HomeMy WebLinkAboutAsbestos Report - SPI Inspections - 9/9/2002 e f
SITE INSPECTION REPORT RECEIVED
Asbestos Inspection Si P 0 91001
426 W. CEDAR Sr
Property
Former Apartment Complex
North One
12001 Highway 101 North
Shelton, WA 98594
Prepared for
North One Investment
P.O. Box 1492
Tacoma, WA 98401
August 2002
ASSOCIATESNOWICKI
ENERGY&-ENVIRONMENTAL MANAGEMENT
Maji Way,WA 986103-6)22
(25))927,5233
- I
II
SITE INSPECTION REPORT
Asbestos Inspection
Former Apartment Complex
North One
12001 Highway 101 North
Shelton, WA 98594
Performed for: North One Investment
P.O. Box 1492
Tacoma, WA 98401
Contact: Don Arsenault
Tel: (253) 759-5000
Fax: (253) 572-5255
Two asbestos inspections were conducted on the eight building apartment complex known as
North One. The first inspection consisted of a detailed inspection of units 200 and 400
conducted on Friday, July 19, 2002. The second inspection date was Wednesday, July 31, 2002.
This inspection is conducted prior to a planned demolition of all structures. Drawings were not
available; consequently a sketch was drawn to depict the buildings as inspected. The 700
inspection; the remaining buildings were not occupied.
Building had one occupied unit during the g g
Two areas were locked and could not be accessed. The vacant buildings were all open with
building materials removed, no windows or door, and not inhabitable.
BuRding Description
By the exterior appearance, the former apartment complex was originally constructed in the
1950's as housing for the adjacent air field, now a municipal airport. The buildings all have
similar construction; wood frame with wood siding and a three-tab roof system. All are built on
a wood foundation over a small crawlspace. Attic insulation is fiberglass, walls are uninsulated
At the time of the inspection all of the windows had been removed; large sections of exterior
siding have been removed; doors may be in place, but inoperable; water was left running in
several units causing major structural damage.
Inspection Summary
Sixty-three individual bulk samples of suspect materials were collected.
Asbestos containing materials identified during the inspection is limited to approximately 240
square feet of 9-inch square asbestos floor tiles and associated mastic found in unit 801. It is
possible that additional areas of asbestos floor tile may be found under plywood floors installed in
many of the unit's kitchen or bathrooms during prior remodeling. Areas were viewed during the
inspection and no tiles were found, but we can not dismiss this possibility.
Asbestos Inspection-North One Complex
Nowicki&Associates,Inc. -August 2002
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Many types of sheet vinyl flooring were sampled and analyzed. All sheet vinyl samples were
found non-detect for asbestos.
All 12-inch square floor tiles and associated mastics were found to be non-asbestos containing,.
The original, 9-inch square floor tile found exposed in the bedrooms of unit 801 was found to he
the only asbestos containing material identified. Approximately 240 square feet of this material
is found in the 801 unit. It is possible that original floor tile may be found under the renovation
work previously conducted in many of the units. Prior renovation work may have included the
installation of new subfloors over existing asbestos tiles in the bathrooms and kitchens. Building,
200 and 400 had the subfloor removed to view under the new material and found no evidence of
prior flooring. However, it is possible that other units had asbestos flooring as the original
flooring and that renovations installed a new subfloor over the existing flooring. .We recommend
that prior to the demolition, all areas where new subflooring was installed have the subfloor
removed to verify that no original asbestos flooring is contained in the floor sandwich.
The building paper under the wood siding was tested and found not to contain asbestos.
OAPCA regulations require that all friable asbestos containing materials be removed prior to
demolition. It is possible to demolish a building with non-friable asbestos containing materials
intact, but additional safety precautions and disposal requirements will apply.
Ronald E. Nowicki PE
Inspector
Attachments: Laboratory Report
Inspector Certificate
Site Sketch
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Ashcntus hupaxuun- Nonh Om Onnplex
Nuwi:ki& AwK:iales. lIx -Augu4 2lM)2
NOWICKI & ASSOCIATES, INC. POLARIZED LIGHT MICROSCOPY'
Laboratory Services BULK ASBESTOS MATERIAL ANALYSIS
33516 9"'Avenue South, Bldg#6
Federal Way, WA 98003
(253) 927-5233- (253) 924-0323 Fax
Client: Don Arsenault Project: North One - Shelton
Address: Contact Person: Ronald Nowicki (NAI)
Lab ID#: 10273 Sampling Date: 7-31-02
Analyst: MQL Analysis Date: 8-1-02
Special Instructions:
Client NAI Lab Description of Sample Asbestos %/Type Other
ID ID Detected Fibrous Material
100-1 10273-01 Bldg 100-PC Ceiling Texture#1 No
100-2 10273-02 Bldg 100-PC Ceiling Texture#2 No
100-3 10273-03 Bldg 100-PC Ceiling Texture#3 No
300-1 10273-04 Bldg 300-PC Ceiling Texture#1 No
300-2 10273-05 Bldg 300-PC Ceiling Texture#2 No
300-3 10273-06 Bldg 300-Brown mottled SV-Bath No 10%Cellulose
/ 800-1 10273-07 Unit 801 - 12x12 Blue Kitchen Tile No
800-2 10273-08 Unit 801 -9x9 Back BR-Wood grain Yes 2% Chrysotile
the
800-3 10273-09 Unit 801 -9x9 Front BR-Beige Tile Yes 2% Chrysotile
500-1 10273-10 Bldg 500-PC Ceiling Texture#1 No
500-2 10273-11 Bldg 500-PC Ceiling Texture#2 No
I500-3 10273-12 Bldg 500- PC Ceiling Texture#3 No
I500-4 10273-13 Bldg 500- PC Ceiling Texture #4 No -
500-5 10273-14 I Bldg 500-PC Ceiling Texture#5 No
600-1 i 10273-15 Bldg 600- PC Ceiling Texture #1 No
600-2 ! 10273-16 Bldg 600- PC Ceiling Texture#2 No
600-3 10273-17 Bldg 600- PC Ceiling Texture #3 No 1
600-4 10273-18 Bldg 600-PC Ceiling Texture#4 No
600-5 10273-19 Bldg 600- PC Ceiling Texture#5 No
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Page 2 of 2
600-6 10273-20 Bldg 600—SV—White square pattern No 40%Cellulose
600-7 10273-21 Bldg 600—SV— Brown No 25%Cellulose
700-1 10273-22 Bldg 700—PC Ceiling Texture #1 No
700-2 10273-23 Bldg 700—PC Ceiling Texture#2 No
700-3 10273-24 Bldg 700—PC Ceiling Texture#3 No
700-4 10273-25 Bldg 700—PC Ceiling Texture#4 No
700-5 10273-26 Bldg 700— PC Ceiling Texture #5 No
700-6 10273-27 Bldg 700—SV—Blue large pebble No 20%Cellulose
700-7 10273-28 Bldg 700— 12x12 Gray Floor Tile No
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IComments.-
Analyst: Michael Lam
Ronald E. Nowicki Analyst Signature:
This report may only be reproduced in full and with permission from the NAi laboratory. The data contained in this report reflect the characteristics of only the items suomineo
I Samples will be disposed of within 30 days after analysis. NAI Laboratory is accredited by the National Voluntary Laboratory Accreditation Program(NVLAP)with Lab Code
200322 Unless otherwise indicated.no analysis was periormed by a participating subcontracted NVLAP accredited laboratory The results of th,s report do not suggest an,
endorsement by NVLAP or any agency of the US Government Test method is in accordance with EPA Method 600/R-93-1 16 for PLM This method has been known io proo-. )v
-naccurale results on difficult samples such as tiles where small asbestos fibers are not detected by PLM In such cases.TEM analysis is recommended Current EPA Slander::
for ACM is 1%by weight Percentages by PLM are approximate with a detection limit of approximately 1%
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NOWICKI & ASSOCIATES, INC.
Laboratory Services
L CHAIN OF CUSTODY 1
Client: AI'Se�'t& C- I Project: f�l�-rH • �e - �>
Address: Date Sampled: 3 l J-1`"i �7 Z
Sampled By: 12_E K�0L'J .C.k i
Telephone: NAI Laboratory ID: _ �aZ 2
FAX Number. RUSH Standard
Sample# Description of Sample Analysis
Lo0 ----
-too 3 #3
J*- Z -- -- --
:zoo - 3 , 6,4
6 LZ• - wood
Relinquished By: Received By:
Signature: Signature:
Company Name: Company Nam
Time: Date: Time Date
Sample Disposition All samples will be disposed of alter 30 days of receipt
Sample Condition Good O Accept 0 Reject 0 (samples are not property contained and sealer of
present in adequate quantity for method :3milys,
it sample is insufficient in quantity and the client desires analysis regardless please check
Analysis method,s,n accordance wrlh I PA Method 600/R-93-i I ti for F'L M
33516 9"Avenue South. Bldg tt6 - Federal way. wA )800 i . (253)927 5233 (253)924 0373 f A
NOWICKI & ASSOCIATES, INC.
Laboratory Services
CHAIN OF CUSTODY
Client: Project: Ntio,2--n4 QNE ,t L__1 01J
Address: Date Sampled:
Pa�E Z o F 3 Sampled By: o L'J.u/ r
Telephone: NAI Laboratory ID: �62,
FAX Number. RUSH Standard _
Sample# Description of Sample Analysis
Soo - I i� S.00 PC Ce-11,
�o - z z
Soo - 3
�o4 -
i Soo- S
> eoo - l �06 [�)c Cam, (_
(moo - z z -
(oo o - 3
6,90 -
11 L oo - V fr s
Relinquished By: Received By:
Signature: Signature:
ICompany Name: Company Name: -_
Time Date: Time Date
I
Sample Disposition All sampl s will be disposed of alter 30 days of receipt
I Sample Condition Good O Accept O Reject O (samples are not properly contained and seated ul
present in adequate quantity for method analysis I
If sample is insufficient in quantity and the client desires analysis regardless, please check I i !
I Analysis method is,n accordance with EPA Method 600IR-93-1 16 for PLM
33516 91°Avenue South. Bldg 116 - Federal Way,WA 98003 - (253)927 5233 - (253)924-0323 Fnx
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NOWICKI & ASSOCIATES, INC.
Laboratory Services
CHAIN OF CUSTODY
Client: Project: 10 ZTt-t
Address: Date Sampled:
Sampled By:
Telephone: NAI Laboratory ID: /6Z2-3
FAX Number: RUSH Standard
Sample# Description of Sample Analysis
L 700 - 1 Zo e 4 t
I3 Zoo - Z � 2
70 O 3 3
700 - �
0o - S I ---
0O - -i� n e,4- v t vt - W v e
7 I ,Zo� � --
Relinquished By: 12� 1�ow.c / Received By:
Signature: i� L�-� Signature: _ (Q
Company Name: Company Name:
Time d u Date / A6 (�90 Time Date 8
Sample Disposition. All samples will be disposed of after 30 days of receipt
Sample Condition Good ❑ Accept ❑ Reject ❑ (samples are not properly contained and sealeu, l
present in adequate quantity for method anatysr.,
If sample is insufficient,n quantify and the client desires analysis regardless. please check L!
Analysis method is in accordance with EPA Method 600/R-93-116 for PLM
33516 9"Avenue South Bldg MG - t-ederai Way• wA %003- (253)927 5233 • (21)3)92.9 03?
NOWICKI & ASSOCIATES, INC. POLARIZED LIGHT MICROSCOPY
Laboratory Services BULK ASBESTOS MATERIAL ANALYSIS
33516 91h Avenue South, Bldg #6
Federal Way, WA 98003 FNFIWQLap
(253) 927-5233 - (253) 924-0323 Fax
Client: North One Project: 200 Building
Address: Contact Person: Ronald Nowicki (NAI)
Lab ID#: 10243 Sampling Date: 7-19-02
Analyst: MQL Analysis Date: 7-19-02
Special Instructions:
Client NAI Lab Description of Sample Asbestos %/Type Other
ID ID Detected Fibrous Material
1 10243-01 Gypsum Drywall No 15%Cellulose
2 10243-02 Rose/Beige SV 201 Bath No 3%Fibrous Glass
10%Cellulose _
3 10243-03 Beige SV Kitchen 201 No 3%Fibrous Glass10%Cellulose
4 10243-04 Popcorn Ceiling Texture 201-1 No
5 10243-05 Popcorn Ceiling Texture 201-2 No
6 10243-06 Popcorn Ceiling Texture 201-3 No
7 10243-07 202 Kitchen SV No 15%Cellulose
8 10243-08 202 Bath SV No 15%Cellulose
9 10243-09 Popcorn Ceiling Texture 202-1 No
10 10243-10 Popcorn Ceiling Texture 202-2 No
11 10243-11 Popcorn Ceiling Texture 202-3 No
12 10243-12 203 SV Kitchen & Closet No 3% Fibrous Glass
10%Cellulose
13 10243-13 203 SV Bath No 3%Fibrous Glass
15%Cellulose
14 10243-14 Sheet Vinyl Bath 204 No 15%Cellulose
15 10243-15 Ceiling Tile— 12x12 204 No 100%Cellulose
16 10243-16 Sheet Vinyl — Kitchen 204 No 15%Ceuwosc
Comments:
Analyst: Michael Lam
i Elizabeth Gilbertson Analyst Signature:
Tn.s report may only be reproduced in lull and with permission from the NAI laboratory The data contained In this repon renew the characteristics of only the.tens .,� .:.
Samples will be di posed o1 vnihin 30 days after analysis NAI Laboratory is aCCrediled by the National Voluntary Laboratory Accreditation Program(NVLAP)wrtn'_ao_ur
200322 Unless otherwise indicated.no analysts was performed by a panicipamtg sub-contracted NVLAP accredited laboratory The results of this repon do not—ggms!&
endorsement by NVLAP or any agency of the US Govemmenl Test method ism accordance with EPA Method 6OO/R-93-116 for PLM This method has been.-,u+-%';r.;. ,.
inaccurate results on difficult samples such as tiles where small asbestos fibers are not detected by PLM In such cases.TEM analysis is recommended Current EPA j;y4LY-'
or ACM is 1%by weight Percentages by PLM are approximate with a detection limit of approximately 1%
NOWICKI & ASSOCIATES, INC.
Laboratory Services
CHAIN OF CUSTODY
Client: ki 49e--7 + 0NC_-- Project: .0o
It
Address: Date Sampled: 19 Zo 02
Sampled By: ZE �lOw,c V-- i ---
Telephone: NAI Laboratory ID: 1�Z4
FAX Number. RUSH Standard
Sample# Description of Sample Analysis
l C�Ll s .ti. 4-ll
3 sv
to
-Z'0Z _ z
Relinquished By. Received By:
Signature: Signature:
Company Name: Company Na
Time. D Time. Date
Sample Disposition All samples will be disposed of alter 30 days of receipt
Sample Condition Good ❑ Accept ❑ Refect ❑ (samples are not properly contained
present in adequate quantity for methoo analyse,
I
If sample is insufficient in quantity and the Ghent desues analysis regardless please check I
I
Analysis me lhod,s ur accordance with I PA Method 600/f? 4.1 1 16 1,)( Ili M
NOWICKI &ASSOCIATES, INC.
Laboratory Services
CHAIN OF CUSTODY
Client: Project:_ e-00
Address: Date Sampled: lG7 J , y v Z
oV'- Z Sampled By: V—c--
Telephone: NAI Laboratory ID: r Z y 3
FAX Number. RUSH Standard
Sample# Description) of Sample Analysis
�_o Z—3
Relinquished By: �OL-J'Cjv_f Received By: _
Signature: nature:
g
Si -
Company Name: IV14/ Company Name:
Time: �, ZO Date: /y / dL Time tA, Date:
'J
Sample Disposition All samples will be disposed of alter 30 days of receipt
Sample Condition Good O Accept ❑ Reject ❑ (samples are not properly contained and seals•.;
present in adequate quantity for method analyse,
if sample is insufficient in quantity and the client desires analysis regardless, please check I
Analysis method is in accordance will) 1 PA Method 6001R-93 116 for Pt M
NOWICKI & ASSOCIATES, INC. POLARIZED LIGHT MICROSCOPY.,
Laboratory Services BULK ASBESTOS MATERIAL ANALYSIS
33516 9"'Avenue South, Bldg #6
Federal Way,WA 98003 C�SIdCap
(253)927-5233 - (253) 924-0323 Fax
Client: North One Project: Bldg 400
Address: Contact Person: Ronald Nowicki (NAI)
Lab ID#: 10242 Sampling Date: 7-19-02
Analyst: MQL Analysis Date: 7-19-02
Special Instructions:
Client NAI Lab Description of Sample Asbestos %/Type Other
ID ID Detected Fibrous Material
1 10242-01 PC Ceiling Texture 401 -#1 No
2 10242-02 PC Ceiling Texture 401 -#2 No
3 10242-03 PC Ceiling Texture 401 -#3 No
4 10242-04 White SV Bath 401 No 20%Cellulose
5 10242-05 Green SV Kitchen 401 No 20%Cellulose
6 10242-06 Green &White Tile Kitchen 401 No
7 10242-07 402 SV Closet—beige No 3%Fibrous Glass
15/o Cellulose
8 10242-08 402 SV Kitchen—light beige No I 2%Fibrous Glass
10%Cellulose
_ 9 10242-09 402 SV Bath—speckled No 115%Cellulose
10 10242-10 402 GWB No 10%Cellulose
11 10242-11 402 PC Living Room No i
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12 10242-12 402 PC Bedroom No
13 10242-13 SV under Kitchen Tile 403 No 1 10%Cellulose
_ 14 10242-14 Gray 12"Tile — Kitchen 403 No
-Tan Mastic No
15 10242-15 Green &.White Tile Bath 403 No
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Bottom Layer of Tile—403 Kitchen !
16 10242-16 No
brown I
�1 Page 2 of 2
17 10242-17 404 While SV Kitchen
-Beige Top Layer No
-Tan Bottom Layer No
18 10242-18 404 SV Bath wall No 20%Cellulose
19 10242-19 404 SV Bath floor No 10%Ct%Cel ou lulo Glass
lubse
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Comments
Analyst. Michael Lam
Elizabeth Gilbertson Analyst Signature:4 1 - - -U-
/✓�G �2iU�'
••ws•epon mar on'r x repmo"d m lull and wnn Permrsslon from[Me NAI laboratory The data confatned n ims repon reflect the cnaraclenst,"or only me items subm.neo
Samdes.fl be d.soose0 of.Ilwn 30 days after m anafyS'S NAI Laboratory's aMredlfea ov file Natronaf Voluntary Laboratory Alxrednatton Program INVLAP)w In Lab Coco
Y:3,2 Jess otft w se�ndcate0.no anatys,s was oerlo—eo by a paroupafmg suOc nnaaea NVLAP amreaeea laboratory Tne tesuns of aus repon 0o not suggest env
rwfnrsemenl by NVLAP a any agency of Ina US Government Test rnalrlad es�n accoraance+it,EPA Metttoo SOWN 93 116 for PLM TNS n1elrlpd has been known 10 pro•.'nn
:na .urale resufls an o'ff"samples such as tiles where smaa asbestos fibers are na detected by PLM to suol roses TEM anatrs's's,e ntenoeo Current FPA Stanna'
rr ACM�s 1%by wergn! Percenlages by PLM are approsfrnate"nth a aeledion 4m1f of appro—atefy 1%
----..........
..___ ----- - _ __ _ - -- ---
NOWICKI & ASSOCIATES,INC.
Laboratory Services
CHAIN OF CUSTODY
Client: ( 1.0(LT'N Qtic Project: `to0
Address: Date Sampled: 1`3) �I,,V o 2
PA6E I of 2 Sampled By: ZE t11owLcXt
Telephone: NAI Laboratory ID: I0?_� z
FAX Number. RUSH Standard
Sample# Description of Sample Analysis
`3
1 40 2 5.\/.
q 40 z 5.✓. _ la 1
to D z G 1j3
Relinquished By i Received By: /
Signature: Signature.
Company Name: _ Company Name
Time Date lime Date
Sample Disposition All samples will be disposed of after 30 days of receipt
Sample Condition Good O Accept U Relect ❑(samples are not property contained and sealeo 0
oreSenf u)adequate godntdy l0r method anillys-
tl.ample is insufficient in quanlav.wo t1w f'm,11 des,res analys,s rcgardlecs please check I i
Analysis method rs on ar;cordance with IPA Method 600IR 97 116 for PLM
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NOWICKI&ASSOCIATES,INC.
Laboratory Services
CHAIN OF CUSTODY
Client. 2�c �ti,E Project 1p,L_D 40 0
Address: Date Sampled: . 1"> J ,.,, p Z
p�E Z 0 e Z Sampled B
Telephone: NAI Laboratory ID: l e 2 w Z
FAX Number. RUSH Standard
Sample#
Description of Sample Analysis
r I `b+z Pic.
If t 3
q03 ti
9 t—
Relinquished By: Icy L/J Lc to Received By:
Signature: iz c %C� �i< < Signature
Company Name: /lJ% Company Name
eTime Gli Date /`� �G12- ° --Time _ Date.
Sample Disposition All samples will be disposed of alter 30 days of receipt
Sample Condition Good ❑ Accept O f7efr,cl ❑(samples are not property contained and sealed w
present to adequate quantity lot memoo analy,
It Sample's,nsuffictent,n quanhly and the chenl deSveS analysis regardless,please check
' Analysis method rs in arcotdam c wdh 1 I'A Method 600/17 9J�t ifi for Pl M
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O WASHINGTON
`\ ASSOCIATION of
4 MAINTENANCE and v '
OPERATIONS '
i ADMINISTRATORS "
t
THIS IS TO CERTIFY THAT 1
E
Ronald Nowicki z
d Participated in the
EPA AHERA
BUILDING INSPECTION / MANAGEMENT
PLANNER
Refresher course offered by the
WASHINGTON ASSOCIATION of MAINTENANCE
and OPERATIONS ADMINISTRATORS
The full day training program . E
covered all topics specified in the
Model Accreditation Plan under E
�i
Section 206 of Title II of TSCA �s
aa�FF
�c The refresher course was taken on January 11, 2002
In Burien, Washington Yf � E
In combination with the Individuals initial certification, this certificate extends
z accreditation for the above named person through 1/11/03
< '. WAMOA-0041-02
' Certificate Number Colin MacRae Course Administra or -11
�;�, 1L 1t'- JL •Jt JL JL -1L JL- .".• f Jt Ji 1L JL =��E
'c >�^�i1At� v�sy5�*/tiy/�! \� �r ♦yvi ��i �� J � i'.�uo/. o °� \%�'� ��.
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Date: Initial C GION CLgiN Date Application Received
Amended: ❑
Completion: ❑ ov o� REC �QED
ORCAA 0 y
Annual: El $500 evf finoa-K►SO�'� 26 2002Ageney Use Only
2940 B Limited Lane NW,Olympia WA 9850 W C p
Phone:(360)586-1044 Fax:(360)491-6308 www.orca9.or2 AR ST'
APPLICATION TO PERFORM AN ASBESTOS PROJECT
A. Project Type: I 1. Asbestos Removal 2. Renovation 13. U Maintenance
4. U Enca sulation 5. Demolition 16. U Emergency 7. U Other:
B. P erty Owner.
hi E� 1„1 (JORT14 p/dl, Phone: 2IC3 ESQ SDoo
Property Owner's
Mailing Address: _C) 6 0 X �{ 2 City: State: W Zip-
.�� e
C. Asbestos Contractor: Con etorO vMer/CEO: ,
Mailin Address: PD) P K Z Phone: S 5_6'�
City: to State: zip: 9�`r<D t I Fax: .2S 5-7 2 -S2�_�
D. Site Address: W p A) Ci s' 7_PAJ State:W � T?iP-7
Project Manager or-,
Contact Person: UDAJ ,?S6A),AUL7 Phone: -2s.3 2u a
E. W Asbestos Survey or No.of Structures: Date Asbestos Survey Conducted: Was Asbestos Found?
❑ Mat'1 Presumed: ' (�U ► p O 2 Wes
❑ If No Attach Survey
AHERA Building AN AxERI SURVEY IS REQWRED BEFORE AU DEMOLMON Certification No.: Expiration Date:
lnspectpr Name: PRaecrs
N0,0l4 ltl Z ! (( 03
F. Demolition No.of tures: Start Ll Training Fire(List Fire Dept.as demolition contractor below)
Information: I Date: qjilo2 1 ❑ Ordered Demolition attach copy of Order
Demolition PrINwwUre;ewamal/fngad&=MbwJon . tunalningbwKemer raw ojJlndepanmwhem
Contractor: �p � �Cl/}Z(L'T QGJlt1�� Phone: 7Sg-S0e0
G. Asbestos No.of Structures: (see Start Date: Completion Wk.Days T W F S Su
Project back if> 1) ! .2 ? D Z Date: 8 ? 1 Hours: 9 ,"_6 c
Information• 1
Will all asbestos material be removed by
Total Quantity to be Removed: Square Feet Linear Feet project con letion Yes ❑ No
Thermal System Insulation: I Ll Boiler/Furnace Ins. I U Duct Ins. Ll Pipe Ins. Other:
Surfacing Mat'1: I LJ Fireproofing I U Paints Plaster I U Textured Coatings Other.
Misc. Mat'l: I U Cement Bd. Cement Pipe AFlooring Mat'I I LUJ Roofing Mat'I Other.
H. Asbestos/Demolition Project Categories: Notification Waiting Period NON-
FUNDABLE FEE
1. LJ Residential Dwelling Asbestos Removal Project Prior Notice $25
2. Demolition 10 Working Days $25
3. LJ less than 10 linear feet or less than 11 square feet Prior Notice $25
4. 10-259 linear feet or 11 - 159 square feet 10 Working Days $100
5. X260-999 linear feet or 160—4,999 square feet 10 Working Days M50
6. LJ 1,000-9,999 linear feet or 5,000-49,999 square feet 10 Working Days 0
7. U 10 000+linear feet or 50 000+square feet 10 Working Days $1 000
8. LJ Annual Permit(Limited removal additional permits,contact ORCAA Prior to start of New Year $500
_97UEmergency Project Prior Notice $50
10. U Amendments no fee for 1 and 2d amendment Prior Notice $25
1. 1 do hereby certify that the information contained in this notification,and supplemental data Payment received date:
described her ' is to the best of my knowledge accurate and complete. I shall not cause or allow Reviewed date:
any asbesto pr ect or de lition activities to begin until the appropriate waiting period has Reviewed by:
elapsed. Permit Number:
Signatur Date:
/„Q'7/O'L Date fazed/malled notification to applicant:
. r
For Compliance With Regulation 1,Section 14Asbestos
The Olympic Region Clean Air Agency is the local air pollution authority for Clallam,Grays Harbor,Jefferson,Mason,Pacific,
and Thurston Counties. The Olympic Region Clean Air Agency's Regulation 1, Article 14, requires advance notification be
submitted to the Agency, on Agency-provided forms, for any asbestos project and for any demolition project, regardless of
asbestos content, involving any structures. Notices of Intent should be mailed or hand delivered to the Agency (address on
reverse side) with the appropriate project fee. An Agency representative will review the notification, and if it is completed
correctly a copy will be returned by mail or fax within 3 to 5 days to information provided in box C and box J. The returned
copy will be your valid notification. You must have an approved permit prior to job commencement.
J. Demolition Contractor: Owner/CEO:
OW Al e/Z o sfr�,8t��-ice >6'`� �u a
Mailin Address: 'P-Qi �7 92 Phone: S-9— SSd00
City: ZA6OI74 46- State: Zi : 9 T Fax: 3 �71 ' r2 fS
GUIDELINES FOR SUBMITTING AN APPLICATION TO PERFORM AN ASBESTOS PROJECT
Enter all applicable information accurately and completely. Incomplete Notices of Intent will be returned.
Box A. Check all appropriate project type.
Box B. Enter the legal property owner information.
Box C. Enter the asbestos contractor information, or "not applicable" (N/A) for demolition projects when no asbestos-
containing materials are present. For a Residential Dwelling asbestos removal project, list the property owner doing the
asbestos removal(include property owner's mailing address).
Box D. Enter the asbestos removal or demolition site address. For a Residential Dwelling asbestos removal project where the
property owner's mailing address differs from the site address listed in Box D, a letter must accompany the Notice of Intent
verifying that the structure located at the site address is currently being used as the property owner's domicile. Multiple
asbestos/demolition projects involving more than one structure must be submitted in accordance with the ORCAA Regulation
1, Section 14.05(a)(8).
*Residential dwelling (ORCAA Article 14, Section 14.03 Definitions) means any non-multiple unit building
containing space for uses such as living, sleeping preparation of food, and eating that is owned, used, occupied, or
intended or designed to be occupied by one family as their domicile. This term includes houses,mobile homes,trailers,
houseboats, and houses with a "mother-in-law apartment"or"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 used as a rental.
Box E. Enter the asbestos survey information or check material presumed (for asbestos projects only). An AHERA building
inspector must conduct an asbestos survey prior to any demolition project (i.e., the wrecking, razing, leveling, dismantling or
burning of a structure, making the structure permanently uninhabitable or unusable). A copy of the survey results shall
accompany the application.
Box F. Enter the demolition project information. If the structure is to be used in a training fire, list the fire department
responsible for conducting the burn as the demolition contractor in Box J. If the property owner has been ordered to perform a
demolition by a government official, submit a copy of the order from the appropriate official.
Box G. Enter all asbestos project information or enter"N/A" for demolition projects with no asbestos removal required. All
multiple structure asbestos projects must be submitted with a work plan map of the structures complete site address, type and
amount of asbestos material to be removed from each structure AHERA asbestos survey,and work schedule.
Box H. Check appropriate project categories in boxes 1 through 8. Asbestos project fee does not include demolition project.
An additional $25.00 is required for a demolition project. Emergency notifications must be submitted with a letter from the
property owner explaining the necessity for the emergency. Emergency demolition notifications must be submitted with a
letter from an authorized government official or a licensed structural engineer documenting that the structure is in imminent f
dangcr of collapse.
Box I. Sign the notification certifying the accuracy and completeness of the information provided on the form.
Box J. Enter demolition contractor mailing information(on back).
Mandatory amendments are required for changes that increase the project type, job size category, the types of asbestos
od
materials to be removed and work schedule changes. A $25.00 processing fee is required for all amendments* (I" and 2
amendments have no fee requirement).
For technical assistance,or inquiries concerning notification and amendment status contact Dean T.Nguyen at(360)586-1044
ORCAA
•.fl'h,.`III.•f IIIYS..M•V 4•,`,"•
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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.
Proiect Site Address: �,� t�0 f�N 1�1 l D� �. County: MA 9,0A)
City: ,•; State: h 19 Zip:
Starting Date: L Completion Date:
•(The re is a 10 working day advance notification period from receipt of permit application)
Property Owner: 'NQti1 Al2SfA),9l.1L7' Telephone: 2 S 3 7S9 SOf�O Fax: S3 JS9 Szr�,
Mailing Address: P-D 6t) / qq Z
Cite: ?-h-C VM B State: l J Zip: 2 Z/O
Demolition Contractor: 506 M�- State License #:
Mailing Address:
Cite S/fiI�!fc; State: Zip:
Con:act Person:_ > Telephone: o2 r.7-2f Fax:
YES N0
Demolition by Wrecking or Dismantling? ($25.00 fee) check # 3 Y�
Training Fire Demolition? (If yes, attach fire department request for training fire)
Renovation, Alteration, Remodeling, Maintenance, or other Construction?
Asbestos found or suspected*
*,kn ORCAA "Notice of Intent to Remove or Encapsulate Asbestos" form and appropriate fee must be submitted prior to any asbestos
rerno�al %work. Asbestos removal projects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or
�rrer::;fli� friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation I Article 14 for additional
that may apply
Asbestos Survey Completed by
AHERA Certified Inspector
Certification WA M 0 4 - ` O L
v:approved permit must Enclose$25 Certification of the Asbestos Survey must
're a,atlable at the job site Processing Fee accompany this form
i
2940 B Limited Lane NW,Olympia,Washington 98502
360-586-1044 ' 800-422-5623 • fax 360-491-6308
homepage:www.orcaa.org • email: info ruorcaa.org
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3502 NORTH 36TH
TACOMA.WA 98407 194076r32s0
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ORDER Of
WASHINGTON MUTUAL BANK
TACOMA MAIN FINANCIAL CENTER
1102 PACIFIC AVENUE•TACOMA.WA 98402
24 HOUR CUSTOMER SERVICE 1-800.7584000
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