HomeMy WebLinkAboutFile Documents.905 Chatfield Rd.0111.2018 (154).ARBK Feb, 21, 2019 3 : 59PM Air Pollution SSP No, 9274 F. 1
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• Submit form to:
IN tiliEi
o Permit Coordinator
DEMOLITION NOTiFICATRON LICATION FORll Colorado Dept.of Public
MI * * Health and Environment I
* '4 ^ 4- APPLICATION FEE MUST Acw i,VIPANY THiS FORM APCD-IE-B1 1
/8,6 I��jj 4340 Cherry Creek Ddve
— INCOMPLETE APPLICATIONS Ih[_ BE RETURNED sou 1
u,
Colorado Depattmenc (Notice will be mailed to the demolition Cb`liti c or unless specified otherwise) Denver,CO 00246.153a
of Public Health Phone:303-892-3100
and Environment Fee; $50 + $5 per 1000 ft2 of area to be demolished $ 85.00 Fay: 303-782-0278
(See instruction ill on reverse side) Asbeatos{�alete.co.us ,:
vr.r _
Company Name:
Building Name:
G.F.Woods Construction 905 Chatfield ii
Street: Square footage of footprint or facility or portion Vacility to be demolished 11
o` 430 E Hyman Ave 6100 11.
City; slate: Zip Code; Skeet: IE.
Aspen CO 81611 905 Chatfield
OTelephone u Fax u 0 City: n Zlp Code: II
0 (970)544-1833 (970)544-1832 o Aspen a,4 81611 il
Project Manager: Cell Phon # 5.�3 P oposa ate v`gg��osff l�CornJ�etion Date li
o Bryan Scott ,S '1 "65�63 0 I(J.`l l/ r
d= I certify that the Certified Asbestos Butldli,y..,,.,,,, ,vr'iab informed me ethod/M s o Demolition;
o about any remaining asbestos-containing materiels In the facility to be O #,
demolished. t €
Si elute; f ' Pd Namo: / Wreckingni El Burning LI Implosion In Moving ❑other,specify: V
L.y
G
� : -Ik.0..i.
//LLen r Re eMng Buildi g Debris: r
/ Burning requires additional authorization-Please call(303)092-3100 and ask
"I i ;./ COu � to speak to the Open Burning Permit Coordinator 1
Genet b ement Corftraelor(SAC) Owner's Name;
Dill Silverstein4.
p al .2 CDPHEAsbestosPermit# TotalOuandtyofAsbestosRemoved g Street:
U a " 1569 Forest Ave
N ac Dale Removal Completed Telephone# Cn
C City; Stale: Zip Code
d re U ( ) "5 Highland Park 11, 60035
Type(s)of Asbestos-Containing Material Removed; 1 n m Contact's Name; Telephone#
�lll7'Y�l` Bill Silverstein (773)505-0807
With my signature below, I certify that(`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
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
m facility.' I also certify that I have informed the owner/operator of the facility or the demolition contractor that any 11
to ,o asbestos-containing material allowed to stay In the facility must remain non-friable during demolition_ Specify type(s)
2
1 of ACM remaining, below: (check appropriate box(es)):
8 t: K
u) t ❑Vinyl asbestos floor tile(VAT) ❑VAT mastic❑Tar/asphalt impregnated rooflr> ` a pl{alt tin s
a a IIa 9 ,„
c. d Spray-applied tar coatings [' Caulking ❑ Glazing ❑ Other, specify:
t• Signature:(tn.Blue Ink) f. •., , - Printed Name: /�r�
r ` / t i.,- NG/22/2O19 I
V •
ale of final Inspection CO pert# Expiration pate Telephone# Cell¢tviii N •
I verify that ail refrigerants from air conditioning/refrigefation appliances have been properly recovered in accordance With AQCC Regulation No. j
15(for Information on CFC requirements call 692-3100).I further verify that all luminous exit signs(containing radioactive material)have been
c11
w 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). I'
1,... 0CHECK THE APPROPRIATE BOX: ::
Z7 G r • ; Ii
CO O C ❑ 9utidln owner r =i Contractor El Other Date: 1.t, 19 IF
v Signature: i i Print
N I.
!'..` r A/i.
• THIS ROX(s FOR CDPHE s. ONLY.
Postmark or Hand Delivery Date- " I Approved By: j e '' Code: �-� initial-310 ❑transfer-380
• Form of Payment&#: c L /c f_)D Z9 t-i ,c Permit#: Record# { Date Issued:
*Regulated asbestos-containing materials means(a)friable asbestos-containing material,(b)Qeg-ory I nonfriable ACM that has become friable,(o)
Category I nonfriable ACM that will be or has been subjected to sanding, rig nding,cutting,or abredin,' or(d)Category II nonfriable ACM that has a high
probability of becoming or has become crumbled,pulverized,or reduceSl\(olp +({ tmd i tty;(h'�.�Qf s:e�C¢ clad to act on the material In the course of
demolition or renovation operations regulated by this regulation, Not,':•� b Ai Iita ni3 sheet r I and linoleum must be properly •
abated/removed prior to demolition_ , •�,,,II / ' 9�{t;:L 'U ik,�
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