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HomeMy WebLinkAboutALL DOCS - 12-00377 - 261 S 1st E - DemolitionBuilding Sofely Deportmd www.rexburg.org Application for Demolition Permit A Applicant nformation Name: Applicant's Address:City/ST/Ztp: Business Phone: ZOg '<8d */(4f cellPhone: Contact Information Petson ot the demolition: Address: Z' Business Phone:2t:?- t"{q - 441{Cell Phone: Demolition Information Property Owners: Site Address Start Date: 9- 27 - /Comoletion Date: of what is being demolished: The U.S. Environmental Protection Agency @,PA) regulates the abatement and disposal of asbestos-containing materials ftom any public ot private building involving demolition, renovation, repair, construction, and maintenance activities. http:/ /deq.idaho.govlairlprog issues/oollutants/asbestos.cfm EPA certifies and licenses asbestos-removal contractors, inspects asbestos-abatement proiects, and enforces laws regarding the proper removal and disposal of asbestos-containing materials. Currendy, EPA and DEQ contract with Industrial Hygiene Resources in Garden City, Idaho, to regulate asbestos temoval aod disposal proiects in ldaho. For more information about asbestos abatement and disposal in ldaho. contact: Industrial Hygiene Resource 206 Murray St Garden City lD 83774 208-323-8287 www.industrialhvsieneresources. com I understand the EPA requitements tegarding asbestos removal and agree to provide information showing compliance with the regulations to the City of Rexburg prior to demolition. REXBURGc\' ***-.-*- Am e ri cab Family Commw ity CITY OFClty ol Rexburg Phone: 208.372.2326 Fox: 208.359.3022 /. ry/ST/Zip: Signature of Applicant r- ./- T)^-l-- n ' TLrreat ttasm servlces- lnc--) ^^^v P.0. llox 238 Blacktbot. Idaho 83221 Oliicc: l0ti-785-1767 Ccll: 20fJ-68l-6462 Aug-20-2012 I{l j: Vacant I louse/apartments2(r I Soutli. I st llast. Rexburg. Idaho 'l'o Whonr it nray coucern: (ircat Basin Services ltas rcnroved the asbestos rnaterials lbund in tlie lnspection report.'ll'ansitc siding on the outside. floor tile ancl sheet vinyl on the inside.. All Asbestos materials wcre clisposed o1'at an EPA Approved landllll as requircd by EpA. Dave l)ricc U. S. EW PROTECTION AGENCT - STATE OT IDAHO NOTIFICATION OF DEMOLITION AND RENOVATION OPEMTORPROJECT#POSTMARK DATERECEIVED NONRCATIO}.I l. TYPEOFNOTIFICATION: COURTESY I_ORIGINAL RSYTSET)_CANCtLED IT. FACILITY DESCRIPTION: Building Nane Horse/apsrtrrcns Addnsr:261 South ld Easa Crg: Rcxburg Starc: ldeho ZipCodc t3460 County: Mrdisor Sitc Loctiolr : Buildingsia(SqurrcFcct)sspron1600 flofFlorys: I fuc in ycrs: original 65-70 ycars Prcscnt Use:Prior Usc: IILTYPEOFOPERATION: -I-DEMO -ORDER"EDDEMO _RENOVATION _EMERCEI.ICYRENOVATION _RnETMlNlNc IV. b Arbcafot Prcscnt? (chcck ooe)_r_Ycs No V. Frcllity Inform.tlotr: Ovrcr Name: Rivicra Apmments LLC Mdress:4132 Ect 465 Nsth City Rigby Slate: ld ZipCode E342 Cmtact Mulon Bird Tclcphotr: 208'745-7525 Fax: da Rcmoval Contnctor Nrmc! Crcrt Brslo Scrvlcca. loc Lhcosc: CSR012012-29 Addrcss:P. O. Box 238 Cityi Blackfoot Stalq ldaho ZipCodr.:E3221 Contscc DrvcPricc Tclcphonc 20E-7E 1761 Far20&78$4053 Olter0pcntor(demolition/gcocnl) RoadhorrcCooeFuctioo Liccnse RCE4l6t Ad&cs:,1132 Ea$ l00Nodl Citfr Rieby Slste: ld ZipC&:8!/,4X ContdJcfiNny Wray Tclcplnnc 208-589&Ms Frx: n/a Vl. htccdure' inc-luding rnelyticrl rlcthods, cmploycd to dctect thc prc'crcc of and to crtlmrrc thc quality of RACM ald Ctcgora t rad Cercgory lt noa'lieDlc PlMteDtcstiq Vll. Approximrlc Amooot of Asbcslor Mrterhls: RACM to be Removed Nonfiiable Asbestm Material to be Removed Nonfiiable Asbestos Mahrial Not to be Removed Caceory I crrtlryll Ctcaryl Cl*ryll Pipcs (lhcr &a) Surfa*Atta(Squarc fcct 600 sq i oftloor tile lfiX) sq 0 of lra$itc Feility Cdnponcnts (cubic ftct) VIll.Schcdllrd DrtG3 l}tilolitlo! orRoorntion: Srcn: Aug-2?-2012 Cmrplae Scpt-lrf-2012 lV. D.ica for Asbcsto! Rcrovrl (MM/DD/YY): StNrt AuCil4-20t2 CmrylacAu9lG20t2 Itrys/tteck Monthy Tuesdry We&cedry Thurday Friday Satu.day Sudry Hnof Opcradon 8am-5pm &n-spm U.S.EPrl \IASTE SHIP]\'IBNT RECORD FOR ITEGULATED ASBBSTOS VI/ASTE I{ATERIAL Il.Q. Hazardous Sub.stance: Solid n*.0.S. (asbestos): ORI\'I-E l(A-9188 10 12 13 GENBRAI'OR \York silr name:.xcl , -Lt 83'14 Z Locatiorr: ACI S Nlttif ittg,\ddres.s: I tJZ 0tflter's Nattre:LC- Orvrrer's Pltonc: 'Fai R,t*bc,R4 R;lu Operator's Nunrc: GREI'I'I|,\SIN SIIRVICES. INC. Contractor l.I). Nunrber: - I,Iilirirr!:,\rlcr'ess: p.o. r'oN l,rti rirv' L'rrt cs{oltotz -e1 III,ACIiFOO'l'. II) $122 I Coutact l'crson: DAYII PRICI,: Ollcrator's I'houe: 208-785-17(t7 \l'r.stc I)ispos:rl site (\l'DS) I)lis'l'IN,\TION; Nunrc: I],\Nn*OCK COUN'I'Y L..\NDITILL l\'DS Phone: 208-236-0607 il,lailing..\drlrcss: 1500 NOItl'll F'ORI' HAI.l,N,llNIt ITOAD POCA'r'lil,L0. lD 83201 Nuntc ttrd address of responsiltle lgcnc.v {l.o(:rl. Disrrict or lit'.\ olfirc rrhcrc irln notificilli(xt rr:rs scntl: Description of \yaste materials 6. Containers Total Quantity (Cubic Yurds) S;lccial II:rndling Ins{ruclion.s und additional inlbrnrntion: OPEIT{ll'OR'S CIIR'IIFICA l'ION: I lrcrclrv riccl:rrc ttrirt tlrc e orlcnt5 rrl'tlris consirurucnt urc lullv urrtl v dcscribcrl:rtrovc by proltcr sltipping nlrttc irnrl rtrj clrr\ilicd. packctl. urlrkcd and l:rltL'rl. an.l arc irr;rll rcrpccts irr Jrrtl:cr e Iighrvly accorrling to applicablc itllcnlrli{ulrl rrt:tl:ovcrttttlcnt tttulrtirnr'. {()[rl:ritt \itllrtrrrc in hcnr ll) lr.Jlirrc trl:ing (irrlJ shcct I)AVE PRICl: l'rilrtcdllr|rrl N;rrrrc owNEtt lr rcccipt. I lll'an.sportcr I ( Nanrc: GnEA'fBASINSIiRVICES.INC. Address: I'.O. BOX 238 . lll,ACItlfOO'l',II) 83221 ,0tUn:r(,8,,,!,I(,.,,,'DiWE PRICE Printcd/t-r'pr,l f :,rnc Nnnre: Addrcss: l,riolc(l/t.r'l)r(l iinnrc rtct' I {Acknrrrvletlr:crncnt rrl' rcccilll of rrtirtr'rills) Pltorte: .Si!:nrturc \,VASTE DISPOSAL SITB al t// /> Dllc rst$rl)Di ) tI,rirrtcrL/rvJ,r,i \;,rrrc )SAL SI'l'E Cl..R'I'll'lCAl'lON: I lrcrcbv iv th l rlle ilh')\'c tg is trut.:r!!'urf,tt.ln(l crxltplclc crL!'pt ils n.rtcil bcun :rcccptctl anrl to lhc bcst of my knorvlcdgc U;xrn trlrtr.ler: ( )\'ncr/'ll)crntor rctains GOt.l).'lianrpr rclairrs l'ln*K. \\'DS rcrainr Yl con4rlerctl ll'IllTE copl ro opnror in ilcrn 2. oo Slrcct lin1l unrl trun\itr rrill hc ttkcn to arr liPr\ approvcd landlill lirr disposll. \ll. \\'lsrc'l nrnsportcr #l: .\Slll:S'l'OS ()\1.\' Ntnlc. (;rc:lt Basirr Scrliccs- lrrc Addrcss: l'.(). iros l3ll ('i(]': lthclilinl Stats; ldaho Zip Cotle: 83221 ('ont:rct: l)lrrr: l)ricc l clephonc: 108-71i5- l 7(r7 l:ar:2(18-7115-l{.}il \1:uitc l r:rusportcr #f,: Narlcr \ .\ r\ddrcri Lrh.Stxlc iz-ip (irdc: (.(xrtitcl 'Iclcpltonc liax: \ll. Wlstr l)isposal: .\.SllLSl'OS O\1.\' Nantt lJilnnock Counlr l.undtill ,\ddre::: l-i{-10 Nonh Fort llull l\.linc ltoad Cat\: l\rcatcll(r Slalc: ldaho ir.ip (irdc: 832U{ Corttlrct: Scalcltousc 'Itlcphorrc: l0li-216-0607 l:ux:201i-236-0(109 Ilf', l)utergrrttr l)crtoliliou (Ctxttplete itcnr XIV and all othcr scctions. orrll il'this pro.icct is an linrcrgcncy l)cnroi |. Attuch n cilp\ ol l.hc Ordcr t(l this noticc. 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A -S FY3" !: -r-t 7= c v-,i- ?. l"l.r I lLlg lrl lc l$t=16 t:lP l7r l;K13 lzlF l8 ls lXltg h.rl=h5 lol(,l\c l|.J ,FNFlx Pl' I 5'tN -v,f,h ti rt rl) lt=9 )i.3 *'ar:!- oH3F:vli - (? 3;3 *?Aa=i--An F =g ;ug3 16ET 03tn .:a '- t\XI\ o o '-.' a Receipt Number: 35 North 1st East / Rexburg, lD. 83440 Phone (208) 359-3020 / Fax (208) 359-3022 12 00377 RPR000P004, Demolition Permit Processing Fee genpmtrreceipts Page 1 of 1