HomeMy WebLinkAboutFile Documents.309 Oak Ln.0021-2022-BRES (37)C°!°frarfupceE#thent
andEnvironment
DEMOLITION NOTIFICATION APPLICATION FORM
AppLicATioN FEE MusT AccoMPAri¥ Tiits 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 = S
(See instniction #1 on reverse side)
Submit form to:
Pemit Coordinator
Colorado Dept. of Public
Health and Environment
APCD-lE-B1
4300 Cherry Creek Drive
South
Denver, CO 80246-1530
Phone : 303J592€100
Fax: 303-782J)278
AsbestDs@stafe.co.us
Ie
Company`Natne:__I£as BtiiidingName:
SH Built Canpalgre Residence
Street:Square footage Of footpririt Of facility or portion of facilfty to be demolished
314 Aspen Business Ctr, Ste. 8 1,382
City: State: 81611 Street: 309 Oak Ln®9t:Aspen CO
Teleohone # I Fax #City: I Pitkin cnty. I zio code:aaIa-(970) 923+ 122 (any@shbuilt.com ..i_a'=Aspen- I I 8161r
Project Manager:Cell Phone #Proposed start Date Proposed completon Data
hfudian Erwin (970) 309-0371 i5E 08/01 /2022 , 01 /30/3023
I cerrify that the Certified Asbestos Bu ilding Inspector has informed me Method/Means of Demolition:H\/\heckingIBumingtIlmplosien H Moving X Other, specify:a about any remaining asbestoscontaining materials in the facility to be a'a
E®a demolished.
Signature:Print Name:
Madian Erwin NIOSH 7400
Landfill Receiving Building Debris:tBuming requires additional author[zation -Please call (303) 692-3100 and ask
Yes to speak to the Open Burning Permit Coordinator-General Abatement Contractor (GAC)I®5 Ormer's Name:a>!iJ2&Quetzal Environlnental #468 Chris Campaigne
CDPH E Asbestos permit # Total Quantity of Asbestos Removed Street: 309 Oak Ln.
Cmly appr'ovar by 22gstfro'6'rviHjt
Trevor S a)I5
Date Removal completed I Telephone #I Aspen CO I 61611
7/1 22 (303) 956-8586 Im'
Type(s) of Asbestos-Containing Material Removed:Contact's Name: Telephone #
ACM vinyl sheet Chris canpaigne (719) 293-0513
Ia
`vi:rm ffiy si-giiatu`i`e b€tow, i ceiifty th.at i possess lit-Ti`€ift AHERA a-th+edifeaEit5'n~ arid sirate Of-C.6iorfide eefffiffiGati.en as
an Asbestos Building lnsp ector. I also certify that I ha ve tho roughly inspected the facility to be demolished, as listed
i;jn the Demolition Site bloc k above, sampled all suspect materials, had all samples analyzed for the presence of
®CL asbestos by a NVLAP-accredited laboratory, and have determined that no Regulated ACM exists anywhere in the0==facility.* I also certify that have informed the owner/operator of the facility or the demolition contractor that any
co.9 asbestos-contain ing in ate rial allowed to stay in the facility must remain non-friable during demolition. Specify type(s)
£ .¥ i Of ,cea,4 renainng, beky9,J: {Sfaeeek apprcp#ate be3±{es}}:
?5a'L='Ea't}
I Vinyl asbestos floor tile (VAT) I VAT mastic I Tar/asphalt impregnated roofing I Asphaltic pipe coatings
I Spray-applied tar coatings I Caulking I Glazing I Other, specfty:--------I---dif`:::::\\I{:I..:ft``{..---=-`_-==i_i€ .;a-. `+-ir--;a: (i.-,,.;
Dat6°¥':aj&grfuTa°3Cirtc,#ci I 5X5ra.ti#.a5o ,2?3 i Telephone #( 9?Li `a?4/,--?/ 3q ; Ce" Ph°:e&?ca -366`3383
!j!
I verify that all refrigerants from air conditioning/refrigeration applia nces 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
disposed of in accordance with 6 CCR 1007-1 subpart 3.6.4.3 (for information on luminous exit sign requirements call 303€92-3320).
CHECK THE APPROPRIATE BOX:
I E] Buildingowner i E] Contractor i E] other i DateI signetwe:PeiRt` Name:
THIS Box IS FOR CDPHE USE ONLy:
PQs_t.m`a_rk o_r Ha_nd_ QeJ`ive_ry Da_t_e_: Asp.ro_ve_d_ fey.: i GQ¢.Q; E` injti`atral`Q E tr`ansf`er`-3ee
Forrtt ofpaym-enr& # PeTmtt# I Re-c-orti# I Date ls"ed:
* Regulated asbestos-containing materials means (a) friable asbest.o_s-.gontainLn.g.pr_aj§[ia|, (b) Qjgt?^qorv I Don_friable ACM that has become friable, (c)
Cateaorv I nonffiable ACM that will be or has been subjected to sanding, arindina, cutting, or abrading or (d) Cateaorv 11 nonffiable 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
demolition or-reno`v'ation operations regulated by this regulaton. Notei Asbestos-containing-sheet vinyl and linoleum must-be-pTapedy-
abated/.rem®vedpriortodemdition.
5
Pitkin County Solid Waste Center
x
Madian Erwin
Digitally signed by Madian Erwin
DN: C=US, E=madian@shbuilt.com,
OU="SH Built ", CN=Madian Erwin
Date: 2022.07.25 15:23:55-06'00'
Madian ErwinMadian Erwin
Digitally signed by Madian Erwin
DN: C=US, E=madian@shbuilt.com, OU="SH Built ",
CN=Madian Erwin
Date: 2022.07.25 15:24:51-06'00'
60.00
By Cody Archuleta at 11:47 am, Jul 26, 2022
By Cody Archuleta at 11:47 am, Jul 26, 2022 X
191006186 / $60
By Cody Archuleta at 11:48 am, Jul 26, 2022