HomeMy WebLinkAbout2374 Nancy Gray Ave - Correspondence/Plans Approval - 11/18/2016B1601090
F& City of Community Development & Neighborhood Services
Collins 281 N. College Ave. Fort Collins, CO 80522; Voice: 970-221-6760
FAX:970-224-6134
CONSTRUCTION WASTE MANAGEMENT PLAN and DOCUMENTATION
Note: Environmental Services staff is able to assist with questions about getting a recycle program
implemented, and will also provide education and site visits upon request (call Caroline Mitchell at (970)
221-6288).
PROJECT INFORMATION
`'% Nanc Gray Ave
Address 3% Y Y Date
Permit No. l Z(:Le U 10 !W
General Contractor & Contact Info: Bel lisimo Inc.
Nico - 970.402.0919
Material'
Vendor hauling the
Facility recycling the
`;TotaI,VOIUmeAJ' w®Igl t"
materlalZ
material'
of matehah
Concrete/Masonry
NA
NA..
Wood/Lumber
Gallegos
Hagmans
I,s c-.-..
Metals
NA
NA
x -
Cardboard
Specialty Appliance
Recycled in Denver
Trash
Gallegos
N/A
Other (describe)
";..
Required Documentation: Provide signed documentation from the hauling company that the volumes &
weights listed above are accurate. If you hauled the materials yourself, attach tickets from locations receiving
the recyclables. Documentation is required in order to receive final project approval from the City.
I and my City -licensed hauler certify that the above materials from my construction site were recycled in the
volume / weight described and were taken to the facilities described.
// Signature (Contractor or Owner) Date
Signature (Licensed Hauler)
Date
'At minimum, the four listed materials must be recycled.
2 Enter vendor name and phone number. If the applicant will haul the material themselves, state such.
' Where will applicant or vendor take the material for recycling? Enter facility name and address.
° To be completed at the end of the project. Please re -submit this form at end of project with these sections completed.
Rev 1/15/14
All PO#: 0
AENTS/MEssAGES: PLEASE MAKE SURE TO ONLY FILL ROLLOFF CONTAINERS LEVEL FULL. ANY CONTAINER
FILLED OVER THE TOP MIGHT DELAY SERVICE.
Please check us out on Facebook - search for Gallegos Sanitation Inc.
INVOICE NUMBER ACCOUNT NUMBER INVOICE DATE
1824336 1 2543110
DATE
DESCRIPTION
S8e Location: BELL ISIMO, INC NANCY GRAY AVE I FORT COWNS, CO 80525
09/2012016
30Y ROLLOFF'1
$0.00
847905
AND RETURN
09/21/2016
_DUMP
/ WOOD _`
$0.00
847910 - MATERIAL REF 564730
R30 WOOD DISPOSAL CHARGE
09/21/2016
30Y RECYCLE ROLLOFF
$0.00
847910
DUMP AND RETURN R30 WOOD
10/07/2016
30Y ROLLOFF
$0.00
851489
DUMP AND RETURN
Date: 111tilL
Job Name:>T
Account #:
Amount:$ 7S'o,av
Memo:l-rfoi •. A ....A.,l
UNIT PRICE QTY BALANCE
$250.00 ✓ 1.00 $250.00
$0.00 2.87
$0.00
$250.00 1.00
$250.00
$250.00 ✓ 1.00
$250.00
V
Charges:
$750.00
�+
Fhwm Charges
$0.00
O
4 wxft Emiro Fees:
$0.00
, ^
IrrvdoeTotal:
$750.00