The URL can be used to link to this page

Home My Public Portal About09-0053 Trinity Chapel OFI` F�1S.-W CITY OF TYBEE ISLAND BUILDING PERMIT DATE ISSUED: 02-10-2009 PERMIT#: 090053 WORK DESCRIPTION ASBESTOS REMOVAL-SANCTUARY WORK LOCATION 911 BUTLER AVE OWNER NAME TRINITY CHAPEL UMC ADDRESS 911 BUTLER AVE CITY,ST,ZIP TYBEE ISLAND GA 31328 PHONE NUMBER CONTRACTOR NAME ACTION INSULATION CO INC ADDRESS PO BOX 4073 CITY STATE ZIP PT WENTWORTH GA 31407 FLOOD ZONE BUILDING VALUATION SQUARE FOOTAGE OCCUPANCY TYPE P TOTAL FEES CHARGED $200.00 PROPERTY IDENTIFICATION# PROJECT VALUATION $12,230.00 TOTAL BALANCE DUE: $200.00 It is understood that if this permit is granted the builder will at all times comply with the zoning,subdivision,flood control,building,fire, soil and sedimentation,wetlands,marshlands protection and shore protection ordinances and codes whether local,state or federal,including all environmental laws and regulations when applicable,subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of issuance. Signature of Building Inspector or Authorized Agent: Qtb P.0.Box 2749-403 Butler Avenue,Tybee Island,Georgia 31328 (912)786-4573-FAX(912)786-9539 www.cityoftybee.org C ) _ . City of Tybee Island - Community Development Dept. isy7776,iv farm,-t n::: ....'; Inspection Report • . 403 Butler Ave. . P.O. Box 2749 - Tybee Island, CA 31328 :ass PSIS :':,""i..;ds,■:1.' Phone 912.786.4573 ext. 114 - Fax 912.786.9539 ;..:rxii,410 • 1 I Z Permit No ;,-- (.- D. -:-"S ...._...- Date Requested Owner's Name ( (c.;:( ijt--, i)1(31"; Date Needed -;..'7/ I 2.1 i 1 0 i " I , ' - 'L 1 J Gen. Contractor ... .('' _Asi Subcontractor i Contact Information 6-1 f-)1( I ---c- Project Address ':':i ) i -i,,: L:4 Liz_ . -----7.,, Scope of Work K V--01,0 Of.. ter--4.=.--brz ', ----IC:)‹ 1:-_--f pore; 4---i I L., • ,' VnAS-rl C. I Inspector . ----, Date of Inspection 1 Inspection -vo t ._-+ 1:7( kb )- Pass 'NI il C3 Fee tA)Oj4.-Z14,flLk-- Inspection pass —s Fail 0 Fee • Inspection Pass Fail 0 Fee Inspection Pass v--, Fail Ej Fee • .1 ii, t L fr,d e't- y+-TY e~•rrOr / CITY OF TYBEE ISLAND,GEORGIA 5"1--er=. Lti CA-- I APPLICATION FOR BUILDING PERMIT er'''g`r' , r D 9 - D 0 C3 (,,, : cation: <r✓!-' Chard- PIN# r NAME ADDRESS TELEPHONE /Owner �, 10 )6iges i c l42,E, r� qs..,,, Architect or E 'neer Gd i _ , wilding 1 1 }�' 'W i� 0 Contractor ,�' !r . A .�.�... • , r (Check all that apply) [] Repair ❑ Residential g Footprint Changes NI Renovation 0 Single Family Discovery Minor Addition ❑ Duplex ❑ Demolition Substantial Addition [1 Multi Family Other ❑ Commercial Details of Project: IR e v o.i L 0 F 0.,5b.c 5166 F)oo R 4-v i '► -5he, Estimated Cost of Construction: $ 1 ). Consttuction Type (Enter appropriate number) (1) Wood Frame (4) Masonry (6) Other(please specify) (2) Wood&Masonry (5) Steel&Masonry (3) Brick Veneer Proposed use: Remarks: A'TT'ACH A COPY OF THE CERTIFIED ELEVATION SURVEY OF LOT and complete the following information based on the construction drawings and site plan: #Units #Be ,,s #Bathrooms Lot Area ving •.: e(total sq. ft.) #Off-street parking s i ac , j Trees located&lis on .$ ;Tian 1 ll Access: Driveway (' • • Avert? With swale? Setbacks: Front �.:r- �' Sides(L) (It) #Stories- Height : 1 stance measured from the average adjacent '" grade of the building to the - 'hi i t 1 f ,f the building,exclusive of chimneys,heating units,ventilation ducts,air co < ti* is #'+ elevators,and similar appurtances. 90IE0 39ad WOSSI69 1 d '8 9 0 t99998LZI6 LZ:1Z 600Z/9Z/10 During construction: On-site rearm=facilities will be provided through 0 14 t _ site waste and debris containers will be provided by ,'a t1 ,.t111`:1lti�C.'f, Construction debris will be disposed by Ure,i bim ears o • . ^. . .� .. ,� I understand that I must comply with zoning.flood damage control,building fire,shore t�ratections and wetlands ordinances.FEMA re atians and all applicable codes and regulations. I understand that the lot must be staked out and that the stakes will be inspected to ensure that the setback requirements are met I understand also that a certified plot plan showing elevation must be attached to this application and that an as-built elevation certification is due as soon as the habitable floor level is established.Drainage: I realize that I must ensure the adequacy of drainage of this property so that surrounding property is in no way adversely affected. I accept responsibility for any corrective action that may be necessary to restore drainage impaired by this permitted construction. ate: 1 \2 8 L••Signature of Applicant: Note:A mil normally takes 7 to 10 days to process, The.fodlowing is to be completed by City personnel: Zoning certification NFIP Flood Zone Approved rezoning/variance? Street address and number:New Existing Is it in compliance with City map? If not,has street name and/or number been reported to MPC? FEMA Certification attached State Energy Code Affidavit attached Utilities and Public Works: Describe any unusual findings) 4. Access to building site ` 10 Distance to water main tap site Distance to sewer stub site a Water meter size Storm drainage Approvals: Si Date !FEES Zoning Administrator ill / Z. Permit( tO ,o 0• Code Enforcement Officer rr,/� I' az-02-01 Inspections _ Water/Sewer / Water Tap Storm/Drainage Sewer Stub Inspections Aid to Const. City Manager TOTAL P D a, 90/1'0 391/d t OSSI89 1 e 2 9 0 I99998LZI6 i :Tz 6002/9Z/T0 MOW MUM V,, 4Yr4 .EORCIA Permit Aj knowledgeuueat of AshestoslEnvfrnnrnentsl NotifieatIon to Geors'a EP P for Projects Involving Demolltlon.Wrecking,or Renovation The undersigned hereby acknowledges that the issuance of this permit does not in any way grant permission to the owner, owner's representative, or permit holder to proceed with demolition, wrecking, or renovation of a structure prior to the filing of any required ten (10) day "Project Notification for Asbestos Renovation Encapsulation or Demolition"form in accordance with the Georgia Asbestos Rules. The Georgia Environmental Protection Division administers the rules, In most cases,the rules require both the owner and the involved contractors to assure the portion of the building involved in the project is thoroughly inspected by an Accredited Asbestos Inspector for materials that contain asbestos; and the removal of the asbestos before renovation, wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed demolition notification from be submitted 10 workings days in advance even if no asbestos is present in the building. Further guidance for regulatory compliance and contact telephone numbers are provided by the brochures entitled Asbestos & Renovation and Asbestos and Demolition. Other environmental issues such as asbestos removal techniques, lead abatement, ground contamination,or unusual site conditions may have EPD regulations that could affect the jest. d -2g- 9 ndersed Date `5 ar Printed Naie Office Use Only: Project Address: .. Permit Number: 90/90 39Jd VOSSI219 1 d T 9 0 T99998LZT6 LZ:TZ 6003/9Z/l0 REQUIRED FOR: Building Permits Relocation Permits sign Permits Demolition Permits Land Clearing,Disturbance or Excavation Permits Tree Removal Permits Relocation Permits Special Review Permits Site Plan Approval Subdivision of Land sketch Plan Approval Preliminary Plan Approval Final Plat Approval Minor Subdivision Plat Approval Major Subdivision Plat Approval In addition to specific requirements for the above permits and approvals, applicants must demonstrate that they are in compliance with the City of Tybee island Storm Water Management requirements as outlined in Chapter 5-4, Code of Ordinances. Section 5-4-9 Prohibition provides,in part,as follows: (4.) It is unlawful for any person to cause or permit any storm water to flow from their property onto the property of another person,unless such storm water naturally flowed thereon prior to any development activity. (5.) It is unlawful for any person to interrupt the flow of any storm water runoff from adjacent property onto then property by any Livvelupmant activity. As part of the City's approval process applicants must illustrate how these storm water management prohibitions will be met,including a showing of how storm water naturally flowed on the affected property(prior to any development activity),and what changes in storm water flow have occurred or are expected to occur,as attachments to this form. The City's approval or permit does not guarantee that the applicant's plans will result in meeting requirements. The final product must actual,. meet the City Ordinance requirements. Applicant name: -a f Ad. Project I.D.. Attachments approved by: Date: 1. Z$—O 96/99 39Vd WOSSIe9 1 d T 9 D I99998LZI6 LZ:IZ 6003/9Z/I0 . , . 1 Genre'c Envro m ntal ProtBcL. ,n On Asian � a f $„ t# ['tarp} pp'i P a 2nI r 3�� t�,�'.3'7 � r� �^�� E Sad �� !:i � a,, r ,,��i° f � s�33' +��.. z•v'y �e�s , ,ti«yi y.a •y . I::, L.. 1.�. n ;;',7%:':1. i{ ;a , Carol A Couch, Ph. D.,Director za ,' . f-i it°;. +:: `''`" :�� 4244 international Parkway, Suite 104 .,. '-.1? . `r Atlanta, Georgia 30354 ai> '' � .Action Insulation, Inc. 11;r t" 2.1 'tii'ii ilsaiil8'i0 1'i CI.- C— .,: V`e10,,Ai'.' SnI .\.t., i?.C .{t._ . -i:-.. a'^t .z.u.. :ti;.. .,.t 141;e:. fa.. .1. #-,n;' .. i s..'inr, i a l. and i't:n ealytil.ttion, Chapter 1`n-.. 14 i_ H:1r_i,`, 1-1• ,.15.:11 a., :ti-i .S E, iOSCON4R) TOR I :1 5k e. and Lilt a34,°/;1:111 t'liable Ast?esi:'i)i C fti t:tirai.ii`; ►al tetrad' V':thin thst•-Stale of Georgia . This Certificate. '\t a) Be Sub:xet To iii~-+'ocaticri. '5usponion, :NJ otiiilc:aion OrAine niinent B) The Dire+-tor For Canso Inch di':%, Eb:tdence Of Noncompliance:nce: Or For Any Misrepreset}talion Made in The Application.Supp ortinn Data Entered Therein Or Attached Therct,-,, Or An S , i', '! _7..t StitT:it:.3ts Or Sitpnoi°.n Data: Or Any Alterations .affcctin".The Ahill* To i e_r i `it i Dut a:, Proper . Company Owner/President Gary Brazen Company Mailing Address Post Office Box 4073 Port Wentworth Georgia 31407 Phone:912/964-2332 FAX 912/964-4367 E-Mail Address actioninsulation @aol.com Company License Number R 061 15 Principal Agent's Name GARY BRAZELL Agent's Date of Birth Agent's Height Agent's Weight 3/22/1955 6 Ft. 2 In. 190 Agent's Authorization Number 0141 15 The Company License and the Agent's Authorization are interconnected, and the issue and expiration dates run concurrently. The issue and expiration dates shown below apply to both the Company License and the Agent's Authorization: _ ISSUE DATE _ EXPIRATION DATE i 6/13/2008 6/13/2011 I I DANA HUGHES r '4V:6: 1 A� Phone:(404)362-2704 Issued By: . / aljosie_larkins@dnr.state.ga.us r;;-: 1,:r. Friday,June 13,2008 GEORGIA PROJECT NOTIFIC ON FORM FOR ASBESTOS RENO VA I IC .NCAPSULA!ION, OR DEMOLITION ION ARE YOU SUBMITTING AN ADVANCE,,077FICA770N? EPD STRONGLY DISCOURAVESSUBMITTAL OF ADVANCE NOTIFICATIONS,BUT IF IT IS ENTIRELY UNAVOIDABLE,CHECK(H)THE BOX BELOW AND FAX THE FIRST PAGE ONLYOF THIS FORM TO (404)362-2563. WHEN SUBMITTING AN ADVANCE NOTIFICATION,YOU ARE STILL REQUIRED TO COMPLETE THIS FORM IN ITS ENTIRETY AND SUBMIT IT VIA MAIL TO THE ADDRESS PROVIDED. EPD NO LONGER ACCEPTS'FAX ONLY'DOCUMENTS!! PLEASE ACCEPT THIS FORM AS ADVANCE NOTIFICATION OF THE PROJECT DESCRIBED BELOW: 0 PERSON SUBMITTING ADVANCE NOTIFICATION: CONTACT PHONE: FAILURE TO SUBMIT ACCURATE AND COMPLETE FORMS WITHIN THE REQUIRED TIME FRAME AND AS INSTRUCTED MAY RESULT IN ENFORCEMENT ACTIVITY BY EPD! INCOMPLETE OR INACCURATE FORMS WILL BE REJECTED AND RETURNED. USE AN ATTACHMENT TO PROVIDE ADDITIONAL INFORMATION FOR ANY SECTION WHEN NEEDED TO PROVIDE COMPLETE DETAILS. DO NOT LEAVE ANY SECTION BLANK-INSERT UNKNOWN OR N/A IF NEEDED! FOR PROJECTS WHERE FEES ARE DUE: FOR PROJECTS WHERE FEES ARE NOT DUE: EPD ASBESTOS FEES LOCKBOX EPD ASBESTOS PROGRAM POST OFFICE BOX 101173 ATTN:ASBESTOS NOTIFICATIONS ATLANTA,GEORGIA 30392 4244 INTERNATIONAL PARKWAY,SUITE 104 (SEE SECTION 6 FOR FEE CALCULATION INSTRUCTIONS) ATLANTA,GEORGIA 30334 SECTION 1A-TYPE OF NOTICE(USE THE APPROPRIATE CHECKBOX TO INDICATE THE TYPE OF NOTICE YOU ARE SUBMITTING) `❑ORIGINAL INITIAL ❑ANNUAL BLANKET($1,000.00 FEE DUE NOW) ❑CANCELLATION ❑ REVISION(IF REVISION,REVISION# ) REVISION NOTE:CHECK THE REVISION BOX IN THE SECTION BEING REVISED AND INSERT THE CORRECTED INFORMATION WHERE APPROPRIATE SECTION 1B-TYPE OF PROJECT CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ ❑RENOVATION/ABATEMENT ONLY ❑RENOVATION/ABATEMENT PRIOR TO DEMOLITION ❑ENCAPSULATION ❑DEMOLITION ONLY ❑JOINT DEMOLITION/RENOVATION ❑ORDERED DEMOLITION ❑ EMERGENCY(SEE ASBESTOS RULES FOR DEFINITION OF EMERGENCY) CI QUANTITY (FOR NON-FRIABLE PROJECTS OR UNDER TRIGGER QUANTITY PROJECTS ONLYI!!) SECTION 2-SITE INFORMATION CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ PROJECT NAME: 7�/t<I 1�y eih 'P,r a -6 Q'/$� vN .e_07. Lo°1 i-c--02,6) PROJECT ADDRESS: `0 ' 3-Mee.? fT 8ti,.,-G PROJECT CITY: iCAFi 6L xc 1,40 ZIP: 3)3 2 COUNTY: (.HAre,f3/21 NEAREST MAJOR INTERSECTION: latu p Le A IA-FA/14E d' 10 4-1 5i-2 se-7 BLDG SIZE IN SQ.FT: 4300 5f j' AGE OF BUILDING IN YEARS: 2. .d- NUMBER OF FLOORS IN BUILDING: I SPECIFIC LOCATION IN BUILDING OF ASBESTOS BEING REMOVED: Ft,e�2 T)Le'/ IAs-1 'rW,.4,i &cte SECTION 3A-ABATEMENT CONTRACTOR CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ ASBESTOS REMOVAL CONTRACTOR: p -- , 1 n 5 A, -la,,` ca‘ n. CONTRACTOR STREET ADDRESS: 310 y 54—y ¢-4- COMPANY CERTIFICATE ERTIFICATE#: R IO B t 5 CITY: -+ P,-f -IAZ ,' TATE: tripr ZIP: 3 C ol PHONE: 12. 11c)ti AX: ,q12 q6,ek 434 7 LICENSED AGENT: ��7 .r6 6., jtotzet f AGENTS ID:0/ �] `I S EXPIRES:Co 113kb I I CELL PHONE:q/2 to 5-.b 5 `3 3b Other Contractor CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ GENERAUSUB/DEMOLITION CONTRACTOR: NI (4 JOB CONTRACTED: 1,4- OTHER CONTRACTOR STREET ADDRESS: IN ( A- CITY: 1 STATE: r..3 I A ZIP: k`V1 p.. PHONE: C I A- FAX: 1 .. SECTION 4- ACM INFORMATION CHECK IF SECTION BEING REVISED FROM A PREVIOUS SUBMITTAL❑ IS ASBESTOS PRESENT? /YES ❑ NO ❑ UNKNOWN Cd' FRIABLE ❑ NON-FRIABLE ❑ BOTH DID AN AHERA ACCREDITED INSPECTOR INSPECT THIS SITE? Q YES ❑ NO 0 ASSUMED ASBESTOS INSPECTOR NAME: L -'1 c/ INSPECTOR PHONE: i,L, ACCREDITATION COURSE: t\i„i1 6(__ CERTIFICATE NUMBER: U. i(_'., EXPIRES: LL✓, Jr-' SECTION 5-WORK SCHEDULES (10 WORKING DAY ADVANCE NOTIFICATION REQUIRED FOR NON-EMERGENCY NOTIFICATIONS!!!) CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ ABATEMENT START DATE ABATEMENT END DATE WORK DAYS(MON-SUN) WORK HOURS(EX:7-4) DEMOLITION START DATE DEMOLITION END DATE WORK DAYS(MONSUN) WORK HOURS(EX:7-4) - F' /4 t,31,./D,.- Y\Y I(le-t' lN,1 /' REV083005F SECTIC -ACM AMOUNTS,TYPE CODES,AND CALCULATION Cl, ,IF SECTION IS BEING REVISED FROM A PREVIOL SUBMITTAL 0 FIRST,LOCATE THE MATERIAL TO BE REMOVED IN COLUMN A. COLUMN B SHOWS THE USUAL NESHAP CATEGORY FOR THE MATERIAL COLUMN C SHOWS THE CATEGORY THE MATERIAL WILL LIKELY BECOME DURING ABATEMENT,AND THAT IS THE CODE THAT SHOULD BE USED FOR COMPLETING THIS FORM. NOW ENTER THE SQ. FT AND/OR L.F. AMOUNTS OF ACM TO BE ABATED DURING THIS PROJECT UNDER THE CORRECT HEADING ACCORDING TO TYPE IN COLUMN 0,E, AND/OR F. THEN, LOCATE THE CORRESPONDING TYPE CODE(S)FOR THE MATERIAL(S) IN COLUMN G AND ENTER THE CODES IN THE SPACES PROVIDED BEFORE PROCEEDING TO THE FEE CALCULATION SECTION. COL B COL C SF OR LF AMOUNT TO BE COL A ABATED DURING THIS COL G1 PROJECT WILL LIKELY COLD COL E COL F BECOME ACM ACM TYPE USUAL NESHAP CATEGORY WHEN CAT CAT RACM TYPE CAT CAT RACM ABATED 1 2 CODE 1 2 ASBESTOS ASPHALT SHINGLES ✓ ✓ 1 AAS ASBESTOS CEMENT(TRANSITE)PANELS ✓ ✓ 2 OR RACM ACP ASBESTOS CEMENT(TRANSITE)ROOFING ✓ ✓ RACM ACR ASBESTOS CEMENT(TRANSITE)SIDING SHINGLES ✓ ✓ RACM ACS ASBESTOS FLASHING ✓ ✓ 1 AF ASBESTOS GASKET v v✓ 1&RACM AG BOILER INSULATION ✓ RACM BI BUILT-UP ROOFING v. ._ ,/ 1 BUR _ ---- -- - 1 CM COVE(BAS EBOARD)MOLDING MASTIC v CEILING PLAS I tR ✓ RACM CP CEILING TILE " RACM CT DUCT SEAM MASTIC ✓ ✓ 1 DSM DUCT VIBRATION DAMPENERS ✓ ✓ 1 DVD EXTERIOR(OUTSIDE)DUCT INSULATION " ' RACM E D_I_ FELT DUCT TAPE V RACM FDT FLOOR MASTIC ✓ ✓ 1 FM. ' FIREPROOFING ✓ RACM FP FIREPROOFING AND OVERSPRAY V RACM F PO FLOOR TILE ✓ �. _. ..._ _1_.. FT _- _._. T ✓ V 1 OR RACM FTM FLOOR TILE AND MASTIC INTERIOR(INSIDE)DUCT INSULATION ✓ -., ✓ RACM IDI JOINT COMPOUND ONLY ✓- RACM JC ✓ LIGHT WEIGHT CONCRETE OTHER: FLOOR LEVELING COMPOUND,CAULKING,ETC.) 1 OR RACM OTR .. V ✓ __ _ .. 1 PIPE INSULATION STRAIGHT RUNS . RACM PI i PIPE INSULATION ELBOWS AND FITTINGS V RACM PIE RESILIENT FLOOR COVERINGS(SHEET FLOORING;LINOLEUM) V V 1 O R RACM RFC ROOF MASTICS AND COATINGS ✓ ! 1 _._ RMC ROOFING SILVER COATING ✓ ✓ 1 OR RACM RSC TEXTURED CEILING v._. RACM TC ' TEXTURED CEILING PLASTER ✓ RACM TCP — ---- -— - TANK INSULATIOIO V RACM TI WALL BOARD AND JOINT COMPOUND v RACM WBJC WINDOW GLAZING ! V __- 1 OR RACM WG_ WALL PLASTER ✓ RACM WP COL.G2: Enter the ACM Type Codes From Col.G 1 For Each Category Below. COL D COL.E COL F CAT 1: 0 TOTAL TOTAL TOTAL CAT 2: '0 RACM: .31Jr) — — — -- -- -- — CALCULATING FEES—Now,Check The Box Next To The Project Type To Indicate Whether This Is A Residential Or Non-Residential Project. ' ex BOX H. IS THIS A RESIDENTIAL PROJECT? ❑ YES (USE TOTAL FROM COL.F TO COMPLE I L THIS SECTION) ' RESIDENTIAL PROJECT COL F TOTAL FEES DUE AND PAYABLE NOW RESIDENTIAL FEE SCHEDULE:104 PER LF/SF OF TOTAL X.10 FRIABLE ACM SUBJECT TO A MINIMUM FEE 0F$25 EQUALS H(b). S AND A MAXIMUM FEE OF$50 PER RESIDENCE H(a). O SF/LF (NOT TO BE LESS THAN$25 OR MORE THAN$50) BOX I. IS THIS A NON—RESIDENTIAL PROJECT? LJ YES (USE TOTAL FROM COL F.TO COMPLETE THIS SECTION) NON-RESIDENTIAL PROJECT TOTAL FEES DUE AND PAYABLE NOW NON-RESIDENTIAL FEE SCHEDULE:104 PER LF/SF COL F TOTAL X.10 ,// C0 OF FRIABLE ACM SUBJECT TO A MINIMUM FEE OF 00 EQUALS I(b). $ `t-s D $25 AND A MAXIMUM FEE OF$1,000 PER FACILITY I(a). T SF/LF (NOT TO BE LESS THAN$25 OR MORE THAN$1,000) Finally,Enter The Check Number For The Fee Payment You Are Submitting,Or Explain WHY The Fee Is Not Being Submitted And WHEN And By WHOM It Will Be Sent � { CHECK NUMBER i `'� 0 0 FOR THE AMOUNT SHOWN IN THE TOTAL FEES DUE COLUMN(S)ABOVE HAS BEEN SENT: ES IF NOT,WHY NOT? REV 083005F SECTION 7-WASTE TRANSPORTER )OSAL SITE,AND BUILDING OWNER INFORMATI CHECK IF SECTION IS BL REVISED FROM A PREVIOUS SUBMITTAL❑ WASTE TRANSPORTER WASTE TRANSPORTER NAME _ y, i n ,r•NSPORTER CONTACT PERSON: TRANSPORTER'S MAILING ADDRESS: f Bj� t os- CITY: nv 10 STATE: r.-7C,,, ZIP: 3 --&J55 PHONE: i2gq,(J C 5 FAX:CI gbGsCJC��r� DISPOSAL SITE DISPOSAL SITE NAME: ,5u fa. • 1 DISPOSAL SITE COUNTY: DISPOSAL SITE STREET ADDRESS: '25c,E) CITY: Spi jailAjuAL STATE: Q ZIP: 5)L.f 9 PHONE: FAX: PROJECT OWNER t PROJECT OWNER'S NAME: �� OWNERS REPRESENTATIVE: OWNER'S STREET ADDRESS: p S-r• e,-r R vrt_ OWNER'S MAILING ADDRESS(IF DIFFERENT): $ �� CITY: -1k-be e 1.616,1,d STATE: (- ZIP: 3 13.7 b�' PHONES 12 qg(0-6464: FAX:G);)2-�3�Ci'(vdc,rsc.� SECTION -WORK METHODS:METHOD OF DEMOLITION AND/OR RENOVATION ACTIVITY(DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED) CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ SECTION 9—ADDITIONAL PROJECT INFORMATION CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ � WILL ASBESTOS REMAIN IN THE PROJECT AREA? 'NO ❑ YES ❑ UNKNOWN EXPLAIN'YES'OR'UNKNOWN': IF NO ASBESTOS IS PRESENT,WAS THIS PROJECT PREVIOUSLY ABATED? 13 NO ❑ YES ❑ UNKNOWN PRIOR ABATEMENT COMPANY: t� I YEAR ABATED: IN.)/ift.. THAT COMPANY CONTACT PERSON: I PLr I PHONE: ,41 CERTIFICATION OF INFORMATION AND ACKNOWLEDGEMENT CHECK IF SECTION IS BEING REVISED FROM A PREVIOUS SUBMITTAL❑ I THE UNDERSIGNED CERTIFY THAT AN INDIVIDUAL TRAINED IN THE PROVISIONS OF FEDERAL REGULATIONS (NESHAP/40 CFR PART 61 SUBPART M)WILL BE ON THE PROJECT SITE DURING DEMOLITION AND/OR RENOVATION ACTIVITIES DESCRIBED IN THE NOTIFICATION. EVIDENCE THAT THIS PERSON AND ALL OTHER PROJECT PERSONNEL HAVE ACCOMPLISHED THIS TRAINING WILL BE AVAILABLE FOR INSPECTION DURING NORMAL BUSINESS HOURS AND ANYTIME REGULATED ACTIVITIES ARE BEING CONDUCTED ON SITE. I FURTHERMORE UNDERSTAND THAT I AM RESPONSIBLE FOR THE ACCURACY AND COMPLETENESS OF THE INFORMATION CONTAINED WITHIN THIS NOTIFICATION SUBMITTAL, AND FOR PROMPT SUBMITTAL OF ALL REVISIONS, SUPPORTING DOCUMENTS, AND PROJECT FEES. PRINTED NAME OF AGENT/DESIGNEE: •_ _Al SIGNATURE OF AGENT/DESIGNEE: r,s4 DATE:• REPRESENTING: II/OWNER ❑CONSULTING FIR,A ❑ OTH-f RADE CONTRACTOR OTHER TRADE TYPE: q/A ABATEMENT CONTRACTOR COMPANY CERTIFICATE# Q {I I EXPIRATION DATE: (6 13 Zo!l • ALWAYS REFER TO THE INSTRUCTIONS WHEN IN DOUBT ABOUT PROPER COMPLETION OF ANY SECTION • NEVER LEAVE BLANK SPACES-INSERT`N/A'OR'UNKNOWN'FOR ANY BLANK WHERE YOU DO NOT HAVE THE INFORMATION REQUESTED • ALWAYS PRINT RESPONSES NEATLY AND LEGIBLY • ALWAYS KEEP A COPY OF THIS FORM FOR YOUR RECORDS,AND PROVIDE COPIES TO ALL OTHER INVOLVED PARTIES • DO NOT FAX THE ENTIRE NOTIFICATION WHEN SUBMITTING ADVANCE NOTIFICATIONS-USE THE FIRST PAGE ONLY OF THIS FORM. SUBMIT THE ENTIRE FORM VIA MAIL TO THE LOCKBOX FOR FEE PROJECTS OR TO THE EPD OFFICES FOR COURTESY& DEMOLITION NOTIFICATIONS • EPD NO LONGER ACCEPTS'FAX ONLY DOCUMENTS'-DO NOT FAX THE ENTIRE PROJECT NOTIFICATION-SUBMIT THE ENTIRE FORM VIA MAIL. • NEVER SUBMIT PROJECTS WHERE FEES ARE DUE WITHOUT ATTACHING THE REQUIRED FEE CHECK OR MONEY ORDER • NOTIFICATIONS WITH FEES MUST BE MAILED TO THE EPD ASBESTOS FEES POST OFFICE ADDRESS. NOTIFICATIONS WITHOUT FEES MAY BE MAILED DIRECTLY TO THE EPD OFFICES. • DO NOT SUBMIT`TWO-SIDED'PHOTO COPIES IT IS YOUR RESPONSIBILITY TO SUBMIT THIS FORM ACCURATELY COMPLETED AND ACCOMPANIED BY ALL APPLICABLE FEES. EFFECTIVE IMMEDIATELY, YOU WILL BE ISSUED A NOTICE OF DEFICIENCY FOR THE FIRST FAILURE TO SUBMIT A COMPLETE & ACCURATE FORM AND ALL APPLICABLE FEES, A NOTICE OF VIOLATION ON THE SECOND FAILURE, AND WILL BE REQUIRED TO ATTEND AN ENFORCEMENT CONFERENCE ON THE THIRD FAILURE. BEGINNING JULY 31, 2006, PROJECT NOTIFICATIONS SUBMITTED ON ANY FORM OTHER THAN THIS ONE FORMS WILL BE RETURNED AND YOU WILL BE REQUIRED TO RESUBMIT THE NOTIFICATION ON THE CORRECT FORM REV 083005F R.B.F. R.B.F. = 1/2° REBAR FOUND H 0.38' P.K.S. = P. AIL SET : 3 P.O.L. = POIN i ON LINE o! 6—B . co Q 6—A N _ f m / BRICK BUILDING %" /i; �,-'� S 69°00'00" E - ,,./ % :%" 157.42' /,'! { -- R.B.S. `s' � - r I'd-/-, / �; ,/' p EAVE LINE•• ' WOOD FENCE ° N g 10.69' -' //%' ,�i /��/!j'i 0 • :/ %, ,/ }( 0 /" // // , i — % '?II 26.72' • /,/;' //; ////,i //.'/ / ././//,/,,,z • • Q %; '/,//;; /EXISTING ONE STORY/�///// / .I:< w ca //,'-/,/ :BRICK CHU CH BUILDING /,/,,,,/,,-/,/,./..:' • W ' n lt ,, W ://,.////:',// ,��/ / /,; :I//:///'��'/ //;////‘''/ //'' 26.72' , { , _ _ , BRICK SIGN• • • Z �1 N O • R.B.F. • .' - N 69 P.K.S. IN CRACK °00 • I 157.42 00" W TE •' TH STREET 60' R/W • I REFERENCE: STATE OF GEORGIA 1. PLAT BY BARRETT LAND SURVEYING, INC. DATED 4/17/92 CHATHAM COUNTY 2. SUBDIVISION MAP OF TYBEE ISLAND BY PERCY SUGDEN DATED JULY 20, 1928. PLAT OF LOTS 7—An 7—:, 8—A & 8—B, WARD 3 TYBEE ISLAND, KNOWN AS No. 911 BUTLER AVENUE, TYBEE ISLAND GEORGIA • FOR: TRINITY CHAPEL UNITED METHODIST CHURCH • '' DATE OF SURVEY: FEBRUARY 16, 2006 ,, DATE OF PLAT: FEBRUARY 17, 2006 G G'T :1 SCALE: 1"-- 30' ,e<' .� IN MY OPINION THIS PLAT IS A CORRECT O \ /No. ;5 REPRESENTATION OF THE LAND PLATTED 0' 30' 60' _ _ E.O.C. FIELD 1/ 20,155 ( !9 '` 0 1 �� < ERROR/POINT BERT BARRETT, JR. 'A� 6suR\JC \' - ADJ. METHOD NONE LAND SURVEYING, P.C. B BARO- . E.O.C. PLAT 1/ INF. 145 RUNNER ROAD TOTAL STATION GEODIMETER 610 SAVANNAH, GA. 31410 2/J / /O C (912) 897-0661 t m ni i_R11