HomeMy WebLinkAbout22-4190REINSPECTION FEES: (c) With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c) the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection, whichever is greater, for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
Complete Plans, Specifications add fee Must Accompany Application. All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRACTOR SIGNATURE PEfAIT OFFICE()
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received Phone Contact for Permitting
owners Name Sixth Avenue LLC Co/Duff & Phelps, A oll one Number
Owner's Address 917 W Washington MS 316 Chicago IL 6 6070wner Phone Number
Fee Simple Titleholder Name I ®® Owner Phone Number �—
Fee Simple Titleholder Address
JOB ADDRESS 5522 [aura Street Unit 28 LOT#
SUBDIVISION------� PARCEL ID# 12-26-21-0028-00500-0000
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEWOONSTR� ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE 0 SFR Q COMM OTHER
TYPE OF CONSTRUCTION BLOCK FRAME STEEL 0
DESCRIPTION OF WORK demo and legal disposal of SF mobile home
BUILDING SIZE----� SQ FOOTAGE 88Q HEIGHT
=BUILDING $5490.00 VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE PROGRESS ENERGY W.R.E.C.
=PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
0
GAS ROOFING Q SPECIALTY = OTHER
/ t
BUILDER _N COMPANY Johnson's Excavation &Services, Inc.
SIGNATURE REGISTERED I Y / N FEE CURREN / Y N
Address 1706 Trap I Rd, Plant City, FL 33566 License # CBC059540
ELECTRICIAN COMPANY =
SIGNATURE REGISTERED Y / N FEE CURREN Y ( N
Address License# F
PLUMBER COMPANY
SIGNATURE REGISTERED Y / N FEE CURREN
Address License # s
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y / N FEE CURREN
Address I License #
OTHER COMPANY =..
SIGNATURE REGISTERED Y / N FEE CURREN Y / N
Address License #
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
COMMERCIAL Attach (2) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
-PROPERTY SURVEY required for all NEW construction.
ba I 11 11 11 14 1 1 11
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A/C upgrades over $7500)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage)
Driveways -Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division —Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that 1, the applicant, have been provided with a copy of the "Florida Construction Lien Law —Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner', I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection -Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
Southwest Florida Water Management District -Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers -Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit -Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency -Asbestos abatement.
Federal Aviation Authority -Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone ' V' unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
Who is/are 6drsonaltv known to rbe Sr has/have produced
me this
identification.
I t ,V J Notary Public
Commission No. CH RUPP
M
Y COMMISSION # HH 175744
Name of Notary typed, printe F,4)0*M._ hAFIRES.'_J8_r1U&y 10, 2026
%,P
"e.$0 ftnded Thru Notary PW* UrWwwbrs
INSTR#2022118020OR E3KI0621 PG Page 1 of 1
05/26/2022 09:27 AM Ropt: 2460872 Rec: 10.00 IDS: 0.00 IT: 0.00
Nikki AlvarezSowles, Esq., Pasco County Clerk & Comptroller
v.
- 4�
k kt.
O SCE COMMENMMENT
' to & >;loridti, County of
tanderr�it tlara'rt t3Y.ty glvr rio�toe at
rovesrDent will be made' t�D oortein real propony, and its �accnrdan
with Chapter 713, Florida Statutes, the followlrtg Information Is proOded In'Ittfs Woo of'Comnt eerr eat.
9. UpscrIpMon trfpwooa t floral desorlDtlon of the nronerty_ and satraof nddrnqa if avAIIAFAAt .
2.
=
r.,. F f .tRt l.:F O A: ♦ i; � t i:: •., ,. M •' w .:♦M v
4 o,: *,
C W P Mn CMw > 0♦
U. Surety (If applicable, a copy of tie payment bond is at ched)
Name Mof Telephone tUumber.
Tag cIunt of Dond ,
6, Lender
Name -- elephoarla Iklunnbar
l
Num er
T,elephoneNumbe
9. Expiration date of notice of cornmencernent (the; xpfratiot- doto will be 1 yw
unfass e different date Ip sprclffed)
, v
IN
ASOy.
Sigrwwro of owner or i *a, rF'()warf or Loseso s Authorizad r0r Orll rtnerllt vegae
The foregoing In*tVrr ani was acknowledged Moro rite this day of _ b � 4 '
f� w m r era 0. 0p n
es
a of autto y, &O., cif , #rust " M In C arat per � 0 If of'Aft n tea* t w auto sl
frS of florid ._ PIiu4 � � �
F3ipn�sttaro Nag�ry u _�..---�----�- -_�
SUSAN t.. KOWAL
PersonallyICtiC3Ys7i OR PiYDducedI0 � �j : tiYGCMj,,lISSION#GG911739
Typo of Ili Pr�Ddixced �t ' X' i 2CS: 0ctobar 12, 2023
; ,4� �>c�- tkkd 7i�stk �i�t�?ub31c tJnderv�iter�
Florida Department of DEP Form 62-257.900(l)
Effective 10-12-08
Environmental Protection Page 1 of 2
FL Division of Air Resource Management
Ow NOTICE OF DEMOLITION OR ASBESTOS RENOVATION
TYPE OF NOTICE (CHECK ONE ONLY): Z ORIGINAL [3 REVISED [3 CANCELLATION El COURTESY
TYPE OF PROJECT (CHECK ONE ONLY): ® DEMOLITION E3 RENOVATION
IF DEMOLITION, IS IT AN ORDERED DEMOLITION? [3YES E1 NO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION? E]YES F-1 NO
IS IT A PLANNED RENOVATION OPERATION? DYES El NO
1. Facility Name Sixth Avenue LLC
Address 5522 Laura Street
City Zephyrhills State
Site Unit 28
Ill
Zip 33542
Consultant Inspecting Site
County Pasco
Terracon
Building Size 880 _ (Square Feet) #of Floors 1 Building Age in Years 50
Prior Use: 17 School/College/University [:] Residence E] Small Business M Other
Present Use: E] School/College/University El Residence E] Small Business E] Other
11. Facility Owner Sixth Avenue LLC Phone (L4131J52-7097
Address 917 W. Wasington MS 316 C/o Duff & Phelps, A Kroll Business
City Chicago State IL Zip 60607
Ill. Contractor's Name JOHNSON'S EXCAVATION& SERVICES, INC. - DONATHAN A JOHNSON phone ((813) 52-7097
Address 1706 E Trapnell Rd
City Plant City State FL Zip 33%6
Is the contractor exempt from licensure under section 469.002(4), F.S.? [:] YES E] NO
IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date)
Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: 06/13/2022 Finish: 06/30/2022
V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques
to be used and description of affected facility components. demo done by excavator and legal disposal of removed product by roll off
Procedures to be Used (Check All That Apply):
Strip and Removal F] I Glove Bag Bulldozer Wrecking Ball
X Wet Method Z1 Dry Method E] Explode Burn Down
OTHER:
VI. Procedures for Unexpected RACM: Stop, Contain area, call environmental compliance services
Vil. Asbestos Waste Transporter: Name JOHNSON's EXCAVATION & SERVICES, INC. - DONATHAN A JOHNSON Phone (L8 �3) 52-7097
Address 1706 E Trapnell Rd
City Plant City State FL -Zip 33566 4936
Vill. Waste Disposal Site: Name ENTERPRISE LF & RECYC (FKA SID LARKIN & SON, INC.) Class
Address 41111 Enterprise Rd
City Dade City State FL -Zip 33525 1589
IX RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and 11 nonfiriable ACM.
physical assessment, sampling and analysis for suspect material
Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in Block Below: (Print or Type)
0 square feet surfacing material
0 linear feet pipe
0 cubic feet of RACM off facility components
0 square feet cementitious material
0 square feet resilient flooring
0 square feet asphalt roofing
*Identify and describe surfacing material and other materials as applicable:
0
Other materials or facility components description:. (R)ACM to remain in place during demolition:
I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on -site
during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during
normal business hours.
Donathan Johnson 05/23/2022
(Print Name of Owner/Operator)
05/23/2022
(Signature of Owner/Operator) (Date)
DEP USE ONLY PolstmarktDatd Received ID# 116308
Mr. Nicholas Eilerman
Environmental & Compliance Project Manager
Realty Systems, Inc.
c/o Equity LifeStyle Properties
5100 W. Lemon Street
Tampa, Florida 33609
Re: Pre -Demolition Asbestos Survey
6 th Ave MHP (Loc. #7800)
Unit 28
5522 Laura Street
Zephyrhills, FL 33542
Project No. H4197389
1007W01=0
0: (813) 282-5973
E: nicholas eilermani@,,Itguityrifestylq.com
Terracon conducted pre -demolition asbestos sampling associated with the planned demolition of
Unit 28. As requested through a task order, dated September 5, 2019, our scope of service
included the collection of bulk samples of suspect asbestos -containing materials (ACM). Samples
were submitted to an accredited laboratory for analytical analysis and reporting of results.
Asbestos sampling was performed on September 10, 2019 by Mr. Karl Kologiski, an AHER
accredited building inspector. Eighteen (18) bulk samples were collected from Nine (00
homogeneous areas of suspect ACM. Bulk samples were submitted under chain of custody 0
Cates Laboratories, Inc. for analysis by polarized light microscopy with dispersion staini *
techniques per EPA/600/R-93/116. I
Based on the results of laboratory analysis of the designated, suspect materials, the following
materials were found to contain asbestos:
OSHA Work
Location 14A Description Asbestos NESHAP Est Quantity" I
Sampl_e f— Classification Class
Exterior Door & M2-9 Gray Caulking Behind 1 25 S.F S
Metal Window - Door 7% Non -Friable Cat 1 2 Entry Doors,, & & Work Class 11
Window Frames M2-10
Frames 9 Windows
FFront Bay M3-111 White Caulking — I —Window— _M312 Perimeter Window _4 3% Non -Friable Cat 1 3 S.F. Work Class 11
Frame
ji RI-13 Silver -White -Beige
Roof Dock 3% Non -Friable Cat I 480 S.F. Work Class 11
RI-14 Roof Sealant
Roof Cap to
Wall Joint R2-1 5 Beige Sealant 7% Non -Friable Cat 1 20 S.F. I Work Class 11
Behind Trim R2-16
Terracon Consultants, Inc, 5463 West Waters Avenue, Suite 830 Tampa, Florida 33634
P [8131221 0050 F [8131221 0051 terracon.corn
Pre -Demolition Asbestos Survey
6th Ave MHP (Loc# 7800) Unit 28 m Zephyrhills, Florida
September 16, 2019 m Terracon Project H4197389
s.f. = Square Feet
Chrysotile Asbestos
(*) Estimated quantities are to be verified by contractor prior to disturbance and not to be relied upon
for bidding or notification purposes.
In addition to having the ACM properly abated, we recommend contacting your local regulator(s)
for confirmation of their pre -renovation requirements and to maintain a copy of the survey
onsite.
Asbestos sampling was conducted in a manner consistent with the level of care and skill ordinarily
exercised by members of the profession currently practicing under similar conditions in the same
locale. The results, findings, conclusions and recommendations expressed in this report are
based on conditions observed during the sampling event. If other suspect ACM are identified,
please contact Terracon so that we can assess the implications. This letter report has been
prepared on behalf of and exclusively for use and reliance by Realty Systems, Inc. This report is
not a bidding document. Contractors or consultants reviewing this sampling report must draw
their own conclusions regarding further investigation or remediation deemed necessary. Terracon
does not warrant the work of regulatory agencies, laboratories or other third parties supplying
information, which may have been used in the preparation of this report. No warranty, expressed
or implied, is made.
Terracon appreciates the opportunity to provide this service to Realty Systems, Inc. If you have
any questions regarding this asbestos survey report, please contact the undersigned at (813)
221-0050.
Sincerely,
llbrtacw
Florida Asbestos Business License Number ZA-337
Prepared by:
le 9A'� 14r4i"�
Karl Kologiski
J
Attachments: Analytical Results
Reviewed by:
Tom Holley, C.1 H.
Florida Licensed Asbestos Consultant AX75
Authorized Project Reviewer
2
Responsive m Resourceful a Reliable
PLM REPORT SUMMARY
Cates Laboratories NVLAP Lab No. 200569-0
7339Motor Circle TDSHS License No. 30-0287
Dallas, Texas 75207 (214) 920-5006
Client: Terracon Lab Job No.: PLM-21064
Project: 6th Ave. MHP #28; 39345 Zephyrhills, FL Set No.: 30987
Project No: H4197389 Report Date: 9/13/2019
Identification: Asbestos, Bulk Sample Analysis Sample Date: 9/10/2019
Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116 Page I of 3
On 9/11/2019, eighteen (18) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS.
Copies of the lab data sheets are attached; additional information may be found therein. The results are summarized below:
Lab
Client
Sample Description/Location
Asbestos Content
Sample No.
Field I.D.
CL751073
CI -I
Textured Ceiling Panel - Living Room
None Detected - Textured Paint
None Detected - Paper
None Detected - Wallboard Material
CL751074
CI-2
Textured Ceiling Panel - Bedroom
None Detected - Textured Paint
None Detected - Paper
None Detected - Wallboard Material
CL751075
FI-3
Beige Square Pattern Sheet Flooring - Hallway
None Detected
CL751076
FI-4
Beige Square Pattern Sheet Flooring - Bedroom
None Detected
CL751077
F2-5
Square Stone Pattern Sheet Flooring - Bathroom
None Detected - Sheet Flooring
None Detected - Fibrous Backing
CL751078
F2-6
Square Stone Pattern Sheet Flooring - Bathroom
None Detected - Sheet Flooring
None Detected - Fibrous Backing
CL751079
MI-7
Floor Insulation - Front Entrance
None Detected - Wrap/Mastic
None Detected - Insulation
CL751080
MI-8
Floor Insulation - Hallway
None Detected - Wrap/Mastic
None Detected - Insulation
CL751081
M2-9
Grey Sealant - Window Frame
7% Chrysotile
CL751082
M2-10
Grey Sealant - Door Frame
Not Analyzed - Positive Stop
CL751083
M3-11
White Caulking - Front Bay Window Trim
None Detected - Caulking
7% Chrysotile - Grey Sealant
CL751084
M3-12
White Caulking - Front Bay Window Trim
None Detected - Caulking 1
3% Chrysmile - Caulking 2
Positive Stop - Grey Sealant
CL751085
RI-13
Roof Sealant, Silver/Black - Metal Roof, Front
3% Chrysotile - Silver Paint
None Detected - White Sealant
3% Chrysotile - Beige Sealant
CL751086
RI-14
I
Roof Sealant, Silver/Black - Metal Roof, Rear
I
Not Analyzed - Positive Stop
I
These samples were analyzed by layers. The overall percent asbestos for the sample is reported when relevant. The EPA considers a material to be asbestos containing
only if it contains greater than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing
Materials (RACM) — materials that are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by
CVAE. CatesLab utilizes CVAE on a routine basis and does not include point counting unless specifically requested by the client. The results may not be reproduced
except in full.
PLM REPORT SUMMARY
AoV,- Cates Laboratories NVLAP Lab No. 200569-0
1339 Motor Circle TDSHS License No. 30-0287
Dallas, Texas 75207 (214) 920-5006
Client: Terracon Lab Job No.: PLM-21064
Project: 6th Ave. MHP #28; 39345 Zephyrhills, FL Set No.: 30987
Project No: H4197389 Report Date: 9/13/2019
Identification: Asbestos, Bulk Sample Analysis Sample Date: 9/10/2019
Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116 Page 2 of 3
On 9/11/2019, eighteen (18) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS.
Copies of the lab data sheets are attached; additional information may be found therein. The results are summarized below:
Lab
Client
Sample Description/Location
Asbestos Content
Sample No.
Field I.D.
CL751087
R2-15
Black Mastic - Roof Cap to Wall Joint
None Detected - Black Mastic
7% Chrysotile - Beige Sealant
CL751088
R2-16
Black Mastic - Roof Cap to Wall Joint
Not Analyzed - Positive Stop
CL751089
M4-17
Concrete Slab - Carport
None Detected
CL751090
M4-18
Concrete Slab - Walkway
None Detected
These samples were analyzed by layers. The overall percent asbestos for the sample is reported when relevant. The EPA considers a material to be asbestos containing
only if it contains greater than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing
Materials (RACM) — materials that are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by
CVAE. CatesLab utilizes CVAE on a routine basis and does not include point counting unless specifically requested by the client. The results may not be reproduced
except in full.
q
Cates Laboratories
1339 Motor Circle
Dallas, Texas 75207 (214) 920-5006
Client: Terracon
Project: 6th Ave. MHP #28; 39345 Zephyrhills, FL
Project No: H4197389
Identification: Asbestos, Bulk Sample Analysis
Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116
On 9/11/2019, eighteen (18) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS.
Copies of the lab data sheets are attached; additional information may be found therein.
NVLAP Lab No. 200569-0
TDSHS License No. 30-0287
Lab Job No.: PLM-21064
Set No.: 30987
Report Date: 9/13/2019
Sample Date: 9/10/2019
Page 3 of 3
The samples were analyzed in general accordance with the procedures outlined in the Method for the
Determination of Asbestos in Bulk Building Materials, EPA/600/R-93/116 or the U.S. Environmental
Protection Agency EPA 40 CFR Appendix E to Subpart E of Part 763, Interim Method of the Determination of
Asbestos in Bulk Insulation Samples, by polarized Light microscopy. The results of each bulk sample relate
only to the material tested and the results shall not be used by the client to claim product certification, approval,
or endorsement by NVLAP, NIST, or any agency of the Federal Government.
Specific questions concerning bulk sample results shall be directed to the Laboratory Director.
Analyst: Kathy Schosek
Laboratory Director: John R. Cates, P.G.
Approved Signatory:
- ff t �-70�-- -
P
NVLAP LAB CODE 200569-0
Mr. Nicholas Eilerman
Environmental & Compliance Project Manager
Realty Systems, Inc.
c/o Equity LifeStyle Properties
5100 W. Lemon Street
Tampa, Florida 33609
Re: Pre -Demolition Asbestos Survey
6 th Ave MHP (Loc. #7800)
Unit 28
5522 Laura Street
Zephyrhills, FL 33542
Project No. H4197389
I
fit
P: (813) 282-5973
E: nicholas eiIerman(a-),__1W1111:Z_1
Terracon conducted pre -demolition asbestos sampling associated with the planned demolition of
Unit 28. As requested through a task order, dated September 5, 2019, our scope of service
included the collection of bulk samples of suspect asbestos -containing materials (ACM). Samples
were submitted to an accredited laboratory for analytical analysis and reporting of results.
Asbestos sampling was performed on September 10, 2019 by Mr. Karl Kologiski, an AHER
accredited building inspector. Eighteen (18) bulk samples were collected from Nine (" homogeneous areas of suspect ACM. Bulk samples were submitted under chain of custody Is
Cates Laboratories, Inc. for analysis by polarized light microscopy with dispersion staini I*
techniques per EPA/600/R-93/116. I
Based on the results of laboratory analysis of the designated, suspect materials, the following
materials were found to contain asbestos:
—T--NE—SHAP HA/ Cia as Est. Quantity** OSHA Work
Location Description Asbestos (% s!'
sample # sification Class
Gray Caulking Behind
Exterior Door & M2-9
Window Frames M2-10 Metal Window - Door 7% Non -Friable Cat 1 2 Entry Doors, & Work Class 11
Frames 9 Windows
Front Bay M3-111 White Caulking — I
Perimeter Window I 3% Non -Friable Cat 1 3 S.F. Work Class 11
Window M3-12 Frame
R1-13 Silver -White -Beige
Roof Dock Roof Sealant Non -Friable Cat 1 480 S.F. Work Class 11
RI-14
�-`!5
Wall Joint R R2-1 Beige Sealant 70/6 Nan -Friable Cat 1 20 S.F. Work Class 11 1
Behind Trimim R2-16
Terracon Consultants, Inc. 5463 West Waters Avenue, Suite 830 Tampa, Florida 33634
P [8131 221 0050 F [8131221 0051 terracon.corn
Pre -Demolition Asbestos Survey
SmAve K8HP(Luc#78O0)Unit 28mZephyr i|ls.F|ohda
at=Square Feet
OChryswbleAabosto
Fl Estimated quantities are to he verified by contractor prior to disturbance and not to be relied upon
for bidding o,notification purposes.
In addition to having the ACM properly abated, we recommend contacting your local regulator(s)
for oonOnnehon of their pre -renovation requirements and to maintain a copy of the survey
DnS0e.
Asbestos sampling was conducted in8manner consistent with the level 0fcare and skill ordinarily
exercised by Dlgnlbe[S of the p[Of8SSk}D currently practicing under SirDi|8[ conditions in the same
|0oe|e. The resuKs, findings, conclusions and nRQ}rDrD8DdEdioOS expressed in this report are
based on conditions observed during the sampling event. Ifother suspect ACM are ideOtifi8d,
please contact T8rracon SV that we can assess the innp|iC8U0nS. This letter report has been
prepared on behalf ofand exclusively for use and reliance by F(aa|h/ Systems, Inc. This report is
not a bidding document. Contractors or consultants reviewing this sampling report must draw
their own conclusions regarding further investigation or remediation deemed necessary. Terrmoon
does not warrant the work of regulatory agencies, laboratories or other third parties supplying
inf0rOnotion, which may have been used in the preparation of this report. No vvGrr8Dtv, expressed
or implied, is made.
T8rn]cOn appreciates the opportunity to provideUlis service to R0@hv 8veterns' Inc. If you have
any questions regarding this asbestos survey report' please contact the undersigned at (813)
221-OO5U.
�
*fibwmacom
Florida Asbestos Business License Number ZA-337
Prepared by:
KadKokogisk
AHERABuilding Inspector
Attachments: Analytical Results
Reviewed by:
Tom Holley, C] H.
Florida Licensed Asbestos Consultant /0<75
Authorized Project Reviewer
PLM REPORT SUMMARY
Cates Laboratories NVLAP Lab No. 200569-0
1339 Motor Circle TDSHS License No. 30-0287
49 Dallas, Texas 75207 (214) 920-5006
Client: Terracon Lab Job No.: PLM-21064
Proj ect: 6th Ave. MHP #28; 39345 Zephyrhills, FL Set No.: 30987
Project No: H4197389 Report Date: 9/13/2019
Identification: Asbestos, Bulk Sample Analysis Sample Date: 9/10/2019
Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116 Page I of 3
On 9/11/2019, eighteen (18) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS.
Copies of the lab data sheets are attached; additional information may be found therein. The results are summarized below:
Lab
Client
Sample Description/Location
Asbestos Content
Sample No.
Field I.D.
CL751073
Cl-I
Textured Ceiling Panel - Living Room
None Detected - Textured Paint
None Detected - Paper
None Detected - Wallboard Material
CL751074
CI-2
Textured Ceiling Panel - Bedroom
None Detected - Textured Paint
None Detected - Paper
None Detected - Wallboard Material
CL751075
FI-3
Beige Square Pattern Sheet Flooring - Hallway
None Detected
CL751076
FI-4
Beige Square Pattern Sheet Flooring - Bedroom
None Detected
CL751077
172-5
Square Stone Pattern Sheet Flooring - Bathroom
None Detected - Sheet Flooring
None Detected - Fibrous Backing
CL751078
F2-6
Square Stone Pattern Sheet Flooring - Bathroom
None Detected - Sheet Flooring
None Detected - Fibrous Backing
CL751079
MI-7
Floor Insulation - Front Entrance
None Detected - Wrap/Mastic
None Detected - Insulation
CL751080
MI-8
Floor Insulation - Hallway
None Detected - Wrap/Mastic
None Detected - Insulation
CL751081
M2-9
Grey Sealant - Window Frame
7% Chrysotile
CL751082
M2-10
Grey Sealant - Door Frame
Not Analyzed - Positive Stop
CL751083
M3-11
White Caulking - Front Bay Window Trim
None Detected - Caulking
7% Chrysotile - Grey Sealant
CL751084
M3-12
White Caulking - Front Bay Window Trim
None Detected - Caulking 1
3% Chrysotile - Caulking 2
Positive Stop - Grey Sealant
CL751085
RI-13
Roof Sealant, Silver/Black - Metal Roof, Front
3% Chrysotile - Silver Paint
None Detected - White Sealant
3% Chrysotile - Beige Sealant
CL751086
RI-14
Roof Sealant, Silver/Black - Metal Roof, Rear
Not Analyzed - Positive Stop
These samples were analyzed by layers. The overall percent asbestos for the sample is reported when relevant. The EPA considers a material to be asbestos containing
only if it contains greater than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing
Materials (RACM) — materials that are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by
CVAE. CatesLab utilizes CVAE on a routine basis and does not include point counting unless specifically requested by the client. The results may not be reproduced
except in ful I.
PLM REPORT SUMMARY
Ao* Cates Laboratories NVLAP Lab No. 200569-0
1339 Motor Circle TDSHS License No. 30-0287
Dallas, Texas 75207 (214) 920-5006
Client: Terracon Lab Job No.: PLM-21064
Project: 6th Ave. MHP #28; 39345 Zephyrhills, FL Set No.: 30987
Project No: H4197389 Report Date: 9/13/2019
Identification: Asbestos, Bulk Sample Analysis Sample Date: 9/10/2019
Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116 Page 2 of 3
On 9/11/2019, eighteen (18) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS.
Copies of the lab data sheets are attached, additional information may be found therein. The results are summarized below:
Lab
Client
Sample Description/Location
Asbestos Content
Sample No.
Field I.D.
CL751087
R2-15
Black Mastic - Roof Cap to Wall Joint
None Detected - Black Mastic
7% Chrysotile - Beige Sealant
CL751088
R2-16
Black Mastic - Roof Cap to Wall Joint
Not Analyzed - Positive Stop
CL751089
M4-17
Concrete Slab - Carport
None Detected
CL751090
M4-18
Concrete Slab - Walkway
None Detected
These samples were analyzed by layers. The overall percent asbestos for the sample is reported when relevant. The EPA considers a material to be asbestos containing
only if it contains greater than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing
Materials (RACM) — materials that are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by
CVAE. CatesLab utilizes CVAE on a routine basis and does not include point counting unless specifically requested by the client. The results may not be reproduced
except in full.
49 Cates Laboratories
1339 Motor Circle
Dallas, Texas 75207 (214) 920-5006
Client:
Terracon
Project:
6th Ave. MHP #28; 39345 Zephyrhills, FL
Project No:
H4197389
Identification:
Asbestos, Bulk Sample Analysis
Test Method:
Polarized Light Microscopy/Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116
On 9/11/2019, eighteen (18) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS.
Copies of the lab data sheets are attached; additional information may be found therein.
1-11-INUC Z1 4 a] k In 111 M k'
NVLAP Lab No. 200569-0
TDSHS License No. 30-0287
Lab Job No.: PLM-21064
Set No.: 30987
Report Date: 9/13/2019
Sample Date: 9/10/2019
Page 3 of 3
The samples were analyzed in general accordance with the procedures outlined in the Method for the
Determination of Asbestos in Bulk Building Materials, EPA/600/R-93/116 or the U.S. Environmental
Protection Agency EPA 40 CFR Appendix E to Subpart E of Part 763, Interim Method of the Determination of
Asbestos in Bulk Insulation Samples, by polarized light microscopy. The results of each bulk sample relate
only to the material tested and the results shall not be used by the client to claim product certification, approval,
or endorsement by NVLAP, NIST, or any agency of the Federal Government.
Specific questions concerning bulk sample results shall be directed to the Laboratory Director.
Analyst: Kathy Schosek
Laboratory Director: John R. Cates, P.G.
Approved Signatory:
NVLAP LAB CODE 200569-0