HomeMy WebLinkAbout1800 W Mulberry St - Applications/Demolition - 07/01/2010 (2)pF C
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Colorado Deparintent
of Public Health
and Fnvtmntnent
DEMOLITION NOTIFICATION APPLICATION FORM
APPLICATION FEE MUST ACCOMPANY THIS FORM
INCOMPLETE APPLICATIONS WILL BE RETURNED
(Notice will be mailed to the demolition contractor unless specified otherwise)
Fee $50 + $5 per 1000 fe of area to be demolished = $
(See Instruction Y1 on reverse side)
Submit fort.
PemM Cocrd nabor
Colorado Dept of P bl
H llh d E to merit
APC04E431
4300 Cherry Creek D ve
South
Deriver CO 8024E-1530
Phone 30o-692J100
Fax 303 782-0278
Asbeslos®state m us
Company lam
Bu Id g Name
street
Square footage of footprint of facility or portion of facility to be demolished
O
fa
Sheet
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1800 W Mulberry
C
( one �/
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)
City
{ County
vp Cod
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Fort Collins
I Larlmer
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Proposed Start Date t Proposed Completion Date
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y
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l certify that th Certified Asbestos B 8ding Inspector has rdormed me
Method/Means of Demolition
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E
p
bout a y reme ng asbestos-contamr g materials n the faGlRy, to be
to
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kwredang [IBuint ig* ❑ Implosion ❑ Moving ❑ Oaten speC4
re
rid
ece g 8 ldmg b s.
8 rung requires dddmnal t'iorizettan - PLase call (303) 692 3100 a d ask
t we k !o th Operi Bum g Permd Coordma-or
Gen ral Abatement Contractor ( )
` I
Owner's Name
(A
c
Jefl•and Jennifer Makepeace
CDPHE Asbe tas P rrril S
Total Ouantdy of Asbestos Rem red
Street
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O A
NC
1A
e
Out Remov I Completed
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City
state
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Fort Coilms
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With my signature below I certify that I possess current AHERA accreditation anti state of Colorado certtficatfon as
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an Asbestos Building Inspector I also certify that I have thoroughly inspected the facility to be demolished as listed
d
in the Demolition Site block above sampled all suspect materials had all samples analyzed for the presence of
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asbestos by a NVLAP accredited laboratory and have determined that no Regulated ACM exists anywhere in the
facility I also certify that I have informed the owner/operator of the facility or the demolition contractor that any
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asbestos -containing material allowed to stay in the facility must remain non friable during demolition Specify type(s)
y
of ACM remaining below' (check appropriate box(es))
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❑ Vinyl asbestos floor file (VAT) [:1 VAT mastic ❑ Tarlasphalt impregnated roofing E] Asphaltic pipe coatings
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❑ Spray -applied tar coatings ❑ Caullan ❑ Glezin ❑ Other specify
GI
s gnat a (I Btu I k) Pn ted Na ie
Andrew Dunnell
D t f Final Inspectin CO Cyst d Exp ratio Date Teleph not i CA Phone H
June 8 2010 1 %89� I 10/14/2010 ( (970) 222 6849 1 (970) 222 6949
1 enfy th tall refrigerants from air conditionrng/refngeration appliances have been property recovered in accordance with AOCC Regulation No
15 (for information on CFC requireme is gall 692 3100) I further verify that all luminous exit signs (containing radioactive material) have been
disposed of i eccordanee with 6 CCR 1007 1 subpart 3 64 3 (for forinatio lumnous exit sign requirements call 303-692 3320)
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CHECK THE APPROPRIATE BOX
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❑ Buld g Owner ❑ Contractor ❑ Othe Date
V
Sgnat Prl t N me
THis Box is FOR CDPHE USE ONLY
Postmark or Hand Delivery Date App oved By Code ❑ initial-310 ❑ transfer 380
form of Payment & # Permit # Record # DatP Issued
•- -•-•----•------�•••a •• ••n ...�a.0 101411dUM aaua,wxtinlauuna marenal 10) I-aregory 1 nonmaDISAL:M that has become fin ble (c)
Ceteeory I nonfnable ACM that will be or has been subjected to sand g g d q cuthng or abrading or (d) Category 11 nonfnable ACM that has a high
p b b I ty f becoming or has become crumbled pulverized or reduced to powder by the forms expected to act on the material In the course of
demoldtion or renovation operations requtated by ths regulation Note Asbestos containing sheet vinyl and It ale m m st be p ape ly
ab ted/rem ved p o to demold
MR
81003993