2015-417 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150417-42297 Date Issued: Wednesday, September 28, 2016
This is to certify that work requested to be done as shown by Permit Number P20150417-42297
has been completed.
Tax Map Number: 239.15-1-3
Location: 8 ROCKY SHORE RD
Owner: Sally Kelly
Applicant: Sally Kelly
This structure may be occupied as a: Demo only of garage/carport
By Order of Town Board
TOWN OF QUEENSS�BURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
� TOWN OF QUEENSBURY
f.
` W 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150417 Application Number: A20150417
Tax Map No: 523400-239-015-0001-003-000-0000 I
Permission is hereby granted to: SALLY KELLY
For property located at: 8 ROCKY SHORE Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: SALLY KELLY Demolition
30 OAKWOOD Dr Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-417
Demolition of garage/carport
$30.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, September 10, 2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the e iration date.) I
Dated at the Tow of Qu sb , , lay, September 10,2015
SIGNED BY Y \ for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received
DEMOLITION PERMIT APPLICATION Permit#: L} _
17
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee _ O` _
Provide 2 plot plans drawn to scale,showing lot boundaries it i. en tbd adjacent roads/streets. Show all existing structures
on property and indicate which are to be demolished., h i� to to +.; II utilities
Date molition Location K�
art
Tax Map ID ol3q° 15 -1 -E
SEP 0 9 20� �°�- �----�`�-
TOWN OF QUEENSBURY
, U �DS � uC' ONING OFFICE
((rdAPPLICANT WNER
Address .1_,C;),_ 1_2s Address 36 O3JLt oc{
La e�r - -__L\ /2$�.� CIPLee.43,4-(a _AY lo? 801t
Phone (Q�$ -s65-5 Phone
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: /V tnr! Phone: /2e-09'
1. Person Responsible for Work CO A. E Q._
2. Where will demolition material be disposed? A_ C0-14.1/1 ,4 YS 7 /(-11_
3. All buildings to be demolished require an Asbestos Survey ye s
4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begin
a) Is there any asbestos in the building to be demolished ____ Yes _jNo
b) If Yes,our office needs the following information ____ Yes ____ No
Name of firm removing the asbestos 466-Q-5 K.,5 gap was0 4d
License number of firm 01/pe Sib,#•.L14-e.4 6aC,L
Indicate where the asbestos material will be disposed CL/1p{ Yvej a �' � /`CS- cAsaS
6. Structure Information IAA"eQ . lto itS 6e S-(v 5 S e ,
a) Indicate the structure(s)to be demolished ___ Residence .4_ Garage ___ Business
Storage Bldg. ___ Other
b) Size of Structure )1.c)--- -1 /8 "Y2 S - 4Sast_
c) Number of Stories
d) Foundation Type ' r"
e) Foundation N/4
f) Structure(s) 0-702/1-6V j41-or b(cd q
7. Utilities Information
a) Indicate utilities for this structure ___ Gas ___ Electric ___ Propane ___ Public Water ___ Public Sewer
___On-site well water pump �%,,
a) Have you notified the Town Water Department for public water and sewer disconnect? ____ Yes __' No
b) Have all utilities been disconnected? _ _ Yes ____ No
8. Signature
Print Name: _,Cain ,�� c ,rlc Date 9-'7 -
Signature: Date
Town of Queensbury Building& Codes - Demolition Permit - December 2014
1 ,
PA't7-LABS
FILE COPY PrvMssaionwl's Qhoio®
I4Errerw+mantai Tasting
1675 North Commerce Parkway, Weston,Florida 33326
Tel:(954)384-4446 Fax:(954)384-4838 Toll Free:(800)427-0550
Certificate of Asbestos PLM Analysis
(This report contains data that were produced under subcontract by EHS NVLAP Lab Code#101882-0)
Prepared for: DAVID KELLY
Phone Number: 518-744-7823
Fax Number: N/A
Email Address: KELLY.DAVID56@GMAIL.COM
Test Location: DAVID KELLYD n
8 ROCKYSHORE RD t1
QUEENSBURY,NY 12804
11 SEP 0 9 20:51 111)
Sample Number: 866437-1
Pro Lab COC#: 866437 TOWN OF QUEENSBURY
BUILDING& CODES
Date Analyzed: 07/20/2015
Report Date: 07/21/2015
Asbestos Results: SEE ATTACHED DATA SHEET AND LAB RESULTS
fe do-fir /`')
Erika Piechowski, Technical Manager Carlos Ochoa, Quality Control Manager
Samples analyzed by this test method are subject to the inherent limitations of light microscopy.This report cannot be
used by the client to claim product endorsement by NVLAP or any agency of the U.S.Government.This report shall not
be reproduced,except in full,without written permission from PRO-LAB/SSPTM,Inc.
If you have questions or comments,please contact PRO-LAB at(800)427-0550
(*Please see attached datasheet)
PRO-LAD
Prnfeesicnal's Choice
''Ennvironmental Testing"
1675 North Commerce Parkway, Weston,Florida 33326
Tel:(954)384-4446 Fax:(954)384-4838 Toll Free:(800)427-0550
Certificate of Asbestos PLM Analysis
Sample List
866437-1-GARAGE/SHED ROOF
Samples analyzed by this test method are subject to the inherent limitations of light microscopy.This report cannot be
used by the client to claim product endorsement by NVLAP or any agency of the U.S.Government.This report shall not
be reproduced,except in full,without written permission from PRO-LAB/SSPTM,Inc.
If you have questions or comments,please contact PRO-LAB at(800)427-0550
(*Please see attached datasheet)
•
AmeriSci Richmond
13635 GENITO ROAD
AMERI SCI MIDLOTHIAN, VIRGINIA 23112
TEL:(804)763-1200 • FAX: (804)763-1800
PLM Bulk Asbestos Report
Environmental Hazards Services, Inc. Date Received 07/17/15 AmeriSci Job # 115071938
Attn: Howard Varner Date Examined 07/20/15 P.O. # 15-07-02476
7469 Whitepine Road ELAP # 10984 Page 1 of 1
RE: 10-3788; David Kelly; 8 Rockyshore Rd; Queensbury, NY
Richmond, VA 23237 12804
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
866437-1 115071938-01 No NAD
Location: (by NYS ELAP 198.6)
by David W. Ralbovsky
on 07/20/15
Analyst Description: Black/Gray, Heterogeneous, Non-Fibrous,Bulk Material
Asbestos Types:
Other Material: Non-Asbestos 39.8
Comment: Heat Sensitive(organic):22.1%;Acid Soluble(inorganic): 38.1%; Inert(Non-asbestos): 39.8%
•
Reporting Notes: / rzy1,07/5 Analyzed by:David W.RalbovskCC� ,,,/ ; f. Date
*NAD=no asbestos detected, I- tion Limit<1%,Reporting Li•� s:CVES=1%,4Pt25%,1000 Pt Ct=0.1%;"Present"or NVA="No
Visible Asbestos"are observations ade during a qualitative a `f sis;NA=not analyzed; NAPS=not analyzed/positive stop; PLM Bulk Asbestos
Analysis by EPA 600/R-93/116 per 40 CFR 763(NVLAP Lab Code 101904-0)and ELAP PLM Analysis Protocol 198.1 for New York friable samples
which includes quantitation of any vermiculite observed(198.6 for NOB samples)or EPA 400 pt ct by EPA 600/M4-82-020(NYSDOH ELAP Lab#
10984); CA ELAP Lab#2508; Note: PLM is not consistently reliable in detecting asbestos in floor coverings and similar NOB materials. NAD or Trace
results by PLM are inconclusive,TEM is currently the only method that can be used to determine if this material can be considered or treated as
non-asbestos-containing in New York State(also see EPA Advisory for floor tile, FR 59, 146,38970,8/1/94). NIST Accreditation requirements mandate
that this report must not be reproduced except in full without the approval of the laboratory. This PLM report relates ONLY to the items tested.
Reviewed By:
Fwu�t.'-',.tx