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HomeMy WebLinkAboutBLD2013-00123 - EXPIRED THIS BUILDING IS NOT FINALED . THIS IS AN INCOMPLETE BUILDING APPLICATION . THE PERMIT WAS NEVER ISSUED. 91 BLD13-00123 BUILDING PERMIT APPLICATC Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00123 Received Date: ---4/15/2013 SITE ADDRESS: 621 S POINT RD J`{- 1-Vrc- q PORT LUDLOW, 98365 STEVEN D MEACHAM =',� . 'PHONE..f OWNER: �� VIRGINIA L MEACHAM 645 MT OLYMPUS DR SW ISSAQUAH WA 980274000 SQUAMISH HARBOR BCH Block: Lot: SUBDIVISION: PARCEL NUMBER: 996600026 Section: 4 Township: 27 N Range: 01 E CONTRACTOR: TBD PHONE: REPRESENTATIVE: GEORGE WITTLER PHONE: (360) 779-6699 697 5400 17791 FJORD DR NE, STE N-140 (360) POULSBO WA 98370 PROJECT DESCRIPTIOI' DEMOLITION - REMOVE EXISTING GARAGE TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date. _ � Amount Paid By: Date: Receipt: Approved/Date Type Permit $76.00 ZAL 04/15/13 140245 Total: $76.00 A/17/0(11'1\\4irlcmorIArlofo\fnrmc\G RI fl Ann PIA rnf • • Zoe Ann Lamp From: Zoe Ann Lamp Sent: Tuesday, May 07,2013 2:57 PM To: 'George Wittier' Subject: RE: Meacham Garage Replacement George: Thank you for the information. The Permit number for the garage is BLD13-00124 and the demolition permit number is BLD13-00123. BLD13-00124 is waiting on Plan Check and Septic Review sign off. You also need to submit a contractor name and license number. BLD13-00123 is waiting on Septic Review sign off and the ORCAA permit. Have you submitted the application and asbestos survey with fees to ORCAA? When you receive the signed permit from ORCAA please submit a copy of it to us. Sincerely, Zoe Ann Lamp, AICP Associate Planner, DRD Lead Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 Phone: 360-385-9406 Fax: 360-379-4473 e-mail: zlamp @co.jefferson.wa.us Jefferson County DCD Mission: To preserve and enhance the quality of life in Jefferson County by promoting a vibrant economy, sound communities and a healthy environment. AU e-mail sent to this address will be received by the Jefferson County e-mail system and may be subject to Public Disclosure under Chapter 42.56 RCW Please note: The Department of Community Development is open to the public 9:00 a.m.—4:30 p.m. Monday- Thursday; Closed Noon- 1:00 p.m.; Closed Fridays. From: George Wittier [mailto:george @azon.us] Sent: Tuesday, May 07, 2013 2:38 PM To: Zoe Ann Lamp Subject: Meacham Garage Replacement Ms Zoe Ann Lamp, I am checking to see what the permit status is on the Meacham Garage Replacement Project is.The address is 621 South Point Road, Port Ludlow, WA. I did not receive a permit number. Please advise. Attached is the HazMat Survey and ti ned signature page that was left off on the copy I provided at the time of the application. Thank you George Wittier architect 2 • • fr, u' r°o, Accelerated Analytical LLC• ir to P.O. Box 309 Littlerock, WA 98556 acceleratedanalytical @comcast.net (360) 239-0354 T 4 Asbestos Survey Report Located At: 621 South Point Rd. Ludlow, WA 98365 • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA Table of Contents 1.0 INTRODUCTION 3 1.1 Purpose 3 1.2 General 3 1.3 Building Description 3 2.0 SAMPLING 4 2.1 Laboratory Analysis 4 2.2 Sample Analysis 4 3.0 SURVEY RESULTS 4 4.0 LIMITS OF SURVEY 5 APPENDIXES 6 Appendix A: Laboratory Results/ Documentation 7 Appendix B: Site Photographs 8 P.O Box 309 2 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA 1.0 INTRODUCTION 1.1 Purpose This good-faith asbestos survey was performed as part of pre-demolition activities to identify the presence, location and quantity of any asbestos-containing materials (ACM) within the construction area. The intent of this asbestos survey is to comply with governing asbestos regulations required by Federal Standards and with the Washington State guidelines. Currently, the State of Washington requires a "good faith inspection" for the identification of asbestos-containing materials prior to any remodeling or demolition work. 1.2 General On April 03, 2013, Todd L. Venable, AHERA Accredited Building Inspector, of Accelerated Analytical, conducted an inspection for suspect-ACM at 621 South Point Rd. in Port Ludlow, Washington. This Asbestos Inspection was performed as part of pre-demolition, activities. The site inspection included all accessible areas within the structure. 1.3 Building Description The Structure was occupied at the time of inspection. The structure was a Stick Built 3-bay Garage. The structure had a Cement Foundation System, Aluminum Siding, and a Flat Asphaltic Roof System. The interior was composed of Wooden Walls and Ceiling System. The floor system was finished concrete. P.O Box 309 3 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA 2.0 SAMPLING The sampling objective was to determine the quantity and location(s) of asbestos containing materials. There were two (2) samples collected at the time of inspection. Sample A was collected from the Asphaltic Roofing materials, Sample B was collected from the Corrugated Vinyl Roofing Material. 2.1 Laboratory Analysis The bulk ACM samples are analyzed at Seattle Asbestos Test LLC, 19711 Scriber Lake Road, Suite 103, Lynnwood, WA 98036 using polarized light microscopy (PLM) with dispersing staining in accordance with U.S. EPA method 600/R-93-166 as specified in 40 CFR Chapter I (7-1-93 edition) Part 763, Subpart F, Appendix A, pages 499-504. Polarizing light microscopy quantifies asbestos concentrations at between 100% - 1% detection levels. Levels below 1% can be stated as "ND". 2.2 Sample Analysis A Asphaltic Roofing Main Roof Damaged N/A None Detected B Vinyl Roofing Side Roof Damaged N/A None Detected 3.0 SURVEY RESULTS Samples A Et B tested Negative for Asbestos Content. P.O Box 309 4 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA 4.0 LIMITS OF SURVEY Asbestos surveys are non-comprehensive by nature and subject to many limitations as described below. Our assessment has considered risks pertaining to asbestos; however, this survey is limited to only those locations sampled. This survey was not designated to identify all potential concerns or eliminate all risk associated with potential asbestos containing materials (PACM5). Evaluation of other risks, such as toxic and hazardous substances in (or in contact with) soil and ground water, structural, electrical, mechanical, radon gas, slope stability, building settlement, moisture, or site-drainage/flooding, have not been included. No warranty, expressed or implied, is made. The site visit consisted of a through visual walk-through of the subject area for the purpose of viewing and sampling PACMs. Advance Environmental Inc. is not responsible for materials, which require destructive means to access, or materials that are hidden from sight, those materials hidden behind walls or materials, which cannot be found with reasonable diligence. Accelerated Analytical LLC performed this survey in accordance with the generally accepted standards of care in the sampling profession in Washington State at the time of this study. This asbestos survey was performed in preparation for a demolition of the subject structure. Accelerated Analytical LLC Todd L. Venable AHERA Accelerated Analytical LLC P.O Box 309 5 Phone:360-239-0354 Litderock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA APPENDIXES P.O Box 309 6 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA Appendix A: Laboratory Results/ Documentation P.O Box 309 7 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA Appendix B: Site Photographs P.O Box 309 8 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net . S Accelerated Analytical Asbestos Survey Report 621 South Point �R w Port Ludlow WA \ .�. . % Asphaltic Roo ing A Interior walls and ceiling ,_ » � Corrugated Roofing B P.O Box 309 9 me:a6239-9 Ltde mck,Washington 98556 Email:acc eler aanaly R&qm 4 1.9CON eed JEFFERSTY too ` ' DEPARTMEON NT OF COUN COMMUNITY DEVELOPMENT 40. 1 621 Sheridan Street• Port Townsend •Washington 98368 a . 360/379-4450 • 360/379-4451 Fax q� � www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): MoV Er IF4ST)N C} Covvca AiLlo CL&TFOCT f(C M IENT CaAr izd44, 7 5-1UPi Tax Parcel Number. Tr“POCX) 2 CP Property Size: (acres/square feet) Site Address and/or Directions to Property: C.Pe C :co-rf-f °6 NT 12aAU )eT lJ ctov`1) L JA �ce 5 Property Owner(s)of Record: 'T ✓� ^)J$� VI i'¢CA t if4 /�t (H Ain Telephone: Fax: email: � Mailing Address: C� )t C�.,l'Mfpras .DiK '31J LS O/�rt•k� WJ �gjOZ,1 Applicant/Agent(if different from owner): Cceofeae. (.3.)I` Z.L.K. Telephone: 3(ag".)— 7 —t h Fax: ..C)—be?7-54L ) email:neO( 4,51y1"t . U Mailing Address: What kind of Permit?(Check each box that applies 1,.ilding ❑Critical Areas Stewardship Plan Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family *Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]*” ❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)*" ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat" ❑Home Business ❑Cottage Industry ❑Binding Site Plan" ❑Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments*" ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Storrnwater Management ❑Shoreline Master Program Exemption/Permit Revisions** O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development" ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please Identify any other local,state or federal permits required for this proposal,if known: _DESIGNATION OF AGENT I hereby designate V'S.LO(. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE )e Date:x By signing this application form,the owner/agent attests that the information provided herein,and In any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. Signature: Date: The action or actions Applicant will undertake as a result of the Issuance of this pemtlt may negatively Impact upon one or more threatened or endangered species and could lead to a potential lake'of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA.°Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PeanitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: T -iW ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: ' EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ,`F Q,Wood Existing: _ ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System O Alteration/Remodel ❑ Concrete Total: Height: Xlndividual System ❑ Repair ❑ Masonry SEP Permit# eK Demolition ❑ Other: Bedrooms: `1 Water Supply: Existing: N A Setback: `A.Pr•vate well 0 Two Party Type of Heat: Proposed: 0 Public Total: Name of System: If this is a Commercial Project you must answer the following: ,` tt tt Number of Parking Spaces: Current N A Proposed: OA Number of ADA Parking Spaces: 1•/ tc Number of occupants Sn�dudes owners,tenants,employees,etc) Current 7.1 A Proposed iir, IBC Occupancy:h IBC Type of construction: Ye) Will you have Food Service? Y-s IIIZ If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured I Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. 4,T d r.i .T. 9 ;" x x i t t r u t S•uare Foote!e Current Pro••Sect r �_ ao..L _):*-' Ali,i ,,,, ., „-e:E_A I1if., , tt „r t:1 ,_:r Main Floor Heated `• . App 2"°Floor Heated Consistency Review: Other Heated :: 00 T Unheated Basement x State Surcharge fee: :'fin ` , Other i 1t - Pot Water Review fee: Garage/Carport ', 3 vxfa � � SUBTOTAL do(o' • it 911/Rd Approach fee: • TOTAL: $ b bi ° Receipt Number: /q0 a iiS .a Cash/Check Number: a A . 3 •rsvx'RJs!.�' ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish I fiS I I 3 Initials: / G:\Permit Center\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc . ��� ��� . ���y ���o _ �� J�PF��������]�T� oEpAwT�ewTopcO� DEVELOPMENT ^ �� �� - 621 Shrridan Street 'Port Townsend 'VYmehingtong830V 350/379'4*50' 360/379-4451 Fax x"m°roj*Monol.wa.usicnmmdnvemp'nent Master Permit Application MLA: __ - - 1 Prolect Description(include separate sheets as necessary) i 4'-'�� 1 Site Address and/or Directions to Property: 1 • .! What kind of PerTnit?(Check each box that applies ''. Alyilding 173 Critical Areas Stewardship Plan '-: -srii.Demolition Permit Li Variance(Minor,Major or Reasonable Economic Use) 1 10 Single Family :A,Garage Attached. !Detached D Conditional Use(C(a),CO),or Cl" 1 1,...i Manufactured Horne 0 Modular 0 Discretionary'LT or Unnamed Use Classification ! 0 Commerdal" '111 Special Use(Essential Public Facilities)** `: fl Address_________ill Road Approach 0 Short Plat** 1.=.1 Home Business 0 Cottage Inclustiy HI Binding Site Nan" Li Propane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments'''' LIAllowed'Yes"Use Consistency Analysis 0 Plat Vacation/Atteration- H Slorrnwater Management L.-/Shoreline Master Program Exemption/Permit Revisions*' 0 Site Plan Approval Advance Determination tSPAAD)* El Shoreline Management Substantial Development** , Temporary _Shoreline Management Wireless'I- Plan/UDC/Land Use District Map Amendment 2;Forest Practices Act/ReleaSe of Six-year Moratorium Li Jefferson County Shoreline Master Program Amendment , •May require°Pre-Application Conference 0 Tree Vegetation Request , Please identify any other local,state or federal permits required for this proposal,if known: I hereby designme_c,.. _d{?;Lig,,,ie„,te,-...:.1_ ',..mr,r,.., to act as my agent in matters relating to this application for permit(s), : By signing this application form.the owneriageot attests that the informabon provided herein,and in any enactments.is true correct to the best ot i m, ,w'mmk"w°moge Any material falsehood«any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs.reasonable attorneys fees and expenses which may in any wa accrue against Jefferson County as a result of or in consequence of the granting of this permit , i Im*m�xn°mmp,��.o�*,^and nvh'o/ewn'vJene�mcvumv and^^omnm*�m,�vw,^m�~v,v'�eo�xvm°wwwon^em�p/^a*o° \ review and any required later inspections. Stun access and and nqhi of entry wixueammmeav^lem'oouwymont informs the County.v writing"t/^* Signature -____ Deny_ t111 _' '___--____—_ ____-___-___�-______'—_______--___-__ -__-___-- ---_Y The action or actions Applicant will undertake of negatively~w�*"��vopm"mm�mmumv�v, " ^ may �=°' ecoangered species and could lead to a potential lalce of an endangered species as those terms are defined in the federal law known ac the Endangered Species Act or ESA"Jefferson County makes no assurances to the applicant that the actions that will he undertaken because this I permit has been issued will not viotat the ESA Any indivi'eual,group or agency can file a lawsuit on behalf of an endangered species regarding yaur action(s)even if you are in n Applicant"c*ov~mdg^mth-*he,she n,x holds individual and n^w mv The Applicant has read this disclaimer and n^aw,mw°abelow s.o"m.= Date: ��/z�^ | __. ---------- '-- /-- ( ---- �������� � ' ' - -- -� ^ .r,..ir,ii,i'Txi,..^°°x"^xym'*"x`xn,^x^owi,2,.perr""^nx+,.~5-29 OS+" III I BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the pa,cel refetenced herein,that they are not licensed contractors and tr,:,t they wit he assuming the its o.rrblty of the General Gontractor for the proposed prole; ...------ ,,,, _______ Signature --... Date ..,-------- -------tir GE NEPAL CONTRACTOR OR MANUFACTURED HOME INSTALLER* Ptiorti.: FAY. i MAILING-ACADRE.!:,S. Ewa: CutriTeActoft'sliceNsc WAINS NUMBER: NUMBER _...... AR—HITECT/ENUNEEi4 PHONE ( ) FAX:( ) .•-, MAILING ADDRESS: &mot Project Type: Pr-me Type: Bathrooms: , Shoreline: I Type of Sewage Disposal: New .'",‹ Wood Existing- 1(...w.c. , , Sewer Addition Steel Proposed : Bank Community System Afteration/Remoder Concrete Total ---- Height t a' i'd uaI System • epair : Masonry . _. SEP Permit# ,$)(-:Demolition Other. Bedrooms• ' Water Supply: Existing '''"4 A Setback ."/ Private well 1 wo Party -- - - , P : f ype of Heat _. roposed Public Name of System: If this is a ommercial Pro'ec ou must answer the topilowinsed.;: Number 0, __ _a,, g_paces: Number of Parking Spaces. Current: _ir ____......„ roPo N& 11,16 I Proposed Psecirktn.. .,,,,:* Number of occuparitcIncludes owners,tenants.employees,et,,_,C._u:nfot_ __. P — Will you have Food Service? le."..itiQ, IBC°C'kAiPancY: . --'61---- IBC Type of'AInstrucl:°r- rnark-ailiterns below that apply: If this is a P pane Tank and/or Applia e installation permit. I Underground Tank ; Above ground Tank Size of Propane Tank: ,. Heat Stove Cook Stove Woodstove 1 Fireplace Insert Hot Water 1 Pellet Stove 1 Other Is this appliance being instaljed in a Manufactured!Mobile Home? Yes I When applying fora permit to install a propane tank must also submit a site plan showing all of the buildings,a"property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components. including the reserve area. . - ,77.71 . ,.r.--....u4n.vf.nik ',.-..%.. ';-. ..:-,..-. ' ,.i,'-'3,4:,..-:-„ik.,-;;.„ hurrent Proposed 7. .„-- ,- A,-- ,,,. ,4, : ...-., ..,..:,,,-...., . Amatot ,,,,t,, , , Square Footage _ ed -r....,..Gate,' -'' ' q '•-,"- ' - • Main Floor Heated i ;-:..-.:,,.r-r.- '- EH Bid App Review: I .. 1 .1,--Z4-FI-Oef—Fteated i — --14,St?..,,,.,-.1 ., Consistency Review: 1 Other Heated A :; ''''''' -''' Base fee: ' .i:.,'" l. ,- , Mezzanine I 1..4--:inf.-i''':"•‘:' Additional Section: ; I ' r--- ------t—a' Heated Basement : ' :','.,,-.'-... Plan Check fee: ■ -4 . . UnhaatedWasement ;::,:si'..:.''' State Surcharge fee: 1 Other Unheated 4- .' ,.. .. ..,- i--- ---- 1 r' '"' "' Pot Water Review fee: t Garage/Carport : i i ' ' * - SUBTOTAL : • :4;.',...i.,::..,;.-. , , ..,.. .. _ , .. . . Decks 1 1-- •-.----r4...---t4:-- 911/Rd Approach fee: I ,-,,,,,,,,,, ' - --- Other TOTAL: $ ' - — i,- - --; i 4'.`;"ttiii,,;„:.,-.: Receipt Number: ; -',, '','',;-• ''-' Cash/Check Number: 1 i i . rESTIkiiitED COST(REQUIRED) Date; 1 : ; . 1 +Fair market vatue of ell labor and materials foundatton to finish 1 , , , initials: -I : ------ , p„..r.„0.-(1,,,,,ktf il...-0)Rt..,1Slittf\DILI.Ft.)RM::,',N11.“,:,Print s Applic.)144)5 24 1 ,1,.,, 0 S ® _ ®�; Accelerated Analytical LLC• `y, IS 1 '�� " P.O. Box 309 Littlerock, WA 98556 acce leratedana(ytical @comcast.net (360) 239-0354 f N. Ai Asbestos Survey Report Located At: 621 South Point Rd. Ludlow, WA 98365 I Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA Table of Contents 1.0 INTRODUCTION 3 1.1 Purpose 3 1.2 General 3 1.3 Building Description 3 2.0 SAMPLING 4 2.1 Laboratory Analysis 4 2.2 Sample Analysis 4 3.0 SURVEY RESULTS 4 4.0 LIMITS OF SURVEY 5 APPENDIXES 6 Appendix A: Laboratory Results/ Documentation 7 Appendix B: Site Photographs 8 P.O Box 309 2 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA 1.0 INTRODUCTION 1.1 Purpose This good-faith asbestos survey was performed as part of pre-demolition activities to identify the presence, location and quantity of any asbestos-containing materials (ACM) within the construction area. The intent of this asbestos survey is to comply with governing asbestos regulations required by Federal Standards and with the Washington State guidelines. Currently, the State of Washington requires a "good faith inspection" for the identification of asbestos-containing materials prior to any remodeling or demolition work. 1.2 General On April 03, 2013, Todd L. Venable, AHERA Accredited Building Inspector, of Accelerated Analytical, conducted an inspection for suspect-ACM at 621 South Point Rd. in Port Ludlow, Washington. This Asbestos Inspection was performed as part of pre-demolition, activities. r The site inspection included all accessible areas within the structure. 1.3 Building Description The Structure was occupied at the time of inspection. The structure was a Stick Built 3-bay Garage. The structure had a Cement Foundation System, Aluminum Siding, and a Flat Asphaltic Roof System. The interior was composed of Wooden Walls and Ceiling System. The floor system was finished concrete. P.O Box 309 3 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA 2.0 SAMPLING The sampling objective was to determine the quantity and location(s) of asbestos containing materials. There were two (2) samples collected at the time of inspection. Sample A was collected from the Asphaltic Roofing materials, Sample B was collected from the Corrugated Vinyl Roofing Material. 2.1 Laboratory Analysis The bulk ACM samples are analyzed at Seattle Asbestos Test LLC, 19711 Scriber Lake Road, Suite 103, Lynnwood, WA 98036 using polarized light microscopy (PLM) with dispersing staining in accordance with U.S. EPA method 600/R-93-166 as specified in 40 CFR Chapter I (7-1-93 edition) Part 763, Subpart F, Appendix A, pages 499-504. Polarizing light microscopy quantifies asbestos concentrations at between 100% - 1% detection levels. Levels below 1% can be stated as "ND". 2.2 Sample Analysis Sample Location of Friable Asbestos Material ` Condition Number Samples Yes/No Content A Asphaltic Roofing Main Roof Damaged N/A None Detected B Vinyl Roofing Side Roof Damaged N/A None Detected 3.0 SURVEY RESULTS Samples A 8t B tested Negative for Asbestos Content. P.O Box 309 4 Phone:360-239-0354 Litderock,Washington 98556 Email:acceleratedanalytical @comcast.net • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA 4.0 LIMITS OF SURVEY Asbestos surveys are non-comprehensive by nature and subject to many limitations as described below. Our assessment has considered risks pertaining to asbestos; however, this survey is limited to only those locations sampled. This survey was not designated to identify all potential concerns or eliminate all risk associated with potential asbestos containing materials (PACMs). Evaluation of other risks, such as toxic and hazardous substances in (or in contact with) soil and ground water, structural, electrical, mechanical, radon gas, slope stability, building settlement, moisture, or site-drainage/flooding, have not been included. No warranty, expressed or implied, is made. The site visit consisted of a through visual walk-through of the subject area for the purpose of viewing and sampling PACMs. Advance Environmental Inc. is not responsible for materials, which require destructive means to access, or materials that are hidden from sight, those materials hidden behind walls or materials, which cannot be found with reasonable diligence. Accelerated Analytical LLC performed this survey in accordance with the generally accepted standards of care in the sampling profession in Washington State at the time of this study. This asbestos survey was performed in preparation for a demolition of the subject structure. Accelerated Analytical LLC Todd L. Venable AHERA Accelerated Analytical LLC P.O Box 309 5 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA APPENDIXES P.O Box 309 6 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA Appendix A: Laboratory Results/ Documentation P.O Box 309 7 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA Appendix B: Site Photographs P.O Box 309 8 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA M1 H= a ' A � a j c , x.44, , it s Asphaltic Roofing A Interior walls and ceiling t Corrugated Roofing B P.O Box 309 9 Phone:360-239-0354 Littlerock,Washington 98556 Email:acceleratedanalytical @comcast.net • • SEATTLE ASBESTOS TEST, LLC nvLAP Accredited,29016g4 CHAIN OF CUSTODY ' Client Name - 4-r-C-0 A^Vti-Yr r-C-A 1, LL.c Address City i-r-r-rt-E-rtac-le ST Uu A 7XP 185f Phone: (?6°)2- —4)3 5 Fax: — Email: Project Location: ( 2-t So v To?c-s-,01 i-c-r3v),;;N ' Project Manager: R-ki i--;"' Turn Around Time a4‘,.-.Number of Samples A Client Job# 1 5/3 -A IMMO WENT SAMPLE# IIIIIIMaae.aagtaat-alIllM LAB ID A/R 1 1) R c C-=4.1 (7. 2 13 11111111111121111"MI 111111 3 INIIIIIIIIIIIIIII 111111111 4 1111111111111111111 MIME 5 IIIIIIIIIIIIIIIIM MIN 6 111111111111111111111111 INEIIMIIIIIIIIIIIIINIII 11111111111111111 8 IIIIIIIIIIIIIIIIII MIMI 9 IIIIIIIIIIINIIIIIII 10 111MNIIIIIIIIIIM 111111111 111111111111111111111 11111111111111111111111111111 1121 aIIIIIIIII"IHIIIIMIIIIIIIIIIIIIIIIIIIMIIIIIMIMIIIIIMM IIIIBIIIUIIIIIIIIIIIIIIIIIIIIIIMIIINIIIIIIIIIIIIIIIIII 111111 sinifill IMIIMIIIINIIIIIIIIMIIIIIIIIIMI IINIIIIIIIIINII M 16 111111 18 11111111111111111111111 19 20 MB - Print Name Company Name Date Time f.,..41 1-.,c3.4:i V E-0-a-rs,....e. /010 A Elt. i-1/37i7 ELIPM g`i L-P"' -5p,'4-C4L- IIIIIIM=1 A .A• 4-14310 IIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIPIINII—m.or 1,,,, , ReceivedirrAvidiMEUlarm ,r--i'S" 1211,11211111M1 IIIIMIVIWOMIZIEWMAIIIIINUNIIIIMMIIIIIIIIIMINIME . -, I LIIIIMMIN11111110111.11111111111111111111111 - MOAN 0 111 17..„....% Seattle Asbestos Test warrants the test results to be of a precision normal for the type and methodo ogy employed for each sample submitted and disclaims any other warrants,expressed or implied,including warranty of fitness for a particular purpose and warranty of merchantability.Seattle Asbestos Test accepts no legal responsibility for the purpotm for which the client uses the test results. By giving on this form the clients agree to relieve Sande Asbestos Test of any liability that may arise from the test results. S SEATTL.E ASBESTOS TEST Lynnwood Laboratory:19701 Scriber Lake Road,Suite 103, Bellevue Laboratory 12727 Northup Way,Suite 1,Bellevue, Seattle Laboratory 4500 9th Ave.NE,Suite 300,Seattle,WA 98105, Lynnwood,WA 98036,Tel:425.673.9850,Fax:425.673.9810 WA 98005,Tat 425.861.1111,Fax:425.861.1118 Tel:206.633.1111,Fax:206.633.4747 ANALYTICAL LABORATORY REPORT RIM by Method EPA/600/R-83/116 Attn.: Mr.Rylan Baker Client Accelerated Analytical,LLC Address: P.O.Box 309,Little Rock,WA 98556 Jolgt: 1313-A Betch#: 201310488 Date Received: 4/4/2013 Samples Reed: 2 Data Analyzed: 4/5/2013 Samples Analyzed: 2 Project Loc.: 621 Southpoint Rd,Port Ledlow, WA Analyzed by: Christina Buce Reviewed by: Steve(Fanyao)Zhang,President Lab ID I Client Sample ID Layer Description % Asbestos Fibers Non-fibrous Components % Non-asbestos Fibers Black asphaltic None Cellulose 1 A 1 material with Asphalt/binder 14 , detected Synthetic fibers fibrous material Beige brittle None 2 B 1 material with detected Filler, Binder 23 Glass fibers fibrous material 1 ------- Jefferson Co Dept of Comm IOWA- Online Payments • Page 1 of 1 ,, ' Jefferson County Step 1:Select Payments Step 2:Review and Submit Step 3:Confirmation and Receipt Step 3: Confirmation and Receipt Result: Payment Authorized Confirmation Number: 10223168 Your payment has been authorized successfully and payment will be processed. Jefferson County Department of Community Development thanks you for your payment.For questions about your account,please call 360-379-4452 Thank you for using our bill payment services. Please save or print a copy of this receipt for record keeping purposes. My Bills Description Amount Due Building Renewal Fee payment of$76.00 on Permit Number 996600026 $76.00 Subtotal: $76.00 Customer Information Convenience Fee: $2.50 First Name: George Total Payment: $78.50 Last Name: Wittier Address Line 1: 17791 Fjord Dr Ne Address Line 2: Ste N140 City: Poulsbo State: Washington Zip Code: 98370 Phone Number: 3607796699 Email Address: jadams@co.jefferson.wa.us Payment Information Card Number: ************9000 Expiration Date: **f** Print https://client.pointandpay.net/web/JeffersonCoDeptofCommDevWA 4/15/2013 , — - co , I N m . " I m s WO N a lrOd HMOS© > ; ':....0 �I m 0 1 to C' vaias.00ns IlilIt !' 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