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2007, 04-06 Permit App: 07001145 Demo Bldg Project Number: 07001145 Inv: 1 Application Date: 4/6/2007 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: DEMO-EXISTING BLDG 12X14 Contact: STIMSON CONTRACTING Address: PO BOX 1687 C-S-Z: MEDICAL LAKE,WA 99022 Setbacks:Front Left: Right: Rear: Phone: (509)244-2636 Group Name: Site Information: Project Name: NOTICE OF INTENT#07-0116 Plat Key: 001222 Name: HILLCREST ACRES 01ST ADD District: Sout Parcel Number: 45272.2343 Block: Lot: SiteAddress: 12418 E 20TH AVE Owner:Name: BURGESS,SCOTT G&NICOLE M Address: 12418 E 20TH AVE Location::CSV SPOKANE VALLEY,WA 99216 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 9,818 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review In ormation: Review Building Plan Review Released By Sewer Review Released By: Demolition Permit Contractor: STIMSON CONTRACTING Firm: STIMSON CONTRACTING Address: PO BOX 1687 Phone: (509)299-6040 MEDICAL LAKE,WA 99022 Item Description Units Unit Desc Fee Amount DEMOLITION ACCESSORY 1 NUMBER OF $20.00 Permit Total Fees: $20.00 Operator: jmm Printed By: jmm Print Date: 4/6/2007 Project Number: 07001145 Inv: 1 Application Date: 4/6/2007 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: .a- u . 3 �.. �:. ,� .. . - _ Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Demolition Permit $20.00 $20.00 $0.00 $20.00 $20.00 $20.00 $0.00 $20.00 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: jmm Printed By: jmm Print Date: 4/6/2007 APR 04 2007 10 24 FR COSU PERMIT CENTER 5096880037 TO 2442554 P.01/02 Pernik Center 7 11703 rni E Sprague Ave,Suite B-3 PERMIT NUMBER: ` _(/( Waaneig, Spokane Valley,WA 99206 PERMIT FEE: %M T• (509)0814446_ > AX(509)668.0037 VV«/VS t a & LLJ . eValeV.org � 1 Community Development APR 5 20,717-L14-9R-7, . Demolition f l Commercial Permit ApplicationLi ' `�' ZResidential SITE ADDRESS:— I a N 1 S E ' ok--& W-v v OAtS.,iC4 i tA1 IA –l`L a t _D ASSESSORS PARCEL NO: y Sed 1 a • @ `A3 .Building iiding Owner: . Contractor: . . ' • • Name:� ,—+�J.,.. Lo �QAc7ck� Name: e5��'C v ��55 _ Address: l a lsis E (90-1/4-- . Address: kx.cfpc ZIP:n� City: State: WA ZiP an j. I t .CitY:V� L State:u f'(O �C� P x =14 z:ax: Phone u_ a�3� Fax.: o U -acs-9 Sc� �� -?�� Date: Contractor Lic No 3 - s-601 Contact Pelson` . City Business Lic.No: Name: U e L Y '�'l�elc9 1 Y1' °h Phone: o`''' c3 l•i iI. a�= Describe the scope of work in detail n D LtDQ o A site plan is provided. — c3 LE l '012---iNmT d-.1(3.(x3E' o Spokane County Utilities has approved the disconnection. — 06,-ro- (A)Ars o Notice of Intent# The permittee verifies,acknowledges and agrees by their signature that: 1)Ownership of this City of Spokane Valley Permit inure to the property owner. 2) The signatory is the property owner or has permission to represent the property owner in this transaction. 3) M construction is to be done in full compliance with the City of Spokane Valley Development Code. 4) This City of Spokane Valley Permit is not a permit or approval for any violation of federal,state or local laws,codes or ordinances. Ownership a = .I',g de \•lopment rights granted by any issued permit inure to the 151— property owner. Signature Date 4 lc Method of Payment: ❑ Cash ❑ Check 0 MasterCard 0 VISA Bankcard it: Expires: VIN#: Authorized Signature: REVISED 211037 Rpr 06 2007 12: 14PM SPOKRNEttCOUNTYttUTILITIES 4777178 p• 2 PPR 06 2007 11:56 FR COS) PERMIT CENTER ' 505638003'Y TO 4777178 P.01/02 SI ne 4g0100Wiley 11703 E Sprague Ave Suite 8.3 •Spokane Valley WA 99206 s 509.688.0036 t Fax: 509.688,0037 t N Transmittal Date: 4/8/2007 To: SPOKANE COUNTY UTILITIES Fax: 509-177-4115 _ 4 i 7- --1 a t° ,k • £i From; CSV PERMIT CENTER _ Re ReviewlApproval of Demolition Permit Application 111414-- Attn: LOUIS YORK Request: SITE ADDRESS: 12418 E 20TH "10 PERNEIT PURPOSE: Tear down existing building and replace with new one ----X „4- 1 s be,to 01,..) or c t,on .14 —11,a..., f...:kit 1, A'l n al S 1 C�Lc>t+ e.We-k-- \SN OT jn1'1�� l�c A-0 �1"�' ir-1✓�nAl/4,v-- &ar C --e-u-' �' y-e—r ni 14- s ks a - \.�4u, L ..1�1 1},Aca I 47'1 -76' g z. d Lilo 4,1/4 APR 06 2007 12:13 4777178 PAGE.02 Apr 06 2007 12: 14PM SPOKANE#COUNTY#UTILITIES 4777178 p• 1 APR 06 2007 1156 FR COSY PERMIT CENTER 5096E00037'TO 4777178 P.02/02 LP?, 11 PVofieSx..A. � On by -11)(30 Si,ck.f• 2� Q,q� �roP 5 de,�ot .� a' t,3'9" • • 36 . �.co` 6wroPS • ++� MLitt a SP4� Jolter use leo • 1511 9'$ S � tvvaj 3bt• ° ** TOTAL PRGE.02 ** APR 06 2007 12:13 4777178 PAGE.01 APR 04 2007 10:25 FR COSY PERMIT CENTER 5096880037 TO 2442554 P.02/02 • 000110\ Permit Center Srioane 11703 E Sprague Ave,Suite B-3 Spokane Valley,WA 99206 (509)6 r (509)688-0036 FAX:(509)688-0037 www.spokanevailey.orc Community Development • MINIMUM RESIDENTIAL SITE PLAN REQUIREMENTS • Site Address or parcel number • Abutting Street Names • Actual Property Configuration • Property Dimensions, Property Lines and Property Corners • Property Square Footage o www.spokanecounty.org/assessor/ • Actual Structural Footprint for proposed and existing structures with dimensions and square footage also identified . • Proposed and existing building setbacks • Distances (in feet) between existing and proposed primary and accessory structures • Location of existing or proposed driveways • Location of septic tank and drain field • 2 Sets of the site plan • 8 '/2x11 sheet of paper • Indicate North Arrow • All bordering Utility and Access easements **********SAMPLE SITE PLAN ON BACK**************** PC9. (( q ** TOTAL PAGE.02 ** BSCAPCA NOI No. SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY aEr 1VE D 1101 West College,Suite 403,Spokane,WA 99201 NOTICE OF INTENT APR 0 5 2007 Agency Use Only (NOI)TO PERFORM: Agency Use Only A. Project Type: 1. U Asbestos Removal 12.U Asbestos Removal&Demolition 1 3.U DemolitioA is&)W41=41F my avai a e B. Property G ., 4'0-4" Fax: Owner: Ci��- 0�� Phone: Property Owner's �-yN.S `� . Mailing Address: 1 to 1 E. _ OCity; + sok w, ' '^1 State:Lt r Zip:91a i lD C. Siten Address: I aLI,l SE. 02Q CityO Y.A1.L Uhl-a, State: WA Zip:icl Zip: a t l Responsible Site _„.... Job Site Contact Person: "rue. GT.vv\.'f : 1-4 Phone: °,[9,— �aa D.,.-Asbestos Survey or If surve erformed,was asbestos found? Date Survey /' No.of Structures: laMaterial Presumed ❑ Yes YIA If No,Attach Surve Conducted: 1`7�G q (see back if>1 AHERA Building Certification � Exp. i I I 1-1/07,CA, Inspector Name: clR4-ALE ESTOS 6/7_:7LQgumber: 1 R^0 tp —O (oq Date: E. Asbestos Project No.of Structures: Start Completion Wk.Days:Su M T W Th F Sa Information: (see back if>1 I Date: Date: Hours: Total quantity Ln. Sq. Will all asbestos material be U Yes Will work schedule U Yes to be removed: Feet Feet removed by project completion? U No fax pgm.be used? U No List individual type and quantity of materials to be removed or provide an attachment of same: Abatement Contractor: Phone: Fax: Mailing Address: City: State: Zip: F. Demolition No.of Structures: Start , ❑ Training Fire(List Fire Dept.as demo.contractor Information: (see back if> 1) Date: -+to 107 below) U Ordered Demolition(attach copy of Order) Demolition �- 4-4,, Contractor: `J l 1vv\%C'N\ OcM � Phone:C0°l a41-1 o-)( S)2 o,Fax: qt —a5 Sv1 Mailing 2 �� nn ED Address: [ �� ((D�� City:PA 1 StateLt)Ps Zip:‘i`1C9a a. G. Asbestos/Demolition Project Categories: Notification Non-Refundable Does this project involve a fire-damaged structure?U Yes No Waiting Period Project Fee 1. ❑ Owner-Occupied Residential Asbestos Removal&Demolition Project* Prior Notice $30 ist Owner-Occupied Residential Demolition Project Only 2. - All Other Demolitions With No Asbestos Removal Project 10 Days $250 3. U 10-259 linear feet or 48- 159 square feet(see back of form for options) 3 Days $250 4.U 260-999 linear feet or 160-4,999 square feet 10 Days $500 5. U > 1,000 linear feet or>5,000 sqr a feet 10 Days $1,250 6. ❑ Emergency Asbestos Project or Emergency Demolition Project Prior Notice Twice Project Fee 7. ❑ Alternate Means of Compliance for Friable Materials or U Demolition 10 Days Twice Project Fee 8. ❑Alternate Means of Compliance for Nonfriable Asbestos Materials 10 Days Twice Project Fee 1 9.U Exception for Hazardous Conditions Concurrent with Project Regular Project Fee * The two categories in G.1 apply only to owner-occupied,single-family residences,which means any non-multiple unit building containing living space that is currently occupied(prior to and after renovation/demolition) by one family who owns the property as their domicile. One of the categories in G.2-9 must be used for all other renovation/demolition 2rojects.For more information,contact SCAPCA at(509)477-4727. H. Optional:List additional parties you would like copies of this NOI and/or related notices sent to(list name&fax number and/or mailing address): I. I certifythat the information contained in this notification and any supplemental data provided is,to the best Completeness Review .y knowledge,acc to and complete. CI NOI complete ❑NOI deficient- See Attached r 'lure Represen rng qte Agency Use Only Your advance notification period will begin when a completed NOI,including required fees,is received by SCAPCA. A copy of the asbestos survey,completed notification&all amendments must be available for inspection at all times at the job site. NOI 8/06 E!hED SCAPCA NOI No. SPOKANE COUNTY AIR POLLUTION CONTROL AUTHORITY a B Q1`' ` 1101 West College,Suite 403,Spokane,WA 99201 t NOTICE OF INTENT APR 0 5 2007 Agency Use Only (NOI)TO PERFORM: Agency Use Only A. Project Type: 1. U Asbestos Removal 2.U Asbestos Removal&Demolition 13.U Demolitiok, bsto B. Property,, - ��,,� avai a e I.UfWifUL AU I r�ORI1Y Owner: LL�ZT 0�br. . Phone:g` `Ial- Fax: Property Owners2 Mailing Address: L9 IA, C_ - C City; )Ckkg_ Vet.Lig� State: Zip:9001 C. Site � � �/n� Address: 1 a k_ t�j E E. o2O City y0 0114_ U' / State: CU Zip:c!-l a. 1 (40_ Responsible SiteJob Site Contact Person: E 11 XSt �� vv\, N Phone: 0n9.-2Aa- ' D. &1-2Aa- D.,a Asbestos Survey or If surve erformed,was asbestos found? Date Survey /' No.of Structures: / U Material Presumed U Yesy� If No,Attach Surve Conducted: # (see back if>1) / AHERA Building ",, _ Certification R^ _0 �� Exp. Date:p. I I I I-1107-CA. Inspector Name: /h Th1 )'1-/3G /�S,I,SEE STOS ofrTh72'-(4 umber: 1 E. Asbestos Project No.of Structures: Start Completion Wk.Days:Su M T W Th F Sa Information: (see back if>1 I Date: Date: Hours: Total quantity Ln. Sq. Will all asbestos material be ❑ Yes Will work schedule ❑Yes to be removed: Feet Feet removed by project completion? ❑No fax pgm.be used? U No List individual type and quantity of materials to be removed or provide an attachment of same: Abatement Contractor: Phone: Fax: Mailing Address: City: State: Zip: F. Demolition No.of Structures: Start ,-1 ❑ Training Fire(List Fire Dept.as demo.contractor Information: (see back if> 1) ' Date: (p 10-]' below) ❑ Ordered Demolition(attach copy of Order) Demolition Contractor: �\vv‘SceC7N\T'QJ 1` Phone:Cb"t t -tiA-71t{o Fax: ccc QX-4LI-as sN Mailing �� Address: 1 2 e\, l lo`i City:l 1 .o U4 Statet.OPs Zip:'`10a- -a- G. .G. Asbestos/Demolition Project Categories: Notification Non-Refundable Does this project involve a fire-damaged structure?❑ Yes No Waiting Period Project Fee 1. ❑ Owner-Occupied Residential Asbestos Removal&Demolition Project* prior Notice $30 ►A'Owner-Occupied Residential Demolition Project Only 2. • All Other Demolitions With No Asbestos Removal Project 10 Days $250 3. LI 10-259 linear feet or 48- 159 square feet(see back of form for options) 3 Days $250 4.U 260-999 linear feet or 160-4,999 square feet 10 Days $500 5. ❑ >1,000 linear feet or>5,000 sqn a feet 10 Days $1,250 6. U Emergency Asbestos Project or Emergency Demolition Project Prior Notice Twice Project Fee 7. ❑ Alternate Means of Compliance for Friable Materials or ❑Demolition 10 Days Twice Project Fee 8. ❑Alternate Means of Compliance for Nonfriable Asbestos Materials 10 Days Twice Project Fee 9.U Exception for Hazardous Conditions Concurrent with Project Regular Project Fee * The two categories in G.1 apply only to owner-occupied,single-family residences,which means any non-multiple unit building containing living space that is currently occupied (prior to and after renovation/demolition) by one family who owns the property as their domicile. One of the categories in G.2-9 must be used for all other renovation/demolition projects.For more information,contact SCAPCA at(509)477-4727. H. Optional:List additional parties you would like copies of this NOI and/or related notices sent to(list name&fax number and/or mailing address): I. I certify that the information contained in this notification and any supplemental data provided is,to the best Completeness Review •,y knowledge,accur to and complete. 1;110UI complete ❑NOI deficient- ,.��.� tP q_I:; See& 5 A eked`O 1 1 r: •ture Represen mg Date � Agency e lty INIIII Your advance notification period will begin when a completed NOI,including required fees,is received by SCAPCA. A copy of the asbestos survey,completed notification&all amendments must be available for inspection at all times at the job site. NOI 8/06 l This information provides an overview of Notice of Intent requirements. It is not intended as legal advice or as a substitute to applicable laws and regulations. The Spokane County Air Pollution Control Authority (SCAPCA) is the local air pollution authority for Spokane County. SCAPCA's Regulation I, Article IX and Article X, Section 10.09, requires advance notification be submitted to SCAPCA, on an Authority approved form, for any asbestos project involving materials equal to or greater in size than 10 linear feet or 48 square feet(per structure,per calendar year)and for any demolition project,regardless of asbestos content, involving structures with a projected roof area greater than 120 square feet. Asbestos and demolition projects involving materials and structures below the notification thresholds listed above are still subject to all other requirements of SCAPCA Regulation L Article IX and Article X,Section 10.09. GUIDELINES FOR SUBMITTING AN ASBESTOS/DEMOLITION NOTIFICATION Notices of Intent(NOIs)should be mailed or hand delivered to SCAPCA with the appropriate non-refundable project fee(NOIs may be faxed to SCAPCA if a prepayment account has been set-up with SCAPCA). SCAPCA will review the NOI to ensure that, based on available information, there is no missing information, the form has been filled out correctly, appropriate fees accompanied the NOI, and the project start date(s)comply with the advance notification periods(e.g.,prior notice,3-day notice, 10-day notice,etc.). Unless otherwise indicated,all information requested on the NOI form must be provided for it to be considered complete. After the NOI is reviewed,a copy will be returned (via fax, if possible)to the parties listed in box B,E,F,and/or H. SCAPCA's completeness review(lower,right-hand corner of form)is not required prior to beginning work, provided the NOI meets all applicable requirements. However, if work begins on a project and it is subsequently determined that a complete NOI was not received by SCAPCA,a Notice of Violation may be issued. Box A. Check the appropriate project type. Box B. Enter the legal property owner information. Box C. Enter the project site address for the asbestos project or demolition. Include the name of a responsible site contact person and a telephone number where he/she can be reached(preferably a cellular telephone number where the person(s)can be reached on-site). Box D. Check asbestos survey or material presumed. If asbestos survey is checked,fill out all information requested. Except as provided for in Article IX,Section 9.03,all renovation and demolition projects must have an asbestos survey performed by an AHERA Building Inspector. Demolition with no asbestos discovered in the survey must submit a copy of the survey along with the notification. Asbestos removal projects only may check the material presumed box if all materials are to be removed and disposed of as asbestos-containing materials in accordance with SCAPCA Regulation I,Article IX and Article X,Section 10.09. Box E. Enter the asbestos project information, including contractor and mailing address or other properly trained company or person performing the asbestos project. For multiple asbestos projects or demolitions, provide a work plan, including a map of the structure(s) involved,site address of the structure(s),the amount and type of asbestos-containing material in each structure,and a detailed work schedule. For projects where a detailed work schedule cannot be provided,the work schedule fax program must be used. When using the work schedule fax program,asbestos contractors or property owners are not required to submit amendments for work schedule changes occurring between the start and completion dates. SCAPCA may allow asbestos contractors or property owners to use the work schedule fax program for non- multiple asbestos projects or demolitions,provided the asbestos contractor or property owner has good reason(s),as determined by SCAPCA, which are conveyed to SCAPCA in writing with the submittal of the Notice of Intent. Contact the Washington State Dept. of Labor & Industries for applicable training/certification requirements. Box F. Enter the demolition project information. If the structure is to be used in a training fire, list the fire department as the demolition contractor. If the property owner has been ordered to perform a demolition by government official, submit a copy of the order from the appropriate official. Refer to above paragraph for requirements on multiple structure projects. Box G. Enter all project information requested. All multiple structure asbestos project notifications must be submitted with a work plan including a map of the area, site address for each structure, type and amount of asbestos in each structure, and a detailed work schedule. Check one project category in boxes #1-5. The project fee includes the demolition fee. Asbestos removal projects and demolition with an asbestos removal involving less than 10 linear feet or 48 square feet may be filed as project category#3. An emergency asbestos project or demolition may be requested by checking the appropriate job size category in boxes#2-5 and then checking the applicable emergency box in category#6. Emergency asbestos project notifications must be submitted with a letter from the property owner explaining the necessity for the emergency. Emergency demolition notifications must be submitted with a letter from an authorized government official or a licensed structural engineer documenting that the structure is in imminent danger of collapse. To request an alternative means of compliance for friable or nonfriable materials,check the appropriate job size category in addition to the applicable box in categories#7 and#8. A work plan must be submitted by an appropriately trained individual along with the notification.Box#9 is reserved for the Exception for Hazardous Conditions. Box H. Optional—list other parties involved with the project that you wish to receive a copy of the notification if it is considered deficient and/or when it is considered complete. Box I. Sign the notification certifying the accuracy and completeness of the information provided on the form. Mandatory amendments are required for changes that increase the project type,job size category, the types of asbestos materials to be removed and work schedule changes. No fee is required for work schedule changes if the contractor is participating in the work schedule fax program. A$0.00 processing fee is required for all other amendments. For technical assistance,contact SCAPCA at(509)477-4727. Your advance notification period will begin when a completed NOI,including required fees,is received by SCAPCA. A copy of the asbestos survey,completed notification&all amendments must be available for inspection at all times at the job site. NOI 8/06 04/P;'2007 14:09 5095351893 C PAGE 01117 91Jda4fe Asbestos,Lead, & Mold ::7 'ti Abatement Phil L. Berg, Owner A TO: C /P FAX: — , . &I,.. �t �� C RFCFT'\TED APH 1 5 ZOO? FROM: Phil L. Berg, Owner PHONE: (509) 891-7575 FAX: (509) 535-1893 DATE: ApkiP 06 ,0010 RE: tT±CA2 A.ufoivj .- / )1/( . aO e� Number of pages including transmittal cover sheet: COMMENTS: `'1 (?,-2264.4)_)./±1 A f _A ) 1 Q//1 ` ' '% / 41c).- ' ixbt) r 16190 N.West Newman Lake Drive,Newman Lake,WA 99025 Office-(509)891-7575 FAX-(509)535-1893 RECEIVED 04-05-07 02:15PM FROM-5095351893 T0-SCAPCA PAGE 01 04/05/2007 14:09 5095351893 C PAGE 02/17 `-96Cielfttlej Offwije, 644944 Located at: Demolition of Out-Building 12418 E. 20t Avenue Spokane Valley, Washington Owner; Unknown Prepared for: Stimson Construction PA_ Box 1687 Medical Lake, WA 99022 (509)-244-2636 Fax: (509)244-2554 By t..9/544daik tL'Afiegf&i4 Phil Berg, President AHERA Building Inspector Asbestos Abatement-Surveys-Inspections 16190 N. West Newman Lake Drive,Newman Lake,WA 99025 Office. (509)891-7575 Fax: (509)-535-1893 RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 02 0410512007 14: 09 5095351893 C PAGE 03117 Table of Contents 1. Summery of Findings/Acknowledgment 2. Introduction,Scope, Building Description,Lab Information,Methodology, & Results. 3. Chart A—Asbestos Containing Materials 4. Chart B--Non Asbestos Containing Materials 5- Chart C—Definitions 6. Chart D—SCAPCA Checklist 7. SCAPCA Compliance Assistance Info re: Renovation,Demolition, &Asbestos S. Chart E—Sample Material List 9. Chart F--Asbestos In Home 10. Appendix 1--Lab Certifications and Lab i,csults 11.Appendix 2—Inspector Certifications RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 03 04. e5/2007 14: 09 5095351893 C PAGE 04/'17 Page - 1 - Summary of Findings 1. ASBESTOS CONTAINING MATERIALS: NO - See Chart A 2. NON-ASBESTOS CONTAINING MATERIALS:YES - See Chart B 3. PRESUMED ASBESTOS CONTAINING MATERIALS: NO Conclusion: Based on our technical inspection;which included destructive means, we did not find asbestos. Property owner and Stimson Construction may have Cascading Creations vroeged with demolition. Acknowledgment "1 acknowledge that I have read andunderstand this report.I further acknowledge that hidden asbestos materials may exist in concealed areas that may be exposed during my work. If suspect materials(refer to page C)are discovered, I will treat the material as asbestos containing until testing proves otherwise." Firm Name: Signature: Name: (Print or Type: Title: —. Address: Phone Number: 1. AAA is not responsible for hidden asbestos that cannot be found using destructive means. 2_ This survey is limited to the scope of the project as slated by owner, or the owner's representative. 3. Anyone having questions about this report please do not hesitate to contact AAA or S.C.A.P.C.A. @ 1101 W. College Avenue, 403 Spokane,WA 99203 Phone: (509) 477-4727,www.scapca.org Thank you, l ,/)11�. Phil L. Berg RECEIVED 04-05-07 02:15PM FROM-5095351893 T0-SCAPCA PAGE 04 04/05/2007 14:09 5095351393 C PAGE 05/17 Page - 2 - 1. Introduction On April 04, 2007 Affordable Asbestos Abatement(A.A.A.), was contracted by Stimson Construction,to conduct an asbestos survey for the demolition of an out- building located at: 12418 E. 20th Avenue, Spokane Valley,Washington. This survey includes the out-building only. No other structures on the property are included in this survey. 2. Scope: DEMOLITION OF: OUT-RIM-DING The property at: 12418 E. 20th Avenue, Spokane Valley, Washington,was first inspected on April 04, 2007 as requested by Stimson Construction. The AHERA Inspector was Mr. Phil.Berg,of Affordable Asbestos Abatement. Mr. Bergs AHERA Inspector Certification Number is: 1311 -06-069, Expiration Date: 11-18-07. Affordable Asbestos Abatement is located at: 16190 N. West Newman Lake Drive Newman Lake, WA 99025 Phone: (509) 891-7575 Fax: (509) 535-1893 Building Description OUT-BUILDING 4. Lab Information A. Global Industrial Corporation, 6515 E. Main Street, Suite#128, Mesa,AZ 85205 (NIST)NVLAP I.D.t/200670-0,NVLAP Code: 18/AO1,EPA-600/M4-82-020. Phone: 1-(5480)-497-0280. B. Samples we analyzed,using an EPA recommended polarized light microscope method with dispersion staining. The lab results are included. Survey Methodology The sampling was in accordance with; 40 CER 7686. As rcqucatcd per S.C.A.P.C.A.Reg, 1,Article IX, Section 9.02.0 and 9.03.Using destructive methods, six samples of suspect ACM's were taken from six homogenous areas. S. Results A. ACM-(ACM is any materials containing grater than 1%asbestos.)NO- ACM-Listed on Chart A B. Non-ACM: YES-Listed on Chart B C. Presumed ACM: NO D. Assumed Non-YEACM: Metal, Wood,Glass, Fiberglass, Insulation,and Concrete. RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 05 04/05/2007 14: 09 5095351893 C PAGE 06/17 CHART - A Asbestos Containing Materials # Suspect Location Friability Damage Sample ID Lab Type Square Materials Results Feet A D 1111111111111 111 • Friable,Non Friable Category 1(unlikely to become friable if disturbed),Non'Friable Category II (Likely to become friable if disturbed) + No damage, Significant Damage # TSI Thermal System Insulation Misc Miscellaneous Material # Surf Surface Material #Ln. FtLineal Feet # Sq. FtSquare Feet RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 06 04/0512007 14: 09 5095351893 C PAGE 07/17 Chart - B Summary of Non-Asbestos Containing Materials Suspect Location Sample ID Lab Results Materials 1 Window rutty Exterior WP Negative 2 Roofing Felt#1 Roof RF1 Negative 3 Roofing Felt#2 Roof RF2, Negative 4 Roofing, Gray Roof R Negative 5 Sidin Felt#1 Exterior SF1. Negative 6 Siding Felt#2 Exterior SF2 _ Negative 7 Siding Felt#1 Exterior SF3 Negative _ S 9 ^ 10 —11 12 13 14 l.5 16 17 18 19 — 20 21 22 23 - ' RECEIVED 04-05-07 02:15PM FROM-5095351893 T0-SCAPCA PAGE 07 04/05/2007 14: 09 5095351893 C PAGE 08/17 • Chart - C According to OSHA and WISHA standards,the following definitions apply: • "Asbestos-containing material (ACM)" means any material containing more than one percent asbestos. • "Presumed asbestos-containing material(PACM)"means thermal system insulation and surfacing material found in buildings built before the EPA Asbestos Regulations concerning these materials went into effect. • "Thermal system insulation" includes any material applied to pipes,fittings,boilers, breaching,tanks,ducts,or other structural components to prevent heat loss or gain. • "Surfacing material"means material that is sprayed, trawled-on or otherwise applied to surfaces (such as acoustical plaster on ceilings or freproofin.g'zn.aterials on other structural members.) • "Miscellaneous Material" means any suspect asbestos-containing material on structural components, structural members or fixtures, such as floor and ceiling tiles. A miscellaneous material does not include surfacing material or thermal system insulation. • "Suspect asbestos-containing material"means material that has—historically contained asbestos.excluding thermal and surfacing materials. It includes,but is not limited to: roofing material,fire barriers, gaskets, flooring material and siding. • "Friable materials"arc those asbestos-containing materials that,when dry, can be crumbled,disintegrated, or reduced to power by hand pressure or by the forces expected to act upon the material hi the course---of demolition,renovation, or disposal_ RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 08 0410512007 14:09 5095351293 C PAGE 09117 Chart - I) ASBESTOS SURVEY CHECKLIST ' The following is a checklist to help an ABERA Building Inspector perform a thorough Asbestos Survey: I.Qualifications: Yes I No Does your survey include... Inspector nclude.,- lnspector name Phone# Certification# if Certification expiration date V - — Laboratory name — "r Address • `� Certification# V 11.Survey Preparation and Building Description _ Have you reviewed... T Previous surve s Specifications Building drawings V Other - Have you included the buildings... Approximate age rtif Size(sq.fl.) . Use Nuinber of floors Other Vi Does your survey include... _ f HVAC I Mechanical spaces Plumbing/pipe chases Flvur& walls,&ccilin:s Roofing&siding d Insulation&fireproofi> Caulking, mastics.putty. &misc. — `/ I Other Have you identified... — ✓ Areas deemed"inaccessible" Other areas not inspected i d Have you taken the correct number of samples...' V RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 09 04/05/2007 14: 09 5095351893 C PAGE 10117 Chart - E Sample Asbcstos-Containing Material List • Window Glazing • HVAC duct insulation • Stucco • Boiler/tank insulation • Cement Pipes • Breaching insulation • Cement Board/tran.si • Ductwork flexible connections • Duct tape/paper • Construction mastics • Furnace insulation • Vinyl. Sheet Flooring/Mastic • Acoustical ceiling texture Vinyl Floor Tile/Mastic ("popcorn") • Poured Flooring • Electrical panel partitions • Pipe Insulation/Fittin,gs • Electrical wiring insulation • Plaster/Wall.Joints • Chalkboards Textured paints/Coatings • Roofing shingles • Ceiling Tiles/Pancls/Mastic • Built-up roofing • Spray-Applied insulation • Base Flashing • Blown-in Insulation • Rolled roofing • Fireproofing • Sink insulation • Caulking/putties • Packing Materials • Incandescent light fixture backing • High Temperature Gaskets • Joint compound/wallboard • Lab Hoods/Table Tops • Brick mortar • Fire Blankets • Vinyl wall coverings • Fire Curtains/hose • Vapor barrier • Elevator brake shoes Cement roofing shingles • Asphalt flooring • Paper on backside of fiberglass • Gray roofing paint insulation • Nicolet(white) roofing paper • Erkot roofing material • Sub flooring slip sheet • Laboratory fume hoods • Mudded pipe elbow insulation • Paper fire box in walls • Fire doors Note: This list dose not include, every product that may contain asbestos. It is intended as a general guide to show which types of materials may contain asbestos. RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 10 04/0512007 14: 09 5095351893 C PAGE 11,'17 • — Chart F ASBESTOS IN YOUR HOME CALL SCAPCA BEFORE REMODELING OR DEMOLISHING. Don't put yourself or others at risk of exposure. EXTERIOR SURFACES MISCELLANEOUS Cement Asbestos Siding Woodstoves Cement Asbestos Flooring: Roofing & Felt Vinyl Asbestos Sheets, Window Putty Tiles, and Undershooting ,�,v Old Built-In Items: 4% �'r• Dishwashers .. _• j?. and Ranges ;a r r' s Z - , -. ii;. = ,i, J 111.11k_ ' LY:^ . s •111110ft Air&1;4 i" f ii H, _ rte./ = it _i t f` l; 1. i Y MEI ,-.i/►--4•1 - �----ai l �- — r auI .i , . -� c71,6,-. r - - ;',. . -a- r:I tom- 4NM1 G2 M ' - ' i l?1' - arl IIINIIIIk . -------= 7 '''''- ._, _, IL _ . HEATING & INTERIOR SURFACES VENTILATION Sprayed-on Popcorn Ceilings Heat Source Covering Pipe Insulation Acoustical Tiles ...•.-----.......... -' Door and Cover Gaskets Srieetrocic Tape Mud 0 Spokane County Air Pollution Air Duct Covering Control Authority 1101 West College,Suite 403 ■Y v1 1 Spokane,WA 99201 (509)477-4727 • www.scapca-or® RECEIVED 04-05-07 02:15PM FROM-5005351893 TO-SCAPCA PAGE 11 04/05/2007 14:09 5095351893 C PAGE 12/17 APPENDIX-1 LAB CERTIFICATIONS & LAB RESULTS RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 12 = A A/ United States Department of Commerce C csj E National Institute of Standards and Technology w v ig HvIll isi N 1 al o m to 1 H up•. �' O N o -0 cn a,13 UD Cil CO CJI r OD O W T 0 0 Certificate of Accreditation to ISO/IEC 17025 / 999 a c m u 7 NVLAP LAB CODE: 200670-0 Y n n Global Industrial Corp. Mesa,AZ • 0 1 • is recognized by the National Voluntary Laboratory Accreditation Program for conformance with criteria set forthin o MST Handbook 150:2001 and all requirements of ISO/!EC '17025:1999. Accreditation is granted Tor specific services, listed on time Scope of Accreditation, far. _ c 1 0 N BULK ASBESTOS FIBER ANALYSIS 4 m 2006-04-01 thraug,h2007-03-31 sl. ..triA. ir e,vy.,- _o For the Nafionaf instiivte of Standards and Technology 11 m Effective dates rfa 'Of ' f13r CO N1LAP-DIC[REV,1005-Z5,19) ---1 04;`051'2007 14:09 5095351893 C PAGE 14/17 � per 05 2007 11 :51RM Global Industrial Carp 480-497-0540 P- 1 4 7.,.,,.,..,. . .. ,, ,, .,,,,., ... sailLINDustRIAlicoRR ,,,r4a,„;:: ..H ,..44 ,,.„ p_.,,,„2, ,,, ,:,,,,f ."..:.,, Report W. 07-GIC-1258 AFFORDABLE ASBESTOS Date of Receipt: 4./512007 Report Date; 4/512007 Project STIMPSON 12418E 20TH Date of Analysis: 4rt-2oar Semple MaterielCompositionCliertt#� Location Description D etecdotl WP Window Pular,White None Detected Non Fibrous 100% Felt,Black None Detected Cellulose 30% RFi Roof Non Fibrous 70% Felt,Black None Detected Cellulose 30% RF2 Roof Non Fibrous 70% None Detected Fiberglass 20% R Roofing,Gray Non Fibrous 80% None Detected Cellulose 30% SF1 siding Felt,Bleck Non Fibrous 70% Siding Felt,Buds None Detected Cellulose 30% SF2 Non Fibrous 70% SF3 Siding Felt,®reek None Detected Cellulose 30%Non Fibrous 7O 6575 E Main St Salta no Mesa Az er2o5 Phone(460)497.4MMo Pim(.50/4970540 Page 1 NVLAP CODE 2008!0-O RECEIVED 04-05-07 02:15PM FROM-5005351893 T0-SCAPCA PAGE 14 04/512007 14:09 5095351893 C PAGE 15l'17 Apr 05 2007 I1: 1Rm Gloi=a1 Indust:ri'a1 Corp. X480-497-0840 P•e Sample Material pB1>ErGtion Composition Client# . Location Description ASBESTOS TYPES: Chrysotile,Crocidolite,AnthophylUte,Tremolite,An►oeite.Aetinolite The samples listed above were suspect of containing asbestos. A result of"T(waDvt"means*thorough tmerch using appropriate techniques was conducted and no type of asbestos was discovered. Samples sulmitted to this facility will be disposed of unless the •.Cil be archived for a period dna more than 3 years. The analysis performed is in client requests me samples be rammed. R"["'�* onlyto the samples submiticd.lY n not our accordance odd:EPA 60Q/1yi4.$2-020 with a deteetion limit of 1%. Test results apply report bei shall not t reproduced polity to distribute sue clatomer'e information without the written consent of the customer. The test c sept[a tUll,wftbout the written approval*fuse lubnraror7. Shawn Kearney Angela Kearney Lobxrstory Director President Aunty et 6515 E Main St Suite 128 Mem AZ 85205 Phone(480)497-0280 Fax(480)497.0540 Page 2 N111,AP CODE 2006-70-0Papa RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 15 g4/05/2007 14:09 5095351893 C PAGE 16/17 APPENDIX-2 INSPECTOR CERTIFICATIONS RECEIVED 04-05-07 02:15PM FROM-5095351893 T0-SCAPCA PAGE 16 E4/05/'2807 14: 09 5095351893 C PAGE 17/17 . ' `~_ _ 0. SA 4 • ..4 tit .1/4 ,,,' ;:1/4,'..t.-:.t..---4iii,--;,i', • '-';'•'''''J'y '+'") . PCI ',..7.;-' : ;.....—,,,,..,,z,vrio:-.; '''qW ::;:. ‘4,:19t!..''''.. el) E___, —3=, ,.,.. ',. . •-•,, , ?' I ,,m,r2.2_,_,..,--........„,4 k .,,..:e..,., , . . 8 . ..,:,,...t ,_ ..;,A.ca.i.kh....4. 7.•,,.i .. ,,..r.,k.,';', z.. r")..4 t4-1 ' % ° -7.---,,,' .. ', T-"' '-v-'''' -) ' ,,:,‘44, g E.....1 rulo = 8 --4.•C:-., ---"...--- -..!7 -. ..cs :„.... „,,,,....,.„A.,,„„.........ei, ..,....,..: . ., ,....,•„.......„),..„.„.....„ ,.... ,....,.. .. . ,. • „Tax-- RECEIVED 04-05-07 02:15PM FROM-5095351893 TO-SCAPCA PAGE 17