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BLD-2018-0129 - COMMERCIAL TENANT IMPROVEMENT
W 2 2,,, 4.) ::: hu: 7 - ELEVEN NO . I 8488 „AR _, m — m n� 113 U-S m O fl W m _m a m o� +4 g n 0 0 2o CV �.N O O UST SYSTEM REMOVAL 1116 UJ f-- m o v 6 w 73 E ° U a ° i p e 0 n E ; o -am 2 0 U a m ° a°_ Q U t o a w w a U . 0 CIPiiANTE N a o M J 7 U-p U m - CO- w 3 r gym i o PLANNING & BUILDINGDEPT: 1102 12TH STREET APPROVED PLANS0. KANO I/: 3 LC) — P--.0i1:- 0129 r) r ADDRESS: i L °o- APPROVEDSY; 6:44C--- I Q ANACORTES . WASHINGTON SUBJECT TO FIELD INSPECTION. APPROVED FLANS SHALL NOT BE ALTERED WITHOUT AUTHORIZATION, la's AGENCY NOTES PROJECT DESCRIPTION INDEX SITE AREA: 15,000 SF 10.34 ACRES REMOVAL OF THREE (3 12,000 GALLON (EA) UNDERGROUND FUEL STORAGE SHT00 COVER SHEET UST SYSTEM REMOVAL � TANKS (USTs), PRODUCT AND VENT PIPING, MONITORING EQUIPMENT, 5HT01 EXISTING CONDITIONS MAP EXISTING FLOOR AREA: 3,000 SF CONVENIENCE STORE DISPENSERS, CANOPY,AND CONCRETE SLAB. ±575 SF FUEL CANOPY SITE WILL BE BACKFILLED AND CONCRETE WILL BE PLACED TO MATCH SHT02 TEMPORARY EROSION CONTROL PLAN fl OCCUPANCY CLASSIFICATION: (M) MERCANTILE EXISTING. SHT03 SITE DEMOLITION PLAN ZONE: COMMERCIAL r SHT04 GRADING AND RESTORATION PLAN r PARCEL: P55259 SHT05 GENERAL NOTES 11 APPLICABLE CODES: JURISDICTION: SKAGIT COUNTY, WA I CONTACT INFORMATION PROJECT OWNER: JOSE RIOS MANAGER ENVIRONMENTAL SERVICES 7-ELEVEN INC PO BOX 711 DALLAS, TX 75112 JOSE.RIOS@711.COM 972-828-6592 (work) p 972-742-5943(cell) '0 CONTACT PERSON: PAUL FAIRBAIRN STANTEC CONSULTING SERVICES 11130 NE 33RD PLACE SUITE 200 co BELLEVUE,WA 98004 c0c0 Paul.Fairbaimc Stantec.com oO 425-289-7343 ;work) 206-369-8383 cell) 0 ENGINEER: VICINITY MAP SITE Z MARC SAUZE, P.E. STANTEC CONSULTING SERVICES w n, w 11130 NE 33RD PLACE SUITE 200 LLI BELLEVUE,WA 98004 0 t i Z Marc.Sauze Stantec.com `` 1 , 425-894-2329(cell425-869-9448 ext ) (work) " ,r�i to,.it * Z Lil 2 O N _Z n. W r 2 3 _•�++..�.. W o Q w [Li - tii = L. 0, ' 44 z w c �" ' r +ramilill.€ t r ' : • NO O 1.1 1 Lu s� I. .Nommit .- •. - �,, 4O O a • J -- r r `s e�,. Z I! < U , . f". ' . , ri \ - Permit-Seal SITE LOCATION • *..,. ill C S r __. i ` l a 1 0 r of PROJECT lir - .0 Ir. J6A, „oil* LOCATION /../' t .Pjr I I* r ,M -- i 1 - "VAL ' . ii a Ilikt 1.4. "1‘41/#g''K hp . • . t. % Q ' - —" File Name: 7i1 1848&5HTs0 S.dwgo >- ail !T0. x �'` �. SYF PF PF FES 2018 7 c..) .• 2 74,,,:1---- ,,,... ,. Dwn. Chkd. Dsgn. Dafe STATE.ROUTE 20 PUR Drawing No. 711-18488-SHTs 0-5 o - Know what's below.13-Qo -- Revision Sheet _� Call before you dig. - - t .. � -r , -- l A 0 of LEGEND PROPERTY INFORMATIONU c 0 SITE ADDRESS: 1102 12TH STREET, o • PROPERTY BOUNDARY ANACORTES,WA. IIII) °a STORM DRAIN SKAGIT COUNTY PARCEL NUMBER: P5525944 z SANITARY SEWER LINE TOWNSHIP, RANGE, SECTION: T35 01 13C o c o WATER LINE THAT PORTION OF BLOCK 57 OF MAP OF THE E o a o �a eN CITY OF ANACORTES, SKAGIT COUNTY, - m o.5- UNDERGROUND STORAGE WASHINGTON, AS PER PLAT RECORDED IN o a m TANK(UST) VOLUME 2 OF PLATS, PAGE 4, RECORDS OF 2 T, SKAGIT COUNTY, DESCRIBED AS FOLLOWS: T °2 CATCH BASINS BEGINNING AT THE SOUTHEAST CORNER OF 00 6 SAID BLOCK 5T, THENCE WESTERLY ALONG THE wV) 2 2 - ` MANHOLE------} SOUTH LINE OF SAID BLOCK 57, 150 FEET; J _ THENCE NORTHERLY ALONG A LINE WHICH IS_ "' PARALLEL TO THE EAST LINE OF SAID BLOCK 57, v T° w 100 FEET, MORE OR LESS, TO THE SOUTH LINE Q o ` ° '8 OF AN ALLEY; THENCE EASTERLY ALONG THE ▪ a ' 0 a 0 SOUTH LINE OF SAID ALLEY, 150 FEET TO THE o u y T 0 0 EXISTING BUILDING G EAST LINE OF SAID BLOCK 7;THENCE ▪ 5- Q7 a o 3000 SF PROPERTY BOUNDARY g ° ° - SOUTHERLY ALONG SAID EAST LINE, 100 FEET, z 2 o°' ;°° TO THE POINT OF BEGINNING. o L 3 u, "_ MAR 1 2 2018 I APPROX LOCATION OF LANDSCAPING SANITARY SERVICE LINE >- >- f -° 0 a Z A o,. CONTACT INFORMATION g PROJECT OWNER: IIMANAGER Z JOSE RIOS �m � �� #m �► m ��• � ELEVEN INC ENVIRONMENTAL SERVICES 7-ELEVEN , PO BOX 711 STORE NO. 18488 iDALLAS, TX 75112 1 i 9772-828169�7wo(work) I I 972-742-5943(cell) 1 I S J J I I CONTACT FAIRBAIRN Q D �t < 1 STANTEC CONSULTING SERVICES 0 C� CD CD c� 11130 NE 33RD PLACE SUITE 200 U S CLANCY LLC � Z Z z ft BELLEVUE,WA 98004 PARCEL#P55257 oo oo o Paul.Fairbaim Stantec.com C� < o 4 0 Q p 425-289-7343 work) r I W r 206-369-8383 cell) I 0 � 1 ENGINEER: SAUZE,P.E. I 1STANTEC CONSULTING 1 30 NE 33RD PLACE SUITE SERVICES 0 N I BELLEVUE,WA 98004 CONCRETE PORCHI Marc.SauzeStantec.com o I W 425 894 425-869-2329 48 {ce11xt�72 (work) I 44mmrr. #_ _ s, 4I _ _._. , - = r 0) t I ..,. u, W a a , Q Q o I cO' 1 i ,--K19-7--- 1 <7) i.70.0**"............°....... ASPHALT CANOPY 575 SF . 0 I ,/ a a I L CO co '...) _-- -_-. S so _ r O WATER LANDSCAPING ACCESS tr / LANDSCAPING z I-- METER7 W Q hiv:i ;w ti , w 4 SIGN c) z cn 1 POWER POLE Z = C� Q Z SIDEWALK w 1 C Q 1 I0 Z J CNI N � 2 0 _ w o w Z I114 Lu" z 12TH STREET o >- (STATE ROUTE 20 SPUR) Q < a 3 a Permit-Seal IXENE U i ,cr „ocili WAspkt,..., ....,,1 ill ..... - iri, Ili '. _ c k8 i ` hit- NI • m Project N er - 0 o.u, File Name: 71 I-18488-SHTs 0-5.dwg 2 m i J 1 >: i SYF PF PF FEB 2018 EN o. Dwn. Chkd. Dsgn. Date t2 10 5 0 10 20 Drawing No. 711-18488-SHTs 0-5 m CV ■■■■■■ ■■■ ,M MEMMMEMME IMMMMMIEME Revision Sheet �� APPROXIMATE SCALE IN FEET A l of 5 ya LEGEND PROPERTY INFORMATION t3 U SITE ADDRESS: 1102 12TH STREET, a a, a - • PROPERTY BOUNDARY ANACORTES, WA. (10) . ..-S STORM DRAIN SKAGIT COUNTY PARCEL NUMBER: P55259 O 8-. o i U W, SANITARY SEWER LINE TOWNSHIP, RANGE, SECTION: T35 01 13C .o a 1 N i C GAS LINE THAT PORTION OF BLOCK 57 OF MAP OF THE m a? CITY OF ANACORTES, SKAGIT COUNTY, Irti orb t WATER LINE WASHINGTON, AS PER PLAT RECORDED IN s m m VOLUME 2 OF PLATS, PAGE 4, RECORDS OF o ELECTRIC LINE SKAGIT COUNTY, DESCRIBED AS FOLLOWS: 9 BEGINNING AT THE SOUTHEAST CORNER OF g Q=° 3 _.2 — _ . , ....) TELEPHONE LINE SAID BLOCK 57;THENCE WESTERLY ALONG THE SOUTH LINE OF SAID BLOCK 57, 150 FEET; -o UNDERGROUND STORAGE THENCE NORTHERLY ALONG A LINE WHICH IS o o �� _ — - _ _ TANK(UST) PARALLEL TO THE EAST LINE OF SAID BLOCK 57, Q a o .„o Y y 100 FEET, MORE OR LESS,TO THE SOUTH LINE E ; t OF AN ALLEY; THENCE EASTERLY ALONG THE o u N T a g CATCH BASINS SOUTH LINE OF SAID ALLEY, 150 FEET TO THE c�� � m p � a MANHOLE EAST LINE OF SAID BLOCK 57;THENCE w w a o o, o,o EXISTING BUILDING UTLINE ALONGIDSAID EAST LINE, E FEET, 3000 SF PROPERTY BOUNDARY TO THE POINT OF BEGINNING. ° 3 o o SURFACE WATER FLOW � J I V� � ur I! Mr M _ to M �� II! MI rf Ir 1111 �� �� � • • � DIRECTION DURING AND AFTER ° RESTORATION r SOIL STOCKPILE 1 0 0 LANDSCAPING I >- DEMOLITION AREA i I i I Q • 1 z APPROX LOCATION z CONTACT INFORMATION a OF VENT PIPING U PROJECT OWNER: 1 I z MANAGER ENVIRONMENTAL SERVICES 7-ELEVEN INC 1 r� r■ i a >■I I• g r� PO BOX 711 7-ELEVEN +r i II DALLAS, TX 75112 r -..r JOSE.RIOS@711.COM STORE NO. 18488 II. 972-828-6592(work) 972-742-5943 (cell) CONTACT PERSON: 1 I >` � PAUL FAIRBAIRN jI I 1 J D Go -I Ul — f STANTEC CONSULTING SERVICES 11130 NE� � � � � `} � ¢ � ' BELLEVUE, WA 98004RD E SUITE 200 00 00 � O U 5 CLANGY LLC I z p z o I. p Paul.Fairbaim425-289-7343 Stantec.com I 1= o �- p p NOTES 206-369-8383celf ) PARCEL#P55257 Q p Q p Q p ' N CC N W N 1 , 1. STORM DRAIN INLETS NEED TO BE REMOVED AT ENGINEER: 0 lai 0 O v LI THE END OF THE JOB. MARC SAUZE, P.E. 0 I — I 2. STORM DRAIN INLETS ARE ONLY TO BE STANTEC CONSULTING SERVICES i INSTALLED IN DRAINAGE DEVICES PER THE 11130 NE 33RD PLACE SUITE 200 MANUFACTURER'S RECOMMENDATIONS.CATCH BELLEVUE,WA 98004 BASIN INSERTS ARE NOT TO BE INSTALLED IN Marc.Sauze@Stantec.com Il CURB INLETS. 425-869-9448 ext 172 (work) I CONCRETE PORCHI 425 894 2329 (cell) Ln W 3. INSERTS SHALL BE INSPECTED AND MAINTAINED ili m #III # ss im m• 4i im ui M WHEN A 1/2 INCH RAIN ACCUMULATES WITHIN A 24 HOUR PERIOD.CLEAN AND/OR REPLACE 1 !:2- , r wwZ INSERT WHEN HALF OF THE TRAP IS FILLED WITH d� W SEDIMENTS. — CANOPY d Q 575 SF / 0 -� TEMP CB FILTER m 0 2 ) NTS -N '.:* . r 1 ' ' . — 1.7.00°..°4°.°°....°.°1 i $ , /1.: l------/ i i -1: ASPHALT y - O_ I \. y„#._.r •Vl INSTALL TEMPORARY `¢ 0) Ce rP) 2 - z IL STOCKPILENOTE5 �SO WWIPLA TICCOVERIN i. PLASTIC SHEETING IS USED TO PROVIDE — IMMEDIATE PROTECTION TO SLOPES AND O0 STOCKPILES, 0 0 LK _ _ • i 2. DO NOT USE PLASTIC COVERING UPSLOPE OF Z Z `/ AREAS SUCH AS STEEP AND/OR UNSTABLE OZC W O ACCESS LANDSCAPING SLOPES THAT MIGHT BE ADVERSELY AFFECTED LANDSCAPING BY CONCENTRATED RUNOFF. U 3. WHEN POSSIBLE, INSTALL AN INTERCEPTOR F— I— z ' Z (. 1) INSTALL TEMPORARY SIGN DIKE AT THE TOP OF THE PLASTIC TO DIVERT Li Ce CC) col = Q POWER POLE 2 CB FILTER(TYP) FLOWS AWAY FROM THE PLASTIC. LU 1 CNI Z 00 4. TOE-IN THE TOP OF THE SHEETING IN A 6"x6" SIDEWALK TRENCH BACKFILLED WITH COMPACTED NATIVE MATERIAL. 1 J O Q W • 5. INSTALL A GRAVEL BERM,RIPRAP, OR OTHER Ilinm , r / SUITABLE PROTECTION AT THE TOP OF THE Q ``/ SLOPE IN ORDER TO DISSIPATE RUNOFF ►— VELOCITY. 6 6 � O 12TH STREET ANCHOR THE PLASTIC USING SANDBAGS OR ;IliCL- OTHER SUITABLE TETHERED ANCHOR SYSTEM Z c/� W (STATE ROUTE 20 SPUR) SPACED ON A 10'GRID SPACING IN ALL Q DIRECTIONS- 7. OVERLAP SEAMS 1-2'.TAPE,ROLL AND STAKE Permit-Seal 3 I THEENT SEAMSE AND THEN WEIGHT DOWN THEG 1 fNr a d 8. BARRIER IS REQUIRED AT TOE OF STOCK PILES. x N 9. REPLACE TORN SHEETS AND REPAIR OPEN "� R SEAMS. COMPLETELY REMOVE AND REPLACE , PLASTIC WHEN IT BEGINS TO DETERIORATE. y�} // tja •• m f,lr 2 SOIL STOCKPILE ;� '' 0 2 NTS . •a Project Number. r o3921 __ , File Name: 711-18488-SHTS 0-5.dwg a -o SYF PF PF FEB 2018 m Own.o Chkd, Ds�1n. Date • 10 5 0 10 20 Drawing No. 711-18488-SHTs 0-5 1111 a� Revision Sheet �� APPROXIMATE SCALE IN FEET A 2 of 5 :t. coop - 41"11111111111IMMIF , >, Qo 1111) c SCOPE OF WORK PROPERTY INFORMATION0 O G.C. = OWNERS CONTRACTOR SITE ADDRESS: 1102 12TH STREET, a m a e OT = OTHERS ANACORTES, WA. 3 f3 g O � ifl 0 G.C. REMOVE EXISTING DISPENSERS. SKAGIT COUNTY PARCEL NUMBER: P552594w z 2 m o o� I� G.C. DEMOLISH EXISTING GASOLINE TOWNSHIP, RANGE, SECTION: T35 01 13 E 2 o v_ DISPENSER CANOPY SUPPORT E—£43 COLUMNS, FOOTINGS AND THAT PORTION OF BLOCK 57 OF MAP OF THE CONCRETE PUMP ISLANDS. CITY OF ANACORTES, SKAGIT COUNTY, t m c.r O G.C. SAW-CUT, BREAK,AND REMOVE WASHINGTON, AS PE PLAT RECORDED IN t o a CONCRETE SURFACE OVER VOLUME 2 OF PLATS, PAGE 4, RECORDS OF m o-0 UNDERGROUND STORAGE TANKS SKAGIT COUNTY, DESCRIBED AS FOLLOWS: 9 �, (USTs), PRODUCT PIPING,AND BEGINNING AT THE SOUTHEAST CORNER OF o Q� C DISPENSER AREA_ SAID BLOCK 57;THENCE WESTERLY ALONG THE t it SOUTH LINE OF SAID BLOCK 57, 150 FEET; .8° D o • �.� QC _ _ _ �� J ,5 �� r 4O G.C. EXCAVATE AND STOCKPILE UST OVER THENCE NORTHERLY ALONG A LINE WHICH IS "'11J o BURDEN SOIL ON 6-MIL VISQUEEN PARALLEL TO THE EAST LINE OF SAID BLOCK 57, S S °o mt SHEETING. COVER STOCKPILE WITH 100 FEET, MORE OR LESS, TO THE SOUTH LINE cp E - 2 i 0 • OF AN ALLEY THENCE EASTERLY ALONG THE a - o EXISTING BUILDING VISQUEEN. o m a 3000 SF PROPERTY BOUNDARY SOUTH LINE OF SAID ALLEY, 150 FEET TO THE Q u - c o ' O c.c. REMOVE 3-EXISTING 12,000 GALLON EAST LINE OF SAID BLOCK 57;THENCE . ° x a USTs. EXISTING PRODUCT, VAPOR, SOUTHERLY ALONG SAID EAST LINE, 100 FEET, z o o °10 TO THE POINT OF BEGINNING. o .., o o P • AND VENT PIPING, PERFORM UST r, I CLEANING, TRANSPORTATION,AND w m m co °DISPOSAL. O G.C. REMOVE EXISTING PRODUCT PIPING CONTACT INFORMATION _ o ` LANDSCAPING LINES. 0 REMOVE 3-EXISTING VENT RISERS PRJOJECT OSE R OSN1;R: AND VENT LINES_ MANAGER ENVIRONMENTAL SERVICES REMOVE THREE (3) EXISTING 7-ELEVEN INC O c.c-ro. REMOVE EXISTING ELECTRICAL PO BOX 711 - 12,000 GALLON TANKS CONDUITS FROM SUB-PANEL TO TANK DALLAS,TX 75112 I a0. Z TURBINE & FILL SUMPS,ANNULAR JOSE.RIOS@711.COM DISPENSER, AND ALL LOW VOLTAGE 972-828-6592 (work) , . I U SENSORS. 972 742-5943 (cell) /// i z REMOVE ANY PETROLEUMCAVATE UST BASIN IN TO CONTACT FAIRBAIRN ` g CONTAMINATED SOIL(PCS) IF STANTEC CONSULTING SERVICES 7-ELEVEN ENCOUNTERED. STOCKPILE PCS ON 11130 NE 33RD PLACE SUITE 200 VISQUEEN AND COVER WITH BELLEVUE, WA 98004 STORE NO. 18488 VISQUEEN UNTIL SOIL IS Paul.Fairbairn acStantec.com TRANSPORTED OFF-SITE FOR 425-289-7343 work) 1/1: 4DISPOSAL AT SEPARATE FACILITY. 206-369-8383 cell) • 1 OVER EXCAVATE AREAS OF USTs • (� AND DISPENSER ISLAND IN ORDER TO ENGINEER: 1 // I REMOVE CONTAMINATED SOIL IF MARC SAUZE, P.E. r 3i0©i0 ENCOUNTERED. REUSE SOIL AS MARC SC CONSULTING SERVICES U S CLANCY LLC 7♦12 ./ BACKFILL IF CLEAN. BELLEVUE3WA PLACE80 SUITE 200 PARCEL#P55257 10 c.c. PERFORM BACKFILL AND SURFACE Marc.Sauze@Stantec.com RESTORATION ACTIVITIES (SEE SITE 425-869-9448 ext 172 (work) GRADING AND RESTORATION PLAN). 425-894-2329 (cell) 11 i REGRADE SO STORMWATER FLOWS 1 !\****4441%.. INTO EXISTING STORM DRAINS. I I LEGEND GENERAL NOTES - ' CONCRETE PORCH 1. CONSTRUCTION ACTIVITIES WILL BE COMPLETED I ❑ / PROPERTY BOUNDARY IN ACCORDANCE WITH CITY OF ANACORTES ul W DEVELOPMENT DEPARTMENT REQUIREMENTS. STORM DRAIN 2. ALL HAZARDOUS MATERIALS TO BE ' Z - SANITARY SEWER LINE TRANSPORTED SAFELY, ELIMINATING THE NEED id/ I W FOREMTAINTENANCE AND THREAT TO PUBLIC + a GAS LINE i Q WATER LINE 3. CONTRACTOR SHALL INSTALL PROTECTIVE CHAIN LINK FENCING OF AREA TO BE DEMOLISHED PER 0 ELECTRIC LINE LOCAL REQUIREMENTS. • 1 TELEPHONE LINE 4. CONTRACTOR SHALL ENSURE THAT ALL STORM DRAINS AND CATCH BASINS BE PROTECTED FROM ii oi,li SEDIMENTATION RUN-OFF. ANY ACCUMULATION 1 / 1 OF SEDIMENT OF OR AROUND FILTER FABRIC i.' ; DEMOLITION AREA UNDERGROUND STORAGE PROTECTION SHALL BE REMOVED IMMEDIATELY INCLUDES CANOPY. TANK(UST) WITHOUT WATER AND DISPOSE OF MEDIA OR EL Q© � SEE SHEET 4 FOR SOIL STOCKPILE WIT REMOVED FOR DISPOSAL AT AN OFF-SITE LITY. ' / RESTORATION AREA. CATCH BASINS 1 ® # 5. DO NOT ALLOW VEHICLES TO TRACK " SEDIMENTATION OFF-SITE. • V' MANHOLE 6. DEMOLITION TO BE PERFORMED BY AN h DEMOLITION LEGEND EXCAVATOR. ASPHALT / CANOPY / 7. CONTRACTOR TO PERFORM ALL WORK IN V //� DEMOLITION AREA ACCORDANCE TO FEDERAL, STATE,AND LOCAL 575 SF CODES. c 8. AMOUNT OF REPLACED IMPERVIOIJS SURFACE 15 '• ‹. � co APPROXIMATELY 1,830 SQUARE FEET. ; co 00 -cr. .4\ — . oa = 0 I N ,........ .") Z 0 ` • — LANDSCAPING ACCESS f LANDSCAPING UJ W Z Ce SIGN Oij Z Q a SIDEWALK POWER POLE w O rIliii, Z W N Q W O c E L'i 12TH STREET 2 (STATE ROUTE 20 SPUR) I o z P ,_ ,_ � � Q 6... � d cv WASH r'. [ 1<„ ' g Permit-Seal s . Tr l' ( I, •., ,762t •*{4, m lir og -"I • mProject Nurnbe! 185703921 -p o.m Rle Name: 7 1 1-1 8488-SHTs 0-5.dwg mm J Lo Li %3:'CD D SYF PF PF FEB 2018 a xDwn. Chkd. Dsgn• Dale 10 5 0 10 20 Drawing No. 711-18488-SHTs 0-5 0.7! .3� Revision Sheet 3 -- APPROXIMATE SCALE 1N FEET A 3 of 5 lid SCOPE OF WORK PROPERTY INFORMATION o V G.C. = GENERAL CONTRACTOR SITE ADDRESS: 1102 12TH STREET, o a o OT = OTHERS ANACORTES, WA. a) ® a �_0 m D .- CC m O G.CA PERFORM BACKFILL AND SURFACE SKAGIT COUNTY PARCEL NUMBER: P55259 2 m a RESTORATION.THE BACKFILL S I °t MATERIAL SHALL BE CLASS-II TOWNSHIP, RANGE, SECTION: T35 01 13 . U " a AGGREGATE BASE MATERIAL C1? COMPACTED TO 95% COMPACTION. THAT PORTION OF BLOCK 57 OF MAP OF THE '° a IMPORT GRAVEL BORROW VIA SOLO CITY OF ANACORTES, SKAGIT COUNTY, _m a? DUMP TRUCK TO DISPLACE VOLUME WASHINGTON, AS PER PLAT RECORDED IN o a 2-0 OF REMOVED USTs. PLACE BACK VOLUME 2 OF PLATS, PAGE 4, RECORDS OF m @ m _ CLEAN OVERBURDEN AND COMPACT SKAGIT COUNTY, DESCRIBED AS FOLLOWS: g , IMPORT CRUSHED SURFACING TOP BEGINNING AT THE SOUTHEAST CORNER OF b 6 = COURSE (CSTC)VIA DUMP TRUCK. SAID BLOCK 57;THENCE WESTERLY ALONG THE 2 FILL MATERIAL DEEPER THAN 4 FEET SOUTH LINE OF SAID BLOCK 57, 150 FEET; IIII C D a aC - _ FROM SURFACE GRADE WILL BE THENCE NORTHERLY ALONG A LINE WHICH IS w 2•E b f COMPATED TO 90% MAXIMUM DRY PARALLEL TO THE EAST LINE OF SAID BLOCK 57, U 4 °_b m m DENSITY. THE UPPER 4 FEET OF 100 FEET, MORE OR LESS, TO THE SOUTH LINE 8 E o f 0 ' - BACKFILL TO GRADE WILL BE OF AN ALLEY; THENCE EASTERLY ALONG THE0EXISTING BUILDING COMPACTED TO 95%. SOUTH LINE OF SAID ALLEY, 150 FEET TO THE rk Q U H T °o a 3000 SF PROPERTY BOUNDARY EAST LINE OF SAID BLOCK 7; THENCE M - ° s O G.C. BACKFILL MATERIAL WILL BE PLACED SOUTHERLY ALONG SAID EAST LINE, 100 FEET, z o o C- .5. 1N 12"LIFTS AND COMPACTED TO TO THE POINT OF BEGINNING. o J $m .1 � • �■■�t +� �l � rN s + IT (95%) OF O MAXIMUM INCHES OD CSTC A - m m mS. �- r WILL BE PLACED AND CO PACT D. \-1 RESURFACING WILL BE COMPLETED. O G.C. PERFORM GRADING OF BACKFILL TO LANDSCAPING MATCH CURRENT SLOPE ON SITE. THE SUB-GRADE (THE GROUND ON WHICH THE PARKING LOT IS LAID) MUST BE SMOOTH, FIRM,AND EVEN. '\ a O G.C. STORMWATER WILL FLOW TO CATCH a z BASINS. a U 1 � to L/_l_ .7_// //7 /7 ,_ 7-ELEVEN ,- - : - ///i STORE NO. 18488 ' ' ' LEGEND CONTACT INFORMATION ' % PROJECT OWNER: - a� PROPERTY BOUNDARY JOSS RIGS MANAGER ENVIRONMENTAL SERVICES STORM DRAIN 7-ELEVEN INC PO BOX711 U S CLANCY LLC � ��� � 1 � SANITARY SEWER LINE DALLAS, TX 75112 PARCEL#P55257 � •� JOSE.RIOS@711.COM • GAS LINE 972-828-6592 (work) 972-742-5943 (cell) y WATER LINE CONTACT PERSON: �� ELECTRIC LINE PAUL FAIRBAIRN o I /2/ r' STANTEC CONSULTING SERVICES 0 TELEPHONE LINE 11130 NE 33RD PLACE SUITE 200 ' BELLEVUE, WA 980D4 "' Paul.Fairbaim Stantec_com CONCRETE PORCH FORMER UNDERGROUND 425-289-7343 (work) o / ' /' W STORAGE TANK(UST) 206-369-8383 (cell) / / �- RESTORATION AREA ENGINEER: I 7/7/ - , co = ���� MARC SAUZE, >- L- P.E. Z STANTEC CONSULTING SERVICES U W CATCH BASINS 11130 NE 33RD PLACE SUITE 200 a 0 BELLEVUE, WA 98004 Q // MANHOLE Marc.Sauze Stantec.com Q 425-869-9448 ext 172 (work) /' //) O425-894-2329(cell) • / *4 je 4# - / • ' 7i Ole 1,830 5F SAW CUT AREA RESTORATION LEGEND GENERAL NOTES \\ �/ 1. CONSTRUCTION ACTIVITIES WILL BE COMPLETED \ / SAWCUT LINE IN ACCORDANCE WITH CITY OF ANACORTES \ / DEVELOPMENT DEPARTMENT REQUIREMENTS. f \` /' L----J EXCAVATION LINE 2. ALL HAZARDOUS MATERIALS TO BE TRANSPORTED SAFELY, ELIMINATING THE NEED \444 FOR MAINTENANCE AND THREAT TO PUBLIC \ , SAFETY. ASPHALT CANOPY 3. CONTRACTOR SHALL INSTALL PROTECTIVE CHAIN LINK FENCING OF AREA TO BE DEMOLISHED PER 575 SF LOCAL REQUIREMENTS. 4. CONTRACTOR SHALL ENSURE THAT ALL STORM Ri c SEDIMENTATIONA DRAINS AND CATCH BASINS FROM BE PROTECTED RUN-OFF. ANY ACCUMULATION PROTECTION SHALL OF SEDIMENT OF OAROUND REMOVED IMMEDIAMLY WITHOUT WATER AND DISPOSE OF ON-SITE OR CO ce REMOVED FOR DISPOSAL AT AN OFF-SITECO FACILITY. NI- oo 111 IR M 0 I! INNIE a• NW IN aNMI in 40 a rio-- ,_ O 5. DO NOT ALLOW VEHICLES TO TRACK SEDIMENTATION OFF-SITE. \\*.. EMOLITION LANDSCAPING ; ACCESS1 /t LANDSCAPING 6 EDXCAVATOR TO BE PERFORMED BY AN LL! w W lim 7. CONTRACTOR TO PERFORM ALL WORK IN O ACCORDANCE TO FEDERAL, STATE,AND LOCAL SIGN CODES. c c z Q POWER POLE 8, AMOUNT OF REPLACED IMPERVIOUS SURFACE IS Z = 0 > Z SIDEWALK w }-- ° Q f APPROXIMATELY 1,830 SQUARE FEET. > C' I Z I I 0 J Jam - , 12 0 Lu o O i IN. r 12TH STREET (STATE ROUTE 20 SPUR) 1 o Q � CY o) ~ nrr . a I PermLciit-Seal - oc As,arki,; .., g i44 , „ _ _ - woh: d , R. Al . �` - MIN. 4" DEPTH O � � CRUSHED rn MIN. 4" DEPTH /_ TOP COURSE (CSTC)ACINGNA- . ', ' 43 l �/ 4"-8" CRUSHED SURFACING NATIVE NATIVE = - TOP COURSE (CSTC) SOIL N ,oz rE}tIiRE9 T'I_2�• + f SOIL cT MIN. COM ACTED BACKFILL Project Number 1$5703921410 I o m File Name: 711-1848&SHTs 0-5.dwg m� T FLAT BOTTOM. BOTTOM OF MIN. 11.25" V UST EXCAVATION DEPTH 8"-2' (APPROX.) SYF PF PF FEB 2018 VI;: COMPACTED BACKFILL Dwn. Chkd. Dsgn. Date 10 5 0 10 20 Drawing No. 711-18488-SHTs 0-5 >N CROSS SECTION g^ UPPER 2 FEET UST EXCAVATION CROSS SECTION UST EXCAVATION �• • ••• • Revision Sheet NOT TO SCALE NOT TO SCALE APPROXIMATE SCALE IN FEET co A 4 Of 5 >04 GENERAL PLAN NOTES[ IF APPLICABLE] Ili) . m8 a CONTACT INFORMATION 1. WORK HOURS: ;� a•all) �� oem IP o THE CITY OF ANACORTES ORDINANCE ALLOWS WORK FROM 7:00 A.M. TO 10:00 P.M, SEVEN DAYS A WEEK (COA ORD.#2316). SOMEONE IN CHARGE IS % i ° z' CITY OF ANACORTES: TO BE ON SITE AT ALL TIMES WHEN WORK IS IN PROGRESS. IF WORK IS DONE ON WEEKENDS, PLEASE INFORM THE PROJECT MANAGER SO THE CITYIA I\. C ° ` ° 1. STEVEN LANGE PROJECT MANAGER OF ANACORTES CAN HAVE AN INSPECTOR ON SITE. CONTRACTOR WILL BE BILLED FOR CITY OF ANACORTES OVERTIME. t-Co n o OFFICE: 360.293.1920 -a 2 N C E LL:360.661.346B 2. CALL 48-HOURS BEFORE THE FOLLOWING: o 8 FAX:360.293.1938 E-MAIL:STEVEL@CITYOFANACORTES.ORG FOR INSPECTION CONTACT 360.299.1951. . a m. m o ° 2. JIM BALDWIN, PUBLIC WORKS INSPECTOR c A. PRIOR TO WORK START-UP w a N W , 42 a_ OFFICE: 360.299.1972 B. PRIOR TO ANY UTILITY CONSTRUCTION IN THE RIGHT OF WAY. n Co CELL:360.661.3547 C. PRIOR TO POURING CAST-IN-PLACE CONCRETE STRUCTURES. . ° FAX:360.293.1938 D. PRIOR TO PLACING ANY CRUSHED ROCK ON ROADWAY SUB GRADE. Q o E . '' .m a E-MAIL: JIMB@CITYOFANACORTES.ORG E. PRIOR TO PLACING CURB, GUTTERS AND SIDEWALKS. ' o CO o a 0 a Q 3. ERIC SHJARBACK,ASSISTANT CITY ENGINEER F. PRIOR TO ASPHALT PAVING. C o o OFFICE: 360.293.1920 z 3. MATERIALS AND WORKMANSHIP: I ! V•i - b FAX:360.293.1938 o JI ° A. ALL MATERIALS USED, MUST MEET WSDOT, APWA AND CITY OF ANACORTES SPECIFICATIONS. ^ m s B. ALL WORK AND MATERIALS THAT DO NOT MEET THE ABOVE SPECIFICATIONS MUST BE REMOVED AS DIRECTED BY THE PROJECT INSPECTOR. THE PROJECT MANAGER IS THE KEY PERSON OF CONTACT FOR THE CITY OF ANACORTES REGARDING TECHNICAL AND ENGINEERING MATTERS.THE C. SUBGRADE COMPACTION TESTS: WILL BE DONE BEFORE ANY C.S.B.0 IS PUT IN PLACE,ALL TRENCHES WILL BE TESTED FOR COMPACTION. THE PUBLIC WORKS INSPECTOR IS THE KEY PERSON OF CONTACT FOR THE CITY OF ANACORTES FOR QUALITY ASSURANCE, SAFETY, FIELD MATERIAL TESTING LAB NEEDS 24-HOUR NOTICE. USE THE TESTING PROTOCOL PROVIDED BY THE CITY. ITEMS TO BE COMPACTION TESTED WILL a COORDINATION AND INSPECTIONS.ANY PERSON OTHER THAN THE PROJECT MANAGER AND PUBLIC WORKS INSPECTOR SHOWING IMPLIED INCLUDE THE PIPE BEDDING (SECTION 7-08.3(1)C), BACKFILL(SECTION 7-08.3(3)AND SUB GRADE FOR SURFACING (SECTION 2-06.3(2))AND ASPHALT AUTHORITY ON-SITE SHOULD BE DIRECTED TO THE PROJECT MANAGER. IF THE PROJECT MANAGER IS UNAVAILABLE FOLLOW THE LINE OF (SECTION 5-04.3(10)B). COMMUNICATION. D. INSPECTION:ALL ASPECTS OF THIS PROJECT WILL BE INSPECTED INCLUDING PIPING, BACKFILL, SUB GRADE, CONCRETE AND ASPHALT, AS WELL ›- AS FORMS, CURB, GUTTER AND SIDEWALK. IF A PORTION GETS BACKFILLED BEFORE INSPECTION, THE CONTRACTOR WILL DIG UP THAT PORTION ADDITIONAL CONTACT INFORMATION: FOR INSPECTION. 24-HOUR NOTICE REQUIRED. KNOW THE SCHEDULE AND LET THE CITY KNOW. a E. TESTING PROTOCOL: PRIOR TO CONSTRUCTION,A PROCTOR AND SIEVE ANALYSIS SHALL BE SUBMITTED, REVIEWED AND APPROVED BY THE CITY a 1. CITY OF ANACORTES STREET DEPARTMENT MAC JACKSON, FOREMAN OF ANACORTES ON ALL MATERIAL USED IN THE RIGHT-OF-WAY. SEE THE CITY OF ANACORTES TESTING SCHEDULE. OFFICE:360.293.1921 F. ALL COMPACTION TEST SHALL BE APPROVED BY THE CITY OF ANACORTES ENGINEER AND PROJECT MANAGER PRIOR TO PLACING OF CRUSHED m 2_ CITY OF ANACORTES WATER DEPARTMENT TERRY NEMETH, FOREMAN SURFACING, ASPHALT, CURB, GUTTER, SIDEWALK (INCLUDING TRENCH RESTORATION WHEN TEST MAY BE REQUIRED IN EACH LIFT). 2_ I OF ANACORTES G. CITY OF ANACORTES MAY REQUIRE ADDITIONAL TESTS ON SUB GRADE, TRENCHES, CONCRETE, OR ASPHALT. THE COSTS OF TESTING SHALL BE PAID FOR AS INDICATED IN THE CONTRACT DOCUMENTS. 3. COMCAST CABLE 4. TRAFFIC CONTROL AND PUBLIC SAFETY(MOSTLY OMITTED): CASEY JONES, CONSTRUCTION CELL: 425.508.7335 FAX:360.527.8302 E. CONSTRUCTION SAFETY: IS THE RESPONSIBILITY OF THE CONTRACTOR. E-MAIL: CASEY_JONES@CABLE.COMCAST.COM 4. CASCADE NATURAL GAS DEWIGHT BELL 5. ROADWAY EMBANKMENT AND SUBGRADE CONSTRUCTION(OMITTED): 360.336.2189, EXT. 4211 (8-5) 6. TRENCHES IN DEVELOPED RIGHT-OF-WAY(OMITTED): AFTER HOURS: 1.800.552.0615 FAX:360.336.2564 SEE CITY OF ANACORTES STANDARD CONSTRUCTION DETAILS AND SECTION 7 OF THE CURRENT WSDOT SPECIFICATIONS FOR ROAD, BRIDGE AND 5. PUGET SOUND ENERGY TERESA LOOP MUNICIPAL CONSTRUCTION. C EL L:360.941.2066 FAX:360.647.6518 7. DRAINAGE SYSTEM CONSTRUCTION(OMITTED): E-MAIL:TERESA.LOOP@PSE.COM 8. RESTORATION OF RIGHT-OF-WAY(OMITTED): us 6. PSEIINTOLIGHT SHERI CLARKE 11. FINAL INSPECTION AND ACCEPTANCE: SEE SECTION 1-05.11 AND SECTION 1-08.5) -, OFFICE:425.256.2701 WHEN CONTRACTOR HAS COMPLETED ALL OF THE WORK ON THE APPROVED PLANS, THE CONTRACTOR WILL: CELL:206.604.3858 I 0 FAX:425.462.3149 A. COMPLETE THE "FINAL INSPECTION GUIDELINES FOR CONTRACTORS INSPECTION FORM". 0, E-MAIL: SHERI.CLARKE@PSE.COM B. GIVE THE COMPLETED `FINAL INSPECTION GUIDELINES FOR CONTRACTORS INSPECTION FORM"TO THE PW INSPECTOR AND REQUEST A SITE r INSPECTION. ALL SITE INSPECTIONS ARE ON WEDNESDAYS BETWEEN 9 AM AND 12 PM. r I�iiii 7. VERIZON NORTHWEST CHRIS PARMETER, ENGINEER OFFICE: 360.757.2486 C. THE PROJECT MANAGER, ENGINEER OF RECORD, INSPECTOR, CONTRACTOR AND OTHER CITY OF ANACORTES DEPARTMENTS WILL WALK THE I a FAX:360.757.4338 SITE AND CREATE A PUNCH LIST. THE CONTRACTOR WILL COMPLETE THE PUNCH LIST AND CHECK OFF EACH ITEM, THEN RETURN IT TO THE a E-MAIL: CHRIS.PARMETER@VERIZON.NET INSPECTOR FOR REINSPECTION. THE INSPECTOR WILL VERIFY THAT ITEMS ON WALK THROUGH ARE COMPLETED. D. THE CITY WILL NOT MAKE THE FINAL INSPECTION UNTIL THE PHYSICAL WORK REQUIRED BY THE CONTRACT AND APPROVED PLANS, INCLUDING I m FINAL CLEANUP AND ALL PROR EORDERED BY THE PROJECT MANAGER, HAS BEEN COMPLETED. (SECTION 1-05.11) INADVERTENT DISCOVERY LANGUAGE E AND APPROVED BY T E PROJEC CT T ANAGER. BE GRANTED UNTIL "AS BUILT' DRAWINGS (BOTH DIGITAL AND HARD COPY) HAVE BEEN RECEIVED F. THE CONTRACTOR MUST FURNISH ALL DOCUMENTATION REQUIRED BY LAW, TO ALLOW THE CITY OF ANACORTES TO PROCESS FINAL 1. IN THE EVENT ANY ARCHEOLOGICAL OR HISTORIC MATERIALS ARE ENCOUNTERED DURING PROJECT ACTIVITY, WORK IN THE IMMEDIATE AREA ACCEPTANCE OF THE CONTRACT. (INITIALLY ALLOWING FOR A 100' BUFFER; THIS NUMBER MAY VARY BY CIRCUMSTANCE) MUST STOP AND THE FOLLOWING ACTIONS TAKEN: 12. MISCELLANEOUS: 2. IMPLEMENT REASONABLE MEASURE TO PROTECT THE DISCOVERY SITE, INCLUDING ANY APPROPRIATE STABILIZATION OR COVERING AND B. UTILITY LOCATES NUMBER: 1.800.424.5555. REQUIRED BEFORE STARTING ANY GROUNDWORK. 3. TAKE REASONABLE STEPS TO ENSURE THE CONFIDENTIALITY OF THE DISCOVERY SITE; AND 4. TAKE REASONABLE STEPS TO RESTRICT ACCESS TO THE SITE OF DISCOVERY. 5. THE PROJECT PROPONENT WILL NOTIFY THE CONCERNED TRIBES AND ALL APPROPRIATE COUNTY, STATE,AND FEDERAL AGENCIES, INCLUDING EROSION CONTROL NOTES THE DEPARTMENT OF ARCHEOLOGY AND HISTORIC PRESERVATION. THE AGENCIES AND TRIBE(S)WILL DISCUSS POSSIBLE MEASURE TO REMOVE OR AVOID CULTURAL MATERIAL AND WILL REACH AN AGREEMENT WITH THE PROJECT PROPONENT REGARDING ACTIONS TO BE TAKEN AND A. A CERTIFIED EROSION AND SEDIMENT CONTROL SUPERVISOR IS REQUIRED.THE ESC SUPERVISOR MUST HAVE ATTENDED AND EROSION AND c DISPOSITION OF MATERIAL. SEDIMENT CONTROL CLASS WITHIN 3-YEARS FROM TODAY'S DATE. MUST PROVIDE CERTIFICATION CARD. g B. THE CERTIFIED EROSION AND SEDIMENT CONTROL SUPERVISOR WILL OVERSEE AND BE RESPONSIBLE FOR ALL EROSION CONTROL. THE .5 6. IF HUMAN REMAINS ARE UNCOVERED,APPROPRIATE LAW ENFORCEMENT AGENCIES SHALL BE NOTIFIED FIRST, AND THE ABOVE STEPS FACILITIES SHALL BE INSPECTED DAILY AND MAINTAINED TO ENSURE PROPER FUNCTIONING. WRITTEN RECORDS SHALL BE KEPT OF WEEKLY ce a)FOLLOWED. IF THE REMAINS ARE DETERMINED TO BE NATIVE, CONSULTATION WITH THE AFFECTED TRIBES WILL TAKE PLACE IN ORDER TO REVIEWS AND AFTER EVERY SIGNIFICANT STORM EVENT OF THE ESC FACILITIES DURING THE WET SEASON (OCTOBER 1 TO APRIL 30). MONTHLY MITIGATE THE FINAL DISPOSITION OF THE SAID REMAINS. REVIEWS DURING THE DRY SEASON (MAY 1 TO SEPTEMBER 30). WRITTEN RECORDS SHALL BE TURNED INTO THE PROJECT MANAGER OR 00 INSPECTOR ON A WEEKLY BASIS AT THE WEEKLY SCHEDULED PROJECT MEETINGS. OD 7. SEE THE REVISED CODE OF WASHINGTON, CHAPTER 27.53. "ARCHEOLOGICAL SITES AND RESOURCES," FOR APPLICABLE STATE LAWS AND C. SHALL BE IN PLACE PER THE APPROVED SET OF PLANS PRIOR TO ANY CONSTRUCTION START. p0 STATUTES. SEE ALSO WASHINGTON STATE EXECUTIVE ORDER 05-05, "ARCHEOLOGICAL AND CULTURAL RESOURCES."ADDITIONAL STATE AND D. THE EROSION CONTROL SHALL BE INSPECTED ONCE A DAY AND MODIFIED TO MEET THE SURROUNDING CONDITIONS AS NEEDED. FEDERAL LAW(S) MAY ALSO APPLY. E. PROVIDE A SIGN DISPLAYING A 24-HOUR CONTACT NUMBER AND NAME OF THE ESC SUPERVISOR. THE LETTER SIZE SHALL BE A MINIMUM OF 2" O COPIES OF THIS PLAN ARE RETAINED ON SITE WHILE PROJECT ACTIVITY IS UNDERWAY. LETTERS. THIS SHALL BE IN PLACE PRIOR TO CONSTRUCTION START. REMEMBER, THE LOOK OF THE SIGN WILL BE A REFLECTION OF THE Z CONTRACTOR AND DEVELOPER AND DEVELOPMENT. F. THE STORM DRAIN SYSTEM AND EXISTING DITCHES SHALL BE CLEANED DAILY (SECTION 7-07.3).ALL DRAINAGE SYSTEMS SHALL BE CLEANED TO 1.1.1 w THE ACCEPTANCE OF THE CITY OF ANACORTES PRIOR TO ACCEPTANCE OF THE PROJECT. w CONSTRUCTION SEQUENCE G. STABILIZED DURATION O CONSTRUCTION HEPROJECT. ADDI IT ONAL MEASUOADS SHALL BE INSTALLED AT THE RES MAY BE REQUIRED SUCH AS WASH PNING ADS TOF O ENSURE THATON ALL PAND VED AREAS RE KEPT INTAINED DURING THE 0 ") Z CLEAN. NO MUD IS ALLOWED TO ENTER ONTO CITY STREETS. Z 2 1- > 1. SCHEDULE A PRE-CONSTRUCTION MEETING WITH CITY. PROVIDE TWO DAY(48 HR) NOTICE. H. ANY SOILS EXPOSED THAT WILL NOT BE DISTURBED FOR TWO (2) DAYS DURING THE WET SEASON OR SEVEN (7) DAYS IN THE DRY SEASON SHALL N Z 0 , BE IMMEDIATELY STABILIZED WITH THE APPROVED ESC METHODS (SEEDING, MULCHING, PLASTIC COVERING, ETC.) uJ z Z w 2. REVIEW EROSION CONTROL NOTES. I. TWO (2)WEEKS PRIOR TO THE BEGINNING OF THE WET SEASON(OCTOBER 1), ALL DISTURBED AREAS SHALL BE REVIEWED TO IDENTIFY WHICH --I CV c' W I- ONES CAN BE SEEDED IN PREPARATION FOR THE WINTER RAINS. DISTURBED AREAS SHALL BE SEEDED WITHIN ONE (1)WEEK OF THE BEGINNING w C) j Ce O 3. PROVIDE TEMPORARY CONSTRUCTION FENCING AROUND WORK AREA. NOTE: STORE TO REMAIN OPEN DURING CONSTRUCTION. OF THE WET SEASON. A SKETCH MAP OF THOSE AREAS TO BE SEEDED AND THOSE AREAS TO REMAIN UNCOVERED SHALL BE SUBMITTED TO THE t: Z PROJECT MANAGER. THE PROJECT MANAGER CAN REQUIRE SEEDING IN ADDITIONAL AREAS IN ORDER TO PROTECT SURFACE WATERS, ADJACENT ,� W --1 4. CALL FOR UTILITY LOCATES_ PROPERTIES OR DRAINAGE FACILITIES. 1- c Q J. PENALTIES FOR AN EROSION CONTROL VIOLATION ARE SUBJECT TO A$300 TO$1000 FINE UNDER CHAPTER 17.66-PENALTIES FOR VIOLATION. O }- w 5. INSTALL TESC MEASURES AND MAINTAIN DUST CONTROL WHILE PREVENTING DISTURBANCE OF ANY AREAS OF VEGETATION OUTSIDE THE EACH DAY IS CONSIDERED A DIFFERENT VIOLATION. 13: U z CONSTRUCTION ZONE. Z j w a 6. DEMOLISH EXISTING STRUCTURES. BEGIN FUELING STRUCTURE DEMOLITION, PAVING REMOVAL AND HAUL OFF. likE O Permit-Seal L wAs `..--, r N 7. BEGIN EARTHWORK ACTIVITIES AND TANK REMOVAL.ANY SOIL REMOVAL OR IMPORT SHALL BE CONDUCTED IN A CLEAN TRANSFER TO TRUCKS a {f, - 1 WITHOUT ANY TRACKING OF SOIL BEYOND THE WORK AREA. ANY DISCHARGE OF SOIL BEYOND THE WORK AREA SHALL BE REMOVED IMMEDIATELYf It 6.. -% VIA SWEEPING. 8. INSTALL COVERS OVER ALL STOCKPILES PER THE DEPART OF ECOLOGY STANDARD DETAIL. U 9. RELOCATE SURFACE WATER CONTROLS AND EROSION CONTROL MEASURES OR INSTALL NEW MEASURES SO THAT AS SITE CONDITIONS CHANGE }� 6 THE EROSION AND SEDIMENT CONTROL IS ALWAYS IN ACCORDANCE WITH THE CITY OF ANACORTES STANDARDS. `I7NAL. 4 a at 10.COVER ALL AREAS THAT WILL BE UNWORKED FOR MORE THAN SEVEN DAYS DURING THE DRY SEASON OR TWO DAYS DURING THE WET SEASON EkPIF 11-2 #prat, S WITH STRAW, WOOD FIBER MULCH, COMPOST, PLASTIC SHEETING OR EQUIVALENT. Project 11.STABILIZE ALL AREAS THAT REACH FINAL GRADE WITHIN SEVEN DAYS. Number 185703921 om m m File Name: 711 18488 SHTs 0-5.dwg e m 12.SEED OR SOD ANY AREAS TO REMAIN UNWORKED FOR MORE THAN 30 DAYS. a= 13.UPON COMPLETION OF THE PROJECT,ALL DISTURBED AREAS MUST BE STABILIZED AND BEST MANAGEMENT PRACTICES REMOVED IF sYF PF PF FEB 2018 4 APPROPRIATE. Dwn. Chkd. Dsgn. Date CD-7, 14.ALL TEMPORARY EROSION CONTROL MEASURES SHALL BE REMOVED UPON FINAL SITE STABILIZATION AND APPROVAL BY CITY INSPECTOR. Drawing No. 71 1-1 8488-SHTs 0-5 go Revision Sheet r M O -O 5 of 5 >� City of Anac®rtes Invoice/Permit#: BLD•-2018-0129 904 6th Street Applied date: 03/13/2018 P.O.Box 547 Issue date: 05107/2018 Anacortes, WA 98221-0547 Expire date: 05/02/2019 frd, zi:�� c 380} 293-1901 Job Address: 1102 12TH ST Permit Type: Demolition Permit ANACORTES WA 98221-2164 Project: APN: P55259 Remarks: Remove underground automotive fuel tanks, pumps and canopy. Owner: THIRD STEVENSON PROP CORP Contractor: Address: PO BOX 711 Address: DALLAS TX 75221-0711 Phone: Phone: License#: General information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: 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 DOE NOT PRE ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING RUCTI OR THE PERFORMANCE OF CONSTRUCTION. SIGN RE OF OWNER OR AUTHORIZED AGENT IS -51 i��! Stantec Consulting Services Inc. 11130 NE 33rd Place,Suite 200 Bellevue,WA 98004 Tel: {425)869-9448 Stantec Fax: {425) 869-1190 March 30,2018 File: 185703921.700.0300 Mr. Jose Rios 7-Eleven, Inc. P.O. Box 711 Dallas,TX 75221 Reference: Pre-Demolition Asbestos Survey Report • 7-Eleven Store#18488 1 102 121h Street Anacortes, Washington 98221 Dear Mr. Rios: Stantec Consulting Services Inc. (Stantec) appreciates the opportunity to provide you with the following pre-demolition asbestos-containing materials (ACM) survey report. One survey was performed on the fueling islands, canopy, and underground storage tank (UST) pad at the property referenced above (herein referred to as the Property) on March 16, 2018. The Property consists of an operating 7-Eleven convenience store and gasoline station. The purpose of the survey was to evaluate for the presence of ACMs that would require special handling and/or disposal in accordance with applicable federal,state, and local regulations. BACKGROUND At the request of 7-Eleven, Inc. (7-Eleven), Stantec provided a pre-demolition asbestos survey of accessible materials in support of the planned demolition of the fueling islands, canopy, and UST pad only. The convenience store building located at the Property was excluded as a part of the survey as it is not scheduled for renovation or demolition. The fueling facilities consist of two fueling islands, with two dual-sided fueling dispensers situated on the two separate concrete islands. A metal canopy supported by two steel columns covers the fueling islands. PROJECT PERSONNEL The survey was performed on March 16, 2018, by Ms. Deitrie Hanson, Geologic Project Specialist with Stantec and Environmental Protection Agency (EPA), Asbestos Hazard Emergency Response Act (AHERA), Accredited Asbestos Building Inspector (#1628169). Cresigr with cc nnm.nny In mind Marr.::'n 30, 2018 Mr.Jose Rios Page 2 of 6 Reference: Pre-Demolition Asbestos Survey Report 7-Eleven#18488, 1102 12th Street,Anacortes,Washington SUSPECT ASBESTOS CONTAINING MATERIALS Asbestos is a potential health hazard capable of causing respiratory system fibrosis and various forms of systemic cancers. Its condition, handling, and disposal are regulated by federal, state, and local agencies. Materials that contain asbestos generally do not pose a health threat unless the asbestos fibers are disturbed by renovation, construction or demolition, and may then become airborne and inhaled. Asbestos exposure in construction is regulated when construction, alteration, repair, maintenance, or renovation of structures, substrates, or portions thereof contain asbestos is regulated by the United States Department of Labor, Occupational Safety and Health Administration (OSHA) regulation 29 CFR 1926.1 101 and Washington State Department Labor and Industries (WSDLI), [Washington Administrative Code (WAC) 296-62 (Asbestos in Construction Standard)]. The WSDLI require employers to implement specific work practices, which protect workers from airborne asbestos exposure, when materials are found to contain detectable concentrations of asbestos. Building materials, which contain even low levels of asbestos (trace amounts), can potentially generate substantial concentrations of airborne asbestos fibers when disturbed. Therefore, control measures should be instituted which adequately address worker health and safety during planned renovation or demolition activities involving these materials. The EPA defines a homogeneous area as a surfacing material, thermal system insulation, or miscellaneous material that is uniform in color and texture. The use or application of the homogeneous area is also used to identify suspect ACMs. The EPA and OSHA define ACM as any material that contains more than one percent (by weight) of asbestos (>1%). Only one sample from a homogeneous area with an asbestos concentration >1% is required to collectively identify that material as an ACM.The EPA additionally categorizes ACM as follows: • Category I non-friable ACM - asbestos containing packings, gaskets, resilient floor covering, and asphalt roofing products containing more than 1% asbestos as determined using the PLM method. • Category II non-friable ACM - any material, excluding Category I non-friable ACM, containing more than 1% asbestos as determined using the PLM method that, when dry, cannot be crumbled, pulverized, or reduced to powder by hand pressure. • Regulated asbestos-containing material (RACM) - (a) Friable asbestos material, (b) Category I non-friable ACM that has become friable, (c) Category I non-friable ACM that will be or has been subjected to sanding, grinding, cutting, or abrading, or (d) Category II non-friable ACM that has a high probability of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act on the material in the course of demolition or renovation operations regulated by this subpart. Daslccri wink QvrnmunitV in mmd March 30, 2018 Mr.Jose Rios Page 3 of 6 Reference: Pre-Demolition Asbestos Survey Report 7-Eleven#18488, 1102 12th Street,Anacortes,Washington. For the purpose of this report, materials with any detectable concentration of asbestos are considered positive. Sampling and Analysis Stantec conducted a pre-demolition survey of materials at the Property in order to identify suspect ACMs in general accordance with the AHERA sampling guidelines as outlined in 40 CFR Part 763. The location, condition, friability, and the potential for suspect ACMs to be impacted {i.e. disturbed) was assessed and documented. Bulk samples of readily accessible suspect ACMs were collected. Consistent with building demolition and renovation regulatory requirements, building material sampling was conducted regardless of the age and/or condition of the structure. A total of eleven (1 1) bulk samples were collected from three homogeneous areas at the Property. The samples were analyzed by Polarized Light Microscopy in accordance with the EPA "Method for the Determination of Asbestos in Bulk Building Materials" (EPA/600/R93/1 16, July 1993). Analysis was performed by EMSL Analytical, Inc. {EMSL) located in Seattle, Washington. This laboratory is accredited by the National Institute of Standards and Technology's National Voluntary Laboratory Accreditation Program (NVLAP Lab Code 200613-0). A summary of the laboratory analytical results is included in Table 1 below, The bulk sample log and laboratory analytical results are provided in Attachment A; a sample location diagram is provided in Attachment B; and a photographic log is provided in Attachment C. Findings Table 1 below provides a summary of the suspect materials identified and sampled during this survey.The table includes the EPA category, as applicable. Table 1 -Asbestos Bulk Sample Results Sample Homogeneous Location Asbestos Condition Quantity EPA No. Area of Material Content Estimate Category Ol A Caulking, Pale 01 B Gray Base of dispensers ND Damaged 24 LF NA 01C 02A 02B Concrete,Gray Dispenser Islands ND Good 64 SF NA 02C 03A 03B 03C Concrete,Gray UST Pad ND Damaged 1,207 SF NA 03D 03E 0.06ian with r,gnmxrdly in rnkrx7 March 30, 2018 Mr, Jose Rios Page 4 of 6 Reference: Pre-Demolition Asbestos Survey Report 7-Eleven#18488, 1102 12th Street,Anacortes,Washington Notes and Abbreviations: No other suspect materials were observed on the fueling island canopy. LF=Linear Feet SF=Square Feel NA=Not Applicable ND=Non-Detect RECOMMENDATIONS Asbestos-Containing Materials Based on the findings of the surveys, no asbestos containing materials were identified. No additional assessment/survey appears warranted at this time. It should be noted, however, that the asbestos survey was limited to accessible materials only and did not include underground utilities or canopy column cavities. Additionally, the convenience store building was excluded from the scope of this survey. Historically, some underground utility piping has been known to contain asbestos (e.g. Transite pipe). If renovation/demolition of portions of the Property includes removal of on-site portions of underground utilities (storm drains, sewer, domestic water laterals, etc.), evaluation of the asbestos content of these components must be performed prior to the removal process. Suspect materials identified in these locations are assumed positive for asbestos until sampling and analysis indicates otherwise, If during the course of a renovation/demolition project suspect ACMs are discovered that are not included within this report, those materials are to be assumed positive for asbestos unless additional sampling, analysis and/or assessment indicates otherwise. A copy of this report should be kept on the site during any renovation or demolition activities. LIMITATIONS Reasonable efforts have been made by Stantec personnel to locate, sample, and/or identify suspect ACMs associated with the Property. For any facility, the existence of unique or concealed materials and debris is a possibility. In addition, sampling and laboratory analysis constraints typically hinder the investigation. Stantec does not warrant, guarantee, or profess to have the ability to locate or identify all hazardous materials in a facility. The survey is limited in nature, as only full demolition of the gasoline dispenser island canopy will reveal all concealed conditions. This report is intended for use in planning based on the agreed upon scope of work. This report is not intended to be a bidding document. Quantities of materials identified are estimates only and would need to be verified. If during the course of a renovation/demolition project suspect ACMs are discovered that are not included within this report, those materials should be treated accordingly until additional sampling, analysis and/or assessment can be performed. D ri wilh s:urmaanlly In mina 01111110 . March 30,2018 Mr.Jose Rios Page 5 of 6 Reference: Pre-Demolition Asbestos Survey Report 7-Eleven#18488, 1102 121h Street, Anacortes,Washington Additionally, the passage of time may result in a change in the environmental characteristics at the Property. This report does not warrant against future operations or conditions that could affect the recommendations made. The results, findings, conclusions, and recommendations expressed in this report are based only on conditions that were observed during Stantec's surveys of the Property. These observations are time dependent, are subject to changing site conditions, and revisions to federal, state, and local regulations. Reliance on this letter report by Third Parties (i.e., other than 7-Eleven, Inc.) shall be at the Third Party's sole risk. If you have any questions regarding this report or require further clarification, please do not hesitate to contact the Stantec personnel identified below. Regards, Stantec Consulting Services Inc. Prepared by: Reviewed by: , lrL WRIjdOtt—.. /7-d Deitrie Hanson, WA DOC #6317 Paul Fairbairn EPA Accredited Building Inspector Project Manager Geologic Project Specialist Phone: (425) 869-9448 ext. 143 Phone: (425) 869-9448 ext. 157 Povl,Fairbairnw?stantec_cam p itrie,Harr&aridstontoc_carn Approved By: "4f.d.,4041449.1 Danielle Manning EPA Accredited Building Inspector EPA Accredited Project Designer Senior Project Manager Phone: (916) 472-3926 ,1{-ar}Jeije_ marsnina@stQntec.com malign will~cammunlly in mind CIO March 30,2018 Mr.Jose Rios Page 6 of 6 Reference: Pre-Demolition Asbestos Survey Report 7-Eleven#18488, 1102 12fh Street,Anacortes,Washington Attachments: A: Laboratory Analytical Results and Bulk Sample Logs B: Sample Location Diagram C: Photographic Log D: Employee Certification Dcralgn wlltn c.umriuiliy in rrilna Attachment A Laboratory Analytical Results and Bulk Sample Logs I n wllhl communliy In mind • E EMSL Order: 511800811 MSL Analytical, Inc. Customer ID: SEC058 It? 3317 3rd Ave S,Suite D 2nd floor Seattle,WA 98134 Customer PO: Tel/Fax:(206)269-6310/(206)900-8789 hElp i/Iwm ern7I Cem/eaatr.eleb.emsl.com Project 1D: Attention: Deitrie Hanson Phone: (425)869-9448 Stantec Consulting Services Inc. Fax: (425)869-1190 11130 NE 33rd Place Received Date: 03/19/2018 1:34 PM Suite 200 • Analysis Date: 03/22/2018-03/23/2018 Bellevue,WA 98004 Collected Date: Project: 185703921.700.0300 Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 01A Pale gray caulking: Gray <1%Hair 100%Non-fibrous(Other) None Detected Base of dispensers, Non-Fibrous 511800811-001 NE corner dispenser Homogeneous #1 01 B Pale gray caulking: Gray <1%Hair 100%Non-fibrous(Other) None Detected Base of dispensers, Non-Fibrous 511800811-0002 SW corner dispenser Homogeneous #4 01 C Pale gray caulking: Gray 100%Non-fibrous(Other) None Detected Base of dispensers, Non-Fibrous - 511ea0e11-5003 NE corner dispenser Homogeneous #3 02A Gray concrete: Gray 15%Quartz None Detected Dispenser islands,NE Non-Fibrous 85%Non-fibrous(Other) 511800811-0004 corner North Homogeneous dispenser 028 • Gray concrete: Gray 15%Quartz None Detected Dispenser islands, Non-Fibrous 85%Non-fibrous(Other) 511800811.0005 SW corner North Homogeneous dispenser 02C Gray concrete: Gray 15%Quartz None Detected Dispenser islands, Non-Fibrous 85%Non-fibrous(Other) 511000811•000e SW corner South Homogeneous dispenser - 03A Gray concrete:UST Gray 20%Quartz None Detected pad,middle W side Non-Fibrous 80%Non-fibrous(Other) 511800811-0007 Homogeneous 03B Gray concrete:UST Gray 20%Quartz None Detected pad,near center Non-Fibrous 80%Non-fibrous(Other) 5 11800811-000 8 Homogeneous 03C Gray concrete'UST Gray/Black 10%Cellulose 20%Quartz None Detected pad,SE corner Non-Fibrous 70%Non-fibrous(Other) 511800811-0009 Homogeneous Result includes a small amount of inseparable attached material 03D Gray concrete:LIST Gray 5%Cellulose 20%Quartz None Detected pad,middle N side Non-Fibrous 75/Non-fibrous(Other) 511800811-0010 Homogeneous Result includes a small amount of inseparable attached material 03E Gray concrete:UST Gray/Black 5%Cellulose , 20%Quartz None Detected pad,NE corner Non-Fibrous 75%Non-fibrous(Other) 511800811-0011 Homogeneous Result includes a small amount of inseparable attached material (Initial report from:03/23/2018 13:52:32 , ., nn 0001_0001-1.78 Printed:3/23/2018 10:52 AM Page 1 of 2 EMSL • EMSL Order: 511800811 Analytical, Inc. Customer ID: SEC058 4. 3317 3rd Ave S,Suite D 2nd floor Seattle,WA 98134 Customer PO: Tel/Fax:(206)269-6310!(206)900-8789 map:8wof.ental.rarn f seelU lm re eloi*el rem Project ID: w • • • Analyst(s) �• Jason Sfuhr(7) Lauren Kerber,Laboratory Manager Rudy Baum(4) or Other Approved Signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may riot be reproduced,except In full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method Ilmllatkons_ Interpretation and use of test results are the responsibility of the client. This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST or any agency of the federal government. Non-friable organically bound materials present a problem matrix and therefore EMSL recommends gravimetric reduction prior to analysis. Samples received In good condition unless otherwise noted. Estimated accuracy,precision and uncertainty data available upon request.Unless requested by the client,building materials manufactured with multiple layers(i.e.linoleum,wallboard,etc.)are reported as a single sample.Reporting limit is 1% Samples analyzed by EMSL Analytical,Inc.Seattle,WA NVLAP Lab Code 200613 (Initial report from:03/23/2018 13:52:32 14.38_PLM_0008_0001-1.78 Printed:3/23/2018 10:52 AM Page 2 of 2 OrderID: 511800811 EMSL Analytical, Inc. ® Asbestos Chain of Custody 3317 3rd Ave S EMSL Order Number(Lab Use Only): Suite D. # 5 1 1 8 0 0 0 1 1 Seattle, WA 98134 aMSL AnALYnC 1L�INC. , PHONE: (206)269-6310 "'°^"°'"' FAX: (206)900-8789 Company Name: Stantec Consulting Services, Inc. EMSL Customer ID: Street: 11130 NE 33rd Place Suite 200 City: Bellevue State/Province: WA l ZiplPostal Code: 98004 Country: US Telephone ft:4252897357 Fax#: 4258691190 Report To(Name): Deitrie Hanson Please Provide Results: n Fax [J Email 1 Email Address: deitrie.hanson@stantec.com Purchase Order: Project Name/Number: 185703921.700.0300 EMSL Project ID(Internal Use Only): I U.S.State Samples Taken: WA CT Samples: ❑Commercial/Taxable ❑ResidentiallTax Exempt EMSL-13111 to:❑Same ✓❑Different-If Bill to is Different note Instructions ht Comments.' Third Party Billing requires written authorization from third party 1 Turnaround Time(TAT)Options*—Please Check �/ , El Hour 1 El Hour I El24 Hour I El1:48 Hour I 72 Hour I El 96 Hour l gl 1 Week I ❑ 2 Week 'For TEM Air 3 hr through 6 hr,please call ahead to schedule.-There is a premium charge for3 Hour TEM AHERA or EPA Level II AT. You will be asked to sign an authorization form for this service. Analysis completed in accordance with EMSL's Terms and Conditions located in the Analytical Price Guide. I PCM-Air [JCheck if samples are TEM—Air❑4.4.5hr TAT(AHERA only) ' TEM-Dust from NY ❑NIOSH 7400 ❑AHERA 40 CFR,Part 763 ❑Microvac-ASTM D 5755 ❑w/OSHA Bhr.TWA ❑NIOSH 7402 ❑Wipe-ASTM D6480 PLM-Bulk(reporting limit) El EPA Level II ❑Carpet Sonicatlon(EPA 600/J-93/167) LCJPLM EPA 600/R-93/116(<1%) ❑ISO 10312 SoiliRocklVermiculite ❑PLM EPA NOB(<1%) TEM-Bulk ❑PLM EPA 600/R-93/1161with milling prep(<1%) Point Count DIEM EPA NOB ❑PLM EPA 600/R-93/116 with milling prep(<0.25%) 0400(c0.25%)01000(<0.1%) ONY3 NOB 198.4(non-friable-NY) DIEM EPA 600/R-93/118 with milling prep(<0.1%) Point Count w/Gravimetdc ❑Chatfield SOP ❑TEM Qualitative via Filtration Prep 0400(<0.25%)❑1000(<0.1%) E1I EM Mass Analysis-EPA 600 sec.2.5 ❑TEM Qualitative via Drop Mount Prep ❑NYS 198.1 (friable In NY) TEM—Water:EPA 100.2 ❑Cincinnati Method EPA 600/R-04/004—PLMITEM II----�l (BC only) 1I NYS 198.6 NOB(non-friable-NY) Fibers>10pm ❑Waste CDrinking Other: ❑NYS 198.8 SOF-V All Fiber Sizes1r ❑NIOSH 9002(<1%) DWaste ❑Drinking ❑Check For Positive Stop—Clearly Identify Homogenous Group Filter Pore Size(Air Samples): DOO�/p�in 00.45pm Samplers Name: Deitrie Hanson I Samplers Signature: r(` ,!ref//�'� 17-f'�✓ Volume/Area(Air) Date/Time Sample# Sample Description HA#(Bulk) Sampled see attached Asbestos Bulk Sample Logs 1 Client Sample#(s): /'//{�z// 01 A - 03 E n Total#of Samples: I I I Relinquished(Client): Omit a f , Date: 3 /i LOI S Time: 133+ Received(Lab): % %�r>i/� Date: /(/ Time: /.3?y Comments/Special Ins /da.hans°n®9tamaarAm Please emai the labomlo na Buffo'stanlecconsulhn Mces,Inc,. 33rd Place,Suds 200,Bellevue.WA.98004,US AmmWm:Dotdo Hanson Phone'4252897357 EmeIL deltde hanson@sunlec cam Purchase Order.( Page 1 of 't-_pages • coreonceoaumenl-esbesies COL-R10-b5109nata 1 I Paae 1 Of 4 0 Q, Co 2� a P1o�e=gulte�A .. 1\1 :1,713 e`+ve *Bb9 gbABel:tg251 ��q,t190to, 0. �'-tA251 - � � d � seven StQt .� �� � � rr,e: 7� �ntStreeStantec. Site�° �ip2 $221 �p�p�ES C$ Goes Sit° �ddtess: �nCCC�gs, SamPte L0Catton a 74�q3p� iSIZQX ��- �Ct °fie:Ptio\e ? 7 92A `�aki- cruantINY Cond. p' ��c Q2'C'�� pcal t#; 18� MptEitiA Sstt�'Ote ���.�� • �Qaatlon �� eD���'Y D t6►e �AtER1A� ptoo�� �t��t� 1.00 Co 114eV) IIIC Matet�ol ��� 0Allw 10...11' °tan ��`� ` 92.13S . �,��`���, Wia016.10 Noes: DesCOC)n � .° S .I. 00111 5ott?.1 QtY.: 9-A\-. 001 °6 agi 0•10100•1 A/AR0 pssE$ >aa wilissok _ . pate: .e‘at:),,e..., G°ntoe by to 6y `� �c 9�I fa 1-41 okiliolell. alnten° ae, tavr Mgci Nvar, FF Received ri �otian: f{ugh iii �tibti'l �e� �Q,��: vetr+e�t Air N,o . Re1it►G`�ished� ' . 0 t m n d'sU\1e 2� P\tlGe, 0 9�fa 11\30 le��251 gj 40 Fo3cka251 669 00 ���,�a�1,� �a�of � Nuns°� �StQS #\aABb opee NO '� S venS�°te . 7-�,�e cee\ \ (5 Stantec � 5\te °m�' : �p2 j�\h es," 9S �1 SAZ`h'p�ti ' `Q�attcn KnoCOT\ ran°desS\e Agate Same o �s �e 18A �n jiiiiiiii_ �e# �' �Y vento�e Task Same S e• 1 `©�A���Nasim a ��,n�' �2i C� 'Z,{" � i01'S":( ptalen�Nnm ,\$�?p3g2 MA�E�,A� estimate ��, g �v 0 �St,���� ptcAen'c LOGS\dn ook, twot 4 __.. p5 5 '� C 140,104.01. 0? 0 Dts19 " 02—c -ok ei) .1c- -t a oi. • "I P . fro il) 1. CCAoc; -R t`► gkes; CV L IS .AS (DA 6 *Or1.1. . 'Coto\akq•: . 011‘ -- - N aa�'RQ A�5�5 \ao IMW 00 _. . _. Ffka0e � ov4 wi- 003ce-. __--------- - " coro vi __ 1,1,ec, 4\gt, 0 Nne� pr oo� Re \� � `ow � S pQge�� gs,*114ovemgItautiebai__ h -g =geV0,0\se n ro ai Stantec Asbestos Bulk Sample Loght 1-1Belevue,WA, d Tel:(425(869-9448 N G1 1 (9 ® 0 ® �9 ./ Fax:(425(864-1190 r d 1 IS e/ 9 A 1 m 0 Site Name: 7-Eleven Store #18488 Date: 3-16 2018 0 Project Name: 7-Eleven Store #18488 AnacortesH Project#: 185703921 Task#: 700.0300 Site Address: 1102 121h Street Inspector: D. Hanson H Anacortes,WA 98221 MATERIAL MATERIAL LOCATIONS SAMPLES Floor# Location Quantity Cond. Sample# Sample Location HA# 03 Estimate I. UST PAD l 1207SF t 03 A UST PAD Middl2Westside Material Type: CONCRETE 03 B (LST PhD near carter co Color: GRRU 03 c LLST PAD SEcorner 0 03 D 1.1STPAD middle hiorthsi(le COVERS 03 E iLSTPAD MEcorner Description UST PAD - P a ToralQty. .n��.j2 ' Sr G . Notes: HAZARD ASSESSMENT Friable: Yes No Contact by a Med High Maintenance: —-_ _ - - - - Vibration: C Med High Air Movement: Low Med High ii�bb ,(� e �?d(17V Dae: 34 Yo Received By: Date: Relinquished By: t , _ — --- - -- Page 3 of 3 Attachment B Sample Location Diagram I]a lu a%All cunirrairmlyI,mind • • . -.._ _TSB —,. / _F— - --- f I 'LANDSCAPING 0 I 03 D U 7-ELEVEN I ri::r o3E 1 �I \ 03A I - rl I - II — — — k. A�t03C cn w — I w Z t;; I " a 1 i O I 018 •02C 026 01 C 1 0-TA ' ; ASPHALT 02A • CANOPY SIGN, � I LANDSCAPING ;ACCESS LANDSCAPING SIDEWALK +1 su --sEI --.,L,. n u )1' p — - 12TH STREET (STATE ROUTE 20 SPUR) J. 1 LEGEND ————. SITE BOUNDARY • 01 A• NON-ACM SAMPLE LOCATION ---.— EXISTING WATER LINE 0 30 60 • EXISTING SANITARY SEWER LINE SCALE IN FEET • -----.;— EXISTING STORM SEWER LINE No warranty is made by Stenlec as w the 000wdOy.rer7grarnpfotenarss of these data.Onglnal data ware compiled from various scurans_Thls Informadon may not meet National Map Accurary Standards,This product was dayoloped nlacwonrcalyaac may be updated without no bhcalmn,Any roproduchon may Iasull Ina loss of scale and 01 Intetmafon, FOR: ligi FIGURE- CLCVCN 4 Stantec FACILI;V NO.'18488 SAMPLE LOCATION DIAGRAM 1 1102 12TH STREET ANACORTES,WASHINGTON • 11130 NE 33RD PLACE,SUITE 200 BELLEVUE,WASHINGTON JOB NUMBER: DRAWN BY. CHECKED BY: APPROVED BY: DATE: PHONE:(425)889-9448 FAX:(425)869-1190 185703921 STA DH pp MARCH 2018 i, � _ I - -" - i, -. •S I T _ � i• I I .1 Attachment C Photographic Log DaAlgati*LIh communilyr in min Photograph Log Oei Stantec Site Name:7-Eleven#18488- 1102 12th Street,Anacortes,Washington 98221 Photographer: D. Hanson, Stantec Consulting Services Inc. Date:March 16,2018 imitin 411 1:1 1 ' . .. .ill ' .- I•1 ll 'Llr 1 i iF le �- • r7r. - Photo#1 View of the northeast side of the fueling island canopy. AY- _ ...., -I • 9 -4i / Photo#2 View of the southwest side of the fueling island canopy. • Dosign with commonly In mfoct ' Photograph Log 51 Stantec Site Name: 7-Eleven#18488- 1102 12th Street, Anacortes,Washington 98221 Photographer: D. Hanson, Stantec Consulting Services Inc. Date:March 16,2018 • 1 I . N y r NP- et-. .. ■ I I I ■ rt "■ Photo#3 View of the southeast side of the dispenser island canopy and sign. I 7" ' .' i. ism ird lin . IY 1,, -,,,,r ...,. , 1..„ - ___ __ - ....... •. It ...k ..,_ .,...,_.,_ ,• . . . . ,• ef I ,- ,I Photo#4 View of the northwest side and north corner of the canopy roof. DersiQrp wrlhl uociurnirillv in mind Photograph Log tantec Site Name:7-Eleven#18488-1102 12th Street,Anacortes,Washington 98221 Photographer: D. Hanson, Stantec Consulting Services Inc. Date:March 16, 2018 di Will likr-) r 101111111101.--dr_ --- _ Photo#5 View of the east corner of the canopy roof. 4.' ram' Photo#6 View of the 01 B sample location. n-uorI wlll,cumrnunlly In rrilnd Photograph Log Stantec Site Name: 7-Eleven#18488-1102 121h Street,Anacortes,Washington 98221 Photographer: D. Hanson, Stantec Consulting Services Inc. Date:March 16,2018 L . - A Photo#7 View of the 02B sample location. • 11 +. Photo#8 View of the 03A sample location. 17:1Ftaigh with urrrimuniry In rnlrw Photograph Log 4 tanteG Site Name:7-Eleven#18488-1102 12Ih Street,Anacortes,Washington 98221 Photographer: D. Hanson,Stantec Consulting Services Inc. Date:March 16,2018 • • • • J fr .,, • .5r ;x . .,'M1r '1 • ' ;1 �' , I I, Photo#9 View of the 03C sample location. 03E. 1 . . , :ti4 k . Photo#10 View of the 03E sample location. Deslr�n with car iniunlly In mind Attachment D Employee Certification .1gn wnlh ednwnLu,lty In mind _ ~ -` �' - - c .!- .: ......-7. (10,..‘,} Qflirttfttate of Qtomptttton - �tii • This is to certify that •,;, \ . Deitrie M . Hanson ,„ .1 ., �: l ..,..,,, z `.. y;'`. 1 .E.-..P. • has satisfactorily completed - 4 hours of refresher training as an •._ AHERA Building Inspector =• ;T , \` { }' k ,.1 ti •. /..7. 4-:: to comply with the training requirements of ! ' TSCA Title II , 40 - CFR 763 (AHERA) � ' }3+ ti ,.f • f '\ ((1;.; , 1628169 + .1 Certificate Number -7:-.1).-/ ARGUS D Jun 28, 2017 Expires in 1 year. • 1 N�., n Date(s) of Training k- I ,I �� / l/J TRAINING•CONSULTING 1 Exam Score: NA '.` A�rrdGon c JMPAN If appropriate: Instructor ARGUS PACIFIC,INC/ I900WEST NICKERSON ST,SUITE 315/SEATfLE,WASHINGTON 981 19/206,285.3373/ARGUSPACIFIC.COM ; 7 .:: (crtttttatc (ornptctton - f� • Asbestos Project Designer Refresher Course DOSH #:CA-015-106. ►t Danielle Manning AP D R082917000 2 N 14 980. EloyM4.,11-eS '1/4-3 \X-1--tA-- Cisneros Michael W. Horner Principal Instructor Training Director V • § 8/29/2017 8129/2017 8/29/2017 8/29/2018 • Course Start Date Course End Date Exam Date Expiration Date This course satisfies the education requirements for Asbestos accreditation under the Toxic Substances Control Act, Title II. This course has been approved by the Department of Industrial Relations, Division of Occupational Safety and Health of the State of California A NATEC International, Inca V v National Association of Training and Environmental Consulting -,,, - > 10DTechn®fogy Circle- Suite A, Anaheim, CA 92805 • www.natecintl.com • 800-969-3228 Important Industry Contacts NATEC International, Inc. NATEC International, Inc. CAL-OSHA: Ph# (916) 574-2993 National Association of Training and Environmental Consulting National Association ofTraining and Environmental Consulting (916) 483-0572 Fax Natification 'Naze:Ca,d is not lEalbble5abstgute fur certhcale and Is n6t sseeptdd by SILAIIMO as poof cr., Web: tiwvw_di r.ca.gov-or cal osha.cort Anaheim,CA 4 Oakland,CA • Fresno.CA • Sacramento,CA certification This Card Acknowledges That CDPH/CLPPB:Ph# (510) 620-5600 • Danielle Manning web: www.cdph.ca.gov/programs/CLPPB Holds Training Certification For SCAQMD: Ph# (909) 396-3739 Asbestos Project Designer Refresher Course Fax#(909) 396-3342 P.O. Box 25205 Anaheim,CA 92825-5205 BAAQNSD: Ph# (415) 749-4762 (714)678-2750, (800)969-3228,Fax(714}678-2757 (Valid for 12 months} www.natecintl.com Training Date 8129I2017 Michael W.H�omer Certificate No.APDR0829170002N14980 Training Director Certificate This Certifies that Danielle Manning has successfully completed 4 hours training entitled Asbestos Building inspector Refresher Toxic Substances Control Act Title 11 (AHERA) Ihisis an annual certification. It must be renewed. Environmental 3140 Gold Camp Drive #130 Rancho Cordova, CA 95670 Safety Phone 916 638-5550 Training Fax 916 638-5.551 Professionals Ltd. Division Approval #CA-006-06 I.D. #: 5291 Certification #: 22225 Course Date: 12/07/17 11 Authorized Signature: Brandy Snider Expiration Date: 12/07/18 i_ s t From: Official Payments-Customer Service To: Hanson,Deltrie Subject: Confirmation of Payment Date: Monday,April 02,2018 10:23:24 AM Official Payments Dear Official Payments Customer: Thank you for selecting Official Payments Corporation for electronic payment of Asbestos Notification or Demolition. Your payment of$53.00 was sent to Northwest Clean Air Agency, WA on 04-02-2018. Your confirmation number is 03432D. • To check the status of your payment, visit the Official Payments Corporation web site at httpsifwww.officialpayments.com/pc_paym.jsp. Please be prepared to provide your e-mail address deitrie.hanson@stantec.com and one of the following two items: -Your confirmation number, 03432D OR -The last four digits of the card you used for payment, 7874 To become a registered user of Official Payments Corporation, enabling you to access your complete tax and fee payment history, visit our Web site at https://www.officialpayments.com/pc_sign.jsp. Again, thank you for using Official Payments Corporation. We hope you enjoy the convenience, cash • management, and payment card benefits earned from your payment. Customer Service Official Payments Corporation Questions? Call toll-free 1-800-487-4567. Did you know you can charge your state and federal income taxes? Visit Official Payments Corp. at http://www.officialpayments.com for more information. • ! I Make a payment 01: ISee what I can nay 110 Log in to My Account 41g1 Official Payments 6060 Coventry Drive Elkhorn, NE 68022 www.OfficialPayments.com This email message and any attachments are intended only for the use of the addressee named above and may contain information that is proprietary and confidential. If you are not the intended recipient, any dissemination, distribution, or copying is strictly prohibited. If you received this email message in error, please immediately notify the sender by replying to this email message or by telephone. Thank you. From: noreolv@formstack.com To: Hanson,Deitrie Subject: 1 NWCAA Asbestos Removal&/or Demolition Date: Monday,April 02,2018 3:13:21 PM • Formstack Submission For: 1 NWCAA Asbestos aemoval &/or Demolition Submitted at 04/02/18 3:11 PM NWCA.A Al.?:;_roval Number: 1.8-158 Date and time: Mar 30, 2018 02:48 PM Payment information: Paid$53 03432D Project: Demolition only (Check k:. box that best describes yo��o 0 certify that I both own and will live in the subject property of this application, or in the case of demolition, a newly constructed property at this address,: Project type(check all that apply): Facility description or building name: 7-Eleven Store No. 18488 Anacortes Site addaesse 1102 12th Street Anacortes, WA 98221 County: Skagit Facility type: Commercial Is this project a K-12 school?: No School name: Is this project a federal building or No marine vessel?: Age: 33 Size: 660 Square Feet Number of floors: 1 Asbetsos location in building: square feet: linear feet: Project start date: Completion date: Asbestos cor...ractor name(TBD if r;_+known): Asbestos contractor job number: Owner or i2. k:?s.+.sin ve: Certification number: Asbestos contractor irnaV171g ass: Work-shift days: WI,{ ': : 3anrs: Name of supervisor /responsible person: Phone number: Fax: Asbestos d➢isrooszl side: Type of materials scheduled for removal: Class; i (TSI/Surfacing) be removed; Class 2 (Non-TSI/Surfacing): • Control methods: Estimated cost of asbestos abatement project: • Estimated demolition date: May 07, 2018 Will a licensed contractor perform the demolition for you?: Deraol 1iio ? contractor: Demolition contractor phone: State license l'2r3iber: City: ZIIPP: Permitting authority: City Planning, Community, & Pla._ fang or building se3.:vices agency Economic Development (it known.): Department • Asbestos survey conducted: Yes State why no survey was conducted.: Date of Removal: Asbestos con {.ctor: A}IERAA asbestos inspector name: Deitrie Hanson AHHERA asbestos insl,eel or pi! .,, : (425) 289-7357 AHERA asbestos inspector 1628169 certification number: Attach your asbestos s r ,_ly sa; ,..,�;.,/ page: View File Third Stevenson Property Property owner: Corp. (Southland Corp.) dba 7-Eleven, Inc. Phone number: (972) 828-6592 • Property owner email: joserios@7-11.com n'oper+y owner mailing address; • P.O. BOX 711 Dallas, Texas 75221 Name of person completing this form Deitrie Hanson if different from above: ills: Geologic Project Specialist Phone: (425) 289-7357 Email - confirmation will be seat: Le;.:-: deitrie.hanson@stantec.com Is this an emergency- (exempt from waiting period, additional fee applies): No Erictiy l:xpla.in why this is an, emergency:: Additional comments:: 2018 FEES: Pr°oyecl c:stegory,. notification waiting periods and fees (choose one): 2018 FEES: Additional fees (mark any that Demolition.fee$53 PP y): Total fee: 53.00 I CERTIFY T `.IAT THE INFORMATION CONTAINED IN THIS NSTIF'ICATI•N AND ANY SUPPLEMENTAL INFORMATION I agree PROVIDED IS,TOrftlEr BEST OF' MY KNOWLEDGE, ACCURATE AND COMPLETE.: Copyright©2018 Formstack,LLC.All rights reserved.This is a customer service email. Formstack,8604 Allisonville Road,Suite 300,Indianapolis,IN 46250 C?' 4 Cityof Anacortes b. invoice/Permit#: BLD-2018-0129 ` 904 6th Street P.O.Box 547 Applied date: 03I13I2018 Issue date: 05/07/2018 '• 10 Anacortes, WA 98221-0547 Expire date: 05/02/2019 (360) 293-1901 Job Address: 1102 12TH ST Permit Type: Demolition Permit ANACORTES WA 9822 1-21 04 Project: APN: P55259 Remarks: Remove underground automotive fuel tanks, pumps and canopy. Owner: THIRD STEVENSON PROP CORP Contractor: Address: PO BOX 711 Address: DALLAS TX 75221-0711 Phone: Phone: License#: General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: 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 ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER OR AUTHORIZED AGENT I r�r Client#:95622 PACINORTI9 ACORDTM DATE IMMroD1YYYY) M CERTIFICATE OF LIABILITY INSURANCE 610612DD7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 2R1611E-ACT Marci Berger Propel Insurance PHONE IArc,No,Eat):800 499-0933 FAX (AfC,No): 866 577-1326 Tacoma Commercial Insurance EMAIL roer marci.ber elinsurance.com 1201 Pacific Ave,Suite 1000 ADDRESS: g p INSURER(S)AFFORDING COVERAGE NAIL# Tacoma,WA 98402 INsuRERA:Ironshore Specialty Insurance 25445 INSURED INSURER B:Zurich-American Insurance Compa 16535 Pacific Northern Environmental Corp INSURER C: dba: CCS; PNE Corp;AET 1121 Columbia Blvd INSURER D INSURER E: Longview,WA 98632 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. ILNrSRR TYPE OF INSURANCE NSR WVD POLICY NUMBERR POLICY EFF POLICY E P LIMITS {MMlDDIYY`(Y) (MM1DD A GENERAL LIABILITY X X 000540807 07/0112016 07/01/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESO(Ea occu ante) $1,000,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $25,000 X XCU Included PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGO $2,000,000 —I POLICY X IT LOC $ JEC B AUTOMOBILE LIABILITY X X BAP576146003 07/01/2016 07/01/2017 caMBINEDSINGLELIMIT 1 00D 000 {Ea accldenq $ � , X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS {Per accident) A UMBRELLA LIAB X OCCUR X X 000541007 07/01/2016 07/01/2017 EACH OCCURRENCE _ $19,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $19,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X WC933685406 07/01/2016 07/01/2017 X WORYTLAiM TS ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y1N Incl.WA Stop Gap E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? N N I A (Mandatory in NH) Incl. USL&H E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $1,000,000 A Pollution 000540807 07/0112016 07101/2017 $1,000,000I$10,000 Ded. A Professional 000540807 07/01/2016 07/01/2017 $1,000,0001$10,000 Ded. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Stantec Consulting Services, Inc.and its Affiliates and Clients are included as additional insureds with respects to Commercial General Liability and Auto Liability on a primary, non-contributory basis as per the attached endorsements/forms.A Waiver of Subrogation is in favor of certificate holder with respect to Commercial General Liability,Auto Liability and Workers Compensations as per the attached endorsements/forms.Excess Liability policy extends over General Liability,Auto, Employers Liability, Pollution and Professional. 30 Day notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION Stantec Consulting Services, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Inc.and its Affiliates ACCORDANCE WITH THE POLICY PROVISIONS. Insurance Department 10160-112th Street AUTHORIZED REPRESENTATIVE Edmonton,AB T5K2L6 A I ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(201 0/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2730396/M2557705 MRBOO This page has been left blank intentionally. 000540807 . • I I1ry ''• 1 rrf i I ,• � your scrfr.kobo:ci. Wording from EPIC for Additional Insured and Waiver of Subrogation Found on page 26, 34 and 36 of form SECTION 11—WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds,but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers, d. An organization other than a partnership,joint venture or limited liability company, you are an insured. Your executive officers and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust,you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Any subsidiary, associated, affiliated, allied or limited liability company or corporation, including subsidiaries thereof,of which you have more than 50%ownership interest at the effective date of the policy period qualify as a Named Insured. 3. Any organization you newly acquire or form,other than a partnership,joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period,whichever is earlier; b. Coverage under this policy does not apply to bodily injury, property damage or environmental damage that occurred before you acquired or formed the organization; c. Coverage under this policy does not apply to personal and advertising injury arising out of an offense committed before you acquired or formed the organization;and d. Coverage under this policy does not apply to damages arising out of any act,error or omission or professional incident that took place before you acquired or formed the organization. 4. Each of the following is also an insured: a. Your volunteer workers only while performing duties related to the conduct of your business, or your employees, other than either your executive officers(if you are an organization other than a partnership,joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these employees or volunteer workers are insureds for: (1) Bodily injury or personal and advertising injury: (a) To you, to your partners or members (if you are a partnership or joint venture) or to your members(if you are a limited liability company); (b) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs(1)(a)above;or (c) Arising out of the providing or failure to provide professional health care services except incidental health care services provided by any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services and provided you are not engaged in the business of providing such services. (2) Property damage or environmental damage to property owned, occupied or used by, rented to, in the care,custody or control of, or over which physical control is being exercised for any purpose by you, any of your employees,volunteer workers, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Any person (other than your employee), or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only with respect to liability arising out of the maintenance or use of that property and until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this policy. e. Any person or organization you agree to include as an insured in a written contract, written agreement or permit, but only with respect to bodily injury, property damage, environmental damage or personal and advertising injury arising out of your operations,your work,equipment or premises leased or rented by you,or your products which are distributed or sold in the regular course of a vendor's business,however: (1) A vendor is not an insured as respects bodily injury, property damage, environmental damage or personal and advertising injury: (a) For which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement except that which the vendor would have in the absence of the contract or agreement; (b) Arising out of any express warranty unauthorized by you; (c) Arising out of any physical or chemical change in the product made intentionally by the vendor; (d) Arising out of repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from you, and then repackaged in the original container; (e) Arising out of any failure to make inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business,in connection with the distribution or sale of the products; (f) Arising out of demonstration, installation servicing or repair operations, except such operations performed at the vendor's location in connection with the sale of the product;or (g) Arising out of products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor. a. A manager or lessor of premises, a lessor of leased equipment, or a mortgagee, assignee, or receiver is not an insured as respects bodily injury, property damage, environmental damage or personal and advertising injury: a. Arising out of any occurrence that takes place after the equipment lease expires or you cease to be a tenant;or b. Arising out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor of premises, or mortgagee, assignee,or receiver. a. Any person or organization that has at least a 50% controlling interest in you but only with respect to bodily injury, property damage, environmental damage or personal and advertising injury arising out of their financial control of you. Page 34 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under this policy, our obligations are limited as follows: a. a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. However, regardless of whether b. below applies, in the event that a written contract or agreement or permit requires this insurance to be primary for any person or organization you agreed to insure and such person or organization is an insured under this policy, we will not seek contributions from any such other insurance issued to such person or organization Page 36 5. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this policy,those rights are transferred to us. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. However, if the insured has waived rights of recovery against any person or organization prior to a loss, we waive any right of recovery we may have under this policy against such person or organization. This page has been left blank intentionally POLICY NUMBER: BAP 5761460-03 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the-following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO THE LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required-to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: BAP 5761460-03 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium$ Insurance Company Countersigned By WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance This page has been left blank intentionally. . PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT Co DEMOLITION PERMIT APPLICATION Mailing Address: P.O. Box 547, Anacortes, WA 98221 74' `'_ Office Location: 904 6'4 Street, Anacortes WA 98821 Phone: (360) 293-1901, Fax: (360) 293-1938 PLEASE REFER TO THE DEMOLITION PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS BUILDING DEMOLITION 0 UNDERGROUND TANK DECOMMISSIONING/REMOVAL La PROJECT ADDRESS(Street,Suite#): ' Parcel(s)#: 1102-12th Street P55259 Subdivision/Lot#: APPLICANT: Phone: Fax: 7-Eleven Inc. 972.828.6592 Address(Street,City,State,Zip): E-Mail Address: PO Box 711;Dallas,TX 75112 jose.rios@711.com PROPERTY OWNER: Phone: Fax: _.;.5 ■ /7-Eleven pa/4'C • 972.828,6592 Address(Street,City,State,Zip): E-Mail Address: PO Box 711;Dallas,TX 75112 jose.rios©711.com CONTACT PERSON: Phone: Fax: Paul Fairbairn,7-11 Project Manager;Stantec Consulting Services Inc. 425.869.7343 425.869.1190 Address(Street, City,State,Zip): E-Mail Address: 11130 NE 33rd Place Suite 200;Bellevue,WA 98004 paul.fairbairn@stantec.com CONTRACTOR:* Phone: Fax: To Be Determined Address(Street, City,State,Zip): E-Mail Address *All Contractors&subcontractors must have a valid City of Contractor's License# Exp.Date: Anacortes business license prior to doing work in the City. Business License#: Exp.Date: Contact the City's Finance Department at(360)299.1968. PROPOSED WORK: Removal of three 12,000 gallon Underground Fuel Storage Tanks,product and vent piping,monitoring equipment,dispensers,canopy,and concrete slab. Site will be backfilled ans asphalt will be placed to match existing. UTILITY DISCONNECTION: Water Department Yes 0 No cit Electricity Yes 0 No Gas Yes 0 No g Cable TV Yes 0 No I declare under penalty of perjury that the information I have provided on this fowl/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. Print Name: Paul Fair�irn Owner 0 Agent g(specify): PM for 7--1 Projects • Stantec Consulting- Signature: Date: 311/2018 see attached authorize ion Page 1 of 3 • C,p 0s . .4” a., s A CM r'fo f PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT `'°1111117'^"` DEMOLITION PERMIT CHECKLIST 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 BUILDING DEMOLITION: RESIDENTIAL 0 COMMERCIAL 6d TYPE OF STRUCTURE TO BE DEMOLISHED: Fuel Canopy and Dispenser Island METHOD OF DISPOSAL: Materials will be hauled off site to an appropriate disposal facility. FLOOR AREA OF STRUCTURE TO BE DEMOLISHED: 575 square feet HAVE YOU NOTIFIED THE NORTHWEST CLEAN AIR AGENCY(NWCAA) 10 WORKING DAYS OR MORE BEFORE BEGINNING DEMOLITION-(360)428-1617 Yes 0 No 2" NWCAA will be notified a minimum CRITICAL AREAS ON PROPERTY? Yes 0 No n#10 nays prinr in rlPmnlitinn UNDERGROUND TANK DECOMMISSIONING/REMOVAL: METHOD OF TANK ABANDONMENT: Fill in Place 0 Fill Material: Removal g Number of Gallons: 3 @ 12,000 gallons each PERMIT TYPE: cola da d � SUBMITTAL REQUIREMENTS: § • fa 17'4 The number indicates the number of ° a 19 copies for submittal(if applicable). g m• c Ito Demolition Permit Application 1 1 1 Site PIan 1 1 1 Pedestrian Safety Plan 1 Asbestos Survey—Prepared by a Washington State Certified Asbestos 1 1 Abatement Contractor Provide Proof of NWCAA Demolition Permit Approval' 1 1 1. Contact the Northwest Clean Air Agency(NWCAA) at(360)428-1617 or online at http://nwcleanairwa.gov for a demolition permit and a list of WA State Certified Asbestos Abatement Contractors if needed. Page 2 of 3 FOR OFFICE USE ONLY: FIRE DEPT.APPROVAL: DATE: POLICE DEPT.APPROVAL: DATE: PUBLIC WORKS DEPT.APPROVAL: DATE: MUSEUM APPROVAL: DATE: BUILDING DEPT.APPROVAL: DATE: Page 3of3 r 1029403-1 0004 10/22/2010 001 9 -NA\ ''', , 1'`...wr.-ilit Fees. 00i86I3 $5 "qG, 0. p4 „r�u.2 , .JEi,FAX you 1,4 ..,c EMAIL anainEer:ngi c{y'ofw 3uorieb V V f`s Cr RIGHT-OF-WAY PERMIT APPLICATION a ®� 4 ,. ) RCW 19.122 Underground Utilities `9 CO CALL BEFORE YOU DIG - (800)424-5555 '9•p~"o lg,•' Applicant shall submit application 5 days prior to start of work and application shall include: l-iTl Payment of assessed lee �r-{21' Drawing illustrating proposed work and its location. See checklist on Page 2 of 2. ante CG 2026 or similar City named as additional insured. Minimum$1.000,000 each occurrence,$2,000,000 general aggregate and$2,000,000 products-completed operations aggregate limit Proof of both state and city business licenses - .--{l -Perlt r 1arice Bond—Construction cost x 150%before work begins t Agreement Required To be completed by City: i' Yes 1 No Site Address: City Approved Exemption I- Yes l_ No /t EDEN ASSIGNED PERMIT NUMBER: ��f� �Z '` 12.0W - aGtO - OIa3 Parcel No. Owner Information (Required) Contractor Information (Required) Name � � ' Name e ' Address Address �/ r — 07/7 r,./J7L-r- City City Phone Phone Email Email �J Address Address 4 Work Includes(check all that apply)o / Curb Cut 0 Water K Sewer n Storm Street Cut Sidewalk ❑ Phone L Other Describe Work to be Performed: (Notification of Utility Companies is Required) ReY1/rr f' 52 - ..ce'? e-- 77: M9At.'' /1o' fife" .: 4,\1\14 -.4ZO.Z,,,,--..) /0 D bzif , Approval Signature Date By signature below Applicant concurs that the Applicant shall defend, indemnify and hold the City, its officials,em- ployees and volunteers harmless from any and all claims, injuries.damages, losses or suits including attorney fees, arising out of or in connection with activities or operations performed by the Applicant or on the Applicant's behalf out of issuance ooff thiis PP rmit,except for injuries and damages caused by the sole negligence of the City. La ✓€ ____41/` ZI , Applican i Signature Date Final Inspection Approval Signature Date { NON- REFUNDABLE PERMIT FEE: (To Be Completed by City) 0 Curb Cut $50.00 Li Street Cut $50.00 Inside Travel Way $50.00 ci Outside Travel Way $20.00 ❑ Sewer Inspection Fee $50.00 ❑ Sewer Re-Inspection Fee $25.00 TOTAL FEE ASSESSMENT $6 640 • A Site Plan (to scale)must be attached that include all of the following: This checklist will aid the applicant in preparing a site plan. Permits that require installation of substantial improve- ments may require plans drawn and designed by a licensed engineer. Please check with City staff prior to submit- ting your application. • • Draw the plan to a standard Engineering Scale[1"=10', 1"=20"etc.]on a minimum size sheet of 8 1/2 x 11 and a maximum size of 11x17. • Include the owners name, the parcel ID number, site address. north arrow,drawing scale and date. • Include the contractor's name,address and phone number • Existing Right-of-Way lines, property lines. edge of pavement, curb/gutter, sidewalks,driveways and plant- ing strips with dimensions between each. a Adjoining street name(s)to the reference property • All existing public and private utilities in the area of the proposed project(Water, Sewer, Storm, Phone. TV. Gas and Power)_ dimensioned to the edge of pavement, curb/gutter, sidewalk,driveways, planting strips • If applicable show easements, critical areas such as streams,wetlands and steep slopes a Proposed new construction.The proposed improvements shall be shown in heavier line type than the ex- isting information • Dimension the proposed new construction to the edge of pavement,curb/gutter,sidewalks, driveways, planting strips. or another identifiable site feature that will help identify the proposed improvements in the field. • Erosion Control Plan. • Traffic Control Plan per current MUTCD(See standard drawings at htto://mutcd/fhwa.dot.gov) If the work requires any lane or street closures,the City of Anacortes Public Works Inspector must be notified a mini- mum of 48-hours prior to scheduled work for proper public notification by the City of Anacortes. Work within the City Right-of-Way is permitted by approval of the City Engineer All work in the right-of-way must be bonded. The applicant and owner must use warning signs,traffic control, and barricades as necessary to ensure public safety in the work area The applicant and owner must restore the right-of-way to previous condition. Perma- nent restoration may include overlays of portions of the right-of-way and restoration of landscaping which have been disrupted by excavation work The applicant and owner are liable for damage to public and private property Page 2of2 f r ! 011 �` OWE( mot« O I : 'e„ s I, / it Iii r IF Tv # s .'' 1 # V; 40 • 011 .14 gilt 1 4 4 - . * ,. 7„ 4119' ' , , ,.. 11 4L 1PItr It vi, Illr -1,• I. , r i '1.4r r —. fir ' 4 I C itibillr 1. '_ ilipri'llivillir7 I-- his i r—.. . C 1 I .r k, t irtAl VI 0 -r. 011 it lit r fin' tlIPA. 00rceitit r ' it 4, IIc:,• IOU + > # ^ , ,� pt , , 7N •i6, 4.4 ii 4g)Z IMP/a 6r ..,. A ID • 411A) a e as,"1141, ...., rt. .1.4 bio.opq 4, • . . . ., .. , , ,,.. • .... „.: .. t ..... I.. All fak I . 401 IMilkl. .... vilfiiir ... .. Ilil. 1 infr • . . otoill - . 4110111111.1. V 4 . - f (.... .. . .. •:. _ . 41' Nisi -401 . , • • . .4' a."' • . I. , - milito.-• i lh 14441114 - t 4:, 1 ..4.,- .0 I'Vejp 04 l'., . 4 ' • :'• ' , .4, . •* . -1 41 vr" .0 A., , - .r. • . . IN : -,1 i •.,,-AF: ,,, )111' .._ . . .., 1 $ ....:, ;4„:0' , -,, -, • , . OF .41. ... • ..• liiir . " .II lillibitik 4•1' , , . .. $.• kit444 ' , ' -1-:11 -. . .. - r. .. rark • .... , ir°40 • . .• "7-1, - V•* C' .. . - . 4 • ... . • .. -. . tt II • 4 AN, '-•— 1. - . ....41411 . 111141, J k • ....r ' . , • 10 ... . '.. • ...-44,„ . II 0/22 ,920 1 C. iiita mi 1 kr v N' II 4, - 4. lar *t. .110r; • V' .. ... t . V 4 .. ..."Iiiiikt . 16 r _ .. 40 .. - .lam - k''. ,' 4� at , k . 0 41110h1' v.. . .4 ob. . .1:0114 4.01ft %MO, ie ... ..,,,,,,„ in _...„ , INH 1 lb . I 1 -. 'I'l r ' '. - . b 1 ocs q *0.c Voui... 4. , 404 t.00" . . illpiihM , fall' Nihitioli:it I I '41 - _' • r. iL, / ' ; r.a owilleiSLIN ' 411 .... •••• 41* Ili. . . 11 ©12210 II© 16 Pi 14 4."-- - . _ , IlY 1 i. , s 1028603-2 0093 10/14/2010 001 9 Permit Fees 008811 $55.00 �T Y tO City of Anacortes Permit#: BLD-2010-0419 t E 904 6th Street Issue date: 10/14/2010 P.O.Box 547 'tq Anacortes, WA 98221-0547 Expire date: 04/11/2012 `;'IllI 'c ` (360) 293-1901 Job Address: 1102 12TH ST Permit Type: Plumbing Permit ANACORTES WA 98221-2104 Project: APN: P55259 Remarks: Replace drains in floor. Owner: 7-11 SOUTHLAND CORP. Contractor: Address: PO BOX 711 Address: DALLAS TX 75221-0711 Phone: Phone: License#: General Information: Fees: #of Slop Sinks 1 Plumbing Permit Fee 55.00 #of Water Closets 1 Total Calculated: 55.00 #of Kitchen Sinks 1 #of Lavatories 2 Deposits/Receipts: 0.00 Total Due: 55.00 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR RFORMANCE OF CONSTRUCTION. (14— 07/01) GNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY PLUMBING PERMIT APPLICATION Building Department P.O. Box 547 Anacortes, WA 98221 Phone No.: 360-293-1901 FAX: 360.293.1938 SITE ADDRESS: `/ Q 2 / CONTRACTOR Name 6z K ✓ Q7 R-sc 1'1 c M.,6(rt$, _-L-C PROJECT DESCRIPTION Address o 607( g7 0 City/State/Zip 3 0--) A- Phone i.(2 5 /I_ _FAX Permit Fee 20.00 State Licence# F ,x.fwec.9'3 0 J Exp Fixture Type Fee Each No. Amount City of Anacortes Business License# K Toilet 7.00 PROPERTY OWNER Bathtub 7.00 Name 7-/l Shower 7.00 Address //02, I2_ 4-ut Dishwasher 7.00 City/State/Zip 0,42 C.h f2.1-•2J t&- L Hand Sink 7.00 ()— Phone FAX Kitchen Sink 7.00 E-mail Address Clothes Washer 7.00 APPLICANT Electric HWT 7.00 Name irdt,K 1Q- 13 o fZ C h 44,40 Utility Sink 7.00 Address Po /3 id $ Urinal 7.00 City/State/Zip Su `4. Lv 14- Water Interceptor 7.00 Phone 9, �4? /321 FAX Drinking Fountain 7.00 E-mail Address ea c& CQ R tc o P-045 QS /u�•��K Slop Sink 7.00 CONTACT Water Piping 7.00 Name C 014 4,,2 t4C v. Hose Bibb 7.00 Address Grease Interceptor 7.00 City/State/Zip Additional Fixtures 7.00 Phone FAX TOTAL FEES DUE E-mail Address I HEREBY ACKNOWLEDGE I HAVE READ THIS PERMIT APPLICATION AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACTIVITIES COVERED BY THIS PERMIT APPLICATION.WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHLL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS LICENSE.STOP WORK ORDERS WILL BE ISSUED ON JOB SITES WHERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT PROPER LICENSE. ft.„( 2v/? APP CANT'S SIGNATURE DATE Last Updated 11-29-05 0721904-1 0003 08/0712007 002 4 Permit Fees 007103 $115.88 1^t Y Q ., City of Anacortes Permit#: BLD-2007-0489 904 6th Street Issue date: 08/07/2007 ",",90yS, P.O.Box 547 Anacortes, WA 98221-0547 Expire date: 08/06/2008 __ CIS.' <;irear 4"r (360) 293-1901 ty Job Address: 1102 12TH ST Permit Type: Sign Permit ANACORTES WA 98221-2104 Project: APN: P55259 Remarks: Replace existing 5x5 sign. Owner: C/O SOUTHLAND CORP THIRD STEVENSON Contractor: Address: Address: Phone: Phone: License#: General Information: Fees: Building Valuation 2500 Building Permit Fee 67.50 Plan Review Fee 43.88 State Building Code Fee 4.50 Total Calculated: 115.88 Deposits/Receipts: 0.00 Total Due: 115.88 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY City.of Anacortes Sign Pennit Application Owner/Application Information 44. Site Address: ST Parcel No.: Lot: Block: Addition: Owners Name: 5 otA T N Lamp C ORR s Phone No.: A i 6 - 41)et(net Address: to g oat 1•7 S'x.O I State: Chalk o s, int Zip: 1 Sla 1 Contractor Information Sign Contractor: SA4E SOL`e.T1*Ord L C Phone No.: 2$) •S1t3Q'Lt Mailing Address:2 3 beat • A. Trtkta Thai*" State: WA, Zip: 4 S Ito'-. State Contractors License No.: 504E3eL4C 433444 Exp. Date: 21:44 General Information No. of Existing Signs: I Gross Area of Existing Signs: 5 D sq.ft. Total Lineal Feet of Building Frontage: Side I /o ft./Side 2 4. e ft. aoct+ ;at eat Ry4aa.3 Cawr,y S5cs' tos poems Proposed Sign Area: 3.S sq.ft. S bG*••1 ways, sow/ f'its' Pttce s icra 0.1 4+At,.? AL, Type of Sign and Number of Each: Wall Projecting Free Standing Pole / Electric ./ Non-Electric Value of Sign(s) (labor and materials) $ 0.1)1> Note: No Moving Parts or Lights are Allowed rm Application Checklist "ii � 'f r p ` Please include the following items with application if applicable. I 1. A sketch showing building frontage area. 2. A sketch showing sign, lettering, sign area, sign location, and s gn lieight"from "" grade. 3. Detail(s) of the sign support(s) and all structural connections. 4. Indicate setbacks from property line. 5. Electrical work requires a permit and inspection from the Department of Labor and Industries. Please c hem at 360-416-3000. Signature: LiAiirs! Date: 7 y d _ Applicant or Owner 115, gss Bid -ecG7 ocla l Go is ' ALLC-. Y %.;u 7- F_ l- rN rJ i 1 i- 5T'` L= : . F, _ 1 . .g i iti‘kj.),__IiS / t1; • l gig A- •51� I7 it ` .. }s wa -,---- (ikit_.\-6 en l cdn .O L I Str [r. r - I -ft �HOV - APPROVED BY: _UCH BUYER/LESSEE 1DRAWING OF PREMISES AND EM,RPE O' MENTS - PLOT ECG:- �,' _ • LOCATION OF PROPERTY: II/4.W I 7A Srrr cr 2,E FF EXHIBIT i Cr 4dig 4 ✓ C r/ u. �; B I ie.i.., . OAT E: 1APPHOV ku ' GATE: :IicLT: —Cr. -st• , . all,...,6 '- • - 11 II I. 1 .., .. • . , __. , . •i ,,,----- )';---__-- - , -. . . . iiiIINIMMINIONUMbo ..--- V .. _ ... . .-• 1 ' . • limme 11111111.11°1111111111111111111111111111111111111, -,,,.....- . . Mg /Aim ,00112 ,v rotl 'volt)1 20 opteraa....."*".-.1 Cap vent i�=�� I 5'-1 1/2" � �1 INSTALLATION,— Ballast Mounting access. "Bm• 1 Fluorescent lamp • (3 places) " V 1 11 9 REGULAR �i■ Raceway 1 10 UNLEADED •1111 11111 ill �;,::, it , >_ Product panel � 11 1/8 Iracking 9 MID GRADE 12 UNLEADED10 111Ill Digital pricer---ii- il 1 12° 9 MM module i,i 10 UNLEADED 1'I'yl�lI Ili ItII• not to scale SCALE:314'=1'-0° SECTION VIEW 3 Product Panel SPECIFICATION SIGN CABINET LIGHTING I Size:59 1/8"x 61 3/8" Fluorescent,(3)F60T12 Cool white lamps Depth:Cabinet 8",Total depth 11 9/16" BALLAST REPLACEMENT ITEMS CONSTRUCTION Lighting Components,EESB83216L Extruded aluminum,painted Bronze 12"DIGITAL PRICER ITEMS SELL UNIVERSAL ITEMS SELL FACES TOTAL LUMENS Driver board&LED's for Digits $401 LCD Keypad $1,230 Potycarbonate 16200 Colors:Red with white copy Lumens per sq.ft.:648 LED Decimal Point w/o Receiver $41 Hand held Remote Control $206 WEIGHT DIGITAL PRICER MODULES Control Board $286 Receiving Wireless Unit (cotialCN) $165 Crated:200 lbs..Uncrated 150 lbs. 12"Mark IV Premier Series w/red LED's Power Supply $246 Receiving Wireless Unit ( goN) $125 SERVICE ELECTRICAL Enclosure&Perforated Panel $1056 External Power Cable (coNN°NEECTon) $42 Hinge.both faces Circuits(2)20 Amp.(1)Fluorescent Lighting, Internal Signal and Power Cables $103 External Power Cable,Interconnect( ) $62 MOUNTING (1)Price Modules Thermostat $206 External Data Cable,Interconnect $22 Between pole with minimum of(8) CONNECTION LOAD NOTE:oUE TO MARKET FLUCTUATIONS PRIG ARE SUBJECT TO CHANGE. 3/8"machine bolts(by others) 7.%Anpi Account 7 Eleven Brawn Sy 1.Mullen Project Mkt 25 SF 3 Product Sign M Rep. U.McGrath Sale 116 Appredor t, 25 S Q. FT. 3 PRODUCT SIGN ImagePoint. Bero C eered 14 Mar 07 Bet.Perked 111. 07-0314 Pg 1 of 1 0627604-1 0001 10/03/2006 002 8 Fermi`. Fees 007206 $338.63 4" ' 0 : City of Anacortes Permit#: BLD-2006-0653 904 6th Street Issue date: 10/03/2006 P.O.Box 547 Expire date: 10/03/2007 Os Anacortes, WA 98221-0547 'fir (360) 293-1901 Job Address: 1102 12TH ST Permit Type: Sign Permit ANACORTES WA 98221-2104 Project: APN: P55259 Remarks: Install new sign Owner: CIO SOUTHLAND CORP THIRD STEVENSON Contractor: YOUNG ELECTRIC SIGN CO Address: Address: 10535 SW AVERY TUALATIN OR 97062 Phone: Phone: (503)612-6672 License#: General Information: Fees: Building Valuation 15000 Building Permit Fee 202.50 Plan Review Fee 131.63 State Building Code Fee 4.50 Total Calculated: 338.63 Deposits/Receipts: 0.00 Total Due: 338.63 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 ANY OTHER STATE OR L A LAW REGU'ATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. CcV SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY Gem"\ v-V -33 (03 &d- DLoS3 City of Anacortes Sign Permit Application Owner/Application Information Site Address: //0 2 /2 LS/. Parcel No.: Lot: Block: Addition: Owners Name: 7- PhoneNo.: aCO' a / Address: I/0.2 l3 SA Anewer-1es State: (A)p , Zip: Q&a a I Contractor Information Sign Contractor: Ioun) CaeCTr C, SiSn Cn. PhoneNo.: 6O'3-(o Ica gib 7a Mailing Address: (053c S.I.J. etoeryl State: oP. Zip: g70(0a State Contractors License No.: \IOU 10 ca F S I J t or Exp. Date: Oft 1/0l0 General Information \) No. of Existing Signs: I (to&P Re J Gross Area of Existing Signs: / sq.ft. Total Lineal Feet of Building Frontage: Side 1 CO ft./Side 2 U b ft. Proposed Sign Area: q sq.ft. Type of Sign and Numb r of Each: Wall Projecting Free Standing Pole Electric V Non-Electric Value of Sign(s) (labor and materials) $ IC WO Note: No Moving Parts or Lights are Allowed Application Checklist s )cr Please include the following items with application if applicable. 1. A sketch showing building frontage area. 2. A sketch showing sign,lettering,sign area,sign location, and sign height from grade. 3. Detail(s)of the sign support(s)and all structural connections. 4. Indicate setbacks from property line. 5. Electrical work requires a permit and inspection from the Department of Labor and Industr'es. Please II them at 360416-3000. Signature: � - 1/it / Date: q/S/p ep Applicant or Owner /// 1 i a � i 1 3 i $ C: . +` =1: ANACONTE - eN_ E r A PL ....,1-- NS _I m P - 5 1 _ 4, PERMIT NO. - ?9G� -GK!� 3 8 a i ADDRESS uLaa - ia$ i i 0 4 J 3 d W A ,It C e 1 l� '' SUBJECTTOa0rrD INSPECT ON. OVERSIGH I g � Existing Signage i3OR IOLAT'+N OF CODE IS NOT INCLUDED. I 176 sq ft e Proposed Signage 1 528" X 36 /144 = 132 sq ft Existing E 1 i i 1 a OR ELEC TRiCAL_ irfC."Ft„.O COH g 25% Difference 8' Striped f DEPT. _ASOR v ,NDUSTRIE3 4X 6 6'Leesss Xiped Panels 525 E. COLLEGE WAY, SUITE H Striped Panels Yv CUNT VERNON WA 98273 d . = m A 1X 3' Logo Panel r3001 R,,-loony a s L - a2 UG 9 O > I 528in jco W` t. s cci W K 2 I_: "3c. a Q F a Cz O 4 O o Y i -.1 m - 2 i i ELEVEN cri i a I Proposed signage consists of single faced, backlit, m illuminated sign boxes. Faces are moulded acrylic 0" 12" 24" 36" 48' 60" 72' 84' 96" 120' with first surface vinyl copy. Illumination by tInnlllllllluli IFlIFllifiiliiiilliinilnfnliiiiil 2 fluorescent tube controlled by photocell. SCALE SELKIRK SIGNS Customer: 7-Eleven Drawing Name: Store Fascia Sign DetailsP. & SERVICES LTD Store #: 18488 Date Drawn: 12 Jul 06 By: Shayne Hoecheri w Address: 1102 12th St. Revision; Revision Date: n 421 Patterson St. W., Cranbrook, B.C. VI C 6T3 City/State.: Anacortes, WA Work Order #: 20321 Ph. (250)489 3321 - Fax (250) 426-8852 shoecherl@selkirksign.com © 2004 Selkirk Signs & Services Ltd. This design is the sole property of Selkirk Signs &Services Ltd. and may not be used, www.selkirksigns.com or duplicated in any form without the express written permission of Selkirk Signs & Services Ltd. i 11/4 7 C iIDy 5D' Froo 1 Eieva{ 00 501 . 3 ply I � •J I 1 '' rr11 n f` 1--1 <jf'J7�t i: tJ Lt,:i 4 , SYR u C -fa R� �/� 7T�c Nl�En� r DETA I L S;cir � V J°Orac- Sxv�' ,, ,,ek -„ 3" A 1 Lai bol.fS e�fh 1 3 a r .3 /SX 3 Lai �1+ Every 3a } JF a 0619504-2 0001 07/14/2006 002 8 r_,,,,.t Fees 007105 $38.20 0 Y b Cit•ety of Anacortes Permit#: BLD-2006-0505 904 6th Street Issue date: 07/14/2006 "+ P.O.Box 547 Expire date: 07/14/2007 VP'+ Cl�, Anacortes, WA 98221-0547 (360) 293-1901 Job Address: 1102 12TH ST Permit Type: Mechanical Permit ANACORTES WA 98221-2104 Project: APN: P55259 Remarks: Replace existing freezer and roof mounted condensor unit. Owner: 7-11 INCORPORATED Contractor: SOURCE REGRIGERATION/HVAC INC Address: 20817 72ND E Address: 800 E ORANGETHORPE AVE KENT WA 98032 ANAHEIM CA 92801-1123 Phone: (253) 796-7159 Phone: License#: SOURCRI995PE General Information: Fees: # BOILERS < 100000 BTU 1 Mechanical Permit Fees 38.20 Total Calculated: 38.20 Deposits/Receipts: 0.00 Total Due: 38.20 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 CANC7L THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 1S ATURE OF/oFinn ER OR AUTHORIZED AGENT ISSUED BY mr i Lo"ok Up a Contractor, Electrician or Plumber License Detail Page 1 of 3 Topic Index I Contact Info Search ;:`a:>--;t-?s. $.?.a,s: ''r%1:t?:'.=:":? Home Safety Claims Et Insurance Workplace Rights Trades£t Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber Printer Friendly Version 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. License Information License SOURCRI995PE Licensee Name SOURCE REFRIGERATION/HVAC INC Licensee Type CONSTRUCTION CONTRACTOR 602140981 Verify Workers Como Premium UBI Status Ind. Ins. Account Id Business Type CORPORATION — I Address 1 800 E ORANGETHORPE AVE Address 2 City ANAHEIM County OUT OF STATE State CA Zip 928011123 Phone Status ACTIVE Specialty 1 COMMERCIAL/INDUSTRIAL/REFRIG Specialty 2 UNUSED Effective Date 10/5/2001 Expiration Date 11/18/2007 • Suspend Date Separation Date Parent Company Previous License EDISOS*024MF Next License Associated License Business Owner Information Effective Expiration Name Role Date Date https://fortress.wa.gov/lni/bbip/Detail.aspx?License=SOURCRI995PE 7/14/2006