HomeMy WebLinkAboutPermit File BLD-2022-0555 2008 R Avenue �' C) City of Anacortes Invoice/Permit M BLD-2022-0555
904 6th Street
Applied date: 07/13/2022
P.O.Box 547
t Issue date:
Anacortes, WA 98221-0547
Expire date: 07/08/2023
(360) 293-1901
Job Address: 2008 R AVE Permit Type: Residential Demolition Permit
ANACORTES WA 98221-2537 Project:
APN: P58060
Remarks: Demolish old SFR.
Owner: MJB PROPERTIES LLC Contractor: GARY MERLINO CONSTRUCTION CO
Address: 5050 1 STAVE 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 M
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 commenced within 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 exami is application and know the same to
be true and correct.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSU
- !S
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PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
Office Location:904 6th Street, Anacortes WA 98821
`44C(0) Phone: (360)293-1901
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
Deconstruction / Demolition Permit
+. d 3 u
Submittal Requirement Checklist E o o
Q LL
CL
Q
Deconstruction/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 utilities that 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.httij://nwcleanairwa.gov for more information.
Asbestos Survey and Remediation Report, if required by NWCAA x x
u Prepared by a Washington State Certified Asbestos Abatement Contractor.
Pedestrian Safety Plan x
City of Anacortes 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 pced(@cityofanacortes.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 PCED,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@citvofanacortes.or for assistance.
• Contact your.Habitat for Humanity Store at 360-428-9402 (httg�llwww.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://sustainableconnections.orp_lpro rams/toward-zero-waste)
GENERAL PROCESS OUTLINE
• Notify the Northwest Clean Air Agency in writing and obtain needed permits:
https://nwcleanairwa.jzov/r)ermits-and-serviceslasbestos-and-demolition/.
• 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:
Zoos R Ave P58060
TYPE OF STRUCTURE
X 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: sq.ft.
528
Demolish existing house
---------------- - --- - ------------------------------------------------------
Method of Disposal: ; Date of original construction of structure:
landfill ; 1935
HISTORIC RESOURCES INFORMATION:
---------------------------------------------------------------------------------------, -------------------------------
Is the structure listed on the City of Anacortes Local, prior to demolition,are you
' If identified ri
State, or National register of historic places? ` willing to salvage from the structure
I historically significant architectural features?
YES* XNO
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:
- ---------------------- r --------r--------------------------------
----------------------------
Water Disconnect ❑Retain i Storm i XDisconnect ❑Retain
--------- --------------------------------------- -------------------------
Sewer I Disconnect Etetain Garbage Discontinue ❑Retain
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: _ _ I Disposal Location:
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 12062555153
ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS:
5050 1st Ave S, Suite 102 jblais@gmccinc.com
CONTRACTOR INFORMATION
NAME:* PHONE:
Gary Merlino Construction 2062555153
CONTRACTOR'S BUSINESS LICENSES STATE LICENSE#: CITY OF ANACORTES
*All Contractors&Subcontractors must have a Garymccl 50MW ENDORSEMENT?
valid City of Anocortes business license prior to EXPIRATION DATE: r1V1YES [:]NO
work in the City. 2/14/2023
ADDRESS(STREET,CITY,STATE,ZIP): EMAILADDRESS:
9125 10th Ave S, Seattle WA 98108 Jblaisagmccinc.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:
OX PROPERTY OWNER CONTRACTOR OTHER(LIST BELOW)
NAME: I 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 best of knowledge and belief.
2-12-
ATW DATE
Deconstruction/Demolition Permit Application Submittal Checklist
Updated December 2021
Page 4 of 4
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1600 South Second Street Asbestos / Demolition Notification Approval
+"® Mount Vernon,WA 98273-5202 and Permit to Work
northwest r'' Ph 360-428-1617
CIea„ I fax 360-428-1620
1 1 info@nwcleanairwa.gov
agency www.nwcleanairwa.gov Notification # 22-397
Project Site Received Date 07/12/2022
2008 R Avenue Approval Date 07/13/2022
Anacortes, WA 98221 Fee Amount $ 59.00
Receipt # 3110
Project Details
Project Type Demolition only
Building Type Single Family Residence
❑ Emergency
Estimated Demolition Date 07/25/2022
p Survey
Survey Link [Survey on file with NWCAA]
❑ Owner Occupied Abatement
Asbestos Locations
❑ Class I ❑ Class II ❑ Vermiculite ❑ Non-friable Fee Exempt Material
Owner
Site Owner MJB Properties, LLC
Owner Phone (206) 255-5153
Notification Submitted by Jimmy Blais
Notification Contact Phone (206) 255-5153
Notification Contact Email jblais@gmccinc.com
This notification must be posted at the work site.
You must file an amendment if there are any changes to the project scope or schedule.
<http://nwc[eanairwa.gov/forms/asbestos-project-amendment/>
Information on asbestos and demolition can be found on the agency website.
<http://nwcleanairwa.gov/permits-a nd-services/asbestos-and-demolition/>
Asbestos disposal information
<http://nwc[eanairwa.gov/download/disposal-information/>
NWCAA asbestos regulations can be found in Section 570 Asbestos Control Standards.
<http://nwclea na irwa.gov/regulation/section-550-590/section-570/>
Generated: 07/13/2022 01:49 PM
Asbestos Inspection Northwest
20675 State Route 534
Mount Vernon WA 98274
425.443.2031
Survey No. 7.12.22.1
Today's Date: 7.12.22
Client: MJB Properties C/O Jim Blais
Email:jblais@gmccinc.com
RE:Asbestos Survey: 2008 R Ave Anacortes WA
On July 5th 2022, 1 inspected a single story residential building(462 sq ft), 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.
#13 BULK SAMPLES was collected, and #13 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#185202 (expires June 1st, 2023)
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eurofins
CEI
July 11, 2022
Asbestos Inspection NorthWest
20675 State Route 534
Mount Vernon, WA 98274
CLIENT PROJECT: 2008 R Ave, Anacortes
CEI LAB CODE: A228506
Dear Customer:
Enclosed are asbestos analysis results for PLM Bulk samples received at our laboratory on
July 8, 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,
Tianbao Bai, Ph.D., CIH
Laboratory Director
0
rAvtQ
TESTING
NVLAP LAB CODE 101768-0
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413
tiff eurofins
ICEI
ASBESTOS ANALYTICAL REPORT
By: Polarized Light Microscopy
Prepared for
Asbestos Inspection NorthWest
CLIENT PROJECT: 2008 R Ave, Anacortes
LAB CODE: A228506
TEST METHOD: EPA 600 / R93 / 116 and EPA 600 / M4-82 / 020
REPORT DATE. 07/11/22
TOTAL SAMPLES ANALYZED: 13
# SAMPLES >1% ASBESTOS:
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413
.ti Asbestos Report Summary
tiff e u rof i n s By: POLARIZING LIGHT MICROSCOPY
PROJECT: 2008 R Ave, Anacortes LAB CODE: A228506
METHOD: EPA 600/ R93/ 116 and EPA 600/ M4-82 1020
ASBESTOS
Client ID Layer Lab ID Color Sample Description %
HM1 A228506.01 White Corrugated Sheeting None Detected
HM2 A228506.02 Black Tarpaper None Detected
HM3 A228506.03 Black Tarpaper None Detected
HM4 A228506.04 Black Shingle None Detected
HM5-1 A228506.05 White Popcorn Texture None Detected
HM5-2 A228506.06 White Popcorn Texture None Detected
HM5-3 A228506.07 White Popcorn Texture None Detected
HM6-1 Layer 1 A228506.08 White Texture None Detected
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Layer 2 A228506.08 White Drywall None Detected
HM6-2 Layer 1 A228506.09 White Texture None Detected
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Layer 2 A228506.09 White Drywall None Detected
HM6-3 Layer 1 A228506.10 White Texture None Detected
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Layer 2 A228506.10 White Drywall None Detected
HM7 A228506.11A Gray,Black Vinyl None Detected
A228506.11 B Clear Mastic None Detected
HM8 A228506.12A Teal,Beige Vinyl None Detected
A228506.12B Clear Mastic None Detected
HM9 A228506.13A White,Gray Vinyl None Detected
A228506.13B Tan Mastic None Detected
730 SE Maynard Road - Cary, NC 27511 - 919.481.1413 Page 1 of 1
ti eurofins ASBESTOS BULK ANALYSIS
'�• By: POLARIZING LIGHT MICROSCOPY
I CEI
Client: Asbestos Inspection NorthWest Lab Code: A228506
20675 State Route 534 Date Received: 07-08-22
Mount Vernon, WA 98274 Date Analyzed: 07-11-22
Date Reported: 07-11-22
Project: 2008 R Ave, Anacortes
ASBESTOS BULK PLM, EPA 600 METHOD
F
ient ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS
ab ID Description Attributes Fibrous Non-Fibrous %
HM1 Corrugated Sheeting Heterogeneous 35% Fiberglass 65% Binder None Detected
A228506.01 White
Fibrous
Bound
HM2 Tarpaper Homogeneous 65% Cellulose 35% Tar None Detected
A228506.02 Black
Fibrous
Bound
HM3 Tarpaper Homogeneous 65% Cellulose 35% Tar None Detected
A228506.03 Black
Fibrous
Bound
HM4 Shingle Homogeneous 45% Fiberglass 40% Tar None Detected
A228506.04 Black 15% Gravel
Fibrous
Bound
HMS-1 Popcorn Texture Heterogeneous 65% Binder None Detected
A228506.05 White 20% Calc Carb
Non-fibrous 15% Foam
Bound
HM5-2 Popcorn Texture Heterogeneous 65% Binder None Detected
A228506.06 White 20% Calc Carb
Non-fibrous 15% Foam
Bound
HM5-3 Popcorn Texture Heterogeneous 65% Binder None Detected
A228506.07 White 20% Calc Carb
Non-fibrous 15% Foam
Bound
730 SE Maynard Road • Cary, NC 27511 - 919.481.1413 Page 1 of 4
Oeurofins ' ASBESTOS BULK ANALYSIS
By: POLARIZING LIGHT MICROSCOPY
CEI
Client: Asbestos Inspection NorthWest Lab Code: A228506
20675 State Route 534 Date Received: 07-08-22
Mount Vernon, WA 98274 Date Analyzed: 07-11-22
Date Reported: 07-11-22
Project: 2008 R Ave, Anacortes
ASBESTOS BULK PLM, EPA 600 METHOD
Client ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS
Lab ID Description Attributes Fibrous Non-Fibrous %
HM6-1 Texture Heterogeneous 2% Paint None Detected
Layer 1 White 83% Binder
A228506.08 Non-fibrous 15% Calc Carb
Bound
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Layer 2 Drywall Heterogeneous 15% Cellulose 85% Gypsum None Detected
A228506.08 White
Fibrous
Bound
HM6-2 Texture Heterogeneous 2% Paint None Detected
Layer 1 White 83% Binder
A228506.09 Non-fibrous 15% Calc Carb
Bound
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Layer 2 Drywall Heterogeneous 15% Cellulose 85% Gypsum None Detected
A228506.09 White
Fibrous
Bound
HM6-3 Texture Heterogeneous 2% Paint None Detected
Layer 1 White 83% Binder
A228506.10 Non-fibrous 15% Calc Carb
Bound
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Layer 2 Drywall Heterogeneous 15% Cellulose 85% Gypsum None Detected
A228506.10 White
Fibrous
Bound
HM7 Vinyl Heterogeneous 5% Fiberglass 95% Vinyl None Detected
A228506.11 A Gray,Black
Fibrous
Bound
730 SE Maynard Road - Cary, NC 27511 - 919.481 1413 Page 2 of 4
tiff eu rofi ns ASBESTOS BULK ANALYSIS
By: POLARIZING LIGHT MICROSCOPY
l CEI
Client: Asbestos Inspection NorthWest Lab Code: A228506
20675 State Route 534 Date Received: 07-08-22
Mount Vernon, WA 98274 Date Analyzed: 07-11-22
Date Reported: 07-11-22
Project: 2008 R Ave, Anacortes
ASBESTOS BULK PLM, EPA 600 METHOD
Client ID Lab Lab NON-ASBESTOS COMPONENTS ASBESTOS
Lab ID Description Attributes Fibrous Non-Fibrous %
A228506.11 B Mastic Homogeneous 100% Mastic None Detected
Clear
Non-fibrous
Bound
HM8 Vinyl Heterogeneous 100% Vinyl None Detected
A228506.12A Teal,Beige
Non-fibrous
Bound
A228506.12B Mastic Homogeneous 100% Mastic None Detected
Clear
Non-fibrous
Bound
HM9 Vinyl Heterogeneous 65% Cellulose 25% Vinyl None Detected
A228506.13A White,Gray 10% Fiberglass
Fibrous
Bound
A228506.13B Mastic Homogeneous 100% Mastic None Detected
Tan
Non-fibrous
Bound
730 SE Maynard Road • Cary, NC 27511 - 919.481.1413 Page 3 of 4
tiff 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: APPROVED BY:
Justin Shu Tianbao Bai, Ph.D., CIH
Laboratory Director
INvi1.
TESTING
NVLAP LAB CODE 101768-0
730 SE Maynard Road • Cary, NC 27511 • 919.481.1413 Page 4 of 4
ASBESTOS
CHAIN OF CUSTODY
C: EILAGS LAB USE ONLY.•
730 SE Maynard Road, Cary, NC 27511 ICEI Lab Code: IJi�
Tel: 866-481-1412; Fax: 919-481-1442 JCEl Lab I.D.Range:
COMPANY INFORMATION PROJECT INFORMA110N ,3
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#: All�{C
Email: asbestosinspectionnw@hotmail.com PO#: Cq
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 5 DAY
PLM BULK EPA 600 ❑ ❑ 0 ❑ ❑ ❑
PLM POINT COUNT 400 EPA 600 ❑ ❑ ❑ ❑ ❑ ❑
PLM POINT COUNT(1000) EPA 600 ❑ ❑ ❑ ❑ ❑ ❑
PLM GRAV w POINT COUNT EPA 600 ❑ ❑ ❑ ❑ ❑
PLM BULK CARB 435 ❑ ❑ ❑ ❑ ❑
PCM AIR NIOSH 7400 ❑ ❑ ❑ ❑ ❑ ❑
TEM AIR EPA AHERA ❑ ❑ ❑ ❑ ❑ ❑
TEM AIR NIOSH 7402 ❑ ❑ ❑ ❑ ❑ ❑
TEM AIR ISO 10312 ❑ ❑ ❑ ❑ ❑ ❑
TEM AIR ASTM 6281-09 ❑ ❑ ❑ ❑ ❑ ❑
TEM BULK CHATFIELD ❑ ❑ ❑ ❑ ❑
TEM DUST WIPE ASTM D6480-D5 2010) ❑ ❑ ❑ ❑ ❑ ❑
TEM DUST MICROVAC ASTM D5755-D9(2014) ❑ ❑ ❑ ❑ ❑ ❑
TEM SOIL ASTM D7521-13 ❑ ❑ ❑ ❑
TEM VERMICULITE CINCINNATI METHOD J ❑ ❑ ❑ ❑
OTHER: ❑ ❑ ❑ ❑ ❑ ❑
REMARKS/ SPI�CIAL INSTRUCTIONS:
Sp f PC,S '
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Samples will be disposed of 30 days after analysis Page of
Version: CCOC.01.17.1/2.LD
ASBESTOS
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Company: Asbestos Inspection NW Job Contact: Douglas Boze
Project Name: -,7 00 l?' R
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Page of
Version: CCOC.01.17.212.LD
Asbestos Inspection Northwest
20675 State Route 534
Mount Vernon WA 98274
425.443.2031
Client: MJB Properties C/O Jim Blais
Survey Number: 7.12.2022.1
Date of Survey: 7.5.22
Asbestos Survey Address: 2008 R Ave Anacortes WA
Material# Location of Type Friable? Condition Quantity Sample Asbestos
and area Location
Description
HMI Front entry Misc No Some 40 sq ft North side ND
corrugated walls damage of wall
sheeting,
white
HM 2 black Under Misc Yes Intact 500 sq ft SE corner ND
tar paper exterior by
wood window
siding
HM 3 black Under roof Misc Yes Intact 462 sq ft By east ND
tar paper shingles on entry
roof
HM 4 tan On roof, 3 Misc No Intact 462 sq ft East entry ND
shingles tab style
HM 5-1 Living Surfacing Yes Intact 286 sq ft Bedroom ND
painted room and entry in
popcorn bedroom living
ceiling only room
HM 5-2 Same as Surfacing Yes Intact 286 sq ft Bedroom ND
painted above entry,
popcorn bedroom
ceiling side
HM 5-3 Same as Surfacing Yes Intact 286 sq ft Bedroom ND
painted above center
popcorn
ceiling
HM 6-1 Bedroom Surfacing Yes Intact 300 sq ft Main ND
drywall and living entry
with room walls right of
texture door
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 6-2 Bedroom Surfacing Yes Intact 300 sq ft West wall ND
drywall and living entry to
with room walls kitchen,
texture right side
HM 6-3 Bedroom Surfacing Yes Intact 300 sq ft Bedroom, ND
drywall and living north
with room walls window
texture
HM 7 On floor, Misc No Intact 462 sq ft Bathroom ND
wood throughout transition
pattern
planking
HM 8 teal In Misc No Intact 64 sq ft Bathroom ND
square bathroom transition
vinyl under HM
7
HM 9 In kitchen Misc Yes Intact 112 sq ft South ND
white vinyl under HM entry
with 4" 7
square
pattern
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.
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.