERA Certification No.: 1004060
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AHERA Certification Expires on: February 4, 2004
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NVL Laborelorles, Inc., Page 9
4708 Aurora Avenue North. Seattle, WA 98103
Ok OnAN AA7-ninn . F:v i*7ns;% s;*AA--ooqPt
MEMO TO:
FROM:
PROJECT
SITE ADIE
FINAL PROJECT APPROVAL FORM
TO:
DATE:
PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
PLEASE SIGN
�/,,�X-/_ENGINEERING DIVISION DATE_k1Q__LZa,7-1-'
I'LLANLSMN 7
V��-7
PLANNING DIVISION DATE
# f a y,-- -
PERMIT ADB# DATE INSPECTED ellel-)
DESCRIPTION OF WORK TOBE INSPECTED 1404,),1,0 kf� 0 1
A field inspection was conducted to determine compliance with -approved plans. Final ap proval
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
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE —INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
1:ten11):b1dg:fonns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining 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 .......
Au P , SHEETROCK NAILING ...
SPECIAL INSPECTION ...
1A
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. "91
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