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HomeMy WebLinkAboutPermit File BLD-2022-0396 2004 R Avenue City of Anacortes Invoice/Permit#: BLD-2022-0396 904 6th'= Street 1 Applied date: 05/25/2022 `"" P.O.Box 547 Anacortes, WA 98221-0547 Issue date: 05/25/2022 ` � ►' (360) 293-1901 Expire date: 05/20/2023 Job Address: 2004 R AVE Permit Type: Residential Demolition Permit ANACORTES WA 98221-2537 Project: APN: P58059 Remarks: Demolish an SFR. Owner: MJB PROPERTIES LLC Contractor: GARY MERLINO CONSTRUCTION CO Address: 5050 1STAVE S Address: 9125 10TH AVE S STE 102 SEATTLE WA 98134-2400 SEATTLE WA 98108-4612 Phone: (206) 255-5153 Phone: (206)762-9125 License#: General Information: Fees: Dwelling Units 1 State Building Code Fee Resi 6.50 Demolition permit 60.00 Total Calculated: 66.50 Deposits/Receipts: 0.00 Total Due: 66.50 The issuance or granting of this permit shall not be construed to be a permit for, or approval of, any violation of this Code or any other ordinance or order of the City, of any state or federal law, or of any order, proclamation, guidance advice or decision of the Governor of this State.To the extent the issuance or granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or federal law, or order, proclamation, guidance advice or decision of the Governor of this State, this permit shall not authorize such work and shall not be valid. The building official is authorized to prevent occupancy or use of a structure where in violation of this Code, any other City ordinances of this jurisdiction or any other ordinance or executive order of the City,or of any state or federal law,or of any order, proclamation,guidance advice or decision of the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect, inaccurate or incomplete information, or in violation of any City ordinance, regulation or order, state or federal law, or any order, proclamation,guidance or decision of the Governor.This permit becomes null and void if work or construction authorized is not commencedin 180 days or if construction work is suspended or abandoned for a period of 180 days at any time after work is commenced. I have read and a iatfi ned t'is application and know the same to be true and correct. SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED Y 1 � y3cy r wi ss _� t a lit k PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT _. Mailing Address: P.O. Box 547,Anacortes, WA 98221 'i' Office Location:904 6`Street,Anacortes WA 98821 ' Phone: (360)293-1901 �o DECONSTRUCTION & DEMOLITION PERMITS A demolition permit is required for deconstruction/demolition of structures and decommissioning of underground storage tanks. A demolition permit is required for partial demolitions of structures when the proposed work is not otherwise covered by a building permit. STRUCTURE TYPE , Y Deconstruction / Demolition Permit o Submittal Requirement Checklist p 0 d o C ? LL TTDeconstruction/Demolition Permit Application Form—Page 3 x x x Site Plan,drawn to scale, including the following: Property lines, easements, footprint of all existing structures, labeled as proposed ❑ to be demolished or retained,and all utilitiesthat serve structures to be demolished, including: potable water, sanitary and storm sewers, electric service, natural gas, x x x and propane(as applicable). Include proposed stormwater Best Management Practices to be employed during site work for erosion control and provisions for long term stabilization of the site. Documentation of approval by Northwest Clear Air Agency ❑ Unless deemed exempt by the NWCAA,all city required demo permits also require a permit X x from NWCAA. Go to http://nwcleanairwa.gov for more information. ❑ Asbestos Survey and Remediation Report, if required by NWCAA x x Prepared by a Washington State Certified Asbestos Abatement Contractor. Pedestrian Safety Plan x City of An Fire Department Special Purpose Permit for Tank Removal x Photographs of the building if it is 50 or more years old • Please include photos of all sides of the building's exterior architecture,and ❑ unique interior details. x x • Submit digitally by email to pcedc@citvofanacortes.org on a thumb drive,or printed paper copies with your permit application. SEPA checklist ❑ (*Only required for structures with recognized historic significance or not exempted under WAC 197-11-800(2)(g)). Check with PLED,360-299-1984,for assistance. Submit Application Application Fee Please send applications in PDF format to See the Land Use Permit Fee Schedule buildingpermit@cityofanacortes.org An email with a link to a file share site is also acceptable. Paper copies may be requested after initial review. Deconstruction/Demolition Permit Application Submittal Checklist Updated December 2021 Page 1 of 4 BUILDING MATERIALS SALVAGE OPTIONS Did you know that salvaging usable materials from your project can save money, conserve valuable material and energy resources, and help preserve Anacortes history? Instead of demolishing and taking materials to the landfill, please consider relocation, salvage, or deconstruction. Here are several resources you may wish to consult while planning your project: • The City of Anacortes Museum / Historic Preservation board can provide advice for researching the property's history, suggest potential alternatives to demolition, and identify historically significant architectural features of the structure that may be ideal for salvage during structure removal. Please contact the Anacortes Museum at 360-293-1915 or coa.museum ci ofanacortes.or for assistance. • Contact your Habitat for Humanity Store at 360-428-9402 (https://www.habitat.org/restores;'donate- goods)and they may remove or transport usable building materials from your project and give you a tax credit in exchange. • Some private companies may offer full deconstruction services to remove an entire building. A helpful resource is the Construction Recycling Toolkit published by Sustainable Connections available on their website: https:/Isustainableconnections.org/programs/toward-zero-waste-. GENERAL PROCESS OUTLINE • Notify the Northwest Clean Air Agency in writing and obtain needed permits: https://nwcleanairwa.gov/permits-and-services/asbestos-and-demoIition- • Call 811(Call Before You Dig)to notify utility companies with potential facilities in the area of your dig site. They will send a locater to identify these facilities. • Gather needed information and submit a deconstruction / demolition permit application to the City of Anacortes. • After permit issuance, install erosion control Best Management Practices per plan. • Ensure City water service is shut off. • Cap side sewer per Anacortes Engineering Design Standards and call for an inspection (360-299- 1972). • Notify other non-City utility service purveyors (gas, electricity, cable, etc.) to determine requirements for service interruption or disconnection. • Septic tanks must be pumped and abandoned per Skagit County Health Department requirements. • Any fuel tanks (above or underground) must be removed/decommissioned in accordance with State regulations. Contact Anacortes Fire Department for a permit and inspection (360-293- 1925). • Dispose of building and construction materials in an approved manner. • Stabilize the site to prevent stormwater/erosion impacts to surrounding properties and streets. Deconstruction/Demolition Permit Application Submittal Checklist Updated December 2021 Page 2 of 4 PERMIT APPLICATION FORM PROPERTY INFORMATION PROJECT ADDRESS(STREET,SUITE#): ASSESSOR PARCEL NUMBER: 2004 R avenue P58059 TYPE OF STRUCTURE * Single Family ❑ Multifamily,#of Dwelling Units: ❑ Commercial/Industrial ❑ Duplex ❑ Other Use Type: ❑ Underground Fuel Tank STRUCTURE INFORMATION FOR BUILDINGS: Description of Work: Size of structure: 1,368 sq.ft. Demolish existing single family ——---------------------- Method of Disposal: ; Date of original construction of structure: Landfill 1925 HISTORIC RESOURCES INFORMATION: ------------------------------- ---------------------------------------- : -------------------------------------------------------------------------------------- Is the structure listed on the City of Anacortes Local, If identified prior to demolition,are you State, or National register of historic places? willing to salvage from the structure historically significant architectural features? YES* ©NO Designation: YES XNO ------------- --------------------------------------------------------------- —— —- - ------------ ----------------------------------------------------------------- *If yes,SEPA review is required prior to issuing a demolition permit. Note: Check with the City of Anacortes Museum and/or the WA State Dept. of Archaeological and Historic Preservation's WISSARD system to answer this question. UTILITY&SERVICES DISCONNECTION/ INTERRUPTION INFORMATION Identify which City services you would like to disconnect/stop: --------------- -------- ------------- T X Disconnect Retain Water QDisconnect ❑Retain ; Storm ❑ ❑ --- ----------------------------------------------------- ------------------ 71 Sewer Disconnect �tetain ? Garbage Discontinue Detain For private utilities(gas, electricity, cable, etc.), you will need to contact the applicable companies if their services are to be interrupted or disconnected. FOR UNDERGROUND STORAGE TANKS: DECOMMISSIONING TYPE: -.. ---------- --------- -- ❑Abandonment in place (Fire Dept.Approval required) ! ❑ Removal Date of pump&rinse: Disposal Location: I Type of inert fill: Approximate age of tank: ICC Certification#: Deconstruction/Demolition Permit Application Submittal Checklist Updated December 2021 Page 3 of 4 PROPERTY OWNER INFORMATION NAME: PHONE: MJB Properties,LLC 206-255-5153 I _ ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS: 5050 1st Ave South,Suite 102 Jblais@gmccinc.com CONTRACTOR INFORMATION NAME:* PHONE: Gary Merlino Construction 206-255-5153 CONTRACTOR'S BUSINESS LICENSES STATE LICENSE#: CITY OF ANACORTES *All Contractors&Subcontractors must have a GaryMcc150MW ENDORSEMENT? valid City of Anacortes business license prior to EXPIRATION DATE: ®YES [—]NO doing work in the City. 2/14/2023 ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS: 9125 10th Ave S, Seattle, WA jblais@gmccinc.com FINANCING INFORMATION (Required if project valuation exceeds$5,000, per RCW 19.27.095) Lender administering the construction financing or firm issuance a payment bond (if any)on behalf of the prime contractor for the protection of the owner, if the bond is for an amount not less than 50%of the total amount of the construction project (if owner is self-financing, please indicate). Completion of this information may be deferred until permit issuance. NAME: PHONE: N/A ADDRESS(STREET,CITY,STATE,ZIP): CONTACT PERSON Select one person the city will contact for anything related to this project: ❑X PROPERTY OWNER CONTRACTOR OTHER(LIST BELOW) NAME: PHONE: ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS: SIGNATURE I hereby declare that I am either the owner of the property listed on this application, or the owner of this property has authorized me to be their representative to act for them. I also declare under penalty of perjury under the laws of the State of Washington that all of the statements and answers contained herein, and the information submitted with this application form is in all respects,true, correct, and complete to the beat of knowledge and belief. 3/25/2022 SIGNATURE DATE Deconstruction/Demolition Permit Application Submittal Checklist Updated December 2021 Page 4 of 4 psc lean air,org Paget Sound Agency Notification Case #: 202201472 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # AP0A6FDE93C8 Transaction Date 03/25/22 Owner's Name MJB Properties LLC Phone (206) 255-5153 Project Street Address 2004 R Avenue City Anacortes Zip 98221 Contact Person Jimmy Blais Phone (206) 255-5153 Mailing Address 5050 1st Ave S, Suite 102 Seattle,WA 98134 This project includes a demolition. Demolition Start Date 07/01/22 Completion Date 12/31/22 Demolition will be completed by a demolition contractor Demo Contractor Property Owner Contractor Job # Contact Phone Mailing Address (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed.The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. Asbestos Inspection Northwest 20675 State Route 534 Mount Vernon WA 98274 425.443.2031 Survey No. 3.21.22.1 Today's Date: 3.21.22 Client:Jimmy Blais Email:jblais@gmccinc.com RE:Asbestos Survey: 2004 R Ave Anacortes WA On March 8th 2022, 1 inspected a single story residential building with full basement(2300 overall), located at the above address,for the purpose of determining the presence or absence of building materials that might contain asbestos.The purpose for the survey was for demolition.Only the materials listed were sampled and tested. No other materials were sampled. Title 40 Code of Federal Regulations (40 CFR),subpart M,section 61.141, established the allowable limit of asbestos in building materials at 1%by weight. Materials containing more than 1%asbestos are regulated and must be handled in accordance with Federal,State, and Local regulations. Surveys are based on "visible and accessible materials"and although reasonable effort was made to locate and test all suspect materials,some suspect materials may remain hidden in walls or below floor underlayment or other areas until demolition or renovation work makes them accessible. If other suspect materials are discovered during the course of demolition or remodel activities, they will require testing prior to continuing work.All square footages are estimates and should be verified by a contractor prior to bidding. #15 BULK SAMPLES were collected,and #15 samples was subsequently analyzed for asbestos content by Polarized Light Microscopy(PLM) at CEI Labs in Cary North Carolina.All samples were negative for the presence of asbestos. This letter along with the attached material list and lab report will comprise the "Asbestos Survey". Please call or email if you have questions. All the best, Douglas Boze AHERA Building Inspector Certification#181819 (expires June 16th,2022) 21905 64th Ave W,#100 Mountlake Terrace,WA 98043 n (206)285-3373 OF AV r This certifies that TMINING•CONA `nNG n Douglas E. Boze has satisfactorily completed 4 hours of online refresher traininq as an AHERA Building Inspector to comply with the training requirements of �TSSCA Title II,40 CFR 763(AHERA) -L EPA Provider#1085 Instructor:Andre Zwanenburg Date:Jun 16,2021 Expires in 1 year. Cert.Num:181819 ti eurofins CEI March 15, 2022 Asbestos Inspection NorthWest 20675 State Route 534 Mount Vernon, WA 98274 CLIENT PROJECT: 2004 R Ave, Anacortes CEI LAB CODE: B225918 Dear Customer: Enclosed are asbestos analysis results for PLM Bulk samples received at our laboratory on March 14, 2022. The samples were analyzed for asbestos using polarizing light microscopy (PLM) per the EPA 600 Method. Sample results containing >1% asbestos are considered asbestos-containing materials (ACMs) per EPA regulatory requirements. The detection limit for the EPA 600 Method is <1% asbestos by weight as determined by visual estimation. Thank you for your business and we look forward to continuing good relations. Kind Regards, //' ✓�w a—, Tianbao Bai, Ph.D., CIH Laboratory Director NV TESTING NVLAP LAB CODE 101768-0 730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 tit eurofins ICEI ASBESTOS ANALYTICAL REPORT By: Polarized Light Microscopy Prepared for Asbestos Inspection NorthWest CLIENT PROJECT: 2004 R Ave, Anacortes LAB CODE: B225918 TEST METHOD: EPA 600 / R93 / 116 and EPA 600 / M4-82 / 020 REPORT DATE: 03/15/22 TOTAL SAMPLES ANALYZED: 15 # SAMPLES >1% ASBESTOS: 730 SE Maynard Road • Cary, NC 27511 • 919.481 .1413 ti Asbestos Report Summary ti•~ e u rof i n s By: POLARIZING LIGHT MICROSCOPY CEI PROJECT: 2004 R Ave, Anacortes LAB CODE: B225918 METHOD: EPA 600 / R93/ 116 and EPA 600/ M4-82/020 ASBESTOS Client ID Layer Lab ID Color Sample Description % HM1 B225918.01A Tan Vinyl Flooring None Detected B225918.01 B Clear Mastic None Detected HM2 B225918.02A Tan,Black Vinyl Flooring None Detected B225918.02B Black Mastic None Detected HM3 B225918.03 White Ceiling Tile None Detected HM4 Layer 1 B225918.04 White,Pink Plaster Skim Coat None Detected - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 B225918.04 Gray Plaster Base Coat None Detected HM5 Layer 1 B225918.05 White,Tan Plaster Skim Coat None Detected - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 B225918.05 Gray Plaster Base Coat None Detected HM6-1 B225918.06 Off-white Texture None Detected HM6-2 B225918.07 Off-white Texture None Detected HM6-3 B225918.08 Off-white Texture None Detected HM7-1 Layer 1 B225918.09 Off-white Texture None Detected - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 B225918.09 White,Tan Drywall None Detected HM7-2 Layer 1 B225918.10 Off-white Texture None Detected - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 B225918.10 White,Tan Drywall None Detected HM7-3 Layer 1 B225918.11 Off-white Texture None Detected - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 B225918.11 White,Tan Drywall None Detected HM8 B225918.12 Off-white Window Glazing None Detected HM9 B225918.13 Tan Paper Barrier None Detected HM10 B225918.14 Black Roofing None Detected HM11 B225918.15 Black Tarpaper None Detected 730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 Page 1 of 1 ti eurofins ASBESTOS BULK ANALYSIS 'L• CEI By: POLARIZING LIGHT MICROSCOPY Client: Asbestos Inspection NorthWest Lab Code: B225918 20675 State Route 534 Date Received: 03-14-22 Mount Vernon, WA 98274 Date Analyzed: 03-15-22 Date Reported: 03-15-22 Project: 2004 R Ave, Anacortes ASBESTOS BULK PLM, EPA 600 METHOD Client ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS Lab ID Description Attributes Fibrous Non-Fibrous % HMI Vinyl Flooring Heterogeneous 100% Vinyl None Detected B225918.01 A Tan Non-fibrous Bound B225918.01 B Mastic Homogeneous 100% Mastic None Detected Clear Non-fibrous Bound HM2 Vinyl Flooring Heterogeneous 50% Cellulose 30% Vinyl None Detected B225918.02A Tan,Black 20% Tar Fibrous Bound B225918.02B Mastic Homogeneous 100% Mastic None Detected Black Non-fibrous Bound HM3 Ceiling Tile Heterogeneous 50% Fiberglass 10% Paint None Detected B225918.03 White 40% Mineral Wool Fibrous Loosely Bound HM4 Plaster Skim Coat Heterogeneous 65% Binder None Detected Layer 1 White,Pink 30% Silicates B225918.04 Non-fibrous 5% Paint Bound - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 Plaster Base Coat Homogeneous 65% Silicates None Detected B225918.04 Gray 35% Binder Non-fibrous Bound 730 SE Maynard Road - Cary, NC 27511 • 919.481 1413 Page 1 of 5 eurofins ASBESTOS BULK ANALYSIS ti. By: POLARIZING LIGHT MICROSCOPY CEI Client: Asbestos Inspection NorthWest Lab Code: B225918 20675 State Route 534 Date Received: 03-14-22 Mount Vernon, WA 98274 Date Analyzed: 03-15-22 Date Reported: 03-15-22 Project: 2004 R Ave, Anacortes ASBESTOS BULK PLM, EPA 600 METHOD Larb t ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS D Description Attributes Fibrous Non-Fibrous % HM5 Plaster Skim Coat Heterogeneous 65% Binder None Detected Layer 1 White,Tan 30% Silicates B225918.05 Non-fibrous 5% Paint Bound - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 Plaster Base Coat Homogeneous 65% Silicates None Detected B225918.05 Gray 35% Binder Non-fibrous Bound HM6-1 Texture Heterogeneous 65% Binder None Detected B225918.06 Off-white 30% Perlite Non-fibrous 5% Paint Bound HM6-2 Texture Heterogeneous 65% Binder None Detected B225918.07 Off-white 30% Calc Carb Non-fibrous 5% Paint Bound HM6-3 Texture Heterogeneous 65% Binder None Detected B225918.08 Off-white 30% Perlite Non-fibrous 5% Paint Bound HM7-1 Texture Heterogeneous 65% Binder None Detected Layer 1 Off-white 30% Perlite B225918.09 Non-fibrous 5% Paint Bound - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 Drywall Heterogeneous 20% Cellulose 80% Gypsum None Detected B225918.09 White,Tan Fibrous Bound 730 SE Maynard Road - Cary, NC 27511 - 919.481.1413 Page 2 of 5 tiff eurofins ASBESTOS BULK ANALYSIS GEI By: POLARIZING LIGHT MICROSCOPY Client: Asbestos Inspection NorthWest Lab Code: B225918 20675 State Route 534 Date Received: 03-14-22 Mount Vernon, WA 98274 Date Analyzed: 03-15-22 Date Reported: 03-15-22 Project: 2004 R Ave, Anacortes ASBESTOS BULK PLM, EPA 600 METHOD Ent ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS ID Description Attributes Fibrous Non-Fibrous % HM7-2 Texture Heterogeneous 65% Binder None Detected Layer 1 Off-white 30% Perlite B225918.10 Non-fibrous 5% Paint Bound - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 Drywall Heterogeneous 20% Cellulose 80% Gypsum None Detected B225918.10 White,Tan Fibrous Bound HM7-3 Texture Heterogeneous 65% Binder None Detected Layer 1 Off-white 30% Perlite B225918.11 Non-fibrous 5% Paint Bound - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Layer 2 Drywall Heterogeneous 20% Cellulose 80% Gypsum None Detected B225918.11 White,Tan Fibrous Bound HM8 Window Glazing Heterogeneous 95% Binder None Detected B225918.12 Off-white 5% Paint Non-fibrous Bound HM9 Paper Barrier Homogeneous 100% Cellulose None Detected B225918.13 Tan Fibrous Loosely Bound HM10 Roofing Homogeneous 70% Cellulose 30% Tar None Detected B225918.14 Black Fibrous Bound 730 SE Maynard Road - Cary, NC 27511 - 919.481.1413 Page 3 of 5 •.ti eurofins ASBESTOS BULK ANALYSIS 'L By: POLARIZING LIGHT MICROSCOPY CEI Client: Asbestos Inspection NorthWest Lab Code: B225918 20675 State Route 534 Date Received: 03-14-22 Mount Vernon, WA 98274 Date Analyzed: 03-15-22 Date Reported: 03-15-22 Project: 2004 R Ave, Anacortes ASBESTOS BULK PLM, EPA 600 METHOD Client ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS Lab ID Description Attributes Fibrous Non-Fibrous % HM11 Tarpaper Heterogeneous 50% Fiberglass 40% Tar None Detected B225918.15 Black 10% Gravel Fibrous Bound 730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 Page 4 of 5 v% eurofins LEGEND: Non-Anth = Non-Asbestiform Anthophyllite Non-Trem = Non-Asbestiform Tremolite Calc Carb = Calcium Carbonate METHOD: EPA 600/ R93 / 116 and EPA 600 / M4-82 /020 REPORTING LIMIT: <1% by visual estimation REPORTING LIMIT FOR POINT COUNTS: 0.25% by 400 Points or 0.1% by 1,000 Points REGULATORY LIMIT: >1% by weight Due to the limitations of the EPA 600 method, nonfriable organically bound materials (NOBs) such as vinyl floor tiles can be difficult to analyze via polarized light microscopy (PLM). EPA recommends that all NOBs analyzed by PLM, and found not to contain asbestos, be further analyzed by Transmission Electron Microscopy (TEM). Please note that PLM analysis of dust and soil samples for asbestos is not covered under NVLAP accreditation. Estimated measurement of uncertainty is available on request. This report relates only to the samples tested or analyzed and may not be reproduced, except in full, without written approval by Eurofins CEI. Eurofins CEI makes no warranty representation regarding the accuracy of client submitted information in preparing and presenting analytical results. Interpretation of the analytical results is the sole responsibility of the client. Samples were received in acceptable condition unless otherwise noted. This report may not be used by the client to claim product endorsement by NVLAP or any other agency of the U.S. Government. Information provided by customer includes customer sample ID and sample description. ANALYST: 2 APPROVED BY: k�'——. Zane Heinz Tianbao Bai, Ph.D., CIH Laboratory Director Scott Minyard O r4vt TESTING NVLAP LAB CODE 101768.0 730 SE Maynard Road • Cary, NC 27511 • 919.481 1413 Page 5 of 5 ASBESTOS CHAIN OF CUSTODY LAB USE ONLY. 730 SE Maynard Road, Cary, NC 27511 CEI Lab Code: Tel: 866-481-1412; Fax: 919-481-1442 CEI Lab I.D.Range: COMPANY INFORMATION PROJECT INFORMATION CEI CLIENT#: Job Contact: Douglas Boze Company: Asbestos Inspection NW Email/Tel: 425.443.2031 Address: 20675 State Route 534 Project Name: Mount Vernon WA 98274 Project ID#: 4- G; lal-,LeS Email: asbestosinspectionnw@hotmaiLcom PO#: 221,q i Tel: 425,443.2031 Fax: STATE SAMPLES COLLECTED IN: WA IF TAT IS NOT MARKED STANDARD 3 DAY TAT APPLIES. TURN AROUND TIME ASBESTOS METHOD 4 HR 8 HR 24 HR 2 DAY 3 DAY S DAY PLM BULK EPA 600 ❑ ❑ ❑ ❑ ❑ PLM POINT COUNT 400) EPA 600 ❑ ❑ ❑ ❑ 0 0 PLM POINT COUNT 1000) EPA 600 ❑ ❑ 0 0 0 PLM GRAV w POINT COUNT EPA 600 ❑ ❑ ❑ ❑ ❑ PLM BULK CARB 435 ❑ 0 0 0 0 PCM AIR NIOSH 7400 ❑ ❑ (] ❑ ❑ ❑ TEM AIR EPA AHERA ❑ ❑ ❑ ❑ 0 TEM AIR NIOSH 7402 ❑ ❑ 0 ❑ ❑ 0 TEM AIR ISO 10312 ❑ ❑ ❑ ❑ ❑ ❑ TEM AIR ASTM 6281-09 ❑ ❑ ❑ ❑ ❑ 0 TEM BULK CHATFIELD 0 0 ❑ ❑ ❑ TEM DUST WIPE ASTM D600-05(2D10) ❑ ❑ ❑ ❑ 0 ❑ TEM DUST MICROVAC ASTM D5755-09(2014) 0 ❑ Cl ❑ 0 0 TEM SOIL ASTM D7521-13 0 0 ❑ 0 TEM VERMICULITE CINCINNATI METHOD ❑ ❑ 0 ❑ OTHER: ❑ 0 ❑ ❑ ❑ ❑ REMARKS / SPECIAL INSTRUCTIONS: ❑ Accept Samples Reject Samples Relinquished By: DateMme Received By: Date/Time Samples will be disposed of 30 days after analysis Page of Version: CCOC.01.17.1/2.LD ASBESTOS = SAMPLING FORM (: ElL-,.-A-- GS COMPANTCONTACT INFORMATION Company: Asbestos Inspection NW Job Cold; Douglas Boze Pro'ed Name: 200 2 Project ID#: Tel: 42&443.2031 VOLUME/ SAMPLE ID# DESCRIPTION 1 LOCATION AREA TEST �✓t PLM TEM14 p PLM TEM p u c"*n PLM TEM Q PLM TEM p K PLM TEM Q PLM TEM Q _ Z PLM TEM 0 3 PLM TEM p r 4 ( wlorq PLM TEMVVIL Q _Z PLM TEM 0 PLM TEM Q PLM TEM Q r- ���(/ PLM TEM 0 PLM TEM Q PLM Ctl TEM p PLM TEM Q PLM TEM PLM TEM Q PLM TEM 0 PLM TEM Q PLM TEM 0 PLM TEM p PLM TEM 0 PLM TEM Q PLM TEM Q PLM Q TEM Q PLM Q TEM p PLM Q TEM p Page of Version: CCOC.01.17.2/2.LD Asbestos Inspection Northwest 20675 State Route 534 Mount Vernon WA 98274 425.443.2031 Client:Jimmy Blais Survey Number: 3.21.2022.1 Date of Survey: 3.8.22 Asbestos Survey Address: 2004 R Ave Anacortes WA Material# Location of Type Friable? Condition Quantity Sample Asbestos and area Location Description HM 1 12" Kitchen, Misc Yes Intact 160 sq ft At stove ND beige hallway in kitchen square and bath vinyl HM 2 Under HM Misc Yes Intact 49 sq ft Heat vent ND beige vinyl 1 in in floor bathroom HM 3 drop Living rom Misc Yes Intact 120 sq ft NE corner ND ceiling panels, white _ HM 4 SE Misc Yes Intact 90 sq ft At light ND plaster bedroom switch wall HM 5 Hallway Misc Yes Intact 27 sq ft In hallway ND plaster by light switch HM 6-1 Throughout Surfacing Yes Intact 700 sq ft Kitchen ND bumpy entry, white dining texture room side HM 6-2 Same as Surfacing Yes Intact 700 sq ft SW ND bumpy above bedroom white texture _ HM 6-3 Same as Surfacing Yes Intact 700 sq ft . Dining ND bumpy above room at white light texture NOTE: Friability assessments were made on these materials in their present, undisturbed condition on the survey date,AS IS. Damage or disturbance of any kind may cause some non-friable materials to become friable. HM 7-1 Walls and Surfacing Yes Intact 1000 sq ft At game ND drywall ceiling of room with downstairs light orange game switch peel room, SW texture and SE room HM 7-2 Same as Surfacing Yes Intact 1000 sq ft SW room ND drywall above light with switch orange peel texture HM 7-3 Same as Surfacing Yes Intact 1000 sq ft SE room ND drywall above light with switch orange peel texture HM 8 Exterior Misc No Intact 20 sq ft(3 NE ND window windows, windows) window glaze NE ground floor and NW side HM 9 Under Misc Yes Intact 1000 sq ft NE corner ND vaper exterior barrier wood paper siding _ HM 10 3 Entire roof Misc No Intact 700 sq ft South ND tab side roofing, tan HM 11 Under Misc Yes Intact 700 sq ft South ND black tar shingles on side paper roof NOTE: Friability assessments were made on these materials in their present, undisturbed condition on the survey date,AS 15. Damage or disturbance of any kind may cause some non-friable materials to become friable. N/D=None Detected N/T=Not Tested-previous sample(s) tested positive All quantities are approximate-field verification recommended Material# Location Type Friable? Condition Quantity Sample Asbestos and of area Location Description NOTE: Friability assessments were made on these materials in their present, undisturbed condition on the survey date,AS IS. Damage or disturbance of any kind may cause some non-friable materials to become friable.