HomeMy WebLinkAbout820 W Prospect Rd - Applications/Demolition - 08/07/2018 (3)Aug. 7. 2018 8:31AM V r Pollution HP No
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DEMOLITION NOTIFICATION APPLICATION FORM
APPLICATION FEE MUST ACCOMPANY THIS FORM
INCOMPLETE APPLICATIONS WILL BE RETURNED
Colorado Department (Notice will be mailed to the demolition contractor unless specified otherwise)
of public Health
and Environment Fee: $50 + $5 per 1000 ft2 of area to be demolished m $ 55.00
(See Instruction #1 on reverse side)
Submit roan to,
Permit Coordinator
Colorado Dept. of Public
Health and Environment
APCD-IE-81
4300 cherry Creek Drive
South
Denver, Co 60246-1530
Phone:3o3.6sz-31oo
FaX: 303-702-0279
Asbestos®slate.cw.us -
Company Name:
Building Name:
Earth Services & Abatement
East Shed
Street:
Square footage of footprint of facility or pardon of facility to be demolished
6700 E 50th Ave
30
0
+-
City:
State:
zip code:
Street:
m
Commerce City
CO
80022
.2
820 W Prospect
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rn
Telephone #
FaX #
City:
County'
zip Code:
0
303 991-1280
303 991-1282
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Fort Collars
Larimer
80526
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Project Manager.
Cell Phone #
Proposed Start Date
Proposed Completion Date
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Steve Gibeault
(720) 281-7528
0
afzo/1a
8124/18
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1 certify that the Certified asbestos Building Inspector has Informed me
Method/Means of Demolition:
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about any remaining asbestos -containing materials in the facility to be
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demolished.
®wreckin t
g ❑ Burning ❑ implosion t1 Moving ❑ Other, specify
SI Ur ' P lName:
0
Steve Gibeault
Landfill Recpirglauilding Debris:
Larimer County Landfill
Burning requires nal aulhodon- Please call (3d3) 6e2-moo and ask
to speak to the 0 n eurBurnin Permitit Coordinator
t e
General Abatement Contractor (OAC)
Owners Name:
N/A
Landmark Construction LLC
p N O
Permit #
CDPHE ASPe/
Total Quantity 1`Asbeatoa Removed
Street:
0
Nl
315 Oconee St
Date Removal Completed
Telephone #
City:
State:
Zip Cade:
d C
e
Q IX
N
Irv/a
Athens
GA
30601
Type(s) or Asbestos -Containing Material Removed: !LLJm
contact's Name:
Telephone#
P/
Turner Douglas
706-543-1910
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
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)
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of ACM remaining, below: (check appropriate box(es)):
a, rr
a
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❑Vinyl asbestos floor file (VAT) ❑VAT mastic El7ar/asphalt impregnated roofing ❑Asphaltic pipe coatings
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❑ Spray -applied tar coatings ❑ Caulking ❑ Glazing ❑ Other, specify:
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Signature: (in Blue Ink)
Printed Name:
KyIf
U
Date off Final In ction
` -1-
0 Cen #
18 71
Ex trail DaI
4 -/2-1
Telephona # .r� j
(393 5 %25-- )
Cell Phone �jj
( 0�2) �� y'y`%7�r%
I verify that all refrigerants from air conditloning/refrigoration applianoes 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 (containing 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 303-592-3320).
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CHECK THE APPROPRIATE BOX:
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❑ Building Owner
® Contractor
❑ Other
Date:.
Signa Print Name:
THIS SOX IS FOR CDPHE USE ONLY:
EofrkPayment&#:
Approved ey:
Code: initial-310 ❑ Uansfer-3t30
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S
Permit #:
Record #
Date Issued: "
- Regulated asbestos -containing materials means (a) friable asbestos-contammo matenal, (b) category I nontnable ACM inat nos become insole, (c)
Category I nonfriable ACM (hot will be or has been subjected to sanding, grinding, cultinn• or abrading or (d) Category 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 material in the course of
0, mm2lltion, or renovation operations regulated by this regulation. Note: AsbeAlos- &.tiger )(Iny -q�d linoleum must be properly
abated/removed prior to demolition. }`'�{ j 1 ('_, .,�
ir'�UI I 1�n !1'i<1.ml IF Rev.611301e8