HomeMy WebLinkAbout520 Peterson St - Special Inspections/Field Verification - 06/16/2017 (2)Planning, Development & Transportation Services
Fort Collins
Community Development & Neighborhood Services
281 North College Avenue
P.O. Box 580
Fort Collins, CO 80522.0580
970.416.2740
970.224.6134- fax
fcgov.com
Asbestos
Statement Disc 1 qqG 1 •
Address Permit#
In accordance with the State of Colorado Senate Bill 13-1 S2, property owners, applying for a
remodel permit, shall indicate their awareness about their property having been inspected for
Asbestos Containing Materials.
Property owner, please check the appropriate box below' and sign:
❑ I do not know if an asbestos inspection has been conducted on this property.
An asbestos inspection has been conducted on this property on or about
❑ An asbestos inspection has not been conducted on this property.
Signature
�o• 1�(0.1"'1
Date
Your remodel project may be subject to State and Federal Regulations requiring an inspection
for ACMs. Asbestos can be found in these and many other building materials: ceiling tiles and
textures, vinyl floor coverings and mastic, boiler and pipe insulation, heating and cooling duct
insulation, roofing products and clapboard shingles, etc.
For more information about Asbestos or forms, please contact:
_Asbestos Compliance Assistance Group
Toll Free.. 1-800-886-7689
Phone: (303) 692-3100
httus://www.colorado.Qov/pacific/sites/default/tles/AP ASB-RenovationDemolitioh.p
https://www. colorado.gov/cdphe/asbestos
Email address: cdphe. asbestosna,state. co. us