Loading...
HomeMy WebLinkAbout1010 BAYSHORE DR._13-0546___________Menager, Dwayne From: Youts,Melissa A (DSHS)< Melissa.Youts@dshs.state.tx.us > Sent: Tuesday, April 16, 2013 1:16 PM To: Menager, Dwayne Subject: RE: 1010 N. Bayshore Dr 10 Day Notification Ammendment Looks great, just make sure it is signed before you put it in the mail Thank you and have a great day! Melissa Youts, Administrative Assistant III Texas Department of State Health Services Environmental Health Notifications Group Mel issa.Youts(cDdshs.state. tx. us Phone: 512-834-6770 ext. 2474 Fax: 512-834-4524 From: Menager, Dwayne fmailto:MenagerD(&Iaportetx.govl Sent: Tuesday, April 16, 2013 1:12 PM To: Youts,Melissa A (DSHS) Subject: 1010 N. Bayshore Dr 10 Day Notification Ammendment Good Afternoon Melissa, Please find attached the amended 10 Day Notification if It looks ok I will get in the mail today. Thank you for your assistance. Respectfully, Dwayne Menager Chief Inspector Inspections Division 281-470-5070 7: TEXAS Department of r State Health Services For Oj/i a Use Only: Notification #: . ASBESTOS/DEMOLITION NOTIFICATION FORM DO NOT WRITEINTHIS BOX- FOR DEPARTMENT USE ONLY , Date received: / / Postmark date' // Walk-in date: / TYPE OF NOTIFICATION: (Select one and fill in the requested information) //�✓/� ® ORIGINAL ❑ AMENDMENT No. _ ❑ CANCELLATION ❑ EMERGENCY • Was emergency request made to the Regional Office or Environmental Health Notifications Group (EHNG) by phone? ❑Yes ❑No •If yes, the DSHS reference #: and name of the Regional or EHNG representative with whom you spoke? Date: / / Time: _ ❑a.m. ❑p.m. -Describe the reason for Emergency: _ ❑ ORDERED: (For structurally unsound facilities, attach copy of demolition order and identi, fy Governmental Official) Name: _ Registration No. _ Title: _ Date of order (Mlvl/DD/YY): / / Date order to begin (MM/DD/M: (_) Below if Amended AMENDMENTS: You must complete the entire form and mark the appropriate check box(et) along the left-hand side of this form to indicate amended information. TYPE OF WORK ❑ Asbestos Abatement ® Demolition ❑ Annual Consolidated O&M ❑ Abatement/Demolition Is this a phased project? ❑ Yes ® No FACILITY INFORMATION 1. Facility Location CONTRACTOR ❑....... Description or Facility Name: Restroom Building ❑ COPY ....... Physical Address: 1010 Bayshore Dr. ❑....... County: Harris City: TX Zip: 77571 ❑....... Facility Contact: Scott Bradley Phone #: (281) 470-5103 2. Type of Facility (Select one) ® Public ❑ Federal ❑ Industrial/Manufacturing ❑ NESHAP-Only ❑ Public School K-12 3. Facility Details ❑...... Description of Area/Room Number: _ ❑...... Age of Building: _ Size: 1,000 So If Number of Floors: 1 ❑...... Is this building occupied? ❑ Yes ® No ❑...... Prior Use: Restroom Facility El ...... Future Use: N/A ❑...... Date of Asbestos Survey/NESHAP Inspection: 04/09/13 ❑...... DSHS Inspector License #: 602374 ❑...... Analytical Method: ❑ PLM ❑ TEM ❑ Assumed Asbestos ❑...... DSHS Laboratory License #: 30-0031 IF THE APPROVED PLANS ARE MODIFIED, A NEW SUBMITTAL TO THE CITY IS REQUIRED PRIOR TO THE CHANGE OCCURRING. ® No Suspect Material WORK SCHEDULE/ASBESTOS AMOUNTS (Note. if the start date(s) entered below cannot be met, the DSHS Regional or Local Program ogee must be notified prior to the scheduled start data Failure to do so is a violation ofTAHPA Section 295.61) 1. Asbestos Abatement Work Schedule: El ...... Start date: / / and End date: / / ❑...... Work days: ❑Mon. ❑Tues. ❑Wed. ❑Thurs. ❑Fri. ❑Sat. ❑Sun. ❑....... Working hours: _ ❑ a.m. ❑ p.m. to _ ❑a.m. ❑p.m. 2. Demolition Work Schedule: ❑...... Start date: 04/25/13 and End date: 04/30/13 ❑...... Workdays: ®Mon. ®Tues. ❑Wed. ®Thurs. ®Fri. ❑Sat. ❑Sun. ❑...... Working hours: 7:00 ® a.m. ❑ p.m. to 5:00 ❑a.m. ®p.m. FORM APB #5, REV 5/07 tx�. Bel6w if; Amended C. ASBESTOS AMOUNTS ❑... ... Is Asbestos Present? ❑ Yes ® No (Complete the table below if asbestos is present) Asbestos -Containing Building Material Type Approximate amount of Asbestos *Only mark the boxes below on this chart if they are being amended Pipes Ln Ft Ln M Surface Area SQ Ft SQ M RACM to be removedRACM left in lace durin demolitionInterior dFt Cate o I non -friable removedExterior Cate o I non -friable removed Cate or Inon-friable left in lace durin demolition Interior Cate o II non -friable removed Exterior Category H non -friable removed El Cate or R uon-friable left in place during demolition RACM Off -Facility Component ... - ... I - 1. DESCRIPTION OF WORK PRACTICES AND PROCEDURES ❑...... 1. Description of procedures to be followed in the event that unexpected asbestos is found or previously non -friable asbestos material becomes crumbled, pulverized, or reduced to powder: Survey found no ACM; stop work & contact DSHS ❑...... 2. Description of planned demolition or abatement work, type of material, and method(s) to be used: ❑....... 3. Description of work practices and engineering controls to be used to prevent emissions of asbestos at the demolition site: Survey found no ACM; wet demolition PROJECT INFORMATION ❑...... A. FACILITY OWNER Facility Owner Name: City of La Porte Phone #: (281) 204-5293 Attention: Scott Bradley Mailing Address: 1322 S. Broadway City: La Porte State: TX Zip: 77571 ❑...... B. ASBESTOS ABATEMENT CONTRACTOR #1 DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: _ Zip: Office Phone #: ( ) Job -Site Phone #: ( ) CONTRACTOR COPY ❑...... C. ASBESTOS ABATEMENT CONTRACTOR 02 (Only if there is more than one Contractor) DSHS Asbestos Contractor License #: n/a Contractor Name: Address: _ City: _ State: _ Zip: Office Phone #: ( ) Job -Site Phone #: ( ) D. ASBESTOS SUPERVISOR ❑... ... DSHS Supervisor License #: n/a Site Supervisor: ❑... ... DSHS Supervisor License #: _ Site Supervisor: IF THE APPROVED PLANS ARE MODIFIED, A NEW SUBMITTAL TO THE CITY IS REQUIRED PRIOR TO THE CHANGE OCCURRING. FORM APB #5, REV 5/07 W i Beldw if Amended E. NESHAP TRAINED INDIVIDUAL ❑... ... NESHAP Trained Individual: n/a Certification Date: / / ❑... ... F. DEMOLITION CONTRACTOR Demolition Contractor: City of La Porte - Public Works Department Address: 2963 N. 23 d Street City: La Porte State: TX Zip: 77571 Phone #: (281) 470-5103 ❑... ... G. PROJECT CONSULTANT OR OPERATOR DSHS License No.: n/a Project Consultant or Operator: Address: _ City: _ State: _ Zip: _ Phone #: ( I ❑...... H. Waste Transporter DSHS Waste Transporter License #: n/a Waste Transporter: Address: _ City: _ State: _ Zip: _ Contact Person: Phone #: ( 1 ❑... ... I. Waste Disposal Site TCEQ Permit #: n/a Waste Disposal Site: Address: _ City: _ State: _ Zip: Phone #: ( 1 CONTRACTOR COPY CERTIFICATION STATEMENT I hereby declare that I have examined this notification and, to the be my knowledge and belief, all information provided is complete, true, and correct. I affirm that I am the owner or, or delegated agent and that I am responsible for the fee associateo with this notification. so understan t the owner, operator, or delegated agent is responsible for notification to the ent. / l ;Signature of Owner, Operator or Delf6ated Agent) E-mail Address: brad levsQlanortetz.eov Phone #: (281) 204-5293 IMPORTANT INFORMATION Date: 04/12/13 IF THE APPROVED PLANS ARE MODIFIED, A NEW SUBMITTAL TO THE CITY IS REQUIRED PRIOR TO THE CHANGE OCCURRING. NOTIFICATION TIMELINESS REQUIREMENT: Your Asbestos/Demolition Notification form must be postmarked no less than ten working days (not calendar days) prior to the start of any asbestos abatement or demolition. FILING FEE: An invoice will be mailed to the facility owner upon completion of the project. CALL FOR ASSISTANCE: (512) 834-6747 or (888) 778-9440 (toll free in Texas) MAIL FORM TO: ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP TEXAS DEPARTMENT OF STATE HEALTH SERVICES PO BOX 143538 AUSTIN, TX 78714-3538 FORM APB #5, REV 5/07 I LOFLIN ENVIRONMENTAL SERVICES, INC. April 10, 2013 City of La Porte 604 West Fairmont Parkway La Porte, Texas 77571 Subject: Report of Limited Asbestos Survey 1010 North Bayshore Drive — La Porte, Texas Loftin Environmental Services, Inc.; Project No. 646-13-02 Dear Gentlemen, A limited asbestos survey was performed on April 9, 2013 at the above referenced facility in La Porte, Texas. The purpose of this work was to identify the presence and quantity of asbestos containing materials associated with the structure, and assess those materials that may be disturbed by building demolition. Visual observation of the structure revealed only CMU walls, foam pipe insulation, and a concrete slab. It was determined that there were no materials associated with the building. that were suspected of containing asbestos, therefore no bulk samples were collected. Loftin Environmental Services, Inc. appreciates this opportunity to provide these testing services. If you have any questions concerning this report or the work performed please contact us. Sincerely, Loftin Environmental Service, Inc. Joshua M. Songster Texas DSHS Inspector 9602374 CONTRACTOR COPY 2020 Montrose • Houston, Texas 77006 • (713)521-3300 • FAX (713)523-0829 IF THE APPROVED PLANS ARE MODIFIED, A NEW SUBMITTAL TO THE CITY IS REQUIRED PRIOR TO THE CHANGE OCCURRING. i Menager, Dwayne From: Bradley, Scott Sent: Tuesday, April 16, 2013 11:46 AM To: Menager, Dwayne Cc: Huber, Mark Subject RE: 1010 N Bayshore Asbestos Report See belowllll From: Menager, Dwayne Sent: Tuesday, April 16, 2013 11:39 AM To: Bradley, Scott Cc: Huber, Mark Subject: RE: 1010 N Bayshore Asbestos Report Yes! • We are 1 day short on the notification. I am working on the amendment the earliest start date will be the Friday 04/26 ,— OK — not a problem! • Do we need to add an extra day at the end? Due we need to add an extra day? New completion date would be Wednesday 05/O1? Extra Day may be a good idea. • Also will the demolition be by Heavy equipment? What type equipment? Or by hand? Heavy Equipment' • I will need to have you sign the amended form after changes are made and get it mailed today I leave at 31at today for a doctor's appt. Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Tuesday, April 16, 2013 9:47 AM To: Menager, Dwayne Subject: RE: 1010 N Bayshore Asbestos Report Did you get a call from the lady from the State? From: Menager, Dwayne Sent: Friday, April 12, 2013 11:46 AM To: Bradley, Scott Cc: Clark, James; Huber, Mark; Mick, David Subject: RE: 1010 N Bayshore Asbestos Report Scott, We will call you when the demo permit is ready to be picked up. We will be mailing the 10 day state notification today with the start date of Thursday 04/25 Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Thursday, April 11, 2013 10:50 AM To: Menager, Dwayne; isonaster(ulloflinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie; Mick, David Subject: RE: 1010 N Bayshore Asbestos Report Dwayne, I will be the primary contact for this project since it is a Parks Building. Scott Bradley Parks Superintendent 281-204-5293 cell 1322 S. Broadway La Porte, TX 77571 Thanks in advance! From: Menager, Dwayne Sent: Thursday, April 11, 2013 10:16 AM To: Bradley, Scott; isongster(olloflinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie Subject: RE: 1010 N Bayshore Asbestos Report Scott, We will need some information to complete and mail the 10 Day notification to the State. • Loflin Environmental Services DSHS Laboratory License # 646 1 0 • The primary contact person's name, title & phone #. (On the airport hanger demo David Mick was the primary contact, will this still be the primary contact?) See ab e r • What will be the start date and end date? Start -Thursday 04/25/2013 End Tuesday April 30, 2013 • What days of the week? Thurso da—y, F d Monday, Tuesday, • What hours will the work be performed? 7 a.m. to 5 p.m r • Total square feet of the structure to be demolished? If we can complete the 10 day notification today and David Mick is able to sign it we can get it mailed / post marked tomorrow 4/12/13 the earliest start date would be Monday 04/24/13) Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Thursday, April 11, 2013 7:48 AM To: Joshua Songster Cc: Menager, Dwayne; Clark, James Subject: RE: 1010 N Bayshore Asbestos Report Thanks Josh. Dwayne, Please let me know what step needs to be completed next in regards to this project. I have copied James Clark on this as his crew will be doing the work assisted by Parks if needed. Scott From: Joshua Songster fmaiIto:jongsterCalloflinenvironmental.com1 Sent: Wednesday, April 10, 2013 2:52 PM To: Bradley, Scott Cc: Menager, Dwayne Subject: 1010 N Bayshore Asbestos Report Menager, Dwayne From: Menager, Dwayne Sent: Tuesday, April 16, 2013 2:02 PM To: Bradley, Scott Cc: Huber, Mark Subject: RE: 1010 N Bayshore Asbestos Report Attachments: Ammendment 10 Day Notification.pdf See the attached 10 day notification amendment reflecting the new start and completion dates. Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Tuesday, April 16, 2013 11:55 AM To: Menager, Dwayne Cc: Huber, Mark Subject: RE: 1010 N Bayshore Asbestos Report I sure willl II From: Menager, Dwayne Sent: Tuesday, April 16, 2013 11:47 AM To: Bradley, Scott Cc: Huber, Mark Subject: RE: 1010 N Bayshore Asbestos Report If you can come by on your way out to sign the form that would be greatl From: Bradley, Scott Sent: Tuesday, April 16, 2013 11:46 AM To: Menager, Dwayne Cc: Huber, Mark Subject: RE: 1010 N Bayshore Asbestos Report See below I I! I From: Menager, Dwayne Sent: Tuesday, April 16, 2013 11:39 AM To: Bradley, Scott Cc: Huber, Mark Subject: RE: 1010 N Bayshore Asbestos Report Yesl • We are 1 day short on the noc rication. I am working on the amendment the earliest start date will be the Friday 04/26; OK — notaproblem! • Do we need to add an extra day at the end? Due we need to add an extra day? New completion date would be Wednesday 05/01? Extra Day may be a good idea. • Also will the demolition be by Heavy equipment? What type equipment? Or by hand? Heavy Em t • 1 will need to have you sign the amended form after changes are made and get it mailed today L I leave at 1:30 today for a doctor's appt. Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Tuesday, April 16, 2013 9:47 AM To: Menager, Dwayne Subject: RE: 1010 N Bayshore Asbestos Report Did you get a call from the lady from the State? From: Menager, Dwayne Sent: Friday, April 12, 2013 11:46 AM To: Bradley, Scott Cc: Clark, James; Huber, Mark; Mick, David Subject: RE: 1010 N Bayshore Asbestos Report Scott, We will call you when the demo permit is ready to be picked up. We will be mailing the 10 day state notification today with the start date of Thursday 04/25 . Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Thursday, April 11, 2013 10:50 AM To: Menager, Dwayne; isonasterCNoflinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie; Mick, David Subject: RE: 1010 N Bayshore Asbestos Report Dwayne, I will be the primary contact for this project since it is a Parks Building. Scott Bradley Parks Superintendent 281-204-5293 cell 1322 S. Broadway La Porte, TX 77571 Thanks in advancel From: Menager, Dwayne Sent: Thursday, April 11, 2013 10:16 AM To: Bradley, Scott; iongster(@Ioflinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie Subject: RE: 1010 N Bayshore Asbestos Report Scott, We will need some information to complete and mail the 10 Day notification to the State. • Loflin Environmental Services DSHS Laboratory License # 646 1 • The primary contact person's name, title & phone #. (On the airport hanger demo David Mick was the primary contact, will this still be the primary contactee abo e • What will be the start date and end date? Start -Thursday 04/25/2013 End Tuesday April 30, 2013 • What days of the week? Thursday, Friday— Monday, r • What hours will the work be performed? 17 a.m. to 5 • Total square feet of the structure to be demolished? If we can complete the 10 day notification today and David Mick is able to sign it we can get it mailed / post marked tomorrow 4/12/13 the earliest start date would be Monday 04/24/13) Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Thursday, April 11, 2013 7:48 AM To: Joshua Songster Cc: Menager, Dwayne; Clark, James Subject: RE: 1010 N Bayshore Asbestos Report Thanks Josh. Dwayne, Please let me know what step needs to be completed next in regards to this project. I have copied James Clark on this as his crew will be doing the work assisted by Parks if needed. Scott From: Joshua Songster rmailto:iongster@)Ioflinenvironmental.coml Sent: Wednesday, April 10, 2013 2:52 PM To: Bradley, Scott Cc: Menager, Dwayne Subject: 1010 N Bayshore Asbestos Report Menager, Dwayne From: Bradley, Scott Sent: Friday, April 12, 2013 8:55 AM To: Menager, Dwayne Subject: RE: 1010 N Bayshore Asbestos Report Already done From: Menager, Dwayne Sent: Friday, April 12, 2013 8:41 AM To: Bradley, Scott Subject: RE: 1010 N Bayshore Asbestos Report Are there anti; utilities to the structure gas or electric that we need to request disconnects for? Dwayne From: Bradley, Scott Sent: Friday, April 12, 2013 7:42 AM To: Menager, Dwayne Subject: RE: 1010 N Bayshore Asbestos Report I am on the wayl From: Menager, Dwayne Sent: Friday, April 12, 2013 7:12 AM To: Bradley, Scott Subject: RE: 1010 N Bayshore Asbestos Report Scott, I have the notification form ready for your signature, If you can come this morning and sign it that would be great! Thanks, Dwayne From: Bradley, Scott Sent: Thursday, April 11, 2013 10:53 AM To: Menager, Dwayne; jsongsterCalloflinenvironmental.com Subject: RE: 1010 N Bayshore Asbestos Report Josh, Please verify this # - I may have sent a number from an old project. Thanksl Scott From: Menager, Dwayne Sent: Thursday, April 11, 2013 10:16 AM To: Bradley, Scott; iongsterCalloFlinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie Subject: RE: 1010 N Bayshore Asbestos Report Scott, We will need some information to complete and mail the 10 Day notification to the State. • Loflin Environmental Services DSHS Laboratory. License #, • The primary contact person's name, title & phone q. (On the airport hanger demo David Mick was the primary contact, will this still be the primary contact?) • What will be the start date and end date? • What days of the week? • What hours will the work be performed? • Total square feet of the structure to be demolished? If we can complete the 10 day notification today and David Mick is able to sign it we can get it mailed / post marked tomorrow 4/12/13 the earliest start date would be Monday 04/24/13) Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Thursday, April 11, 2013 7:48 AM To: Joshua Songster Cc: Menager, Dwayne; Clark, James Subject: RE: 1010 N Bayshore Asbestos Report Thanks Josh. Dwayne, Please let me know what step needs to be completed next in regards to this project. I have copied James Clark on this as his crew will be doing the work assisted by Parks if needed. Scott From: Joshua Songster[mailto:Songster(a)loFlinenvironmental.com1 Sent: Wednesday, April 10, 2013 2:52 PM To: Bradley, Scott Cc: Menager, Dwayne Subject: 1010 N Bayshore Asbestos Report e Pf Ct�s ,`i�tt /I� 4Mtir� �ycr� April 12'h 2013 Reliant Energy/Houston Lighting & Power Customer Service via e-mail: servicepermit@centerpointenergy.com RE: Utility Disconnects Dear Sirs, The City has scheduled the demolition of a City owned cture. We would appreciate your prompt assistance in the removal of electrical ers/drops prior to the demolition equipment arriving at the locations on 04/25/2013 #1) 1010 BAYSHORE DR. Please confirm receipt of this have any questions, please ce 5070. `Respectfully, Dwayne e ger Chief Ins p for City of Porte Insoe tons Division ;st and confirmation of the completed work. If you Mark Huber at #281-470-5067 or me at #281-470- Enroreement\Dengerous Building\HLP Disconnect Ltr.doe Sc 9 Fc �tiK eft �C t` oy er'' April 12, 2013 Centerpoint Energy Via e-mail: servicepermit@centerpointenergy.com RE: Utility Disconnects Dear Sirs, The City has scheduled the demolition of a City owned your prompt assistance in the removal of removal/disco to the demolition equipment arriving at the location. #1) 1010 BAYSHORE DR. Please confirm receipt of this request have any questions, please contact Di 470-5066. Thank you. Respectfully, 7Y? Dwayne Menager Chief Inspector City of La Porte Inspections D. isiol . We would appreciate of gas meters/risers prior infirmation of the completed work. If you Menager at 4281-470-5070 or me at #281- Menager, Dwayne From: Bradley, Scott Sent: Thursday, April 11, 2013 10:50 AM To: Menager, Dwayne;jsongster@loflinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie; Mick, David Subject: RE: 1010 N Bayshore Asbestos Report Dwayne, I will be the primary contact for this project since it is a Parks Building. Scott Bradley Parks Superintendent 281-204-5293 cell 1322 S. Broadway La Porte, TX 77571 Thanks in advance From: Menager, Dwayne Sent: Thursday, April 11, 2013 10:16 AM To: Bradley, Scott; jsongsterCalloflinenvironmental.com Cc: Clark, James; Huber, Mark; Wilmore, Debbie Subject: RE: 1010 N Bayshore Asbestos Report Scott, We will need some information to complete and mail the 10 Day notification to the State. • Loflin Environmental Services DSHS Laboratory License # 646 1 • The primary contact person's name, title & phone #. (On the airport hanger demo David Mick was the primary contact, will this still be the primary contact?) See ab e • What will be the start date and end date? Start -Thursday ti • What days of the week? Thursday, Friday^Monday, Tues • What hours will the work be performed? 7 a.m. to 5 p.m r • Total square feet of the structure to be demolished? 100C If we can complete the 30 day notification today and David Mick is able to sign it we can get it mailed / post marked tomorrow 4/12/13 the earliest start date would be Monday 04/24/13) Dwayne Menager Chief Inspector Inspections Division 281-470-5070 From: Bradley, Scott Sent: Thursday, April 11, 2013 7:48 AM To: Joshua Songster ' Cc: Menager, Dwayne; Clark, James Subject: RE: 1010 N Bayshore Asbestos Report Thanks Josh. Dwayne, Please let me know what step needs to be completed next in regards to this project. I have copied James Clark on this as his crew will be doing the work assisted by Parks if needed. Scott From: Joshua Songster[mailto•isonaster(&IoFlinenvironmental.com1 Sent: Wednesday, April 10, 2013 2:52 PM To: Bradley, Scott Cc: Menager, Dwayne Subject: 1010 N Bayshore Asbestos Report Wilmore, Debbie From: Wilmore, Debbie Sent: Wednesday, April 10, 2013 2:27 PM To: James Murray Cc: Bradley, Scott; Tietjens, Tim; Barr, Stephen; Menager, Dwayne; Huber, Mark; Wilmore, Debbie Subject: FW: Asb. Survey - City structure @ 1010 N. Bayshore Or Jim, It is my understanding your company has completed the survey of the 1010 N. Bayshore Dr. property. The findings report/letter and the invoice should be e-mailed to Mr. Bradley at the City's Parks Dept. (bradlevsPlaportetx.aov ). We would appreciate Dwayne Menager (menagerd(dlaportetx.Rov) being copied as well. Mr. Bradley and Mr. Menager will utilize the report as part of the ongoing permit/demolition process. Thank you for your help. Respectfully, Debbie Debbie S. Wilmore, CBO, HCO Chief Building Official 604 W. Fairmont Pkwy. LaPorte, Tx 77571 #281-470-5066 From: Wilmore, Debbie Sent: Friday, April 05, 2013 9:05 AM To: James Murray Cc: Tiet]ens, Tim; Barr, Stephen; Menager, Dwayne; Huber, Mark; Bradley, Scott; Weber, Eddie; Wilmore, Debbie Subject: Asb. Survey - City structure @ 1010 N. Bayshore Dr Jim, Thanks for confirming if the State requires the survey. Ed Weber will await a phone call early next week. I want to inform you my retirement date is next Thursday, 04/11f°. 1 appreciate your patience with my questions and all the guidance/knowledge you have shared thru the years. It's been a pleasure working with you. Have a great weekend! Debbie From: James Murray rmailto:imurray(alloflinenvironmental.com] Sent: Friday, April 05, 2013 8:17 AM To: Wilmore, Debbie Subject: Re: Asbestos Survey - City structure Debbie, You are correct. Survey needed. We can get to early next week. Jim On Apr 4, 2013, at 10:26 AM, Wilmore, Debbie wrote: Good morning Jim & Joe, I was advised you were both out of the office; however, they thought the work schedule would allow your company to perform an asbestos survey about the middle of next week. The City has a structure located at 1010 N. Bayshore Dr. (Klein Retreat) — it is a concrete block wall restroom building with minimal plumbing and electrical. City contact to get into the building will be Ed Weber — Cell #281-204-5343. Since it is non-residential & owned by the City, I believe the State requires a survey, abatement (if applicable) & the 10- day State start notice rp E to demolition. Is this correct or is there any exception? If required, our Division will handle the notification, etc. Please advise if the survey is needed and if it is, what day it could be done. We would need a letter of findings and the invoice would be paid thru our Parks Department. As always, we appreciate your assistance. Thank you, Debbie Debbie S. Wilmore, CBO, HCO Chief Building Official 604 W. Fairmont Pkwy. LaPorte, Tx 77571 N281-470-5066 Wilmore, Debbie From: Bradley, Scott Sent: Wednesday, April 03, 2013 8:42 AM To: Wilmore, Debbie Cc: Tietjens, Tim; Barr, Stephen Subject: RE: Klein OK — Ed Weber will be the contact for Parks — his cell p is 281-204-5343. The address is 1010 N. Bayshore Dr. Thanks! Scott — 18/— From: Wilmore, Debbie Sent: Wednesday, April 03, 2013 8:24 AM To: Bradley, Scott Cc: Tietjens, Tim; Barr, Stephen; Wilmore, Debbie Subject: RE: Klein Scott, Thanks for the well wishes! On Klein — when Tim & I spoke w/Stephen by phone on 03/26 °, he was going to e-mail me the Klein address & Parks contact name/#. I need that to get the ball rolling. Can you provide? Thanks, Debbie From: Bradley, Scott Sent: Wednesday, April 03, 2013 7:16 AM To: Wilmore, Debbie Cc: Barr, Stephen Subject: Klein Debbie, Congrats on your retirementl Hope you and Don are able to do some travelling and enjoy life! One last work question? What is the status of the asbestos survey of Klein Retreat restroom building? We are ready to demolish but know we need that completed first. Thanksl Scott Wilmore, Debbie From: Tietjens, Tim Sent: Tuesday, March 26, 2013 3:57 PM To: Alexander, Corby; Leach, Traci Cc: Barr, Stephen; Wilmore, Debbie Subject: RE: Neighborhood Centers Restroom Building Yes we do. Debbie will conduct the asbestos survey and do the subsequent state notification when she knows the demo dates (to be included in the report). Tim From: Alexander, Corby Sent: Tuesday, March 26, 2013 11:13 AM To: Leach, Traci Cc: Tietjens, Tim Subject: RE: Neighborhood Centers Restroom Building Would we not require an asbestos study for any demolition? Corby D. Alexander City Manager, La Porte, Texas 604 West Fairmont Parkway La Porte, Texas 77571 Phone: 281-470-S011 Fax:281-842-1259 From: Leach, Traci Sent: Tuesday, March 26, 2013 11:09 AM To: Alexander, Corby Subject: FW: Neighborhood Centers Restroom Building FYI... regarding the defunct restroom facility at Klein retreat that has been a crime problem.... From: Barr, Stephen Sent: Tuesday, March 26, 2013 10:58 AM To: Mick, David Cc: Leach, Traci; Bradley, Scott; Rigby, Marlene; Tiegens, Tim Subject: Neighborhood Centers Restroom Building Hello all, Pursuant to my conversation with Traci, I met with Dave on site at the Klein/Neighborhood Centers property to inspect the restroom building. Dave concurred that the CMU walls and interior fixtures would not be an issue for them to demolish. We discussed leaving the galvanized steel outer framework and roof intact. Dave will go back and discuss with his staff and develop a timeline for demolition. I spoke with Tim and we would be required to obtain a demolition permit through the Planning Department before proceeding. eim doesn't think his department would require environmental or asbestos sLwey since the building is ssentially open air, concrete block construction with stainless and porcelain plumbing fixtures, and minimal electrical components. There are no building materials present that would conceivably contain asbestos or other detrimental components. That being said, Dave will work on his timeline and I will work on preparing documentation for the demolition process. Thanks to all for your help on this. Regards, Stephen 03 -a City of La Porte 604 W Fairmont Pkwy La Porte, Tx 77571 (281)470-5073 INSPECTION LINE:(281) 470-5130 ****BUILDING PERMIT**** ---------------------------------------------------------------------------- Application Number . . . . . 13-00000546 Date 5/02/13 Property Address . . . . . . 1010 N BAYSHORE DR HCAD Number: 040-277-000-0002 Alternate Search Method: Application type description DEMOLITION ACCESSORY Subdivision Name . . . . . . ABST 35 J HUNTER Property Use . . . . . . . . REAL RES SINGLE FAMILY Property Zoning . . . . . . . RES - MID DENSITY Application valuation . . . . 0 ---------------------------------------------------------------------------- Type of Work demo restroom structure ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CITY OF LA PORTE CITY OF LA PORTE PO BOX 1115 604 W FAIRMONT PKWY LA PORTE TX 775721115 LA PORTE TX 77571 (281) 470-5000 ---------------------------------------------------------------------------- Permit . . . . . . BLDG PERMIT -DEMOLITION Additional desc . . DEMO RESTROOM STRUCTURE -CITY J Permit pin number . 431288 Permit Fee . . . . .00 Plan Check Fee ., .00 Issue Date . . . . 5/02/13 Valuation . . . . 0 Expiration Date 7/01/13 ---------------------------------------------------------------------------- Special Notes and Comments 1. LOFLIN ENVIRONMENTAL SERVICES INC ASBESTOS SURVEY DATED 4/10/13 IDENTIFIED NO SUSPECT ASBESTOS CONTAINING MATERIALS. (ACM) 2. PUBLIC WORKS CREW TO PERFORM DEMOLITION OF 1000 SQ FT CMU BLOCK RESTROOM BLDG AND REMOVE ALL DEBRIS/MATERIALS 3. ADD FILL AS NEEDED, PROPERTY TO BE LEFT INLEVEL, MOWABLE CONDITION. 4. DEMOLITION SUPERVISOR IS RESPONSIBLE FOR ENSURING COMPLIANCE WITH APPLICABLE ASBESTOS RULES/REGULATIONS FOR ANY UNEXPECTED ACM FOUND DURING DEMOLITION 5. ONCE DEMO AND CLEAN UP IS COMPLETE, CALL FOR CITY FINAL INSPECTION - 281-470-5130 - FOR CLOSURE OF DEMOLTION PERMIT. 6. DEMOLITION START DATE 4/25/13 - END DATE 4/30/13 PA wct_� av-91' 0 City of La Porte 604 W Fairmont Pkwy La Porte, Tx 77571 (281)470-5073 INSPECTION LINE:(281) 470-5130 ****BUILDING PERMIT**** ---------------------------------------------------------------------------- Page 2 Application Number . . . . . 13-00000546 Date 5/02/13 ---------------------------------------------------------------------------- Special Notes and Comments FEE WAIVED FOR CITY PROJECT ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- Permit Fee Total .00 .00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total .00 .00 .00 .00 (SIGNATURE OF CONTRACTOR OR AUU/HORIIIZ]kD AGENT) DATE (APPROVED (APPROVED BY BUILDING OFFICIAL OR AUTHORIZED 'AGENT) SDATE� **NOTE: ON "NON-RESIDENTIAL"BUILDINGS, MUNICIPALITIES VERIFYANASBESTOS SURVEY BE PROVIDED WITH THE PERMIT APPLICATION. SG�I l Iy/ftl�ciLe For City Use 01 iof Project Address: ` IOLITION PERIVIIT APPLICATI( City of La Porte 281-470-5073 /0/J QAyS//or�_ /)a Subdivision: _ 4_ •Q,,j Owner's Name: C l �aPM L411zlt3 -(--7Es7ta b ll is_�hedI1892 / 1ie9 cv .A 3-5 s Hu,s 7 1L r Ln P4zTC ae/- L/7'D -siJ3 _F- Sc_ai i ulindLe. Y Address: P•y �.�x l�/ S— L A f or i 7 7 S7 z Street City Zip Contractor:/ of L� P.ar rz li.�(�11C waf 1` Phone: -11-1- `( 7`4 Address: -2 YL 3 of . i 3 ry J S',- L n P.r r- 7 7 -5.7 I Street City Zip Contractor Email address: Fax: -Contact Person:Seoi i /,5RA-J4e 16/- 3a4- SL. 3 Describe Work: Demolition of building (s) RESIDENTIAL "* ON -RESIDENTIAL ASYCV 509 (EFF. 01-01-02) TED. COPY OFASBESTOS SURVEYMUST l a. Last use of Building t `es' R e Use Zone A - a- Flood Zone A - F� Received Asbestos Survey (if applicable): (D or N or N/A Checked/Approved for Issuance By: ) . /✓I. Date) /Z// 3 CE: N (If CE related, add additional comment that requires specific compliance period from permit issuance) J 04 SgecialCon_ditions ©.La FL•^t F^Iv]Roar9E I;AL Sytces 1�c /1r�;as S r� . Jqr L L 3 Ji._Nc-�u3'-E c"i /1 ]'6�Si �3 C:...s :'.nt.��rtc /✓IA YER)nLS CALM). G.'rl �.N 1. NN. .W ✓ V'r,nAL•.1 o+ ff ry to o: 1s Kgypaa rr zl, #,! W3..rca [%L!.'NAc4 w i i k RPPLIC,\0L- Ex HCAD Permit No. I ✓ PermitFeE N� j"Erz WA'v.-S C 'y f2osccr S:\City Planning Share\04-INSPECTIONS DMSIONUnspections\Demo P p .doc Rev. August2012 © apr 12. 20139:00:26 4:.1CDi -- ,—_-- --_— ql5 Property Description Inquiry Location ID: HCAD Number. Alternate Search Method: y Location address: Primary related party VFT:B�IVOT.ug 11 a 14 LC RAHCE W B ABBT 35 J HUNTER 30758 04D-277-000-0002 1010 N BAYSHORE OR CrrY OF LA PORTE CLp I id X Esh C:uC91 4(I(IfP55 ' RCIdIPU Oanp... d ' TEXAS P% Department '' 11 :: State Health Services ervices ice Use Only: Notification #: ASBESTOS/DEMOLITION NOTIFICATION FORM DO NOT wRiTE iN THIS BOX. FOR DEPARTMENT USE ONLY Date received: / / Postmark date: / / Walk-in date: —/—/— TYPE OF NOTIFICATION: (Select one and fill in the requested information) ❑ ORIGINAL ® AMENDMENT No. I ❑ CANCELLATION ❑ EMERGENCY *Was emergency request made to the Regional Office or Environmental Health Notifications Group (EHNG) by phone? ❑Yes ❑No *If yes, the DSHS reference #: and name of the Regional or EHNG representative with whom you spoke? Date: / / Time: _ ❑a.m. ❑p.m. *Describe the reason for Emergency: _ ❑ ORDERED: (For structurally unsound facilities, attach copy of demolition order and Identify Governmental Official) Name: _ Registration No. Title: _ Date of order (MM/DD/YY): / / Date order to begin (MM/DD/YY): M Betow, if Amended AMENDMENTS: You must complete the entire form and mark the appropriate check boxes) along the left-hand side of thisforin to indicate amended information. TYPE OF WORK ❑ Asbestos Abatement ® Demolition ❑ Annual Consolidated O&M ❑ Abatement/Demolition Is this a phased project? ❑ Yes ® No FACILITY INFORMATION 1. Facility Location ❑....... Description or Facility Name: Restroom Building ❑....... Physical Address: 1010 Bayshore Dr. ❑....... County: Harris City: La Porte Zip: 77571 ❑....... Facility Contact: Scott Bradley Phone #: (281) 470-5103 2. Type of Facility (Select one) ® Public ❑ Federal ❑ IndustriaVManufacturing ❑ NESHAP-Only ❑ Public School K-12 3. Facility Details ❑...... Description of Area/Room Number: _ ❑...... Age of Building: _ Size: 1,000 Sci ft Number of Floors: 1 ❑...... Is this building occupied? ❑ Yes ® No ❑...... Prior Use: Restroom Facility ❑...... Future Use: N/A ❑...... Date of Asbestos Survey/NESHAP Inspection: 04/09/13 ❑...... DSHS Inspector License #: 602374 ❑...... Analytical Method: ❑ PLM ❑ TEM ❑ Assumed Asbestos ® No Suspect Material ❑...... DSHS Laboratory License #: 30-0031 WORK SCHEDULE/ASBESTOS AMOUNTS (Note.. Ythe start dxets) entered below cannot be ma the DSHS Regional or Local Program office must be nodfled prior to the scheduled start date Failure to do so Is a violation of TAMPA Section 295.61.) 1. Asbestos Abatement Work Schedule: ❑...... Start date: / / and End date: / / ❑...... Work days: ❑Mon. ❑Tues. ❑Wed. ❑Thurs. ❑Fri. ❑Sat. ❑...... Working hours: _ ❑ a.m. ❑ p.m. to _ ❑a.m. [-]p.m. 2. Demolition Work Schedule: ®...... Start date: 04/26/13 and End date: 05/01/13 ®...... Work days: ®Mon. ®Tues. ®Wed. ❑Thurs. ®Fri. [-]Sat. ❑...... Working hours: 7:00 ® a.m. ❑ p.m. to 5:00 ❑a.m. ®p.m. *Sun. E J ■ COPY ' FORM APB #5, REV 5/07 (XA ,'Below if Amended C. ASBESTOS AMOUNTS ❑... ... Is Asbestos Present? ❑ Yes ® No (Complete the table below if asbestos Is present) Asbestos -Containing Building Material Type Approximate amount of Asbestos *Only mark the boxes below on this chart tjthey are being amended Pipes Ln Ft Ln M Surface Area SQ Ft SQ M Cu Ft ❑RACM to be removed ❑RACM left in place during demolition El ❑Interior Category I non -friable removed ❑ El ❑ Exterior Category I non -friable removed ❑ El Ca o I non -friable left in place during demolition ❑ ❑ Interior Category II non -friable removed El Exterior Category II non -friable removed El Cat o II non -friable left in place during demolition ❑RACM Off -Facility Component DESCRIPTION OF WORK PRACTICES AND PROCEDURES ...... 1. Description of procedures to be followed in the event that unexpected asbestos is found or previously non -friable asbestos material becomes crumbled, pulverized, or reduced to powder: Survey found no ACM; stop work & contact DSHS ®...... 2. Description of planned demolition or abatement work, type of material, and method(s) to be used: Heavy Equipment BackHoe ❑....... 3. Description of work practices and engineering controls to be used to prevent emissions of asbestos at the demolition site: Survey found no ACM; wet demolition PROJECT INFORMATION ❑...... A. FACILITY OWNER Facility Owner Name: City of La Porte Phone #: (281) 204-5293 Attention: Scott Bradley Mailing Address: 1322 S. Broadway City: La Porte State: TX Zip: 77571 ❑... ... B. ASBESTOS ABATEMENT CONTRACTOR #1 DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: Zip: Office Phone #: ( 1 Job -Site Phone #: ( 1 ...... C. ASBESTOS ABATEMENT CONTRACTOR 92 (Only if there is more than one Contractor) DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: _ Zip: Office Phone #: ( 1 Job -Site Phone #: ( 1 D. ASBESTOS SUPERVISOR ❑... ... DSHS Supervisor License #: n/a Site Supervisor: _ ❑... ... DSHS Supervisor License #: _ Site Supervisor: FORM APB #5, REV 5/07 W Below if Amended E. NESHAP TRAINED INDIVIDUAL ...... NESHAP NESHAP Trained Individual: n/a Certification Date: / / ❑... ... F. DEMOLITION CONTRACTOR Demolition Contractor: City of La Porte - Public Works Department Address: 2963 N. 23rd Street City: La Porte State: TX Zip: 77571 Phone #: (281) 470-5103 ❑...... G. PROJECT CONSULTANT OR OPERATOR DSHS License No.: n/a Project Consultant or Operator: Address: _ City: _ State: _ Zip: _ Phone #: ( ) ❑... ... H. Waste Transporter DSHS Waste Transporter License #: n/a Waste Transporter: _ Address: _ City: _ State: _ Zip: _ Contact Person: Phone #: ( ) ❑... ... 1. Waste Disposal Site TCEQ Permit #: n/a Waste Disposal Site: Address: _ City: State: _ Zip: Phone _# { ) CERTIFICATION STATEMENT I hereby declare that 1 have examined this notification and, to the best of my knowledge and belief, all information provided is complete, true, and correct. I affirm that I am the owner, operator, or delegated agent and that I am responsible for the fee associated with this notificatiir. I also understand that the owner, operator, or delegated agent is responsible for notification to the depaynnent. l� /)/ / / Date: 04/16/13 or Delegated Agent) Scott Bradley - Parks Superintendent (Printed Name & Title) E-mail Address: brad levs(a)laportetx.eov Phone #: (281) 204-5293 IMPORTANT INFORMATION NOTIFICATION TIMELINESS REQUIREMENT: Your Asbestos/Demolition Notification form must be postmarked no less than ten working days (not calendar days) prior to the start of any asbestos abatement or demolition. FILING FEE: An invoice will be mailed to the facility owner upon completion of the project. CALL FOR ASSISTANCE: (512) 834-6747 or (888) 778-9440 (toll free in Texas) MAIL FORM TO: ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP TEXAS DEPARTMENT OF STATE HEALTH SERVICES PO BOX 143538 AUSTIN, TX 78714-3538 FORM APB #5, REV 5/07 t °TEXAS FaLUse Only: Departmentd Notification#: State Health Services A eRFCTnC/IIF.Mni,TTTnN NOTMICATION FORM DO NOT WRITE IN THIS BOX - Date received:_/_/_ Postmark di TYPE OF NOTIFICATION: (Select one and fill In the reques C)/� � � W O to VN I ❑ ORIGINAL ® AMENDMENT No. 1 ❑ CANCELLATI C� o ❑ EMERGENCY 1� � 0. i *Was emergency request made to the Regional Office or Enviro: G� N ❑Yes ❑No dME Of yes, the DSHS reference #: and name of the Regional i wo r``o ; Date: / / Time: _ ❑a.m. ❑p.m. `` of o ❑ *Describe the reason for Emergency: r c s _ 03tM(1 0 o i ❑ ORDERED: (For structurally unsound facilities, attach copy, Name: _Registration No. _ a Title: _ Date of order (MM/DD/YY): / / Date order to be: i, 'g N v C � (_) AMENDMENTS: You must complete the endre form and mark the appro/ o -E eo Below if indicate amended informationu w oo m Amended TYPE OF WORK !_ � m o v z N . oo ❑ Asbestos Abatement ® Demolition ❑ Annual Consolid o o n Is this a phased project? ❑ Yes ® No = w o - o FACILITY INFORMATION 1. Facility Location a a a ❑....... Description or Facility Name: Restroom Buildin¢ o ❑....... Physical Address: 1010 Bayshore Dr. ❑....... County: Harris City: La Porte Zip: 77571 ❑....... Facility Contact: Scott Bradley Phone #: (281) 470-5103 2. Type of Facility (Select one) ® Public ❑ Federal ❑ lndustria[IManufacturing ❑ NESI- 3. Facility Details ❑...... Description of Area/Room Number: _ ❑...... Age of Building: _ Size: 1,000 Sa ft Number of Floors: 1 ❑...... Is this building occupied? ❑ Yes ® No ❑...... Prior Use: Restroom Facility 3 ❑...... Future Use: N/A d c ❑...... Date of Asbestos Survey/NESHAP Inspection: 04/09/13 0 N ❑...... DSHS Inspector License #: 602374 P. ° x ❑...... Analytical Method: ElPLM ❑ TEM ❑ Assumed Asbesto! M F, ❑...... DSHS Laboratory License #: 30-0031 is. y 5 WORK SCHEDULE/ASBESTOS AMOUNTS (Note: ifthe 0 d' Program office mustust be nohfled prior to the scheduled start data Faiture t, CD (l 0 1. Asbestos Abatement Work Schedule: ❑...... Start date: / / and End date: / / ❑...... Work days: ❑Mon. ❑Tues. ❑Wed. ❑Thurs. ❑Fri. ❑...... Working hours: _ ❑ a.m. ❑ p.m. to _ ❑a.m. [ 2. Demolition Work Schedule: ®...... Start date: 04/26/13 and End date: 05/01/13 ®......Workdays:®Mon. ®Tues. ®Wed. ❑Thurs. ®Fri. ❑...... Working hours: 7:00 ® a.m. ❑ p.m. to 5:00 ❑a.m. ®p.: FORM APB #S, REV 5/07 ��d °TEXAS Department of State Health Services Ftorumb Use Only: Notification #: ASBESTOS/DEMOLITION NOTIFICATION FORM DO NOT WRITE IN THIS BOX- FOR DEPARTMENT USE ONLY Date reccivcd: /_/_ Postmark date:_/_/_ Walk-in date:_/_/_ TYPE OF NOTIFICATION: (Select one and fill In the requested information) ❑ ORIGINAL ® AMENDMENT No. I ❑ CANCELLATION ❑ EMERGENCY *Was emergency request made to the Regional Office or Environmental Health Notifications Group (EHNG) by phone? ❑Yes ❑No •If yes, the DSHS reference #:_ and name of the Regional or EHNG representative with whom you spoke? Date: / / Time: _ ❑a.m. ❑p.m. •Describe the reason for Emergency: _ ❑ ORDERED: (For structurally unsound facllitles, attach copy of demolition order and idenl6 Governmental Official) Name: _ Registration No. W Below If Amended Title: _ Date of order (MMIDD/YY): / / Date order to begin (MM/DD/YY): / / AMENDMENTS: You must complete the entire form and mark ME appropriate check box(a) along the left-hand side of this form to Indicate amended information. TYPE OF WORK ❑ Asbestos Abatement ® Demolition, ❑ Annual Consolidated O&M ❑ Abatement/Demolition Is this a phased project? ❑ Yes ® No FACILITY INFORMATION 1. Facility Location ❑....... Description or Facility Name: Restroom Building ❑....... Physical Address: 1010 Bayshore Dr. ❑....... County: Harris City: La Porte Zip: 77571 ❑....... Facility Contact: Scott Bradley Phone #: (281) 470-5103 2. Type of Facility (Select one) ® Public ❑ Federal ❑ IndustriaVManufacturing ❑ NESHAP-Only ❑ Public School K-12 3. Facility Details ❑...... Description of Area/Room Number: _ ❑...... Age of Building: _ Size: 1,000 Sci ft Number of Floors: 1 ❑...... Is this building occupied? ❑ Yes ® No ❑...... Prior Use: Restroom Facility ❑...... Future Use: N/A ❑...... Date of Asbestos Survey/NESHAP Inspection: 04/09/13 ...:.. DSHS Inspector License#: 602374 ❑...... Analytical Method: ❑ PLM ❑ TEM ❑ Assumed Asbestos ® No Suspect Material ❑...... DSHS Laboratory License #: 30-0031 WORK SCHEDULE/ASBESTOS AMOUNTS (Note: If the start dme(s) entered below cannot beme,the DSHS Regional orLocal Program office must be nodited prior to the scheduled start dare Failure to do so is a violation of TAHPA Section 295.61.) 1. Asbestos Abatement Work Schedule: ❑...... Start date: / / and End date: / / ❑...... Workdays: ❑Mon. ❑Tues. ❑Wed. ❑Thins. ❑Fri. []Sat. ❑Sun. ❑...... Working hours: _ ❑ a.m. ❑ p.m. to _ ❑a.m. ❑p.m. 2. Demolition Work Schedule: 19...... Start date: 04/26/13 and End date: 05/01/13 0...... Work days: ®Mon. ®Tues. ®Wed. ❑Thurs. ®Fri. ❑Sat. []Sun. ❑...... Working hours: 7:00 ® a.m. ❑ p.m. to 5:00 []a.m. ®p.m. FORM APB #5, REV 5/07 if pded C. ASBESTOS AMOUNTS ❑... ... Is Asbestos Present? ❑ Yes ® No (Complete the table below if asbestos is present) Asbestos -Containing Building Material Type Approximate amount of Asbestos *Only mark the boxes below on this chart !f they are being amended Pipes Ln Ft Ln M Surface Area SQ Ft SQ M Cu Ft RACM to be removed RACM left in place during demolition ❑ ❑ Interior Category I non -friable removed ❑El Exterior Category I non -friable removed ❑ El ❑Cate o I non -friable left in place during demolition ❑ ❑ Interior Category H non -friable removed ❑ Exterior Category IT non -friable removed ❑ ❑ Cat o H non -friable left in lace duringdemolition RACM Off-Facili Component DESCRIPTION OF WORK PRACTICES AND PROCEDURES ❑...... 1. Description of procedures to be followed in the event that unexpected asbestos is found or previously non -friable asbestos material becomes crumbled, pulverized, or reduced to powder: Survey found no ACM; stop work & contact DSHS ®...... 2. Description of planned demolition or abatement work, type of material, and method(s) to be used: Heavy Equipment BackHoe ❑....... 3. Description of work practices and engineering controls to be used to prevent emissions of asbestos at the demolition site: Survey found no ACM; wet demolition PROJECT INFORMATION ❑...... A. FACILITY OWNER Facility Owner Name: City of La Porte Phone #: (281) 204-5293 Attention: Scott Bradley Mailing Address: 1322 S. Broadway City: La Porte State: TX Zip: 77571 ❑... ... B. ASBESTOS ABATEMENT CONTRACTOR #1 DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: Zip: Office Phone #: ( 1 - Job -Site Phone #: ( ) ❑... ... C. ASBESTOS ABATEMENT CONTRACTOR #2 (Only if there Is more than one Contractor) DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City:_ State:_ Zip:_ Office Phone #: ( 1 - Job -Site Phone D. ASBESTOS SUPERVISOR ❑... ... DSHS Supervisor License #: n/a Site Supervisor: ❑... ... DSHS Supervisor License #: _ Site Supervisor: FORM APB #5, REV 5/07 It ,�� W'if mended E. NESHAP TRAINED INDIVIDUAL ❑... ... NESHAP Trained Individual: n/a Certification Date: / / ...... F. DEMOLITION CONTRACTOR Demolition Contractor: City of La Porte - Public Works Department Address: 2963 N. 23'' Street City: La Porte State: TX Zip: 77571 Phone #: (281) 470-5103 ❑...... G. PROJECT CONSULTANT OR OPERATOR DSHS License No.: n/a Project Consultant or Operator: Address: _ City: _ State: _ Zip: _ Phone #: ( ) ❑... ... H. Waste Transporter DSHS Waste Transporter License #: n/a Waste Transporter: _ Address: _ City: _ State: _ Zip: Contact Person: Phone #: ( ) ❑... ... I. Waste Disposal Site TCEQ Permit #: n/a Waste Disposal Site: Address: _ City: _ State: _ Zip: Phone #: ( ) CERTIFICATION STATEMENT I hereby declare that I have examined this notification and, to the best of my knowledge and belief, all information provided is complete, true, and correct. I affirm that I am the owner, operator, or delegated agent and that I am responsible for the fee associate{ with this notificati . I Is understand that the owner, operator, or delegated agent is responsible for notification to the deoAnenu /1 / Date: 04/16/13 of Owner, Operator# Delegated Agent) (Printed Name & E-mail Address: brad leysAlaportetx.eov Phone #: (281) 204-5293 IMPORTANT INFORMATION NOTIFICATION TIMELINESS REQUIREMENT: Your Asbestos/Demolition Notification form must be postmarked no less than ten working days (not calendar days) prior to the start of any asbestos abatement or demolition. FILING FEE: An invoice will be mailed to the facility owner upon completion of the project. CALL FOR ASSISTANCE: (512) 834-6747 or (888) 778-9440 (toll free in Texas) MAIL FORM TO: ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP TEXAS DEPARTMENT OF STATE HEALTH SERVICES PO BOX 143538 AUSTIN, TX 78714-3538 FORM APB 45, REV 5/07 TEXAS } Department of Slate Health Services a .Fo . yjt a Use 0^ly�, r i 1 -Notif ASBESTOS/DEMOLITION NOTIFICATION FORM DO NOT WRITE IN THIS BOX- FOR DEPARTMENT USE ONLY Dete'iaeived� - . % ' / • Pds`imark date ... / /'.: . Welk m date. ' . /_P - y TYPE OF NOTIFICATION: (Select one and fill in the requested information) ® ORIGINAL AMENDMENT No. L ❑ CANCELLATION &XK ❑ EMERGENCY *Was emergency request made to the Regional Office or Environmental Health Notifications Group (EHNG) by phone? ❑Yes ❑No *If yes, the DSHS reference #: and name of the Regional or EHNG representative with whom you spoke? Date: / / Time: _ ❑a.m. ❑p.m. *Describe the reason for Emergency: _ ❑ ORDERED: (For structurally unsound facilities, attach copy of demolition order and identify Governmental Official) Name: _ Registration No. Title: _ Date of order (Iv0vI/DD/YY): / / Date order to begin (MM/DD/YY): (11 Below if Amended AMETDMENTS.- You must complete the entire form and mark the appropriate check box(&) along the left-hand side of this form to Indicate amended inrormadon. TYPE OF WORK ❑ Asbestos Abatement ® Demolition ❑ Annual Consolidated O&M ❑ Abatement/Demolition Is this a phased project? ❑ Yes ® No FACILITY INFORMATION 1. Facility Location ❑....... Description or Facility Name: Restroom Building ❑....... Physical Address: 1010 Bayshore Dr. ❑....... County: Harris City: TX Zip: 77571 ❑....... Facility Contact: Scott Bradley Phone #: (281) 470-5103 2. Type of Facility (Select one) ® Public ❑ Federal ❑ Industrial/Manufacturing ❑ NESHAP-Only ❑ Public School K-12 3. Facility Details ❑...... Description of Area/Room Number: _ ❑...... Age of Building: _ Size: 1,000 Sci ft Number of Floors: 1 ❑...... Is this building occupied? ❑ Yes ® No ❑...... Prior Use: Restroom Facility ❑...... Future Use: N/A ❑...... Date of Asbestos Survey/NESHAP Inspection: 04/09/13 ❑...... DSHS Inspector License #: 602374 ❑...... Analytical Method: ❑ PLM ❑ TEM ❑ Assumed Asbestos ® No Suspect Material ❑...... DSHS Laboratory License #: 30-0031 CITY COPY WORK SCHEDULE/ASBESTOS AMOUNTS (Note: if the start dates) entered below cannot be met, the DSHS Regional or Local Program office must be nodfied prior to the scheduled start date. Failure u, do so is a violation of TAHPA Section 295.61.) 1. Asbestos Abatement Work Schedule: ❑2.... Start date: / / and End date: / / ❑...... Workdays: ❑Mon. ❑Tues. ❑Wed. ❑Thurs. ❑Fri. ❑Sat. ❑Sun. ❑...... Working hours: _ ❑ a.m. ❑ p.m. to _ (--]a.m. []p.m. 2. Demolition Work Schedule: �...... Start date: 04/25/13 and' End date: 04/30/13 ❑...... Workdays: ®Mon. ®Tues. ❑Wed. ®Thurs. ®Fri. ❑Sat. ❑Sun. ❑...... Working hours: 7:00 ® a.m. ❑ p.m. to 5:00 ❑a.m. ®p.m. FORM APB #5, REV 5/07 W Below if Amended C. ASBESTOS AMOUNTS ❑... ... Is Asbestos Present? ❑ Yes ® No (Complete the table below if asbestos is present) Asbestos -Containing Building Material Type Approximate amount of Asbestos "Only mark the boxes below on this chart if they are being amended Pipes Ln Ft Ln M Surface Area SQ Ft SQ M Cu Ft LJ RACM to be removed RACM left in place during demolition Interior Category I non -friable removed ~. Exterior Category I non -friable removed Cate o I non -friable left in place during demolition Interior Category H non -friable removed Exterior Category H non -friable removed , `.•.q;? Cate o 11 non -friable left in place during demolition RACM Off -Facility Component DESCRIPTION OF WORK PRACTICES AND PROCEDURES ❑...... 1. Description of procedures to be followed in the event that unexpected asbestos is found or previously non -friable asbestos material becomes crumbled, pulverized, or reduced to powder: Survey found no ACM; stop work & contact DSHS �..... 2. Description of planned demolition or abatement work, type of material, and method(s) to be used: &"U y i,y. 60<4r/A ❑....... 3. Description of work practices and engineering controls to be used to prevent emissions of asbestos at the demolition site: Survey found no ACM; wet demolition PROJECT INFORMATION ❑...... A. FACILITY OWNER a B TY Facility Owner Name: City of La Porte Phone #: (281) 204-5293 �° Attention: Scott Bradley Mailing Address: 1322 S. Broadway City: La Porte State: TX Zip: 77571 ❑... ... B. ASBESTOS ABATEMENT CONTRACTOR #1 DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: Zip: Office Phone #: ( ) Job -Site Phone #: ( ) ❑... ... C. ASBESTOS ABATEMENT CONTRACTOR #2 (Only if there is more than one Contractor) DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: _ Zip: Office Phone #: ( ) Job -Site Phone #: ( ) D. ASBESTOS SUPERVISOR ❑... ... DSHS Supervisor License #: n/a Site Supervisor: ❑... ... DSHS Supervisor License #: _ Site Supervisor: FORM APB #5, REV 5/07 W - Beldw if ' Amended E. NESHAP TRAINED INDIVIDUAL ❑... ... NESHAP Trained Individual: n/a Certification Date: / / ❑... ... F. DEMOLITION CONTRACTOR Demolition Contractor: City of La Porte - Public Works Department Address: 2963 N. 23rd Street City: La Porte State: TX Zip: 77571 Phone #: (281) 470-5103 ❑... ... G. PROJECT CONSULTANT OR OPERATOR DSHS License No.: n/a Project Consultant or Operator: Address: _ City: _ State: _ Zip: _ Phone #: ( 1 ❑... ... A. Waste Transporter DSHS Waste Transporter License #: n/a Waste Transporter: _ Address: _ City: _ State: _ Zip: Contact Person: Phone #: ( ) ❑... ... I. Waste Disposal Site TCEQ Permit #: n/a Waste Disposal Site: Address: _ City: _ State: _ Zip: Phone #: ( ) CERTIFICATION STATEMENT I hereby declare that I have examined this notification and, to the be my knowledge and belief, all information provided is complete, true, and correct. I affirm that I am the owner or, or delegated agent and that I am responsible for the fee associate with this notification. XB(so undetstap t the owner, operator, or delegated agent is responsible for notification to =04/12/13 of Owner, Opera�oH Aaced Agent) Scott Bradley - Parks Superinten&nt �� (Printed Name & Title) E-mail Address: brad levstallaportetx.eov Phone #: (281) 204-5293 cC 0 y IMPORTANT INFORMATION NOTIFICATION TIMELINESS REQUIREMENT: Your Asbestos/Demolition Notification form must be postmarked no less than ten working days (not calendar days) prior to the start of any asbestos abatement or demolition. FILING FEE: An invoice will be mailed to the facility owner upon completion of the project. CALL FOR ASSISTANCE: (512) 834-6747 or (888) 778-9440 (toll free in Texas) MAIL FORM TO: ENVIRONTN ENTAL HEALTH NOTIFICATIONS GROUP TEXAS DEPARTMENT OF STATE HEALTH SERVICES PO BOX 143538 AUSTIN, TX 78714-3538 FORM APB #5, REV 5/07 LOFLIN ENVIRONMENTAL SERVICES, INC. April 10, 2013 City of La Porte 604 West Fairmont Parkway LaPorte, Texas 77571 Subject: Report of Limited Asbestos Survey 1010 North Bayshore Drive — la Porte, Texas Loflin Environmental Services, Inc.; Project No. 646-13-02 Dear Gentlemen, A limited asbestos survey was performed on April 9, 2013 at the above referenced facility in La Porte, Texas. The purpose of this work was to identity the presence and quantity of asbestos containing materials associated with the structure, and assess those materials that may be disturbed by building demolition. Visual observation of the structure revealed only CMU walls, loam pipe insulation, and a concrete slab. It was determined that there were no materials associated with the building that were suspected of containing asbestos, therefore no bulk samples were collected. Loflin Environmental Services, Inc. appreciates this opportunity to provide these testing services. If you have any questions concerning this report or the work performed please contact us. Sincerely, Loflin Environmental Service, Inc. Joshua M. Songster Texas DSHS Inspector #602374 2020 Montrose • Houston, Texas 77006 • (713)521-3300 • FAX (713)523-0829 CITY COPY Menager, Dwayne From: Joshua Songster<jsongster@loflinenvironmental.com> Sent: Wednesday, April 10, 2013 2:52 PM To: Bradley, Scott Cc: Menager, Dwayne Subject: 1010 N Bayshore Asbestos Report Attachments: 646-13-02 Report (no suspects).pdf kHealth Services DO NOT WRITE IN THIS BOX - Date received: / / Postmark & TYPE OF NOTIFICATION: (Select one and fill in the requi ® ORIGINAL ❑ AMENDMENT No. _ ❑ CANCELLt ❑ EMERGENCY *Was emergency request made to the Regional Office or Envin ❑Yes ❑No *If yes, the DSHS reference #:_ and name of the Regional Date: / / Time: _ ❑a.m. ❑p.m. *Describe the reason for Emergency: ❑ ORDERED: (For structurally unsound facilities, attach co Name: _ Registration No. Title: _ Date of order (MM/DD/YY): / / Date order to W Below if Amended AMENDMENTS: You must complete the entire form and mark the ape indicate amended information. TYPE OF WORK ❑ Asbestos Abatement ® Demolition ❑ Annual Consoli Is this a phased project? ❑ Yes ® No FACILITY INFORMATION 1. Facility Location ....... Description Description or Facility Name: Restroom Building ....... Physical Physical Address: 1010 Bayshore Dr. ....... County: County: Harris City: TX Zip: 77571 ....... Facility Facility Contact: Scott Bradley Phone #: (281) 470-5103 F :e Use Only: Notification N: A TTnN FORM r11� tom+ `` too to OJ LL O 0 O.0 31Mn N 00 Q 2. Type of Facility (Select one) ® Public ❑ Federal ❑ Industrial/Manufacturing ❑ NESF 3. Facility Details ❑...... Description of Area/Room Number: _ El ...... Age of Building: _ Size: 1,000 Sa ft Number of Floors: I ❑...... Is this building occupied? E] Yes ®Noin ❑...... Prior Use: Restroom Facility ❑...... Future Use: N/A O o in ...... Date Date of Asbestos S1wey/NESHAP Inspection: 04/09/13 b E x El ...... DSHS Inspector License #: 602374 t G F ...... Analytical Analytical Method: ❑ PLM ❑ TEM ❑ Assumed Asbesti #: 30-0031 O u. 3 0 ❑...... DSHS Laboratory License WORK SCHEDULE/ASBESTOS AMOUNTS (Note•. iltl U C i Program office must he notifiedprior to the scheduled start date Fallure 1. Asbestos Abatement Work Schedule: E] ...... Start date: / / and End date: / / ❑...... Workdays: [-]Mon.❑Tues. ❑Wed. ❑Thurs. ❑Fri. ❑...... Working hours: _ ❑ a.m. ❑ p.m. to _ ❑a.m. [ 2. Demolition Work Schedule: ❑...... Start date: 04/25/13 and End date: 04/30/13 ❑...... Workdays: ®Man. ®Tues. ❑We . ®Thurs. ®Fri. ...... Working Working hours: 7:00 ® a.m. ❑ p.m. to 5:00 ❑a.m. 01 n w 0 V 00 C L Cr) O oo in V x {n v a m o a n Z H X 00 n w c co H x a E O c A E n 0 o Q x FORM APB #5, REV 5/07 ,jUt- Fir f °TEXAS Departmentoi State Health Services F u'r Jfrcl Use Only: otification #: XION FORM DO NOT WRITE IN THIS BOX- FOR DEPARTMENT USE ONLY Date received:_/_/_ Postmark date: / / Walk-in date: —/—/— TYPE OF NOTIFICATION: (Select one and fill In the requested information) ® ORIGINAL ❑ AMENDMENT No._ ❑ CANCELLATION ❑ EMERGENCY • Was emergency request made to the Regional Office or Environmental Health Notifications Group (EHNG) by phone? ❑Yes [:]No elf yes, the DSHS reference #: and name of the Regional or EHNG representative with whom you spoke? Date: / / Time: _ ❑a.m. ❑p.m. •Describe the reason for Emergency: _ ❑ ORDERED: (For structurally unsound faciiilies, attach copy of demolition order and identify Governmental of Name: _ Registration No. Title: _ Date of order (MM/DD/YY): / / Date order to begin (MM/DD/YY): (I) Below if Amended AMENDMENTS: You must complete the entire form and mark the appropriate check box(er) along the left-hand side of this form m indicate amended information. I Ir6 Ur WUKK ❑ Asbestos Abatement ® Demolition ❑ Annual Consolidated O&M ❑ Abatement/Demolition Is this a phased project? ❑ Yes ® No FACILITY INFORMATION 1. Facility Location El ....... Description or Facility Name: Restroom Building El ....... Physical Address: 1010 Bayshore Dr. El ....... County: Harris City: TX Zip: 77571 El ....... Facility Contact: Scott Bradley Phone #: (281) 470-5103 2. Type of Facility (Select one) ® Public ❑ Federal ❑ Industrial/Manufacturing ❑ NESHAP-Only ❑ Public School K-12 3. Facility Details ❑...... Description of Area/Room Number: _ El ...... Age of Building: _ Size: 1,000 Sa ft Number of Floors: I El ...... Is this building occupied? ❑ Yes ® No ❑...... Prior Use: Restroom Facility El ...... Future Use: N/A El ...... Date of Asbestos Survey/NESHAP Inspection: 04/09/13 ❑...... DSHS Inspector License #: 602374 ❑...... Analytical Method: ❑ PLM ❑ TEM ❑ Assumed Asbestos ® No Suspect Material El ...... DSHS Laboratory License #: 30-0031 WORK SCHEDULE/ASBESTOS AMOUNTS (Note.. 1(the start datels) entered below cannot be mel, the DSHS Regional or Local Program o07ce must be notified prior to the scheduled start date Failure to do so is a violation ofTAHPA Section 295.61.) 1. Asbestos Abatement Work Schedule: ❑...... Start date: / / and End date: / / ❑...... Work days: ❑Mon. ❑Tues. ❑We ❑ d. Thurs. []Fri.[—]Sat.❑Sun. ❑...... Working hours: _ ❑ a.m. ❑ p.m, to _ ❑a.m. []p.m. 2. Demolition Work Schedule: ❑...... Start date: 04/25/13 and End date: 04/30/13 ❑...... Work days: ®Mon. ®Tues. ❑Wed. ®Thurs. ®Fri. ❑Sat. ❑Sun.❑...... Working hours:7:00 ®a.m: p.m. to 5:00 ❑a.m. ®p.m. FORM APB #5, REV.5/07 .dw if emended C. ASBESTOS AMOUNTS ❑...... Is Asbestos Present? ❑ Yes ® No (Complete the table below ljasbestos is present) Asbestos -Containing Building Material Type "Only mark the boxes below on this chart if they are being amendedSQ Ft SQ M Cu Ft RACM to be removed Tj ❑_71RACM left in lace durin demolition Interior Ca o I non-friableremoved Exterior Cate o I non -friable removed ❑ Cate o I non -friable left in lace duringdemolition Ej Interior Ca o H non -friable removed ❑ Exterior Category H non -friable removed ❑ Category II non -friable left in place during demolition RACM Off -Facility Component DESCRIPTION OF WORK PRACTICES AND PROCEDURES ❑...... 1. Description of procedures to be followed in the event that unexpected asbestos is found or.previously non-friabib asbestos material becomes crumbled, pulverized, or reduced to powder: Survey found no ACM: stop work & contact DSHS ❑...... 2. Description of planned demolition or abatement work, type of material, and method(s) to be used: ❑....... 3. Description of work practices and engineering controls to be used to prevent emissions of asbestos at the demolition site: Survey found no ACM: wet demolition PROJECT INFORMATION ❑... ... A. FACILITY OWNER Facility Owner Name: City of La Porte Phone #: (281) 204-5293 Attention: Scott Bradley Mailing Address: 1322 S. Broadway City: La Porte State: TX Zip: 77571 ❑...... B. ASBESTOS ABATEMENT CONTRACTOR #1 DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: Zip: Office Phone #: ( ) - Job -Site Phone #: ( ) ❑... ... C. ASBESTOS ABATEMENT CONTRACTOR #2 (Only ijthere Is more than one Contractor) DSHS Asbestos Contractor License #: n/a Contractor Name: _ Address: _ City: _ State: _ Zip: Office Phone #: ( ) Job -Site Phone #: ( 1 D. ASBESTOS SUPERVISOR ❑... ... DSHS Supervisor License #: n/a Site Supervisor: _ ❑... ... DSHS Supervisor License #: _ Site Supervisor: FORM APB #5, REV 5/07 Amended E. NESHAP TRAINED INDIVIDf,: , ❑...... NESHAP Trained Individual: n/a Certification Date: / / El ...... F. DEMOLITION CONTRACTOR Demolition Contractor. City of La Porte - Public Works Department Address: 2963 N. 23ra Street City: La Porte State: TX Zip: 77571 Phone #: (281) 470-5103 ❑... ... G. PROJECT CONSULTANT OR OPERATOR DSHS License No.: n/a Project Consultant or Operator: Address: _ City: _ State: _ Zip: _ Phone #: ( ) ❑... ... H. Waste Transporter DSHS Waste Transporter License #: n/a Waste Transporter: Address: _ City: _ State: _ Zip: Contact Person: _Phone #: ( ) ❑... ... 1. Waste Disposal Site TCEQ Permit #: n/a Waste Disposal Site: Address: _ City: _ State:_ Zip: Phone #: ( ) CERTIFICATION STATEMENT I hereby declare that I have examined this notification and, to the be -my knowledge and belief, all information provided is complete, true, and correct. I affirm that I am the owne�,ype or, or delegated agent and that I am responsible for the fee associate) with this notification. A-Mso understand ehlrttiP owner t d the of Owner, Operator or Deflated Agent) Name opera or, or elegated agent is responsible for notification to E-mail Address: brad levsAlaportetx. ov Phone #: (281) 204-5293 IlWPORTANT INFORMATION Date: 04/12/13 NOTIFICATION TIMELINESS REQUEREMENT: Your Asbestos/Demolition Notification form must be postmarked no less than ten working days (not calendar days) prior to the start of any asbestos abatement or demolition. FELING FEE: An invoice will be mailed to the facility owner upon completion of the project. CALL FOR ASSISTANCE: (512) 834-6747 or (888) 778-9440 (toll free in Texas) MAIL FORM TO: ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP TEXAS DEPARTMENT OF STATE HEALTH SERVICES PO BOX 143538 AUSTIN, TX 78714-3538 FORM APB #5, REV 5/07 Print Details Page 1 of 1 HARRIS COUNTY APPRAISAL DISTRICT Tax Year: 2013 REAL PROPERTY ACCOUNT INFORMATION 0402770000002 Owner and Property Information Owner Name & CITY OF LA PORTE Legal Description: TRS 3 3A 4 THRU B 9A 9B 10 Mailing Address: PO BOX 1115 11 & 14 LA PORTE TX 77572-1115 LOWRANCE W B ABST 35 J HUNTER Property Address: 1010 BAYSHORE DR LA PORTE TX 77571 State Class Code Land Use Code Building Class Total Units XV -- Other Exempt (Government) 4600 -- Vacant Exempt Land E 0 Land Area Building Area Net Rentable Area Neighborhood 1 Market Area Map Facet Key Map® 160,519 SF 0 0 1 2164.03 1 4027-- Pasadena I 6253B 580C Value Status Information Capped Account Value Status Shared CAD Pending All Values Pending No Exemptions and Jurisdictions Exemption Type Districts Jurisdictions AIRS Status 2012 Rate 2013 Rate Total 020 LA PORTE ISD Pending 1.330000 040 HARRIS COUNTY Pending 0.400210 041 HARRIS CO FLOOD CNTRL Pending 0.028090 042 PORT OF HOUSTON AUTHY Pending 0.019520 043 HARRIS CO HOSP DIST Pending 0.182160 044 HARRIS CO EDUC DEPT Pending 0.006617 047 SAN JACINTO COM COLD Pending 0.185602 071 jCrTY OF LAPORTE I Pending 1 0.710000 Valuations Value as of January 1, 2012 Value as of January 1, 2013 Market Appraised Market Appraised Land 01 Land Improvement 01 Improvement Total 01 0 Total Pending Pending Land Market Value Land Site Unit Size Site Appr Appr Total Unit Adj Unit Line Description Code Type Units Factor Factor O/R O/R Adj Price Price Value Factor Reason 1 4600 -- Vacant Exempt SF5 SF 160,519 1.00 1.00 1.00 -- 1.00 Pending Pending Pending Land 1 Building Vacant (No Building Data) http://www.hcad.org/records/print.asp?crypt=%94%9A%BO%94%BFg%84%91 %7F%7Co... 4/4/2013 I." 1"` n , RN Pal "lus, V-7/ F Qj, °�' �' • ,� 929 : ��°S E j 923 j S i . r- Urgyq�F I ' rt rA rmp - ___ 106 10?3 7 7i - t V �, yy 4 Y sk gNSgS - qtF $ 1010 , �i— ry ___ 8l0' I' p / Legend Parcels aq rry ! CM Limb -- Railmaa -. -Drainage ChannMs r of 1 o City of La Porte 1 ' = 119 Z; s Pone, 'P57 ay La Porte GIS Mapping (281)471-5020 �, www.laporte&gov iviv DHi anunr- UR. �1370-h d t> 4P,% C L p 3k��rr�.3��M�h`,'���,