HomeMy WebLinkAbout17601 59TH AVENUE NE_BLD1221_2026 DEMOLITION
PERMIT APPLICATION
Department of Community& Economic Development
City of Arlington •.18204 59th Ave NE •Arlington,WA 98223 • Phone(360)403-3551
THIS APPLICATION MUST BE ACCOMPANIED WITH A COPY OF THE ASBESTOS/DEMOLITION NOTIFICATION FROM PUGET
SOUND CLEAN AIR AGENCY, TWO(2)COPIES OF AN ASBESTOS SURVEY REPORT AND ABATEMENT REPORT
(if applicable)COMPLETED BY AN APPROVED AGENCY.
Type of Permit:(check one) ❑ Residential Commercial ❑ Industrial
Project Address: -17601 S l" A v,,i,, NE Parcel lD#: 316S2.26e)20o`f o o 2,nC
Lot#: Subdivision: Valuation.
Building Area(Sq Ft) 2,g No. of floors: Number of Buildings:
Owner: (o.,,q PUD 1V0. I Phone Number:
Address: P•Q. Re nI 107 City: 9ve.reAt State: W A zip Code: 9 9 206
Contact Person: Phone Number: (4m) 2-&r-'72o
Cell Phone: ( 2-661 yil- Solo E-mail: C*Aq `p e�Ces►S�r.iat;on Co.+g
Address: 1 3036 dG✓orlu t,rK City: Matc.II•Go State: �IVA7 Zip Code: Ik2-75
Contractor: Pf 116 y Phone Number: CH 2 r) 2 6S-721
Address: i 3 0 3 6 B r y r_rI%l P,Lri 2—4. City: M ski lkc o —State: WA Zip Code: `192 7S
Contractor's License Number: P F_��L T'-03�� Expiration: 1Y ay m 6-r r ?t>17
Scope of Work: 7 F-�L
Dc�Io Cx1s+io4
S4e_ 9rwlih�
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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 Stat of Washington.
i� 123/l �,
Ap is nts Signature Date
Print Applicants Name
FOR STAFF USE ONLY Received
zil
NOV 2 3 2016
Permit'# Accepted By Amount Received Receipt# Date Received
RFP 10137 - Appendix C
1p FACILITIES AHERA INSPECTION REPORT
Snohomish County PUD No. 1
ASBESTOS INSPECTION REPORT
Arlington Airport Property,Red Barn
PREPARED FOR: Snohomish County PUD
PO Box 1107
Everett, Washington 98206-1107
INSPECTION PERSONNEL: Scott Basom
EPA AHERA-Certified Building Inspector
Number 13-0403 (exp. March 14, 2015)
INSPECTION DATE: 06/24/2014
REPORT PREPARED By: Scott Basom
REPORT ISSUE DATE: 7/14/2014
Snohomish County PUD No. 1
10/31/2013
FACILITIES AHERA INSPECTION REPORT
TABLE OF CONTENTS
1.0 EXECUTIVE SUMMARY I
1.1 ASBESTOS TEST RESULTS I
2.0 BACKGROUND 1
3.0 SCOPE OF WORK 1
4.0 RESULTS 1-2
5.0 LIMITATIONS 2
FIGURES
FIGURE 1: SAMPLE LOCATIONS 3
APPENDICES
APPENDIX A. INSPECTION METHODOLOGY
APPENDIX B. ACM SAMPLE DATA SHEET
APPENDIX C. PHOTO LOG AND PHOTOS
APPENDIX D. LABORATORY ANALYTICAL RESULTS
APPENDIX E. INSPECTOR CERTIFICATION
FACILITIES AHERA INSPECTION REPORT
1.0 EXECUTIVE SUMMARY
On June 24, 2014, Scott Basom, a Certified AHERA Building Inspector, with the
Snohomish County PUD District 1, Facilities Department, conducted a survey for suspect
asbestos-containing building materials (ACBM's) in the Arlington Barn at 17601 59th Ave.
NE,Arlington,WA. Sampling was conducted at the request of Doug Wilson,prior to
Demolition activities.
This document summarizes an asbestos inspection complying with the 40 CFR 763 Asbestos
Hazard Emergency Response ACT (AHERA). The document may also serve the purpose of
a "Good Faith Inspection" report(WAC 296-62-07721).
The information in this document needs to be communicated and made available to all
contractors and employees performing work in the structure referred to in this report as
the Arlington Barn, confined to 3.0 Scope of Work, of this report.
1.1 ASBESTOS
Five bulk samples were taken of suspect asbestos containing building materials to determine
the presence of asbestos. The samples were sent to RGA Laboratories for testing using
polarized light microscopy(PLM). Results of RGA's analysis found no asbestos in any of the
five samples. See the attached RGA Lab Analysis and report for details.
2.0 BACKGROUND
The purpose of this inspection was to determine if asbestos containing materials(ACM) are
present in the building materials on the Arlington Barn at 17601 59th AVE NE,Arlington,
WA.
The Barn is a wooden structure, in dilapidated condition, of unknown age, is vacant and
centrally located on acreage at the above address. The approximate size of the structure is,
32' x 54' x 30' high. Except for roofing materials and a short length of electrical wiring,no
other suspect ACM's were observed.
3.0 SCOPE OF WORK
The scope of work is to demolish and remove the structure in preparation for construction of
a new local office for Snohomish PUD District 1.
4.0 RESULTS
Results:
Sample identification(ID)numbers were assigned to each building material sample. The
sample ID#s begin with an acronym that represents the building, followed by a room#,then
a sample number. Each unique material within the room gets a sample number i.e.;
wallboard, ceiling tile, floor tile etc. and decimals are used to identify multiple samples taken
1
"FACILITIES AHERA INSPECTION REPORT
of homogenous materials. Example: sample ARB-01.1 was taken from the ARlington Barn,
material category 01, sample 1,which is wiring insulation connected to a ceiling mounted
light fixture, and it is one of multiple samples taken from a homogenous material within the
room. Homogenous sampling areas include samples of the homogenous materials found in
different rooms or areas.
Samples containing more than 1% asbestos are regulated as an asbestos containing material
(ACM). If a sample of a homogenous material contains greater than 1% asbestos then all the
material in the homogenous sample area is an ACM. Building material containing 1% or less
asbestos is considered non-ACM. All five of the samples tested are NON-ACM..
If during the course of renovation or demolition suspect materials are discovered that
are not identified in this survey,the materials should be treated as asbestos containing
materials until laboratory analysis proves otherwise.
5.0 LIMITATIONS
Asbestos inspections are non-comprehensive and subject to many limitations,including those presented below.
Our assessment has considered risks pertaining to asbestos;however,this inspection is limited to only those
locations sampled.This inspection was not designed to identify all potential concerns or to eliminate all risks
associated with demolition,material removal,or construction.This asbestos inspection was performed in
preparation for removal of asbestos containing materials in accordance with State of Washington and PSCAA
laws and regulations.
Materials that are suspected to exist in wall cavities and other hidden spaces are assumed to be asbestos-
containing until these areas can be inspected by an AHERA-certified building inspector.
The hazardous building materials and conditions presented in this report represent those observed on the dates
we conducted the asbestos inspection.This inspection is intended for the exclusive use of Snohomish County
PUD for specific application to the referenced property.This inspection is not intended to replace construction
or demolition plans,specifications,or bidding documents.This report is not meant to represent a legal opinion.
2
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APPENDIX A
INSPECTION METHODOLOGY
The asbestos inspection was performed by an AHERA-certified building inspector following
a modified sampling protocol in accordance with 40 CFR 763, the PSCAA Regulation III,
Article 4, and the State of Washington Department of Labor and Industries WAC 296-62-
077021.
The District survey followed work practice and engineering controls for asbestos sampling as
specified for Class III asbestos work(29 CFR 1926.1101).
The inspector marked the sampling locations on the remodel plans with a unique number
corresponding to the sample number to identify the material from which the sample was
collected.
Materials uniform in type, texture, color, and date of installation are considered to be
homogeneous materials (HMATs). Size and pattern changes for materials, such as ceiling
and floor tiles,may indicate that materials should not be considered homogeneous. Materials
were grouped into HMATs and assigned numbers. An HMAT#is an un-biased, non-
repeating, consecutive number assigned by the inspector to numerically represent a specific
HMAT. Unique sample numbers were generally developed as follows:
Building-HMAT#-HMAT SERIES#
A unique building code was given to each of the samples taken on the property. The
Arlington Barn samples were was identified as ARB-OX.Y. Where X is the homogeneous
material number, and Y is the sample letter or number.Numbers were used to designate
samples. Example,ARB-01.1, ARB is Arlington Barn, 01 is the homogenous series and .l is
the sample.
Suspected ACM samples were collected and stored in heavy-duty, self-sealing plastic bags
and shipped through the Operations Warehouse to the RGA Environmental lab in Seattle,
Washington. Samples were analyzed via polarized light microscopy(PLM) in accordance
with EPA 600/R-93/116, "Method for Determination of Asbestos in Bulk Building
Materials."
APPENDIX B
PV ACM BULK SAMPLE DATA SHEET PAGE t OF I
Project Name/Address:,_Arlington Barn Demo/17601 59`—"Ave NE,Arlington,WA
PUD Project#_A24891-01 Sampled By: Scott Basom Sample Date: 6 /24/ 14
Sample(s) Sent To: X RGA EMSL Other
Fax or Email Report To: sabasom isnopud.com
Additional Recipient(s): _
HM# 1 Material Description: Electrical wire insulation
Sample ID Sample Location&Material Location: Quantity: 10' long
ARB-1.1 Inside lighting 151 floor,ceiling at south center
ARB-1.2 Inside lighting I"floor, ceiling at south center
HM# 2 Material Description: Green Asphalt Rooflng&vapor barrier
Sample ID Sample Location&Material Location: Quantity: 2500 SF
ARB-2.1 Outside on the ground at the southwest corner of the barn
ARB-2.2 Outside on the around at the southwest corner of the barn
ARB-2.3 Outside on the ground at the east side near the entrance door
HM# Material Description:
Sample ID Sam le Location&Material Location: Quantity:
HM# Material Description:
Sample ID Sample Location&Material Location: Quantity:
HM# Material Description:
Sample ID Sample Location&Material Location: Quantity:
Special Instructions:
Results Due By:
APPENDIX C
WDURN
Project#
Field Photo Log Memory Card ID:iPhone
Date Downloaded: 6.24.14 Downloaded B :Scott Basom
Camera Final File Date Taken Photographer Picture Location, Subject
File Name Name
2014-06-24 Same 6.24.14 Scott Basom 17601 59` Ave NE Arlington WA Old Red
15.01.35 Barn-Interior light with wiring ARB-1.1
2014-06-24 Same 17601 59`' Ave NE Arlington WA Old Red
15.16.47 Barn-Outside roofing sample ARB-2.1
2014-06-24 Same " 17601 59th Ave NE Arlington WA Old Red
15.28.24 Bann-SE Elevation
APPENDIX C
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APPENDIX D
A
-7- RGA Hy
E N V I R O N M E N T A L NVLAP LAB CODE 200613-0
7/8/2014
Scott Basom
Snohomish County PUD
P.O. Box 1107
Everett, WA 98203-
RE: Bulk Asbestos Fiber Analysis; Batch# 141377
Dear Scott Basom,
Enclosed please find test results for the bulk samples submitted to our laboratory for analysis.
Examination of these samples was conducted for the presence of identifiable asbestos fibers using
polarized light microscopy(PLM)with dispersion staining in accordance with U.S. EPA method 600/R-
93/116, "Method for Determination of Asbestos in Bulk Building Materials."
For samples containing more than one separable layer of materials,the report will include findings for
each layer (labeled L-1 for layer one, L-2 for layer two, etc.). For multi-layered samples, NESHAP
requires that layers must be analyzed and reported separately.The asbestos concentration in a sample
is determined by visual estimation.
For those samples with asbestos concentrations between 1 and 10 percent based on visual estimation,
the EPA recommends a procedure known as point counting (NESHAP,40 CFR- Part 61). Point counting
is a statistically more accurate means of quantification for samples with low concentrations of asbestos. If
you would like us to further refine the concentration estimates of asbestos in these samples using point
counting, please let us know.
This report is considered highly confidential and will not be released without your approval. Samples are
archived for thirty(30) days following analysis. Samples that are not retrieved by the client are discarded
after thirty(30) days.
This report relates only to the items tested. If samples are not collected by RGA Environmental
personnel, accuracy of the results is limited by the methodology and expertise of the sample collector.
Analyses are cross-checked with other laboratories for quality assurance purposes.This report shall
not be reproduced except in full,without written approval of RGA Environmental. It shall not be used to
claim product endorsement by NVLAP or any other agency of the U.S. Government.
It has been a pleasure to be of service to you. Please call if there is anything further we can assist you
with.
Sincerely,
Russell Browne
Laboratory Director
Enclosure: Bulk Sample Results
3317 3rd Avenue S,Suite D,Seattle,WA 98134•P:(206)281-8858•F:(206)291-8922
www.rgaenv.com
- - -
3317 3rd Avenue S,Suite D,Seattle,WA 98134 HW�A
��� OFFICE:(206)281-8858 FAX::(206)281-8922 email:laboratory@rgaenv.com ENVIRONMENTAL Bulk Asbestos Fiber Analysis
EPA 600/R-93/116 NVLAP LAB CODE 200613-0
Snohomish County PUD RGA Batch Number: 14-1377
Project Location: 17601 59th St.NE Client Job Number:
Arlington,WA Number of Samples: 5
Report Key - -
Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous
RGA Lab ID Layer Description Components Components Components
Layer Comments(if applicable)
ARB-1.1 L-1 No Asbestos Detected 80% Rubber Particles
14012947 Black rubbery material 10°% Mineral Particles
10°% Resin and Binder
L-2 No Asbestos Detected 100% Copper Wire
Copper wire
ARB-1.2 L-1 No Asbestos Detected 80% Rubber Particles
14012948 Black rubbery material 10% Mineral Particles
10% Resin and Binder
L-2 No Asbestos Detected 100% Copper Wire
Copper wire
ARB-2.1 Black asphaltic material with white No Asbestos Detected 10% Glass Fiber 60% Asphalt Filler and Binder
14012949 rocks 20% Mineral Particles
10% Rocks
ARB-2.2 Black asphaltic material with green No Asbestos Detected 10% Glass Fiber 60% Asphalt Filler and Binder
14012950 rocks 20% Mineral Particles
10% Rocks
ARB-2.3 Black asphaltic material with green No Asbestos Detected 10% Glass Fiber 60% Asphalt Filler and Binder
14012951 rocks 20°% Mineral Particles
10% Rocks
This report relates only to the items tested.Tf samples are not collected by RGA Erwironmental personnel,accuracy of the results is limited by the methodology and expertise of the sample collector.Analyses are cross-
checked with other laboratories for qua lily assm anec purposes.This report shall not be reproduced except in full,without written approval of RGA Envirorunental.TI shall not be used to claim product endorsement by
NVLAP or any other agency of the U.S.Govcmmcnt. 11 ,
Sampled By: Client
Received By: Dawood Mirza 6/30/2014 -�
Reviewed By: Russell Browne 7/8/2014 Analyzed By: Abdulrazzak Mansurd 7/8/2014 Page 1 of 1
RGA Environmental, Inc. Sample Log f
3317 3rd Avenue S,Suite D
Seattle,WA, 98134 I
ivww.rgaenv.eom Chain of Custody
Ph:(206)281-8858 Fax:(206)281-8922
I
7 11 I
Client Company: Snohomish County PUD RGA Batch#:
i
Client Address: Client Job#:
PO BOX 1107 Client P.O.#: C73015
Everett WA 90206 Number of Samples:�5
City State Zip
425-783-8421 TYPE OF ANALYSIS
Phone#:
end or Cell#: ASBESTOS: METALS:
I
Fax 4: PCM(air) Paint Soil I
e-mail Address:sabasom0snonud.com X PLM(bulk) Wipe Air
Pt.Count(bulk) TCLP Water
Attention to: Scott Basom Other(Specify Method):
Project Location: Turn Around Time (other):
17601 59th Ave. NE 2 hour/4 hour Same Day One Day
I
Arlington,WA Two Days 3 Days 5 Days
,` x 2S c�
Condition: Good Damaged Severe Damage Price per Sample: $
# Client Sample ID I RGA Laboratory ID I Comments # Client Sample ID I RGA Laboratory ID I Comments
1 ARB-1.1 ►}p ,1- 94'3 11
2 ARB-1.2 2�10 12
3 ARB-2.1 3-94a 13
4 ARB-2.2 1z q S'> 14
5 ARB-2.3 _ti S 15
6 16
7 17
8 18
9 19
10 20
Signature Date Time
,Sampled by:
Relinquished by:
Received bz:
Received for Laboratory b : 4ok
Analyzed by: Ili
Preliminary Results Reported to Client by:
Final Report to Client h
Special Instructions: /
Results Due by: dULYS,2014
C00016-(Rev.1/14) *Unless requested in writing,all samples will be properly disposed of 30 days after fmal report date. Page 1 of 1
%'V LAP LAB C01 200613-0
3317 3rd Avenue S,Suite D,Seattle,WA 98134
OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory@rgaenv.com
RGA
ENVIRONMENTAL Bulk Asbestos Analysis Invoice # 14-1377
Snohomish County PUD 7/8/2014
P.O. Box 1107 RGA Batch Number: 14-1377
Everett,WA 98203- Client Job Number:
Project Location:
17601 59th St.NE
Arlington,WA
Purchase Order Number: C73015
LABORATORY
Service Turn-Around Date Rate Number of Samples Extended
PLM 5 day 7/8/2014 $25.00 5 $125.00
Please pay this amount: $125.00
Remit to Dept.61
RGA Environmental,Inc.
1466 66th Street
Emeryville,CA 94608
Phone: (800)776-5696
Fed ID#94-3051012
Terms Net Upon Receipt of Invoice
i
Certificate of completion
This is to cedlty that
Scott Basom
has 9a11sfacta9ly completed
4 hours of refresher training as an
AHERA Building Inapector
incomWiUS EPA Reg 110 IIA cr dhadw17922Part7e3
Course Date:3114/2014 � 14-0557
ink Rofix ahtr ioquueQ by:911412015
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CITY OF ARLINGTON
238 N. OLYMPIC AVE -ARLINGTON, WA. 98223
PHONE; (360) 403-3551
BUILDING PERMIT
Address:17601 59th Avenue NE Permit#:1221
Parcel#:31052200400200 Valuation:0.00
OWNER APPLICANT CONTRACTOR
Name:PUBLIC UTILITY DISTRICT NO 1 Name:Pellco Construction,Inc. Name:Pellco Construction,Inc.
Address:PO BOX 1107 Address:13036 Beverly Park Road Address: 13036 Beverly Park Road
City,State Zip:EVERETT,WA 98206 City,State Zip:Mukilteo City,State Zip:Mukilteo,WA 98275
Phone: Phone:206-641-5088 Phone:206-641-5088
MECHANICAL CONTRACTOR PLUMBING CONTRACTOR
Name: Name:
Address: Address:
City,State,Zip: City,State,Zip:
Phone: Phone:
LIC#: EXP: LIC#: EXP:
JOB DESCRIPTION
PERMIT TYPE: Demolition CODE YEAR: 2015
STORIES: CONST.TYPE:
DWELLING UNITS: OCC GROUP:
BUILDINGS: OCC LOAD:
PERMIT APPROVAL -
1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED
THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC 1 l0/IRC 110.
SALES TAX NOTICE:Sales tax rel o construction and construction materials in the City of Arlington must be reported on your sales tax return form
and co d City of Arlington#310 i
'Signature Print Name Date Released By Da
CONDITIONS
Approved as submitted.
THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY, ANY
CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION.
PERMIT FEES
Date Description Fee Amount
11/28/2016 Demolition Fee $100.00
11/28/2016 State Building Code Surcharge Fee $4.50
Total Due: $104.50
Total Payment: $0.00
Balance Due: $104.50
CALL FOR INSPECTIONS
BUILDING(360)403-3417
When calling for an inspection please leave the following information:
Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon
CITY OF ARLINGTON
238 N. OLYMPIC AVE -ARLINGTON, WA. 98223
PHONE; (360) 403-3551
BUILDING PERMIT
Address:17601 59th Avenue NE Permit#:1221
Parcel#:31052200400200 Valuation:0 00
OWNER •• APPLICANT CONTRACTOR
Name:PUBLIC UTILITY DISTRICT NO 1 Name:Pellco Construction,Inc. Name:Pellco Construction,Inc.
Address:PO BOX 1107 Address:13036 Beverly Park Road Address:13036 Beverly Park Road
City,State Zip:EVERETT,WA 98206 City,State Zip:Mukilteo City,State Zip:Mukilteo,WA 98275
Phone: Phone:206-641-5088 Phone:206-641-5088
MECHANICAL CONTRACTOR PLUMBING CONTRACTOR
Name: Name:
Address: Address:
City,State,Zip: City,State,Zip:
Phone: Phone:
LIC#: EXP: LIC#: I 1
JOB DESCRIPTION k�)(
PERMIT TYPE: Demolition CODE YEAR: 2015
STORIES: CONST.TYPE:
DWELLING UNITS: OCC GROUP:
BUILDINGS: 1 OCC LOAD:
PERMIT APPROV
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED
THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110.
SALES TAX NOTICE:Sales tax rel to construction and construction materials in the City of Arlington must be reported on your sales tax return form
and co d City of Arlington#310
"Signature Print Name Date Released By Da
CONDITIONS
Approved as submitted.
THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION.
PERMIT FEES
Date Description Fee Amount
11/28/2016 Demolition Fee $100.00
11/28/2016 State Building Code Surcharge Fee $4.50
Total Due: $104.50
Total Payment: $0.00
Balance Due: $104.50
CALL FOR INSPECTIONS
BUILDING(360)403-3417
When calling for an inspection please leave the following information:
Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon
i�
i
Permit Information
Date 11/23/2016
Permit Number 1221
Project Name Snohomish County PUD
Applicant Name Pellco Construction, Inc.
Applicant Address 13036 Beverly Park Road
City, State,Zip Mukilteo
Contact Cody Bye
Phone 206-641-5088
Email cody@pellcoconstruction.com
Permit Type Demolition
Site Address 17601 59th Avenue NE
Valuation 0.00
Status Applied
Permit Issued
Permit Expires
Square Feet 0
Type of Construction/Occupancy Load
Number of Stories 0
Proposed Use Remove Barn
Assigned To Launa Peterson
Property Information Owner Information
Parcel#:31052200400200 PUBLIC UTILITY DISTRICT NO 1
PUBLIC UTILITY DISTRICT NO 1 PO BOX 1107
17601 59TH AVENUE NE EVERETT,WA 98206
Contractors
Contractor Name Primary Phone Email Contractor License License#
Contact Type
IPellco Construction, 206-641- (Labor&
Inc. Cody Bye 5088 Cody@pellcoconstruction.co CONTRACTOR (Industries PELLCI*0380C
Review
Date T e Description Target Date Completed Date Assigned To Status
11/23/2016 Demolition 11/28/2016 Kevin Olander In Review
11/23/2016 (Demolition 11/28/2016 PW Admin Rev in Review
11/23/2016 (Demolition 11/28/2016 PW Storm Rev In Review
11/23/2016 Demolition 11/28/2016 PW-Sew-Rev I'n Review
11/23/2016 Demolition '11/28/2016 PW-Wat-Rev In Review
Fees
Fee Description Notes Amount
Demolition F24322 10.00.0 $100 00
State Building Code Surcharge Feel 386 00.01.0 $4.5
Total $104.50
Uploaded Files Upload File
i
Date File Uploaded B
11/23/2016 11:16:06AM 11221 Application df IFoster,Kristin
11/23/2016 11,16:06 AM 1.221 Asbestos Survey_.pdf IFoster, Kristin
DEMOLITION
PERMIT APPLICATION
_ Department of Community& Economic Development
City of Arlington •.18204 59th Ave NE•Arlington,WA 98223 • Phone(360)403-3551
THIS APPLICATION MUST BE ACCOMPANIED WITH A COPY OF THE ASBESTOS/DEMOLITION NOTIFICATION FROM PUGET
SOUND CLEAN AIR AGENCY, TWO(2)COPIES OF AN ASBESTOS SURVEY REPORT AND ABATEMENT REPORT
(if applicable)COMPLETED BYAN APPROVED AGENCY.
Type of Permit:(check one) ❑ Residential Commercial ❑ Industrial
Project Address: r7G0l SI" AyeA,, NE Parcel ID#: 916S226im20o l oo29%p
Lot#: Subdivision: Valuation
Building Area(Sq Ft) x 1r 72,$ No.of floors: Number of Buildings
Owner: Phone Number:
Address: P.Q. R-x 1107 City: gyese�kt- State: WA zip Code: 9 S 2-06
Contact Person: L Phone Number: (42,5) 2E&r--72 I 1
Cell Phone: C2061 6'1I— To88 E-mail: �6jj v
Address: 13*96 dc✓crlu P,rk- 12...1 City: 114.44,11fe-n Stater Zip Code: 11U-75
Contractor: Ff Nco ('ten S(NG}1 an rTh c, Phone Number: CH U) 2 6S-72. 1
Address: 2 0 k 6 Bry-esbi PKrK- Q- 4. City: M-.)ki I41 O State: wA Zip Code: 192 7S
Contractor's License Number: PELLCt4 03 2Qe_ Expiration:.Claym 6a r ?1)17
Scope of Work: - S L
Va�to C94-14"I
• "4G
Wa�cr/E I c ol•rt c�.1
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 Stat of Washington.
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Ap is nts Signature Date
Print Applicants Name
FOR STAFF USE ONLY
NOV 2 3 2016
Permit# Accepted By Amount Received Receipt# Date Received
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RFp 10137 - Appendix C
FACILITIES AHERA INSPECTION REPORT
Snohomish County PUD No. 1
ASBESTOS INSPECTION REPORT
Arlington Airport Property, Red Barn
PREPARED FOR: Snohomish County PUD
PO Box 1107
Everett,Washington 98206-1107
INSPECTION PERSONNEL: Scott Basom
EPA AIiERA-Certified Building Inspector
Number 13-0403 (exp.March 14,2015)
INSPECTION DATE: 06/24/2014
REPORT PREPARED BY: Scott Basom
REPORT ISSUE DATE: 7/14/2014
Snohomish County PUD No. 1
10/31/2013
i
f
FACILITIES AHERA INSPECTION REPORT
TABLE OF CONTENTS
1.0 EXECUTIVE SUMMARY 1
1.1 ASBESTOS TEST RESULTS 1
2.0 BACKGROUND 1
3.0 SCOPE OF WORK 1
4.0 RESULTS 1-2
5.0 LIMITATIONS 2
FIGURES
FIGURE 1: SAMPLE LOCATIONS 3
APPENDICES
APPENDIX A. INSPECTION METHODOLOGY
APPENDIX B. ACM SAMPLE DATA SHEET
APPENDIX C. PHOTO LOG AND PHOTOS
APPENDIX D. LABORATORY ANALYTICAL RESULTS
APPENDIX E. INSPECTOR CERTIFICATION
FACILITIES AHERA INSPECTION REPORT
1.0 EXECUTIVE SUMMARY
On June 24, 2014, Scott Basom, a Certified AHERA Building Inspector, with the
Snohomish County PUD District 1, Facilities Department, conducted a survey for suspect
asbestos-containing building materials (ACBM's) in the Arlington Barn at 17601 59th Ave.
NE,Arlington, WA. Sampling was conducted at the request of Doug Wilson,prior to
Demolition activities.
This document summarizes an asbestos inspection complying with the 40 CFR 763 Asbestos
Hazard Emergency Response ACT (AHERA). The document may also serve the purpose of
a "Good Faith Inspection" report(WAC 296-62-07721).
The information in this document needs to be communicated and made available to all
contractors and employees performing work in the structure referred to in this report as
the Arlington Barn, confined to 3.0 Scope of Work, of this report.
1.1 ASBESTOS
Five bulk samples were taken of suspect asbestos containing building materials to determine
the presence of asbestos. The samples were sent to RGA Laboratories for testing using
polarized light microscopy(PLM). Results of RGA's analysis found no asbestos in any of the
five samples. See the attached RGA Lab Analysis and report for details.
2.0 BACKGROUND
The purpose of this inspection was to determine if asbestos containing materials (ACM) are
present in the building materials on the Arlington Barn at 17601 59th AVE NE,Arlington,
WA.
The Barn is a wooden structure, in dilapidated condition, of unknown age, is vacant and
centrally located on acreage at the above address. The approximate size of the structure is,
32' x 54' x 30' high. Except for roofing materials and a short length of electrical wiring, no
other suspect ACM's were observed.
3.0 SCOPE OF WORK
The scope of work is to demolish and remove the structure in preparation for construction of
a new local office for Snohomish PUD District 1.
4.0 RESULTS
Results:
Sample identification (ID)numbers were assigned to each building material sample. The
sample ID#s begin with an acronym that represents the building, followed by a room#, then
a sample number. Each unique material within the room gets a sample number i.e.;
wallboard, ceiling tile, floor tile etc. and decimals are used to identify multiple samples taken
1
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FACILITIES AHERA INSPECTION REPORT
of homogenous materials. Example: sample ARB-01.1 was taken from the ARlington Barn,
material category 01, sample 1,which is wiring insulation connected to a ceiling mounted
light fixture, and it is one of multiple samples taken from a homogenous material within the
room. Homogenous sampling areas include samples of the homogenous materials found in
different rooms or areas.
Samples containing more than 1% asbestos are regulated as an asbestos containing material
(ACM). If a sample of a homogenous material contains greater than 1% asbestos then all the
material in the homogenous sample area is an ACM. Building material containing 1% or less
asbestos is considered non-ACM. All five of the samples tested are NON-ACM..
If during the course of renovation or demolition suspect materials are discovered that
are not identified in this survey,the materials should be treated as asbestos containing
materials until laboratory analysis proves otherwise.
5.0 LIMITATIONS
Asbestos inspections are non-comprehensive and subject to many limitations,including those presented below.
Our assessment has considered risks pertaining to asbestos;however, this inspection is limited to only those
locations sampled.This inspection was not designed to identify all potential concerns or to eliminate all risks
associated with demolition,material removal,or construction.This asbestos inspection was performed in
preparation for removal of asbestos containing materials in accordance with State of Washington and PSCAA
laws and regulations.
Materials that are suspected to exist in wall cavities and other hidden spaces are assumed to be asbestos-
containing until these areas can be inspected by an AHERA-certified building inspector.
The hazardous building materials and conditions presented in this report represent those observed on the dates
we conducted the asbestos inspection.This inspection is intended for the exclusive use of Snohomish County
PUD for specific application to the referenced property.This inspection is not intended to replace construction
or demolition plans,specifications,or bidding documents.This report is not meant to represent a legal opinion.
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APPENDIX A
INSPECTION METHODOLOGY
The asbestos inspection was performed by an AHERA-certified building inspector following
a modified sampling protocol in accordance with 40 CFR 763, the PSCAA Regulation III,
Article 4, and the State of Washington Department of Labor and Industries WAC 296-62-
077021.
The District survey followed work practice and engineering controls for asbestos sampling as
specified for Class III asbestos work(29 CFR 1926.1101).
The inspector marked the sampling locations on the remodel plans with a unique number
corresponding to the sample number to identify the material from which the sample was
collected.
Materials uniform in type,texture, color, and date of installation are considered to be
homogeneous materials (HMATs). Size and pattern changes for materials, such as ceiling
and floor tiles, may indicate that materials should not be considered homogeneous. Materials
were grouped into HMATs and assigned numbers. An HMAT#is an un-biased, non-
repeating, consecutive number assigned by the inspector to numerically represent a specific
HMAT. Unique sample numbers were generally developed as follows:
Building-HMAT# -HMAT SERIES#
A unique building code was given to each of the samples taken on the property. The
Arlington Barn samples were was identified as ARB-OX.Y. Where X is the homogeneous
material number, and Y is the sample letter or number.Numbers were used to designate
samples. Example,ARB-01.1, ARB is Arlington Barn, 01 is the homogenous series and .1 is
the sample.
Suspected ACM samples were collected and stored in heavy-duty, self-sealing plastic bags
and shipped through the Operations Warehouse to the RGA Environmental lab in Seattle,
Washington. Samples were analyzed via polarized light microscopy(PLM) in accordance
with EPA 600/R-93/116, "Method for Determination of Asbestos in Bulk Building
Materials."
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APPENDIX B
PV I ACM BULK SAMPLE DATA SHEET PAGE I OF I
Project Name/Address:_Arlington Barn Demo/17601 590 Ave NE, Arlington,WA
PUD Project#: 324891-01 Sampled By: Scott Basom Sample Date: 6 /24/ 14
Sample(s) Sent To: X RGA EMSL Other
Fax or Email Report To: sabasom(&snopud.com
Additional Recipient(s):
HM# 1 Material Description: Electrical wire insulation
Sample ID Sample Location&Material Location: Quantity: 10' long
ARB-1.1 Inside lighting I"floor, ceiling at south center
ARB-1.2 Inside lighting I"floor,ceiling at south center
HM# 2 Material Description: Green Asphalt Roofing&vapor barrier
Sample ID Sample Location&Material Location: Quantity: 2500 SF
ARB-2.1 Outside on the ground at the southwest corner of the barn
ARB-2.2 Outside on the ground at the southwest corner of the barn
ARB-2.3 Outside on the ground at the east side near the entrance door
HM# Material Description:
Sample ID Sample Location&Material Location: Quantity:
HM# Material Description:
Sample ID Sample Location&Material Location: Quantity:
HM# Material Description:
Sample ID Sample Location&Material Location: Quantity:
Special Instructions:
Results Due By:
3'
APPENDIX C
Puv
Project#
Field Photo Log Memory Card ID:iPhone
Date Downloaded: 6.24.14 Downloaded By:Scott Basom
Camera Final File Date Taken Photographer Picture Location, Subject
File Name Name
2014-06-24 Same 6.24.14 Scott Basom 17601 59`'Ave NE Arlington WA Old Red
15.01.35 Barn-Interior light with wiring ARB-1.1
2014-06-24 Same 17601 59` Ave NE Arlington WA Old Red
15.16.47 Barn-Outside roofing sample ARB-2.1
2014-06-24 Same 17601 591h Ave NE Arlington WA Old Red
15.28.24 Barn-SE Elevation
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APPENDIX C
1 1• 1 1 1•
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APPENDIX D
`� RG
E N V I R O N MENTAL NVLAP LAB CODE 200613-0
7/8/2014
Scott Basom
Snohomish County PUD
P.O. Box 1107
Everett,WA 98203-
RE: Bulk Asbestos Fiber Analysis; Batch# 141377
Dear Scott Basom,
Enclosed please find test results for the bulk samples submitted to our laboratory for analysis.
Examination of these samples was conducted for the presence of identifiable asbestos fibers using
polarized light microscopy(PLM)with dispersion staining in accordance with U.S. EPA method 600/R-
93/116, "Method for Determination of Asbestos in Bulk Building Materials."
For samples containing more than one separable layer of materials,the report will include findings for
each layer (labeled L-1 for layer one, L-2 for layer two, etc.). For multi-layered samples, NESHAP
requires that layers must be analyzed and reported separately. The asbestos concentration in a sample
is determined by visual estimation.
For those samples with asbestos concentrations between 1 and 10 percent based on visual estimation,
the EPA recommends a procedure known as point counting (NESHAP, 40 CFR- Part 61). Point counting
is a statistically more accurate means of quantification for samples with low concentrations of asbestos. If
you would like us to further refine the concentration estimates of asbestos in these samples using point
counting, please let us know.
This report is considered highly confidential and will not be released without your approval. Samples are
archived for thirty(30) days following analysis. Samples that are not retrieved by the client are discarded
after thirty(30) days.
This report relates only to the items tested. If samples are not collected by RGA Environmental
personnel, accuracy of the results is limited by the methodology and expertise of the sample collector.
Analyses are cross-checked with other laboratories for quality assurance purposes. This report shall
not be reproduced except in full,without written approval of RGA Environmental. It shall not be used to
claim product endorsement by NVLAP or any other agency of the U.S. Government.
It has been a pleasure to be of service to you. Please call if there is anything further we can assist you
with.
Sincerely,
Russell Browne
Laboratory Director
Enclosure: Bulk Sample Results
3317 3rd Avenue S,Suite D,Seattle,WA 98134•P:(206)281-8858•F:(206)281-8922
www.i-gaenv.com
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3317 3rd Avenue S,Suite D,Seattle,WA 98134
��� OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory@rgaenv.cam W V
ENVIRONMENTAL Bulk Asbestos Fiber Analysis EPA 600/R-93/1161 NVLAP LAB CODE200613-0
Snohomish County PUD RGA Batch Number: 14-1377
Project Location: 17601 59th St.NE Client Job Number:
Arlington,WA Number of Samples: 5
Report Key
Client Sample ID Layer ID(if applicable) Asbestos Non-Asbestos Fibrous Non-Fibrous
RGA Lab ID Layer Description Components Components Components
Layer Comments(if applicable)
ARB-1.1 L-1 No Asbestos Detected 80% Rubber Particles
14012947 Black rubbery material 10°% Mineral Particles
10% Resin and Binder
L-2 No Asbestos Detected 100% Copper Wire
Copper wire
ARB-1.2 L-1 No Asbestos Detected 80% Rubber Particles
14012948 Black rubbery material 10% Mineral Particles
10% Resin and Binder
L-2 No Asbestos Detected 100°% Copper Wire
Copper wire
ARB-2.1 Black asphaltic material with white No Asbestos Detected 10% Glass Fiber 60% Asphalt Filler and Binder
14012949 rocks 20% Mineral Particles
10°% Rocks
ARB-2.2 Black asphaltic material with green No Asbestos Detected 10% Glass Fiber 60% Asphalt Filler and Binder
14012950 rocks 20% Mineral Particles
10% Rocks
ARB-2.3 Black asphaltic material with green No Asbestos Detected 10% Glass Fiber 60% Asphalt Filler and Binder
14012951 rocks 20% Mineral Particles
10% Rocks
This report relates only to the items Icsted.If samples are not collected by RGA Environmental personnel,accuracy of the results is Iimiled by the methodology and expertise of the sample collector.Analyses are cross-
checked with other laboratories for quality assurance purposes,This repot t shall not be reproduced except in full,without written approval oI'RGA Environmenal,It shall not be used to claim product endorsement by
NVLAP or any other agency of the U.S.Government. I ' 1
Sampled By: Client
Received By: Dawood Mirza 6/30/2014 -
Reviewed By: Russell Browne 7/8/2014 Analyzed By: Abdulrazzak Mansurd 7/8/2014 Page 1 of 1
RGA Environmental, Inc. Sample Log
3317 3rd Avenue S,Suite D
Seattle,WA, 98134
wivw.rgaenv.c°m Chain of Custody
Ph:(206)281-8858 Fax:(206)281-8922 r 11
Client Company: Snohomish County PUD RGA Batch M
Client Address: Client Job#:
PO BOX 1107 Client P.O.#: C73015
Everett WA 90206 Number of Samples: ,r,
City State Zip `
425-783-8421 TYPE OF ANALYSIS I
Phone#:
2nd or Cell#: ASBESTOS: METALS:
Fax#: PCM(air) Paint Soil
e-mail Address:sabasomta'7_snopud.com X PLM(bulk) Wipe Air
Pt.Count(bulk) TCLP Water
Attention to: Scott Basom 10ther(Specify Method):
Project Location: Turn Around Time (other):
17601 59th Ave. NE 2 hour/4 hour Same Day One Day +
Arlington, WA Two Days 3 Days 5 Days
c�
Condition: x Good Damaged Severe Damage Price per Sample: $ —2,
# Client Sample ID I RGA Laboratory ID I Comments # Client Sample ID I RGA Laboratory ID I Comments
1 ARB-1.1 t}p VL 14"3- 11
2 ARB-1.2 2 9`(� 12
3 ARB-2.1 1 944 13
4 ARB-2.2 L 9 5" 14
5 ARB-2.3 �'t, S It 15
6 16
7 17
8 18
9 19
10 20
Signature Date Time
Sampled by: ✓ -r r_�
Relinquished by:
Received b :
Received for Laboratory by: QA wa,4 M k1'4-w,
Analyzed b
Preliminary Results Reported to Client by: l
Final Re orl to Client by:
Special Instructions:
Results Due by: Jul_Y�,,2014
C00016-(Rev.1/14) *Unless requested in writing,all samples will be properly disposed of 30 days after final report date. Page 1 of 1
arch
NVLAP LAB CODE 200613-0
3317 3rd Avenue S,Suite D,Seattle,WA 98134
RGA OFFICE:(206)281-8858 FAX:(206)281-8922 email:laboratory@rgaenv.com
ENVIRONMENTAL Bulk Asbestos Analysis Invoice # 14-1377
Snohomish County PUD 7/8/2014
P.O. Box 1107 RGA Batch Number: 14-1377
Everett,WA 98203- Client Job Number:
Project Location:
17601 59th St.NE
Arlington,WA
Purchase Order Number: C73015
LABORATORY
Service Turn-Around Date Rate Number of Samples Extended
PLM 5 day 7/8/2014 $25.00 5 $125.00
Please pay this amount: $125.00
Renvt to Dept.61
RGA Environmental,Inc.
1466 66th Street
Emeryville,CA 94608
Phone: (800)776-5696
Fed ID#94-3051012
Terms Net Upon Receipt of Invoice
Certificate of Completion
This is to cerm that
Scott Basom
has satisFactuily complelEd
4 hours of refresher training as an
AHERA Building Inspector
in compliance with TSCA I roe a AHERA 40 CFR Part763
U,S EPA RcgronloAcvectaGon9792
Course Date�311412014 14-0557
T �J� Ro6rcrh�t,cquned by:311-01201 S
�`)` 8 d 7 , A,, ^suite D
134.888.261,8858
E V V i K U N M E N TA www rgatraming.com
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Date: 03/12/2026
Permit#: 1221
Permit Date: 11/23/2016
Review Date: 11/23/2016
Permit Type: DEMOLITION
Review Type: DEMOLITION
Target Date: 11/28/2016
Scheduled Time: 00:00
Completed Date: 11/23/2016
Description: I assume PUD did an environmental assessment on the area of the barn. Ok, to issue. BB
Review Status:
Assigned To: PW Storm Rev
Time In: 00:00
Time Out: 00:00
Hours: 0.0
Property Information
Parcel#: 31052200400200 PUBLIC UTILITY DISTRICT NO 1
PUBLIC UTILITY DISTRICT NO 1 PO BOX 1107
17601 59TH AVENUE NE EVERETT,WA 98206
Zoning: Lot: Block:
Permit#: 1221
Permit Date: 11/23/16
Permit Type: DEMOLITION
Project Name: Snohomish County PUD
Applicant Name: Pellco Construction, Inc.
Applicant Address: 13036 Beverly Park Road
Applicant, City, State, Zip: Mukilteo
Contact: Cody Bye
Phone: 206-641-5088
Email: cody@pellcoconstruction.com
Scope of Work: Remove Barn
Valuation: 0.00
Square Feet: 0
Number of Stories: 0
Construction Type:
Occupancy Group:
ID Code:
Permit Issued: 12/05/2016
Permit Expires:
Form Permit Type:
Status: COMPLETE
Assigned To: Launa Black
Property
Parcel# Address Legal Description Owner Name Owner Phone Zoning
31052200400200 17601 59TH AVENUE NE PUBLIC UTILITY
DISTRICT NO 1
Contractors
Contractor Primary Contact Phone Address Contractor Type License License#
Pellco Construction,Inc. Cody Bye 206-641-5088 13036 Beverly CONSTRUCTION Labor&Industries PELLCI*038QC
Park Road CONTRACTOR
Plan Reviews
Date Review Type Description Assigned To Review Status
11/23/2016 DEMOLITION BUILDING
11/23/2016 DEMOLITION No comments,LT PW-ADMIN-GIS
11/23/2016 DEMOLITION I assume PUD did an environmental assessment on the pW Storm Rev
area of the barn.Ok,to issue.BB
11/23/2016 DEMOLITION No issues.FR PW-SEW-REV
11/23/2016 DEMOLITION No Comments.GS PW-WAT-REV
Fees
Fee Description Notes Amount
Demolition $100.00
State Surcharge- 1st DU Residential- 1st Unit $4.50
Total $104.50
Attached Letters
Date Letter Description
11/28/2016 Building Permit
Payments
Date Paid By Description Payment Type Accepted By Amount
12/05/2016 Tim Tobin 62574596 cc $104.50
Outstanding Balance $0.00
Notes
Date Note Created By:
02/20/2019 Expired.Filed in address files.No final was done. Raelynn Jones
Uploaded Files
Date File Name
12/05/2016 1980352-1221 Issued Permit.pdf
11/23/2016 1965232-1221 Asbestos Survey..pdf
11/23/2016 1965233-1221 Application.pdf