HomeMy WebLinkAbout22-4195MONO
Issue Date: 05/31/2022
REINSPECTION 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.
11�111!111vpi voir I I 111 � �, � I III iii
!11111113
P- 0 - -♦ 0 0 0 - . - . . .
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 PEPT OFFICEU
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
*fire 0 0 0 1
uffa
A 0
MoTTE-ToW. 0 A E
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received 1 Phone Contact for Permitting
-I—I-1-1—I-1— ."Y"'i'1T Y-Y-:i-i=7—r r
Owner's Name Sixth Avenue LLG c/o Duff & Phelps, A oil�e Number I
Owner's Address 917 W Washington MS 316 Chicago IL 6 607OwnerPhoneNumber
Fee Simple Titleholder Name I I Owner Phone Number
Fee Simple Titleholder Address I I
JOB ADDRESS 5512 Laura St, Unit#26 LOT#
SUBDIVISION PARCEL ID# I 12-26-21-0028-00500-0000
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR a ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK FRAME STEEL
DESCRIPTION OF WORK demo and legal disposal of SF mobile home
BUILDING SIZE I SO FOOTAGE 780 HEIGHT
=BUILDING $ 5490.00 VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY
=PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING 0 SPECIALTY = OTHER
FINISHED FLOOR EL TI NS 1— , FLOOD ZONE AREA =YES NO
BUILDER
SIGNATURE
Address 11706 E.
COMPANY
REGISTERED
FL 33566
ELECTRICIAN COMPANY
SIGNATURE REGISTERED
Address
Johnson's Excavation & Services, Inc.
Y/ N FEE CURREM1 �Y,/ N I
License # I CBC059540
Y/ N FEE CURREM1
License #
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREM1 Y I N
Address License# �—
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREM1 Y I N
Address I License #---
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREM1 Y / N
Address License#
111111111111111111111111111111111111111/111111111111/11111111111111
RESIDENTAL 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 subdivisionsAarge 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 (Plot/Survey/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 I, 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.
MAY RESULT IN YOUR
IIZ•Za = 1$1RT Kt7 F.il]�II
f6fe me this
Subscribed sworn to r n befofe me
n
K,
Johnson
has have produced
Who is/ personally 'ho me or has/have
identification.
4 abdden
Notary Public
Commission No.
Public
INSTR#2022118024OR BK10621 PG1981 Page lfl
05126/2022 09:27 AM Rcpt: 2460875 Rec: 10.00 IDS: 0.00 IT: 0.()0
Nikki Alvarez-Sowles, Esq., Pasco County Clerk & Comptroller
"47 1W
.00 =W01-21MI-Mas"',
ReZ—rn Tto.�����—
Plant 0lV-'FjWdA TAMAR
NOTICE OF COMMENCEMENT
State of Florida, county of
The undersignea nareby(pvasnice atmorovementwill bra made tocertalnrealpropsrty, and In accordance
with Chapter 713, Florida Slattutes, the following information Is provided In this Notice of Commeocement.
I criotion of oroneriv Ilaaaf descrintlon of, tM bronartv. arvistrbef address.1f avallaHa� , -
PA
9
M
Interest In Proper
- 166SI V
Name and address of fee simple titlehoider (W dKerent from Owner listed above)'
Name N,Address
4, Contractor
Name Johnson's Excavation & Services. Inc, _Telephone Number _813-752-70-97
Address 1706 East TrapHell ,Road -Plant City, Forida 385M
5. Surety (if applicable a copy of the payment bond Is attached)
N-a- � I Telephone . Number
—_
Address, Amount of Bond
6. Lander
Name-6-19— Telephone Number,_
Address
7. Persons rnrifih4n the of Florida designated by Owner upon whom notices or other domments may
be served as provided by §713.1 3(11)(a)7, Flodda Statutes.
Name ________Je1ephono Number__
Address
8, In addiitiWn——hlmself or herself, Omer designates the folloi4ing- to receive, a copy of Um Usnor's
Notice as provided in §713.1 3(l)(b), Florida Statutes.
Name Telephone Number_____
Address_,
9. Expiration date of notice of commenwment (the explration date will be I yearfrom the date of recording
uniess a different date Is'speciffed)
ic"
or OnWis or Lowe's Authorized
was acknowledged before me this
for
0 1 P. " ii it 4
�fl M-
Wwn Irament was executed
Arsonally Known zC OR Produced ID SUSAN I., KOWAL
-flGG 9117n
Type of D Produded ------
A7, -XPIRIS: Ocilobar 12,2023
A Tbrj Notary ?Ublio UndefwP tQrs
Florida Department of DEP Form 62-257.900(l)
Effective 10-12-08
Environmental Protection L Page I of 2
RO Division of Air Resource Management
NOTICE OF DEMOLITION OR ASBESTOS RENOVATION
TYPE OF NOTICE (CHECK ONE ONLY): 21 ORIGINAL [:1 REVISED El CANCELLATION [:1 COURTESY
TYPE OF PROJECT (CHECK ONE ONLY): [E DEMOLITION El RENOVATION
IF DEMOLITION, IS IT AN ORDERED DEMOLITION? []YES El NO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION? MYES El NO
IS IT A PLANNED RENOVATION OPERATION? 171YES El NO
I. Facility Name Sixth Avenue LLC
Address 5512 Laura Street
City Zephyrhills State FL
County Pasco
Site Unit 26 Consultant Inspecting Site Terracon
Building Size 780 _ (Square Feet) #of Floors 1 Building Age in Years 50
Prior Use: El School/College/University 171 Residence F71 Small Business 171 Other
Present Use: [3 School/College/University 71 Residence 171 Small Business 171 Other
II. Facility Owner Sixth Avenue LLC Phone C&13)J52-7097
Address 917 W. Wasington MS 316 C/o Duff & Phelps, A Kroll Business
City Chicago State IL Zip 606
7
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 33M6
Is the contractor exempt from licensure under section 469.002(4), F.S.? 17-1 YES [__1 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):
Zip 33542
VI. Procedures for Unexpected RACM: Stop, Contain area, call environmental compliance services
VII. Asbestos Waste Transporter: Name JOHNSON'S EXCAVATION & SERVICES, INC. - DONATHAN A JOHNSON Phone CT13)352-7097
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
EIRM,
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.
Conathan Johnson 05/23/2022
(Print Name of Owner/Operator) (Date)
05/23/2022
(Signature of Owner/Operator) (Date)
DEP USE Y P6stmark/Date Received ID# 116304
MU91M
Mr. Nicholas Eilerman
Environmental & Compliance Project Manager
Realty Systems, Inc.
c/o Equity LifeStyle Properties
5100 W. Lemon Street
Tampa, Florida 33609
P: (813) 282-59-73
E: nicholas eilermannn tam iilyff-
Re: Pre -Demolition Asbestos Survey
6 th Ave MHP MHC (Loc# 7800) — Units 26 & 104
39345 6th Ave
Zephyrhills, FL 33542
Project No. H4227200
Dear Mr. Eilerman:
I I L 11 art re I# ealg I 7117rM77,177M
As requested through a task order dated May 4, 2022, our scope of service included the collecti
4 of bulk samples of suspect asbestos -containing materials (ACM) associated with the plan I
demolition of the structure. Samples were submitted to an accredited laboratory for analytici
analysis and reporting of results.
Limited asbestos sampling was performed on May 11, 2022 by Mr. Karl Kologiski, an AHERA-
accredited building inspector. Sixteen (16) bulk samples were collected from eight (8)
homogeneous areas in Unit 26 and thirty-one (31) bulk samples were collected from fifteen (15)
homogeneous areas in Unit 26. Samples obtained are those materials associated with the
demolition activities. Bulk samples were submitted under chain of custody to Arrowhead
Technologies Inc. for analysis by polarized light microscopy with dispersion staining techniques
per EPA/600/R-93/116.
Based on the results of laboratory analysis of the designated, suspect materials, the following
materials were found to contain asbestos:
Unit 26
A/ _N_ESHAP OSHA Work
Location Description �t Asbestos Est. Quantity"'
Sa1'11p1!s,# �1� Classification Class
Exterior Window
X1 Gasket Material otile Asbestos Non -Friable Cat 11 30 S.F. Work Class ll
and DoorFrames
Roof
Cap
to Exterior
Wall Sea,`! X7
,Gasket Material 5 /° Chrysotile Asbestos Non -Friable Cat II 40 S-F. Work Glass II
Terracan Gansultants', Inc. 5463West Waters-, Avenue, Suite. 8,30 Tampa, Florida°336-34
F [81112`210050, F [81*3]'22t 0051 terracomcom
Limited Asbestos Pre- Renovation Survey
lkwa=
61h Ave MHP (Loc# 7800) Units 26 & 104 x Zephyrhills,
Florida
May 13, 2022s Terracon Project H4227200
Unit 104
MA!
i
Est. NESHAP
osHA Work
Location sample Description
Asbestos (%)
K,
Classification Quantity— f
Class
#
Rear Bedroom Under
Plywood R6 9"x9" Tan Vinyl Floor Tile 3
2% Chrysotile Asbestos
Non -Friable Cat 11 �F 200 S.F.
Work Class 11
Exterior Window and
,I Door Frames R11 Gasket Material
6% Chrysotile Asbestos
Non -Friable Cat 11 30 S.F.
Work Class 11
Roof Deck R12 Roof Coating
2% Chrysotile Asbestos
Aluminum Coasting
Non -Friable Cat 11 670 S.F.
Work Class ll
Carport I Patio Roof to Black & Aluminum Roof
R13 1
6% Black Sealant
2% Aluminum Coasting
Non -Friable Cat 11 76 S.F. i'
Work Class 11
Wall Joint Sealant
Ch stele Asbestos
RoofWall Cap Exterior
ry
R14 Gasket Material
Seamto
6% Chrysotile Asbestos
Non -Friable Cat 11 40 S.F.
Work Class ll
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
Responsivem Resourcefuln Reliable
Tom Holley, CHMM, CIH, CSP
Florida Licensed Asbestos Consultant AX-75
Authorized Project Reviewer
PA
ARROWHEAD
TECHNOLOGIES, LLC PLM REPORTSUMMARY
3151 San Bernadine St.
Clearwater, Florida 33759
813-679-0720 / mha11005@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 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
010256-001
Gasket Material X1-1
5% Chrysotile-Gray Gasket Material
Window Door Frames
i 010256-002
Gasket Material Xl-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 - US/l 1/2014 - issuing Authority: Monte Hai
ARROWHEAD
TECHNOLOGIES. LLC PLM REPORTSUMMARY
3151 San Bernadino St.
Clearwater, Florida 33759
813-679-0720 / mha11005@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.
rLM mpon summary - xevision s - uoi t 1i2u14 - Issuing Autnority: monte Hat
ARROWHEAD
TECHNOLOGIES. LLC PLM REPORTSUMMARY
3151 San Bemadino St.
Clearwater, Florida 33759
813-679-0720 / mha11005@tampabay.rr.com NVLAP Lab Code 200703-0
Terracon
Lab Set No.:
010256
t : 6th Ave MHP #26, 5512 Laura St
AT Job No.:
22-10256
Project No.: H4227200
Report Date:
5/12/2022
ication : Asbestos, Bulk Sample Analysis
Sample Date :
5/11/2022
est 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.
i ii�, i• • � i
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 tile 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.
LaboratoryDirector:
Florida Registration No. 1611
Approved Signatory :
ARROWHEAD
TECHNOLOGIES, L L C PLM REPORT SUMMARY
3151 San Bemadino St.
Clearwater, Florida 33759
813-679-0720 / mhaII005@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 I of 6
On 5/12/2022, thirty-one (3 1) 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 Rl- I
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 farther 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.
LM Keport Summary - Kevision 3 - 05/11/2014 - Issuing Authority: Monte Hal
ARROWHEAD
TECHNOLOGIES. LLC PLM IMPORT 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 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:
t 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 - 01 / 11/2014 - Issuing Authority: Monte nai
ROW HEAD
TECHNOLOGIES, LLC PLM REPORTS' ARY
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, Sulk 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 / 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. Speck 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 Kepon Summary - Kevision 3 - U5/1 t/2U14 - issuing Authority: Monte Hal
(4)ARROWHEAD
TECHNOLOGIES. LLC, T SUMMARY
3151 San Bemadino 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 RIO-21
None Detected -White Caulking
Bath Room
010257-022
Gasket Material R11-22
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
a 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
TECHNOLOGIESLLC PLM REPORT5UM
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 Black Mastic 7
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.
YLM Report Summary - Revision 3 - 05/11/2014 - Issuing Authority: Monte Hai
ARROWHEAD
TECHNOLOGIES. L LC
3151 San Bernadine, St.
Clearwater, Florida 33759
813-679-0720 / mhaII005@tampabay.rr.com
Client
Project :
Client Project No
Identification
:Test Method:
[W Of 11111310] tA *3 OLIVA 10Y
Terracon
6th Ave MHP #104
H4227200
Asbestos, Bulk Sample Analysis
Polarized Light Microscopy / Dispersion Staining (PLM/DS)
EPA Method 600/R-93/116 / EPA Method 600/M4-82-020
NVLAP Lab Code 200703-0
Lab Set No.
010257
AT Job No.:
22-10257
Report Date:
5/12/2022
Sample Date:
5/1112022
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, EPAJ600/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 :