20160230 Permit Pkg 05312016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: BOWEN CONSTRUCTION
Address: PO BOX 42
BUCKLEY WA 98321
Property Information:
Site Address: Ad05 CIILLENS RD SE
Assessor Parcel No.: 21724110700
Contractor Information:
Name: BOWEN CONSTRUCTION
Address: BRIAN BOWEN
PO BOX 42
BUCKLEY WA 98321
Permit No.: 20160230
Issue Date: 5/31/2016
(Work must be completed within 180 days)
Phone: 360- 825 -2018
Owner: BOWEN CONSTRUCTION
Subdivision: HOFFMAN PLAT Lot:
Contractor License No.: Expires
Phone:
0 /00 /0000
Project Information:
Project: DEMOLITION
Description of Work: DEMO OF EXISTING HOUSE AND OUTBUILDING
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
DEMOLITION
Contractor
BRIAN BOWEN
TOTAL FEES:
Applicant's Affidavit:
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
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 further certify that I am currently
registered in thetSt f shington.
`� 31 / ( (�
Signature Date 2C
Firm CAL V CC'o'� �0 n 01A 1 /
t`1 C `
Fees
$ 50.00
$ 50.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mm
(36 ) 458 -3244
REC #: 00232749 5/31/2016 12 :27 PM
OPER: CO TERM: 001
REF #: 31307
PAID BY:
TRAN: 30.0000 BUSINESS LICENSE
BOWEN CONTRUCTION NEW
BUSINESS LICENSES & 35.000R
TRAN: 33.0000 BUILDING PERMITS
20160230 50.0(jCR
BOWEN CONSTRUCTION
9405 CULLENS RD SE
DEMO 50.O(jCR
TENDERED: 85.00 (HECK
APPLIED: 85.00 -
CHANGE: _ 0.00
Olympic Region Clean Air Agency
2940 Limited Lane NW
Olympia, WA 98502
`I (360) 539 -7610 - FAX (360) 491 -6308 Contractor
South Bend Office (360) 942 -2137
,, ( Asbestos Permit
Port Townsend Office 360) 338 -6419
www.ORCAA.org
PROPERTY OWNER
Name: Brian Bowen Phone: (360) 825 -2018 Email:
Mailing Address: PO Box 42 City: Buckley State: WA Zip: 98321
Site Contact Person: John Ross Phone: (253) 380 -7757 Email: testes @ascdemo.com
Site Address: 9405 Cullen RD SE City: Yelm County: Zip: 0
ASBESTOS CONTRACTOR
Contractor Name: Ascendent LLC Phone: (253) 939 -4375 Email: hestes @ascendentdemo
Mailing Address: PO Box 1150 City: Sumner State: WA Zip: 98390
PROJECT INFORMATION
Start Date: Completion Date Work Shift Days: Work Shift Hours:
5/16/2016 5/23/2016 M 141 T O W [41 Th O F W Sa ❑ Su ❑ 7- 3:30pm
# Structures to be Abated: 1 Total Quantity to be Removed Square Feet: 2000 Linear Feet: 0
Disposal Site: Columbia Ridge Landfill, OR
Will all identified asbestos be removed from structure? Will this structure be demolished after asbestos removal?
W Yes ❑No Yes ❑No
Material(s) being removed: Project Category
flooring
textured coating ❑ Annual
❑ Emergency
I do certify that I am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application /permit. I
authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this
application /permit and to ensure compliance with permit conditions, applicable laws and regulations. I understand that granting of this permit by
ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read and
will abide by the conditions set forth in this permit and any addendum thereto.
I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is, to the
best of my knowledge true, accurate and complete.
Electronically submitted by: restes @ascdemo.com
Permit Conditions
Date Application Received Payment Info. 0 Approved Asbestos Permit:
pp Permit# 16ASB005272
Total Fee: $325.00 ❑ Disapproved
Demolition Permit:
5/6/2016 Receive date: 5/6/2016 Review date: 5/9/2016 Permit # DEM
Reviewed by: TG Survey: W Yes ❑No
Agency Use Only Agency Use Only Agency Use Only Agency Use Only
OVER
7M
110""
RICA►',
Olympic Region Clean Air Agency
2940 Limited Lane NW
Olympia, WA 98502
(360) 539 -7610 - FAX (360) 491 -6308
South Bend Office (360) 942 -2137
Port Townsend Office (360) 338 -6419
www.ORCAA.org
Contractor
Asbestos Permit
Asbestos projects within Clallam, Grays Harbor, Jefferson, Mason, Pacific, and Thurston counties REQUIRE A PERMIT and
require that the following conditions be met prior to the demolition or renovation.
Olympic Region Clean Air Agency ( ORCAA) regulations define an asbestos project as the construction, demolition, repair,
remodeling, maintenance, or renovation of any public or private building(s), vessel, structure(s), or component(s)
involving the demolition, removal, salvage, disposal, or disturbance of any asbestos containing material (ACM). ORCAA
defines ACM as 1 percent or more of asbestos. Asbestos - containing roofing material is not considered an asbestos
project if it meets all the requirements in ORCAA Regulation 6.3.1.
The following is merely a reference guide and not a substitute for agency regulations.
1.Asbestos samples must be sent to a NVLAP Laboratory (National Voluntary Laboratory Accreditation Program) per 40
CFR 763.87. A list of labs can be found on ORCAA's website.
22he start date on other structure asbestos abatements must be at least 14 days from the submission date of the
complete application and payment.
3.13 is the responsibility of the building owner and/or asbestos contractor to ensure all ACM identified (or suspected) in the
survey and proposed to be removed, has been removed and properly disposed of in accordance with ORCAA's Regulations.
4.A copy of the asbestos survey, approved Asbestos Permit, and any subsequent amendments must be kept on site and be
available for review by Agency inspection personnel.
5. 121se the Completion Notification and Amendment Form to make changes to the original permit.
62he original asbestos permit will expire on the Completion Date. To change the completion date, a Completion
Notification and Amendment form must be received PRIOR to expiration. If the permit expires and the project is not
complete, you must submit and pay for another asbestos permit. Under no circumstances will a project be extended
beyond 1 year from original start date.
7. 121pon completion of project, fill out and submit Completion Notification and Amendment form, documenting actual date
of completion.
ADDITIONAL REQUIREMENTS:
"Owner Occupied Residential Dwelling" means any single family housing unit which is permanently or seasonally occupied
by the owner of the unit both prior to and after the proposed project. This term includes houses, mobile homes, trailers,
houseboats, and houses with 'mother -in -law apartment' or a 'guest room.' This term does not include structures that are
demolished or renovated as part of a commercial or public project; nor does this term include any mixed -use building,
structure, or installation that contains a residential unit, or any building that is leased or used as a rental, or for commercial
purposes.
Emergency Project: An operation that was not planned but results from a sudden, unexpected event that, if not
immediately attended to, presents a safety or public health hazard, is necessary to protect equipment from damage, or is
necessary to avoid imposing an unreasonable financial burden. This term includes operations necessitated by non - routine
failures of equipment. The property owner must write a letter explaining the reason for the emergency. $50 non-
refundable emergency fee.
ASBESTOS
NORTHWEST
Asbestos Northwest, LLC
30620 Pacific Hwy S. #103, Federal Way, WA 98003
Phone# 253.941.4343 Fax# 253.941.4175
Attn: Rick Estes
Ascendent Inc
106 Frontage Rd N, Pacific, WA 98047
Project Location: 90054 Cullens Rd Se
Project # B 1643
Asbestos NW Batch #: 201610880
Date Analyzed: 5/20/2016
Samples Analyzed: 4
Sample ID
1
Location
ROOM 41
Start Time
07:20
Fibers/
Fields
16/100
Client ID
4
End Time
07:50
Sample Type
EX
Activity
REMOVING WALL CEILING
TEXTURE
Total Time
30
Fibers/ cc
0.1308
Pump
005
Start Rate
1 2
Environment
W DS NPE
Worker
SAMUEL
End Rate
2
Date
Sampled
5,,18 -2016
Protection
CV SAP
Cert #
Total Liters
60
Sample ID
3
Location
ROOM 43
Start Time
07:50
Fibers/
Fields
18/100
Client ID
5
End Time
14 :00
Sample Type
TWA
Activity
1
REMOVING WALL CEILING
1 TEXTURE
Total Time
370
Fibers/ cc
0.0119
Pump
005
Start Rate
2
Environment
W DS NPE
Worker
SAMUEL
End Rate
2
Date
Sampled
Si 1 812016
Protection
CV SAP
Cert #
Total Liters
740
Sample ID
3
Location
ROOM #3
Start Time
07:25
Fibers/
Fields
8 /100
Client ID
6
End Time
07:55
Sample Type
EX
Activity
REMOVING FLOOR TILE
WITH MASTIC
Total Time
30
Fibers/ cc
0.0654
Pump
005
Start Rate
2
Environment
W DS NPE
Worker
LUIS QUEVEDO
End Rate
2
Date
Sampled
�' 191/20 16
Protection
CV SAP
Cert #
Total Liters
60
Sample ID
4
Location
ROOM # I 42 #3 94
Start Time
07:55
Fibers/
Fields
101/54
Client ID
7
End Time
14:35
Sample Type
TWA
Activity
1
REMOVING FLOOR TILE
1 WITH MASTIC
Total Time
400
Fibers/ cc
0.1207
Pump
005
Start Rate
2
Environment
W DS NPE
Worker
LUIS QUEVEDO
End Rate
1.8
Date
Sampled
am p
5/19/2016
Protection
CV SAP
Cert #
Total Liters
760
Sampled By: JULIO DIAZ
Analyzed By: Sean Butler
Page 1 of 1
Date: 5/118/2016
Date: 5/20/2016
11.) U / W/ U
NVL Laboratories, Inc. CHAIN of CUSTODY
4708 Aurora Ave N, Seattle, WA 98103
Tel: 206.547.0100 Emerg.Pager: 206.344.1878 SAMPLE LOG
Fax: 206.634.1936 1.888.NVLIA (685.5227)
Client
Street
Project Manager
Project Location
10"A
L A , B S
NVL Batch Number
Client Job Number
Total Samples ----
Turn Around Time 1-Hr [J4 Hrs 4 Days
2-Hrs E 2 Days 5 Days
4-Hrs E] 3 Days 6 to 10 Days
Please call for TAT less than 24 Hrs
: I
Phone:
Asbestos Air
Email address
Fax:
.11:APCM(NIOSH7400) -- TEM (NIOSH 7402) ::I TEM (AHERA) :ITEM (EPA Level 11) []Other
'Asbestos Bulk 10 PLM (EPA/600/R-93/116) ❑ PLM (EPA Point Count)
� PLM (EPA Gravimetry) [-ITEMBulk
Mold/Fungus
0 Mold Air Cl Mold Bulk --'Rotometer Calibration
A
METALS
Inst./Det Lim
'El -7 -Pa
RCRA Metals
-W
Total Metals
FAA (ppm) Air Filter int Chips-in crn'
Arsenic (As) 7� Mercury (Hg) A
7�1 TCLP
ICp (ppm) [I Drinking water E Waste Water
Barium (Ba) "Selenium (Se) Copper (Cu)
XE lz�
L-i GFAA (ppb Dust/wipe (Area) Other
Nickel (Ni)
Cadmium (Cd) Silver (Ag)
J Soil
Chromium (Cr) Zinc (Zn)
i F-1 Paint Chips in %
Lead (Pb)
:i Other Types
E: Fiberglass ❑ Nuisance Dust [I Other (Specify)
of Analvsis
E--, Silica 17 Respirable Dust
Condition of Package-.71 Good a Damaged (no spillage) El Severe damage (spillage)
Seq.
Lab ID
Client Sample Number
1comments (e.g Sample area, Sample Volume, etc) AIR
3 00- ;
A
2
145-
Results Faxed by
3
4
XE lz�
0(
6
7
8
10
12
13
14
15
Print RWnw ATn-n-R-,in-w--� rnmnnnv data rim"
Sampled by
T-U& Atz
Relinquished by
Received by!��—.
3 00- ;
Analyzed by AA-d
Results Called by
Results Faxed by
Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after analysis.
t1
r
WE
r4 6�V
Project: q4O/ W 1. � illaot,
ASBESTOS A SAMPLING DATA
� Sheet ( of
Job #: 1� 4 1 Competent Person: r) f Sample Date:
Sample No,
Sample
type
Pump Model
lfameWorker cert WSoc Sec asks # emp. rep.
Y�
PPrworl,
t�rffff
<�
Time
(24hr)
Flow Rate
(Ipm)
Sample
Vol
(liters)
LOD
(Flcc)
r
Results
(F#leld)
Results
(F /cc)
0
Pre.
-`'
Pump No
L n/D��rip6or�rfences fir«
Cotp
Otf� ry
P007
Sample No.
Sample
type
Pump Model
Name/Worker cart #fSoc Sec V task 0 emp rep.
PPE wom
Time
(2
Flow Rate
(ipm)
mple
Vol
(liters)
LOD
(Floc)
Results
(Ftfield)
to
Results
(F /cc)
O
Pre
2o�c
Pump No
Local ptioNinte
Post
Total min
Avg
`
fff
/ C
Sample No.
Sample
type
Pump Model
Name/Worker cert x /Soc Sec V tasks # emp. rep.
PPE worn
Time
(24hr)
Flow Rate
(Ipm)
Pre
Sample
Vol
(liters)
LOD
(Flcc)
Results
(Flriefd)
Results
(F/cc
On
On
Pump Nop
LocafionlDescriptiordlnterferences
Controls
Oft
Post
Total min
Avg
Personal Sample Codes
TWA = Time Weighted Average EX = 30 minute Excursion
Number TWA sample sets: TWA 1 = first set, TWA2 = second set
All personal samples are to be collected in the employee's breathing zone
Respirator codes
HF = air purifying half face
FF = air purifying full face
PAPR = powered air purifying respirator
SAP = Type C pressure demand
SAC = Type C continuous flow
Resp. cartridge codes
HE = HEPA
OV = organic vapor
AG = acid gas
ST = stack cartridge
Other PPE codes
CV = coverall
HCV = hooded coverall
B = boots HO = hood
CG = cloth gloves RG = rubber gloves
LG = leather gloves
Area Sample Codes*
OWA= outside work area PR = preabatement IA = inside regulated area
HE = HEPA exhaust DE = outside decon CL = Clearance
*Must use a location description: example - 3' north and 5' west of Column Li, approx 5' high
_
Control codes
G = Glove bag HV = HEPA vacuum W = Wet methods
NPE = Negative pressure DV = Decon with vacuum AM = Alternate means
enclosure DS = Decon with shower PW = Prep Work
ME = Mini - enclosure WTD = work area tear down
Calibration
low Flow Rotometer Mfg. Model # ti/ .; - \% Serial # '� Calibration date hG3��
Data Hi h Flow Rotometer Model # Serial # '� Calibration date
I certify that the above samples were - 6-compliance with applicable standards, regulations and project s pecifications, r ----- —
er name ature Cent # Ex p. date r rrn Date
�
A7IIH-AA Accreditation O—C FOR LAS USE ONLY NVLAP Accreditation
Lab Analyst name Signature Analysis date Reviewer Review date
Print clearly in blue or black ink
J !
i
r11
ASBESTOS A SAMPLING DATA
Sheet / of
Project: Job #: Competent Person: Sample Date: -1= t.
Sample No. I
Sample
type
Pump Model
NamlWorker cert # /Soc Sec #R sks # emp. rep.
/ ,/� clo__k
f i/^"
PPE worn
V
Time
(24hr)
Flow Rate
(Ipm)
Sample
Vol
(liters)
LOD
(F /cc)
D
Results
(F(flfield)
O
Results
(F /cc)
.O�nI
Pre
Pump No.
Lora' nlDescriptigq�terfe ces
IGfl/ "i /L� G�
Control
Posh f�
Tota in
13
AVM J/
tr,t
Sample No.
Sample
type
Pump Model
Name/Worker Soc tasks e # emp. rep.
''c- ��-^
P
/ �
Time
(24hr)
Flow Rate
Qpm)
Sample
iter
(i��s)
LOD
(F/cc)
Results
(FJRetd)
I of
�^
59
Results
(Ficc)
Do-7
r
�
Pump No.
LocationlDescriptioNlnter ferertCes / !
1 L7/
/
Controls
-�
$ rte`
P°' t 'f`
T in
fjr
Avg
Sample No.
Sample
type
'Pump Model
NameWorker 040ysoc. Sec #1 tasks # emp. rep.
PPE wom
(4 )
Flow Rate
(Ipm)
ple
Vol
(liters)
LOD
(Floc)
Results
(F /Reid)
Results
(F /-)
On
Pre
Pump No.
Local ion /Description /Interferences
Controls
Ott
Post
Total min
Avg
Personal Sample Codes
Respirator codes
Resp. cartridge codes
Other PPE codes
TWA = Time Weighted Average EX = 30 minute Excursion
HF = air purifying half face
HE = HEPA
CV = coverall
FF = air purifying full face
OV = organic vapor
HCV = hooded coverall
Number TWA sample sets: TWA1 = first set, TWA2 = second set
PAPR = powered air purifying respirator
AG = acid gas
B = boots HO = hood
SAP = Type C pressure demand
ST = stack cartridge
CG = cloth gloves RG = rubber gloves
All personal samples are to be collected in the employee's breathing zone
SAC = Type C continuous flow
LG = leather gloves
Area Sample Codes'
Control codes
OWA= outside work area PR = preabatement IA = inside regulated area
G = Glove bag HV = HEPA vacuum W = Wet methods
HE = HEPA exhaust DE = outside decon CL = Clearance
NPE = Negative pressure DV = Decon with vacuum AM = Alternate means
'Must use a location description: example - 3' north and 5' west of Column L1, approx 5' high
enclosure DS = Decon with shower PW = Prep Work
E = Mini - enclosure WTD = work area tear down
Calibration
Low Flow Rotometer Mfg. X17711 Model # 5:° V Serial # Calibration date
Data
High Flow Rotometer Mfg. .4 Model # ' Serial # ! Calibration date
1 cert .that the a ove samples were taken in-Anpliance with applicable standards, regulati riss amend project specifications.
er name Cert # Ex p. date r irm Date
q
AIHA Accreditation # D
�F�:7 ,� 9A FOR LAB USE ONLY NVLAP Accreditation # "0
Lab Analyst name Signature Analysis date Reviewer Review date
Print clearly in blue or black ink