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BLD2013-00196
Ilk UILDING PERMIT APPLICAN BRD1e OOp96 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00196 Received Date: 6/25/2013 SITE ADDRESS: 7462 COYLE RD QUILCENE, 98376 OWNER: MICHAEL SAIA PHONE: 503-643-1039 4222 47TH ST SE AUBURN WA 980928443 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 701341001 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: SENTINAL CONSTRUCTION PHONE: 360-297-0080 26119 CALVARY LANE KINGSTON WA 98346 Contractor's License SENTICC961RT Expires 12/30/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DEMOLISHING AN EXISTING 1300 SF CABIN TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: 1,300 VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $76.00 MEB 06/25/13 142202 APPROVED State Building Code $4.50 MEB 06/25/13 142202 Total: $80.50 AUG 0 9 2013 Jefferson County DCD \\fi'Icmor4\rlofo\fnrmc\F PI(l Ann P1,1 rn4 R/9F/9f11Z i S I .? EI i ORCAA Permit Application Status 1 2 AUG ARr l� OH Permit Status Approved ❑ Disapproved Notes Review Date Reviewed by Permit# I�'..-OZCY.140C;;SZIrl Expiration Date Application Reeived Amount Due ❑Cash ❑Check 42rtredit card 1" ©� Additional notes or permit conditions C ►. M "�' ► ►nom. �= ►�.. { �' RECEIVED JUN132013 ORCAA r • Name Mailing address City ZIP State michael saia 4222 47th st se 'auburn I 98092 wa Site address City ZIP 7462 coyle road lquilcene I 198376 FAX Phone number Other contact number Email 253-709-0055 1253-833-7618 I Imountainhighl @comcast.net DEMOLITION CONTRACTOR ❑ check the box if same as property owner information Business/Contractor Name On-site contact E-mail Mailing address City ZIP ___I I Phone number Other contact number DEMOLITION PROJECT INFORMATION Number of structures being demolished 1 Start date. _ Completi da Is asbestos present? '7657e1.1.14. TO b�_1 INo Attach your asbestos survey below Has all identified asbestos been removed • Yes DEMOLITION PROJECT CATEGORY r Complete demolition ❑ Training fire-(complete fields below) ❑ Renovation,alternation,remodeling,maintenance or other construction If training fire,provide fire protection agency name,point of contact and telephone number p Owner occupied residential dwelling-Permit fee:$35.00-Prior Notice-Nonrefundable ❑ Other Structures-Permit fee:$60.00-10 working day wait period-Nonrefundable ❑ Emergency Fee$50.00-must be accompanied by Government Ordered Declaration(other structures only) Attach declaration below PLEASE MAKE A NOTE OF YOUR FEE. Applicant name Date michael saia 06/13/13 • • By checking the box and clicking"Submit"at the bottom of this form,you hereby certify that all identified asbestos in the project area has been removed and the information contained on this form and supplemental data described herein is,to the best of my knowledge,accurate and complete. rA l agree '11111.111111.1.11111111111111111117 ■ ■ - MI M - MINIM • III NNW __________-------...o.............o-s;....... ......_.__-------•'''''.---- _ozza\,----.1...___ r....,,,, ,,,, ,,...,..... ..................r47.....,4., VINIall.,_ _,.----i,„.' i ■ °' V- - s N l✓ X 3` • 11 • 8 ,o Ti; rV Ul te sb t 11 ow \uli■ • ■ ■ ■ jj ' '' 1i ili m ❑ iI XiIi 1 i I m0 j,I I D(I 0) I!1 M M I II Ili Z I I; 0 ll Ii X I I 1 'N li • CO W HI!' M . 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N _ - _ �z 7462 Coyle Road U O ti Ouilcene, 98376 lerVi JEFFERSON COUNTY 4tor` DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax -744-41.1;04:7" www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): 4.1,i4Locq cox 1 t son`# ,t j,i/ Tax Parcel Number: 71Di 34 I COI Property Size: 22)4s 41— (acres/square feet) Site Address and/or Directions to Property: 7440.1. Coyle �ci�k4ei e, MA. 933XP Property Owner(s)of Record: �A• Telephone:/263) $23- 7(PI S Fax: e' email: i l ilat Mailing Address: "4 ' VI • 1 _ ,: - 4.• .r Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan X 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** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions" ❑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 ►' ' U`/i ' / to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE �i. ..i�/ __% Date: Z i 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 attorneys 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. Staffs access and right of entry will be assumed unless the applicant info s the County in writing at the time of the aprali ati n that he r she wants r no Signature: A� _ Date: f% 2 SA/ The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential`take"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 res sibility fo dhering and complying with the ESA. The Applicant has read this di cl and s and dates it below. Signature: Date: in G:\Pem itCenter\ #FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • • . , • * * * ...r• *k* 1.*' ,, 9 .. * • v,• v.,.... ■ •,.v... , 7 ^ . . ,..•, ,, a . I ' . . , , a • , • 4 . * Va."' ...• 1,4.. . • , * ' • *,1`itia T*.4,3*A * • ..a. .* 1 ■ . • • .,. ', • ..•••■•ar a * • , . , .,. '. 4, 9 f t ‘,..,1, ,-. ' 1 **'2%• • ‘..4"i'',. i ,',0,7;•''''. i ;,1.• : ' ' • r . -4 ', ...St vk , S " •• • A ,•' "10` .1***S.• • ir''''• + r. . ...-11 `a, , 4, ... ... ..... ,.111‘.. *...1 •• • • ,4. .• --••• •"\ ''', .. Z". . (7.`,.:-.. - AA 3, .1-311-.%.,14.4 C"; ' 1:f L'Il tr41 - 11k; * •iv iv v... ., '• v■ .. ..9,,,,, 4•4.4.,..„9,. ,* , ..„..• . s p, 1i -.J.. '--f • v.. ). ..4—.. . . ' ....40.... 'e o• , • " ",• . • ' , t "., 4h);,. ., . . • ... 41. t: ..' ••,,,1 .. , • . • . 4 .9..1I• ' • *.':,...,••• •.', L , , • . . 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. Skjnature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Derr- al C�lnt;}'�UC.-�iar� C 2117-c V) 247-CO I MAILING ADDRESS: '.T..00l19' 1�6ClUecs14 Lane/� /� EMAIL:4 l dC � tCOIrS rl,c J .1.136" CONTRACTOR'S LICENSE WAINS NUMBER: � ' �41 NUMBER ARCHITECT/ENGINEER: ��,�11 ._ ` PHONE /, ,o ; r V FAX:( MAILING ADDRESS: 2 W ,� y�!7,7[e.�11�✓ l ' f1.��II • e`.i/ Al • ��J Project Type: s , Frame Type: Bathroom Shoreline: Type of Sewage Disposal: ❑ New Wood Existing: ❑ Sewer ❑ Addition ❑ Proposed: Bank ❑ Community System ❑ Alteration/Remodel Total: Height: ❑ Individual System , ❑ Repair Masonry SEP Permit# • ' Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ol ❑ Public Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current Proposed: Number of ADA Parking Spaces: Number of occupants(indudes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit.mark all items below that apply: 1 Underground Tank I Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank I Pellet Stove 1 Other Is this appliance beinsl installed in a Manufactured/Mobile Home? Yes / No When applying for a penult 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 al/property lines,buildings and septic system components, includin. the reserve area. ��, � s� �,,,�� --sue- � �,� "r �"` � s.� �x`� � .. � Square Footage Current Proposed �"a � Main Floor Heated r r EH Bid App Review: ...7i-e, CC) 2 Floor Heated � ���. Consiste Review: Y Other Heated ''' Base fee: Mezzanine Additional Section: Heated Basement '5 ,', I Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated _ Pot Water Review fee: Garage/Carport '; SUBTOTAL Decks i! 911/Rd Approach fee: � `. Other cf — TOTAL: $ /5-t.e 31)- , {* �_ ;� Receipt Number: ,r1Z ` - pt 1 . Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 62,77211'15 .Fair market value of all labor and materials foundation to finish Initials: d \` G:\PemutCenter\###FORMS###\DRD FORMS\Master Petmit Application 5-29-08.doc • • " • ' -•• • •• • 1yr I•• • • • '• %,* • • 011" Pt; VI 41 3 " 4 NS • • •• • 1 " • • • t • • • •••.64• •••t,lor • • •-•• • r , 1" iS • . z A' • t.4 el1 t'. ete,:••• .t.••- i t. , •• ••• ' 4,6 y ; • •• 1 Contractors or Tradespeople Peer Friendly Page Page 1 of 1 General/Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope of its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name SENTINEL CONST/CONSULTING INC UBI No. 602453858 Phone 3602970080 Status Active Address 26119 Calvary Ln,Suite 700 License No. SENTICC961RT Suite/Apt. License Type Construction Contractor City Kingston Effective Date 12/30/2004 State WA Expiration Date 12/30/2014 Zip 98346 Suspend Date County Kitsap Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type Status 1 2 Date Date SENTIC*027RD SENTINEL Construction General Unused 12/4/1998 11/5/2005 Archived CONSTRUCTION Contractor GODBOC*066K3 CO Construction General Unused 5/23/1994 5/3/1995 Archived CONSTRUCTORS Contractor Business Owner Information Name Role Effective Date Expiration Date GODBOLT, DAVID J President 12/30/2004 CARR, BARBARA ELLEN Vice President 12/17/2012 GODBOLT,JENNIFER E 'Secretary 12/30/2004 12/17/2012 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 1 CBIC SB7501 12/28/2004 Until Cancelled $12,000.00 12/30/2004 Assignment of Savings Information No records found for the previous 6 year period Insurance Information IInsurancelCompany Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 5 CBIC INRSB7501 10/28/2009 10/28/2013 $1,000,000.0009/19/2012 4 CBIC INRSB7501 10/28/2007 10/28/2009 $1,000,000.00 10/01/2008 3 CBIC INRSB7501 10/28/2006 10/28/2007 _$1,000,000.0010/03/2006 Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period Warrant Information No unsatisfied warrants on file within prior 6 year period Infractions/Citations Information No records found for the previous 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 6/25/2013 . • - - 4,11P 44, '1i�a.,a�o,,• Notification of Demolition Permit It is unlawful for any person to cause or allow the demolition(or major renovation)of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. Project Site Address: 7402... GOLtie, 94:1. County: lefet in City: W"%tC 41 State: IAA Zi %b"t2s Starting Date: 05,0//2.01'f 1.O1' Completion Date: 07by -1- "(There is a 10 working day advance notification period from receipt of permit application) Property Owner:__ Telephone: (1 Vj MS 7( Fax: Mailing Address: 1222 -17 City: At inn Ch State: WA. Zip: ` 2. Demolition Contractor:6a+1 net Geoff State License#:6Eisti lGG9ge i 42.1' Mailing Address:` ��� .0 nQ city: 1ti�� State: . ,Zip: Contact Person: -�'.t.lfP✓ C� �L16�' Telephone: X00 2er eirAO Fax:Ye) f7 0*1 YES NO Demolition by Wrecking or Dismantling? ($25.00 fee)check# )( Training Fire Demolition? (If yes,attach fire department request for training fire) y Renovation,Alteration,Remodeling,Maintenance,or other Construction? /' Asbestos found or suspected* *An ORCAA"Notice of Intent to Remove or Encapsulate Asbestos"form and appropriate fee must be submitted prior to any asbestos removal work. Asbestos removal gojects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation t Article 14 for additional requirements that may apply. rr Asbestos Survey Completed by AI ERA Certified Inspector V ec4$16e.Tet,t.`fro' Certification#- 2.561 . l 3.01 .4}3 This approved permit must Enclose$25 Certification of the Asbestos Survey must be available at the job site Processing Fee accompany this form 2940 B Limited Lane NW,Olympia,Washington 98502 360-586-1044 * 800422-5623 * fax 360491-6308 homepage:www.orraa.org * email:info@orcaa.org Rev.07111102 0 • 4kIN • . I .-.. , . ..- -, ..-,- „ • . . .t ...:7....4 , . ..4”, • a .*t"% • •.." % . i . . e,. .t..„.••- ':,..,,it, .■•.,!.• . ? '...i•4)1...C.1.,... :),.. '.1...4 .4 ...; .. ' r. ' t , . ' *$'■i•' , • "•—•• ,. —„„:,, - , ". -.I" . a.. :.:" , ;) *1141,:t•t-•'f, ,,s°• -0-: '' 't• .,$...,..., ,ht.f.:.•• • • ". . , • *P'..1 a .....ke-N-.., ,-—.. A..* 1. • '".14 4.'..... J• • j :... : 4 rn 4;'2N•1111'.'*'' ' 4‘.":•4 ie!:4 4';')i'''•1" •:.* „,„. :'4 4.'4."77:....4 l'''eli.i•!..!.'i 1 ..' .'4 -4..7:: ,...:44,... i.,,..,ct • . • • . • . . ..1...1I-I,• .4"....'" .''i..,.,-,!:e*';:ki.i i-1 .Al I Il -Nr.% ,- ,",ett.i...0, P"Nt. 1'6 •,.."...1 • j."11-* h ww. (4411 CP t ' ■ . •.. 0...11 ...*** ' .ee..4 I r•N. '.'''.'f'''- . . • .. .. • . • , . . .' / ''';'`‘.* ••*, r4. - ‘1 ".4,4* .. k , '''':;AL A: •ea,k ,.......• 0"' * 'A .....-' 4 . '4. . I' -• •.• Il 0 . '..4....• SI . — • • ORCAA Permit Application Status Permit Status Ill Approved ❑ Disapproved Notes Review Date 06/17/13 Reviewed by LS Permit# 13 D E M003507, Expiration Date Application Received 06/13/13 Amount Due $35 ❑Cash ❑Check • ©Credit card $35 Additional notes or permit conditions Vacation home. Not building until early 2014. • Name Mailing address City ZIP State Imichael saia 1 14222 47th st se 1 'auburn 1 98092 wa Site address City ZIP 17462 coyle road 1 (quilcene 1 98376 FAX Phone number Other contact number Email I 1 1253-709-0055 1 253-833-7618 Imountainhigh1 @comcast.net DEMOLITION CONTRACTOR ❑ check the box if same as property owner information Business/Contractor Name On-site contact I I E-mail Mailing address City ZIP I I I I Phone number Other contact number I I I DEMOLITION PROJECT INFORMATION Number of structures being demolished 11 I I I Start date Completion date Is asbestos present? 05/01/14 07/01/14 (No Attach your asbestos survey below Has all identified asbestos been removed IYes I DEMOLITION PROJECT CATEGORY p Complete demolition ❑ Training fire-(complete fields below) ❑ Renovation,alternation, remodeling,maintenance or other construction If training fire,provide fire protection agency name, point of contact and telephone number 1 I Ed Owner occupied residential dwelling- Permit fee: $35.00-Prior Notice-Nonrefundable ❑ Other Structures- Permit fee:$60.00- 10 working day wait period-Nonrefundable ❑ Emergency Fee$50.00-must be accompanied by Government Ordered Declaration (other structures only) Attach declaration below I I PLEASE MAKE A NOTE OF YOUR FEE. Applicant name Date Imichael saia 1 06/13/13 • • By checking the box and clicking"Submit"at the bottom of this form,you hereby certify that all identified asbestos in the project area has been removed and the information contained on this form and supplemental data described herein is,to the best of my knowledge, accurate and complete. ® I agree \\... j ,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,, _, „„,...---_,,, .. \ � ■ g %1 I ! i i ■ �� of ' '� ■ �' *�'' ` I ■ 1 .,1/ / Gl ys/�l .' I 1 . 1 11 mr r ❑ H 1 to it� y ,1 D W_ H G A co v i1 n 0) it C-r1 t l ( � ryry(<�..,,, 11 W 00 IL' i 1 1\1'V X I M� �li g (� c ,1 , `` \`\ ice: ���,.,� c2 A Q 1 1i. 3 tit, i/• �V rr � \\ A `�� \`\ A ,j11 �� 11b ``\•,\ ■1 1 i/! � Z \\\. j{j i%li I CD �+ \\\\ ; ; /j/ v t-. }■ I%1 W a 00 i�( \, ri -{- O o \\' 1 \\.\\\ ,,/, \\. ‘`\ ., co 1-----___:---- \ , \‘,:.\\\‘. \\1 \\\:, ` \ v\\, \ �\ co /,/,/ \\\\ d, \ I • ,\ i r W J i\ ,�l� nn` ❑ (-4 \ ` !r 'V O , , OD i i!�' O i\, p r! , `, .. .14: 0) r 13 \!, 299.98 ., X ES °27'04 "W !i „818.86 N0127�4 E (. 318.83 340.05 p U u p', 0 4 ` Li _. �Y,. yD c. âaia I si1.�1t e• ice= v m T 3 762 Coyle �8d gm J y - Ouilcene, 98376 D b = 0 . 1, hi m ill . PI i \S .11C-N-------3---c. W , • n I 1 X m '`��// I D \ I tl / / // - /// T `\ III \\ / �� ii �\ I / ` p 4i sl 1 I - / 1 /� iA �� 1 Y-----, I FEE, / ® dS 3 /I/, _ m N mi l& AV z A _ x � p pp y ` g I / 1p @ N ti29_ 3 \,\` III © $/ t / / A�\ YS n j 60 Pi n \ M k \,>\\ I I \\ \A A /�`,,\ ; i / 1 I 1 ri- --/-y / i b_ al \ . 1 \/ / / 3 Z CL V1 E 1 / /V j / / J- \ i / V , / / \ 0 ry� ,• I / \ / • D VO ,u I \ X ifP N to Z 51 Lii r lisi .„..1 Z I O m il_i7i • A s ' ■ âaia IZesklence T_ ^J a pp lL1 >i w p� oy g i A • f{` _ m r 7462-Coyle Road 6- CO U Oti LIR n C T1 - p c g 7" Ouilcene, 98376 • • KCB ENVIRONMENTAL SERVICES P.O. Box 220—Scabeck,WA 98380 360.830.5022 COMPENDIUM OF LOCATED ASBESTOS-CONTAINING MATERIALS 7462 Coyle Road Quilcene, WA 98376 Jefferson County After due diligence was exercised in the investigation of this home, no asbestos containing materials were identified attached to it. Jeanie Taylor, us EPA Certified AHERA Buildrn tor 5.3=,.13 43509.13.01.3443 13 • • KCB ENVIRONMENTAL SERVICES P.O. Box 220—Seabeck, WA 98380 360.830.5022 COMPENDIUM OF LOCATED ASBESTOS-CONTA1NING MATERIALS 7462 Coyle Road Quilcene, WA 98376 Jefferson County After due diligence was exercised in the investigation of this home, no asbestos containing materials were identified attached to it. r .1eanie Taylor, US EPA Certified AVIF.RA BuilrgirrtspecaLn 5.34.1 • #3509.13M1.3443 13 0 • f ots , 110,/ \' siwk._ ' OVI2 /Pco KCB ENVIRONMENTAL SERVICES - • (....A C-1"- P.O. Box 220-Seabeck, WA 98380 .cct/iAL I. 360.830.5022 10SI t/ 4))/..c."— )L4 \ COMPENDIUM OF LOCATED ASBESTOS-CONTAINING MATERIALS 7462 Coyle Road Quileene, WA 48376 Jefferson County After due diligence was exercised in the investigation of this home, no asbestos containing materials were identified attached to it. iJeanie Taylor, US EPA Certified AHURA Builrnrtrt,pt. 5.3 .13 43509.13.01.3443 13 • 41A I( C B ENVIRONMENTAL SERVICES PHONE#(360)830-6022 P.O. BOX 220 FAX#(360)830-5020 SEABECK,WA. 98380 14; ,;;* jtaylorke ahoo.com Thix-amount is due upon receipt rea',p nj this Atalement INVOICE May 21. 2013 Michael Sala 7462 Coyle Road Quilcene, WA 98376 Performance of a Certified AHFRA Building Inspection on 5.21.2013 at 7462 Colyle Road. Quilcene,WA 98376.. . . _.. $ 325.00 No sales tax due on seri,icex Paid by check # 5625 on 5.21.13 in the amount of.................. _____.S 325.00 CR No additional amount due. I N IPA Certified AHLRA Building Inspector 31,709-13-01-3443 • KCB • ENVIRONMENTAL SERVICES Ark PHONE#(360)830-5022 P.O. BOX 220 FAX#(360)830-5020 SEABECK,WA. 98380 CERTIFIED AlIERA ASBESTOS INSPECTION 7462 Coyle Road Quilcene, WA 98376 JEFFERSON COUNTY May 21. 2013 Prepared for: Michael Saia 4222 47th Street SE Auburn, WA 98092 • • TABLE OF CONTENTS 001. Regulatory Compliance.................................... 002. Asbestos ..... ..... 003. Sampling Protocol..................... ..................... 004. Survey .Methodology/Limitations.......................... 005. Site Specifications. 006. Summary.„ ...... ... ..... ........... Attachments which may be included: Site location maps Photos Notification forms Lab analysis Field reports Chain of Custody forms Certifications Print outs Miscellaneous information ..„. .„ 2 S 001. Regulatory Compliance This inspection satisfies the current regulation WAC 296- 62-07707 that requires building owners to conduct an inspection before any repair, remodel, or demolition can he performed where asbestos may be disturbed (Chapter 49-17 RCW) and... Puget Sound Clean Air Agency (PSCAA) Regulations, Article 4 of the Asbestos Control Standards Section 4.021a) Asbestos Survey Requirements: -It shall be unlawful for any person to cause or allow a renovation unless the property owner or the owner's agent determines whether there are suspect asbestos containing materials in the work area and obtains an asbestos survey of any suspect asbestos containing materials by an AHERA Building Inspector. An .AIIERA Building Inspector is not required for asbestos surveys associated with the renovation of an owner-occupied, single family residence. (1) If there are no suspect materials in the work area, this determination shall either be posted at the work site or communicated in writing to all contractors involved in the renovation. (2) It is not required that an AHERA Building Inspector evaluate any material presumed to he asbestos containing. (3) Except for renovations of an owner-occupied, single family residence, only an AHERA Building Inspector may determine that a suspect material does not contain asbestos. (4) A summary of the results of the asbestos survey shall either be posted by the property owner or the owner's agent at the work site or communicated in writing to all persons who may come into contact with the material. (h) Requirements for Demolition It shall he unlawful for any person to cause or allow any demolition unless the property owner or the owner's agent obtains an asbestos survey by an AHERA Building Inspector of the structure to be demolished. ( ) It is not required that an AHERA Building Inspector evaluate any material presumed to he asbestos containing material... 3 41110 (2) Only an AHERA Building Inspector may determine that a suspect material does not contain asbestos. (3) A summary of the results of the asbestos survey shall either be posted by the property owner or the owner's agent at the work site or communicated in writing to all persons who may come into contact with the material. Section 4.04 (a) Removal of Friable Asbestos Prior to Renovation or Demolition. Except as provided in Section 4.06c of this Regulation, it shall be unlawful for any person to cause or allow any demolition or renovation that may disturb friable asbestos-containing- material or damage a structure so as to preclude access to friable asbestos containing material for future removal, without first removing all friable asbestos-containing material in accordance with the requirements in this regulation. Notification is required/Or demolition's involving structures with a projected roof area greater than 120 square.feet, even if ACAl is present Friable, asbestos-containing material need not be removed from a component if the component can he removed, stored, or transported for reuse without disturbing or damaging the asbestos. It shall he unlawful for any person to cause or allow the burning of any facility for fire training without removing all asbestos-conthining, materials prior to burning. This includes both friable and nonfriable ACM. Section 4.05 Procedures for Asbestos Projects. Training Requirements It shall he unlawful for any person to cause or allow any work on an asbestos project unless it is performed by persons trained and certified in accordance with the standards established by the Washington State Department of Labor and industries, the federal Occupational Safety& Health Administration (OSI IA), or the United States Environmental Protection Agency (whichever agency has jurisdiction) and whose certification is current. " This certification requirement does not apply to asbestos projects conducted in an owner-occupied, single family residence performed by the resident owner of the dwelling. AHERA (Asbestos Hazard Emergency Response Act) regulation requires this inspection to include the identification of Friable and Non-Friable ACM in (I ) Surfacing Materials, (2) Thermal System Insulation, and (3) Miscellaneous Materials: to delineate homogeneous areas and to sample or"Presume- all materials located. 4 • Friable ACM is thought to release fibers into the air more readily, however, many types of Non-Friable ACM can become airborne if disturbed. Additionally, the condition of the material will he graded and the potential for future damage assessed. The number of samples required is specified in the AHERA Rule (40 CFR 763.86)as follows: Surfacing Materials: (SM) 3 samples per homo- geneous area of less than 1000 square feet, 5 samples for greater than 1000 but less than 5000 square feet, 7 samples for greater than 5000 square feet. Thermal System Insulation: (TS() 3 samples from each homogeneous area that is not"Assumed" to be asbestos, 1 sample per each patched area. and as determined by the inspector for tees, elbows or valves. Miscellaneous Materials: (MM) Sample in amounts determined sufficient by the inspector. Friable asbestos is material that can be crumbled, pulverized or reduced to powder by hand pressure. Non-Friable asbestos can become Friable by sanding. grinding, sawing, or other mechanically induced means. EPA (Environmental Protection Agency) regulates asbestos above 1%, as determined using the method specified in Appendix A. Subpart F. 40 CFR (Code of Federal Regulations) Part 763, Section 1, by Polarized Light Microscopy(PLM). These agencies regulate asbestos in these counties: (Washington State) • Puget Sound Clean Air Agency(PSCAA)King,Kitsap.Pierce.Snohomish • Olympic Regional Clean Air Agency(ORCAA)Jefferson,Clallam,Mason.fhorsion,Pacific, irays j tarhor • Southwest Clean Air Agency (SWCAA)Lewis,Clark,Wahkialonm Cowlitz,Skamanta • Yakima County Clean Air Authority(Ya'AmYgama • Northwest Air Pollution Authority(NAPA)Whatcom,Skat Island • Douglas County Clean Air Commissionughb. • Grant County Clean Air Authority, (,rant • Tri Counties Air Pollution Control Authority.Benton,Walla Walla,Franklin • Spokane County Air Pollution Control Authority(SCAPCA)Spokane • Washington Department of Ecology,(txw)Stevens,Ferry,Okanogan,San Joan,Chelan,KM nas, Kiw:mu.Columbia.(tart)dd.Asonn,Adams'. ,meoln,Pend Oreille 5 A fee must be paid, and the Notice of Intent filed, and be submitted prior to renovation or demolition of a building. There is a required waiting period after filing a notification before work can begin. (Mandatory 10 days for all demolition's) Calendar or working day wait is stipulated by each regulatory agency's policy. Further information regarding compliance may he obtained at our office. It is unlawful for the owner or the owner's agent to remove asbestos in excess of 10 linear feet or 48 square feet per year, per structure, unless the building is an owner-occupied, single family private residence. Washington State law requires asbestos that is left in place, he in good repair and maintained at regular intervals. Maintenance should be documented. References: WA C 296-62-077 Asbestos, Tremolite, Anthophlylite & Actin°lite WA('296-65-001 Asbestos Removal & Encapsulation NESHAP Asbestos Regulations 40 CFR 61 Sub Part M PSCCA Regulation HI Artick 4 AHERA Model Accreditation Plan AHERA Final Rule 40CFR 763 OS/IA 29 CFI? Parts 1910 US' EPA Guidance fOr Controlling Friable ACM in Buildings US EPA ACM in School Buildings, A Guidance Document Part i&2 US'EPA Asbestos Waste Management Guidance tgffice of Solid Waste)liS EPA Reporting ct Recordkeeping RequirementsfOr Waste Disposal 11-90 tiS EPA A,vbe,stos in the Home, A Homeowners Guide 6-88 United.States Environmental Protection Agency:The Asbestos Informer All federally recognized Tribal Lands are not under the jurisdiction of a local air pollution control agency but must report to the US EPA when undertaking asbestos abatement. 6 • 002. Asbestos Definition "Asbestos" includes Chrysotile, Amosite, Crocidolite, tremolite asbestos. anthrophylite asbestos, aetinolite asbestos, and any of these minerals that have been chemically treated and/or altered. Chrysotile is the most commonly used type of asbestos in North America, known as -white asbestos",the only mineral in the serpentine group of asbestos minerals. The word -asbestos" (Greek - not extinguishable) was first recorded in the first century AD, although the substance was known as early as the second century BC. 75% of the world's asbestos is mined in Quebec. Exposure to asbestos fibers can cause asbestosis, various cancers and the deadly mesothelioma which is an inoperable cancer of the chest and abdominal linings. Because there is no known safe level of exposure to asbestos, all exposure should be avoided. Asbestos was used in the United States in over 3600 different building materials, and while it is possible to suspect that a material contains asbestos actual determination can only be made by instrumental analysis. Sample List of Suspect Asbestos Containing Materials • Cement Siding/Wallboard/Pipes • Asphalt Floor Tile/Adhesives • Vinyl Floor Tile/Vinyl Wall Coverings • Vinyl Sheet Flooring • Flooring Backing/Vinyl Wall Coverings • Construction Mastics/Joint Compounds/Spackling/Caulking/Putty • Acoustical and Decorative Plaster • iextud Paints and Coatings • Ceiling Tiles and Lay-in Panels • Spray-on Insulation/Duct& Boiler Insulation • Blown-in Insulation/Wiring Insulation • Fireproofing Materials/Cooling Towers/Base Flashing • Taping Compounds/Chalkboards/Roofing Shingles • Packing Materials(Walls/Floors) • Gaskets/Drywall/Roofing Felt • Laboratory Hoods/Gloves/Table Tops • Fire Blankets/Curtains/Doors • Heating& Electrical Ducts/Pipe Insulation • Elevator Brakes and Equipment Panels Note: This list does not include every product that may contain asbestos, 7 • 1110 003. Sampling Protocol This survey addresses Friable and Non-friable suspect asbestos containing materials to meet NESHAP 40 CFR 61 (National Emissions Standards for Hazardous Air Pollutants) requirements for renovation and/or demolition activities. When suspect ACM is observed our technicians are trained and proficient in gathering samples by approved industry standards, All samples are then analyzed by an independent EPA-approved NVLAP/ NIST/AIHA accredited lab that participates in the PAT program, according to 29 CFR 1910.1001. (j)(8)(ii)(A&B). The samples are analyzed using PLM with dispersion staining to estimate the percentage of asbestos composition by volume. Samples in which less than I% of asbestos mineral is detected is designated as-None Detected" (ND)or-No Asbestos Detected" (NAD). Random samples are gathered of each homogeneous suspect ACM identified during a visual search. A series of samples are gathered (according to the 3-5-7 Al IERA Rule) and are read at the lab for a positive result. If positive, no other samples are read of that material; if the sample is negative of asbestos content, the other samples are studied, All samples gathered must be reported negative for the material to he considered "None Detected". The laboratory analysis of all bulk sampling is included in this report and intended to be an integral part of the inspection data, Guidelines require laboratories reading asbestos samples to read all materials which are included in the submitted sample (tile, mastics, vinyls, adhesives, leveling compounds, etc). Because we frequently submit a -layered" sample, we may not sample mastics/adhesives separately as we feel this would be redundant and cause confusion in the interpretation for our clients and also result in costlier lab fees. Therefore, the number of samples gathered will not always result in the same number of sample results received from the lab. Not all laboratories are qualified to analyze asbestos. The lab must he NVLAP certified, participating in the PAT Program of the Federal government. 8 004. Survey Methodology / Limitations Site reconnaissance was conducted by a Certified AHERA Building Inspector, in accordance with 40 CFR Part 763 Appendix C, who is familiar with the probable uses and locations of suspected Asbestos Containing Build- ing Materials (ACE3M). In addition to a visual walk through. effort is expended to disclose prior uses of the facility, age. and characteristics of construction. and other information which helps determine the potential presence of suspected ACBM. This inspection report is the written opinion of a qualified Certified AIIERA Building Inspector and is based on conditions visible at the time oldie site visit. This report does not constitute a warranty of any kind. Although extensive searches are conducted, there remains a remote possibility that asbestos in some form may lie undetected within the structure; under a floor, inside a duct. behind a wall, or buried in the ground. No degree of demolition was authorized or performed. Sonic printed materials may be included in this report strictly for educational purpose. Estimated dimensions quoted in this report are approximate estimates for location awareness of the materials and arc not intended to be accurate for bidding. The Abatement Contractor should check all measurements by site visit. No portion of this report should he removed from its entirety; copies can be made by folding back the pages. This report should remain on file for future reference regarding this structure. In older structures, it should be noted for personal safety, that most window putty did contain asbestos, and that in the process of removing the putty to repair a pane, some individual contamination would most likely occur. Such windows should be removed with the glass intact. and disposed of as a unit. When flooring is considered suspect of asbestos content, the mastic should always be treated as suspect as well, and should never be chipped, sanded or scraped until tested to determine if asbestos is present. 9 • All questions pertaining to this report should be directed to our office for immediate response. Field notes are included in this report for their interpretive value. Photo's if taken are included for identification. Sample readings resulting in less than one percent (<1%) will not he recorded as asbestos because this amount in unregulated, there/ re not considered asbestos (ACM) Our services have been executed in accordance with generally accepted practices within the limitations of scope. schedule, and budget; no other conditions are expressed or implied. This report does not expire as long as all repairs and remodeling activities atIer the inspection has been performed are conducted using new materials (not inventoried or used) certified asbestos free; and this action is carefully documented. Because materials are being imported into the United States from China, which can contain asbestos, all suspect materials must be tested to ascertain whether or not asbestos fibers are present. There no longer is a -cut off"date from the year that the U.S. stopped the manufacturing of ACM for residential use that we can rely on. This document is protected by the Copyright Act of 1979 under Title 17 of the United States Code. Under no circumstances can this material be used unless it has been financially compensated for, nor can it he re-printed without express authorization from this firm. 10 005. Site Specification: This US EPA Certified Al'ERA Building Inspection has been authorized by the owner, Michael Saia of this single family private residence located at 7462 Coyle Road, Quilcene, WA 98376. within Jefferson County. The site investigation was performed on May 21. 2013 escorted by Mr. Saia. The structure consists of less than 100 square feet, is located on the waterfront of hood Canal and has been very well maintained. it has a composition roof, wood framing and siding, wood floors and interior wood walls with no wallboard. Due diligence was exercised in this inspection, and there were no suspect materials that could be found. The house was built in the late 1960's to early 1970's. according to the owner, but was gutted to the studs during renovations. The owner intends to demolish this structure and rebuild on this property, thus the requirement to obtain this inspection report. No other buildings will be demolished that are over the 120 square feet of roof projection. This report does not expire as long as any work done on the building in the future is carefully documented that all materials are certified to be free of asbestos. This report has been prepared fur the exclusive use of Michael Saia and his representatives for specific application to this site, If new information is developed through borings, or excavation, this inspector should he retained to re-evaluate the conclusions of this report and provide amendments as needed, • 006. Summary: The local Clean Air Agencies require a 10 day wait prior to asbestos abatement of a commercial or other than owner-occupied structures'. and requires the 10 working day wait for all demolitions. A demolition permit, must he purchased from ORCAA whether or not asbestos was identified attached to your structure. It is required to file your Notice of Intent with Olympic Region Clean Air Agency online at ,■,A and you may phone them for more information at 360.539.7610. If you wish to contact the state office of D()SI I at 253.596.3868 or online at u . The Washington state office does not charge a fee. If no asbestos was identified on your property you do not have to file with the state. We suggest you retain this document for as long as you own this property for hold contract to work on it) to verify your compliance to the asbestos standards in place at this time. If there are any questions, please feel free to contact this inspector: Jeanie Taylor, EPA Certified AHERA Building Inspec 509.13.01.34,43 Contracting in Washington State continuously since 1967 12 • KCB ENVIRONMENTAL SERVICES P.O. Box 220—Seabeck, WA 98380 360.830.5022 COMPENDIUM OF LOCATED ASBESTOS-CONTAINING MATERIALS 7462 Coyle Road Quilcene, WA 98376 Jefferson County After due diligence was exercised in the investigation of this home, no asbestos containing materials were identified attached to it. Jeanie Taylor, US EPA Certified AHERA Building7trtspektcLr 5.3',.13 #3509.13.01.3443 13 • • FIELD REPORTS _ LABORATORY FINDINGS K C B Environmental Services 14 • • 1 ,....1110 ti 1 0 ' OS t gLi M .1 w a 1 t . ,i,, , ---�? ,- .. , w 0 6. 1-4.... „, . . 1 4 N C` ' w 4 0 .. at g /y ,, ' 1 C6 {{ sus 1 as :. - .- - et V/ 0 f? t 0 2 •• r 6 MIMI , W tL a w a a �i a z /:,„„,, W a t-- . . a • - CERTIFICATIONS ,.„. Unified Business Identifier#602.287.509/Contracting in Washington State continuously since 1967 • • ,70` ' ,\,„, ...."''',,p'''44',?,,,, 4' , ' / ' Irit , ,,,. X'', ,, • 'Ti'' ''',.., ''''''' '..- '''''' 1 ,,,iiits l' ler ' admiL.1-". 1:, ' ' i or 4,7 ' ,,,I4, let,,. li '4 i'lwf 04' * 11.,..;" , , . --; i IZ::.•..:;',, ,; .4:::: , ... .. . , . ,.. , ( ......4. a ,---, . , -,...... (..) Z 4;4 411111. 0.... 0.1,..... ›,‹ .1 .‹ "1"4 :z..) < wr.,4 ...,. (t) t:1 g •;:f.,1 < r,-, ?) ,t4 c:,,, ."?.: . f,,,T„, 8 ‘14 w... 44 - <-4 --- .— c t-,, ..,.. 1,24- g, >„ b.c3 00 ft t, vt .< >4a\ 0 "" i" I'll ''Y' , c.,...1 0 H 41.47N \ •( - -1.800'' ',,-, - , E-, ;,,D tz4 ',1'.' >: \ i, ,,,,t1 -F-,. ., ,,) A — fa, f, 'r' it' ''''.: l:: C7‘ ili Z ,...., 7 to..4 0.0 F.., reluo, „...,..7. .... 0,...z., - r‘;) Z CI. ,, ti„,", 11-mol oc 0, ..... "ttl \lissit) c.f) „,-:-.. louni4 x ;..1 ;...1.1 2,,,,, t----i-- i„ .eir,- -sic' i.r.; ,.-1 .4 X -) z ef), f., *e• 4-■ *''' a) +'- 7 '"...'.. .,,4' 41:4 .) iF. 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Wed. 091 Fri. )ate: 6 Time Received: t` -' p Co �� Date: 1.i l.0 Contact Name: )3LD: Contact Number: 360 dam' n owner: / . .- address: I� a i 206� _ — Notes: Foundation Plumbing Framing Propane Tank Mechanical Under ground Furance Setbacks Under ground Framing g Gas Rough In Air Seal Above ground Footing Exterior lines Oil Stemwall Hydronic Exterior shear Interior shear Interior lines Ducts Straps Hot Water Htr Appliance Post Hole Ventilation Underfloor Gas/Wood stove Insulation Man-Homes Final Inspection Setbacks Floor Wall Address Posted Foundation— .-^r1;.„ ■ • • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00196 Received Date 6/25/2013 SITE ADDRESS: 7462 COYLE RD Issue Date 8/9/2013 QUILCENE, 98376 APPLICANT: MICHAEL SAIA PHONE: 503-643-1039 4222 47TH ST SE AUBURN WA 980928443 1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701341001 Section: 34 Township: 27N Range: 01W CONTRACTOR: SENTINAL CONSTRUCTION PHONE: 360-297-0080 26119 CALVARY LANE KINGSTON WA 98346 Contractor's License SENTICC961RT Expires 12/30/2014 OWNER, MICHAEL SAIA PHONE: 503-643-1039 if different: 4222 47TH ST SE AUBURN WA 980928443 PROJECT DESCRIPTION: DEMOLISHING AN EXISTING 1300 SF CABIN Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 8/9/2014. REQUIRED INSPECTION: FinalApproval: q-I Lt-(t BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday SPECIAL CONDITIONS APPLY- SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS FOR CASE#BLD13-00196: 1.) The building permit for the replacement home will not be approved until the"Bedroom Restrictive Covenant" has been recorded. \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 8/9/2013