HomeMy WebLinkAboutApplicationGarfield County
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1.1 Community Development Department
108 8th Street, Suite 401
6E4 0' 2416 Glenwood Springs, CO 81601
�OtfN�Y (970) 945-8212
InnELq���LOP��RC`a1 www.garfield-countv.com
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TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
❑ Manufactured Home (SF or Duplex)
❑ Residential (SF, Duplex, orTownhome)
INVOLVED PARTIES
Property Owner: Larry and Lori Schmueser
BUILDING PERMIT
APPLICATION
O Demolition
❑ Reroof
Mailing Address: 68 Wilson Lane, Rifle, CO 81650
Phone: ( 970 ) 625-5554
Contractor: Regional Asbestos Mitigation Services Phone: { 720 252-6346
Mailing Address: 6140 S. Gun Club Rd. Suite K6 #244, Aurora, CO 80016
Architect:
Mailing Address:
Engineer:
Phone:(
Phone: (
Mailing Address:
Manufactured Home Installer:
Phone: (
Mailing Address:
PROJECT NAME AND LOCATION
Describe Work: Demolition and disposal of an old farm house and out buildings.
Job Address: 0009 Wilson Lane, Rifle, CO 81650
Assessor's Parcel Number: Sub.
Owner's Valuation of Work: $ $30,000 Property c; (Sq.Ft or Acres): 11 ac
Sq.Ft of Building: 1500 Height 8 —0"
Lot Block
Class of Work:
Garage:
Septic:
❑ New 0 Alteration 0 Addition
❑ Attached
❑
1505
# of Floors: 1
O Repair i ❑ Move/Relocation
O Detached
O Community
Type of Heat: 0 Natural Gas
0 Propane
Driveway Permit: 0 Exempt
0 Electric 0 Other
O Permit #f:
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. If the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Lesal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ISDS Permit, (3)
another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or a
State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division. In consideration of the issuance of the Building Permit, I agree that I and my agents will comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, ISDS
regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
1 hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the uired information which is correct and accurate to the best of my knowledge.
LARizq 5
ner Print and Sign
Date
Vifire,
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit Fee:
ZS----.
Manu home Fee:
Misc Fees:
Total Fees:
Fees Paid:
Balance D e:
BP Na:
ISDS No:
Setbacks:
OCC Group:
Const Type:
Zoning:
12
BUILDING / PLANNING
DIVISION :
°I17 1 I r
Signed Appr I Date
'Pc 2c 6-D, I/ 53,1 Iz 1 Hp
Colorado Department of Public Health and Environment
Air Pollution Control Division — Indoor Environment Program — Asbestos/IAQ Air Unit
4300 Cherry Creek Drive South, APCD-IE-B1
Denver, Colorado 80246-1530
Phone: 303-692-3100 — Fax: 303-782-0278
E-mail: asbestos@state.co.us
DEMOLITION APPROVAL NOTICE
This approval notice is granted subject to Colorado Air Quality Control Commission Regulation
No. 8, Part 13, adopted December 21, 2007, and effective January 30, 2008 and the Colorado Air
Pollution Prevention and Control Act C.R.S. (25-7-101 and 25-7-501 et seq). This notice signifies
that the structure was inspected for asbestos, luminous exit signs (containing radioactive material).
and Ozone -Depleting Refrigerants and the demolition contractor has properly notified the
Colorado Department of Public Health and Environment pursuant to Regulation No. 8, Part B.
As a contractor, you may be subject to other demolition licenses and permits, depending on the
requirements of the county and municipality in which the work is being performed. The Colorado
Department of Public Health and Environment. Air Pollution Control Division, strongly suggests
that you check with county and municipal authorities in order to determine any other local
building/permitting requirements that must be met.
Please note that certain asbestos -containing materials (ACM) may remain in the structure
during demolition. Therefore, any demolition debris left behind after the completion of post -
demolition site cleanup may constitute a "reason to know of asbestos -contaminated soil" at
the site, subject to the requirements of Section 5.5 of the Solid Waste Regulations (6 CCR
1007-2, Part 1).
THE ORIGINAL APPROVAL NOTICE MUST BE POSTED ON SITE AT ALL TIMES.
Immediately notify the Asbestos/IAQ Unit of project modifications by fax (number above) or e-mail
(address above) and the appropriate county health department by fax. Project modifications include
changes in the scope of work or the scheduled work dates, etc.
This demolition approval notice is valid beginning 9/112016.
The actual scheduled work dates are from 9/1/2016 through 9'30'2016.
Approval issued on: 8/26/2016
Record number: 120568
Notice Number: 16GA5007D
For the location specified below:
Bleak Residence
9 Wilson Lane
Rifle
Garfield County
This notice has been issued to:
Larry Schmueser
68 Wilson Lane
Rifle, CO 81650
Fee Paid: $60.00
Check number: 5616
Asbestos Building Inspector:
John R. Peterman
U'erirication No.: 6601
Inspection Date: 0819/2016
Issued by: SM
Colorado Department
of Public Health
and Environment
0
0
C
0
U
DEMOLITION NOTIFICATION APPLICATION FORM
APPLICATION FEE MUST ACCOMPANY THIS 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 = $ 6073)
(See instruction #1 on reverse side)
Company Name %4
Building Owner - 1.411 60\'fi9
Street
68 Wilson Lane
City:
Rifle
State:
CO
Zip Code:
81650
Telephone #
(970) 625-4271
Fax #
( )
Project Manager
Larry Schmueser
Cell Phone #
(970) 948-5015
1 certify that the Certified Asbestos Building Inspector has informed me
about any remaining asbestos -containing materials in the facility to be
demolished, ...--
Signature
y��
Print Name:
Larry Schmueser
Landfill ReceivingBuilding Debris:
Garfield County
General Abatement Contractor (GAC) ,.....
Regional Asbestos Mitigation Services
CDPHE Asbestos Permit # r'
16GA4295A
Total Quantity of Asbestos Remd
3,915 sq ft
Date Removal Completed
8115116
Telephone #
(303) 690-7777
Type(s) of Asbestos -Containing Ma erial Removed:
Drywall & Floor Vinyl
Con
Demolition Site
Building Owner
Building Name.
Subm:t form to.
Perm.t Coordinator
Colorado Dept. of Pubic
Health and Environment
APCD-IE-B1
4300 Cherry Creek Drive
South
Denver, CO 80246-1530
Phone 303-692-3100
Fax: 303-782.0278
Asbestos®state co us
Bleak Residence
Square footage of footer hof-facitit or portion of facility to be demoiished
Street
0009 WilsorirL-,arie
County:�rj, rl t tic
ZpCode:
81650
Proposed Stan Date , Proposed Completion Date
9016 dkfr 30 gc1d
Method/Means of Demolition
X[ 1recking 0 Burningt ❑ Implosion 0 Mov.ng 0 Utner, specify
rBurning requ:res additional authorization - Please cal; ;303) 592-3191} and ask
to speak to the Open Burning Permit Coordinator
Owner's Name:
Larry & Lori Schmueser
Street
68 Wilson Lane
City:
Rifle
State:
co
Zip Code
81650
Contact's Name:
Larry Schmueser
Telephone #
(970) 948-5015
With my signature below, I certify that 1 possess current AHERA accreditation and state of Colorado certification as
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
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
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)):
❑ Vinyl asbestos floor tile (VAT) ❑ VAT mastic ❑ Tar/asphalt impregnated roofing ❑ Asphaltic pipe coatings
❑ Spray -applied tar coatings ❑ Caulking ❑ Giaziag ❑ Other, specify
5ignalure: (In Blue Ink) I Punted Name
' /2 /� ` � 1 zot% ..J z . PC. it'^, .--+
Date of Final Inspection 'CO Cert # Expiration Date ll Telephone # Ce I Phone 4
) vert that all refrigerants 4, (fit ! (� �� 1(? l 7 ' / ) ; u (22
from air conditioning/refrigeration appliances have been property recovered in accordance with AnCC Regulation No.
15 (for information n 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 cal 303-692-3320)
CHECK THE APPROPRIATE BOX:
X❑ Building Owner
Snig ature:
Contractor
Other
Date
8/15/2016
Postmark or Hand Delivery Date:
Form of Payment & #: tltk
" Regulated asbestos -containing materials means (a) friable asbestos -containing maten8`, (b) Category I nonfriable ACM that has become friable, (c)
Category I nonfriable ACM that will be or has been subjected to sanding, winding, cutt.no. or abrading or (d) Cateaory 11 nonfriable ACM.thathas 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 'regulated by this regulation. Note' Asbestos -containing sheet vinyl and linoleum must be properly
abaied!<embVed prior -to demolition.
Print Name.
THIS Box is FOR CDPHE USE ONLY:
Approved By' q.K
Recor
Larry Schmueser
Code nitial-310 ❑ transfer -380
Date Issued
A 6
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