HomeMy WebLinkAbout639 S COLLEGE AVE - APPLICATIONS - 8/8/2014%coz
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ASBESTOS ABATEMENT PROJECT MANAGER
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WAIVER APPLICATION
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Building Owner 5Ow1L( (OQ�2 tP
SUomlt loan to
Permit Coordinator
Colorado Dept of Pubbo IInaiih
and Env,roarent
APCD-SS-R1
4300 Cherry Creek Onve SULth
Deriver. CO 80246.1530
Phone 303052-3100
Fax 303-702-0276
Street �/ aK4 4"'A V14✓c --
City &,-4 State G0 Zip Code
Phone Number (,g 6,
Building Name
Street (o7A 9 1'
City date- -
Abatement Contractor
State
Zip Code SOS .)y
GAC# z— '
Project Manager Waiver
Colorado Regulation No. 8, Part B, requires that project managers be used to monitor asbestos abatement projects in which
the amount of friable asbestos containing material exceeds 1000 linear feet or 3000 square feet. This requirement may be
waived if the contractor performing the abatement has a history of compliance with Regulation No. 8, or if the building owner
can demonstrate that this requirement is overly burdensome or not feasible by providing a written explanation below.
Check which condition applies:
The abatement contractor has informed me that they have fewer than two compliance determinations with a finding
of guilty in the preceding two years.
For the above project, the project manager requirement is overly burdensome or not feasible. I request a waiver
from the project manager requirement for the following reason(s). Please attach additional pages if necessary.
I understand that use of a Project Manager is an effective means of ensuring the project is properly conducted in compliance
with applicable regulations.
I, the undersigned, hereby certify that the aforementioned statements requesting the waiver are true to the best of my
knowledge and request that the requirement for a project manager be waived for the duration of this asbestos abatement
project. t
Building Owner or Legal,Agent (print name) Signature
The foregoing instrument was acknowledged before me this (month/day/year)
My commission expires (month/day/year)
Witness my hand and official seal. J{
JAINELLE STULTS Notary Public (sign)
NIOTP V P�EI.!C
STATE CIF COLO'SIAJO
g NOTARY II) 2009=r012516
1 MY Coh1MISSION EXPIRES APRIL 21, 2017
t,.. Rev 3/03, J:Wsbestos and Lead UlitsWsbeslos Fonns\PubaclPrefecl Manager Waiver ]ec
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IS1'76
Colorado Department
of public Health
and Environment
ASBESTOS ABATEMENT NOTIFICATION and PERMIT APPLICATION FORNI
FEE MUST ACCOMPANY THIS FORM. INCOMPLETE APPLICATIONS WILL BE RETURNED.
iSingle Family Residential Dwelling (SFRD) — �Pubfi�c�Commercial Building, School, and Single -Family
>50 LF or32 SFora 55-gal. drum,buts260 LF or160SFora55-gallon drum 260 LF or 160 SF or a 55-gallon drum
[ code 2901 L1 s3uu au-ua rernur -
code 265 ❑ 5420 365-Da Permd [code 165/267 ] ❑ y1200 365-Da P&C/SFRD Permit
[ code 1801280 ] ❑ $55 Notice or Permit Transfer [ code 1771 ❑ S80 phase Permit #hase f Multiple I
Submit form to.
Permit Coordinator
Colorado Dept. of Public Health
and Environment
APCD-IE-BI
4300 Cherry Creek Drive South
Denver, CO 80246-1530
Phone: 303-692-3100
Fax: 303-782-0278
asbestos@state.co.us
Abatement Site
Building Owner
Abatement Contractor
Company Name
Building Name
Vacant Buildin
Owner Name
South College 639, LLC
Air Protek, Inc7wilng-etc.)
Specify location in the ouilding where workwilltaplace (e.g. floor, rooStuart
ContactStreet
MacMillan
Address
Entire Building
3340 South Uticva Street
City
State i Zip code
Street Address
Street Address
262 E. Mountain Ave
Denver
CO 1 80236
639 South College Ave
State code
Tclranhnne it 1 Fax #
County Zip code
City _ tY
_ anwn
City
Ft. Collins
!Zip
CO _ 80524
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Project Personnel
CO Project Mgr. Name
waiver
Cell Phone # CO Project Designer fi#
( ) N/A
CO Project Designer Name
Scott Sander
Cell Phone # CO Project Designer #
633
-.....
Bill Warren (970) 227-1976
Project Information
e 1 End Date
8122/2014 912112014
1e End Time
8.00 AM PM I AM 4:30 PM
Emergency? Type of ACM: TSI, Texture, VAT, etc.
Y❑ N® Texture, VAT and TSI
Linear Feet / Type Square Feet/ Type : 55 gal. Drums
one#
! Fax#
221.2636
1 ( ) I
Disposai Site
IName
Tower Landfill
Address
88'" and Tower Road
CDPHE Use Only
Postmark or Delivery date Af
code
Consulting Firm Name Kegmr 14909 i
Sunrise Environmental
rPermit
ayment & # PM req'd?
A.M.S. Name 2600 TSI i 101000 Texture Y N W
Scott Sanders i 800 VAT i I Record # Date Issued:
Cell Phone # CO A-M.S. Cert #
(720) 209.5282 1 633
Please describe below the work practices and procedures to be employed in conducting the abatement of asbestos. BE SPECIFIC. Indicate type(s) of ACBM to be abated (e.g. VAT,
ceiling tile, TSI, etc.). Use another page if necessary.
Removal of approximately 10,000 sq feet of textured drywall walls and ceiling, 800 sq feet of VAT, and 2600 linear feet of TSI under full enclosure. Full enclosure will be under -.02 HG pressure, and waste will be
direct loaded for disposal. All work shall be completed in accordance with CO Regulation # 8