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HomeMy WebLinkAboutBLD2014-00327 BUILDING PERMIT APPLICATION BLD14-00327 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD14-00327 Received Date: 9/9/2014 SITE ADDRESS: 621 S POINT RD PORT LUDLOW, 98365 OWNER: STEVEN D MEACHAM PHONE: VIRGINIA L MEACHAM 3067 PASEO MOUNTAIN AVE HENDERSON NV 89052 9966 SUBDIVISION: Block: Lot: PARCEL NUMBER: 996600026 Section: 4 Township: 27 N Range: 1 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: GEORGE WITTLER PHONE: 360-779-6699 17791 FJORD DR NW. STE N-140 POULSBO WA 98370 PROJECT DESCRIPTIOt DEMOLITION - REMOVE EXISTING GARAGE TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: 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 S76.00 SRE 09/09/14 151519 APPROVED ED Total: $76.00 OCT 2 ? 2014 Jefferson County DCD \\tidemarkldatalforms\F_BLD_App_Bld.rpt 9/9/2014 1 11111 111 4,xv- 0O JEFFERSON COUNTY � DEPARTMENT OF COMMUNITY DEVELOPMENT 'd 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax PDyL1 �� ' _32� �s, p' www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): _ P O f G. T2 AA)D G6d2_ 41 ., _. Tax Parcel Number: `icr( C ZCP Property Size: (acres/square feet) Site Address and/or Directions to Property: 402c 50.5ff i°6[i\YT iRdA Dfble.T LU PLOW/ WA 6E Cp Property Owner(s)of Record: 5•tve �kX VI )IA d\ G HA M Telephone: �I iFaax: email: 2.� �'7 Mailing Address: `f' l5 �J .irJT ' k I Cas DK .. 11)C I s-/ cA-� dW oZ ( Applicant/Agent(if different from owner): CEJ : Lkj Telephone: CrID-if` f) — 4(9 Fax: (J—br31-6qOICI email:otC �J U Mailing Address: �J What kind of Permit?(Check each box that applies ilding 0 Critical Areas Stewards I , -nE C FE 0 v ' Demolition Permit 0 Variance(Minor, Major ori'e-.:•:; • _->• - - ❑Single Family ' Garage Attached-1 Detached 0 Conditional Use[C(a),Ci(d .+ I" ❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unna =. se ClassificatiRpn O Commercial" ❑Special Use(Essential Pd•lig'=cilit@EP" - y 2014 ❑ Change of Use 0 Boundary Line Adjustmer(il ❑ Address 0 Road Approach 0 Short Plat" 'i ❑Home Business ❑Cottage Industry 0 Binding Site Plan" JEFFERSON COUNTY ❑ Propane 0 Long Plat" DE'T OF CO ii _f_1I LOP,ENT ❑Sign 0 Planned Rural Residential rev- •• - - , • ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions'"' O Site Plan Approval Advance Determination(SPAAD)" ❑Shoreline Management Substantial Development"* ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please Identify any other local,state or federal permits required for this proposal,if known: /�J�� DESIGNATION OF AGENT L.( I hereby designate �Pi '6./.0-TIL ' to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date:X( '/t Sill 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 malarial 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing al the lime of the a•plication that h- . •..wa --ii, - _. r Signalur_ / Date: $! t�_ t'e 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- an " ferable r---.•••-'- - for edit, • • .nd • +lying with the ESA. The Applicant has read this disclaimer a d sig s and dates it below. Signature Date' Bf t51/ G:WcrmitCcntcr\###FORMS###\DRD FORMS\Master Pemvr Application 5-29-O8.doc JJJ • BUILDER STATEMENT The signer o1 this st tement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu the respon ity of the General Contractor for the proposed pro' ct Signature: of this Date: a! GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PI II:NE: FAX: • ( ) ( ) MAILING ADDRESS: EMAIL- CONTRACTOR'S LICENSE WAINS - NUMBER: NUMBER ARCHITECT/ENGINEER: ------- PHONE ( ) _ - FAX:( ) -- MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: ( Shoreline: Te — New Type of Sewage Disposal: La Wood Existing: E Sewer G Addition T.1 Steel Proposed: Bank D Community System Alteration/Remodel o Concrete Total: _ Height: C Individual System 0 Repair 0 Masonry —_ SEP Permit# ' Demolition C Other: Bedrooms: Water Supply: Existing: _ Setback: 0 Private well 0 Two Party Type of Heat: Proposed: Total: 0 Public Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees, etc) Current Proposed 13C Occupancy:- IGC 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: i Underground Tank t Above ground Tank Size of Propane Tank: t Heat Stove i Cook Stove i Woodstove t Fireplace Insert t Hot Water Tank i Pellet Stove i 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated E Id App Review: OO 2'Floor Heated Consistency Review: Other Heated se fee: -NO 00 Mezzanine Additional Section: G Heated Basement l L • UO Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated PottWater Review fee: - ---- J Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ U Receipt Number: Cash/Check Number: — ESTIMATED COST(REQUIRED) Date: - —1 'Fair market value of all labor and materials foundation to finish i Initials: G.\Fermi.Center\#1"it1pOR\fco'.t \rlerl MR nrctr..-_...-.-r,nn n- _%nr..-_-1-,. -. , ,- .- -- . • • QAC RF.t.,Koi n..E44 s. � � 2940-B Limited Lane NW o "1 '': Olympia, WA 98502 ORCAA fi 1-800-422-5623 • 1360) 539-7610 �µ..,•� " Fax: (360) 491-6308 EOMVR ORCAA Permit Application St _ i j ! SEP - 9 2014 Permit Status O Approved ❑ Disapproved IJEFFERSON COUNTY -___DE°T.OF COMMUNITY DEVELOPMENT Notes 9/8/14 CK Review Date Reviewed by 14DEM003873 10/30/14 09/08/14 Permit# Expiration Date Application Received $325.00 09/08/14 Amount Due U Cash ❑ Check © Credit card Additional notes or permit conditions ,.rt Angell-. bold Ot(i(e: 116 VV. 8t1i St., Suite 1 1 1, I'urt Angeles, WA 98.562: (360)417-1466 R...0,mond field()lire: MI Oh van Ave., Raymund,WA 98577: I Ih()1 042-21 17 Name Mailing.ress • Steven Meacham 645 Loympus Dr. SW, City ZIP State Issaquah 98027 IWA Site address City ZIP 261 South Point Rd Port Ludlow 98365 FAX Phone number Other contact number Email 206-310-6804 smeacham©beelbrimley.com DEMOLITION CONTRACTOR check the box if same as property owner information Business/Contractor Name On-site contact E-mail Mailing address City ZIP Phone number Other contact number DEMOLITION PROJECT INFORMATION Number of structures being demolished 1 Start date Completion date Is asbestos present? 10/15/14 10/30/14 No Attach your asbestos survey below asbestos survey.pdf Has all identified asbestos been removed Yes DEMOLITION PROJECT CATEGORY ® 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 ® 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 • George B. Wittier 09/08/14 I do certify that I am the owner,authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application/permit. I authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this application/permit and to ensure compliance with permit conditions, applicable laws and regulations. I understand that granting of this permit by ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is,to the best of my knowledge true, accurate and complete. ® I agree Olympic Region Clean Air Agency(ORCAA)• 2940-B Limited Lane NW • O3 0-539- 61A F02A 360-539-7610 I FAX 360-491-6308 Port Angeles Office 360-417-1466ORCAA Raymond Office 360-942-2137137 www.orcaa.org DEMOLITION PERMIT APPLICATION Demolition and renovation projects within Clallam, Grays Harbor, Jefferson, Mason, Pacific and Thurston counties REQUIRE A PERMIT and require that the following permit conditions be met prior to demolition or renovation. Olympic Region Clean Air Agency(ORCAA) regulations define a demolition project as the wrecking, razing, leveling, dismantling or burning (by a fire department for training purposes)of a structure making the structure permanently uninhabitable or unusable. Renovations include the removing of load bearing structural members, but not to the extent to make the structure uninhabitable. The following information is merely a reference guide and not a substitute for agency regulations. 1.A good faith asbestos survey must be conducted by a certified Asbestos Hazardous Emergency Response Act(AHERA) building inspector. Qualified contractors and inspectors may be found in your local Yellow Pages, through the Washington State Department of Labor and Industries, or on ORCAA's website. 2.Asbestos samples must be sent to an NVLAP laboratory(National Voluntary Laboratory Accreditation Program)per 40 CFR 763.87. A list of labs can be found on ORCAA's website. 3.The start date on other structure demolition must be at least 10 working days from the submission date of the complete application and payment. 4. It is the responsibility of the property owner and/or demolition contractor to ensure there is no asbestos-containing material present in the structure to be demolished. 5.Any and alt structures on the same parcel of property that are not proposed to be demolished must be identified as such. 6.A copy of the asbestos survey and approved Demolition Permit, as well as any subsequent amendments, must be kept on site and available for review by Agency inspection personnel. 7. The original demolition permit will expire on the Completion Date. Under no circumstances will a project be extended beyond 1 year from original start date. ADDITIONAL REQUIREMENTS In addition to Agency requirements, most building departments require a demolition permit(separate from ORCAA's Demolition Permit).The Washington State Department of Labor& Industries may also require notification for asbestos removal projects. "Owner Occupied Residential Dwelling"means any single family housing unit which is permanently or seasonally occupied by the owner of the unit.This term includes houses, mobile homes,trailers, houseboats, and houses with'mother-in-law apartment'or a'guest room.'This term does not include structures that are demolished or renovated as part of a commercial or public project; nor does this term include any mixed-use building, structure, or installation that contains a residential unit, or any building that is leased or use as a rental, or for commercial purposes. PROPERTY OWNER 1 BLD13-00123 BUILDING PERMIT APPLICATIvr+l 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 i ] (10 , //q ), PORT LUDLOW, 983 ll.' �/ � ,r �� / 1 t • OWNER: STEVEN D MEACHAM a' VIRGINIA L MEACHAM 645 MT OLYMPUS DR SW ISSAQUAH WA 980274000 SQUAMISH HARBOR BCH SUBDIVISION: Block: Lot: PARCEL NUMBER: 996600026 Section: 4 Township: 27 N Range: 01 E CONTRACTOR: TBD f PHONE: L----Yts-V (e_d * 1 REPRESENTATIVE: GEORGE WITTLER PHONE: (360) 779-6699 17791 FJORD DR NE, STE N-140 (360)697-5400 POULSBO WA 98370 PROJECT DESCRIPTIOP 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: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: ,74 5 7yrt __ Type Amount Paid By: Date: Receipt: Approved/Date Permit $76.00 ZAL 04/15/13 140245 (',p Total: $76.00 1 (0 00 Ci TeC� -1CI •GC) H- 2e.6-eco 1 C hC.u_ ielk rk.e.1-0p w4.1- '6(i aL(ZPPc Cox, nIl7nm¢ \\tirlcmorLlrlahlinrmc\C RI Il Ann fin rnY �¢<°" 06,4 JEFFERSON COUNTY $` DEPARTMENT OF COMMUNITY DEVELOPMENT pSyIN3- Date: /e)114, Time Received: 41/i3 am/6 Mon. Tue. Wed. Thur. Fri. Date: BLD: i'-f- 32.-7 Contact Name: Owner: Contact Number: 360 Address: Col I c c, FvoiC 206 Notes: l 7)EIJAt? Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling go,,,,,N r DEPARTMENT OF COMMUNITY DEVELOPMENT L- 1 621 Sheridan Street,Port Townsend,WA 98368 1 Tel: 360.379.4450 I Fax:360.379.4451 Web:www.co.iefferson.wa.us/communitydeselopment E-mail:dcd@co.iefferson.wa.us SyIN September 09, 2015 STEVEN D MEACHAM VIRGINIA L MEACHAM 3067 PASEO MOUNTAIN AVE HENDERSON NV 89052 RE: SUBJECT: PERMIT TO EXPIRE - NOT RENEWABLE SITE ADDRESS: 621 S POINT RD PERMIT#: BLD14-00327 LEGAL DESCRIPTION: 9966 - SQUAMISH HARBOR BEACH BLOCK: LOT: PROJECT DESCRIPTION: DEMOLITION - REMOVE EXISTING GARAGE DEAR STEVEN D MEACHAM PERMIT# BLD14-00327 WAS ISSUED BY THIS DEPARTMENT ON 10/27/2014 , WAS VALID FOR ONE YEAR AND IS NOT RENEWABLE. According to our records, a final inspection has either not been scheduled or has not been passed. TO SCHEDULE A FINAL INSPECTION, CONTACT THE DEPARTMENT OF COMMUNITY DEVELOPMENT INSPECTION HOTLINE AT 379-4455 and leave your request after the recorded message. In the event a final inspection is not passed, the inspector will give you a written notice of required corrections. You must call for a re-inspection to receive final approval. A FINAL INSPECTION MUST BE SCHEDULED BY 10/1012015. Please contact the Department of Community Development (360) 379-4450 with any questions. 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Asbestos Survey Report Located At: 621 0.� `14\-15GLudlow South WAoint Rd. � 98365 o'c 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 UMITS OF SURVEY 5 APPENDIXES 6 Appendix A: Laboratory Results/ Documentation 7 Appendix B: Site Photographs 8 P.O Lim 309 2 Phoaa360-239-0354 Litderock,Washington 98556 Email a tact 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 Watts and Ceiling System. The floor system was finished concrete. P.O Box 309 3 Phone:360-239-0354 Litdetock,Washington 98556 Email:acceletatedanalytical@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 Material Location of Condition Friable Asbestos 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 & B tested Negative for Asbestos Content. P.d Box 309 4 Phone:360-239-0354 Litderock,Washington 98556 Email acceleratedanalptical@comcastnet 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. Accelerated Analytical 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. a—s-- Todd L. Venable Al1ERA Accelerated Analytical LLC AHERA No: 12-1807 P.O Box 309 5 Phonc360-239-0354 Litde,ock,Washington 98556 Email: accekaxdanalyticak@corncasuaet f i 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 I.itderock,Washington 98556 Email:acceletatedanaly+ical@ccomcast.aet Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA APPENDIXES P.O Box 309 6 Phone:360-239-0354 Litdetock,Washington 98556 F.mai:acceleiateclAnalyticai@comcastnet 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 Iatderock,Washington 98556 Email:arrrlecatedanalytical@comcastuet SEATTLE ASBESTOS TEST,LLC CHAIN OF CUSTODY ° 0 1t, r3 Name �4rr 6LF2 'T Yl -i-- , W . c t,rd't Zl[P � �5 Addy "' ,£c ST Address 17 p, t�L F 3C�( City Lsrr — •., W)23`l-635% Fax: Email: . ..p-r n a+-yr��a� c�:rc..t6 Phare: C3G ) y�aRT 3;,.r , R y LAN a Project Location: to Z t Sv 4c' ' Project Manager. Turn Around Time „::Number of Samples a Client Job# 1513-A tea,. Cr LE DESCRIPTION LAB ID A/R SAMPLE I 43 ��� � 6 '_ 7 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIM8 1111111111111111111111111 9 111.11111111111111111 10 IIIIIIIIIIIIIIIIIIII 1121 IIIIIIIIIIIIIINMIIIIIIIIIIIIIIIM 1134 INIIIIIMIMIIIIIIIIIIIIIIIIIIIIIIIIMIIIII 15 1111111111111111111011111111111111111111111111 16 ��' r�r� � 1817 19NM <Q 11111111111111111.111111 cos parry dame Date Time Print Mune Tnd.A V£..ar3.. Yoraj f3 3 Relln•ulsfi•„ iZ`f yao B N. A.(�• nein::., -_ i 41.41P rii05 t, {1 J ' M t I I 0 c.;-4A411-1.- precision normal for the type and methodo gy employed for each sample Seattle ed Asbestos disclaims aiwarrantsyo the test results to be of a! of illness for a particular purpose and warranty s o f m rcha and any other s Test accepts Impressed nole ar implied,Including pity m For which the client uses the test results. of signing form rhodium Asbestos Test no Seattle its Asbestos Tos arise from the test results. By signing�this the c1Im6 agree to'relieve Asbcstoa Test of say liability that may S�s ,'ATTL . PCA O 'r a • SFAIM.S b.n,. :`'.•.tiS�t�..ayS�L'�o�".. 5'�J 3 �AFw' tC,'.rL`e,S.^^5;:.^e Lab Cade.,.'rGu::'i.70-230376.lyr:{;L'xC':-"efb3Zv3 lynnvoad Laboratory:19701 Sats lake Road,Suits 103, 9ellewe Laboratory:12727 Nornup Way,SUM 1,Balawe, SeNlie La6aala7:450088:Ave.NE,Sues 90Q Sleek,NA Gt105 Lynnwood,WA 98058,Tal:425873.9850,Fax 425.873.9810 WA 98005,Te:425.861.1111,Fax 425.881.1118 Tat,284833.1111,Fax 208.8354747 ANALYTICAL LABORATORY REPORT PLM by Method EPA/600/R-93/1 le Atb,.. Mr.Rylan Baker cart Accelerated Analytical,LLC Me,..: P.O.Box 309,Little Rock,WA 98556 Joan 1313-A aalddr. 201310488 Dare Reoewad: 4/4/2013 Samples Recd: 2 Data analyzed: 4/5/2013 Samples 2 621 Southpoint Rd,Port Ledlow, P alact Lm WA a�1 t -� 1 i 1/ lt.:�,. , Analyzed by: Christina Bute r i R Mwed by: Sieve(Falpao422unp,President Lab 10 Client sample Ie Layer Description % Aabesloe Rbate 1 Non-fibrous Components % Nonaebertos Rbers Black asphaltic None Cellulose; 1 A 1 material with detected Asphalt/binder 14 Synthetic fibers fibrous material Beige brittle 2 B 1 material with None Filler,Binder ` 23 Glass fibers fibrous material i 1 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 Linnlcrock,Washington 98556 Email:acceleratedanalytir iOromcastnet Acteferated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow, WA .41 Itt yam "R > • Asphaltic Roofing A Interior walls and ceiling FFA _ "-- 'I' yJ 1 r•�S 1P G.' NE- CorrugatedLAA .'� Roofing B P.O Box 309 9 Phone:360-239-0354 Litderock,Washington 98556 Email:acce eratedanalytical@comcastnet • • _� Accelerated Analytical LLC. P.O. Box 309 Littlerock, WA 98556 acceleratedanalytical@comcast.net ( vir 1 I SEP - 9 2014 'LJ Iii J LEL JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMFNT S 3 t, �..;... Asbestos Survey Report \\c Located At: j°' ti0'�" 621 South Point Rd. �� Ludlow, WA 98365 �C • • 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 PC urN.inn 2 Phone:360-239-0354 Litderccs,Washington 93556 Emm7:acteleza • • 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 Phone360-239-0354 Littierock,Washington 98556 Email:acceleratedanalytical@a comcast.act S 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 8 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 Material Location of Condition Friable Asbestos 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 1 RESULTS Samples A Et 8 tested Negative for Asbestos Content. P.O Box 309 4 Phone 360-239-0354 Littletock,Washington 98556 R++,ait•accelaatedanalytical@comcast.net i r 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 alt 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. Accelerated Analytical is not responsible for materials, which require destructive means to access, or materials that are hidden from sight, those materials hidden behind watts 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. 11 U-,-- Todd L. Venable AI-IERA Accelerated Analytical LLC AHERA No: 12-1807 P.O Hoz 309 5 Phoan:360-739-0354 Link-rock,Washington 98556 Etna& eccokrateclanalricat®comcast.ne t 1 • • 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 Litderock,Washington 98556 Email:acceieeatedanalrical@coasi.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 Pnmit:acce1eratedanalytical@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:acceletatedanulytica1 comcast.net . i • SEATTLE ASBESTOS TEST,ti CHAIN OF CUST 'MAP At eratigad,Militia ODY Client Name AL• kL�rw,t;n pniAsYTstAL LL i , �,rd� �' � Address �' D 60 3 C f i City S-rr,Sc c- C- ST �3E°)23 i-d3at'f' Fax: "'"— Email:FICL�L-L�T�iJAA%kL`%T 4:-AL [.'.ni�bSi Phone: �y ;vF Svu4'la4c '� (L�. 7°41 7. F j Project 1 Ry LA. Project Location: 62.1 A Client Job# 1513 Turn Around Tome +, Nmnber of Samples OM CLIENY.SAMPLE* SAMPLE DESCRIPTION LAB ID MN A/R 12 3 l3 r111.111 45Milliarililliiiilli�• • �� 6 7 Mr1111181111111111101111111111111111.1111�-� 9o 1.11111111111111111111.1111111110111111111.1111111. �rrrrrrrrrrrrrrrrii 1111:21345 2 rrrrrrrr� rrrr 14 r�� 16111111111111111111.11 6 � �$ rrrrrr �rrrrr 19 'WI 20IIIIill oem INNII rano 'i/3 i3 Mri2•i yja.. -6- .4.s=.i2_ s hells: -., RLLcciv„„d1 Y srA r •� i�Q 3 IT 05 illeMb a ' i� � fjL ivy Sion normal for the type and methodWI em` PioYcd for each sample Seattle Asbestus Test a�saante the test results to be of a pied of fitness fbr a particular purpose and waaaoty ofinerAtaand ity.disclaims any aaresntcexpressed implicit ponsincl�B for which the client uses thetcstremits. Asbestos Test accepts no legal resptatsihillty p�ie tlat�Y arise from the test results. By signing on this form the clients agree to relieve Searle Asbestus Test of any liability • • III HFATTLg ArP—trrTEST ;AF,Ap czraL".ia5:.n La;Cafl=i`Cii.^.`lic-2.73 76,Lyar ;aa:�-203-rw-a Lynnwood Laboratory:19701 Scriber Lake Road,Suite 103, BeeNvua Laboratory:12727 Nomatp Way,State 1,aelewe, Seetae Laboratory:4500 9th Avo.N .Suite 300,Seattle,WA 95105, Lynnwood,WA 98099,Tel:425873.8850,Fax 425.873.9810 WA 9800:5 Td:425.661.1111,Fax 425.861.1118 Tel:208.6331111,Fax 206.833,4747 ANALYTICAL LABORATORY REPORT PLM by Method EPA1800/R-93/116 Arm: Mr.Rylan Baker client Accelerated Analytical,LW Amsess: P.O.Box 309,Little Rock,WA 98558 mit 1313- Bow: 201310488 Doe Racavet 41412013 Seneorea Richt 2 Dale Antayzed: 4/5/2013 Samples Analyzed: 2 lri PrefectLow62 t Southpoint Rd,Port Ledlow, /\R U _) -__)Liq/:14 Analyzed by: Christina Buce Reviewed by Steve(F.n so)Zhen9.Presided Lab Ia Chant Sample ID layer Description T% I,Asbestos Fibers Nort�rats Components % Non-asbestos Fibers Black asphalticNone Cellulose, 1 A 1 material withAsphalt/binder 14 fibrous materialdetected Synthetic fibers Beige brittle None 2 B 1 material with detectedFiller,Binder 23 Glass fibers fibrous material 1 • • 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 Littkrock,Washington 98556 Email•accdetatedanalytir9l&omcast.net Accelerated Analytical Asbestos Survey Report 621 South Point Rd.; Port Ludlow,WA • • 1 ?a / . x Asphaltic Roofing A Interior watts and ceiling • C 1,y• �. 4: . • Corrugated Roofing B P.0 Box 309 9 Phone:360-239-0354 I+ ,Washington 98556 Email:acceleratedanalytical@comcast.net DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00327 Received Date 9/9/2014 SITE ADDRESS: 621 S POINT RD Issue Date 10/27/2014 PORT LUDLOW, 98365 APPLICANT: STEVEN D MEACHAM PHONE: VIRGINIA L MEACHAM 3067 PASEO MOUNTAIN AVE HENDERSON NV 89052 SUBDIVISION: 9966 Block: Lot: PARCEL NUMBER: 996600026 Section: 4 Township: 27N Range: 1E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, STEVEN D MEACHAM PHONE: if different: VIRGINIA L MEACHAM 3067 PASEO MOUNTAIN AVE HENDERSON NV 89052 PROJECT DESCRIPTION: DEMOLITION - REMOVE EXISTING GARAGE 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 10/27/2015. REQUIRED INSPECTION: FinalApproval: ,� 4 Al /Q 27 LS ) 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# BLD14-00327: 1.) Approval of this permit does not provide any assurance of future approvals for onsite sewage disposal on the property or use of any existing septic systems. Actions taken to date and proposed as part of this project may limit or prevent future development of an onsite sewage system. Future proposals must meet current code at the time of application. f led + Geuv \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 10/27/2014