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Home My WebLink AboutPermit Demolition 2006-08-22C Building/Combination Permit PERMIT NO: COM2006-01082ISSUED: 0812212006APPLIED: 0812212006EXPIRES: 0212212007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line SITE ADDRESS: 164816TH ST ASSESSOR'SPARCELNO.: 1703253101300 PROJECT DESCRIPTION: Demolish manufactured home TYPE OF USE: Demolition Springfield TYPE OF WORK: Site Work Only C'U 'equires Residential ' Phone Number: 541-232-1872 et fofth Owner: Address: Contractor Type General CHRIS MATHEWS 1648 16TH ST SPRINGFIELD OR lose ruthraugi copl /es a On R952_ res cen es of 001- e C, Contractor HODGSON TREE SERVICE INC License 128029 Expiration Date 04t02t2008 Phone 541-345-9121 # of Units: # of Stories: Primary Occupancy Grdup: R-3 Height of Structure Secondary Occupancy Group: Type ofHeat: Primary Construction Type rr ^*,^YN Water Type: Secondary Construction Typ-dj U I lU E: Range Type: # of Bedrooms: THIS PEE[tiT SIJALLEXTfiP4trTHf \ tnH\- AUTHO R iZE D UI.J D EM[ri$H RBiI*iT$' ruN T ANY 1BO DA o! i b Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:nla Fronfyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Overlay Dist: # Street Trees Rqd: Square Footage or Bid Amount ) Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: Handicapped: Compact:Paved Drive Rqd: o/o of Lot Coverage: $ Per Sq Ft or multiplier PUBLIC IMPROVEMENTS Description Type of Construction Paee I of2 Value Date Calculated au rn n9 the obtain I, U ILL,II\ U rN I UKlv].A l_!!-rl'\l Valuation Description I GFIELD Building/Combination Permit PERMIT NO: COM2006-01082ISSUED: 0812212006APPLIED: 0812212006 EXPIRESz 0212212007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Fee Description + ll'h Administrative Fee + 57o Technology Fee + 87o State Surcharge Demolition Total Amount Paid Amount Paid Total Value of Project Date Paid 8t22106 8t22t06 8t22t06 8t22t06 Receipt Number 1200600000000001319 1200600000000001319 1200600000000001319 1200600000000001319 $4.s0 $2.25 $3.60 $4s.00 $51,J5 Plan Reviews To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Demolition: After demolition is complete, sewer is capped or septic is pumped and filled and inspection is requested and approved, and all debris is removed from the site. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times construction. # /rz-o( Owner or Contractors Signature Pase2 of2 Date a_i tl ees ralo t(eourred lnsDectrons Construction Contractdrs Board Permit #:Lowt"ao-,6'-6lotZ 700 Summer St IIIE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:IUry!.g!q!4q Address:bq bri sf Issued by:br Date:'7-,:L Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed archttect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statementwill befiledwith thepermit. Fill in the appropriate blanks and initial boxes 1 and 2, md either box 3A or 38 &- & v l. I own, reside in, or will reside in the completed structure. 2 I understand that I must become licensed as a construction contractor if the stucture is sold or offered for sale before or on completion. 3,A.. My general contractor is #ObC-!orrl Tlg s P-{c lTgoz? (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR tr 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Conkactors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reYerse side of this form. 7%4 €^zz-o? (Signature ofpermit applicant) @ate) ffiite copy to issuing agenq) permilfile, pink copy to applicant.) Property_owner. doc 06-0 I -04 Acting as hur Own General Crlntractor?. . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CON$TRUCTION RESPON$IBILITIES . - If you are acting as your own contactor to ctnstruct a new home or make a substantiai improvemeirt to * "*irtirrgstructure, you can prevent many problons by beingamnre of the iollowing responsibilitiesaad ooncerns. Employer Responsibilities You will, in rnost instances, be ruled to be an "employer" and the contractors you contract wi& will be "employees" if you use conhactors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comp[y with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes Som employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhoid the tax from your employees. For more rnformation, call the Depailrnent of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemplolmaont iusurance purposd on the wages of all CInployees. For more information, call the Oregon Employment Deparlment at 503-947-1488. The Oregon Business Identification Number (BIIll) is a combined nqmber for both Oregon Withhqlding a}- Unernployment Insurance Tax. To file for a BIN, call 503-945-8091 or g,ww.dor.state.or.us/formspay.htmll for the appropfiate forms. \ lVorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more informafion, call the Workers' Compensation Division at the Department of Consumer md Business Services at 503 -947 -7 815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. . You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at1-804-8294933 or visit their web site at.Utle]Ujlggey Other Responsibilities and Areas of Concern$ Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to ireet code requirements that may be brought to your attention through inspections. ,, .: ...i.i.: Liability and Property l)amage insurance: Contact your insurance hgent to see if you have adequate insurance " coverage for accidents and omissions such as falling toois, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own geareral contractor, to coordinate the work of rough-iu and finish trades, and to notily building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Constnrction Contractors Board (503-3784621) or write the agency at P0 Box 14140, Salem, OR 97309-5052. ._,. , ;_ , ,. ;i Property_owner.doc 06-0 1 -04 TE:NO Ihls lnformation toNotice Owners Constructionabout wasPrapedy thedevelapedby Construction Contractors tnBoard withaccardance 70oRs 1 the 989I055(5)passed by Legislalure.Aregon 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone C;-' of Springfield Official Receipt L _;lopment Services DePartment Public Works DePartment RECEIPT #: 1200600000000001319 Date: 0812212006 ll:54:05AM Job/Journal Number coM2006-01082 coM2006-01082 coM2006-01082 coM2006-01082 Description Demolition + 57o Technology Fee + 8% State Surcharge + 10o/o Administrative Fee Amount Due 45.00 2.25 3.60 4.50 Item Total:$5s.3s Payments: Type of Payment Received By Batch Number Check Number Authorization Number How Received Amount PaidPaid By CreditCard VONDA SMITH djb 210184 In Person $5 s.3 5 Paymenttotal: ffi cRcceint I Page I of I 812212006 *F*iiloFlql a! SF F'I AI CiFT E:LD 225 FIFTH STREET o SPRINGFTELD,OR97477 o PH:(541)726-3 753 r FAX: (541)726-3689 ,tu.Aw' Your demolition permit is currently being processed' There may be a slight dela-v' of il;;; ;rkirrg dayr for small structures] due to the time required to-review the history of the structure to determine if it needs to be documented before demolition' This documentation is for archival purposes onll'and will not affect the granting of the demolition permit. If the structurJis 'ery large or comp]icated the documentation process may take up to a maximum of 4 working days. Documentation will consisiof photbgraphing the building, taldng-measurements and ;;tG scaled drawings. The documlniation u,ill be undertaken by the Cig' 21no cost to you. Documentuti# i. being done on all structures dated prior to 1940 that may have historic importance to the City's development' THIS DOCTIMENTATION WILL NOT IMPEDE THE DEMOLITION PROCESS' An age cut-off of. tg4owas chosen because this is the date that the National Parks Service and The Sp.i"gn.fa Development Code use to determine potential historic significance. If you would prefer to complete this documentation yourself you must provide the biiy *i f, tt "iolto*ing information: r) black and-white photographs of each elevation, a floor plan"with measurements, and z) a set of elevation drawings with measurements. Thank you for your Patience. I gran t the City of Springfield documentation prior to the Address /(,t f /(^i Property Owner SigPature to n U B Job Nurnber: (-Ovt\49 e - 6t o EZ- Date:t Z 6 DEMOLITION PERMIT APPLICATIONS at: M- FOR 1. 1;tr r+$r".1{iI''tilLr: 225 FIFTH STREET ' SPRINGFIELD, OR 97477 o PH:(541 )726-3753 o FAX: (541)726-3689 DEMOLITION PERMIT APPLICATION Address:4f l{ ""5 2-r Structure to be Demolished:vv4- Job Numb ey Loazt zooG- o I o 8 ? Fb,l The applicant is hereby notified tJrat any redevelopment of th,e subject site must ;;;;iy';ih ali of the applicable laws, codes, ordinances, polices and plans in effect at the time the redevelopment proposal is accepted as complete f9r CltV . , review. This would in"fra" "orrection of substandari conditions associated with il;;t;t;;ia"*rop*""i- e*onlpt"t 9f rych corrections mav include modificatio., of inadeq""i" a."iri"ge facilities; complian-c" tlh building set- backs from prope.ryii"".; "orrecti-on ofsubstandard sidewalks and street ;il;;;;;ii",'i r,.r, Ji"-g h;i;;;;y ; $th an{ pl a cement ; and oth er corr ecti on s 'w,hich may be ,r"""rrl.yio;;;pl; with existing development standards' Furthermore, if an existing use is demolished or otherwise removed prior to.the development of the ;6;J;.", tr'*" the system $evelonpgnt charge credit for ,h;;;J;;;;b "ri.ti'ru ise shail expire two years after the date of issuance of the demolition permit orBtn", ,"-olrul of th. previously existing use' (Springfield Municipal Code g.+t6(r)). My signature below indicates that I hal,e read and understand the above "olaiio"r relating to ttre demolition of the above mentioned structure' $- zz-o; DateSignature }IOTICE: THIS PERM lE IF THE PFRMIT WORK is N01 nEl.D UNDE FN OR II ABAND( ? |rfif,ia.!r'!?3' Lodge Environmental Inc. 2950 ALTANE IANE STE. D EUGENE, OREGON 97402 541.461.8001 FX. 541.461.5453 ccB# 119557 DEQ#FSC654 DHS#97 -O02 WWW.CLEANLODGE.COM Asbestos ana Professional asbestos abatement contractor services are required prior to the restoration of the area S testin tive for asbestos. Oregon Department of Environmental Quality (DEQ) regulations state: Division 248 (340-248- 0010X8) o'Asbestos-containing material (ACM) means any material, including particulate material, that contains more than one-percent asbestos as determined using the method specified in 40 CFR Part763 Appendix E, Subpart E, Section L, Polarized Light Microscopy (PLM)." Due to the limits of PLM testing the Federal Environmental Protection Agency (EPA) recommends and client may request that any material testing underlOo/o asbestos be point counted for more accurate results. Point counting analysis will cost additional. LRAPA - Title 43 - Asbestos Requirements (concerning owner performed asbestos abatements) o/o AsbestosMaterialIab ID #Location Non-detectMain roof Comp shingle26049248 2o/o3ft roll on roofing26049249Porch roof Non-detectVinyl260492s0Entry floor Non-detectVinyl2604925tKitchen & dininq room floor Non-detectVinyl26049252Bathroom floor Non-detectInterior walls Sheetrock w/ texture26049253 Non-detectTexture & tape26049254UtiliW room ceiling 45o/oVinyl260492s5Utility room floor (1) Asbestos abatement conducted inside or out of a single private residence by the owner is exempt from 43-015-10.A, if the residence: (a) is not used as a rental property, (b) is not used as a commercial business; (c) is not intended to be demolished. (2) Asbestos abatement conducted inside a single private residence by the owner-occupant is exempt from 43- 015-8 through 43-015-1 I No other obvious ACM was present during the inspection of the building. However, if ACM not previously identified is encountered during the building, remodeling or demolition activities, Lodge Environmental Inc. recommends that upon discovery of asbestos materials found during demolition, the owner or operator peforming the demolition must:(1) Stop demolition work immediately;(2) Notify the Authority immediately of the occurrence;(3) Keep the exposed asbestos-containing materials and any asbestos-contaminated waste material adequately wet at all times until a licensed asbestos abatemenf contractor begins removal activities; and (4) Have the licensed asbestos Lod e Environmental Inc. 2950 ALIANE I,ANE STE. D EUGENE,oREGON 97402 541.461.8001 FX. 541.461.5453 c c B # 1 1 e s sil,'. Ji?I [i3B?-=o*sff s' - o o' abatement contractor remove and dispose of the asbestos containing waste material. Contractors should be aware of the potential for hidden asbestos containing materials and have pre-planned contingencies for the handling of ACM discovered during renovation/demolition activities' Please note: The owner or operator of a facility that requires a survey pursuant to (LRAPA regulation 43-015-10.A) must keep a copy of the survey report onsite at the facility during any demolition or renovation activity. llv mitted, Ja D. Andreason EPA Building inspector #:06-1729 2006 current Federal and State certifications J.r /_: L vk IrsFrss '!!rj:Fi:Eli: v.'{-:i^i Afi* i*1(?ltri{i}it:i C,iri i;i'l n$'SfiiT'i)'$ fif' L."4SUAL {;.{ i-:\ii;3.$S1.,t1...x:ii(i.i\i FF;'l).iE:)T, :,'{tli 1.41-i$? gE pF,U,ir){*y} ,1..1: A'N\: Tl}i4* lil *iiflF.' T}{is $*iiii Tt,,1. lit,iiii llritlir;{:;'i'i'.}t. 'Yini.: (:,1'.i'ii"iilf i..IT.itr"r'l,0,"([ $Ls€ ij$li :i|'ui', i:i.itli. Y*i; \'ii.i:)T Tr:rKE,r'-r'i Jli](i'iuAl {a$fftE&liiEH tl}Uttli*, :}ri ir;l.irfla r(i l:[i'ili'i T1'11f) lnstlu(tDr Ed Gay rhroush 02109/06 ffi,Clarrttrn 'S, :tqx' i'7 ir: 1;:;r; ;:;:.,;;,';1; csurse oaes; 21,7J08 a6-1129 ,rul\I, I l, ll"lu0- ).luAlYl-ltYL Lf'']vl\nlvr\r Lu lrrv NVL LA bo rato ries, lnc, -- 4708 Aurora Ave. N., Seattle, wA 981-0-3- t"r, 2OO,S+Z'O1OO, Far: 206 634'1938 www,nvllabs.com Bulk Asbestos Fib ers Anal By Light Micro8coPY Glient Lodge Environmental Address: 2950 Allane, Suite D Eugene, OR 97402 is #102063 Batch #: 2608062.00 Client Project #: N/A Date Received: 06/20/2006 Sarnples Received: 8 Samples AnalYzed: I Mothod: EPN600R'93/1 16Attention: Mr, Jake Andreason ProJect Location: 1648 16th St.- SPringfield Or,97477 Lab lD:26049248 Client SamPle #: LE'001 Location: 1648 16th St Layerlof2DescriptionlBlackasphalticfibrousmatgrialwithgranules Non-Fibrous Materials: Other Fibrous Materials:% AsphalUbinder, Granules Glass flbers 30% Layer 2 ol 2 Description: Black asphaltio mastic Non-Fibrous Materials: Other Fibrous Materials:% Asphal Ubinder, Mastic/binder Nono Detected ND Lab lD:26049219 CliEnt SamPle #: LE-002 AsphalUbin dar, Mastic/binder None Detected ND Lab lD:26049250 Gllent SamPle #: LE'003 Location: 164816th St. Layer 1 of 2 Desortption: Black asphaltic fibrous material with light gray granules Non-Fibrous Materials: Other Fibrous Materials:% AsphalUbindor, Granules' Mineralgrains Glass fibers 30% Layor 2 of 2 Description: Black asphaltic mastic Non-Fibrous Materials: Other Fibrous Materials:% Asbestos TYPe: % None Detected ND Asbestos TYPe: % Nono Detected ND Asbestos TYPe: % None Detected ND Asbestos TYPe: % Chrysotile 2% Asbestos TYPe; % None Detectod ND Asbestos TYPe: % None Detected ND Location: 1E4B 16th St, Layer I of 3 Description: Off-white/tan and pink sheet vlnyl Non'FibrousMaterials:OtherFibrousMaterials:0/o Vinyl/binder, Synthetic foam None Detected ND Layer 2 ol 3 Descriptlon: Light gray fibrous backing with gold mastic Non'Fibrous Materials: Other Fibrous Materials:% Fine particles, Binder/Filler' Mastic/binder Cellulose 65% Glass fibers 3% Note: lf samPles are not homogEnoous,then subsamPles of the comPonents were analYzed separalelY' All uutk semPtes are snalfod using EPA 600/R -93/116 Melhod with the following measutement uncerlainties for the mPorted % Asbestos (1 %=0'3%,5%=1 -g70, 1 0%=5.1 5r/0, 201h=l O-30%. 5o%r4o -60%), ThB rcport relEtes only to tho items lesled lf sample was not collecled by I'WL Penonnerl, thon lhe accuraoy of the results is limited b! the methodology and acuitY of lho samPle colleclor, This lEport Ehall not be repmduced except ln full, wi$out NW Laboraloiles, lnc, lt shall SamPled hY: Client Analyzed bY: Nadia Prysyazhnyut<Date:06/2112006 D TAF not used to claim Product endor3ement by NVLqP oJ other a0ency of the US Governmsnt. written approval ol Page 1 of 4 uvtr, l l, lvvu- T. Junlrl- lt t L Ln,vl\n rvr\ r Lv r rtv NVL Laborat ories lnc Attentionl Mr. Jake Andreason Projec-t Locatiolt: 1648 16th St.- SPringfield Or,97477 4708 Aurora Ave. N.,Seattlo, WA 98103 Tel; 206,547.0100, Fax: 206'834'' w\iYw.nvllabs.com 1936 Bulk Asbestos Fibers Anal By Po ht ClienL Lodge Environmental Address: 2950 Allane, Suite D Eugene, OR 97402 IS #102063 Batch #:2608062.00 Client Projeot #; N/A Date Received: 06/20/2006 SamPles Received: I SamPles AnalYzed: I Method: EPA/600R-93/1 1 6 Location: 1648 16th St. Layer 1 of 4 Descrlptlon: Off'white/tan sheet vinyl Non'Fibrous Materials: Other Fibrous Materials:% Vinyl/binder, Synthetic foam None Deteoted ND Layer 2 of 4 Des*iption: Light gray fibrous baoking wlth gold rnastic Non'Fibrous Materials: Other Flbrous Materials:o/o Fine particles, Binder/Filler' Mastidbinder Cellulose 65% Glass fibers \oh Layer3of4Description:Tancompressedfibrousmaterialwithpaint Non-Flbrous Materials: Other Fibrous Materials:% Fine particles' Adhesive/binder' Paint Cellulose 97% Layer4of4Description:Lighttansoftmasticwithpaint(onwood) Non-Fibrous Materials: Other Fibrous Materials:% Layer 3 of 3 Lab lD:26049251 Lab lD:26049252 Descriptlon: Off-white compacted powdery Non'Fibrous Materials: Calcareous Partioles,Binder/Filler, Paint Client SamPle #: LE'004 MasticJbinder Client SamPle #: LE'005 material with Paint(on wood) Other Fibrous Materials:% Cellulose 1% Cellulose 5o/o Asbestos Type: % None Detected ND Asbestos TYPer % None Dotectod ND Asbestos TYPe: % None Detected ND Asbestos TYPet% None Detectsd ND Asbestos Jype: % None Detected ND Asbestos TYPe: % None Detected ND Asbestos TYPe: % None oetEctod ND Location: 1648 16th St, Layer I of 3 Description: Off-white sheet vinyl with pattern Non'Fibrous Materials: Other Fibrous Materials:% Vinyl/binder, Synthetic foam None Detected ND Layer 2 of 3 Doscriptlon: Light gray fibrous backing with mastic Non-Fibrous Materials: Other Fibrous Materials:% Fine partioles' Binder/Filler' Mastic/blnder Cellulose 55% Note: ll samPles are not homoEeneous,then subsamPles of lhe comPonents were onalfied $oParatelY.All bulk samPlos are rnafyttO using EPA 600/R -83/116 Method with the following measuremont uncertainties for the rePorted % Asbeslos 11%=0'3%'51L= 1.9n/o t',t 970'!-1 5 oA, 2)oh=10.30th, 50%=40 €o%).This reporl relales only lo tho itsms lested, lf samPle war nol eallected bY NVL Porsonnel, lhen lhe sccuracy ol lhe resultr is llmlted bY the and ocuitY of the samPle collector,This lePoil shall nol be reproduced exiept in full, without writlen lnc. lt shall Samplotl bY; Olient Analyzed bY; Nadia Prysyazhnyuk Date: 06/2112006 l')TAF not used to gndorsemenl NVIAP or other of rhe us Govornment. approval of NVL Laboratorios, Page 2 ot 4 methodologY JVN, II, IVUU ).J/N I NVL LA boratories lnc. 4708 Aunira Ave, N,, Seattle, WA 901 03 Tel:206.547,0'100, Fex: 206,834.1936 www'nYllabs.com bestos Fibers Ana SISBulk As By Polarized Light Clien[ Lodge Environmental Address: 2950 Allane, Suite D Eugene, OR 97402 #102063 Batch #: 2608062.00 Client Project #: N/A Date Received: 06/20i2006 Samples Received: I Samples Analvzed:8 Method: EPFU600R'93/1 1 6 Attention: Mr. Jake Andreason Project Location: 164816th St, SPringfield Or,97477 Synthetic fibers 10% Glass libers 2o/o Layer 0 of 3 DescriPtisn: Tan compressed flbrous material Non-Fibrous Materials: Other Fibrous Materials;% Fine pa rtioles, Adhesive/binder Cellulose 97% Lab lD:260492s3 Client SamPle #: LE'006 Location: 1648 16th St. Layer I of 3 Descilption: White soft mastic Non-Fibrous Materials: Other Fibrous Materials:0/o Mastic/bindel Cellulose 2o/o Layer 2 of 3 Descriptionr .*"T:J:[ffi:'^:i,::,:,:] materiarwith :'.J?:r. Materiars:o/o Calcareous particles' Binder/Filler' Palnt None Detectod ND Laysr3of3Descriptlon:Off-whitechalkymaterialwithpaper Non-Fibrous Materials: Other Fibrous Materials:0/o Fine particles, Gypsum/binder Cellulose 20% Glass libers 3o/o Lab lD:26049254 Location: 1648 lBth St. Client SamPle #: LE'007 Layer I of 3 Description: Off'white compacted powdery materialwith white paint Non-Fibrous Materials: Other Fibrous Materials:% Calcareous partioles, Binder/Filler, Paint None Detected ND Description: Otf-white compacted powdery material with paint Non-Fibrous Materials: Other Fibrous Materials:% Fine particles, Caulking compound, Paint None Detected ND Layer 2 of 3 Asbestos TYPet% None Detected NO Asbestos Type: o/o None Detected ND Asbestos TYPe: % None DetEcted ND Asbestoa TYPe: % None Detected ND Asbestos TYPe: % NonE Dotoctod ND Asbestos TYPe: % None Detected ND Note: lf semPles ere nol homogeneoue,then subsamPles of the camPonents were analYred ssPa€tsly All bulk ssmple3 .re analyzed using EPA 600/R -93/116 Method wlth the followlnE moaEuremont unce rtalntt€s for tho rePorlod % Asbsstos (1%=0'3%.5%-1-9%, 10016=5''15%, 20%"10.30%, 50%=40 €0%). This rePon retalcs onlY lo the ilems lested ll sample was not coltecled bY fWL penonnel, th en the accutacY of ths rosullE is limiled bY lhe methodologY and flcuitY of the samplE collector, This rcDoil Bhqll not be leprcducod cxc4Pt ln lull, without writlen LaboratorieS, lnc. Ishall Sampled bYl Client AnalYzed bY: Nadia PrysYazhnYuk Date: 06/2112006 D TAF not be used lo claitn product endoEement by NVIAP or eny othEr a0cncy of thg US Govornmsnt. approvEl of NVL Page 3 of 4 lIf L Lnr/vl\llrvrrl lv'r!v uulr, ll, luvu- 7.)lnl\l-lltL Ln',rvr\rrrvr\rLv rrtv Attention: Mr. Jake Andreason Project Location: 1648 16th St. Springfield Or,97477 NVL LA ES I nc. Client Lodge Environmental Address: 2950 Allane, Suite D Eugene, OR 97402 Bulk Asbestos Fibers e Polarized #102083 Batch #: 2608062.00 Client Project #: N/A Date Received: 06/20/2006 SamPles Received:8 Samples AnalYzed: 8 Method: EPt'/600 R-93/1 1 6 Layer 3 of 3 Description: Off-white compacted powdery material with paper Non-Fibrous Materials: Other Fibrous Materials:70 Cellulose 45%Fine particles, Caulking compouttd Asbestos Type: % None Detected ND Lab lD: 26049255 Client Sample #; LE'00E Location: 1648 16th S[ Layer 'l of 3 DescriPtionl Brown sheet vinyl with pattern Non-Fibrous Materials: Other Fibrous Materials:% Vinyl/binder, Synthetic foam None Detected ND Layer 2 of 3 Description: Light gray fibrous backing with mastic Non'Fibrous Materials: Other Fibrous Materials:% Fine particles, Binder/Filler, Mastidbinder cellulose 15Yo Layer 3 of 3 Doscription; Trace tan compressed fibrous material Non'Fibrous Materials: Other Fibrous Materials:% Fine partioles, Adhesive/binder Cellulose 97% Asbestos Type; % None Detected ND Asbestos TYPe: % Chryeotlle 45% Asbestos TYPe: % None Detected ND Sampled by: Client Analyzod bYl Nadia PrysYazhnYuk Date:06/2112006 DR FT Note: lf samples are not homogeneous,then subeamples of thr componenls were analyred separately.All bulk samples sre analyzed using EPA 600/R -93/116 Melhod with lhe following measurgmont uncadainll€s for the rePorled % Asbestos (1%=0-3%,soh= 1 -goh. 10%= 5' 1 50A, 20%=1 U30%, 60%=40 -80%),This rePort relates onlY to the ilems lested. lf sample was nol collecled by NVL penonnel, then tho accuracy ol tho results is limiled bY tho methodologY and acuitY of tho eamplo colleqlor. Thi6 repon ehall not be rcProduced except in tull, without wrinen approv8l of NVL Laboratories, lnc. lt shall not be used to claim prortuct endorsemenl bY NV|AP or ony olhsr auoncy of the US Governmenl. Page 4 ot 4 JUN, ll, luuo v:l/Arvr l\YL LllDUAnlVl\lLu lrtv BATCH ID zorjao62 ooNVL LA ratorles, lnc, . 4708 Aurora Avs N, Seallle, WA 98103 Tel: 208.547.0100 Emerg,Pager: 206.344'1878 Fa* 206.6114,1936 1,888.NV1'LABS (68s's227) Cliont Lodqe Enviro nmental Slrsot 2950 Allane, Sulte D Eugene, OR 97402 Project Mnnager Projecl Location l/Lt ? I 5+. GHAIN Of CUSTODY SAMPLE LOG NvL Brtch Number Cllent Job Number Total Samples Tum Around Time Email addreee L A.B S ,.t[tarl arlFlll lailal O r{r gf+-Hrs ! 4 DaYs O2-Hrs trZoay€ tr5Days tr 4.Hrs fJ 3 oays E 6 to 10 Oays Ptease crll lor TAT le66 than 24 Hr€ jeke.lodqe@comcasl.netSg"i*tr{U<{ Phonar (541) 461.8001 o.-Tu* \lqll Fax: (541) 461'5453 Hm Fax: (541) 689-3955 Asboslos Air Condilion ofPacka0e: D Good E Damaged (no spillage)E Sev8rc damago (sPiltage) Rcsulte Frred bY E/ PC (Nt H tr TEM (NIOSH 74 02)EPA Level ll Other Asbeetot Bulk ,AJ600/R-93/1 1 D PLM PA PLM EPA i TEM BUIK D Mold/Fungus tr Mold Alr Mold Bulk D Rolometer Calibtali on D FAA (PPm)n D Arsenic (As) E Berium (Ba) E Gadmlum (Cd) D Chromium (Qr) D Lead (Pb) Mercury D Copper (Ctr) Nickel(Ni)tr TCLP tr lcP (ppm) tr GFAA (ppb) I Drinking watar E DusUwipe (Area) D Waste E Other ler tr Selenium tr Silver (Ag) Zinc (Zn) D Soil D Paint Chips in % I Olher TYPeU ol Analysls A/Rle VolSample area,NumberCliont#'oo1 Lab lD 2 a 4 5 06 o7 I B I 10 11 12 13 't4 15 ?:t3 rntOL Sempled l/ Received Analyr6d Results Cslled Special lnStructions: Unless requesled in wrltlng, all samples will be disposed of two (2) weehs after analYsls' D Dust 3 Lodge Environmental Inc. 2950 ALIANE 1ANE STE. D EUGENE, OREGON 97402 541.461.8001 FX. 541.461.5453 ccB# 119557 DEQ#FSC654 DHS#97 -OO2 WWW.CLEANLODGE.COM The Federal Environmental Protection Agency Asbestos Informer What is asbestos? Asbestos is a mineral. It is mined in much the same way that other minerals, such as iron, lead, and copper, are. Asbestos is composed of silicon, oxygen, hydrogen, and various metal cations (positively charged metal ions). There are many varieties of asbestos: the three most common are chrysotile, amosite, and crocidolite. Chrysotile fibers are pliable and cylindrical, and often arranged in bundles. Amosite and crocidolite fibers are like tiny needles. The first commercial asbestos mine -- a chrysotile mine -- opened in Quebec, Canada, in the 1870's. Crocidolite asbestos was first mined in South Africa during the 1980's. Amosite asbestos also comes from Africa and was first mined in 1916. Unlike most minerals, which turn into dust particles when crushed, asbestos breaks up into fine fibers that are too small to be seen by the human eye. Often individual fibers are mixed with a material that binds them together, producing asbestos containing material (ACM). Why has asbestos been so widely used? Asbestos appealed to manufacturers and builders for a variety of reasons. It is strong yet flexible, and it will not burn. It conducts electricity poorly, but insulates effectively. It also resists corrosion. Asbestos may have been so widely used because few other available substances combine the same qualities. How many products contain asbestos? One study estimated that 3,000 different types of commercial products contained asbestos. The amount of asbestos in each product varied from as little as one percent to as much as 100 percent. Many older plastics, paper products, brake linings, floor tiles and textile products contain asbestos, as do many heavy industrial products such as sealants, cement pipe, cement sheets, and insulation. How long has asbestos been in use? Asbestos was first used in the United States in the early 1900's, to insulate steam engines. But until the early 1940's, asbestos was not used extensively. However, after World War II, and for the next thirty years, people who constructed and renovated schools and other public buildings used asbestos and asbestos -containing materials (ACM) extensively. They used ACM primarily to fireproof, insulate, soundproof, and decorate. The Environmental Protection Agency (EPA) estimates that there are asbestos containing materials in most of the nation's approximately 107,000 primary and secondary schools and 733,000 public and commercialbuildings Lodge Environmental Inc. 2950 ALTANE ]ANE STE. D EUGENE, OREGON 9740254t.46 1.8001 FX. 541.461.5453 ccB# 1195s7 DEQ#FSC654 DHS#97-002 WWW.CLEANLODGE.COM How are people exposed to asbestos? When asbestos fibers are in the air, people may inhale them. Because asbestos fibers are small and light, they can stay in the air for a long time. People whose work brings them into contact with asbestos -- workers who renovate buildings witli asbestos in them, for example -- may inhale fibers that are in the air: this is called occupational exposure. Workers' families may inhale asbestos fibers released by clothes that have been in contact with ACM: this is called paraoccupational exposure. People who live or work near asbestos- related operations may inhale asbestos fibers that have been released into the air by the operations. this is called neighborhood exposure. The amount of asbestos a worker is exposed to will vary according to The concentration of fibers in the air Duration of exposure The worker's breathing rate (workers doing manual labor breathe faster) Weather conditions The protective devices the worker wears It is estimated that between 1940 and 1980.27 million Americans had significant occupational exposure to asbestos. People may also ingest asbestos if they eat in areas where there are asbestos fibers in the air. When is ACM most likely to release asbestos fibers? Damaged ACM is more likely to release fibers than non-damaged ACM. In a 1984 survey, EPA found that approximat ely 66 percent of those buildings that contained asbestos contained damaged ACM. If ACM, when dry, can be crumbled by hand pressure -- a condition known as "friable" -- it is more likely to release fibers than if it is "non-friable." Fluffy, spray-applied asbestosfireproofing material is generally considered "friable." Some materials which are considered "non-friable," such as vinyl-asbestos floor tile, can also release fibers when sanded, sawed or otherwise aggressively disturbed. Materials such as asbestos cement pipe can release asbestos fibers if broken or crushed when buildings are demolished, renovated or repaired. ACM which is in a heavy traffic area, and which is therefore often disturbed, is more likely to release fibers than ACM in a relatively undisturbed area. a a a a a Lodge Environmental Inc. 2950 ALIANE LANE STE. D EUGENE, OREGON 97402 541.461.8001 FX. 541.461,54 53 ccB# 119557 DEQ#FSC654 DHS#97 -OO2 WWW.CLEANLODGE.COM How can asbestos be identified? While it is often possible to "suspect" that a material or product is/or contains asbestos by visual determination, actual determinations can only be made by instrumental analysis. Until a product is tested, it is best to assume that the product contains asbestos, unless the label, or the manufacturer verifies that it does not. The EPA requires that the asbestos content of suspect materials be determined by collecting bulk samples and analyzing them by polarized light microscopy (PLM). The PLM technique determines both the percent and type of asbestos in the bulk material. EPA Regional Offices can provide information about laboratories that test for asbestos. Does asbestos exposure cause health problems? Some people exposed to asbestos develop asbestos-related health problems; some do not. Once inhaled, asbestos fibers can easily penetrate body tissues. They may be deposited and retained in the airways and lung tissue. Because asbestos fibers remain in the body, each exposure increases the likelihood of developing an asbestos-related disease. Asbestos related diseases may not appear until years after exposure. Today we are seeing results of exposure among asbestos workers during World War II. A medical examination which includes a medical history, breathing capacity test and chest x-ray may detect problems early. Scientists have not been able to develop a "safe" or threshold level for exposure to airborne asbestos. Ingesting asbestos may be harmful, but the consequences of this type of exposure have not been clearly documented. Nor have the effects of skin exposure to asbestos been documented. People who touch asbestos may get a rash similar to the rash caused by fiberglass. What illnesses are associated with asbestos exposure? Asbestos is Asbestosis is a serious, chronic, non-cancerous respiratory disease. Inhaled asbestos fibers aggravate lung tissues, which causes them to scar. Symptoms of asbestosis include shortness of breath and a dry crackling sound in the lungs while inhaling. In its advanced stages, the disease may cause cardiac failure. There is no effective treatment for asbestosis; the disease is usually disabling orfatal. The risk of asbestosis is minimal for those who do not work with asbestos; the disease is rarely caused by neighborhood or family exposure. Those who renovate or demolish buildings that contain asbestos may be at significant risk, depending on the nature ofthe exposure and precautions taken. Lodge Environmental Inc. 2950 ALIANE LANE STE. D EUGENE, OREGON 97402 541.461.8001 FX. 54 1.461.5453 ccB# 119557 DEQ#FSC654 DHS#97-002 WWW.CLEANLODGE.COM Lung Cancer Lung cancer causes the largest number of deaths related to asbestos exposure. The incidence of lung cancer ln people who are directly involved in the mining, milling, manufacturing and use of asbestos and its products is much higher than in the general population. The most common symptoms of lung cancer are coughing and a change in breathing. Other symptoms include shortness of breath, persistent chest pains, hoarseness, and anemia. People who have been exposed to asbestos and are also exposed to some other carcinogen -- such as cigarette smoke -- have a significantly greater risk of developing lung cancer than people who have only been exposed to asbestos. One study found that asbestos workers who smoke are about 90 times more likely to develop lung cancer than people who neither smoke nor have been exposed to asbestos. Ale,sothelioma Mesothelioma is a rare form of cancer which most often occurs in the thin membrane lining of the lungs, chest, abdomen, and (rarely) heart. About 200 cases are diagnosed each year in the United States. Virtually all cases of mesothelioma are linked with asbestos exposure. Approximately 2 percent of all miners and textile workers who work with asbestos, and 10 percent of all workers who were involved in the manufacture of asbestos-containing gas masks, contract mesothelioma. People who work in asbestos mines, asbestos mills and factories, and shipyards that use asbestos, as well as propl. who manufacture and install asbestos insulation, have an increased risk of mesothelioma. So do people who live with asbestos workers, near asbestos mining areas, near asbestos product factories or near shipyards where use of asbestos has produced large quantities of airborne asbestos fibers. The younger people are when they inhale asbestos, the more likely they are to develop mesothelioma. This is why enormous efforts are being made to prevent school children from being exposed. Other Cancers Evidence suggests that cancers in the esophagus, larynx, oral cavity, stomach, colon and kidney may be caused by ingesting asbestos. For more information on asbestos-related cancers, contact your local chapter of the American Cancer Society. Lodge Environmental Inc. 2950 ALTANE IANE STE. D EUGENE, OREGON 97402 541.461.8001 FX. 541.461.5453 ccB# 1195s7 DEQ#FSC654 DHS#97 -002 WWW.CLEANLODGE.COM Common Facts: FACT ONE: Although asbestos is hazardous, human risk of asbestos disease depends upon exposure. FACT TWO: Prevailing asbestos levels in buildings -- the levels school children and you and I face as building occupants -- seem to be very low, based upon available data. Accordingly, the health risk we face as building occupants also appears to be very low. FACT THREE: Removal is often not a school district's or other building owner's best course of action to reduce asbestos exposure. In fact, an improper removal can create a dangerous situation where none previously existed. FACT FOUR: EPA only requires asbestos removal in order to prevent significant public exposure to asbestos, such as during building renovation or demolition. FACT FIVE: EPA does recommend in-place management whenever asbestos is discovered. Instead of removal, a conscientious in- place management program will usually control fiber releases, particularly when the rnaterials are not significantly damaged and are not likely to be disturbed. Lodge Environmental Inc. 2950 ALLANE IANE STE. D EUGENE, OREGON 97402 541.461.8001 FX. 541.461.5453 ccB# 119557 DEQ#FSC654 DHS#97 -OO2 WWW.CLEANLODGE.COM Where Can I Find Asbestos And When Can lt Be A Problem? lVlost products made today do not contain asbestos. Those few products made which still contain asbestos that could be inhaled are required to be labeled assuch. However, untilthe 1970s, manytypes of building products and insulation materials used in homes contained asbestos. Common products that might have contained asbestos in the past, and conditions which may release fibers, include: . sTEAM plpES, BOILERS, and FURNACE DUCTS insulated with an asbestos blanket or asbestos papertape. These materials may release asbestos fibers if damaged, repaired, or removed improperly. o RESILIENT FLOOR TILES (vinyl asbestos, asphalt, and rubber), the backing on VINYL SHEET FLOORING, and ADHESIVES used for installing floor tile. Sanding tiles can release fibers. So may scraping or sanding the backing of sheet flooring during removal.. CEMENT SHEET, MILLBOARD, and PAPER used as insulation around furnaces and wood burning stoves. Repairing or removing appliances may release asbestos fibers. So may cutting, tearing, sanding, drilling, or sawing insulation.. DOOR GASKETS in furnaces, wood stoves, and coal stoves. Worn seals can release asbestos fibers during use. . SOUNDPROOFING OR DECORATIVE MATERIAL sprayed on walls and ceilings. Loose, crumbly, orwater- damaged material may release fibers. So will sanding, drilling, or scraping the material. . PATCHING AND JOINT COMPOUNDS forwalls and ceilings, and TEXTURED PAINTS. Sanding, scraping, or drilling these surfaces may release asbestos.. ASBESTOS CETVIENT ROOFING, SHtNGLES, and SlDlNG. These products are not likely to release asbestos fibers unless sawed, dilled, or cut. ARTIFICIAL ASHES AND EMBERS sold for use in gas-fired fireplaces. Also, other older household products such as FIREPROOF GLOVES, STOVE-TOP PADS, IRONING BOARD COVERS, and certain HAIRDRYERS. AUTOMOBILE BRAKE PADS AND LININGS, CLUTCH FACINGS, and GASKETS. a a a DOI]GLAS NTERNIATIONAL po Box 1524Yeneta, Oregon 91487 (541) 935 9656 (541) 935 6210 fax Email: dintl@dintl.org website: www.dintl.org August 8,2006 To: Christopher D. Matthews 164816th Street Springfield, Oregon 97 477 Re: Pre-demolition Asbestos investigation, Thanks for the opportunity to assist with the required environmental services at this location. The survey (conducted by Lodge Environmental) photos and results from the lab are enclosed in the attached report. The asbestos found in the original survey was abated by yourself and disposed of by Pacific Environmental Group Inc. of Eugene, Oregon on August 8, 2006 The findings from this investigation indicate that no remaining asbestos was found in the structure. Following this activity, the structure is ready for demolition pursuant to the rules set forth in LRAPA'S title 43 regarding asbestos. If you have any questions, please contact me Thanks again.Douglas J. Moore Douglas International www.dintl.org PO Box 1524 Veneta, OR97487 D#-l ,ru(* r':q ASiq 4 ASBESTOS WASTE SHIPMENT REPORT FORM PLEASE PRINT OR TYPE! If you have questions, contact your Iocal DEQ Regional Office in Portland at (503) 229- 5364, Salem at (503) 378-8240 ext.272, Medford at (541) 776-6010 ext.235, or Bend at (5al) 388-6146 ext.226, OR call (800) 452-401I tbr the location of your local regional DEQ office. WASTE CENERATOR: lContr:actor. Iraciliry, or Operator) 1. Asbestos removal site name and address:Christonher f)- Matthews R 1648 16tr' Street Sorinslield.0R Lane 97477 ru Street City/State County zip Contact person:Chris Matthews Phone 51t 232 2. Operator's name and address: Pacific Environrnental Group. lnc. Phone:(54\767-3770 Fax: (541) 767-3715 P- O. Box 22306 E 0regon Lane 97 402 Street City/State County : (541) 746-6228 zip 3. Waste disposal site:sh ort Morrntain Landfill Phone County 97 zipCity/State Sheet Vinvl Floorins / roolins Street 4. Describe asbestos materials 5. Containers: Bags 6. Total quantity (cubic yards): Number:three less than one TR.ANSPORTIR(S): 8. Transporter #l: (Acknolvlecigrnent of receipt of materials) Agent:Douglas J. Moore Address Signature: -i__J9. Tlansporter #2: (Acknor,vledgnrent of receipt of materials) Agent Type:33" X 50" six mi I asbestos labeled Company: Pacitic Environmental Group. lnc. Phone (541\ 767-3770 Fax: (541) 767-3775 pu1.. Arr6c{f A zut6 .DISPOS.ILT tCcrtilicatiorl 01'reecipl oiasbestos malcliii.ls eovered by tlus nunil'est, e)iccpt as noted il ircur 1l be1on..) iu \lasrc Drsposei Srre Stiorr Nioiiiitiin 7 OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packaled, marked and labeled, and are in ail respects in pt'oper condition for transport by highway according to all government regulations. All movement of this asbestos- containing material is recorded on this Waste Shipment Record Form. Name:Company: Pacific Environrnental Group, lnc. Signature: - Date:Auau<r ? lna6 Nline tlrrcl Sigu:trure: Title oDate c il0 Phone. (5-l1i 726 3{r-+7 i i tJiSCRIIPANCY SPACE: LA.ld arracLunanrs as rLeedccl; i-lii.,rsrd.!J iri.r Address: Phone; Fax: Signatru'e: Date: _ DOTJGLAS J. MOORE, PO Box 1524 Veneta Oregon 97487 (541) 935 9656 fax (541) 935 6270 www.dintl.org dintl@dintl.orq INVOICE DATE: August 1,2,2006 rNvorcE # 0060808 ro: ChristopherMatthews 1648 16th Springfield, Oregon 97 47 7 ron: Asbestos investigation services, 7 5.00 Disposal Bags, 6.00 Disposal at Short Mountain 60.00 Total Due This lnvoice $ t4t.00 Terms: Net Due Upon Receipt Of lnvoice PleaseMakeCheckPayabt"ro@,SoleProprietor,DouglasInternational;Inc. THANK YOU FOR YOUR PATRONAGE iJ-,,.i..i,i;i{.}?';I,ii.{i} f,{ON-Ff{.iF.BiE NOTIHCATION OF INTENT TO REMOVE OR ENCAr>ULATE ASBESTOS IN LANE COUNTY, OREGON *"u' itx'f,[,'# H:# A u t h o ritv Springfietd, AK 97477 {$4'i } 735-105e, Fax: (5411 726-1205, toll free (877\ 285-7272 i ir'l;iii ,*l: ,lr"ha[ement Lr ! l: l,l :'t il: dl, 'r,/itor r r/ :) i',. r!a.riiiij : r':' i\r rcfe\' liernotitiort l{crrova( Irrcapsulatiorr R.eirovati<ln rl1aintenance/ Repair titirr:r i1AJ {i:iurvey beerr t:oinplete:d? ves I Nri fi ;.",,.1,"r'*iri.i d I PRG-,[CT I i.lisORMA'f lON Phone City it it\ ti..i.,,. i:.ii.; jIl r:f ,A.Sl:eStOS at tt-'e r't1r' i .rii.8Q()l-/l r;i.;i. i Dat.e 7; l-r -*- i-i:'rri;-i,::r!r:1: pin;ect not!fi<.ation requested: D l{o D Yes -- Discussed with r ii,,r: l.iij ASilEST'{]S JrtATfliillil l,,ii:t: ll Percent of Asbt:str-r ill,"ii,riiiiiy of e^slrestos in project Days or-r Site Date D ftoor tite n roofing lI fett tr sprayon D containment f, negative air bagged n other_ site a n school i-( residence fl college industria[ Dcommercial Dother -!i.,Comptetion Date Hours on Site-------- 1o utrz-fl Estirnate t-l Lab tr Linear tI Square l-l Cubic feet i I rrriic insi;tation li tapr: tr cementatious(eg: transite)I iihive rJackiirg ( rnastic lI sheet vinyi ! other_l\ ,, ,;,,.:,,. irii*\CTl.f[S Ai{D R[totO\iAL PRCICEDURES ..K,.,,,.'' ilierhoci n riiy nrethods with air fittering'i jij:ijr,triic{luiit i] vacuiirn rruck with HEPA fitter r,^i,r,.: j.:fli: air nronitcrring lr: be performed: n yes no .,i ri'il;l;aii. PROCtDtiRES r t r,,ii.e l-c drc;rbox n'\dr".,,,i.e sto(ed Dn sile ,'I i',i,..:te iemo"ed dzii[y iianil-lsad dropbox 'f,we'tted ancl doubte in stcrired container l].waste secured off l-r other :inl- 5l"i I :lir,;it Mountain tr (offin Butte tr other COt.ITRACTOIi i,-.:,-iL.i,:r:torl{arne ?'tt.License No. rir;,, i i l, rg A,dclru.ss 1'. ri i,; ';. lj il'i i-:,eien I i inl ,:il L,ri Srate 0K ZtP Certificate No. P 7D Celt/Pager No Cu rv"is l,lirullr4 u.i} For LRAPA Use: Project._.--..-_---__ Fee Rec'd $ 40* Check #oa6 Project Category and REQUIRED Fee u Emergency Waiver lAdd 50% to required fee) 5--__ .. U- Non-Friabte (5-Day Notice) { Residentiat Project (Occupied Residence, not for Demotition) D' . 40 tin/80 sq ft (Smatt Scate, Short Duration) fl > 40 linear/80 square feet; . ?60 linear/160 square feettr , ?.60 linear/160 sqft; < 1,300 tineari 80[,t sqft I-l > 1,300 linear/800 sqft; < 2,600 linear/1,600 sqftil , 2,600 linear/1,600 sqft; < 5,000 linear13,500 sqftll , 5,000 tinear/3,500 sqft; < 10,000 [inearl6,000 sqft ii , 10,000 linear/6,000 sqft; < 26,000 [inear/16,000 sqft U > 26,000 linear/16,000 sqft; < 260,000 linear/l60,000 sqft Lr > 250000 tinear1160000 sqft 350 439 760 877 444 340 974 + ls this revision to a notification? Yes I No t] 5 +tt s40 s40 5sz( $ 5 s S 1, $2, 52, ,'iiaii :rr g,t\dr:jress ZIP P . : i i, j ! i) iija s e P ri n i t=hlt 1+_&_Q€{*__-__O rga niza ti on-- one-- Date__ Asb:070 I 06- | i .; i:i!.1 i Matthews r8 16thqF ,., -eld, Oregon .t.. I Matthews 1648 16th Springfield, 0regon I a Ei.{ rr