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HomeMy WebLinkAboutState Demolition Documents5GANNh1:1 .0 urjti"l Submit form & Permit CoMina e DEMOLITION NOTIFICATION APPLICATION FORM Colorado Dept. of } * APPLICATION FEE MUST ACCOMPANY THIS FORM n Health la s1 Environment INCOMPLETE APPLICATIONS WILL BE RETURNED 4300 C" creek wive Colorado Depar=ent (Notice will be mailed to the demolition contractor unless specs e) Deriver, co 80246-1530 of IalicHealth Phone: 303-4192-MooandlnvirooA=t Fee: $50 + $6 per 1000 W of area to be demolished $ Fa��sbtee..eoaus (See Instruction #1 on reverse side) Regulated asbestas•writainirlg materials means (a) friable es stns -containing material. (b) Category I nonh iabia ACM that has become friable -(c) Category I nonftlable ACM that will be or has been subjected to sanding. Qrindim cuttinsr, at abrading or (d) Category 11 nonhiabie ACM that lta-higb probability of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act an the material in the couirswof demolition or renovati� operations regulated by this regulation. Note: Asbestos -contain j� lam¢ ifjl r u ust be properly abated/removed prior to demolition. A � �j�j 1/ C ` 0ATE11h�CDPHE &J_- a« nln �� r T/I:Q6pcl e8£t76£S6TLT:01 dSS N0iinl1­10d 8Id:w0.id 02:OT £402 -2T -00N pany Name: Mk Building Name: e. Sfru e street: Sq gs lootpn of reality er portion of raaluy to be demolished � s ta:uP Crod tra Telt: / 1119Q07— SU Fax s 7 C[hr !�-1 G cc�� `v � Zip Cade: � � o 0Rif li 'o FrOMM2na er To n CeR Phone * (aI`�D) 369 - Proposed Sten Date Pro on Date I -� I �--r 1 - [�- l k__ 1 certify thettne Certified Asbestos Building tr►Spectar has infanned rr>0 Methtxi/Means of Demolition: o about any remaining asbeslos-containing materials In the facility to be D y 0 Sip es :X::W�;� p Burning* © implosion p "ng C3 Other, speaty 4 riot Name t1,LL Landfill R ving Building DebNs ;Buming req additional author izatign — Plaaae call (303) 692-3100 and ask to s eak to s t} Burnina Permit Coordinator General temantCan (GAC) � l�rrd/1/f1�i17� owner's Name: L er0 o a! COPHEA&MlosPermitt Total Quantity of AS �ed 70j. streak R d u) � 13 G� a�ol3 131I Date R al Cgnr o ZS 3 'MeJ2 Telephone # %0. .5-7-9— ON 7 State: Zip Code: (p2 3 A „d02Lt ca m T (Ji) AlblStw�cyntaini g atsri oved:. �vr�11 SiG�rhI Contatra Name- Telephone ill r+` S/1t itSr}� ILI -;)Dl _ 71 With my signature belath, I certify that I posses urrent AHERA accreditation and state of Colorado certification as o an Asbestos Building Inspector. I also certify that 1 have thoroughly inspected the facility to be demolished, as listed Q, in the Demolition Site block above, sampled all suspect materials, had all samples analyzed for the presence of asbestos by a NVLAP-accredited laboratory, and have determined that no Regulated ACM exists anywhere in the facility.* i also certify that I have informed the owner/operator of the facility or the demolition contractor that any 0 asbestos -containing material allowed to stay in the facility must remain non -friable during demolition. Specify type(s) of ACM remaining, below: (check appropriate box(es)): aE] Vinyl asbestos floor the (VAT) El VAT mastic C)Tarlaasphalt impregnated roofing El Asphaltic pipe coatings ❑ Spray -applied tar coatings ❑ Caulking ❑ Glazin ❑ Other, a ci . k m S nature: (in Blue Ink) Printed Name: V Date or F1 al I z CO cert s �Q to e r I Telephone 0 ( v) , 64�r, ceu Phone >x xD) M 33� 1 verifyr all refrigerants m air conditioninglrefrigeration appliances have been properly recovered in acw once wish AQCC Regulailon No. 15 {for information on CFC requirements call 592.3100). 1 further verily that all luminous exit signs (containing radioactive materiaq have been cis io disposed of in accordance with 5 CCR 1007.1 subpart 3,6.4.3 (for information on luminous emit sign requirements call 303-592-3320), 30 >y CHECK THE APPROPRIATE BOX: I C G t�uift Owner � contractor ❑ Other Date: � 3 i3 signature: Print Name' THIs Box is FoRa QPHE USE ONLY: Postmark or Hand Delivery date: lll Approved By: w Code: Initial -310 ❑ transfer -380 Form of Payment at, N: 39161J&Q Permit #: Record # Vale issued: Regulated asbestas•writainirlg materials means (a) friable es stns -containing material. (b) Category I nonh iabia ACM that has become friable -(c) Category I nonftlable ACM that will be or has been subjected to sanding. Qrindim cuttinsr, at abrading or (d) Category 11 nonhiabie ACM that lta-higb probability of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act an the material in the couirswof demolition or renovati� operations regulated by this regulation. Note: Asbestos -contain j� lam¢ ifjl r u ust be properly abated/removed prior to demolition. A � �j�j 1/ C ` 0ATE11h�CDPHE &J_- a« nln �� r T/I:Q6pcl e8£t76£S6TLT:01 dSS N0iinl1­10d 8Id:w0.id 02:OT £402 -2T -00N Demolition Notice Application Form Information and Instructions: 1. To determine the proper amount for the application fee, multiply the length of the building (lineal feet) by the width of the building (lineal feet). Divide the total by 1000, round the result up to the next whole number and multiply this number by 5$. This is the square footage fee. Add the square footage fee to the base fee of $50 and submit the total amount to the Divisn along with the demolition notice application form. Ex: 40ft. x 52ft. = 2080 square feet; 2080/1000 = 2.08 (round up to 3); 3 x $5 = $15 (squame footage fee) $15 + $50 (base fee) _ $65 total application fee. 2. In the event that only a load-bearing member is demolished, the square footage fee is calculated the same way as in "number 1". However, you only need to calculate the actual, footprint of the load-bearing member. 3. All spaces must be filled in on the application. If the information is not applicable, please write NIA. Incomplete information may result in a delay in processing the application, which may delay your project. 4. We must have proposed start and end dates for the demolition. 5. There is a 10 working -day advance notification requirement for permit applications. Day 1 is the 1S' business day following the postmark or hand -delivery date. (Working Day means Monday through Friday and including holidays that falls on any of the days Monday through Friday.) If a demolition follows a permitted or noticed asbestos abatement project within 10 business days of the completion of the abatement project, the 10 working -day advance notification requirement will be waived. 6. The Colorado -certified asbestos inspector must sign the form in blue ink. (Original signature must be submitted.) The building owner or the contractor must also sign the application certifying that all refrigerants and luminous signs have been properly removed from the site. 7. If the notice must be modified after the application has been submitted, notify the Asbestos Unit by fax at 303-782-0278 or e-mail at asbestos(@state.co.us by the end of the next regular State business day following the modification. Project modifications include discovery of unidentified asbestos -containing materials, changes in scope of work or the scheduled work dates. Please use the Permit/Notice Modification Form. 8. Recycling of materials, such as concrete or wood, that are bonded or contaminated with asbestos -containing material (ACM), such as floor tile or mastic, is NOT permitted. 9. Demolition of a building that has non -friable asbestos -containing materials remaining must be completed without causing the asbestos -containing materials to become friable. Burning a building with any asbestos -containing materials is PROHIBITED. Concrete floors covered with floor tile shall be removed in as large sections as possible. Operations such as crushing, pneumatic jacking, etc. of materials containing asbestos are not permitted. 10. All provisions of laws and ordinances governing this type of work shall be complied with whether specified herein or not. Demolition permits or approval notices appearing to give authority to violate or override the provisions of any other laws or ordinances shall be invalid. Furthermore, demolition permits or approval notices issued in error or based upon incorrect information supplied to the Division shall also be invalid. CON ENVIRONMENTAL CONSULTANTS ...breathe easel... Final Clearance Air Monitoring Services Date: October 25, 2013 Project: Abatement of ACM texture and sheet vinyl flooring prior to building demolition at 8432 CR 320, Rifle, Colorado. Contractor: Edge Environmental Services, Aurora, Colorado Air Monitoring Descriotion: Phase Con provided final clearance air monitoring services at the project site listed above on October 25, 2013. Air samples were situated inside the enclosure so as to be representative of the entire work space. Air samples were obtained utilizing aggressive sampling methods to aid In ensuring that any fibrous material left in the enclosure would be entrained In the air during the sampling period. Abatement Description: Abatement of ACM texture and sheet vinyl flooring prior to building demolition. Comments and Recommendations: PCM analysis of the final clearance air samples revealed airborne fiber levels inside the containment area(s) to be less than the Colorado State Maximum Allowable Asbestos Level (MAAL) and the EPA clearance level of 0.010 fibers per cubic centimeter of air; therefore, the ardy be re-occup€ed under non -abatement conditions. ✓A. Close o State Air Monitoring Specialist #2930 593 19 314 Road Grand Junction, CO 81507 Office: 970-260-3341 pceconsultants@gwestoffice.net 'dddl6im�r— . CON ENVIRONMENTAL CONSULTANTS ._brBAthe, ecisd... PCM LABORATORY ANALYSIS OSHA Reference Method — NIOSH 7400 Client: Gary Knaus Sampling Date: 10/25/13 Rifle, Colorado Technician/Analyst: D. Close Project: 8432 CR 320 CDPHE Technician ID: 2930 Rifle, Colorado Abatement Contractor: Edge Environmental Services, Aurora, Colorado Description of Work: Abatement of ACM texture and sheet vinyl flooring prior to Building demolition. SAMPLE SAMPLE DESCRIPTION ID AIR VOLUME fibers/fields f/cc 01 Final Clearance Sample - Living Room 595 L 4.0/100 <0.006 f/cc 02 Final Clearance Sample - Rear Hall 595 L 4.5/100 00.006 FICC 03 Final Clearance Sample -- Dining Room 595 L 5.0/100 00.006 F CC 04 Final Clearance Sample - Back Bedroom 595 L 5.0/100 00.006 FICC 05 Final Clearance Sample - Master Bedroom 595 L 6.0/100 <0.006 F CC 06 Blank ------ NONE DETECTED 07 Blank ------ NONE DETECTED * Colorado State Clearance Level is 0.010 f/cc of air Technician/Analyst: � 593 19 3/4 Road Grand Junction, CO 81507 Office: 970-260-3349 pceconsultants@gwestoffice.net r* A -N L IAM LOTM 4 =I. nr;F P7 r* A -N L IAM LOTM 4 =I. .+4 _f Vy`� �.. .rI e I '� ��ri 1 rr.r•.!#! 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