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20080387 Demo Permit 11122008 �oF T� Clty of Yelm Perrnit►vo: DEMO-08-0387-YL Community Development Department Issue Date: 71/12/2008 � (Work must be started within 180 days) Building Division Phone:(360)458-8407 Receipt No: 57215 YELM Fax:(360)458-3144 Applicant: Name: Aero Construction Phone: Address: City: State: Zip Property Information: Site Address: Assessor Parcel No. Subdivision: Lot: Contractor Information: Name: Contact: Phone: Address: City: State: Zip: Contractor License No: Expires: Business License: Project Information: Project: 9301 Cullens Description of Work: Demo Permit of Mfg Home Sq. Ft.per floor:(1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0 Heat Type(Electric,Gas,Other): Fees: Item Item Fee Base Amt Unit Fee Unit Rate No.Units Unit Desc --------------------------- ----------- ----------- ----------- ----------- ----------- ------------- Building Permit-Other 50.00 0.00 0.00 0.0000 0.0000 $1,000 TOTAL FEES: $50.00 Applicant's Affadavit: OFFICIAL USE ONLY I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of #Sets of Prints: Yelm regulations including those governing zoning and land subdivision,and in addition,all covenants, easements and restrictions of record. If applying as a contractor, I futher certify that I am currently registered in the St te of Washington. Final Inspection: ,> � j/ /� ��/ Date: Signature Date Q Firm BY' e CITY OF YELM RESIDENTIAL BUILDING PERMIT APPLICATION FORM Project Address: ��.��/.�ti i2� S� Parcel#:_ � 1�1 2 �1 I \ �� ► �aC � Subdivision: Lot#: Zoning; ❑ New Construction ❑ Re-Model/Re-Roof/Addition ❑ Home Occupation Sign ❑ Plumbing ❑ Mechanical ❑ Mobile/Manufactured Home Placement (-�' Other Project Description/Scope of Work: ,;��,��1,'��,�� a� Ets s�.nr 1��t��r�,,��r�L.- �/c�. Project Value: Building Area (sq. ft) 1S� Floor 2"d Floor� Garage�� Deck,G� Basement Carport �Patio�_ # Bedrooms� #Bathrooms a Heating: GAS/OTHER o LECTRIC ( rcle One) Are there any environmentally sensitive areas located on the parcel? If yes, a completed environmental checklist must accompany permit application. BUILQING OWNER NAME: �' ;�, ,.., s� c t ADDRESS � �'- , • Gso MAIL � /,• z � CITY ✓�Z�t cr�-'��TATE �1 _ ZIP y��l,+l�v TELEPHONE 1.�G 6a � ARCHITECT/ENGINEER LICENSE# ADDRESS EMAIL CITY STATE ZIP TELEPHONE GENERAI. CONTRACTOR J ��ry� � ioi, TELEPHONE ' '- 0� ADDRESS 7 � a.�- ,. EMAIL CITY 5c�v�cs-.�H STATE, k/ _ _ZIP � ,� FAX ` >�y�' CONTRACTOR'S LICENSE# P DAT CITY LICENSE# f PLUMBWG CONTRACTOR T E HONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE# MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE# EXP DATE CITY LICENSE# Copy of mitigation agreement with Yelm Community Schools, if applicable. I hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above described property will be in accordance with the laws,rules and regulations of the State of Washington and the City of Yelm. U � / d Applican ure Da Owner Contractor Owner's Agent/Contractor's Agent (Please circle one.) All permits are non-transferable and will expire if work authorized by such permit is not begun within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days 105 Yelm Avenue West (360)458-3835 PO Box 479 (360)458-3144 FAX Yelm, WA 98597 www.ci.yelm.wa.us �,��G10N CL��, Olyinpic Region Clcan.:1ir:lgency �-.`� /��`�rR`._ 29�}0-B L.united L.�ne N�V ; � ��',F;�, Olympia,\X�_19850Z ' �} ;(360) 58G-]0�4•1=;11(3G0}=�9]-6�0$ �'t� �� r�� Port:ingeles oEFtcc(360}�k17-1-FGG �emoliti.on Pe�mit y4�^ ��c�� ~�, f\il}�mond Office(360)789-3G52 � :`': .!ry1� j4«��' �v�v�vw ORCC.�1r�oLg ,*, ,+rr.xnt.soa•N�ti9"��' [�J Residential ('T�-�1 �--�'�-+�'�� [ ] Commei•cial Permit fee: $25.OQ per structure. Non-refundnble. r*10 Worlcing D�ty�vait period�* PROPERTY OWIVER Name: � Plione: CZ�O�')�1S`J-'S��/(p �mail:Ldn�p.45 p� ��i S�'Ac'N�N V , !.� F.11: (D .-y$O 1 �tobile: _/'� 1lailing:�ddress: iq�: ,� Statc: Ztp: � 7 5 �' � "� ,�e�- .1�� L(��~ �4 D Sitc:lddress: City: State: Lip: C� � p ! 1 � S � � DEMOLITION CONTRACTOR� (�: � Uieck if same as ro CII��owiier inforn�ation - Business I�Tame: Yltone: (�f�'Z�Jn! Z.�{7s F_inail: E �, r� r.��: } Z ve�iy e@ PcE��xb. o� (On ite Contact: Phone: (yz5j 3� OC)SZ. �tobile: (C./Z,S `7$� oL � r.11: (S/ZS�3 -Z � �S� 0 3 �1,j�ling_lddiess: Ci �� State: "Lip: T C� C7 Z�C✓ y�1�7 �7�c.�. D Z� DEMOLITION INFORMA1aION #of Stcuctales beu�g decnolished: Start P�ce: CI�ompletion Dace: p� � d V ��j ZOO S� V ZOU D Asbestos present Y N Survey attached 1'�J N Will all a§bestos be removed Y N ��/J �`� f DEMOLITTON PROJECT CATEGORY [ ] Complece Uemoliuon ' [ ] Trainuig F=ire—Fire�gencj=: [ ] Goeernment Ordeied Demcilivan�Attach copy of Orde� ( Renovakion,.�ltesation,Reinodel'ui ,�•Iaiatenaitce,Oi'OL�7CI COI15CIi]CCI011 I bave read aud rvill aGide Gy tGc ronditionr rrt fortL i�r tGi.r pern�i�o�rd any adde�rdlrn�the�cto. I do bereLy ccrtify that tLe informatio�J ix thi.r afibli�atron ar./i su�fiJen�ental dnta dercriLed berrin ir, to tLe Gerl oj�n,y knowled�ge, atcrrrale and conr�lete. � ina n� Sf�t Z�y2.��-�-t' � �.�-r}-av� ��Ja r��;e �,�:� � l d- � -C�SS Apl�licant Name �-_T--. ture Date Date:�pplication Recei�=ed P��>ment InEo, [ ] :lpproved Asbestos Pennit [ ] C.�sh [ ) L)isapproved Pennic# :1SB�0 � ;'� t��;: �# Dcmoliuon i'ermit 3 [ ] Ciedic Card Revie�v d�ite:_/_/� PeLmit# DElI00 Recei��e dahe:�/.�/._,._ 1Zeviewed Uy: �9 e�lq� Use 0y�1), :'''.� ene7�U.rr Ou/y r1�cvrcp U.rc O»/}� fl e�r��Jse Oirlp 02/25/08 OVCR :�; . NOV-07-08 FRI 04�37 PM ABER LABOR AND INDUSTRY FAX N0, 836090246333482730 P, O1 � # O� PAG�S . iNCLUDING THE �OVER PAGE1 ��L�FQ►X TRANSNlITTAi. D�PARTMENT O� LABOR AN� INDUST�I�S PO BOX 66 415 WEST VI►ISHKAH, SUITE 'I�B ABERD�EN, VI�ASHINGTON 98520 FAX (360) 533-8220 • MAfN LlN� (�6Q) 533�5200 TQ: , '��i�� RO ' �J7�lV�'i1�t, ��i.��O�.I� . �'d�� u�'Z� � M•_ (�H) 36Q DA�1"E: '7�'' ��[�r �� CIBJECT: ��t�t4 �"s ��lb�v �,.:��;�,:�tr �'i' �_� �G�°�1.�"�'�'i ANY GtUES7'IONS PLEAS� CA1.L 'FFiE SEN�ER AT THE NUNiB�� LIS7E�D A�OVE THANK YO►UI NOV-07-08 FRI 04�37 PM ABER LABOR AND INDUSTRY FAX N0, 836090246333482730 P, 02 �'agc 1 of 2 , PpST ON JOBSITE PRIOR TO B�GINNING OF WORK � FAS AI.,TERA��ON PERM�'�'#FP167958$ Conlraclor Name License Numher Insta{lation pescripliort_ AERO CONSTRUCTION AEROCC*121NWdemofition COMPANY , .__ —._.... _._.._._ Sarvices to inspect; PurchdSOfs l'Ylailif�g addre�s Description Quantity Amount PO BOX Z95 ther Services-DEMOLITtON SNOHQMISH WA 98290 F A MaBILElMFG HOME [1� ��-J Telephone number FAX Numhe� •�--- (425)33�F-2a75 ()- Inspection fee:$�.�r^ Premises oWnors name F �� The Dwelling Co(Doug Buch) --!"��"- . Address of Inspcclion 9301l9329 Cullens Rd SE , Yelm . WA 98589 ()- 7'his permit expires in one(1)year from date of last ac#ivity. Applied: 11l6l2008 Expiration: 11I6I2009 Date Approved By Date Approved By M�CWANICAL � . PLUMSINC _,�„� �Ype _.Wµ. TYPe ,r..._._� ��CTRICAL STRUCTURAL TY�e —.�..,...� �YPe . OTNER ....,...._._ OTH�R _,�,,,,� TYPe —._._,. TYP� ---..� lnspecflott Date Area,Building or�quipment Inspected A�tion Taken fnspector IL-�b .Y�.�1,_.�,ay�-ra��cn1 �i��;L��.�,� . - :�,�� .��.�,��z�i � '{' � loo��- � � 1'roperty Owncr: This is yo�rr permanent record o�inspection C�'A([�Ultl�,'TU Pt)ST!'1_tIOK'�'p t3C�,G�LY,L�II]YCr WQRK WIL4 R�SULT IN CIVI[,P�NALTI�S . �. � '��''."""""'"'"T"'�'"'�"'""'°',,"'"�"'"""'�^"-""''""1 nai conduct this inspection iFihere are unrestrainea � V ��,.,f3 '' i; �„�, ply wiih this requircrnent may result irt additional ��" �y . •e fe�s �nd dela�in service. � .��; Steve�palthor {��.�,. P Gonsiruction Compliance Inspoctor fic�ion 4 ;� Dep�rtme��tof LE�bor�nd lndiasUius ° Contr�ctor RAplslr�fion Olymplt1360/902-52a4 I'iumbor and Fleclrir.Al Gorlificalion FAX 360/902-5q37 Faclory Assomblod Strvclures AborUeen 3fi0/g33-8226 ' PQ pqX G6 FAX 360/533��Q24 � Abordyen WA 9852U dafs235k��ni,wa.gov � f , ,, , n � ' i .,.._..w� „�r. .w«.r..�.ua��w?,.1f�w"%xF;�Ly'.'SfNue.' ! hltp://scsd.a�ps-i��siciv.lni.wa.�ov/I'A[KSI'ermit/rptFASPerniit.aspx`?AppID�]O1 1 i/7/2Up8 � ADESA Environmental Investigations September 25, 2008 Mr. Steve Moore Senior Project Superintendent Stanton Northwest 11410 NE 122"d Way Suite 102 Kirkland, WA 98034 Re: Comprehensive Asbestos Building Inspection 9301 Cullens Rd SE Yelm, WA 98589 Dear Mr. Moore, ADESA performed a comprehensive Asbestos Survey of the single family residential structure located at the above referenced site. The residential structure is going to be demolished_in preparation for a new home construction The purpose of this sunrey is to comply with Federal standards, the Washington State Department of Labor & Industries (L&I), and Olympic Regional Clean Air Agency (ORCAA) guidelines. A"good faith inspection" of potential asbestos-containing materials (ACM) is required prior to any remodeling or demolition work in accordance with 40 CFR 763.86 and WAC 196-62-07721. Federal and State standards require inspections to be conducted by an EPA Accredited Asbestos Building Inspector with analysis to be provided by an asbestos laboratory certified by the National Bureau of Standards. All survey work was conducted in compliance with the above mentioned standards. According to the information obtained during the building inspection the structure located at 9301 Cullens Rd SE has the following characteristics: Fireplaces/Vllood Stoves: 0 Physical Condition: Average Construction: Manufactured Number of Bedrooms: 2 Heat Type: FA Baths: 2 Construction Quality: Fair Roofing Material: Composite Fuel Type: Electric Residence Square Footage: Double wide The services performed on the above mentioned property (Subject Property) during this asbestos inspection are detailed below. Scope of Services 1. An ADESA AHERA certified inspector performed a comprehensive asbestos inspection of the residence at the above referenced location to identify Asbestos Containing Materials (ACM) prior to demolition. 2. Suspect materials were sampled and sent to an accredited laboratory for analysis In adherence to 40 CFR 763.86, which governs asbestos sampling protocols, ADESA collected 8 samples of potentially asbestos containing materials. The laboratory was instructed to analyze all separable layers which yielded a total of 12 samples analyzed. The samples of potential asbestos- containing materials (ACM) extracted from the Subject Property were analyzed at Global Industrial Corporation of Mesa, Arizona using polarized light microscopy (PLM) with dispersing staining in accordance with U.S. EPA method 600/R-93-166 as specified in 40 CFR Chapter I (7-1-93 edition) Part 763, Subpart F, Appendix A, pages 499-504. Polarizing light microscopy quantifies asbestos PO Box 1009•Tenino,WA•98589 Phone:360-701-8797•Fax:360-264-202R•Email:wrutherford(aadesa-wa.com ADESA Environmental Investigations,LLC 9301 Cullens Rd SE Yelm,WA 98589 concentrations at between 100% - 1% detection levels. See attached laboratory documents for further details of the analysis. The following table depicts the results of this comprehensive sunrey of asbestos containing materials (ACM). .� �.��j�.� A01 La er 1 Linoleum—Tan—Kitchen/Laund �Non-Asbestos Containin A01 La er 2 Mastic—Yellow—Kitchen/Laund Non-Asbestos Containin A02 Ceilin tile—White—Whole House Non-Asbestos Containin A03 Linoleum—Tan—Bathrooms 1�2 Non-Asbestos Containin A04 Insulation—Pink—Exterior Walls Non-Asbestos Containin A05 Roofin Material—Black—Whole House Non-Asbestos Containin A06 La er 1 Insulation—Pink—Above Ceilin Tiles Whole House Non-Asbestos Containin A06 La er 2 Insulation Backin —Above Ceilin Tiles Whole House Non-Asbestos Containin A07 La er 1 Insulation—Pink—Beneath Floor Non-Asbestos Containin A07 La er 2 Insulation Backin —Beneath Floor Non-Asbestos Containin A08 La er 1 Insulation—Yellow—Beneath Floor Non-Asbestos Containin A08 La er 2 Insulation Backin —Beneath Floor Non-Asbestos Containin Based on the laboratory analysis of samples collected in this comprehensive asbestos survey, no asbestos containing materials (ACM)were discovered. In the event that potential asbestos containing materials are discovered during the demolition, which were not identified in the course of this asbestos inspection, they should be tested prior to disturbance. Please call with questions or concerns regarding this inspection sunrey (360)701-8797. ADESA Environmental Investigations , � ,� � ,�,� %',,� "fl',Ir-�;�. w, � � William`W�.ARutherFord, RSA, AHERA AHERA Cert. NupSber: 1029890 PO Box ]009•Tenino,WA•98�89 Phone:360-701-8797•Far.:360-264-202R•EmaiL•wrutherford�aadesa-wa.com �� GIAB� �N Client: ADESA Report#: 08-GIC-2681 Date of Receipt: 9/22/2008 Report Date: 9/23/2008 Project: 9301 CULLENS RD SE Date of Analysis: 9/23/2008 0908-02 Sample Material Client# Location Description Detection Composition A-01 Linoleum,Tan None Detected Cellulose 20% Layer 1 Non Fibrous 80% A-01 Mastic,Yeilow None Detected Non Fibrous 100% Layer 2 A-02 Ceiling Tile,White None Detected Cellulose 95% Non Fibrous 5% A-03 Linoleum,Tan None Detected Cellulose 20% Non Fibrous 80% A-04 Insulation, Pink None Detected Fiberglass 100% A-05 Roofing Material, Black None Detected Cellulose 20% Non Fibrous 80% A-O6 Insulation, Pink None Detected Non Fibrous 100% Layer 1 A-O6 Backing,White None Detected Cellulose 10% Layer 2 Synthetic Fibers 10% Non Fibrous 80% A-07 Insulation, Pink None Detected Non Fibrous 100% Layer 1 A-07 Backing,White None Detected Cellulose 15% Layer 2 Synthetic Fibers 15% Non Fibrous 70% 6515 E Main St Suite 128 Mesa AZ 85205 Phone(480)497-0280 Fax(480)497-0540 NVLAP CODE 200670-0 Page 1 Sample Material Client# Location Description Detection Composition A-08 Insulation,Yellow None Detected Non Fibrous 100% Layer 1 A-O8 Backing,White None Detected Cellulose 10% Layer 2 Synthetic Fibers 10% Non Fibrous 80°/a ASBESTOS TYPES: Chrysotile,Crocidolite,Anthophyllite,Tremolite,Amosite,Actinolite The samples listed above were suspect of containing asbestos. A result of"Non Detect"means a thorough search using appropriate techniques was conducted and no type of asbestos was discovered. Samples submitted to this facility will be disposed of unless the client requests the samples be returned. Reports will be archived for a period of no more than 3 years. The analysis performed is in accordance with EPA 600/M4-82-020 with a detection limit of l%. Test results apply only to the samples submitted.It is not our policy to distribute the customer's information without the written consent of the customer. The test report shall not be reproduced except in full,without the written approval of the laboratory.This report may not be used by the above client to claim product cerdficallon, approval or endorsement by NIST,National Voluntary Laboratory Accrdeitation Program or the Federal Govermm�et T,7a. . _ , ,✓'�� Shawn Kearney Angela Kearney Laboratory Director President Analyst 6515 E Main St Suite 128 Mesa AZ 85205 Phone(480)497-0280 Fax(480)497-0540 NVLAP CODE 200670-0 Page 2 08-GIC-2681 ,__._.....,�...._.....,,..____�--...�„ "...� .� t ; s w--�---_, ; ; j ` � i ! 6�i � � � ' 1 ' � � a' � � � � . , � � �" � � � � ' � ' ` � � ` � � I � � � ( � � I � i ` ; ; � t � � , � � � � ; a i ; � s 1 v � ,,� ( ! : ; � . ; , � k � ,�( + . 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