HomeMy WebLinkAbout215 E Foothills Pkwy - Correspondence/Demolition - 07/08/2014OF' C000
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Colorado Department
of Public Health
and Envirorunent
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 ft2 of area to be demolished
(See instruction n1 on reverse side)
Submit form to!
Permit Coordinator
Colorado Dept oLE
Health and Envirc
43001
South
Company Name:
" Alpine Demolition
Building Name:
Comer Bakery
Square footags.of footprint of facility_or portion of facility to be demo;he
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5790 W. 56"' Ave
city.
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State:
up Code:
Street: (%�q.
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Arvada
CO
80002
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3300 S. Coll e Avenue
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Telephone k
Fax
City:
County.
Zip Code;
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(303) 421-3366
(303 940-0869
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Ft. Collins
Proposed Start Date
Proposed Completion Date
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Project Manager.
Cell Phone ;f
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Sabrina Martin
I (720) 260-0834
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1 cerfify that the Certified Asbestos Building inspector has Informed me
Method/Meang of Demolition:
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about any remaining asbestos -containing materials In the facilityto be
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demolished.
rocking ❑ Bumingl [I implosion [I moving ❑ Other, specify.
S nature:
Print Nzme:
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Sabrina Martin
+Burning requires additional authorization - Please call (303) 692-3100 and ask
Landfill Receiving Building Debris:
BFI Towel
I to speak to the Open Burning Permit Coordinator
General Abatement Contractor (GAC)
Owner's Name:
Monarch Remediation and Construction
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CDPHE Asbestos Permit is
Total Quantity of Asbestos Removed
Street;
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7+
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14LR2487A
3,600 sf
too i� Ye y
Dale Removal Completed
Telephone K
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Slate;
Zip Code: h
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6126114
(303) 355-1778
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Typo(s) of Asbeslos-Containing Material Removed:
Contact's Name:
Telephone 9
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Transit Panels, CMU Block FiUcr, Gypsum board slam coat, VAT
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With my signature below, I certify that I possess current AHERA accreditation and state of Colorado certification as
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an Asbestos Building Inspector. i also certify that I have thoroughly inspected the facility to be demolished, as listed i1
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in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of 0
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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 1 have informed the ownerioperator of the facility or the demolition contractor that any
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asbestos-containingmaterial allowed to stay in the facility must remain non -friable during demolition. Specify type(s) E
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of ACM remaining, below: (check appropriate box(es)):
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❑ Vinyl asbestos floor the (VAT) ❑VAT mastic E-Tar/asphalt impregnated roofing.El Asphaltic pipe coatings ;1
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❑ Spray -applied tar coatin s ❑ Caulking ❑Glazing ❑ Other, specify -
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Signature: (In B ue Ink)
Printed Name:
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Michael DeMille Ij
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Date of Final Inspection CO Cart m � plraffon Dale
Telephone „ Cell Phone
288-5671 (720) 88-5671
6/26/14 1122 10/29/14
(720)
I verify that all refrigerants from air conditioning/refrigeration appliances have been properly recovered In accordance with AQCC Regulation No.
15 (for Information on CFC requirements call 692-3100). 1 further verify that all luminous exit signs (contalring radioactive material) have been
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disposed of In accordance with 6 CCR 1007-1 subpart 3.6.4.3 (for information on luminous exit sign requirements call 303-692-3320). 19
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CHECKTHE APPROPRIATE BOX: /
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❑ Building Owner
Contractor
❑ Other
Date:
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sign ure: Print Name:
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THIS BOX is FOR CDPHE USE ONLY:
Postmark or Hand Delivery Date 7-��"� Approved By Code nl iai 310 ❑ transfer 3B0
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rCiiill of t"dyiYrErn a>F rr" �"
. , [ LI.. /l`A.1 lMn4 Lnn 4•nnnme rria{trn I!`t
Regulated asbestos -containing matenals means ta) rnagie e311L•MUb- IJLO 1111...mini lai, ,vJ ---. •,-•• • •.__ ____...__,
Category I nonfriable ACM that will be or has been subjected to sanding, grinding, cuftin , or abrading or (d) Category II nonfriable ACM that has a high
probability of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act on the matedal in the course of
demolition or renovation operations regulated by this regulation. Note: Asbestos -containing sheet vinyl and ��I�II��4y I r�ry�y.iu(��j'� e
abatediremoved prior to demolition. /!" 9U PO 6`t�
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