HomeMy WebLinkAbout3405 S Timberline Rd - Applications/Demolition - 08/29/2018uaro-
submit farm to:
Permit Coordinator
DEMOLITION NOTIFICATION APPLICATION FORM Colorado Dept. of Public
Health and Environment
APPLICATION FEE MUST ACCOMPANY THIS FORM as oCherry Creak Drive
INCOMPLETE APPLICATIONS WILL BE RETURNED south
Ctllnrado Department (Notice will be mailed to the demolition contractor unless specified otherwise) Denver, CO 00240.1639
of Public Health Phone: 303-092.3100
per 1000 ft2 of area to be demolished = $60.00 Fab; ossta0276
and Environment Fee; $50 + $5 p Asbesio®state.co.us
(See Instruction #1 on reverse alde)
Company Name: Building Name.
MP Contracting,LLC Madwire- Timberline (Scrubber Buildin
sveet: square footage of ioolpdni orfocility or portion of iaciiity to be demo) shed
_ 550 East 64" Avenue 1356
City: Slate: Zip Code: street:
Denver CO 80229 a 2001 Danfleld Court
Telephone u Fax a N city: County; Zip Code:
U 303 289-5800 303 286.6463 rota Collins Larimcl, $0525
Project Manager: Cell Phone p �!d% ¢�( « Proposed Stan Date oposed Completion Dale
o Brandon Powell 303) �89-3840 a R / 12/A/2018
i cenifyhat the Certified Asbestos Building Inspector has informed me E i5lhodrMeans of De
o about any remaining asbestos -containing matedate in the fecitiry to be ra
E demolished.
me,
R wrecking Q Burmng O Implosion Q Moving Q Omer, specify:
Cu Signature, Prri
C3
hendfill Receiving 0u'Iding s:
�f rBurning requires additional aulhonzalion -Please call (303) 6923100 and ask
�a to speak to the open Burning Permit Coordlnalar
General Abelement Contractor (GAC)
`
Owner's Name:
N/A
m
2001 Danfleld LLC
In ; «
p
CDPHE Asbestos Permit d
Total Quanlity of Asbestos Removed
street:
1430 Twin Oak Court
ur o ro
o v
fa
E-
Dale Removal Completed
Telephone it
City;
Stale:
Zip Code:
For[ Collins
CO
1 80525
Type(s) of Asbeslos-Containing Material Removed:
to
Contact's Name:
T910pndne g
A I f2
Trov Peterson
(970) 567-9770
With my signature below, I certify that 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 in
the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of
asbestos by a NVLAP•accredited laboratory, and have determined that no Regulated ACM exists anywhere in the
facility.' I also certify that I have informed the owner/operator of the facility or the demolition contractor that any
asbestos -containing material allowed to stay in the facility must remain non -friable during demolition. Specify type(s)
of ACM remaining, below: (cP.eck appropriate box(es)):
❑ Vinyl asbestos floor tile (VAT) ❑ VAT mastic ❑ Tar/asphalt impregnated roofing ❑ Asphaltic pipe coatings
I-1 Sorav-applied tar coatings ❑-Caulking_❑ Glazing ❑ Other, specify:
I verity that all refftgarants from an conualunn lull emyerau
15 (for Information on CFC requirements call 092-3100). 1
disposed of in accordance with 6 CCR 1007-1 subpart 3.i
CHECK -THE APPROPRIATE sox:- --
Building Owner ❑ Contractor
Postmark or Hand Delivery Date:
Forn'ofPayment&#: $ c
Con Phone a
2-1976. (92b)i6.7_
ipllences have been property recovered In accordance with AGICC Regulation n
tar verify that all luminous exit signs (containing radioactive material) have been
(for information on luminous exit sign requirements call 303.092-3320).
❑ Other
Approved By;
Permit #;
Dale: 8 /29/ 15
Code; u initial-310 ❑ Transfer-300
Record e I Date Issued:
Regulated asbestos -containing materials means (a) friable aeon-w71�d1111L9 rrr dtm mr, t0J VOIGyVy r rr Will r law IV nwm %I IWk •IVQ WvVV.I.. �L� r-r
Category I nonfriable ACM that will be or has been subjected to esnding, fin : , cullin , or abrading or (d) 9mW nonfrlalble ACM that has a high
peobabllity of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act on the material in the course of .
demolilion or renovation operations regulated by this regulation. Note; Asbestos -containing shoat vinyl and linoleum must be properly staled/remove
prior to demolition. p� PPRO r 0� n Allr 21