BOTH-000559-2016 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: BOTH-000559-2016 Date Issued: Monday,November 14, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000559-2016
has been completed.
Tax Map Number: 301.13-1-3
Location: 14 MOUNTAINSIDE DR
Owner: Joseph Leuci,Maria Leuci
Applicant: Joseph Leuci
This structure may be occupied as a: Demolition of SFD
Asbestos report received and attached By Order of Town Board
TOWN
�OF QUEENSBURY
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
QL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000559-2016
Tax Map No: 301.13-1-3
Permission is hereby granted to: Joseph Leuci
For property located at: 14 MOUNTAINSIDE DR
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
Tvce of Construction
Owner Name: Joseph Leuci Demolition $0.00
Owner Address: 9 MOUNTAINSIDE DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Demolition of SFD
Asbestos report received and attached
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,September 1,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the axx2imtion date.)
Dated at the Town Queens ` / Thu y er 1,2016
SIGNED BY: LL,,,�••6�...ttt���JJJ�ttt111"""/// ��� �for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received _____________
DEMOLITION PERMIT APPLICATION Permit#: O�_��_�01
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee 'tT�yy�_���______
Provide 2 plot plans drawn to scale, showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and indicate which are to be demolished. Indicate the location of all utilities
Date --it2.3110---- Demolition Location Irt rno A1N5� 6R__
Tax Map ID _ 12.311- 10 --_
APPLICANT Sbs"'A d MAII1A LELAL4 OWNER
------------------ -----------------------
Address 3- D0.. Address
---------- ---------------------------
Q6Y Ny (zrso�r
---------------------------- ---------------------------
Phone _�S_1$�l9fo_3SZo------------ Phone
---------------------------
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: Lae uLi ---Phone: lr5(8�7q(v_ LO
I. Person Responsible for Work Jos EPA Le-ttL.1
2. Where will demolition material be disposed I Nput r o BN Kb W AkD'S 6-x(-. 7o APPRoPp Vir
3. All buildings to be demolished require an Asbestos Survey LAND FILLS .
4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
S. 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 _ No
b) if Yes,our office needs the following information ____Yes ____ No
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 ___ Garage ___Business
__Storage Bldg. --- Other
b) Size of Structure 112.00 S.f.
c) Number of Stories 201S 2, QLAXSe0 P-ANC44
d) Foundation Type AUG 4 Ed (,bNcR ETE $LO"L
e) Foundation
I) Structure(s)
7. Utilities Information
a) Indicate utilities for this structure f Gas ✓ Electric ___ Propane f 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. Slgnature
Print Name: �osg P61 (.guc _______ Date $ 14
-------- --------- --- --------
Signature: --=-- ---------------------------- Date ------
Town of Queensbury Building &Codes • Demolition Permit -December 2014
TOWN OF QUEENSBURY
BUILDING DEPARTMENT 301.13-1-3 BOTH-000559-2016
Pased on our limitcd exarn,inaiion,compliance LEUCL 10E SE Maria
our comments sheii not be construed as
indicating the plans and specifications are in 14 Mountainside Drive
hill compliance with the wilding Codes of
New York State. Demo of SFD 1200 s.f. asbestos report)
HANSON
GEOLOGIC & ENVIRONMENTAL CONSULTANTS
VAN VLEET, LLC
FIL =COPY
August 23, 2016 ;i1
AU:i 1 1 !10iS
Mr. Joe Leuci
Foothills Builders
9 Mountainside Drive
Queensbury,New York 12804 TOWN OF QA74' t
BUILDING &RE: Pre-Demolition Asbestos Survey Reviewed By
14 Mountainside Drive
Town of Queensbury, New York Date:
Dear Mr. Leuci:
Hanson Van Vleet, LLC conducted a pre-demolition asbestos containing material (ACM)
survey of the residential structure at 14 Mountainside Drive in the Town of Queensbury,
Warren County, New York. The property is on the north side of Mountainside Drive,
approximately 350-feet west of West Mountain Road. The property is identified as tax parcel
301.13-1-3. HVV is authorized by the New York State Department of Labor under license #
05-0220 to perform asbestos inspections, sample collection and surveys. Samples of each
type of suspected asbestos containing material (SACM) were collected. All samples were
collected by a NYSDOL licensed Class D Inspector, in accordance with 12 NYCRR Part 56,
(referred to as Industrial Code Rule 56)and 29 CFR Part 1910. The sampling was conducted
on August 11, 2016. A copy of the NYSDOL Asbestos license is attached to this letter.
Methods
Prior to initiating sampling, an on-site walk through inspection of the structure was performed
in accordance with Subpart 56-5(e) of 12 NYCRR Part 56. Building plans were not available
for review. Based on the site inspection, sampling of materials was performed to evaluate for
suspect asbestos containing materials (SACM). Bulk samples were collected following
standard sampling procedures. The samples were placed in double sealed sample bags and
delivered by Federal Express to EMSL Analytical for analysis under formal chain of custody
procedures. Friable type materials were analyzed by Polarized Light Microscopy (PLM) via
the NY State ELAP 198.1 method. Non-organically bound (NOB) materials were not
observed during the inspection.
Inspection Results
The inspection revealed wood framed split level residence on a concrete block foundation,
constructed in 1983. The exterior of the structure had vinyl siding, vinyl type windows, vinyl
902 Route 146 (518)371-7940
Clifton Park, New York 12065 Fax(518)371-5885
Pre-Demolition ACM Survey Proposal
9 Mountainside Drive,Queensbury,NY
August 10,2016
Page 2
soffits and wood trim. The structure had a recent architectural shingled roof. The interior
construction consisted of hardwood and ceramic tile floors, wood paneled and drywall walls
and drywall ceilings. Suspect ACM materials identified included: drywall and mudded joint
material.
Asbestos Containing Material Sampling Results
Five samples of each type of suspected ACM were collected for analysis for possible asbestos
content. The samples and results are summarized in Table 1 below. The analytical laboratory
results and chain of custody are attached to this letter.
Table 1
Asbestos Sampling Locations and Analytical Results
14 Mountainside Drive, Queensbury,NY
-Sample No. Type of Material Location Result
SAA Dry Wall Garage Wall None Detected
S-IB Dry Wall Laundry Room eiling None Detected
S-IC Dry Wall Living Room Ceiling None Detected
S-11) Dry Wall Bathroom Wall None Detected
S-IE Dry Wall Bathroom Ceiling None Detected
S-2A Joint Compound Bathroom Wall None Detected
S-213 Joint Compound Hallway Wall None Detected
S-2C Joint Compound Bathroom CeilinR None Detected
S-2D Joint Compound Laundry Room Wall None Detected
_S-2E Joint Compound Laund Room Ceiling None Detected
Conclusions
No asbestos containing materials were identified in the structure. No remedial activities are
required prior to demolition of the structure. The Analytical results and chain of custody are
attached to this letter.
If you have any questions regarding this survey, please contact us at(518) 371-7940.
Very truly yours,
Hanson Van Vleet, LLC
Very truly yours,
Hanson Van Vleet, LLC
&t
James Gironda
NYSDOL Class D Inspector Certificate# 07-05263
CC:NYSDOL
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FIGURE 1:SITE LOCATION MAP FIG-1 H ANSON WATER SUPPLY a
14 MOUNTAINSIDE DRIVE ENVIRONMENTAL CONSULTANTS
QUEEN5BURY,NY VANVLEET, LLC
902 ROUTE 10 CLIFTON PARK,NEWYORK 12085 (518)371-MO FM(518)371-5805
EMSL Analytical, Inc. EMSL Order: 031624333
Customer ID: HANS22
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-00511(212)290-0058 Customer :
ID:
http:/Mv .EMSL.com/manhatenlab@emsl.com Project D
Attention: James Gironde Phone: (518)371-7940
Hanson Van Meet, LLC Fax: (518)371-5885
902 Route 146 Received Date: 08/15/2016 9:58 AM
Clifton Park, NY 12065 Analysis Date: 08/15/2016-08/162016
Collected Date: 08/11/2016
Project: 14 MTN VIEW DR, NY
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample to SIA Description GARAGE WALL-SHEET ROCK
031624333-0001 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/15/2016 Gray 10.00%Cellulose 60.00%Gypsum None Detected
30.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
SamplelD SIB Description LAUNDRY ROOM CEILING-SHEET ROCK
031624333-0002 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/15/2016 Gray 5.00%Cellulose 35.00%Gypsum None Detected
60.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
SamplelD SIC Description LIVING ROOM CEILING-SHEET ROCK
031624333-0W3 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/15/2016 Gray 8.00%Cellulose 52.00%Gypsum None Detected
40.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
SamplelD SID Description BATHROOM WALL-SHEET ROCK
031624333-0004 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/15/2016 Gray 5.00%Cellulose 40.00%Gypsum None Detected
55.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
SamplelD S1E Description BATHROOM CEILING-SHEET ROCK
031624333-0005 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/16/2016 Brown/Gray 10.00%Cellulose 60.00%Gypsum None Detected
30.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB Not Analyzed
Initial Report From:08/16/2016 10:19:06
ASB 196x 0009-1.71 Pdnled 8/16/201610:19:07AM Page 1 of 3
EMSL Analytical, Inc. EMSL Order: 031624333
Customer ID: HANS22
307 West 38th Street New York,NY 10018
Tel/Fax:(212)290-0051/(212)290-0058 Customer PO:
http:1ty EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID S2A Description BATHROOM WALL-JOINT COMPOUND
031624333-0006 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/15/2016 White 65.00%Ca Carbonate None Detected
35.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID S2B Description HALWAY WALL-JOINT COMPOUND
031624333-0007 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/152016 White 60.00%Ca Carbonate None Detected
40.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 196.6 NOB Not Anatyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID S2C Description BATHROOM CEILING-JOINT COMPOUND
031624333-0006 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/152016 White 60.00%Ca Carbonate None Detected
40.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID S20 Description LAUNDRY ROOM WALL-JOINT COMPOUND
0316243330009 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/15/2016 White 70.00%Ca Carbonate None Detected
30.00% Nan-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
SamplelD S2E Description LAUNDRY ROOM CEILING-JOINT COMPOUND
031624333-0010 Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/162016 White 60.00%Ca Carbonate None Detected
40.00% Non-fibrous(other)
PLM NYS 198.6 VCM NotAnalyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Initial Report From:081161201610:19:06
ASB 198x0009-1.71 Printed 8/162016 10:19:07AM Page 2 of 3
EMSLAnalytical, Inc. EMSL Order: 031624333
Customer ID: HANS22
307 West 38th Street New York,NY 10018
Customer PO:
TeVFax:(212)290-0051/(212)2900058
http://www.EMSL.mm/manhattanlab@emsLoom Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above. Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 8/15/2016 Sample Receipt Time: 9:58 AM
Analysis Completed Date: 8/15/2016 Analysis Completed Time: 10:15 PM
Analvst(s):
Emily Myint PLM NYS 198.1 Friable(2) Tiquasha Thompson PLM NYS 198.1 Friable(8)
Samples reviewed and approved by:
James Hall,Laboratory Manager
or Other Approved Signatory
NOB=Non Friable Organically Bound N/A=NotApplicable VCM=Vermiculite Containing Material
-In New York State,TEM is currently the only method that can be used to determine if NOB materials can be considered or treated as non-asbestos containing.
All samples examined for the presence of vermiculite when analyzed via NYS 198.1.
-NYS Guidelines for Vermiculite containing samples are available at http:/t n .wadsworth.org/IabcerUelapmrUrorms/VemiwlitelntedmGuidanm Rev070913.pdf EMSL
maintains liability limited to cost of analysis.This report relates only to the samples reported above and may not be reproduced,except in full,without written approval by
EMSL.EMSL bears no responsibility for sample collection activities or analytical method limitations.Interpretation and use of test results are the responsibility of the client.
Samples were received in good condition unless otherwise noted.
This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,or any agency of the federal government.This report may
contain data that is not covered by the NVLAP accreditation.
samples analyzed b/EMSLMaMIUI,Inc.New York.NY NYS EU 115M
Initial Report From:08/16/201610:19:06
ASB 198x 0009-1.71 Printed 8/162016 10:19:07AM Page 3 of 3
OrderlD:.031624333
EMSL Analytical, Inc.
*- AsbestosANALYTICAL.INC. Bulk Building Material 307 West 38th Street
Chain of Custody New York, NY 10018
9M1L
EMSL Order Number(Lab212
_use Only). PHONE ( )
290-0051
,..r.,....,...,m.........A FAX
(212)290-0058
Hanson Van Vleet LL -C EMSL43111 to: Same Different
_COmpany__ H Bill to is Different note instructions In Comments"
Street:902 Route 146 Third Pert Man re uims written aulhorization tram third rl
C :Clifton Park Stateiprovince:NY .....ZIP/Postal Code 2065
Country:US
Report To Name :James Gironda Telephone#:5183717940
Email Address: J9ironda@hansonvanvleet.com _Fax M 5183717940 I Purchase Order:
Project NamelNumber:14 Mtn View or _ Please Provide Results: ax ✓ :mall ail
U.S.State Samples Taken:NY CT Samples:U Commercial/Taxable Lj Residential/Tax Exempt
Turnaround Time AT O tions*-Please Check
El 3 Hour 6 Hour 24 Hour 48 Hour 72 Hour ILJ 96 our 101Week ❑ 2 Week
'For TEM Air 3 hr through 6 hr.please call ahead to schedule.'Them Is a premium charge for 3 Hour TEM AHERA or EPA Level II TA T. You will be asked to sign
an authonzatlon form for this service. Analisis completed In accordance with EMSL's Terms and Conditions bcated in the Anal bai Price Guide.
PLM-Bulk(reporting limit l TEM-Bulk
❑PLM EPA 600/R-93/116(<1%) ❑TEM EPA NOB-EPA 600/R-931116 Section 2.5.5.1
❑PLM EPA NOB(<1%) ®NY ELAP Method 198.4(TEM)
Point Count ❑400(<0.25%)❑ 1000(<O.1%) ❑Chatfield Protocol(semi-quantitative)
Point Count w/Gravimetric❑400(<0.25%)❑ 1000(<0.1%) ❑TEM%by Mass-EPA 600/R-93/116 Section 2.5.5.2
❑ NIOSH 9002(<1%) ❑TEM Qualitative via Filtration Prep Technique
® NY ELAP Method 198.1 (friable in NY) ❑TEM Qualitative via Drop Mount Prep Technique
® NY ELAP Method 198.6 NOB(non-friable-NY)
❑ OSHA ID-191 Modified ❑
❑ Standard Addition Method
M Check For Positive Stop-Clearly Identify Homogenous Group Date Sampled: 8/ 1116
Samplers Name:James Gironda Samplers Signature:
Sample# HA# Sample Location Material Description
SIA 1 Garage Wall Sheet Rock
S1B 1 Laundry Room Ceiling Sheet Rock
S1C 1 Living Room Ceiling Sheet Rock
S1 D 1 Bathroom Wall Sheet Rock
S1 E 1 Bathroom Ceiling Sheet Rock
S2A 2 Bathroom Wall Joint Compound
S213 2 Hallway Wall Joint Compound
S2C 2 Bathroom Ceiling Joint Compound
S2D 2 Laundry Room Wall Joint Compound
S2E 2 Laundry Room Ceiling Joint Compound
Client Sample#(s): I - S 2�- Total#of Samples: 10 __
G�
Relinquished(Client): Date: Time: I
Received(Lab): �y
Date: (� Time: "l:S y M
Comw„mw tsLSMNloaallnstructi�na.
Page 1 of pages
Page 1 Of 1
New York State—Department of Labor
Division of Safety and Health
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Hanson Van Vleet, LLC FILE NUMBER: 05-0220
LICENSE NUMBER: 28463
902 Route 146 LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 03/24/2016
Clifton Park, NY 12065 EXPIRATION DATE: 03/31/2017
Duly Authorized Representative—D Kirby Vanvleet:
This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of
the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1)
serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of
responsibility in the conduct of any job involving asbestos or asbestos material.
This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the
asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York
State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State
Department of Labor.
Eileen M.Franko, Director
SH 432(8/12) For the Commissioner of Labor
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