HomeMy WebLinkAboutFile Documents.1130 Black Birch Dr.0096.2018 (35).ARBK Colorado Department of Public Health and Environment
Air Pollution Control Division — Indoor Environment Program —Asbestos/IAQ Air Unit
4300 Cherry Creek Drive South, APCD-IE-81
Denver, Colorado 80246-1530
Phone: 303-692-3100 — Fax: 303-782-0278
E-mail: asbestos@state.co.us
D E._ S ITIO `APPROVAL NOTICE
This approval notice is granted.subject to Colorado Air Quality Control Commission Regulation
No. 8, Part B, adopted Dece nber 21, 2007, and effective January 30, 2008 and the Colorado Air
Pollution Prevention and Control Act C.R.S. (25.-7-101 and 25-77501 et seq). This notice signifies
that the structure was inspected for:asbestos, luminous exitigns (containir g,radioactive material),
and Ozone-Depleting Refrigerants and the':demoiition.;contractor has properly notified the
Colorado Department of Public'Health and Environment pursuant to.Regulation No. 8, Part B.
i
As a contractor,you maybe subject to other demolition licenses and permits,;depending on the
requirements of the county and-municipality in which''the,work is being performed. The Colorado
Department of Public Healthand:Enviionnient, Aur,Pollutior Control Division, strongly suggests
that you check with county:and tnutnicipat authorities.in'order to determine:any other local
building/permitting requirements that must be met. .
Please note that certain asbestos-containing materials (ACM) may in the structure
during demolition. Therefore, any demolition debris left behind after the completion of post-
demolition site cleanup may constitute a.'.'reason to.know of asbestos-contaminated soil" at
the site, subject to the requirements of Section 5.5 of the Solid Waste Regulations (6 CCR
1007-2, Part 1).
THE ORIGINAL APPROVAL NOTICE MUST BE POSTED ON SITE AT ALL TIMES.
Immediately notify the Asbestos/IAQ Unit of project modifications by fax(number above) or e-mail
(address above) and the appropriate county health department by fax. Project modifications include
changes in the scope of work or the scheduled work dates, etc.
This demolition approval notice is valid beginning 11/1/2018.
The actual scheduled work dates are from 11/1/2018 through 11/30/2018.
Approval issued on: 9/21/2018
Record number: 141761 Fee Paid: $55.00
Notice Number: 18PI6046D • Check number: 1967
For the location specified below:
Asbestos Building Inspector:
Garage Structure Douglas A.Close
Cerification No.: 2930
1130 Black Birch Dr.
Aspen
Pitkin County Inspection Date: 11/27/2017
This notice has been issued to:
Korn,Ltd.
417 Main St. Suite Y
Carbondale, CO 81623 Issued b
9
QF.co unj,f,n,.(
�4 p Submit form to:
Permit*� tor
DEMOLITION NOTIFICATION APPLICATION FORM ColoraCoorpf of Public
Colorado De
* ', v# APPLICATION FEE MUST ACCOMPANY THIS FORM APCD IF Health and Environment
1
876 INCOMPLETE APPLICATIONS WILL BE RETURNED 4300 Cherry Creek Drive
Colorado Department South
1? (Notice will be mailed to the demolition contractor unless specified otherwise) Denver,CO 80246.1530
of Public Health Phone:303-692-3100
o Fax: 303-782.0278
an Environment Fee: $50 + $5 per 1000 ft2 of area to be demolished = $ 'jC -
(See instruction#1 on reverse side) Asbestos@state.co.us
CompanyName. Building Name: �' "
9v t%m • Name: r e Sf/-u.t7ccre
Street: D�U / Square footage of footprint f f cility or portion of facility o be demolished
° 1AA,� q to Si::
v City: Sae: Zip Code: Street: J
C '�i �q��� �Gt 623 A /130 P/uG/C g rd r'l-
T !phone# Fax# CO City; Co rpr C
/
i
U P olect Manager. Cell Phone#
c Pro tart gate o eGon Date,
° t UlblttA is (9 O ) z14' b ill( o A,� W �j ov
i certify that the Certified A bestos Building Inspector has informed me E Method/Means itlon. f
i O about any remaining asbestos-containing materials in the facility to be 0
E demolished. Ci
S natur i,.wrecking 0 Burning+.0 Implosion 0 Moving 0 Other,specify:
p,_, - r Pr' t Name: Q ,
\ Ceti i - \�iN4\\ 7 1\'t)ottp.-
Landfill Receiving Sul ng Debris: .Z .
T \_ I nWM tBurning requires additional authorization-Please call(303)692-3100 and ask
--- �l to s.eak to the O.en Bernie Permit Coordinator
General Abatement Contractor(GAC) Owners Name: •
a) '2 WVF,�KON j 0�RA\< I 11/(.___ •
p co 0 CDPHE Asbestos Permit# Total • entity of Asbestos Removed 3 Street:
A ° O 00l 13PTI_LtN � 5 i
cm
lE U Date Removal Completed Telephone# J City: 1,, I State:. Zip Cod:
Type(s)of Asbestos-Containing Material Removed: m Contact's Name: Telephone#
I N W kUOjv (CR6) ' l°l' ()Fde' 1
With my signature below, I 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
o in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of
o. asbestos by a NVLAP-accredited laboratory, and have determined that no Regulated ACM exists anywhere in the
l c facility.* I also certify that I have informed the owner/operator of the facility or the demolition contractor that any
t ,o_ asbestos-containing material allowed to stay in the facility must remain non-friable during demolition. Specify type(s)
. 03 of ACM remaining, below: (check appropriate box(es)):
a m ❑Vinyl asbestos floor tile (VAT)❑VAT mastic❑ Tar/asphalt impregnated roofing ❑Asphaltic pipe coatings
.a U 0 Spray-applie r-eeat'ngs ❑ Caulking ❑ Glazing ❑Other, specify:
w ),Sl9nalure:(in nk) Printed Name:
w jaeec ,5 4 _ C
/ Cate o Tina I on C •Cert# Expiration Da e Telephone# Cell Phone
1I 7- 7 q3o /z- .S-tor (Po) a3.?zf( I fie )le. 33
I verl at all refrigerants from air conditioning/re riger lion appliances have been properly recovered in accordance with AMC Regulation No.
`
15(for information on CFC requirements call 692-3100).I further verify that all luminous exit signs(containing radioactive material)have been
a, p 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).
a ' c CHECK THE APPROPRIATE BOX:
c ,.
m C
U El Building Owner Q Contractor ❑ Other n
Date: U I - 7
Signature:t Print Na e: J t (
\--J(?•,!"-A 6 '.\: ),I‘ )45R • 61611QZ
�(//�/ (/ THIS Box IS FOR CDPHE Use -NLY:
f/l0'- /D
Postmark or Hand Delivery Date: Approved By: Code:I ,e'Initial-310 ❑transfer-380Form of Payment&#: (�ilay -17('? cc 00 P it#. pf
( 'l� }� Record 4. 7�n!I Date Issued:
(--1 r r r f� r 111
.Regulated asbestos-containing materi Is means(a)friable asbestos-containing material,(b)Category i nonfriable ACM that has become friable,(c)
Category I nonfriable ACM that will be or has been subjected to sanding,orindinq,cutting,or abrading or(d)Category II nonfriable ACM that has a t)igtl�
probability of becoming or has become crumbled,pulveriz,��..d Qr dc`e�l o poyvder by the forces expected to act on the material in the course oft, ,,+�1
demolition or renovation operations regulated by this rr filet o .: •: let/A est ont rning sheet vinyl and linoleum must be properly -q tiO
abated/removed prior to demolition. t•
UP�-IEV31._ VCDPHE