HomeMy WebLinkAbout2430 S Overland Trl - Applications/Demolition - 09/18/2018No. 7633
Sep. 18. 2018 9r17AM Air Po
DEMOLITION
I I u t I o n S.SP
B180095U
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)
oFPublicHealth
and Environment Fee: $50 + $5 per 1000 11112 of area to be demolished $ 60.00
(See instruction #1 on reverse side)
Submit form to:
Permit Coordinator
Colorado Dept. of Public
Health and Environment
APCD4E-B1
4300 Cherry Creek Drive
South
Denver, CO 60246-1530
Phone: 303-692-3100
Fax 303-782.0278
Asbeslos@91ale.co.us
Company Name:
Building Name:
GLH Construction Inc.
House
street:
. Square rootage of roolp6nl of facility or potion !facility to be demolished
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780 E. Garden Drive
1,372
City:
Stale:
Zip Coda:
Street:
tJ
La
Windsor
CO
80550
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2430 S. Overland Trail
Telephone #
Fax #
City:
Ccun •
Zip Code:
C
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v
070 674.0440
970 674-0443
o
Fort Collins
Larimer
80546
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Project Manager.
Cell Phone #
Proposed Sla I repose ompletion Date
o
Blake Bell
970 674-0440
9 8 9 2B 18
I certify that the Certified Asbestos Building Inspector has informed me
Melho /Mean emolition:
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about any remaining asbestos -containing materials in the facility to be
demolished.
X■ Wrecking ❑ Burning' ❑ Implosion ❑Moving ❑ciry: Other, ape
Signature:
Print Name;
Br- .,�
Blake Bell
Landoll Receivin Bunging Debris:
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Lohogu
+
burning requires additional authorization - Please call (303) 892-3100 and ask
ASY i) ' , 011 W JL
to Speak to the Open Burning Pemllt Coordinator
General Abatement Contractor (GAC)
`
Owner's Name:
Risk Removal, LLC
Lorson South Land Corp.
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COPHE Asbestos Permit
Total Quantity of Asbestos Removed
Elreal:
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ISLR5039A
3,324 s.f.
212 N. Wahsatch Ave. Suite 301
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Date Removal Completed
Telephone #
City:
Slate:
Zip Code:
a n 0
9I12I18
970 221-9121
a
Colorado Springs
CO
80903
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Type(s) of Asbestos -Containing Material Removed:
onlacl's Name:
LC
Telephone #
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lefiCMar)(
719 635-3200
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
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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)
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of ACM remaining, below: (check appropriate box(es)):
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❑ Vinyl asbestos floor tile (VAT) ❑ VAT mastic ❑ Tartasphalt impregnated roofing ❑ Asphaltic pipe coatings
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❑ Spray -applied tar coatings ❑ Caulking ❑ Glazin ❑ Other, specify:
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Signature' (In Blue Ink -
Printed Name:
Y
1
�tna Rarr'SS
to
V
Date 9r Fi I Inspection
Ill
eD eon #
talfZ.
Ezpvati n D to
?e� -tl1
Telephone # Ceti Phone #
110 a06-1,W i 9 NU -of
I verify that all refrigerants from air conditioning/refrigeration appliances 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 exil 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 303-692-3320).
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CHECK THE APPROPRIATE BOX: _
toVEl
XE contractor ❑ other Date: 8-3 1-18
BuildingOwner
-
Signature: Print Name:
Blake Bell
THIS Box 1s FOR CDPHE USE Nt.r: _
Postmark or Hand Delivery Date; a
Approved By:
Code: initial-310 ❑ transfer-360
Form of Payment & #: Gk e 4-) i N2 rS &o
I Permit*
Record #
Date Issued:
• Regulated asbestos -containing materials means (a) triable asoestos-comatmng material, (o) category I nonlnaole AcM that nas oecome Egcp v G�
Category I nonfriable ACM [hat will be or has been subjected to sanding, grinding, cutting, or abrading or (d) Category It 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 7 iuia
demolition or renovation operations regulated by this regulation. Note:. Asbeslos-containing sheet vinyl and linoleum must be properly SEP Pabated/removed prior to demolition. . f�'� � `„ t�'
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