HomeMy WebLinkAbout4417 Corbett Dr - Applications/Demolition - 04/12/2018City of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
DEMOLITION PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).
❑ Demolition -interior non-structural
IN Partial Demolition of existing building
❑ Demolition of entire building or residence
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # '31 iibZSTT Date 4- t -II
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
4417 Corbett Dr. 20,000
Property Owner Name Address City/State Zip Phone
Ramco Gershenson 31500 Northwestern Highway #300 Farington Hills, MI 48334 (248) 350-9900
Applicant Name Address City/State Zip Phone
Jeff Neitenbach 303-532-6863
Contractor Address City/State Zip Phone
Horizon West Builders 3855 E. 151st Ave Brighton/CO 80602 303-532-6863
Contractor City of Ft. Collins Sales Tax # 135117
Sales tax number isrepuiredbyall contractors Are you paying with your trust account? ❑ Yes ® No
Is this a residential or commercial project? ❑ Residential ® Commercial
Is the demolition of an upcoming DevefoymentRevfewproject? ❑ Yes ❑ No
If residential, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage: Square footage if detached
Number of dwelling units to be demolished:
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office IM Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ® No
Type of New Building Planned: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Duplex ❑ Detached Garage ® Commercial Mixed -Use Building
Description of work Exterior Stucco, Portions of East Exterior Wall, Storefront Glass, Sliding Doors
Square footage to be demolished: 400
Subcontractors: List the company name or Gty of Ft Collins license #
pectnCian HB Electric PBimber Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. �#1 e K f
Applicant: Jeff Neitenbach
Print Name: Signature
Date
4/10/2018
Colorado Department
of Public Health
and Environment
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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 + $5 per 1000 ft2 of area to be demolished = $ t ) pr). CV
(See instruction #1 on reverse side)
Submit form to:
Permit Coordinator
Colorado Dept. of Public
Health and Environment
APCD-IE-B1
4300 Cherry Creek Drive
South
Denver, CO 80246-1530
Phone: 303-692-3100
Fax: 303-782-0278
Asbestos@state.co.us
Compan Name:
0-1 ZrA.1 L1L7'1 121.)1(+0EiS
Building Name:
Former Sports Authority (partial per demo Ian
Street:6
Square footage of footprint of facility or portion of facility to be demolished
-500 SF front
of entrance
City:
S te,
Zip Code:
Street
m
4417 Corbett Dr
=
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a
Tee one #
c4S'7- Ob%
Fax #
City:
Fort Collins
County:
Lanmer
Zip Code:
80525
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Ma�n�ager.
Cellne;32.6$63
Pr 13t Dag
P �r o�;etjon Date
45
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I certify that the Certified Asbestos Building Inspector has informed me
Meth d/M✓eans of Demolition:
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about any remaining asbestos -containing materials in the facility to be
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demolished.
t
® wrecking ❑ Burning ❑Implosion El Moving [I Other, specify:
Signaturof 1
Print Name:
Landfill Velgiving Building Debris:
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(0 eX--
t Burning requires additional authorization -Please call (303) 692-3100 and ask
to speak to the Open Burning Permit Coordinator
General Abatement Contractor (GAC)
Ow er s Name:
PQ 1�5 LQ
None
(�-�}G"t(,O'C�L�_*eW50k1
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CDPHE Asbestos Permit #
Total Quantity of Asbestos Removed
Str2eQt� /JCT9E7�1'U L(f�,
E =
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Date Removal Completed
Telephone #
CitJyJ:II
State
Zip Code:
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Type(s) of Asbestos -Containing Material Removed:
Contact's Name:
ac [Z
Telephone #
(Z18) " I--653`P
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
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)):
a
❑vinyl asbestos floor the (VAT) [I VAT mastic ❑Tar/asphalt impregnated roofing ❑Asphaltic pipe coatings
v
❑ SpTay-applied far coating s ❑ Caulkin ❑ Glazin ❑ Other, specify:
a
m
Signatur (In Blue/uN
Printed Name:
[j
James E. Dennison
U
Dat of Final Inspection
CO Cert #
Expiration Date
Telephone #
Cell Phone #
--10-18
235
09/16/2018
(970) 266-8000
(970) 691-6285
1 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 exit 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: f, t
3
m
❑ Building Owner
Contractor
❑ Other
Date:
0 U
Signature: Print Name:
THIS Box Is FOR CDPHE USE ONLY:
Postmark or Hand Delivery Date: ,� 4 Approved By: Code: 'R initial-310 ❑ transfer-380
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Form of Payment & #: /
Permit #:
Record #
Date Issued:
Regulated asbestos -containing materials mans (a) maple asoesios-comammg matenai, (u) udiegury I nUIIII IGUIe MUM Ulct nca ucwuic u,cvm, M
Category I nonfriable ACM that will be or has been subjected to sanding, grinding, cuttin , 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 act on the material in the course of
demolition or renovation operations regulated by this regulation. Note: Asb1 sptot�sxnon(ein�l�'ngsheet vinyl and linoleum must be properly
abated/removed prior to demolition. I� g ;A' � � u � �/ rff
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