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Home My WebLink About16828 91st Ave NE_BLD916_2026 CITY OF ARLINGTON 238 N. OLYMPIC AVE-ARLINGTON, WA. 98223 PHONE; (360) 403-3551 BUILDING PERMIT Address:16828 91st Ave NE Permit 4:916 Parcel#:31052500201600 Valuation:346800 00 OWNER APPLICANT CONTRACTOR Name:TIM KAINTZ Name:Tim Bruggman Name:Springbrook Nursery Address:P.O.Box 610 Address:P.O.Box 1377 Address:9022 84th St NE City,State Zip:LAKE STEVENS,WA 98258 City,State Zip:Monroe,WA 98272 City,State Zip:Arlington,WA 98223 Phone:425-359-4457 Phone:425-308-3519 Phone:360-653-6545 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: 2012 STORIES: 2 CONST.TYPE: DWELLING UNITS: 1 OCC GROUP: BUILDINGS: 2 OCC LOAD: PERMIT APPROVAL 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/IRCI 10. SALES TAX O (' :Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax return form and coded C f t #3101. gtinature Print N nc a Released By bat CONDITIONS Armored entrance required for truck traffic. See Detail G-12 for Rock Construction Entrance requirement. Septic tank shall be abandoned per Department of Health before demolition work is to start. 24 hour notice to the Wastewater Department required for abandonment of septic system. 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 2/24/2016 Demolition Fee $100.00 2/24/2016 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 r Permit Information Date 2/17/2016 Permit Number 916 Project Name Kaintz Applicant Name Tim Bruggman Applicant Address P.O.Box 1377 City,State,Zip Monroe,WA 98272 Contact Tim Bruggman Phone 425-308-3519 Email tb@goldeneagleds.com Permit Type Demolition Site Address 16828 91 st Ave NE Valuation 346800.00 Status Applied Permit Issued Permit Expires Square Feet 3358 Type of Construction/Occupancy Load Number of Stories 2 Proposed Use Demo of building Assigned To Kristin Foster Property • • Owner Information Parcel#:31052500201600 TIM KAINTZ TIM KAINTZ P.O.Box 610 16828 91 STAVE NE LAKE STEVENS,WA 98258 425-359-4457 Contractors Contractor Name Primary Contact Phone Email Contractor Type License License# Sprin brook Nurse 360-653-6545 Isprinni942nm J70NTRACTOR JLabor&Industries PRINN1942NM Review Date Type Description Target Date Completed Date Assigned To Status 2/18/2016 IDemolition 1 12/24/2016 Kevin Olander In Review 2/18/2016 jDemolition /24/2016 IPW Admin Rev In Review 2/18/2016 IDemolition /24/2016 DPW Storm Rev In Review 2/18/2016 IDemolition /24/2016 PW-Sew-Rev In Review /18/2016 emolition /24/2016 PW-Wat-Rev In Review Fees Fee Description Notco Amount Demolition Feel 322.10.00.04 1 $100.0 State Building Code Surcharge Feel 386.00.01.0 $4 5 Upload File Date File. 2/18/2016 10:17:37 AM PSC----r pdf 2/18/2016 10:17:37 AM BpR lication. df 2/18/2016 10:17:36 AM [Asbestos Survev.pdf 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 FROMPUGET 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: 16828 91 st Ave NE Parcel ID#: 31052500201600 Lot#: Subdivision. Valuation: 346800.00 Building Area(Sq Ft)3358 No. of floors: 2 Number of Buildings.-I. Owner: Tim Kaintz Phone Number: 425-359-4487 Address: PO Box 610 City:Lake Stevens State: Wa Zip Code:98258 Contact Person Tim Bruggman Phone Number: 425-308-3519 Cell Phone: 425-308-3519 E-mail:tb@goldeneagleds.com Address: PO Box 1377 City:Monroe State: Wa Zip Code: 98272 Contractor: Springbrook Nursery Phone Number: 360-653-6545 Address: 9022 84th st NE City: Arlington State: Wa Zip Code: 98223 Contractor's License Number:cc sprinni942nm Expiration:8-14-16 Scope of Work: Demo building I hereby certify! t the above information is correct and that the construction on, and the occupancy and the use of the above- described pr r y will be in accordance with the laws, rules and regulations of the Stat of Washington. AAV ppli ignature Date Pri t Applicantffqame FOR STAFF USE ONLY I FEB 17 2016 Permit# Accepted By Amount Received Receipt# Date Received ♦j �/ ^�+ • I Approved Transaction Page 1 of 1 psc lea nair.org Puget Sound Clean Air Agency Notification Case #: 20160OS71 This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site(Reg III,4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction #ATOFEOFBB14C Transaction Date 02/03/16 Owner's Name Tim Kaintz Phone (425) 359-4487 Project Street Address 16828 91st ave NE City ARLINGTON Zip 98223 Contact Person Tim Bruggman Phone (425) 308-3519 Mailing Address PO Box 610 Lake Stevens,WA 98258 This project includes a demolition. Demolition Start Date 02/22/16 Completion Date 03/11/16 Demolition will be completed by a demolition contractor Demo Contractor Springbook Contracting Contractor Job # Contact Gordy Phone (425) 508-9434 Mailing Address 9022 84th st ne Arlington Wa 98223 ,WA 98223 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed.The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. https:Hsecure.pscleanair.org/Asbestos/Approved.aspx 2/3/2016 A-T Asbesto-Test, Inc. 1429 Ave.A H187,Snohomish,WA 98290 425-489-4040 xu•�r.urb�nioa•,rr.rnnr,nr/�g¢esraestcom ASBESTOS SURVEY House and Garare(y 16828 91"Ave.NE.,Arlineton, WA 98223 Page I of 8 January 29,2016 PAT2160109 Golden Eagle Development Services POB 1377 Monroe,WA 98272 Attn.: Tim Bruggman cc: Mick Cermak tb aC)eoldeneaeleds.com ; mcermakOlp_ihomes.com On January,212016,Asbesto-Test personnel conducted an Asbestos survey(per U.S.E.P.A./A.H.E.R.A.guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State)of the house and-aru e(a)16828 91"Ave.NE.,Arlington, .Snohomish C,ountj% 6f ashin(,ton 98223. This survey purpose is to identify asbestos containing materials,prior to demolition. Note: Samples of suspect Asbestos Containing Materials were taken and analyzed for the presence of asbestos. THERE WAS NO ASBESTOS DETECTED/N ANY OF THE SAMPLES TAKEN.if there is any additional suspect ACM located prior to or during demolition(such as,but not limited to,those materials listed on the lost page of this report),that was not discovered in this survey,the material(s)must be Presumed Asbestos Containing Material unless tested otherwise by laboratory analysis. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The house is one story wood frame on a basement. The siding is wood. The siding vapor barrier materials were sampled. The roofing is composition. The composition roofing materials were also sampled. INTERIOR CONSTRUCTION, FINISHES, AN FLOORINGS: The interior construction is wood and drywall. The drywall/taping materials were sampled.The vinyl flooring materials with relating backing and mastic materials were sampled.The masonry tile and mortar materials were also sampled. The miscellaneous mastic materials were also sampled. INSULATION: The insulation was sampled. continue to page 2 40BBB Page g f 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage ref,16828 91"Ave. NE.,Arlin(Ttun, WA 98223 ELECTRICAL SYSTEM: The electrical wiring insulation did not appear to be the kind to be ACM. The power may have been"on"at the time of the inspection,thus sampling was not safe. Any suspect electrical wiring insulation or any suspect TSI(Thermal System Insulation)found in, around, or behind any located fuse or breaker boxes should be considered to be ACM (Asbestos Containing Material), unless determined otherwise by laboratory analysis. HEATING AND VENTILATION SYSTEM:There is an electric forced air furnace in the structure.There was no relating suspect ACM located. Note:It was not possible to dismantle the furnace and ducting to locate and/or evaluate any additional suspect ACM that may be concealed, inside the unit, or associated in hidden areas. It is our opinion any further handling of the furnace system should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect materials are located prior to and/or during any demolition or renovation, any and all additional related suspect materials should be considered to be ACM (Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. Any TSI that may be present inside or outside the furnace and/or ducting system including but not limited to all gaskets,joint compounds, sealants, and/or insulations,are PACM unless tested otherwise by laboratory analysis. • There is a fireplace in the house. The fire brick materials were sampled. The fireplace decorative brick and mortar materials were also sampled. MISC.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: There is a wood frame garage adjacent to the structure. The roofing is composition.The siding vapor barrier materials and composition roofing materials were sampled. There is also a wood frame shed on the back portion of the property.The composition roofing materials under the metal roof of the shed were sampled. #of structures included in survey:one house,one garage,one shed Requested by: Tim Bruggman 1n W Rv.MrBOn SuJ9315 S,M,WA W119 29B Je'33] I,uc nIMes lRol '-. CIJ .Mph.,L.PON— umlJcromy ccmlmm I,J.JM,vu nl ealnbMl.e n, R.Oeeuo BUIIEIng InWdOr ,,o,n A vnM TdCA TO,II IJO CrR 760(Al ILIIAI COL ww 15159] gUu'W QM.111M'Mw2' 97n 16 JWnwkwnw rq fyr4 IM.:N GU I6 Christopher Patterson Inspector,certified A.H.E.R.A. Accred.#151593 EXP.May 28,2016 continue to page 3 BBBZPAP4M (:�D 1429 Ave.D.9187,Snohomish,WA 98290 425-489-4040;j775-665-0420 shrrr.asbestokst.com:taL00xbleslohyl.com Page 3 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garane(a),16828 91'Ave. NE.,Arlington, WA 98223 THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL DOWNSTAIRS 1.0 masonry tile NAD non-fibrous materials entry&stairwell 2.0 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 3.0 sheet vinyl flooring NAD non-fibrous materials laundry-color:light gray cellulose,fiberglass 4.0 mastic NAD adhesive beneath previous sample listed 5.0 mastic NAD adhesive,cellulose holding base cove-homogenous throughout 6.0 sheet vinyl flooring NAD non-fibrous materials bathroom-color:white cellulose,fiberglass 7.0 mastic NAD adhesive beneath previous sample listed 8.0 drywall NAD non-fibrous materials sample 1 cellulose,fiberglass, paint,gypsum 8.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 9.0 drywall NAD non-fibrous materials sample 2 cellulose,fiberglass, paint,gypsum 9.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 10.0 drywall NAD non-fibrous materials sample 3 cellulose,fiberglass, paint,gypsum 10.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass continue to page 4 40 Aga BBB CID /429Ave.D.9187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 rrnr•w.ashtwotestcoir infix-akishmsiotestconr i Page 8 g January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage &16828 91"Ave. NE.,Arlinp-ton, WA 98223 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL MAIN FLOOR 11.0 mastic NAD adhesive,cellulose bathroom countertop 12.0 sheet vinyl flooring NAD non-fibrous materials bathroom floor-color: light blue/off white cellulose,fiberglass 13.0 mastic NAD adhesive beneath previous sample listed 14.0 "squeak paper" NAD cellulose,tar beneath wood flooring throughout 15.0 mastic NAD adhesive,cellulose kitchen holding laminate on countertop 16.0 masonry tile NAD non-fibrous materials kitchen splash 17.1 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 18.0 sheet vinyl flooring NAD non-fibrous materials kitchen under pergo&in pantry-color:gray 19.0 mastic NAD adhesive beneath previous sample listed 15.0 masonry tile NAD non-fibrous materials bathroom splash&shower 16.0 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 17.0 sheet vinyl flooring NAD non-fibrous materials bath floor-color:cream 18.0 mastic NAD adhesive beneath previous sample listed 19.0 mastic NAD adhesive,cellulose kitchen holding laminate on countertop 20.0 masonry tile NAD non-fibrous materials shower continue to page 5 •� ASS BBB a_T 1429 Ave.D, #187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 a•uac.n.�•hnrfafesl.canr.HrJn(�t�ash/vsloten.cnm i i Page 5 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage(a)16828 91't Ave.NE.,Ariington, {d A 98223 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL 21.0 decorative fireplace brick NAD non-fibrous materials fireplace exterior 22.0 mortar NAD non-fibrous materials, holding fireplace brick sample 1 cellulose 22.1 mortar NAD non-fibrous materials, holding fireplace brick sample 2 cellulose 22.2 mortar NAD non-fibrous materials, holding fireplace brick sample 3 cellulose 23.0 firebrick NAD non-fibrous materials inside fireplace 24.0 drywall NAD non-fibrous materials kitchen cellulose,fiberglass, paint,gypsum 24.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 25.0 drywall NAD non-fibrous materials dining room cellulose,fiberglass, paint,gypsum 25.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 26.0 drywall NAD non-fibrous materials living room cellulose,fiberglass, paint,gypsum 26.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 27.0 drywall NAD non-fibrous materials master bathroom cellulose,fiberglass, paint,gypsum 27.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 28.0 drywall NAD non-fibrous materials master bedroom cellulose,fiberglass, paint,gypsum 28.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass continue to page 6 BBB ® CD 1429Ave,D.#187,Snohomish,WA 98290 425-489-4040;f775-665-0420 wmitimbestotest.eom;in/oOktshteNtotesixt?m I Page 6 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage(a) 91"1 Ave.NE.,Arlington, WA 98223 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL COMMON AREAS: 29.0 insulation NAD fiberglass,cellulose color:beige 30.0 composition roofing NAD cellulose,tar, non-fibrous materials 31.0 vapor barrier NAD cellulose,tar beneath previous sample 32.0 mastic NAD cellulose,adhesive holding composition roofing 33.0 vapor barrier NAD cellulose,fiberglass beneath siding exterior GARAGE The composition roofing is homogenous with the house. 34.0 vapor barrier NAD cellulose,tar beneath siding exterior continue to page 7 BBB® C I1�8 AST �.YI�MM 1429Ave.D.#187,Snohomish,WA 98290 425-489-4040;f775-665-0420 +rw+r.asbN.e�mrq.c-nnr:hf�shlevlMe-y.cn�n i � ti Page 7 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Gara,w(a 16828 91"Ave. NE.,Arlinwon. WA 98223 Arlington WA98223 a Ad M I& AM 1 continue to page 8 NMI �.., ®I 1429 Ave.A#187,Snohomish,WA 98290 425-489-4040;f775-665-0420 wwwasbe tore t.cnm:idgRiu'bleslolest.com i . � ■ i ■ F k . _ r ME Lr E� ■ No �+ME 0 MEN } . _ J ■ ME 4b 1 _ El M ME No ■ A 0Z 1• IN •N , ■ ■ 04 L i ' ■ ■ MEN _ •■ • • r ELMI • ■ ■ T ■ ■ 1r ■ 1 ■ ■ ■ ■ MINI _ ■ ■IL ■ : -■ml ti; L 7 Elm ■ '•. 1 ` . ■ b• Page 8 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garrt._-e(a) 16828 91"Ave. NG,Arlington, WA 98223 Samples taken ore listed with their corresponding analyses.If asbestos is detected,those samples containing asbestos are listed first and noted with the initials'ACM". Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials,as prescribed byA.H.E.R.A.guideline. If during demolition or renovation,any additional suspect asbestos containing materials are located[may include but not limited to: sheet vinyl flooring,tile flooring,wall or ceiling texturings or points,concrete siding or skirting,cement pipes,cement wallboard, electrical cloth,electrical wiring insulation,thermal paper,wallboard,joint compounds,vinyl wall coverings,spackling compounds,or any other suspect TS1(Thermal System Insulation)],those materials are presumed Asbestos Containing Materials unless determined to be non-asbestos by laboratory analysis. Asbesto-Test Inc.does not guarantee approximations of quantities of ACM,which may be listed with the analyses.It is therefore recommended professional abatement price and/or disposal quotes be obtained by inquiring as to fees per area of specific ACM material(i.e.square or linear foot etc.),or by on site assessment. Any and all materials identified as ACM and/or PACM in this report must be abated prior to disturbance in renovation or demolition. PLM(polarized light microscopy)has been known to miss asbestos in small percentages of some samples,which contain asbestos, thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM(scanning electron microscope)or TEM(transmitting electron microscope),to insure analytical accuracy when asbestos is reported in small percentages Analytical test method:USEPA 600/R93/116—(PLM);WAC 296-62-a7753 App.J ••One percent is the USEPA regulatory limit for asbestos in bulk samples. Key: "FRIABLE'signifies"Easily Airborne" ACM signifies"Asbestos Containing Material" PACM signifies"Presumed Asbestos Containing Material" CAB signifies"Concrete Asbestos Board" a signifies"less than" TSI signifies"Thermal System Insulation" HVAC signifies"Heating Ventilating Air-Conditioning" NAD signifies"No Asbestos Detected" END OF REPORT ArLynn Hammond, Pres., BSc. Analytical Chemist,AIHA proficient Inspector,certified A.H.E.R.A. accred.#152486(Expires July 28,2016) 1 BBB �$ CD 1429 Ave.D.#187,Snohomish,WA 98290 425-489-4040;f775-665-0420 wIt'H•.asbesrafvsf.cwm:Ja&daybiestotest.com r DEMOLITION PERMIT APPLICATION Department of Community& Economic Development City of Arlington•.18204 59th Ave NE• Arlington,WA 98223• Phone(380) 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 BYANAPPROVED AGENCY. Type of Permit:(check one) ❑ Residential ❑ Commercial ❑ Industrial Project Address: 16828 91 st Ave NE Parcel ID#: 31052500201600 Lot#: Subdivision: Valuation. 346800.00 Building Area(Sq Ft)3358 No. of floors: 2 Number of Buildings.1- Owner: Tim Kaintz Phone Number: 425-359-4487 Address: PO Box 610 City:Lake Stevens State: Wa Zip Code:98258 Contact Person:Tim Bruggman Phone Number: 425-308-3519 Cell Phone: 425-308-3519 E-mail: tb@goldeneagleds.com Address: PO Box 1377 C; Monroe 9 City: State:�L6— Zip Code: 8272 Contractor: Springbrook Nursery Phone Number: 360-653-6545 Address: 9022 84th st NE City: Arlington State: Wa Zip Code: 98223 Contractor's License Number:cc sprinni942nm Expiration:8-14-16 Scope of Work: Demo building I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described pr rty will be in accordance with the laws, rules and regulations of the Stat of Washington. Appli ignature Date Pri t ApplicantsMarne FOR STAFF USE ONLY Permit# Accepted By Amount Received Receipt# Date Received A-T Asbesto-Test, Inc. 1429 Ave.D.fl187,Snohomish,WA 98290 425-489-4040 wo'u•.a.�hee'/al<•,ar.snot:lnfrfryNbeyolt-sr cour ASBESTOS SURVEY House and Garage Ca)16828 91"Ave.NE.,Arlington, WA 98223 Page I of 8 January 29,2016 PAT2160109 Golden Eagle Development Services POB 1377 Monroe,WA 98272 Attn.: Tim Bruggman cc: Mick Cermak tb(W)2oldeneag1eds.com ; meermak(&Igihomes.com On January,212016,Asbesto-Test personnel conducted an Asbestos survey(per U.S.E.P.A./A.H.E.R.A.guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State)of the house and garage(d�16828 91'Ave. NE.,Arlington, Snohomish County, Washington 98223. This survey purpose is to identify asbestos containing materials,prior to demolition. Note: Samples of suspect Asbestos Containing Materials were taken and analyzed for the presence of asbestos. THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN.If there is any additional suspect ACM located prior to or during demolition(such as,but not limited to,those materials listed on the last page of this report),that was not discovered in this survey,the material(s)must be Presumed Asbestos Containing Material unless tested otherwise by laboratory analysis. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The house is one story wood frame on a basement. The siding is wood. The siding vapor barrier materials were sampled. The roofing is composition. The composition roofing materials were also sampled. INTERIOR CONSTRUCTION, FINISHES, AN FLOORINGS: The interior construction is wood and drywall. The drywall/taping materials were sampled. The vinyl flooring materials with relating backing and mastic materials were sampled.The masonry tile and mortar materials were also sampled. The miscellaneous mastic materials were also sampled. INSULATION: The insulation was sampled. continue to page 2 .yr�a aBE '; NAT 1033-1 Page 2 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Gunwe la: 16828 91"Ave. NE.,Arlington, WA 98223 ELECTRICAL SYSTEM: The electrical wiring insulation did not appear to be the kind to be ACM. The power may have been"on"at the time of the inspection,thus sampling was not safe. Any suspect electrical wiring insulation or any suspect TSI(Thermal System Insulation)found in, around, or behind any located fuse or breaker boxes should be considered to be ACM (Asbestos Containing Material), unless determined otherwise by laboratory analysis. HEATING AND VENTILATION SYSTEM: There is an electric forced air furnace in the structure. There was no relating suspect ACM located. Note:It was not possible to dismantle the furnace and ducting to locate and/or evaluate any additional suspect ACM that may be concealed, inside the unit, or associated in hidden areas. It is our opinion any further handling of the furnace system should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect materials are located prior to and/or during any demolition or renovation, any and all additional related suspect materials should be considered to be ACM (Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. Any TSI that may be present inside or outside the furnace and/or ducting system including but not limited to all gaskets,joint compounds, sealants,and/or insulations,are PACM unless tested otherwise by laboratory analysis. • There is a fireplace in the house. The fire brick materials were sampled.The fireplace decorative brick and mortar materials were also sampled. MISC.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: There is a wood frame garage adjacent to the structure. The roofing is composition.The siding vapor barrier materials and composition roofing materials were sampled.There is also a wood frame shed on the back portion of the property.The composition roofing materials under the metal roof of the shed were sampled. #of structures included in survey:one house, one garage,one shed Requested by: Tim Bruggman ,!NYJW WAA AA N 11•ii,Sune J15 ®3 ticairlx I� [09 Hi:s'f]J Ini,;reilinxs lnl _ ~- Christopher L.Pederson nmaoy� w1ea Ast—Ale BuddInp 111SPIC10, pngrs x.M 18C,A T.14111 i,D CI P 161 W W HAI Cart Num, 16159J Gll6•"9,^1 ro..•:..cam,....i,r, k.Wms Mnv 2B Christopher Patterson Inspector, certified A.H.E.R.A. Accred.#151593 EXP.May 28,2016 continue to page 3 04 A-T 1429 Ave.D.9187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 tvxw.ashrsyoresLcam:nd abrasroterr.coin Page 3 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage(a)16828 91't Ave. NE.,Arlington, WA 98223 THERE WAS NO ASBESTOS DETECTED IN ANY OF THE SAMPLES TAKEN ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL DOWNSTAIRS 1.0 masonry tile NAD non-fibrous materials entry&stairwell 2.0 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 3.0 sheet vinyl flooring NAD non-fibrous materials laundry-color:light gray cellulose,fiberglass 4.0 mastic NAD adhesive beneath previous sample listed 5.0 mastic NAD adhesive,cellulose holding base cove-homogenous throughout 6.0 sheet vinyl flooring NAD non-fibrous materials bathroom-color:white cellulose,fiberglass 7.0 mastic NAD adhesive beneath previous sample listed 8.0 drywall NAD non-fibrous materials sample 1 cellulose,fiberglass, paint,gypsum 8.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 9.0 drywall NAD non-fibrous materials sample 2 cellulose,fiberglass, paint,gypsum 9.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 10.0 drywall NAD non-fibrous materials sample 3 cellulose,fiberglass, paint,gypsum 10.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass continue to page 4 AM BBB ® CD .uww 1429Ave.D.#187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 wivivoshestotes/.corn;into(@&vhtestote tcom Page 4 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage 0)16828 91"Ave.NE.,Arlington, RYA 98223 ANALYSIS ID ASBESTOSHTYPERQUANTITY OTHER MATERIAL MAIN FLOOR 11.0 mastic NAD adhesive,cellulose bathroom countertop 12.0 sheet vinyl flooring NAD non-fibrous materials bathroom floor-color: light blue/off white cellulose,fiberglass 13.0 mastic NAD adhesive beneath previous sample listed 14.0 "squeak paper" NAD cellulose,tar beneath wood flooring throughout 15.0 mastic NAD adhesive,cellulose kitchen holding laminate on countertop 16.0 masonry tile NAD non-fibrous materials kitchen splash 17.1 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 18.0 sheet vinyl flooring NAD non-fibrous materials kitchen under pergo&in pantry-color:gray 19.0 mastic NAD adhesive beneath previous sample listed 15.0 masonry tile NAD non-fibrous materials bathroom splash&shower 16.0 mortar/mastic NAD non-fibrous materials, holding previous sample cellulose 17.0 sheet vinyl flooring NAD non-fibrous materials bath floor-color: cream 18.0 mastic NAD adhesive beneath previous sample listed 19.0 mastic NAD adhesive,cellulose kitchen holding laminate on countertop 20.0 masonry tile NAD non-fibrous materials shower continue to page 5 : 0lBS F� 1429Ave.D.9187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 snva,.asbeslotest.comr MJi✓d�{?ashtestme tcanr Page 5 of 8 January 29,2016 PAT2I60109 Asbesto-Test,Inc. 425-489-4040 House and Carrie(w 16828 91'Ave. NE.,Arlineton, WA 98223 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL 21.0 decorative fireplace brick NAD non-fibrous materials fireplace exterior 22.0 mortar NAD non-fibrous materials, holding fireplace brick sample 1 cellulose 22.1 mortar NAD non-fibrous materials, holding fireplace brick sample 2 cellulose 22.2 mortar NAD non-fibrous materials, holding fireplace brick sample 3 cellulose 23.0 firebrick NAD non-fibrous materials inside fireplace 24.0 drywall NAD non-fibrous materials kitchen cellulose,fiberglass, paint,gypsum 24.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 25.0 drywall NAD non-fibrous materials dining room cellulose,fiberglass, paint,gypsum 25.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 26.0 drywall NAD non-fibrous materials living room cellulose,fiberglass, paint,gypsum 26.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 27.0 drywall NAD non-fibrous materials master bathroom cellulose,fiberglass, paint,gypsum 27.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass 28.0 drywall NAD non-fibrous materials master bedroom cellulose,fiberglass, paint,gypsum 28.1 drywall taping compounds NAD non-fibrous materials, sampled per AHERA guideline cellulose,fiberglass continue to page 6 BBB' A'88 A_T 1429 Ave,D.1187,Snohomish,WA 98290 425-489-4040;.f775-665-0420 niviegsbaweat.rmn;¢Jg((&.vbreyotesr.com Page 6 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage(a)16828 91st Ave.NE.,Arlington, WA 98223 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL COMMON AREAS: 29.0 insulation NAD fiberglass,cellulose color:beige 30.0 composition roofing NAD cellulose,tar, non-fibrous materials 31.0 vapor barrier NAD cellulose,tar beneath previous sample 32.0 mastic NAD cellulose,adhesive holding composition roofing 33.0 vapor barrier NAD cellulose,fiberglass beneath siding exterior GARAGE The composition roofing is homogenous with the house. 34.0 vapor barrier NAD cellulose,tar beneath siding exterior continue to page 7 PlBB BBB CD 1429Ave.D.#187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 vs,soe-asbe stored.cnm:lnlo0askestatest.com Page 7 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 House and Garage(a)16828 91"Ave. NE.,Arlington. WA 98223 a01& continue to page 8 BBB area A-T 1429Ave.D.#187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 www.Osbeyotem,com:flrfAnaSbiyaotest.com Page 8 of 8 January 29,2016 PAT2160109 Asbesto-Test,Inc. 425-489-4040 11ou.se and Gara.(w fa 16828 91'"Ave. )VE.,Arlin-ton, ;VA 18223 Samples taken are listed with their corresponding analyses.If asbestos is detected,those samples containing asbestos ore listed first and noted with the initials'ACM". Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials,as prescribed by A.H.E.R.A.guideline. If during demolition or renovation,any additional suspect asbestos containing materials are located[may include but not limited to: sheet vinyl flooring,tile flooring,wall or ceiling texturings or paints,concrete siding or skirting,cement pipes,cement wallboard, electrical cloth,electrical wiring insulation,thermal paper,wallboard,joint compounds,vinyl wall coverings,spackling compounds,or any other suspect TSI(Thermal System Insulation)],those materials are presumed Asbestos Containing Materials unless determined to be non-asbestos by laboratory analysis. Asbesto-Test Inc.does not guarantee approximations of quantities of ACM,which may be listed with the analyses.It is therefore recommended professional abatement price and/or disposal quotes be obtained by inquiring as to fees per area of specific ACM material(i.e.square or linear foot etc.),or by on site assessment. Any and ail materials identified as ACM and/or PACM in this report must be abated prior to disturbance in renovation or demolition. PLM(polarized light microscopy)has been known to miss asbestos in small percentages of some samples,which contain asbestos, thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM(scanning electron microscope)or TEM(transmitting electron microscope),to insure analytical accuracy when asbestos is reported in small percentages Analytical test method:USEPA 600/R93/116•'(PLM);WAC 296-62-07753 App.J '•One percent is the USEPA regulatory limit for asbestos in bulk samples. Kev: "FRIABLE"signifies"Easily Airborne" ACM signifies"Asbestos Containing Material" PACM signifies Presumed Asbestos Containing Material" CAB signifies"Concrete Asbestos Board" < signVes"less than" TSI signifies'Thermal System Insulation" HVAC signifies"Heating Ventilating Air-Conditioning" NAD signifies"No Asbestos Detected" END OF REPORT ArLynn Hammond, Pres., BSc. Analytical Chemist,AIHA proficient Inspector,certified A.H.E.R.A. accred.#152486(Expires July 28,2016) 41 BBB 1429 Ave.D.4187,Snohomish,WA 98290 425-489-4040;f 775-665-0420 mvr.asbestoregconr,tato0asbtestotectcom CITY OF ARLINGTON 238 N. OLYMPIC AVE -ARLINGTON, WA. 98223 PHONE; (360) 403-3551 BUILDING PERMIT Address: 16828 91st Ave NE Permit#:916 Parcel#:31052500201600 Valuation:346800.00 OWNER APPLICANT CONTRACTOR Name:TIM KAINTZ Name:Tim Bruggman Name:Springbrook Nursery Address:P.O.Box 610 Address:P.O.Box 1377 Address:9022 84th St NE City,State Zip:LAKE STEVENS,WA 98258 City,State Zip:Monroe,WA 98272 City,State Zip:Arlington,WA 98223 Phone:425-359-4457 Phone:425-308-3519 Phone:360-653-6545 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: 2012 STORIES: 2 CONST.TYPE: DWELLING UNITS: I OCC GROUP: BUILDINGS: 2 OCC LOAD: PERMIT APPROVAL 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 O OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110. SALE. TAX C :Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax return form and coded . r t #310L r� �u naturc Print N me c Released By Date, CONDITIONS Armored entrance required for truck traffic. See Detail G-12 for Rock Construction Entrance requirement. Septic tank shall be abandoned per Department of Health before demolition work is to start. 24 hour notice to the Wastewater Department required for abandonment of septic system. 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 2/24/2016 Demolition Fee $100 00 2/24/2016 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: a� �o G -4 � ,75tiN i oo' 'CFO 4 4r two �,q ,- Bin o S�N oh1 R=25' M!N v 12 MIN. ^ o t5 4"-8" QUARRY SPALL PLACE At FUTURE SUBCRAOE ELEVA 17ON pROV10E FULL w/0TH OF !F POSSIBLE INGRESS/EGRESS AREA 18' 2' MAXIMUM WA TER DEP TH 12" THICK, 4"x8" OUARRY SPALLS 6" ADS OVERFLOW TO TEMPORARY SETTLING POND SEE DE TAIL SEL O w 2 LAYERS FIL TER FABRIC REVISED e STANDARD PLAN ROCK CONSTRUCTION ENTRANCE NUMBER AND CONSTRUCTION VEHICLE WASHDOWN PAD G 12 Permit#: 916 Permit Date: 02/17/16 Permit Type: DEMOLITION Project Name: Kaintz Applicant Name: Tim Bruggman Applicant Address: P.O. Box 1377 Applicant, City, State, Zip: Monroe,WA 98272 Contact: Tim Bruggman Phone: 425-308-3519 Email: tb@goldeneagleds.com Scope of Work: Demo of building Valuation: 346800.00 Square Feet: 3358 Number of Stories: 2 Construction Type: Occupancy Group: ID Code: Permit Issued: 02/24/2016 Permit Expires: Form Permit Type: Status: COMPLETE Assigned To: Kristin Foster Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 31052500201600 16828 91 STAVE NE TIM KAINTZ 425-359-4457 111 Single Family Residence-Detached Contractors Contractor Primary Contact Phone Address Contractor Type License License# Springbrook Nursery 360-653-6545 9022 84th St NE CONSTRUCTION Labor&Industries SPRINNI942NM CONTRACTOR Plan Reviews Date Review Type Description Assigned To Review Status 02/18/2016 DEMOLITION Armored entrance required for truck traffic BUILDING 02/18/2016 DEMOLITION Customer didn't check box to tell us if it is a residential, PW-ADMIN-GIS commercial or an industrial building.Permit does not have information asking applicant if there is a well,septic tank or sewer system on the property.This information would be helpful in making a complete review. 02/18/2016 DEMOLITION No comments for this review.KC PW Storm Rev The application is not clear what type of building structure this is.If this is a home the septic tank shall be abandoned 02/18/2016 DEMOLITION per Department of Health before demolition work is to PW-SEW-REV start.24 hour notice to the Wastewater Department required for abandonment of septic system. 02/18/2016 DEMOLITION no concerns for water dept.DS 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 02/18/2016 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 02/24/2016 Golden Eagle Development Check#1424 Kristin Foster $104.50 Services Outstanding Balance $0.00 Uploaded Files Date File Name 02/24/2016 1490511-BLD 916 Signed Permit.pdf 02/18/2016 1482362-Application.pdf 02/18/2016 1482363-PSCleanAir.pdf 02/18/2016 148236 1-Asbestos Survey-.pdf Date: 04/24/2026 Permit#: 916 Permit Date: 02/17/2016 Review Date: 02/18/2016 Permit Type: DEMOLITION Review Type: DEMOLITION Target Date: 02/24/2016 Scheduled 00:00 Time: Completed 02/18/2016 Date: Description: The application is not clear what type of building structure this is. If this is a home the septic tank shall be abandoned per Department of Health before demolition work is to start. 24 hour notice to the Wastewater Department required for abandonment of septic system. Review Status: Assigned To: PW-SEW-REV Time In: 00:00 Time Out: 00:00 Hours: 0.0 Property Information Parcel#: 31052500201600 TIM KAINTZ TIM KAINTZ P.O. Box 610 16828 91 STAVE NE LAKE STEVENS,WA 98258 Zoning: I I I Single Family Residence - 425-359-4457 DetachedLot: Block: KAINTZTK@MSN.COM Date: 04/24/2026 Permit#: 916 Permit Date: 02/17/2016 Review Date: 02/18/2016 Permit Type: DEMOLITION Review Type: DEMOLITION Target Date: 02/24/2016 Scheduled 00:00 Time: Completed 02/18/2016 Date: Description: Customer didn't check box to tell us if it is a residential, commercial or an industrial building. Permit does not have information asking applicant if there is a well, septic tank or sewer system on the property. This information would be helpful in making a complete review. Review Status: Assigned To: PW-ADMIN-GIS Time In: 00:00 Time Out: 00:00 Hours: 0.0 Property Information Parcel#: 31052500201600 TIM KAINTZ TIM KAINTZ P.O. Box 610 16828 91 STAVE NE LAKE STEVENS,WA 98258 Zoning: 111 Single Family Residence - 425-359-4457 DetachedLot: Block: KAINTZTK@MSN.COM Date: 04/24/2026 Permit#: 916 Permit Date: 02/17/2016 Review Date: 02/18/2016 Permit Type: DEMOLITION Review Type: DEMOLITION Target Date: 02/24/2016 Scheduled Time: 00:00 Completed Date: 02/18/2016 Description: Armored entrance required for truck traffic Review Status: Assigned To: BUILDING Time In: 00:00 Time Out: 00:00 Hours: 0.0 Property Information Parcel#: 31052500201600 TIM KAINTZ TIM KAINTZ P.O. Box 610 16828 91 STAVE NE LAKE STEVENS,WA 98258 Zoning: 111 Single Family Residence - 425-359-4457 DetachedLot: Block: KAINTZTK@MSN.COM Approved Transaction Page 1 of 1 pscleanair.org Puget Sound Clean Air Agency Notification Case #: 201600571 This page must be printed. A printout of the notification, all amendments to the notification,and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site(Reg III,4.03(a)(6)). Fee Amount Paid $65.00 Credit Card Transaction # ATOFEOFBB14C Transaction Date 02/03/16 Owner's Name Tim Kaintz Phone (425) 359-4487 Project Street Address 16828 91st ave NE City ARLINGTON Zip 98223 Contact Person Tim Bruggman Phone (425) 308-3519 Mailing Address PO Box 610 Lake Stevens,WA 98258 This project includes a demolition. Demolition Start Date 02/22/16 Completion Date 03/11/16 Demolition will be completed by a demolition contractor Demo Contractor Springbook Contracting Contractor Job# Contact Gordy Phone (425) 508-9434 Mailing Address 9022 84th st ne Arlington Wa 98223 ,WA 98223 (1) I certify that the information I have provided is to the best of my knowledge true and accurate. (2) I understand that I must file an Amendment to this Notification if: • The type of project has changed.The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The project's start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. ��Another Notif' at' If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. https:Hsecure.pscleanair.org/Asbestos/Approved.aspx 2/3/2016