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Home My WebLink AboutState Asbestos Abatement ApplicationColorado Department of PublicHealth andEnvironment 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 = $ 65.00 (See instruction #1 on reverse side) Submit form to: Permit Coordinator Colorado Dept. of Public Health and Envìronnlbnt APCD-IE-81 4300 Cherry Creek Drive South Denver, CO 80246-1530 Phone: 303-692-31 00 Fax: 303-782-0278 Asbestos@state.co.us ¡ o o(! o C) o =o tsoo Company Name. Aspen Deconstruction.LLC. oË(t, o =o Eoo Building Name: Residential 557 N. Mill St State:Zip Code: 81611CO Square footage of footprint of facility or portion of facility to be demolished 2500 sqft. Street: 0054 White Tail Drive Telephone # (970) 618s834 Fax# () City: Glenwood Sprinss Garfield County:Zip Code: 81601 Project Manager: JP Strait Cell Phone # (970) 6185834 Proposed Start Date 7.25.19 Proposed Complet¡on Date 8.1 0.1 9 I certiñ/ that the Certif¡ed Asbestos Building lnspector has informed me about any remain¡ng asbestos-containing materials in the faciìity to be demolished. MethodiMeans of Demolition: X! Wrecking E Burningt E lmplosion ! Moving ¡ Other, specify: s tBurning requires additional authorization - Please call (303) 692-31 0O and ask to soeak to the Ooen Burnino Permit Coordinetor Signature Print Name: JP Strait Landf¡ll Receiving Building Debris: South Canyon gE€ äËË General Abatement Contractor (GAC) o Io Et .= =d¡ Owner's Name: ZAMP,LLC CDPHE Asbestos Perm¡t #Total Quantity ofAsbestos Removed Street: 132 Midland Avenue Suite 4 Date Removal Completed Telephone #()City: Basalt State: CO Zip Code: 81621 Type(s) of Asbestos:Containì ng Material Removed:Contact's Name: Mark Kistner Telephone # (970\ 9458425 o ()o CLø o.99Ëoa)9E ll)l- :Eo '.= oo With my signature below, I certify that I possess current AHERA accredrtation and state of Colorado certification as an Asbestos Building lnspector. 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 appropr¡ate box(es)): t n Vinyl asbestos floor tile (V4I n VAT mastic Sfi@^"phalt impregnated roofing n Asphaltic pipe coatings! Spray-applied tar coatings n Caulking ! Claz¡n-gE Other, specify: Signature: (ln flue lnk) ';/*i*Øu,-4,,,-- Printed Name: Jim Baker Date of Finai ìñspection 0612s119 13434 CO Cert #Expirat¡on Date 04/22:/20 Telephone # (970\920-2100 Cell Phone # (970) 920-2100 g,ä ë Ë þË ı ð,5 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 ex¡t signs (containing radioactive material) hãve been disposed of in accordance with 6 CCR 1 007- 1 subpart 3.6.4.3 (for information on luminous exit sign requirements call 303-692-3320). CHECK THE APPROPRIATE BOX: !Building Owner XI Contractor n Other Date: 5{l sTÉAIT.Signature:Print Name: JP STRAIT - Aspen Deconstruction, LLC Turs Box rs FoR CDPHE Use Ouy: Postmark or Hand Delivery Date:Approved By:Code: I initiat-310 ! transfer-380 Form of Payment & #:Permit #:Record #Date lssued s ìâ1êñôrv I non* Regulated asbestos-containing materials means (a) friable asbestos-containing material, Cateqorv I nonfriable ACM that will be or has been subjected to sanding, grindinq, cuttinq, probability of becoming or has become crumbled, pulverized, or reduced to powder by the demolition or renovation operations regulated by this regulation abated/removed prior to demolition. Note: Asbestos-containing sheet vinyl and linoleum must be properly that has friable, (c) or abrading or (d) Cateqorv ll nonfriable ACM that has a high forces expected to act on the material in the course of Form: DNA08 Rev 01/30/08 Demolition Notice Application Form lnformation and lnstructions: 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 Division along with the demolition notice application form. rt Ex: 40ft. x52ft. = 2080 squarefeet; 2080 /1000=2.08 (round upto 3); 3 x$5 = $15 (square footage fee) $15 + $50 (base fee) = $65 total application fee. 2. ln 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. lf the information is not applicable, please write N/4. 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 1st business day followinq the postmark or hand-delivery date. (Working Day means Monday through Friday and including holidays that falls on any of the days Monday through b, Friday.) lf 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 sígn the application certifying that all refrigerants and luminous signs have been properly removed from the site. 7. lf 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 asbestog@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 PermiUNotice 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 perrnits 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. Þ Form: DNA08 Rev.0l/30/08