HomeMy WebLinkAbout222 Laporte Ave - Correspondence/Demolition - 03/07/2011B flo 6 �
Colorado Department of Public Health and Environment
Air Pollution Control Division — Indoor Environment Program — Asbestos/IAQ Air Unit
4300 Cherry Creek Drive South, APCD-IE-B1
Denver, Colorado 80246-1530
Phone: 303-692-3100 — Fax: 303-782-0278
E-mail: asbestos@state.co.us
Pff"KIWAIL NOYT
This approval notice is granted subJect to Colorado Air Quality Control Commission Regulation
No. 8, Part B, adopted December 212007, and effective January 30, 200,8 and the Colorado Air
Pollution Prevention and Control Act C.R S. (25-7-101 and 25.=7=r501 et seq). This notice signifies
that the structure was inspected for asbestos, luminous exit signs (containing radioactive material),
and Ozone -Depleting Refrigerants and the .demolition contractor has properly notified the
Colorado Department of Public Health and Environment pursuant to Regulation No. 8, Part B.
As a contractor, you may subject to other demolition licenses and permits, depending on the
requirements of the county and municipality in which the work is being performed. The Colorado
Department of Public Health and Environment, Air Pollution Control Division, strongly suggests
that you check with county and municipal authorities in order to determine any other local
building/permitting requirements that must be met.
Please note that certain asbestos containingrmater-ials (ACM) may remain remain in the structure
during demolition. Therefore, any demolition debris left behii d after the completion of post-
'emolition site cleanup may constitue a t"reason to .know of asbestos -contaminated soil" at
.ne site, subject to the requirements of Section' 5 S -of the Solid Waste Regulations (6 CCR
1007-2, Part 1).
THE ORIGINAL APPROVAL NOTICE MUST BE POSTED ON SITE AT ALL TIMES.
Immediately notify the AsbestosIL4Q Unit of project modifications by fax (number above) or e-mail
(address above) and the appropriate county health department by fax. Project modifications include
changes in the scope of work or the scheduled work dates, etc.
This demolition approval notice is valid beginning 3/23/2011.
The actual scheduled work dates are from 3/23/2011 through 4/23/2011.
Approval issued on: 3/10/2011
Record number: 76979
Notice Number: I ILRO851D
For the location specified below:
Creamer
222 LaPorte Ave.
Fort Collins
Larimer County
This notice has been issued to:
Alpine Demolition
5790 W 56th Ave, Ste. "C
Arvada, CO 80002
Fee Paid: $100.00
Check number: 1465
Asbestos Building Inspector:
Michael Phillip Castell
Cerification No.: 4210
Inspection Date: 12/13/2010
Issued by LBM
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B I 10 16 6 5
ASBESTOS/DEMOLITION
NOTIFICATION and PERMIT
MODIFICATION FORM
Submit form to:
Permit Coordinator
Colorado Dept. of Public Health
and Environment
APCD-IE-B1
4300 Cherry Creek Drive South
Denver, CO 80246-1530
Phone:303-692-3100
Fax: 303-782-0278
asbestos@state.co.us
Nam of Facility: Fa�lity Location-
m � it I Q A 4PLe
GAC/Consultant: Phone # Fax #
E-m it Address: Permit Number if already issued):
�i
Please check the appropriate box(es) in A, B and C, as applicable:
A. Upgrade to: Nit
yX 30-day permit ❑ 90-day permit ❑ 1-year permit
B. ❑ Request to cancel above notice/permit. (All but $80 of the application fee will be returned. If you paid by check or money
order, a state of Colorado Warrant will be mailed to the company appearing in the contractor box on the application. If you
paid by credit card, a credit will be issued to the same account used to pay for the original application fee.)
C. Change in:
❑ Supervisor:
❑ A.M.S.:
❑ Project Manager:
Start Date: a3k
❑ Work Times: ❑ Disposal
1
Certification #
Certification #
Certification #
��C
End Date: 'A I
❑ County:
❑ Additional Scope of work (include type of ACM, quantity, location in or on facility and work practices):
I certify that I am the person authorized to sign this modification on behalf of the General Abatement Contractor and that all
statements made in this modification are, to the best of my knowledge, correct and complete. (Note: Making false statements
on this application constitutes second-degree perjury as defined by 18-8-503 C.R.S., and is punishable by law.)
Aut wrized Representative Signature Date
Printed Name Position or4itle
THIS BOX IS FOR CDPHE USE ONLY:
Postmark or Hand Delivery Date: Approved By: Code:
Form of Payment & #: Permit #: 1 Record #: Date Issued:
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