BOTH-000601-2016 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-000601-2016 Date Issued: Wednesday, May 3, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000601-2016
has been completed.
Tax Map Number: 253.3-1-32.1
Location: 1903 RIDGE RD
Owner: Lisa Daigle
Applicant: Lisa Daigle
This structure may be occupied as a: Demolition of Post and Beam Barn
32 ft.by 42 ft. By Order of Town Board
Asbestos previously removed by homeowners:Test Report from EMSL TOWN OF QUEENSBURY
Analytical,Inc.Order No.031626087
Issuance of this Certificate of Compliance DOES NOT relieve the J
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000601-2016
Tax Map No: 253.3-I-32.1
Permission is hereby granted to: Lisa Daigle
For property located at: 1903 RIDGE 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
Tyne of Construction
Owner Name: Lisa Daigle Demolition $0.00
Owner Address: 1903 Ridge RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Demolition of Post and Beam Barn
32 ft.by 42 ft.
Asbestos previously removed by homeowners:Test Report from EMSL Analytical,Inc.Order No.031626087
$30.00 PERMIT FEE PAID-TFIIS PERMIT EXPIRES: Saturday,September 9,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town ofen bu rda , e ,2016
SIGNED BY: J W for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Buildinq & Codes office Use Only
Received
DEMOLITION PERMIT APPLICATION Permit #: _ T�___
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee
Provide 2 plot plans drawn to scale, showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and indicate which are to be demolished. Indicate the location of all utilities
Date _-7_____--_____ Demolition Location
Tax Map ID _J�S3_ ��
APPLICANT _L',5e _A Xk1 LQ-_______ ___ OWNER 1 _ `1Gy
Address �R'1JsC _-T�,� _ AddressP34 C QLChvav_��_F
PhoneC�(�: 1�5—d(°o—lam '-r-�------------ Phone\ _fiJ$__c?569_S¢s5r� --------
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: _ ;SLA _ 0.1 CL�__---__-----Phone: ol—W
i. Person Responsible for Work J
2. Where will demolition material be disposed?
3. All buildings to be demolished require an Asbestos Survev talo-5 o-f� g Qyv hQ�a ��5t�DSe�
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 ____ No
b) If Yes,our office needs the following Information __-_ Yes ____ No
Name of firm removing the asbestos Q 0 V
License number of firm =
indicate where the asbestos material wi dlsp sed ( n Lt 2 1
6. Structure Information
a) Indicate the structure(s)to be demolished Residence ___ Garage ___Business
Storage Bldg.___Other
b) Size of Structure 37- )( 42-
c)
ZX4c) Number of Stories II
d) Foundation Type G 0 Q ll
e) Foundation
f) Structure(s)
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
B. Signature
Print Name: ___ ________ Date
----------- ---- 1�----
Signature: _ r.;4 _ _-___-___ Date __g I J (¢_
Town of Queensbury Building & Codes - Demolition Permit - December 2014
EMSLAnalytical, Inc. EMSLOrder: 031626087
307 west 38th Street New York,NY 10018 Customer ID: ALP150
Te9Fac(212)290-0051/(212)290-0058 Customer PO:
hlip:/Aw .EMSL.com/manhattenlab@emsl.com Project ID:
Attention: Alpine Environmental Services Phone: (518)250-4047
438 New Kamer Road Fax:
Albany, NY 12205 Received Date: 08/30/2016 10:11 AM
Analysis Date: 08/30/2016
Collected Date: 08/28/2016
Project: 16-19640-A/1903 RIDGE ROAD/QUEENSBURY, NY 12804
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous . Asbestos
Sample ID 1 Description- MILK HOUSE_PANEL
031626087-Ml Homogeneity Homogeneous
PLM NYS 198.1 Friable 08/30/2016 Grey None 60.00% Ca Carbonate 11.40%Chrysotile
28.60% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB NotAnalyzed
TEM NYS 198A NOB Not Analyzed
Sample ID 2 Description MILK PARLOR-BOARD
031626087-0002 Homogeneity Homogeneous
PLM NYS 198.1 Friable 06/30/2016 Broom B5.00%Cellulose 15.001/6 Non-fibrous(other) None Detected
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
=FILECOPY
253.3-1-32.1 BOTH 601-2016
TOWN OF QUERISBURY Lisa A. Daigle
BUI!_DING DEF VENT
Based on our limit..^.d e1 Iriin1 tenroDm1ed as 1903 Ridge Road
with our comment``I'= .r ;ecahons are n
indicating hheCe3fls alhe wilding Codes Df Demolition Post 8 Beam Barn
full comp
New York State.
Initial Report From:08/31/2016 06:3D:21
ASB_198x 0009.1.71 Printed 8/31/2016 6:30:22AM Page 1 of 2
EMSL Analytical, Inc. EMSL Order. 031626087
307 West 38th Street New York,NY 10018 Customer ID: ALP150
TellFax:(212)280-00511(212)290.0058 Customer PO:
http:/Rrww.EMSLcom/manhattenlab®emsl.com 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: 8/30/2016 Sample Receipt Time: 10:11 AM
Analysis Completed Date: 8/30/2016 Analysis Completed Time: 3:21 PM
Analyst(s):
Daena Charles PLM NYS 198.1 Friable(1) Yolanda Chow PLM NYS 198.1 Friable(1)
Samples reviewed and approved by: /VW
James Han,Laboratory Manager
or Other Approved Signatory
NOB=Non Friable Organically Bound N/A=NotApplicable VCM=Vem iculite 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 rwn-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:/Avww.wadsworth.orgllabmrVelapcerthonns/VennicuiiteintedmGuidanca_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 mutts 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 endamement by NVLAP,NIST,or any agency of the federal government This report may
contain data that is not covered by the NVLAP accreditation.
Sample anWycetl byWSLMWytlraL Inc New Yerk NY NYe EVP 115M
Initial Report From 08/312016 06:30:21
ASB 198x 0009-1.71 Printed 8/312016 6:30:22AM Page'2 of 2
OrderID: 031626087 Pagel ofi
CHAIN OF CUSTODY
(4- Aipi
� ro'ecK:Residential Asbestos m'ect#16-19640-
Project Address: 1903 Ridge Road emb NY 12804
ins.
am led By.
E N V I R O N M E N T A L S E R V I C E S ate(rime Collected:08/28/1 ntact:At ' e La
er.FedEx racking# 9 S 1 '1.27 '2330
urnZ;ouad Time Pe4uestctL 24 Ho
ALL[NEGATIVE PL"011's ARE TQQIp!NEDIATELY GO TO TEM,
Log Sample Sample Sainple Material Analysis Comments
No. No. Location Requested
I Milk House Panel NYS PLM
2 Milking Parlor Board NYS PLM
nt
= rri
E; "Y
Disposition of Samples;Acccpl_Reject Comments: gbot{LQ��
Relinquished Received By. Date: Time:
e) ts.{ �-.
Alpine Environmental Services,Inc. yC Phone:(518)2504047
43S NewKamer Road 3 a a}` f� Fax:(518)250-4353
Albany,NY 12205 email:lab@alpineenv.com
Page 1 Of 1
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