HomeMy WebLinkAboutCDPHE Application - ApprovedColorado Dcpartment
of Public Health
and Environmcnt
DEMOLITION NOTIFICATION APPLICATION FORM
APPLICATION FEE MUSTACCOMPANY THIS FORM
]NCOMPLETE APPLICATIONS WLL BE RETURNED
(Notice will be mailed to the demolition contractor unless specified othenrise)
Fee: 150 + $5 per 1000 ft2 of arer to be demollshed = | i!9.09--.
(SBr lrutrucuon #1 on r.vcruc lldcl
SuFnl tonl Io:
Prrmll Coordhrbr
Colorrdo O.pl. o{ Puulc
Hoelh rrd EnvlforrnGnt
APCo.te€t
4300 Ch3rry C.ocft Dtlv€
Sqrlh
Dcnvtt, CO 802'16-t 530
Plpoa: 303{92.31(F
F.x: 303-7824278
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strest1308 CounlY Rd 129
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970s/.o..7251
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970 S4$8371
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(970) 37e-83 r 9
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Glenwood Sorines
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P'lc,€d Managoc
Adarn Connor
Propo$d St.rt Dat!
5/23/25
eropooao ComPfrun oetc
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I cadify lhet tho ceftitied A3bostoc Buildlrts hgs lnlo.mid m€
sbdrt arry remahlng
d!iir{!6d.a3b€lo3ronLdnhg rnatertab ln lhc frclity to bo
lo !o48ft lo lhc ODan Butnho Pcnnlt Coordlnalo.
M.lhodrMaane of Dcmolition:
i[uhtor6 rl Swnlngr E lmplolbn 0 tilovins E olhor' rp€dtv:
rBurnlrp ruqulrer rrldilbn l sutho.lratlon - Plr.lc cen (303) 092'31 00 rnd all
Prhl Nrma:
Adam Connor
Landfil ReorMrE Suildlng Dorir: -\.
South Canyon Landnll
gT€
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General Abatomenl Contractor (GAC)
N/A og
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o
Ornra/3 Nrm:
Glenwood Canyon Reson, LLC
COPHE Asb€slo3 Pcrnit I
N/A
Total Quanmy otAsbellor Rcmovcd
N/A
Stre€t
7300 N Ciccro Ave.
Oals R€fipual Co.nda{ed
NIA
Tel€phoo€ I
N/A Lincrlnwood
chv:Sl|Nr:
IL
60712
Typ€{s} of Asbello3-Containlry Mate.i.l Remored:
N/A
Contr.f,s N:nc
Brcndrn Huh
f.a.drffi
312 91a-800C
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\Mth my signature below, I certify that I possess current AHERA accreditaton and statc of Cobrado certificaUon ac
an Asbestos Building lnspector. I also certify that I have thoroughly lnspec{cd thc facility b bc demolishcd, as listcd
in the Demolition Site block above, sampled all suspect materials, had all samplo€ enalyzed fur lhe preoancc of
asbestos by a NVlAP-accredited laboratory, and have determined thet m Rcgulabd ACM exbts snywhcru ln thc
facility.' I also certify that I have informed the owner/operator of lhe Ecility or thc dsmoll0on contractor that any
asbestos-containing materialallowed to stay in the facility must remain non-friable dudng damolltion. Specify typ€(s)
of ACM remaining, below: (check approprlate box(es)):
D fJnyr asbestos floor tile (VAQ n VAT mastic fl Tarlasphalt imprcgrrebd mofirq El ngpheldc plpc costhgr
Fl doiav-apolied tar coatioss E Caulking I Glazing ! Other, specilyr
{ln
lrt
Prlnlrd Nalll:
Sc.<c t^. V+-J..j9
L t 7{'*1*/q c{Plur,
( Q?t,) ?bl -Tflrl
s,b !i EE3lcod6
TG;tv thaGil r€fiqeranta from ak conditioning/retirgsration appliancos havo h.n progctt tacovlfid h noootdmca wlh AACC Rrguhtlon l{o.
t 5 (fo? informationin CFC requhoments call 692-3100). I furlhor verify that a[ lutnhoc ul .lg]E (@t*ahlne .rlloactva [uti4rt) traYr baJr
drsiosed of tn accordance with g Ccn 1007-l subpart 3.6.4.3 (for informatlon on lurfiou cotl igm tqfiun ob 0.ll 303{e2{320).
CHECK THE APPNOPRIA'E BOX:
E;guiloinocrqr X cootractor tr ouGr Dt: 4n4ns
Adam Connor
P,hT NI'|E
RECEIVED
By Llvla Effeilng at 5:29 pm, Mdy 07,2025 pm, May 07,lnUd.3l0 bmrfir-3fr!
APPNOVED
fperoYoa Ey Ltvla Ellarlng at 5:29Postmark or Hand Delivr
Form of Paymenr a*' 141498325 M}R.conlI Ilrb hucd:
nduc.d
oafu,6g!ni{!!g, c.qllino.
lo po$.dcr by lh.
oa
ha becocr
nonlri$LACM lhtl h.r r
mrhhl hlhccourr olon
APPROVED
By Livia Elfering at 5:29 pm, May 07, 2025
fm DNAOI
iloir: Arbcrl*oonlr!*t3 vhyl rnd hobummuil bi pmp..lt