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HomeMy WebLinkAboutFile Documents.975 King St.0043-2020-BRES (7) OF•COL, $' oitte Submit form to: TO Permit Coordinator *%,' ° DEMOLITION NOTIFICATION APPLICATION FORM Colorado Dept.of Public Health and Environment * * APPLICATION FEE MUST ACCOMPANY THIS FORM APCD-IE-B1 1876 / INCOMPLETE APPLICATIONS WILL BE RETURNED 4300 Cherry Creek Drive 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 + $5 per 1000 ft2 of area to be demolished = $ 65 Fax: 303-782-0278 Asbestos@state.co.us (See instruction#1 on reverse side) Company Name: 1 Building Name: Kaegebein Fine Homebuilding I 975 King St Street: Square footage of footprint of facility or portion of facility to be demolished 16 225 Main Street 2,507sf r City: State: ` Zip Code: Street: C.) CIS Carbondale CO 81623 12 975 King St C Telephone# Fax# Cl) City: County: Zip Code: o (970)379-6228 ( ) o Aspen Pitkin 81611 V Project Manager: Cell Phone# w Proposed Start Date ' Proposed Completion Date o Charlie Berger (970) 618 7493 p 1.19.21 2.19.21 I certify that the Certified Asbestos Building Inspector has informed me E Method/Means of Demolition: p about any remaining asbestos-containing materials in the facility to be d E demolished. d 1 1 0 Wrecking 0 Burningt 0 Implosion 0 Moving ❑Other,specify: 0 SignfIl e: Print Name: f i Charlie Berger Landfill Receivinuiloing bris: t Pitkin County Landfill Burning requires additional authorization—Please call(303)692-3100 and ask to speak to the Open Burning Permit Coordinator General Abatement Contractor(GAC) ` Owner's Name: Rocky Mountain Abatement, Inc. c Robert Alpert p is r CDPHE Asbestos Permit# Total Quantity of Asbestos Removed 3 Street: u o t) 20PI5611A 1952 SF O 8214 Westchester Dr., Suite 950 E C Date Removal Completed Telephone# a) City: State: Zip Code: Q re V 09/30/20 (30j) 932-1767 ° Dallas TX 75225 Type(s)of Asbestos-Containing Material Removed: m Contact's Name: Telephone# Wall Texture& Sheet Vinyl Tiffany Phipps (970) 901-7613 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 o in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of a I asbestos by a NVLAP-accredited laboratory, and have determined that no Regulated ACM exists anywhere in the c = facility.* I also certify that I have informed the owner/operator of the facility or the demolition contractor that any N o asbestos-containing material allowed to stay in the facility must remain non-friable during demolition. Specify type(s) N a of ACM remaining, below: (check appropriate box(es)): 13 Q v ❑ Vinyl asbestos floor tile (VAT) ❑ VAT mastic CITar/asphalt impregnated roofing ❑Asphaltic pipe coatings ❑ Spray-applied t ti Caulking ❑ Glazing ❑ Other: s) Signature:(In Blue Ink) Printed Name: ]� V Xou /uS 4 C/dSe U Date i I e .0 I CO Ce I Ex/Cra ye Telephone#._. 339j Cell alone e# 6`O_33�/ I verify tt at alVrefrigerants from air conditioning/refrigeration/e appliances have beenproperly recovered in accordancen with AQCC6 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� 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). N ` CHECK THE APPROPRIATE BOX: . c 4. n m 3 ❑ •Building Owner C tractor ❑ Other Date: 1 O V Signature: Print Name: . Charlie Berger THIS Box IS FOR CDPHE USE ONLY: Postmark or Hand DeliveryDate: 1/5/21 Approved B : (APPROVED , I Code: initial-310 Pp y [By SEK at 3:55 pm,Jan 06,2021 © � 0transfer-380 Form of Payment&#: 153454950-$65 Permit#: Record# Date Issued: *Regulated asbestos-containing materials 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,grinding,cutting, or abrading or(d)Category II 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 demolition or renovation operations regula CAPPROVED jeum must be properly abated/removed prior to demolition. Formm.1318A08 By SEK at 3:55 pm, Jan 06, 2021 Res. 01/30/08