HomeMy WebLinkAboutALL DOCS - 12-00254 - 365 W 1st S - DemolitionBuilding Sofety Deportmd
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Person or Company doinglh.e demoliriont - )7k!er'
Address: O4 5 wt')
City of Rexburg
Permit #:
$25.00 Fee Paid: Yes/No Permit Approved: Yes/No
Application for Demolition
Applicant Information
Name:El>
Appl-icant's Address Ciry/ST/Zip:
Business Phone: +O3 -/€t o cellPhone: .3i3 -5/J/
Contact Information
City/ST/Zrp:
Business Phone:40e- q5-/ o Cell Phone:
Demolition f nformation
Property Owners:
Site Addtess:
The U.S. Environmental Protection Agency @,PA) regulates the abatement and disposal of asbestos-containing materials from any
public or private building involwing demolition, renovation, tepair, construction, and maintenance activities.
http: / /deq.idaho.gov/atlprog issues /pollutants /asbestos.cfm
EPA certifies and licenses asbestos-removal contractors, inspects asbestos-abatement projects, and enforces laws regatding the proper
removal and disposal of asbestos-containing materials.
Currently, EPA and DEQ contract with Industrial Hygtene Resources in Garden Ciry, Idaho, to regulate asbestos rernoval and disposal
projects in ldaho.
For mote information about asbestos abatement and disposal in ldaho, contact:
Industrial Hygiene Resource
206 Murray St
Garden City ID 8371,4
208-323-8287
www.indus trialhys'ieneres ources. c om
I understand the EPA requirements regarding asbestos removal and agree to provide information showing
compliance with the regulations Wth: City2f Rexburg prior to demolition.
Summary of what is being demolished:
Signature of Applicant: -,
termit Processing Fee
JUN
ctry
genpmtrreceiPts
Page 1 of 1
U. S, ENVIRONMENTAL PITOTBCTION AGNNCY . STATN OF TDAHONOTIFTCATTON OF DEMOLTTTON AND RBNOVATION
oPERAT'oRpRoJEcr# Iro"r*o
l, r:YP0 orNorlrtcATIoN: ---couRT[sy *r_oRlGrNAL _ RgvrsitiD _ CANCELH]
,I. FACTLITY DESCRIPI'ION:
Building Name: Vacant housc
Address: 165 Wesr l"sourh
city: Ilcxburg stale: ld zip code : g3460 counry; Madison
Site Location ; Complere demo oihouse
Building Si:n (Sq. Ft) ) 1200 fof Floors: I an<t snrall bassnrcnr n** ,,, }'ilffi
Proscnt U$p: vocant-Prior Use: rcsidential
tll' TvPIi or oPoRATIOn-: -r-D[fvlo - ORDERID D[Mo _ ItrNovAllON _ [NlEltO[NCy RTNOVA]]ON * HRE TRATNINC
lV. Is Asbcstos Prcsent? (chcck onc) _yos x No
V. f8cility Infornrnrion:
Orvner Narne: NO Rexburg Housing LLC
Address:2880 Norrh i5 West
City: ldaho Falls
Contact; Dovid Dance
State: td Zin (-'ode: 8j40?
1'cluphone: 208-528-6635 Far;: N/A
Liccnsr: CSR 012013"29Rrnrovrl Contractor n-amc: Grcat Basin Scrvices, Inc
Addrcss: p. O. Box 2j$
Contact:
Blorkfoo, Sror*, t.tut,o -.
-.......-..ffiil
Davc Price 'Iolcphonc: 208-?85. I 267 l;Bx: Z0g-7gj-t053
City;
-Orher Operulor(eenolitior4ener*l) Strcnmlinert Homcs l-LC Liccnse: nla
Address: 160 Sourh.3ed W(,sr
City: llcxburg Srate: ltl$o Zip Corlc:S3440
_ Contact: Cory Sorensen .lclephone: 20g40j-.{S l0 FiN: n/a
V|'Proccdurc,inc|udingrrna|yticllnrethor|s,cmplo1,cr|to<te1ectlheprescnceof*ndloeJtimale|hequrr|ityofRA(:julnr|Catcgory
non-fioble I'Li\l Lab tcsting
Vl l. Approxinr$tc Amolrnt of Asbcstos lVtaterials:
RACM to be Removed Nonftiable Asbestos Malerial
to be Removed
Nonfriable Asbestos Materiat
Not to be Removed
Category I Catcgory Il Catcgory I Cirtegory ll
Pipes (linear l'eer)
Surface Area (Squarc feet aprox 50ll sq ll
of transite siding
on outsklc
Facility Components (cubic fccr)
VllL Schedslcd Dates Dcmotition or Rcnorttiorr: Sran: .It,
IV, Dstes forAsbestos Removll (MM/DD/yy) : Srsn: June-t9-1012 Conrplctc; June- | 9-20 I 2
DaysAVeek I Monday 'I'ucsdry
I Wcdncschy 'IhLrrsday Fridny Saturda)' I Sunday
X. Description ofplanned Demorition or renovation work to be preformed andtechniques to be used and description ofaffected facirity components: Asbestoswill be dept wer to keep down dust during demo and loading ofdlbris.
method(s) to be employed, including demolition or renovationremoved prior to demo. Complete demo using track-hoes, Ioaders.
XI' Description of work practices and enginee ring controls to be used to comply with the requirements, including asbestos removal and wasrehandling emission control procedures: Mark and post warning signs to proteci public. Drop cloths on goumd under work areas. Hand removal methodsusing bars and hammers' Material removed intact as tuch ar possible. wet rnithods during removal. All maierial will be placed into a 6 mill poly, double linedtrailer. Trailer sealed and labeled for disposal at an EpA approved landfi il.
XlI. Waste Transporter #l: Asbestos onlv
Name: Great Basin Services, Inc
Address: P.O. Box 238
Telephone: 208-785-1767
Waste Transporter #2, Construction debris only
Address: I60 South,3ed West
Telephone: 208-403-4510
XII. Waste Disposal: ASBESTOS ONLy
Name: Bannock County Landfill
Address: 1500 North Fort Hall Mine Rd
Telephone: 208-236-0607 Fax: n/a
XIV. Emergency Demolition (Complete item XIV and all other sections, only if this project is an Emergency Demo)I . Attach a copy of the Order to this notice.
2. Name of Authority Issuing Order: NA Title3, Authority of Order (Citation of Code
4. Date of Order (MIWDD/YY)Date Ordered to BesinEmergency Renovation (Attach separate sheet withthe following information if project is Emergency Renovation.)Date and Hour of Emergence N/A
Description of Sudden, Unexpected Event.
Explanation of how the even caused unsafe conditions or equipment damage or an unreasonable financial burden.
XVI. Description of procedures to be followed in the event that unexpected RACM is found or nonfriable ACM becomes cru m bled, pulverized orreduced to powder.
ACM, enclose area, post warnings and contain . Stop spread ofair-bom fiber release.
,r( an
and r
ofQr
the provisions of NESHAPS (40 CFR PART 61, SUBPART M) will be on site during the demotition or
training has been accomplished by this person will be available during normal business hours.
Date Type or Print Name and Title
June-4-2012 Dave Price / Owner Secretarv
XVII. Iacknoyfedgethe\xisfncegflawsprohibitingthesubmissionoffalseormisleadingstatementsandlcertifythatfactscontainedinthis
of Ownei./Operator Date Type or Print Name and Title
Original Notification must be mailed or hand delivered at lease ten working dsys (Monday-Friday excluding weekends) before demolition or renovation
begins, exoept emergency demolition and emergency renovations which nrust be submitted as soon as possible before operations begin. (Form rcv.3/24/99