HomeMy WebLinkAboutFile Documents.688 Spruce St.0119-2020-BRES (27) ot• cozo.,
4,ti L? Submit form to
c r;;.=> Permit Coordinator
(y I Colorado Dept of Public
; . , DEMOLITION NOTIFICATION APPLICATION FORM
-• ' APPLICATION FEE MUST ACCOMPANY THIS FORM APCD fE-Bt Environment Health and
'r f 8 4300 Cherry Creek Drive
INCOMPLETE APPLICATIONS WILL BE RETURNED South
Colorado Department (Notice will be mailed to the demolition contractor unless specified otherwise) Denver.CO 80246-1530
of Public Health Phone.303-692-3100
and Environment Fee: $50+$5per 1000 ft2 of area to be demolished=$ 65.00 Fax: 303-782-0278
Asbestas@state.co.us
(See instruction#1 on reverse side)
Company Name: Building Name
Avalanche Excavation Private Residence
Street: Square footage of footprint of facility or portion of facility to be demolished
o
City I State Zip Code: Street
03 Silt CO 'i()c), lb
4., I 688 Spruce St.
1"-'_
Telephone?1e� !,. /� Fax# N City: County Zip Code:
6 ( 1�70) 9-7✓.L1-D 4,I q i (�_ ) /V 4 p Aspen Pitkin 81611
0 Project Manager ' Cell Phone�-1# ^ r Proposed Start Date Proposed Completion Date
o Dustin Cheney (�O) c) r()ro).(G l'I�y O 9/15/21 10'15/21
I certify that the Certified Asbestos Building Inspector has informed me E Method/Means of Demolition:
O about any remaining asbestos-containing materials In the facility to be 0)
�_ E demolished
p� rgnature: Print Name: ®Wrecking 0 Burning' 0 Implosion 0 Moving 0 Other,specify
Dustin Cheney
Landfill Receiving Budding D cis
Pitkin County or Garfield ounty Landfills Bunting requires addktonai authorization Please call(303)692-3100 and ask
:o speak to the Open Burning Permit Coordinator
General Abatement Contractor(GAC) L j Owners Name:
L Quetzai Environmental W MNKN.LLC
p > V CDPHE gsbestos Permit# Total Cuantity of Asbestos Re, ved O air 688 Spruce St.
0 c 2 21P11106A 1 (�;Uy0 59. VI. 0,
. C Date Removal Completed Telephone ki, G
r.,, C City: State: t Zip Code:
$ m
V 0 3- I�-; 0 I (3C- ) 1e- S,5S7 T3 i Aspen,CO 81611 CO 1 81611
Type( of Asbestos-Containing Material Removed: m Contact's Name: Telephone#
L)(Lb IAA I I i VI ill ON I Jennifer Goldfarb ( 970 ) 379-2091
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
u in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of
a asbestos by a NVLAP-accredited laboratory, and have determined that no Regulated ACM exists anywhere in the
c c facility.' I also certify that I have informed the owner/operator of the facility or the demolition contractor that any
too asbestos-containing material allowed to stay in the facility must remain non-friable during demolition. Specify type(s)
y r of ACM remaining,below: (check appropriate box(es)):
mtc
.0( ❑Vinyl asbestos floor tile(VAT)❑VAT mastic❑Tar/asphalt impregnated roofing 0 Asphaltic pipe coatings
.0 U ❑Spray-applied tar coatings❑Caulking 0 Glazing❑Other, specify:
m Signaturer{!n lue Ink) ����� Printed Name:
m `r El(eii 3elidr/Soil
U Date of Final Ins ctipn NIL; ert II E cation Date Telephone Cell Phone#
03-ac-. 0,11 3-7g01 off-l Q- -o:�.). 1 (`rio) ly-3(3`l (c170)3(c4 :3 "
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).I further verify that all luminous exit signs(containing radioactive material)have been
`o 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).
Qt co CHECK THE APPROPRIATE BOX:
CO O C ❑ Building Owner In Contractor 0 Other Date: 8/1/21
° Signature; Print Name:
2 1-'344 /�Q!r/i d 04, I Brian Pearson
Postmark or Hand Delivery Date: a ECEIVED at 2:00 pm,Aug 10,20
THIS BApproved ByShort :is FOR CDPIIF l ter nur V.
__ [APPROVED 1
By Wes Short at 2:00 pm,Aug 10,2021 Co ' ❑initial-310 II transfer-380
Form of Payment&#: 172953914 - $65 Permit* Record# Date Issued:
•Regulated asbestos-containing materials means(a)__s $ 1 a< s c c:t 0_ ::a:in,(b) that has become r al:-,,,-,(c)
_ ,, nonfriable ACM that will be or has been subjected to sanding,:-1 .. .•:nr.,or abrading or(d) ,::qc-, .•nonfriable ACM that has a high
probability of becoming or has become crumbled,pulverized,or reduced to powder by the forces expected to act on the material in the course of
or: ,.;!!_.,,,operations regulated by this regulation. Note:Asbestos-containing sheet vinyl and linoleum must be properly
abated/removed prior to demolition.
APPROVED
r.,r*, W.:Au<
By Wes Short at 2:00 pm, Aug 10, 2021