HomeMy WebLinkAbout1129 W Oak St - Applications/Demolition - 03/14/2018DEMOLITION NOTIFICATION APPLICATION FORM
APPLICATION FEE MUST ACCOMPANY THIS:FORM
INCOMPLETE APPLICATIONS WILL BE RETURNED
(Notice .wilt be:mailed`to the demolition contractor unless specified e)
Fee: $60 + $t par 1000 ft2 of area to'be demolished m $
(S"'Ins tructiorc#1 on ravers 91de).
Sub -MA km W
Parml Courtanator
Cdwaao DWL of Public
Heenh anct Environment
APCD-ie-8ti
4300 Cnar,y Civek DO"
South
Denver: co 9D24s-i 53D
Pt m 303b823100
Fax 303-7e2-0278
Asbe amteco.us
Compaq Name: /
Buckling Noma:
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Proposed Start Gate
P etion Date
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I:oertity that the Certified Asbestos BuKTQ Inspector has informed ne
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about" remaining asbastos.containing materials in the facility to be
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t Buming requires add�mitMrizetiononal - Please call (303) 6923i00 and ask
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CDPHE Asbestos'Pernul #
Total Quantity of Asbestos Removed
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Date Rarnmi campieted
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Types) ofAsbestoa•ContaWng Material Removed:.
Name:
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°Wtth:rny signature ielow, I certify that I possess current AHERA accreditation`and state of Colorado certification asp: '
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an Asbestos Building Inspector.; I also certify that I have thoroughiyy inspected the°facility to be demolished, as"listeii
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in the Demolition, Site:blo&above„ sampled all suspect materials; had ail samples analyzed for the present& cif
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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 t have informed the owner%operator of the facility or the demolition; contractor that any
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asbestos -containing material allowed to Stet in the facility must remain non -friable during demolition. Specify type(s)
of ACM remaining; below: (check appropriate box{es)):
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❑ Vnyl;asbestos floor file (VAT) ❑ VAT mastic ar/asphalt impregnated roofing ❑ Asph�aillfic pipe coatings'
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Signature:._., trslnk) - -
Printed Name:
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Brett Darco -
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Data I
Co cen #
Expiration Data
Tt phme # CeA Phone #
12584 i
07113/;l'-
970 222-5849 970 222-6849
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i verflythatell refrigerants from air conditioninglrefligerafion appliances have been property recovered in eoeodence with AQCC Regulation No.
15 (for information on CFC requirements call 692-3100).1 further verify that all luminous exit signs (containing radkm dve material) havei
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diseased of in adordance with 6 CCR 1007.1 subpart 3.6'.4.3 (forirrfon-atioI on`luminous exit sign requirements call 30.3 3320r
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THIS Box is FoR CDPHE USE ONLY:
Postmarkor Hand Da6very Data. 03 fd 1 g
Approved By. —
Code: initial-310 ❑ transfer-380
Farr) of Payment& #. LIr A 31
# 1=R=J�=
Date Issued: