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BOTH-000340-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 et Community Development-Building&Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: BOTH-000340-2016 Date Issued: Friday, May 26, 2017 This is to certify that work requested to be done as shown by Permit Number BOTH-000340-2016 has been completed. Tax Map Number: 303.5-1-93 Location: 36 MEADOWBROOK RD Owner: Marcia Tyminski Applicant: William Roberts This structure may be occupied as a: Demolition due to fire damage Asbestos Report in file/paper and electronic By Order of Town Board TOWN OF QUEENSSBBUR/Y� Issuance of this Certificate of Compliance DOES NOT relieve the r 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. r TOWN OF QUEENSBURY F 742 Bay Road, Queensbury,DIY 1280�4-5904 (S 18)761-8201 Community Development- Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: ESC ri--i-ooO340-201 .Tax Map No: 303.5-1-93 Permission is hereby granted to: Williarn Roberts For property located at: 36 M1 ADOWBROOK 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 Meed and approved and in compliance with the NYS Uniforn Building Codes and the Queensbury Zoning Ordinance Type of Construction Owner Name: Marcia Tyminski Demolition $0.00 Owner address: 36 Meadowbrook RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection agency Plans&Specifications Demolition due to fire damage Asbestos Report in file/paper and electronic $ 30.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,June 1, 2017. (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 expiration date) Dated at the'Town ue bury; Mot y, to 2016 ED 13Y: for the Town of Queensbury S1Cihl Q y Director of Building&Code Enforcement Town of Queensbury Building & Codes Office Use Only Received Permit#: F35-7-T775-1- ------- DEMOLITION PERMIT APPLICATION PermT77— ._C.A c)lk— PermitFee NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED -77 Provide 2 plot plans drawn to scale,showing lot boundaries with dimensions and adjacent roads streets. Show all existing:,structures on property and Indicate which are to be demolished. Indicate the location of all utilities .�Z,3Date Demoll:t ion Location ;-t--q3 Tax Map ID ------- uef I PPLICANT OWNER Address 2- aAddress Z _ Phone ------------ Phone I 2L CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: -------------------------------Phone: ---------- 1. Person Responsible for Work A4 C,5 Aklj�10 InAd 2. Where will demolition material be disposed? 3. All buildings to be demolished require an Asbestos Survey 4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Deoartment,of Labor S. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolitio begin1"1'_11", a) Is there any asbestos In the building to be demolished ____Yes X_No b) If Yes,our office needs the following Information ----Yes ----No juN Name of firm removing the asbestos License number of firm Indicate where the asbestos material will be disposed 6. Structure Information a) Indicate the structure(s)to be demolished Residence .4- Garage --- Business --- Storage Bldg.---other b) Size of Structure c), Number of Stories d) Foundation Type e) Foundation f) Structure(s) C-,4 o.4a a� 2 7. Utilities Information & a) Indicate utilities for this structure _E Gas _ey_-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? _V__ Yes ---- No 8. Llqnature Print Name: -- ------------------ Date Slqnature: I ----------------- Date Tnwn of MiPPnqhiiry Rididinn F. rniac-nommitinn Parmit -naramhor MA f l I 444jFFF � ", � f LIN 03 201 4 r n f4 f r a Gate: 6125116 2/761766 From: James p. Williamson nationalgrid Supervisor Upstate Customer Driven Construction National Grid RE: Confirmation Memo: 36 Meadowbrook Rd Queensbury NY Our gas ops department has retired the gas service to the address above. There is no longer gas to the property. Denise Ransiear Customer Care Coordinator Operations Support Gas Customer Fuifiiiment National Grid Phone: (315)-452-7740 Fax: (315)-458-6896 Denise.RansieaL@nationalgrid.com nationalgrid 300 Erie Boulevard West Syracuse,New York 13202 May 11, 2016 RE: Service Removal for Building Demolition. To: William Roberts 9768 State Route 22- Middle Granville NY 12849 This letter is to confirm that,per your request,National Grid has confirmed electrical service and meters have been removed from 36 MEADOWBROOK RD QUEENSBURY NY 12804. The work was processed on work request number 21761765 meter number 27547034. If you have any questions or need further assistance,please feel free to contact me at 315-460-7665 Sincerely, Christine Marson Customer Fulfillment 315-460-7665 36 Meadewbrook Rd - Google Maps Pae 1 of 1. Go je [Aaps 36 Meadawbroak Rd uu uuuuu ��pp iii i � I q � � i Map data 02016 Google 20 tt i o,✓i✓i✓� ., ///✓✓�✓/// i✓/ " ir✓ E COE odD,%i�� Jj✓�✓ U �,'f�,�i ��lr ��ri ,. �' � f � ".�n""� FIL wmw� d ,��Yf✓" ! �I�N s� J U��j r �✓ r u TOWN OUE BUILDING DEPARTMENT S B "' C.9n our M4Btd exa, " Sr owwV&rneMs Shall nol be construed ued as indica�lri g the plans snad specftflans O-M 41 fuH compfiance nce wiithi [hie &,Aclinig Cxdes of New York State, 36 Meadowbremk Rd Queensbury, NY 12804 Reviewed By. ia : �� a https://www. amgle.com/maps/place/36+1V1'eadowbroak+I da+Queensbury,+... 6/6/2016 t, rt MICHAEL J,STEVENS Licensed,Certlilecl LAYS Abestos Material Inspector P.O.Sax 2202 Glens Falls,Now York 12801 (518)6563270 "`�' llceoldear �'.� •I.c�rn To Whom It May Concern, Please be advised that I have Inspected the property on the state indicated on the enclosed report and taken random samples as required. I have sent the samples to a New York State approved laboratory for testing, Based upon racy Inspection combined with the laboratory test results for,the samples taken from the subject prop- erty,there were no asbestos containing materials(ACM Is),found on the subject property or identified In the sam- ples tested by the laboratory.. Accordingly, It Is nay understanding that,subject to any and all applicable states or locals and regulations at the time of the enclosed test report,the property owner may proceed with remodeling or demoiftlon as the owner sees fit. `hank you, Michael J.Stevens License dumber:72900 MJS keg 303.5-1-93 BOTH000340-2016 Eno" Tyll7lnsid, Marcia 36 Meadowbrook Road Demolition (due to fire) • � Please Reply To: AmedScl New York 117 EAST 30TH ST. Em Sci NEW YORK,NY 10016 .. TEL:(212)679.8600-FAX(212)679.3114 N - Yr FACSIMILE TEL.ECOPY TRANSMISSION To: Michael Stevens From: Jared C.Clarke i Michael J.Stevens AmerFSel Job#: 216054287 Fax#: Subject: FLAP-PLMtrEM 5 day Results Client Project: 36; 36 Meadow Brook Rd.,NY Email: t;nike soldcarsftmait.com i Date: Wednesday,June 01,2016 Number of Pages: Time: 15:00:26 f �v�s sties) Comments: i CONMENT1AUff NOTICE: Unless othavvise indicat4 the fi*watim coutainod in this cownumicatfan is eoaftdaetial htfornation intended far ase of tho individual named above. If the tender of this commuaiostim is not the intents!recipiau.you are hereby natOW that any dimendustion, dishibutim or copying of Ws commudcadm b prohibited. Ifyou bravo received this communication in error,prase bnowdiately no fy the sender by telephone and return thcoriginab message to the above address via the US postal Service atom aWaam Sampbas am disposed of fu 60 days cr oulm odxmiw bsuucted by the pwmml or special ftmMm foes in wiift Thank you. 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AIVIERI SLI :: NEW YORK,NY 10016 TEL:(212)679-8600•FAX(212)679-3114 PLM Bulk Asbestos Report Michael I Stevens r Date Received 05/27/16 A nedSci Job# 216054287 Attn: Michael Stevens Date Examined 06/01/16 P.O.# PO Box 2202 ELAP# 11480 Page 1 of 3 RE:36; 36 Meadow Brook Rd., NY Glens Falls, NY 12801 Client No.t HGA Lab No. Asbestos Present Total % Asbestos #1 216054287-01 No NAD Location: Kitchen Wail-Sheetrock (by NYS ELAP 198.1) by Jared C.Clarke Analyst Description:011White/arown,Heterogeneous, on 06101!18 Fibrous,Bulk Material Asbestos Types:. Other Material: Cellulose 10%, Non-fibrous 90% #2 216054287-02 No NAD Location: Dining Room Wail-Shee0ock (by NYS ELAP 198.1) by Jared C.Clarke Analyst Description:OfiWhite/Brown,Heterogeneous,Fibrous,Bulk Material on 06/01/18 Asbestos Types: Other Material: Cellulose 15%, Non fibrous 85% #3 216054287-03 No NAD Location: Kitchen Gelling-Sheetrock (by NYS FLAP 198.1) by Jared C.Clarke on 06/01/16 Analyst Description:OffWhite/Brown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 12%, Non-fibrous 88% #4 216054287-04 No NAD Location: Living Room Wall-Drywall (by NYS ELAP 198.1) by Jared C.Clarke on 06/01/16 Analyst Description:Grey/Brom,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Materlal: Cellulose 10%, Non-fibrous 90% #5 216054287-05 No NAD Location: Living Room Ceiling-Sheetrock (by NYS ELAP 198.1) by Jared C.Clarke on 06101/16 Analyst Description:GreylBrown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Material:Cellulose 12%, Non-fibrous 88% See Reporting notes on last page AmeriSci Job#: 216054287 Page 2 of 3 Client Name: Michael J.Stevens PLM Bulk Asbestos Report 36; 36 Meadow Brook Rd., NY Client No.!HGA Lab No. Asbestos Present Total %Asbestos #6 216054287-06 No NAD Location: Living Room Wali-Oruvail (by NYS ELAP 188.1) 1 E by Jared C.Clarke on 06MI116 Analyst description:Gray/Brown.Heterogeneous,Fibrous,Bulk Malarial Asbestos Types: Other!!Aerial:Cellulose 15%, Nan-ftrous 85% #7 216054287-07 No NAD Location: Bedroom#1 Wall-Sheebv* (by NYS FLAP 188.1) by Jared C.Clarke on 06/01/16 Analyst Description:Grey/Brown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Material:Cellulose 12%, Non-fibrous 88% #8 216054287-08 No NAD Location: Bedroom#3 Wail-Drywall (by NYS ELAP 188.1) by Jared C.Clarke on 06/01/16 Analyst description:Grey/Brown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 10%, Non-fibrous 80% #9 21$054287-09 No NAD Location: Bedroom#2 Wali-Sheetrock (by NYS ELAP 188.1) by Jared C.Clarice on 06101/16 Analyst description:Grey/Brown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: other Material: Cellulose 20%, Non-fibrous 80% #10 216054287-10 No NAD Location: Bathroom#2 Calling-Drywall (by NYS ELAP 188.1) by Jared C.Clarke on 06101/16 Analyst Description:GreyBrown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Material: Cellulose 20%, Non-fibrous 80% #11 216054287-11 No NAD Location: Pet Kennel wan-Shestraak (by NYS ELAP 198.1) by Jared C.Clarke an 06101/16 Analyst description: PinkBrown,Heterogeneous,Fibrous,Bulk Material Asbestos Types: Other Materiel: Cellulase 15%. Non4dwous 86% See Reporting notes on last page r " k*I ' f�fif