HomeMy WebLinkAbout215 E Foothills Pkwy - Applications/Demolition - 11/21/2014City
}off COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F61 l Collinsi281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATIONI
APPLICATION NUMBER_ L T— APPLICATION DATE
Job Site Address a,1.5 C�. } Vli ��� }� t `1� 5 .2 nit # �j [ ,
PROPERTY OWNER INFO: (All owner information is required — It Is not optional) Phone # �`X_7�>-A(T 56
Last name First Name Middle
Street Address City State -Zip -
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name Cit# ,y of Fort Collins License 11°�rj 1 Supervisor Cart #
Mailing Addressllo D �W , city\h State Zip R.Q.
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm9 Sq Ft. # of Stories Bldg Height _# Dwelling Units
151 Floor Sq Ft 2n° Floor Sq Ft 3° Floor Sq Ft Unfiished Bsmt'Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths /2 Baths # of Fireplaces
Air Conditioning: YeGo0 Energy Info: ( Circle appropriate choice ) 1. ComCheck 11 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑ 4. Simulated Performance Alternative[] 5. Prescriptive w/Air Sealing 11 6. Prescriptive w/ Blower Doofl
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes ❑NoE
Type of Heat: nGas FElectric Electric Main Breaker Size (Residential only) 1115
Value of Construction (including labor, tnateriai &profit) $
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:' -
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Temp. Pedestal Yes❑ No❑
Amp or I<ess LJ 200 Amp
Plumbing
Fireplace
Other
Applicant: i hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort C % ordinan as and state laws regulating building con; ructio .
Applicant Signature /%�i�— {� Print Name �-! Phone SGS"�d'%
Distribution: White — Office Yellow —Applicant Pink — W✓ W/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
U
31orado Department
of Public Health
anal Environment
)� / y /C-;i-o 4;1-3
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 #1 on reverse side)
Submit form to:
Pemrit Coordinator
Colorado Dept. of Public
Health and Environment
APCD-IE-B1
43DO Cherry Creek Drive
South
Denver, CO 00245-1530
Phone: 3os-692-310D
Fax 303-762-0279
Asbeslos®state.co.us
Corn any me:
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footprin of to y or Pont f tac Illy to eQgm Ilshad
State:
Zlp Cotle:
Street �Irl
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T ephone #
580
Fax #
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Zip Cvtle:
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P act nagar.
Cell Phone #
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Proposed Start Date-Pr000sed Camoletlon Date
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I caNfythat the Ce ad Asbestos Building Inspector has informed me E
hod/Mains of Demolition: -
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about any remaining asbestos -containing materials In the facility to be 0
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demolished.
wracking C)Burning+ D Implosion ❑ Moving ❑ Other, specify:
Signature
Prin ama:
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0
rBuming requires additional authorization - Please call (303) 692.3100 and ask
At Re Ivtng Building abris:
i I i
to speak to the Oven Burning Permit Coordinator
General Abatement Contrac r(GAC) `
Owner's Name:
wethn &A,111;L r✓
CDPHE Asbestos PermititN
Total2a Quantity Asbestos Removed 0
Street S)Nxki Z�d
Y; o(a
0
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a
f�
Date Re ova C/o�C7mpletedd
Telephone # C
City:
5
Zip C/�i
o
/6T5
303 355- 8
Typs(s) of Asbestos -Containing Material Removed: m
Telephone #
,7 ,_LIME
! 7[.v-
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ntaofs Name:
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VTdh my signature below, I Corti at I possess current AHERA accreditation and state of Colorado certification as
an Asbestos Building Inspector. I also certify that I have thoroughly inspected the facility to be demolished, as listed
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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
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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)
rn
m
of ACM remaining, below: (check appropriate box(es)):
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m �
w a
❑ Vinyl asbestos floor tile (VAT) ❑ VAT mastic ❑ Tar/asphalt impregnated roofing ❑ Asphaltic pipe coatings
v
❑ S ra -a lied tar coatings Caulkin ❑ Glazin ❑ Other, specify:
at
Signature: (In Blue Ink) Printed Name:
fr=
V
=aweofnel Inspection i6cpuall DaM Telephone # Cell Phone#
) 2o�41I
D 2
verify that'all refrigeranonditioninglr frige an appliances have been property recdvered in accordance with AQCC Regulation No.
692-3100). I further verify that all luminous exit signs (containing radioactive material) have been
15 (for Information on CFC requirements call
6 CCR 1007-1 subpart 3.6.4.3 (for information on luminous exit sign requirements call 303.692-3320).
02
disposed of in accordance with
C �• 0
CHECK THE APPROPRIATE BOX:
❑ Building Owner
Contractor
❑ other
fn L)
Signature:
Print Name:
L b _
THis Box is FOR CDPHE USE ONLY:
Postmark or Henri Delivery Dale:,! _� Approved By: Coda: inftial-310 ❑transfer-360
Form of Payment 8 #/K (� }33 Pertng #:
Record d #
Date Issued:
• Regulated asbestoscontaining materials means (a) frable �mat ties Dacome �rnre tc)oy
Category I nontriable ACM that will be or has been subjected to sanding, grinding, cutting, or abrading or (d) Category nonfiabla 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 material In the course oF,.
demolition or renovation operations regulated by this regulation. Note: Asbestos -containing sheet vinyl and linoleum must be properly
abatedlremoved prior to demolition.
APPROVED
(^1 �-,' V
DATE,,0DPHE_,�4kL R ov oror `I
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