HomeMy WebLinkAbout609 WHEDBEE ST - APPLICATIONS - 8/30/2018pF' COS
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Colorado Department
of Public Health
and Environment
61 ON)7 60
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 = $ 55.00
(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
Company Name:
Building Name:
A.V. Remodeling & Concrete Services
Detached Garage
Street.
1
Square footage off (print of facility or portion pf facility to be demolished
221 'l1Jj
3517 Boulder Street, Unit
+0-
City:
Stale:
Zip Code:
SireeL•
Evans
CO
80620
::
609 Whedbee Street
e
4
Telephone # G'
Fax #
rA
City:
County:
Zip Code:
0
970) - 1214
N/A
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Fort Collins
Larimer
80524
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Project Manager.
Cell Phone If
Proposed Ql- Dale
Proposed Completion Dale
9-30-18
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Rene Vasquez
432 257 - 6300
6
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I certify that the Certified Asbestos Building Inspector has informed me
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Mefhod/ eans of Demolition:
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about any remai ng asbestos -containing materials in the facility to be
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demolished.
t
Wrecking ❑Buming [I Implosion ❑ Moving ❑Other, specify:
Signature:
P 'nl Name: t p
O
t
Burning requires additional authorization - Please call (303) 692-3100 and ask
Landfill Receiving Building Debris:
1� /r- I ^
6.v-Lo-CR.r CL lbw t
to speak to the Doan Burnino Permit Coordinator
General Abatement Contractor (GAC)
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Owner's Name:
N/A per Inspection
Jordan Obermann
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CDPHE Asbestos Permit #
Total Quantity of Asbestos Removed
street:
in o M
N/A
N/A
of
116 N. College Ave STE 5
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Dale Removal Completed
Telephone #
City:
State:
Zip Code:
Q 0
N/A
( N/A
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Fort Collins
CO
80524
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Type(s) of Asbestos -Containing Material Removed:
Contact's Name:
Telephone ,#
N/A
Alex Henze
( 262 ) 313-7875
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
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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)
aM
of ACM remaining, below: (check appropriate box(es)):
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a)
a �
E] asbestos floor tile (VAT) ❑ VAT mastic ❑ Tar/asphalt impregnated roofing ❑ Asphaltic pipe coatings
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❑ Spray -applied tar coatin s ❑ Caulkin ❑ Glazin ❑ Other, specify:
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Signature: (In Blue Ink)
Printed Name:
tE
THIS APPLICATION IS FOR A PERMIT TRANSFER.
LEASE REFER TO ORIGINAL APPLICATION (ATTACHED)
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L)
Date of Final Inspection
CO Cad #
Expiration Date
Telephone #
Cell Phone #
( )
(
I verify that all refrigerants from air conditioning/refrigeration appliances have been property 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:
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M Building Owner
❑ Contractor
❑ Other
Date: 8-23-18
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Signature: Print Name:
Jordan Obermann
THIS BOX Is FOR CDP USE ONLY:
Postmark or Hand Delivery Date: g 30 ��
Approved By:
Code: ❑ initial,31ir transfer-380
Form of Payment & #, ( r a Qda
Permit III:
Record #
Dale Issued:
' Regulated asbestos -containing materials means (a) name asoestos-comalnmg material, to) category I numnaore muivi mat nab uecvrne Marne,�t,u}�t('
CategoryI nonfr)able ACM that will be or has been subjected to sanding, rip nding, cutting, or abrading or (d) Category ll nonfriable ACM that has l� gp
probability of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act on the material in the courseaf�♦
demolition or renovation operations regulated by this regulation. Note: Asbestos -containing sheet vinyl and linoleum must be properly (L`Y" 9,%\%
abated/removed prior to demolition. APPROVED
PRO 1I i(� D P�� nod
Form:DNAe8;;.A:)E//`�/a{3jOh���@�;')n,.'}9yb�`_ R..mnoroa
pF Co
ye j{vX3 s 90
f1
1876 +
Colorado Department
of public Health
andEavironment
61807460
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 = $ 515.00 'r
(See instruction #1 on reverse side)
Submit form to:
Permit Coordinator
Colorado Dept. of Public
Health and Env'ucnment
APCD-IE-B1
4300 Cherry Creek Drive
South
Denver, CO 80246-1530
Phone:303-692-3100
Fax: 303-782-0278
Asbestos@state.co.us
Company Name:
Building Name:
Forgla-st-Zovi eWin
Detached Garage
Street:
1 1v.GDl1 e- AvQ. 1 TE S
Square footage of footprint of facility or portion of facility to be demolished
221
L
ea
Stale: Zip Code:
Street:
VCity:
r} CIOWt
CO S06a4
;;
609 Whedbee St
C
U)
Telephone#
Fax#
City:
County,
Zip Code:
v
- 'ol
(N A)
c
Fort Collins
arimer
80524
Project Manager.
Cell Phone #
oposed
ro e pletion Dale
=
o
Alex z
Mc9�) 3, -7S-75
0
-a
-ay -18
I certify that the Certified Asbestos Building Inspector has informed me
Me eons of Demolition:
O
about any remaining asbestos -containing materials in the facility to be
al
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I:
d
demolished.
t
wrecking ❑ Burning ❑Implosion El Moving ❑Other, specify:
Eilcnature:
Print Name:
Ale -1tme
Landfill Receiving uilding Debris:
t
WAS 1iQ A e - Lla firh
Burning requires additional authorization — Please call (303) 6923100 and ask
LL m en e.r
to speak to the Open Burninq Permit Coordinator
General Abatement Contractor (GAC)
`
Owner's Name:
l `) A Per 1 n 1
2
J
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CDPHE Asbestos Persil #
N
Total Quantity of Asbestos Removed
3+
Street:
(�V �TF_5
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N 1
QV
VJDate Removal Completed
Telephone #
II
City:
State:
Zip CoGdea'``-t
'Removed:
�l t S
,
m
Type(s) of Asbestos -Containing Material
Contact's Name:
Telephone#
N 1 r4
A1er Henze
(Q Ca--7 -75
With my signature below, I certify that I possess current AHERA accreditation and state of Colorado certification as
c
an Asbestos Building Inspector. I also certify that I have thoroughly inspected the facility to be demolished, as listed
d
in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of
¢
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)
u
of ACM remaining, below: (check appropriate box(es)):
m t�
Q
ElVinyl asbestos floor tile (VAT) ElVAT mastic [ITar/asphalt impregnated roofing [IAsphaltic pipe coatings
v
❑ Spray -applied tar coatings ❑ Caulking ® Glazing ❑ Other, specify:
Gt
S' : (in Blue Ink)
Printed Name:
W
:E
m
Brett Darco
V
ate of Final Inspection
CO Cart #
Expiration Date
Telephone # I Cell Phone #
07/19/2018
12584
07/13/2019
970 222-6849 1 (970) 222-6849
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
pdisposed
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:
C .+
m03 �
L]Y Building Owner
❑ Contractor
❑ Other
Date-
U
SignaWre' Print Name:
OHIS
Box Is FOR CDPHE UsFrO LY ;onn
Delivery Date: S
Eof
Approved By: ��
Code: [ initial-310 ❑ transfer-38050ut
nt & #. 61I J4'Z(�0 � ' S_
Permit#:
Record #
Date Issued:
APPROVED
���� $��DPHE
OF CO(O
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1876
Colorado Department
of Public Health
and Environment
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 ftz of area to be demolished = $ G 5.00
(See instruction #1 on reverse side)
Submit form to:
Permit Coprl I?r 1
Colorado DDc�i'iR1i ofPP15A20
Health and Environment
APCD-IE-B1 APCD
4300 Cherrftemijwup
South SOurco 3
Denver, CO 80246.19 0
Phone: 303-692-3100
Fax: 303-782-0278
Asbeslos@stale.co.us
Company Name:
Building Name:
Forcite- + Sow Ow e n
Detached Garage
Street:
» Colt 5
Square footage of footprint of facility or portion of facility to be demolished
tv. eflve.
620
VCity:
2
a°'
Fore Collins
State:
CID
Zip Code:
805A4
Street:
609WhedbeSt.
C
Telephone #
Fax #
���
city:
County:
Zip Code:
Q
m 7q-? -a35L1
c
Ft. Collins
Larimer
80524
Project Manager:
Cell Phone #
Prope-ed Start Date
Proposed Completion Date
=
=
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A%A-x Henze.
aOa 3)3_�875
-4. •aoao
-i-1 -a6a O
I certifythat the Certified Asbestos Building Inspector has informed me
9 P
h:
Method/Means of Demolition:
O
F
about any remaining asbestos -containing materials in the facility to be
demolished.
N
4)
wrecking ❑ Burningt ❑ Implosion ❑ Moving ❑ Other, specify:
r :
P inl Name:
►4lex l�enz
t
requires authorization —Please call (303) 692 3100 and ask
Burningi,Q
Landfill Receiving Building Debris:
/
a&Ufii� fi(J w
to
to speak to the Open Bumin Permit Coordinator
en Bu in
General Abatement Contractor (GA
`
Owners Name:
L
w
N Per i'ns ecr ' a In
4)
6 a; n Fo
p W
"' "
O
CDPHE Asbestos Permit #
Total Quantity of AsbestoslRemoved
O
Street:
c90 wreclbee 5�.
(v L
(T
C
a
Date Removal Completed
Telephone #
C
City:
Collins
State:
Gc�
Zi Code:
osaLA
Type(s) of Asbestos -Containing Material Removed:
Contact's Name:
Telephone #
en Fo K
67 a1S-a1a4
With my signature below, 1 certify that I possess current AHERA accreditation and state of Colorado certification as
`o
an Asbestos Building Inspector. I also certify that I have thoroughly inspected the facility to be demolished, as listed
0
in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of
0.
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
rn 2
asbestos -containing material allowed to stay in the facility must remain non -friable during demolition. Specify type(s)
M
of ACM remaining, below: (check appropriate box(es)):
v
❑ Vinyl asbestos floor tile (VAT) El VAT mastic ElTar/asphalt impregnated roofing El Asphaltic pipe coatings
.O
❑ Spray -applied tar coatings ❑ Caulking ® Glazing ❑ Other, specify: 1- 2'x3' windo►v with glazing only
N
Sjgn r • (in -Blue Ink)
Printed Name:
(
ar
-
Brett Darco
0
ale f nal Inspection
CO Cart#
Expiration Date
Telephone # Cell Phone #
07/19/2018
12584
07/13/2020
970 222-6849 970 222-6849
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 exit signs (containing radioactive material) have been
C 00
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).
`
CHECK THE APPROPRIATE BOX:
mO C
ElBuilding Owner
Contractor
❑ Other
Date:
Signature:
Print Name:
Sordan 0bermann
THIS Box is FOR CDPHE USE ONLY.
nd Delivery Date: .40
Eof
Approved By: �
Code: rM initial-310 ❑ transfer-380
t & M C_1�140 i l ((�0 �r V 0
Permit M
Record # Date Issued:
roan: DNA08 7m"-
Rev.01130/08