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HomeMy WebLinkAboutBLD-2019-0248 - DECONSTRUCTION & DEMOLITION f: Cityof Anacortes Invoice/Permit#: BLD-2019-0248 904 6th Street Applieddate: 04/23/2019 _ P.O.Box 547 Issue date: `'+ Cry;` Anacortes, WA 98221-0547 Expire date: 04/17/2020 41/ (360) 293-1901 Job Address: 1010 23RD ST Permit Type: Demolition Permit ANACORTES WA 98221-2524 Project: APN: P57199 Remarks: Demolition of existing home and move all debris and concrete pad. Owner: FORBES HANSEN Contractor: TONKA GROUND WORK Address: 13553 S GREEN ST Address: 1410 41ST ST ANACORTES WA 98221 ANACORTES WA 98221-3515 Phone: (360) 507-5175 Phone: (360)661-1339 License#: TONKAGW895CP General Information: Fees: Dwelling Units 1 State Building Code Fee Resi 6.50 Total Calculated: 6.50 Deposits/Receipts: 0.00 Total Due: 6.50 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF JY__OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER 6R AUTHORIZED AGENT ISSUED BY - mod ' tes Invoice/Permit#: BLD-2019-0248 ..t r -c y'i,,Y Applied date: 04/23/2019 } 18221 0547 Issue date: 1 Expire date: 04/17/2020 N'' Permit Type: Demolition Permit Project: Finance Department 019153-0040 Carla B. 04/24/2019 09:19AM move all debris and concrete pad. PERMITS AND INSPECTIONS FORBES HANSEN Contractor: TONKA GROUND WORK BLD-201.9-0248 Demolition Permit Address: 1410 41ST ST Demolition of existing ANACORTES WA 98221-3515 home and move all approved Phone: (360)661-1339 2019 Item: BLD-2019-0248 License Building Code Fee #: TONKAGW895CP Resi 6:50 Payment Id: 241503 Fees: State Building Code Fee Resi 6.50 6.50 Total Calculated: 6.50 Deposits/Receipts: 0.00 Subtotal 6.50 Total Due: Total 6.50 6.50 03FINANCE CREDIT CARD 6.50 Visa ************3124 Ref=41312267085 Auth=067600 3124 1 Change due 0.00 Paid by: FORBES HANSEN 11111111111 II1 11111 III I'II II 1111111 Signature: ____..._._.__ _____- Thank you for your payment ORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF COPY \BANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I DUPLICATE RECEIPT JED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE 0 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR .__.__ E PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER RAUTHORIZEDAGENT ISSUED BY 'rONOW120 APR•2 3 2019 CITY OF Atimcgrga, COMMUNITY,&ECONOMIC DEVELOPMENT DEPARTMENT c .' DEMOLITION & OIL TANK DECOMMISSIONING PERMIT APPLICATION Mailing Address:P.O. Box 547,Anacortes, WA 98221 Office Location: 904 6th Street, Anacortes WA 98821 Phone: (360)293-1901, Fax: (360) 293-1938 PLEASE REFER TO THE PERMIT CHECKLIST THAT FOLLOWS FOR SUBMITTAL REQUIREMENTS BUILDING DEMOLITION: ❑ N/A y" COMPLETE BUILDING DEMOLITION El PARTIAL DEMOLITION 4 RESIDENTIAL ❑ COMMERCIAL ❑ FLOOR AREA TO BE DEMOLISHED: 0 METHOD OF DISPOSAL: ❑ DATE OF CONSTRUCTION OF STRUCTURE TO BE DEMOLISHED UNDERGROUND OIL TANK DECOMMISSIONING: N/A ❑ REMOVAL ❑ ABANDONMENT IN PLACE(FIRE DEPT.APPROVAL RQD) 0 SIZE OF TANK: ❑ APPROXIMATE AGE OF TANK: 0 DISPOSAL LOCATON: _ ❑ DATE OF PUMP&RINSE: El ICC CERT#: ❑ IF ABANDONED,SPECIFY TYPE OF INERT FILL: PROJECT ADDRExS,S(Street, Suite#,): PARCEL(S): /o'a Z3i& s. 7-k/ p 5 7ill APPLICANT: Phone: ,cv4e5 AC- 36 - s' 7 5i 7 5 Address(Street,City,State,Zip): c'j Z /E-Mail Address: /3 s 5 li �� -rsb l~a��� iy7,0d utnA. PROPERTY OWNER: Phone: 5tao - 607 48/Q0 Address(Street,City,State,Zip): E-Mail Address: z //, � R tom. / 630 / st ( � .1_5vv\, Address(Street,City,State,Zip): E-Mail Address: CONTRACTOR n� s, )ti4 ZZi/ ON TRAC OR/DECO SSIONER'S FIRM N Pl �:ol3 Address(Street,City,Start ,,Zip): E-Mail Address: /7/5- -Yl� 3T �il2zt.t��v ¢�� ,aYtlt�--�� / ! n " * Contracthf's Lice e� x�te: All Contractors&subcontractors must have a valid City of Anacortes�i4 k u 9cC ��20/2 business license prior to doing work in the City. Contact the City's usiness Lice ##: Ex . ate: Finance Department at(360)299-1968. 6a._ S- 4'9/ o /1c/� PROPOSED WORK: P ,� E gran - /L „Is vutl r I declare under penalty of perjury that the information I have provided on this form/application is true,correct,and complete,and that I am the property owner or duly authorized agent of the property owner to submit a permit application to the City of Anacortes. 00/04...Y Print Name: T`�des Owner ❑ Other C (specify): Signature: �.�"`�".-' �uu Date: �`ri-3/z/1 i Page lof2 ?;1 CleanAir agency DEMOL ISHING ? CHECK FOR ASBESTOS BEFORE YOU START Definition of demolition (NWCAA Regulation 570): Demolition means the wrecking, razing, cn dismantling, or burning of a structure, making all or part of the structure uninhabitable or unusable. L Q) You cannot legally start any demolition project or most renovation projects until certain asbestos, requirements are met ... 0 (I) f, DANGER ASBESTOS �' Demolition % CANCER AND LUNG C Cn DISEASE HAZARD • l' '19 Procedures PERSONNEL ONLY rt J RESPIRATORS AND PROTECTIVE CLOTHING 0 ARE REQUIRED IN THIS AREA C a, KNOW THE LAW PLAN AHEAD Conduct an asbestos survey. The survey must be conducted by an AHERA-certified building inspector. (AHERA stands for Asbestos Hazardous Emergency Response Act.) These inspectors are listed in the phone book yellow pages under"Asbestos Consulting and Testing"and on NWCAA's website at http://nwcleanairwa.gov/permits-and-services/asbestos-and-demolition/. File a Notification of Demolition. A completed notification and fee must be submitted to the Northwest Clean Air Agency (NWCAA). Forms are available online at http://nwcleanairwa.gov/ hermits-and-services/asbestos-and-demolition/. Wait. A 10-day, federally mandated waiting period applies to all asbestos demolition projects except in emergency situations with prior agency approval. This gives NWCAA a chance to review and/or inspect projects to ensure compliance. Homeowners doing their own work are required to submit a 24-hour asbestos removal notification but must still wait 10 days after submitting a Notification of Demolition. Properly remove asbestos. All asbestos-containing materials identified in the AHERA survey must be removed from the structure by a certified asbestos contractor prior to demolition, but after submitting a Notice of Intent to Remove Asbestos and observing a 10-day waiting period. For more information: This document contains only a brief summary of asbestos requirements. For full details, contact the Northwest Clean Air Agency at http://nwcleanairwa.gov/ or call 360-428-1617. Failure to comply with the asbestos requirements of NWCAA Regulation 570 may result in penalties. Note to contractors: Check with L&I for additional requirements at www.lni.wa.gov. 1600 South Second Street Asbestos / Demolition Notification Approval o Mount Vernon, WA 98273-5202 and Permit to Work northwest " Ph 360-428-1617 cIe nAi1 fax 360-428-1620 l info@nwcleanairwa.gov agency www.nwcleanairwa.gov Notification # 19-227 Project Site Received Date 04/22/2019 1010 23rd Street Approval Date 04/22/2019 Anacortes, WA 98221 Fee Amount $ 54.00 Receipt # 7465D Project Details Project Type Demolition only Building Type Single Family Residence ❑ Emergency Estimated Demolition Date 04/26/2019 d Survey Survey Link [Survey on file with NWCAA] El Owner Occupied Abatement El Class I El Class II ❑ Vermiculite ❑ Non-friable Fee Exempt Material Owner Site Owner Frank Hansen Owner Phone (360) 507-5175 Notification Submitted by Forbes Hansen Notification Contact Phone (360) 507-5175 Notification Contact Email forbesahansen@gmail.com This notification must be posted at the work site. You must file an amendment if there are any changes to the project scope or schedule. <http://nwcleanairwa.gov/forms/asbestos-project-amendment/> Information on asbestos and demolition can be found on the agency website. <http://nwcleanairwa.gov/permits-and-services/asbestos-and-demolition/> Asbestos disposal information <http://nwcleanairwa.gov/download/disposal-information/> NWCAA asbestos regulations can be found in Section 570 Asbestos Control Standards. <http://nwcleanairwa.gov/regulation/section-550-590/section-570/> Generated: 04/22/2019 10:58 AM PHIL,L,IPS ENVIRONMENTAL, SERVICES 29354 BACUS RD. SEDRO WOOLLEY,WA 98284 360-854-7900 FAX 360.854,7731 February 8, 2016 Survey No. 16028 Forbes Hansen 11629 Pointe Place Anacortes, WA 98221 360-507-5175 forbesahansen@gmail.com RE: Asbestos Survey: 1010 23rd. Street,Anacortes,WA 98221 On February 4, 2016, I inspected a single family residence along with detached shed and garage located at the above referenced address for the purpose of determining the presence or absence of building materials that might contain asbestos. Title 40 Code of Federal Regulations (40 CFR), subpart M, section 61.141, established the allowable limit of asbestos in building materials at 1%by weight. Materials containing more than 1% asbestos are regulated and must be handled in accordance with Federal, State, and Local regulations. Surveys are based on 'visible and accessible materials' and although reasonable effort was made to locate and test all suspect materials, some suspect materials may remain hidden in walls or below floor underlayment or other areas until demolition or renovation work makes them accessible. If other suspect materials are discovered during the course of demolition or remodel activities they will require testing prior to continuing work. Sixteen bulk samples were collected and subsequently analyzed for asbestos content by Polarized Light Microscopy with Stain Dispersion. Samples#1, 5, and 6 were found to contain more than 1% asbestos. These materials will require handling/removal by trained asbestos workers prior to any remodeling,renovation, or demolition that will lead to the disturbance or removal of asbestos. Prior to removal of these materials,ten- day notices must be filed with the local Clean Air Agency and the State Department of Labor& Industries. This letter along with the attached material list and lab report will comprise the `Asbestos Survey'. Please call us if you have any questions. Sincerely, e, Dave B. Phillips AHERA Bldg. Insp. Cert.# 154454 (expires 12-8-16) enclosure PHILLIPS ENVIRONMENTAL, SERVICES 29354 BAcus RD. SEDRO WOOLLEY,WA 98284 360-854-7900 FAX 360-854.7731 Client: Forbes Hansen Asbestos Survey- 1010 23rd.Street Survey#: 16028 11629 Pointe Place Anacortes,WA 98221 Anacortes,WA 98221 360-507-5175 Survey date: 2-5-16 Homogeneous Material List Material#&Description Location(homog.area) Type Friab Cond Qty. Sample#&Location Asbestos 1 Vinyl sheet Kitchen floor Misc N F 150sf 1 Kitchen floor Chry.40% 2 Vinyl tile&mastic Master bath floor Misc N F 2 Master bath floor N/D 3 2 layers vinyl sheet Utility room floor Misc N F 3 Utility room floor N/D 4 Vinyl tile Main bath floor,top layer Misc N F 4 Main bath floor,top layer N/D 5 Vinyl sheet Main bath,below 'Misc N F 30sf 5 Main bath,below Chry.40% underlay underlay 6 Vinyl sheet Kitchen counter top& Misc N F 20sf 6 Kitchen counter top Chry.40% backsplash 7 Acoustical tile Living room ceiling Misc N F 7 Living room ceiling N/D 8 Vermiculite Attic Tsi N F 8a Attic Trem.<1% 8b Attic Trem.<1% 8c Attic N/D 9 Mastic Main bath,tub surround Misc N F 9 Main bath,tub surround N/D 10 Drywall&jt.comp Main bath wall Misc N F 10 Main bath wall N/D 11 Drywall&jt.comp. Master bedroom wall Misc N F 11 Master bedroom wall N/D 12 Asphalt roof w/sand House roof Misc N F 12 House roof N/D 13 Asphalt roof w/sand Shed roof Misc N F 13 Shed roof N/D 14 Asphalt roof w/sand Garage roof Misc N F 14 Garage roof N/D Also observed is one mercury switch thermostat in the hallway N/D=None Detected Note: Friability assessments were made on these materials in their present undisturbed condition, N/T=Not Tested-previous sample tested positive damage or disturbance of any kind may cause some non-friable materials to become friable. Quantities shown are approximate-field verification recommended PHIL,L,IPS ENVIRONMENTAL SERVICES 29354 BACUS RD. SEDRO WOOLLEY, WA 98284 360-854-7900 American Industrial Hygiene Association Lab I.D. # 102950 FAX 360-854.7731 ASBESTOS BULK SAMPLE ANALYSIS Client Name: Forbes Hansen 11629 Pointe Place Survey #: 16028 Anacortes, WA 98221 360-507-5175 forbesahansen@gmail.com Source of Samples: 1010 23rd. Street, Anacortes, WA 98221 Date Rec'd: 2-5-16 Analytical Method: Polarized Light Microscopy with Dispersion Staining (PLM-DS Method) Sample #: 1 Lab No.: 80974 Location: Kitchen floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'!: % Asbestos Type: % Layer 1 of 3 Off white &brown vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% Chrysotile 40% Layer 3 of 3 Yellow mastic Mastic/binder Cellulose trace None detected Sample #: 2 Lab No.: 80975 Location: Master bathroom floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 4 Off white &brown vinyl tile Vinyl/Binder None detected None detected Layer 2 of 4 Clear mastic mastic Cellulose trace None detected Layer 3 of 4 Grey leveling compound Binder/Fine particles Cellulose trace None detected Layer 4 of 4 White leveling compound Binder/fine particles Cellulose trace None detected Sample #: 3 Lab No.: 80976 Location: Utility room floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 5 Off white vinyl w/foam backing Vinyl/Binder None detected None detected Layer 2 of 5 Yellow mastic Mastic/binder Cellulose trace None detected Layer 3 of 5 Off white vinyl sheet Vinyl/Binder None detected None detected Layer 4 of 5 Black fibrous paper-like material Binder/Fine particles Cellulose 60% None detected Layer 5 of 5 Brown mastic Mastic/binder Cellulose trace None detected Sample #: 4 Lab No.: 80977 Location: Main bath floor, top layer Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 2 Off white &brown vinyl tile Vinyl/Binder None detected None detected Layer 2 of 2 Clear mastic mastic Cellulose trace None detected Sample #: 5 Lab No.: 80978 Location: Main bath floor, below underlay Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 3 Off white pebble pattern vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% Chrysotile 40% Layer 3 of 3 Yellow mastic Mastic/binder Cellulose trace None detected Q6A Analyst._ Date: 2-7-16 Dave B. Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. PHILLIPS ENVIRONMENTAL SERVICES 29354 BACUS RD. SEDRO WOOLLEY, WA 98284 360-854-7900 American Industrial Hygiene Association Lab I.D. # 102950 FAX 360-854-7731 ASBESTOS BULK SAMPLE ANALYSIS Sample #: 6 Lab No.: 80979 Location: Kitchen counter top Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 3 Off white pebble pattern vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% Chrysotile 40% Layer 3 of 3 Yellow mastic Mastic/binder Cellulose trace None detected Sample #: 7 Lab No.: 80980 Location: Living room ceiling Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 1 Tan acoustical tile Binder Cellulose 80% None detected Sample #: 8a Lab No.: 80981 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 1 Vermiculite Vermiculite/debris Cellulose trace Tremolite <1% Sample #: 8b Lab No.: 80982 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 1 Vermiculite Vermiculite/debris Cellulose trace Tremolite <1% Sample #: 8c Lab No.: 80983 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 1 Vermiculite Vermiculite/debris Cellulose trace None detected Sample #: 9 Lab No.: 80984 Location: Main bath, tub surround mastic Layers Description: Non-Fibrous Material: Other Fibrous Mat'1: % Asbestos Type: % Layer 1 of 1 Yellow mastic Mastic/binder Cellulose trace None detected Sample #: 10 Lab No.: 80985 Location: Main bathroom wall Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 2 White compacted powdery material Binder/fine particles Cellulose trace None detected Layer 2 of 2 Drywall Gypsum/fine particles Cellulose 20% None detected Sample #: 11 Lab No.: 80986 Location: Master bedroom wall Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 2 White compacted powdery material Binder/fine particles Cellulose trace None detected Layer 2 of 2 Drywall Gypsum/fine particles Cellulose 20% None detected Sample #: 12 Lab No.: 80987 Location: House roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 2 Asphalt roof w/sand Asphalt/sand Glass 20% None detected Layer 2 of 2 Asphalt roof w/sand Asphalt/sand Glass 20% None detected Q6Akill )--t4: Analyst._ Date: 2-7-16 Dave B. Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. PHIL,LIPS ENVIRONMENTAL SERVICES 29354 BAGUS RD. SEDRO WOOLLEY, WA 98281E 360-854r7900 American Industrial Hygiene Association Lab I.D. # 102950 FAX 360-8554-7731 ASBESTOS BULK SAMPLE ANALYSIS Sample #: 13 Lab No.: 80988 Location: Shed roof Layers ' Description: Non-Fibrous Material: Other Fibrous Mat'!: % Asbestos Type: % Layer 1 of 2 Asphalt roof w/sand Asphalt/sand Cellulose 20% None detected Layer 2 of 2 Asphalt roof w/sand Asphalt/sand Cellulose 20% None detected Sample #: 14 Lab No.: 80989 Location: Garage roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'!: % Asbestos Type: % Layer 1 of 2 Asphalt roof w/sand Asphalt/sand Glass 20% None detected Layer 2 of 2 Asphalt roof w/sand Asphalt/sand Glass 20% None detected QtA Analyst._ Date: 2-7-16 Dave B. Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. 4/22/2019 Official Payments-Pay Taxes,Utility Bills,Tuition&More Online This is a"printer friendly" page. Please use the"print"option in your browser to print this screen. OFFICIAL 1111 PAYMENTS Northwest Clean Air Agency, WA CleanAsbestos Notification or Demolition agency Confirmation Number: 07465D Payment Date: Monday,April 22,2019 Payment Time: 10:32AM PT Payer Information Name: Forbes Hansen Street Address: 13553 South Green Street Anacortes Anacortes,WA 98221 United States Daytime Phone (360)507-5175 Number: E-mail Address: forbesahansen@gmail.com Project Site Address: 1010 23rd Street Card Information Card Type: Visa Card Number: Card Verification * * Number: Payment Information Payment Type: Asbestos Notification or Demolition Payment Amount: $54.00 Convenience Fee: $2.25 Total Payment: $56.25 Thank you for using Official Payments. If you have a question regarding your payment, please call us toll free at 1-800-487-4567.To make payments in the future, please visit our website at www.officialpayments.com. Copyright©2019 Official Payments Corporation.All Rights Reserved. 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