HomeMy WebLinkAbout820 W Prospect Rd - Applications/Demolition - 08/07/2018 (4)2018 8:30AM
Air Pollution S S P
No.7170 P. 5
Aug. 7.
N
Colorado Department
of Public Health
and Environment
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 4 $5 per 1000 ft2 of area to be demolished = $ 55.00
(Sao Instruction #1 on reverse side)
Submit form to:
Permit Coordinator
Colorado Dept. of Public
Health and Environment
APCD.IE•Bl
4000 Cherry Creek Oftve
South
Denver, CO 80246-1530
Phone: 303-602-3100
Fax: 303.782.0278
AsIbe3tosQslate.co.us
Company Name:
Building Name:
Earth Services & Abatement
Green House
Street:
square footage of footprint of facility or portion of facility to be demolished
6700 E 50th Ave
35
v
city.
Slate:
zip Coda:
Street:
11
Commerce CityCO
80022
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820 W Prospect
Telephone #
Fax #
City.
County:
Zip Code:
C
In
303) 991-1280
303 991-1282
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Fort Collins
Latimer
80526
U
,
Project Manager.
Cell Phone #
Proposed Stan Date
Proposed Completion Dale
GSteve
Gibeault
(720) 281-7528
-aerzorle
erz4ne
I certify that me Cenined Asbestos Building Inspector has informed me
MethodWeans of Demolition:
R
E
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aboutany remaining asbestos -containing materials in the facility to be
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demolished.
t
® Wrecking ❑Burning ❑ implosion ❑ Moving ❑ Other, epecify,
Si r :
Print Name:
0
Steve Gibeault
end Rece g Building Debris:
Larmer County Landfill
r requires additional authorization -Please call (303) 892-3100 and ask
con
los eak to maOpen Burnin Permit Coordinator
sipeak
General Abatement Contractor (GAC)
Owners Name:
NIA
Landmark Construction LLC
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to
CDPHEAsbestos
Permit#
TotalQuantirysRemoved
Street:pL
wo
<
IVe
315 Oconee St
Date Removal Copleted
f/
Telephone #
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City:
Slate:
GA
Zip Code:
30601
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to
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Athens
m
Type(s)ofAsbestoe-Conl§inin aledalRemoved:
Contacl'sName,
Telephone#
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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ACM remaining, below, (check appropriate box(es)):
-
❑ Vinyl asbestos floor tile (VAT) ❑ VAT mastic ❑ Tar/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)
Pdnled Name:
V
Dale of Final I s action
CO Cert #
Explration Dat
Telephone # Cell Phone
,#,. ?o
z2�I I
c-(Z-r
(343) s� -d17?7 W2 ),-3'f-V
1 verify that all refrigerants from air conditloninglrefrlgeration appliances have been properly recovered In accordance with AQCC Regulation No.
15 (for Information on CFO requirethenta call 592-3100). 1 further verify that all luminous exit signs (containing radioactive material) have been
pdl6posed
of In accordance with 6 CCR 1007-1 subpart 3.6.4.3 (for Information on luminous exit sign requirements call 303-692-3320).
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CHECK THE APPROPRIATE BOX:
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❑ Building Owner
® Contractor
❑ Other
Date: '
Sign
Print Name:
THIS Box is FOR CDPHB USE ONLY:
Postmark or Hand Delivery Date: g
Approved 9)
Code:4Nnitlal-310 ❑ transfer -no
Form of Payment & #:G� cbr\ yp sl Se —
Permit #:
Record #
Date Issued
* Regulated asbestos -containing materials means (a) friable asbestos -containing material, (b) Category I nonfriable ACM that has become friable, (c)
Category I nonfriable ACM that will be or has been subjected to sanding, grinding, cutting, 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 art on the material in the course of
demolition or renovation operations regulated by this regulation. Note: Asbestos �p� `(lieg;gt�eej;�Itr]y� �(t )VoleUm must be properly
abated/removed prior to demolition. yytt`` /, ,lt fII I!y���\/\�+.6`,-I E., �/L//�//�j/(�//
f.0f-q➢ I':11YI ////..�'6 P�I/i�hI�IP:�: _YF✓'•' ..' .. - Rev MAMA A