HomeMy WebLinkAbout19023 47TH AVE NE_035338_2026 C I T Y O F A R L I N G T O N
C O N S T R U C T I O N P E R M I T
PE RM I T NO - a GD3-533E3
O: ner: CITY OF ARLINGTON 238 N. OLYMPIC ARLINGTON 98223
Value of Work: Tax ID: 153105-4-012-0009 Phone: 435-5785
Describe Work: DEMO
Proposed Use:
Legal Description:
Job Address: 19023 47TH AVE HE
Contractor's Name Type Address License#
CORNERSTONE GEN
TOTALS Fee 1AX y
Permit Fee $100. 00
State fee $4. 50
SIGNATURE:
TOTAL FEE. . . . . . . . . . . . . . . . . $104. 50 I HEREBY CERTIFY THAT I HAVE READ
AND EXAMINED THIS APPLICATION AND
PAYMENTS. . . . . . . . . . . . . . . . . . :0. 00 KNOW THE SAME TO BE TRUE AND COR-
T ALL PROVISIONS LAWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . $164. 50 R NANCES GOVE KING HIS TYPE OF
WORK WILL C LIE WITH WHETHER
DATE �la� IQ� RECEIPT E F1`ED OR J$OT.
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FROM FAX NO. Jul. 02 2000 07:15PM P1
Arlington Muniolpa:l Airport
111204 Ed'Dr.N.E:. Arli"gton Municipal
Arlington,WA.W1.23 Airport
P"
Tas Soott Black Fruit: Rob Putnam
FAM Pegew 3 including cover
Phona: [Click Mere and type phone number] Date: 3/14/2003
Rw PSCAA Cm N/A
CI Urgew CI For Review [] Plea"Comment r l Pieese Reply 13 Please Recycle
• Commena,: Here is a copy of the Puget Sound Clean Air Permit for the Coastal Fibre Site. Lot
me know if YOU need anything else. Rob
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FROM : FAX NO. Jul. 02 2000 07: 16PM P2
p�Ya, as NcvO�CLEAN AIR Date Receind
G' 1
110 Union Srroet,Suite 500
` ���nr�J O��' n Y Scottie.wA 98Ia1-2039 MAR 0 7 2003
lI V www.psoleattt;ir.Org rUGE���, ,,,,,
NOTICE OF INTENT
A. pre#ect ype. 1.❑ Asbestos Removal 2. Asbestos Removal&D olitlQ31-1 I G1-Demotldon,No Asbestos Remavtrl
P�rouertyC"vner: 11-4w
Mailiutt Address. 22014 s 1 ' "' "� '�� U City: Ar 14'vkJ k6" Lattue Q Z1t):
C. Asbestos rr•= `_ "�'
Contractor Ne-,- �O•bsC. A6xAe>'"e,�+ Owner/CF-O: F%e-)(
Mailing Address: :9'7'S X S'^A+44i Avf,M a S ,. 3 p Contractor
�. Phone: 2 $D'). Iob No.:
City: V State: Ind P, 7.in: 2 Fax:
Address: ? ' Ayevi.e— w F— City.: AA m4v4r Zip: 98 223
Site
Manager: Rob PAIicL" LocalPbonc:
E. Asbestos Survey o r No. of Date Asbe::to8 Surve J ) Was Friable Asbestos Identified? Yea o
Q Mat'l Presumed SttuCtttres: Was conducted: y2 13J� Was Nonfrinble Asbestos Identified? Yes o
n nvey ,requ R R or'e/ enw r on pre Rr r Attach a copy of the survey,if rlonfriablo cAbostos
AI-ILRA Building Inspector: is identified gr' no asbestos in identified on
Loc- r,o vy — hG Za++'� �SSas(•. survey. E A-r' qfc i-b
Certification No.: 0 z— S 14 0 �tv., . L)AA
IF, Qtmolltion Start �y No,of /- 1. Training Fire(List Ere Dept.)
Itrformaflon: pate. M'�y'�'4" t� Struettuea: to 72. C1 Ordered Demolition attach copy of order
Demolition !,crew dseaollrlore cuptrq kr'r mr llhrg address an sack I Will tionfriable asbcutos be left in place during deino't U Ya ' No
Contracror. [,Qr.a�,�.ppt� E-, Prt.' -& LLILI If yes.List type and qty.
6• Asbestos Project Work Days: M T W Th F Sa Su
llnfortm Rtion: Start pate: /// Commotion Detc: 1/U�C7,, Hours:
Y"o Will all triable asbegtpA Ycs
Total Qty,to be Removed:_ '�` Linear Ft. 1, 1 I , Scuare Ft, ,naterial-p rattwvad? G7 No
Thermal Sys em Insulation: Boilc0umwe Irv. Duet Ina, Ripe W. other: 1I Br
Sin-facingMta'l: ri roofing Paints Plaster Texhucd Coatings Other t
Misc, Mat'! Ccmcne B� Cement Pipe Friable Flooring or Roofing Mat'l Other, ; MM tq Ito fin}„ c
II. Asbesto-r/Dotnolltion F reject Catogariea: 1381I8901 on..Perlod Asbestos Demolition
1, Single-Fsmily Residence_
Surchargg
A.
Q Asbe itos Removal F reject Only IzA.Dior Notice A. $�25
B. Cl Demolition project(with or withoutasbeatos removal project) ���fat• ays* B_ SSO
Asbestos removal can boffin upon notification;demolition must wait 1 ``t
2, All Other Demolitto,is With No Asbestos Removal project a 8 $200
id 259 linear fct:or z 4R- 159 gguarc feat of asbestos > 1 s 1 SO x
4. 2G0-999 linear fpM or 160 4999 8 uarc feet of asbestos . 10 Ua s S 10p
5.-�I-�400-9,999 Imcftr r`ect or 5,000.49,999 squnre feet of asb 10 Da s 5750 S250
6, L! 10 1�00 linear feet�R>50 0()0 q uare feet of asbestos 10 Da , $2 1
7• HmaICY A9hgJtoB Project or L�mergec•cy Demolition Project Prior Nptiee Twice 1'rojoct Fee
Si to-rnmi�y RuiAettcee are,xerapt from cn>ct�cncy fee;however,prtq"owt1M8 mutt Provides n en_ ncy roquent)
1-' I certify that the infilr cation cor t t'JA thi,t:oti ,trren ppletltental date ia,ro the beet of ro lrnowlext�- - � y sr,accurate mtnpldta, Agenc iUlt my
■ R "enfin Dote Rev(ewtd Ilv l
Pug t Sound Cloaa Air Ai"mey Form No.: 66-160(Retried 9102)9t'S 3 7 t
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The Puget Sound Clean Air Agency requbw advance notification before any person commences a friable asbestos project
involving materials equal to or grouter in size than 10 linear feet or 48 aquetre foot and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet(Regulation
III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency, on current Agency
forms, b ,�oval aid deai4litiaa i>roin_volYLg materials and stn�cture� �ow the „ ificatio�
Alg-f�i=g Ali o icic ��
The Agency notifict;tibn form must be usod to subtnit a notification for an asbestos project, a combined asbestos and
demolition project acid a demolition project where no asbestos retnoval is required prior to demolition. After receiving a
complete notification with the appropriate project fee, the Agency will mview the form and return a copy to the asbestos
and demolition coatnictor by mail, The reruroed copy will be your validated notification.
r, Detaorttloa k.
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Contractor: t4.41r4 S'�tDrt� ►�-�+G.P SGb �.� Owner/CPO: K41c 0"" " .1
Mailing Address: �Li St�'�., A Phone: " �. $I&2" 'a I+� Cnntractt►r's
+ �jd Job
city3� f=='h�'S� State: Zi -iD � Fax: Upip'•',�1 ea
$ " $
GUIDELINE$FOR SUEIlr 'rMNG AN ASSESTOSIDEMOLITION NOYIFICAiION
Stcp I. (rock the appropriate project type in noY A,
Step l Eittter property c wner information in Box B,
Step 3. Better tho asbaslos eontuictor or pre4wrlY owner infortntation,if the property owner is conducting a sin�te-family reaideptia]
project,in Nor C. print,,lcarly this is your return mailing label.
Step 4. Enter the situ address for all notificatiatta in BOX M For multi-structure projects,snitch supplentenial shoot with a gift map
(include an address for each site)and d list of the type and amount of friable sabeatos to be removed Rom each structure,
stop s. Check either nst.estns survey or material Presumed in Box E. All dernolitiorts require that act Asbestos 1<um-d Emergency
Response,Act(,4HER A),asbestos survey be conducted by a ecrtiflod AHERA building Inspector,
t
1 1 �� ati s r [for w ,g)2 is idor � and pr4iccts ryharo no oat Q
AMU. as
Stcp 6. Enter the project information, in Dos V and check the training fire or ordered demolition box if gppropriate(a copy of the
official onler mulct be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire
requirements are contained in Regulation I, Scction 8.08. If any nonfriable asbestos materials will be left In place dtuittg demolition,
check yea and list the type and quantity ofmateritti.
Step 7, Enwr asbestos project information in Box G.
Step 8. pot Stngie-Famill Realdendal projects
without astrtstos rotnaval ,check BOX H1A for renovation projects.BOAC BIB for demolition projecta with or
Asbestos removal may be conducted Rflor a complete notification is received,but demolition activities can
only begin cn the 10"'day Idler the notification is nteeived.
For Commercial >tabctrtos projects; check the pnojeot category H2 - 6 that matches the amount of friable asbestos that will be
removed. If a demolition it involved, include the appropriate surcharge(additional fee) in your payment. To file for tin eiuergency
asbestos or demolition project, chock the appropriato box I — 6 and the applicable Cm en
���fl�>t3lpanjed by a lette`fi p T1rrir� erg cy box in H7.
Yntl)_th rrujJe pr cut in ligo W-1 O I c t ' cd' to ' a 4.0f jc); r ce
Stop 9- Plea;;e Certify the accuracy and completeness of the information provided by signing the notification in Bon i.
Mandatory amendments to the notification arc required for changes that increase the project category,niatetials to he removed anc changes to start date.<;o lotion date change tho typos of asbestos
work schedule changes if the contractor is and work schedule for asbestos projects. No fee Is required for
required for a 1 amonchnents, Em+►nc�mpahn8 in the Agency work achc ttie fax program, A S25.00 processing fee is
Puget Sound ,,lean A.ir Agency asbestos regulations and forms can downloaded from the Agency web Page at www.pscleanair.org.
For technical tccvistance cotttt:et(206)6894059 and Ibr administrative inquiries contact(206)689-4090,
LM 9
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l'lgct Sound oe*r.Alf Agency f"orm 2412 66-160(Reviled 9/02)7'S
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City of Arlington Building Dept
PUBLIC WORKS CHECKLIST
k,533 DATE / —ol✓ &e)3
LEGAL 1,�3/0,5 `
Plat Lot Tax ID#
NAME j gV I I )6t e-n
ADDRESS 0'� T6 Ac
BUILDING USE rsy�-,M o # of BUILDING UNITS
Existing Required Signature Date
Water Meter
Fire Hydrant
Side Sewer Permit
Monitoring Manhole
Cross-Connection Control
Sewer: Off site
On site
Water: Off site
On site
Pretreatment Discharge
Permit
Water/Sewer Fees
I` fl ���. Date received
W_AS-Te-I W�t_TM (VjaQt) Date Yellow returned
Date Pink returned
�'��6►R � OEM 0 � SGY1-1f1� d' .
M�1'� Ij (,I N e'S 1q 4 A/P
Memo
Date: 2/3/2003
To: City of Arlington ,Airport Division
Cc: File
From: Scott Black
RE: Demolition At 19023 47th Ave
Prior to the start of the building demolition you must locate all services and main
lines. These must be capped off and inspected. Notify Earl Anderson in the Water
Department and Virgil Renfroe in the Wastewater Department for inspections
pertaining to the capping of these services.
These items must be completed prior to final sign off of permit by Building
Department.
Thank you,
Scott Black, Building Inspector
AUG�07-2002 03:51Ph1 FROM-PRE:' ASSOCIATES 208Z81F T-770 P.002/Q03 F-784
3-10 6thAve.North,Suite 200 S6attle,WA 98109
fb Prezant
OlgDICE:(206)281-8858 FAX;(206)281-8922
Bulk Asbestos Fiber Analysis Kw' a�p
Shaw Environmental PAI Batch Number: 02-2246
3350 Monte Villa Parkway Client rob Number: COC#1738
Bothell,WA 98021- Number of Samples: 2
Project Location, Arlington Turn Around Time: 5 day
Coastal Fibre
Batch Number: 02-2246 Shaw Environmental
Lab Sample Number: 02009641 COC#1738
Arlington
Client Sample Number: #1-Floor Tile Coayral Fibre
L-1 Gray thin sheet vinyl coating
Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 90% Plastic Particles
10% Vinyl Filler and Binder
Comments:
This sample is a brittle sheet viriyl tile piece with a vinyl top layer and a granular tile backing.
L-2 White hard granular brittle sheet vinyl backing
Asbestos ii ibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 87% Gypsum Filler and Binder
101/1. Mineral Particles
3% Mineral Fragments
Comments:
L-3 Transparent mastic with wooden splinter material
Asbestos 17brow,Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 4% Cellulose 90% Resin and Binder
6% MineWME I V E P
Cnmmenu:
JAN 15 20U3
Batch Number: 02-2246 Shaw Environmental CITY OF ABUNGTON
Lab Sample Number: 02009642 cOnirton 03 -5-3
3�-
Mlineron Client Sample Number: *2-Rooting Coaxial Fibre
Sampled By: Client
Received By: John McCaslin 8/5/2002 "
Reviewed By: George MCCaslin 8/7/2002 Analyzed By: Deivie Hanson 8/7/2002
Page 1 or2
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AUG-OT-2002 03:51PM FROM-PRE, ASSOCIATES Z06281' T-770 P-003/003 F-784
* Prezarft 330 6th Ave.North,Suite 200 SCRUIC,WA 98109
OFMCN:(206)281-8858 FAX(206)281-8922
Bulk Asbestos Fiber Analysis V Its aG
L-1 Tan and orange painted rocks
Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 99% Rocks
1% Paint
Comments:
This sample contains two different roofing materials.One contains Ian painted rocks.
The other piece contains green painted rocks on top of asphaltic papery material.
L-2 Black asphaltic fibrous material
AsbestosFibrntr.5 Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 20% Polyurethane 57% Asphalt Filler and Binder
10% Glass Fiber 10ak Rocks
3% Vermiculite
Comments:
L-3 Green painted rocks
Asbestos Fibrou6 Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 99% Rocks
1% Paint
Comments:
L-4 Black fibrous asphaltic papery material
Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 60% Cellulose 37% Asphalt Filler and Binder
39'a Spider Silk
Comments;
�3 -533
RECEIVFr-
JAN 15 2003
CITY OF ARLINGTON
Sampled By: Client
Receivcd By; John McCaslin 8/5i2002
Reviewed By: Gcurge McCaslin 8/7/2002 Analyrcd By: Deirric Hanson 8/7/2002
Page 2 of 2
�. S
--RECeIVED
i CITY OF ARLINGTON JAN 15 2003
CONSTRUCTION
PERMIT CITY OF ARLINGTON
❑ COMBINATION ED BUILDING ❑ MECHANICAL ❑ PLUMBING Cl SIGN PERMIT NO.
U'w I
MAIL ADDRESS CI1 Y ZIP PHONE
-/ - 0/-/ __2 IA_J 0/ �163 - 2NO
ARCHIVtCTORDESIGNER MAIL ADDRESS CITY ZIP PHONE
GLNLRAL CONTRACTURL�feip� -MAIL ADDRESS CITY ZIP PHONE LIC NSE I
cc, �-t7f f �C�• �o v���U �.:crGiu,�,.J C/�a`�� �zr-�r�3aY�cu,,�ST�L �Fj'���
MLCIIANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I
PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE
CLASS OF WORK
NLW ❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION ❑BUILDING RELOCATION
VALUAT ION Of WORK
s 75 , 0v0
ULSLRIB WORK / ) /
PRUMI D z
OfBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
LLGALULSCKIPIIUNOI PKUPLRTY(SHOWN BELOW OR ATTACH f OUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LUI BLOCK OF WILL BE COMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.THE
GRANTING OF PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO
/Sr OS d/,?- 00 O VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
TAX ID NUMBER LOCAL LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF
v� r !� �� CONSTRUCTION.PERMIT EXPIRES 1 YEAR FROM DATE OF ISSUANCE.
SIGNATURE M CTORORAUTHORIZEDA DATE
JOB AUURI SS
l3-0,3
(OFFICE USE ONLY) MECHANICAL
PLUMBING
NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE
WATER CLOSE] (TOILEI) AIR COND.UNITS-II.P.EA.
BA I II I UB REFRIGERATION UNITS-H.P.EA.
LAVATURY(WASH BASIN) BOILERS--H.P.EA
SIIOW'LR GAS FIRED A.C.UNITS-TONNAGE EA.
KI ICIIL'N SINK 6 DISP. FORCED AIR SYSTEMS-B.T.U. MEA
DISHWASHER WALL HEATERS- B T.U. M
LAUNDRY TRAY UNI1 HEATERS- B.T.U. M
CLOT I ILS WASIIER EVAPORAT IVE COOLERS
WAILR IIEATLR CLOIHES DRYERS
URINAL VLNTILATICN FAN
DRINKING FOUNIAIN RANGE HOOD COMMERCIAL
I'LOOR DRAIN AIR HANDLING UNIT- CPM
VACUUM BRLAKERS STOVE
ROOI DRAINS - RAINLEADERS METAL FIREPLACE 6 CHIMNEY
SINK ISEKVICE - BAR,ETC.) WATER HEATER
GAS PIPING
SUB TOTAL 3 SUBTOTAL f
PERMIT S PERMIT f
TOTAL FEE $ TOTALFEE S
SIDL YARUSLIBACK STRELI SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE
FEE RECEIPT NO.
USI /UNI LOT AREA VACANT SITE VALUATION FEE
❑YES ❑NO FEES
I S I'L Uf CONS OCCUPANCY(jRUUP NO.OF DWELLING UNITS PLAN CHECKING NG
BU'LDING $
SI/.L O UULUG. NO.OT STURILS MAX.000.LOAD
PLUMBING
FIRE SPRINKLERS REQUIRED
❑YES ❑NO MECHANICAL
STATE BLDG.CODE
COMMENTS ENERGY CODE SURCHARGE
U.B.C.
PENALTY SEC.303(a)
WATER/SEWER FEES
TOTAL
- PERMIT VALIDATION
WHEN PROPERLY VALIDATED IIN THIS SPACE)THIS IS YOUR PERMIT d RECEIPT
PAID CRM BY
nUILI iNG to nn,L DATE
APPLICANT, 7 r'r'1�UfiER, n' DC OCr'T.
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RECEIVED
cs- JAN 15 2003
CITY OF AR'LINGTO
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N 887141'W — — 1257.16' —
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RECEIVE®
% JAN 15 2003
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CITY OF ARL.INGTi Ct,