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HomeMy WebLinkAbout22-4193BGR-004193-2022 "Ills Issue Date: 05/31/2022 Per it ildin Gener" iI Rsidntial) gi W5W E 5534 Eugene Dr 12 26 21 002B 00500 0000 Lot 104 Name: SIXTH AVENUE LLC Permit Type: Building General (Residential) Contractor: JOHNSON'S EXCAVATION I Class of Work: Demolition ISERVICES INC Address: 917 W Washington MIS 316 Building Valuation: $5,900.00 CHICAGO, IL 60607 Electrical Valuation: $1.00 Phone: Mechanical Valuation: $1.00 Plumbing Valuation: $1.00 r, Total Valuation: $5,903.00 Total Fees: $100.00 Amount Paid: $100 .00 Date Paid: 5131/2022 12:09:15PM REINSPECTION FEES: (c) 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. I 1 11177111 -- 37W ME �#NZMMM accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. 'f I 1A CONTRACTOR SIGNATURE PE IT OFFICE[) PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER I 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Phone Contact for Permitting T Owner's Name Sixth Avenue LLC c/o Duff & Phelps, A 14011 %W4M9n. Number IL Owner's Address 917 W Washington MS 316 Chicago IL 6 607pwnerPhoneNumber Fee Simple Titleholder Name I I Owner Phone Number l Fee Simple Titleholder Address JOB ADDRESS 5534 Eugene Drive Unit#104 LOT# SUBDIVISION PARCEL ID# 3-00500-0000 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH e INSTALL REPAIR PROPOSED USE Q SFR Q COMM OTHER TYPE OF CONSTRUCTION BLOCK Q FRAME LJ STEEL DESCRIPTION OF WORK demo and legal disposal Of SF mobile home SIZE —�� SO FOOTAGE 920 HEIGHT BUILDING =BUILDING $ 5900 OO VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ AMP SERVICE PROGRESS ENERGY Q W.R.E.C. =PLUMBING $ =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION =GAS 0 ROOFING SPECIALTY 0 OTHER FINISHED FLOOR ELEV NS FLOOD ZONE AREA =YES NO BUILDER COMPANY Johnson's Excavation & Services, Inc. SIGNATURE _ ,�" REGISTERED Y 1 N FEE CURREN Y / N 1706 E. r hell Plant City, Address y, FL 33566 License # C�C059540 ELECTRICIAN COMPANY =^�Ts� SIGNATURE REGISTERED Y / N FEE CURREN Y / N Address I License# �— PLUMBER COMPANY = SIGNATURE REGISTERED Y / N FEE CURREN Y / N Address _ License # MECHANICAL COMPANY SIGNATURE REGISTERED Y / N FEE CURREN Y / N Address L I License #� OTHER R ST SIGNATURE GI& D Y/ N FEE CURREN Y/ N Address License #—�� I III I I I I I I I I t I I I I I I I I I I I I I I i 1 1 1 9 1 1 1 1 1 1 I I i 1 1 I I I I 1 1 1 1 1 I 1 1 i 1 1 1 I i 1 1 1 1! 1 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, Stonnwater 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. ... 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 (PloUSurvey/Footage) Driveways -Not over Counter if on public roadways..needs ROW 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department 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. WARNING TOO YOUR FAILURE TO RECORD A NOTICE OF C ' IENCEMENT MAY RESULT IN YOUR ENC MEN TWICE PR TO YOUR PAYING ICZE M PRR PROPERTY. IF YOU OE7R1 U� T, ING, CONSULT �ED T OBTAIN F NAN( WITH YOUR L E 0 A BEFORE RECORDING YOU OT 11 ACEMENT, OT J FLORIDAJURAT .. I I OWNER OR AG Sibs bed an om to ( f this Su, s i ad an swor to ed)b re the this tj,,�Ae Donathah=h! Don an A. Johnson ols/ per nown)6 me s/h.ve produced Who is/ re personally o to me or has/have produced a�l!nt".t..n as identification. ti Notary Public Comm CH BRASWELL RUPP Commission No. RUE ON # HH 175744 my COMMISSI My COMMISSION I HH 175744 Name dnte jaMMY 10, 2020 Name of Notary typed, printed or ary 10, 2026 EXPIRES: Janu Bonded Tliou Notwy PuW Underwriters Wf*d Rn ll ftk UWmftera INSTR#2022118026OR BK10621 PG1 983 Page 1 of 1 05/26/2022 09:27 AM Rcpt: 2460877 Rec: 10.00 IDS: 0.00 IT: 0.00 Nikki Alvarez-Sowles, Esq., Pasco County Clerk & Comptroller penwt WIM[W. F0110filorcel ID �—� propared by,, giros �aat'fYaprs�It Rid "�, OMMENCEMENT X 17, a. h -V Intelsst In Pr t '0 nt'f'rOM er� Name and addreo ss ffeersimplWe ahoTd—aiOW Narne Addreso- 4. Contm6tor .�752-7097 fl, Lender NaMik A,0O�_______Ta1sphone 7. Parsono within tho State of Florida c0signated byOwnor "Ponurbom noffbas W other doe" be served as provided bV Flprlda Statutes. —_Tblaphone Number__.--1 8, In addition to hiMself Orborself, Ownadasfqnat�s thifolowing to roativou copyoftha L*noes Notioa as provided In §713 1 Florida Statutes, IN WARNING TO OWNER, MY $Wnoture of 0—na4or � essoa, or 69-noes or LespOWS AudWrIzed The lbregoing 1r7,1rurnent was aoknowle0ged 0 tOMO for W91 I slanatum of ry reonally Known _��OR ProduoedlD_ We of ID Produced_ ME R 11 KOWAL WCO[WA! SION#GG911739 EXPIRE -0cf0ber12,2023 ITT Florida Department of DEP Form 62-257.900(l) Effective 10-12-08 Environmental Protection Page 1 of 2 FLO A Division of Air Resource Management NOTICE OF DEMOLITION OR ASBESTOS RENOVATION TYPE OF NOTICE (CHECK ONE ONLY): ORIGINAL [I REVISED El CANCELLATION ❑ COURTESY TYPE OF PROJECT (CHECK ONE ONLY): DEMOLITION [I RENOVATION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? []YES F­1 NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? []YES ❑ NO IS IT A PLANNED RENOVATION OPERATION? 7YES ❑ NO 1. Facility Name Sixth Avenue LLC Address 5534 Eugene Dr City Zephyrhills —State FL Zip p 33542 0000 County Pasco Site Unit 104 Consultant Inspecting Site Terracon Building Size 920 (Square Feet) #of Floors 1 Building Age in Years 50 Prior Use: 7 School/College/University F1 Residence 7 Small Business 7 Other Present Use: [] School/College/University El Residence 7 Small Business 7 Other 11. Facility Owner Sixth Avenue LLC —Phone ((U3)352-7097 Address 917 W Wshington MS 316 City Chicago State IL Zip 6W7 Ill. Contractor's Name JOHNSON'S EXCAVATION &amp; SERVICES, INC. - DONATHAN A JOHNSON Phone ((813) �52-7097 Address 1706 E Trapnell Rd City Plant City State FL Zip 36 6fi Is the contractor exempt from licensure under section 469.002(4), F,S.? 0 YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/ddtyy) 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): VI. Procedures for Unexpected RACK Stop, Contain area, call environmental compliance services VII. Asbestos Waste Transporter: Name JOHNSON's EXCAVATION & SERVICES, INC. - DONATHAN A JOHNSON Phone ((813) 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 nonfriable 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) (Date) 05/23/2022 I 152MIM Mr. Nicholas Eilerman Environmental & Compliance Project Manager Realty Systems, Inc. c/o Equity LifeStyle Properties 5100 W. Lemon Street Tampa, Florida 33609 lit W" F-: (813) 282-5973 E: nicholas ei :!:H :!g ;11 dg�ft�� Re: Pre -Demolition Asbestos Survey 6th Ave MHP MHC (Loc# 7800) — Units 26 & 104 39345 6th Ave Zephyrhills, FL 33542 Project No. H4227200 Terracon conducted limited pre -demolition asbestos sampling of the designated Units 26 and 104. As requested through a task order dated May 4, 2022, our scope of service included the collection of bulk samples of suspect asbestos -containing materials (ACM) associated with the planed demolition of the structure. Samples were submitted to an accredited laboratory for analytical analysis and reporting of results. Limited asbestos sampling was performed on May 11, 2022 by Mr. Karl Kologiski, an AHER accredited building inspector. Sixteen (16) bulk samples were collected from eight ( homogeneous areas in Unit 26 and thirty-one (31) bulk samples were collected from fifteen (1 homogeneous areas in Unit 26. Samples obtained are those materials associated with t demolition activities. Bulk samples were submitted under chain of custody to Arrowhe Technologies Inc. for analysis by polarized light microscopy with dispersion staining techniqu per EPA/600/R-93/116. I materials were found to contain asbestos: Unit 26 Location HjiY— Description Asbestos (%) --kE—SHAP Est. Quantity - OSHA Work Sam Is # ClassificationClass Exterior Window and Door Frames X1 Gasket Material 6% Chrysotile Asbestos Non -Friable Cat 11 30 S.F. Work Class II i Roof Cap to h riorW i X7 Gasket Material 6% Chrysotile Asbestos Non -Friable Cat 11 40 S.F. Work Class II L,'E 8 'c Avenue, Suite-, W Tampa, Flaridaa36'34 Terracun, Consultants, Inc; 5462 West, Waters R [ata] 221000, F [8-,,1a] 221 4051' terracomcom Limited Asbestos Pre- Renovation Survey 6th Ave MHP (Loc# 7800) Units 26 & 104 a Zephyrhills, Florida May 13, 2022n Terracon Project H4227200 Unit 104 NESHAP t Est. OSHA Work Location I Description Sample Asbestos Classification Quantity — Class 7 Rear Bedroom Under R6 9"x9" Tan Vinyl Floor Tile 4 Plywood 2% Chrysotile Asbestos Non -Friable Cat 11 200 S.F. Work Class 11 Exterior Window and R11 Gasket Material 5% Chrysotile Asbestos Non -Friable Cat 11 30 S.F. Work Class if Door Frames Roof Deck R12 -i Roof Coating 2% Chrysotile Asbestos Aluminum Coasting Non -Friable Cat 11 570 S.F. Work Class 11 Carport Patio Roof to Black & Aluminum Roof 'A R13 6% ck Seala 2% AluBlmianum Coasting Non -Friable Cat H i 76 S.F. # Work Class 11 Wall Joint Sealant Ch sotile Asbestos Roof Cap to Exterior i R14 Gasket Material 5% Chrysotile Asbestos Non -Friable Cat 11 i 40 S.F. 1 Work Class If Wall Seam s.f. = Square Feet (**) 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 -demolition 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, Terracon Consultants, Inc. Florida Asbestos Business License Number ZA-337 Prepared By: Reviewed By: Karl Kologiski, CIEC, MRSA Staff Industrial Hygienist Accredited Asbestos Inspector Attachments: Analytical Results Tom Holley, CHMM, CIH, CSP Florida Licensed Asbestos Consultant AX-75 Authorized Project Reviewer 2 Responsiven Resourcefula Reliable ARROWHEAD TECHNO<06IES. LLC PLM REPORTSU 3151 San Bernadino St. Clearwater, Florida 33759 ". 813-679-0720 / mhall005@tampabay.rr.eom NVLAP Lab Code 200703-0 Client : Terracon Lab Set No.: 010256 Project : 6th Ave MHP #26, 5512 Laura St AT Job No.: 22-10256 Client Project No.: H4227200 Report Date: 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11/2022 !'Test Method : Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 1 of 3 On 5/12/2022, sixteen (16) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below: Lab Sample No. Sample Description / Location Asbestos Content i 010256-001 Gasket Material X1-1 5% Chrysotile-Gray Gasket Material Window Door Frames 010256-002 Gasket Material X1-2 Not Analyzed Window Door Frames 010256-003 Exterior White Caulking X2-3 None Detected -White Caulking AC Unit Mount 010256-004 Exterior White Caulking X24 None Detected -White Caulking Upper Blue Boarder Trim 010256-005 12" Gray Vinyl Floor Tile X3-5 None Detected -White Floor Tile Interior Under New Plywood Floor None Detected -Clear Adhesive 010256-006 12" Gray Vinyl Floor Tile X3-6 None Detected -White Floor Tile Interior Under New Plywood Floor None Detected -Clear Adhesive 010256-007 Roof Flashing Sealant X4-7 None Detected -White Coating Carport Roof to Wall Joint 010256-008 Roof Flashing Sealant X4-8 None Detected -White Coating Porch Roof to Wall Joint These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable -- be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full. PLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hal ARROWHEAD TECHNOLOGIES. LLC PLM REPORTSUMMARY 3151 San Bernadino St. Clearwater, Florida 33759 813-679-0720 / mha]1005@tampabay.rr.com NVLAP Lab Code 200703-0 Client : Terracon Lab Set No.: 010256 Project : 6th Ave MHP #26, 5512 Laura St AT Job No.: 22-10256 Client Project No.: H4227200 Report Date : 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11 /2022 Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 2 of 3 On 5/12/2022, sixteen (16) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below: Lab Sample No. Sample Description / Location Asbestos Content 010256-009 White/Silver Lower Roof Coating X5-9 None Detected -White Silver Coating Porch Roof 010256-010 White/Silver Lower Roof Coating X5-10 None Detected -White Silver Coating. Carport Roof 010256-011 White/Silver Roof Coating X6-11 None Detected -Aluminum Coating Original Roof Deck Under Replacement Roof None Detected -White Coating 010256-012 White/Silver Roof Coating X6-12 None Detected -Aluminum Coating Original Roof Deck Under Replacement Roof None Detected -White Coating 010256-013 Gasket Material X7-13 5% Chrysotile-Gray Gasket Material Upper Blue Boarder Wall to Roof Seam 010256-014 Gasket Material X7-14 Not Analyzed Upper Blue Boarder Wall to Roof Seam 010256-015 Concrete X8-15 None Detected -Concrete Carport Slab 010256-016 Concrete X8-16 None Detected -Concrete Patio Slab These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full. YLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hal ARROWHEAD TECHNOLOGIES, LLC PLM REPORT SUMMARY 3151 San Bernadino St. Clearwater, Florida 33759 813-679-0720 / mhaII005@tampabay.rT.com NVLAP Lab Code 200703-0 'Client: Terracon Lab Set No. 010256 Project 6th Ave MHP #26, 5512 Laura St AT Job No. 22-10256 :Client Project No.: H4227200 Report Date: 5112/2022 Identification Asbestos, Bulk Sample Analysis Sample Date: 5/11/2022 Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 3 of 3 These samples were obtained as a part of a building survey; this report is only intended to be used as a part of the survey report issued by the surveyor. This report explains the laboratory analysis and results. The surveyor's report explains the sampling protocol used, when the samples were obtained, the location(s) of the samples, where the materials were observed in the building, quantities of materials observed, condition of the materials and the extent of his/her survey. Sample locations and material descriptions are given by the surveyor on the chain of custody but included here (possibly abbreviated) only as a convenience for the reader. This report may not be reproduced without written permission of Arrowhead and must be reproduced in full. 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, and the Interim Method for the Determinationof Asbestos in Bulk Insulation Samples, EPA 600/M4-82-020. The results of each bulk sample relate only to the material tested and the results shall not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. Floor the and other resinously bound materials, when analyzed by the EPA method, may yield false negative results because of limitations in separating closely bound fibers and in detecting fibers of small length and diameter. When a definitive result is required, Arrowhead recommends utilizing alternative methods of identification, including Transmission Electron Microscopy. Specific questions concerning bulk sample results shall be directed to the Laboratory Director. Analyst: Monte Hall, P.G. Laboratory Director Monte Hall, P.G. Florida Registration No. 1658 Approved Signatory : 14)ARROWHEAD TECWNOLOtaIES. LLC PLM'. REPORT SUMMARY 3151 San Bernadino St. Clearwater, Florida 33759 813-679-0720 / mha11005@tampabay.rr.com NVLAP Lab Code 200703-0 Client : Terracon Lab Set No.: 010257 Project : 6th Ave MHP #104 AT Job No.: 22-10257 Client Project No.: H4227200 Report Date: 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11 /2022 Test Method : Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 1 of 6 On 5/12/2022, thirty-one (31) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below: Lab Sample No. Sample Description / Location Asbestos Content 010257-001 DW/JC RI-1 None Detected -Joint Compound w/ Pair Ceiling Living Room None Detected -Tan DW Paper Backing', None Detected -White Drywall Material" 010257-002 DW/JC RI-2 None Detected -Joint Compound w/ Pair Ceiling Hallway None Detected -Tan DW Paper Backing'; None Detected -White Drywall Material; 010257-003 Tan Square Pattern VSF R2-3 None Detected -Tan VSF Surface Kitchen None Detected -Off White Backing 010257-004 Tan Square Pattern VSF R24 None Detected -Tan VSF Surface Kitchen None Detected -Off White Backing 010257-005 Gray Sink Undercoating R3-5 None Detected -Gray Sink Mastic Kitchen 010257-006 Gray Sink Undercoating R3-6 None Detected -Gray Sink Mastic Kitchen 010257-007 1" Gray Ceramic Floor Tile R4-7 None Detected -Gray Ceramic Tile Hallway None Detected -Tan Mortar None Detected -Woven Glass Wrap These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable -- be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full. YLM Keport Summary - Kevision 3 - 05/11/2014 - Issuing Authority: Monte Hal ARROWHEAD TECHNOLOGIES, LLC PLM REPORT SUMMARY 3151 San Bernadine, St. Clearwater, Florida 33759 813-679-0720 / mha11005@tampabay.rr.com NVLAP Lab Code 200703-0 ,Client: Terracon Lab Set No.: 010257 `Project : 6th Ave MHP #104 AT Job No.: 22-10257 Client Project No.: H4227200 Report Date : 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11/2022 "Test Method: Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 2 of 6 On 5/12/2022, thirty-one (31) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below: Lab Sample No. Sample Description / Location Asbestos Content 010257-008 1" Gray Ceramic Floor Tile R4-8 None Detected -Gray Ceramic Tile Hallway None Detected -Tan Mortar None Detected -Woven Glass Wrap 010257-009 Textured Wall Panel R5-9 None Detected -White Texture Bedroom None Detected -Tan DW Paper Backing None Detected -White Drywall Material 010257-010 Textured Wall Panel R5-10 None Detected -White Texture Bedroom None Detected -Tan DW Paper Backing None Detected -White Drywall Material 010257-011 Textured Wall Panel R5-11 None Detected -White Texture Bath Room None Detected -Tan DW Paper Backing None Detected -White Drywall Material 010257-012 9x9 Tan Pattern FT R6-12 2% Chrysotile-Tan Floor Tile Bedroom Under Plywood 010257-013 9x9 Tan Pattern FT R6-13 Not Analyzed Bedroom Under Plywood 010257-014 Textured Ceiling Panel R7-14 None Detected-Wht/Tan Ceiling Panel Bedroom These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable -- be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full. PLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hal ARROWHEAD TECHNOLOGIES. LLC PLM REPORT SUMMARY 3151 San Bernadino St. Clearwater, Florida 33759 813-679-0720 / mha11005@tampabay.rr.eom NVLAP Lab Code 200703-0 Client : Terracon Lab Set No.: 010257 Project : 6th Ave MHP #104 AT Job No.: 22-10257 Client Project No.: H4227200 Report Date : 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11/2022 Test Method : Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 3 of 6 On 5/12/2022, thirty-one (31) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below: Lab Sample No. Sample Description f Location Asbestos Content 010257-015 Textured Ceiling Panel R7-15 None Detected-Wht/Tan Ceiling Panel Bedroom 010257-016 Carpet Mastic R8-16 None Detected -Brown Mastic Living Room None Detected -Wood Panel 010257-017 Carpet Mastic R8-17 None Detected -Brown Mastic Living Room None Detected -Wood Panel 010257-018 Wood Pattern VSF R9-18 None Detected -Brown VSF Surface Bath Room None Detected -Off White Backing None Detected -Clear Adhesive None Detected -White Vinyl Floor None Detected -Clear Adhesive None Detected -Tan VSF Surface None Detected -Off White Backing None Detected -Clear Adhesive These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable -- be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full. PLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hal �ARROWHEAD TECHNOLOGIES. LLC PLM REPORTS' Y 3151 San Bernadino St. Clearwater, Florida 33759 813-679-0720 / mha11005@tampabay.rr.com NVLAP Lab Code 200703-0 Client: Terracon Lab Set No.: 010257 Project : 6th Ave MHP #104 AT Job No.: 22-10257 Client Project No.: H4227200 Report Date: 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11/2022 Test Method : Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 4 of 6 On 5/12/2022, thirty-one (31) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below: Lab Sample No. Sample Description / Location Asbestos Content 010257-019 Wood Pattern VSF R9-19 None Detected -Brown VSF Surface Bath Room None Detected -Off White Backing None Detected -Clear Adhesive None Detected -White Vinyl Floor None Detected -Clear Adhesive None Detected -Tan VSF Surface None Detected -Off White Backing None Detected -Clear Adhesive 010257-020 White Interior Caulking R10-20 None Detected -White Caulking Bath Room 010257-021 White Interior Caulking R10-21 None Detected -White Caulking Bath Room 010257-022 Gasket Material RI 1-22 5% Chrysotile-Gray Gasket Material Door/Window Frames 010257-023 Gasket Material R11-23 Not Analyzed Door/Window Frames 010257-024 Roof Coating R12-24 None Detected -White Coating Roof Deck 2% Chrysotile-Aluminum Coating These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos i Containing Materials (RACM) -- materials which are friable or may become friable -- be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. I The results may not be reproduced except in full. PLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hal (*ARROWHEAD TECHNOLOGIES. LLC PLMREPORT SU Y 3151 San Bernadino St. Clearwater, Florida 33759 813-679-0720 / mha11005@tampabay.rr.com NVLAP Lab Code 200703-0 Client : Terracon Lab Set No.: 010257 Project : 6th Ave MHP #104 AT Job No.: 22-10257 Client Project No.: H4227200 Report Date : 5/12/2022 Identification : Asbestos, Bulk Sample Analysis Sample Date: 5/11/2022 Test Method : Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Page 5 of 6 On 5/12/2022, thirty-one (31) bulk material samples were submitted by Karl Kologiski for asbestos analysis by PLM/DS. Copies of Bulk Sample Analysis sheets are attached; additional information may be found therein. The results are summarized below. Lab Sample No. Sample Description / Location Asbestos Content 010257-025 Roof Coating R12-25 None Detected -White Coating Roof Deck 2% Chrysotile-Aluminum Coating 010257-026 Roof Flashing R13-26 None Detected -White Flashing Patio Roof to Wall Joint 5% Chrysotile-Remnant BIack Mastic 010257-027 Roof Flashing R13-27 None Detected -White Flashing Carport to Wall Joint 2% Chrysotile-Aluminum Coating 010257-028 Gasket Material R14-28 5% Chrysotile-Gray Gasket Material Upper Metal Band Trim Roof Cap to Wall Joint 010257-029 Gasket Material R14-29 Not Analyzed Upper Metal Band Trim Roof Cap to Wall Joint 010257-030 Concrete R15-30 None Detected -Concrete Carport 010257-031 Concrete R15-31 None Detected -Concrete Patio These samples were analyzed by layers. Specific layer or component asbestos content is indicated when relevant. The EPA considers a material to be asbestos containing only if it contains more than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) -- materials which are friable or may become friable -- be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. Arrowhead utilizes CVAE on a routine basis and does not include point counting unless specifically requested. The results may not be reproduced except in full. PLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hal ,-A)ARROWHEAD TECHNOLOGIES. LLC PLM REPORT SUMMARY 3151 San Bernadino St. ? Clearwater, Florida 33759 813-679-0720 / mha11005@tampabay.rr.com NVLAP Lab Code 200703-0 Client : Terracon ;ct : 6th Ave MHP #104 it Project No.: H4227200 :ification : Asbestos, Bulk Sample Analysis Method : Polarized Light Microscopy / Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 / EPA Method 600/M4-82-020 Lab Set No.: 010257 AT Job No.: 22-10257 Report Date : 5/12/2022 Sample Date: 5/11 /2022 Page 6 of 6 These samples were obtained as a part of a building survey; this report is only intended to be used as a part of the survey report issued by the surveyor. This report explains the laboratory analysis and results. The surveyor's report explains the sampling protocol used, when the samples were obtained, the location(s) of the samples, where the materials were observed in the building, quantities of materials observed, condition of the materials and the extent of his/her survey. Sample locations and material descriptions are given by the surveyor on the chain of custody but included here (possibly abbreviated) only as a convenience for the reader. This report may not be reproduced without written permission of Arrowhead and must be reproduced in full, 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, and the Interim Method for the Determination of Asbestos in Bulk Insulation Samples, EPA 600/M4-82-020. The results of each bulk sample relate only to the material tested and the results shall not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. Floor the and other resinously bound materials, when analyzed by the EPA method, may yield false negative results because of limitations in separating closely bound fibers and in detecting fibers of small length and diameter. When a definitive result is required, Arrowhead recommends utilizing alternative methods of identification, including Transmission Electron Microscopy. Specific questions concerning bulk sample results shall be directed to the Laboratory Director. Analyst: Monte Hall, P.G. Laboratory Director: Monte Hall, P.G. Florida Registration No. 1658 Approved Signatory :