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DEMO-000397-2017 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: DEMO-000397-2017 Date Issued: Wednesday, July 26, 2017 This is to certify that work requested to be done as shown by Permit Number DEMO-000397-2017 has been completed. Tax Map Number: 290.14-1-20 Location: 43 MARTELL RD Owner: Derek Swift Applicant: Derek Swift This structure may be occupied as a: Demolition of residence and decks(due to fire damage in April 2017) By Order of Town Board Asbestos Report Received TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the 4 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 (5 18)761-8256 BUILDING PERMIT Permit Number: DEMO-000397-2017 Tax Map No: 290.14-1-20 Permission is hereby granted to: Rick McGuire For property located at: 43 MARTELL 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 Tvoe of Construction Owner Name: Derek Swift Demolition-Residential $0.00 Owner Address: 266 Middle RD Total Value $0.00 Lake George,NY 12845 Contractor or Builder's Name/Address Electrical Inspection Agency Rick McGuire Plans&Specifications Demolition of residence and decks(due to fire damage in April 2017) Asbestos Report Received $30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,July 12,2018 (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 exp/J�J tion date.) Dated at the Town of ueensb f/ h s y 12,2017 SIGNED BY: �/ for the Town of Queensbury. Director of Building&Code Enforcement —>moLL-A(3 r a� -k 7 - Town of Queensbury Building & Codes Office Use Only Received DEMOLITION PERMIT APPLICATION Permit#: i_LQ NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee ,�_�,Q__ 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 _3= Z6I (\ Demolition Location Tax Map ID _ �2`10. 14_I_-).o� (� APPLICANT �CPtLC_ rT-r - _ _ OWNER / _ -- -- -- -- Address ZLG V1l i 1 �t CC --, e-- KC- ------- ----� -�--�--- - Address .��_'=.=.�_G.J� ----- -��4-�- ZS J_4�.��� Phone _S1F=A _QT3----------- Phone ---------- CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: _______________________________Phone: 1. Person Responsible for Work %CL" . -),c 2. Where will demolition material be disposed? Cr, r-rAy 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 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 ,),V d�—r 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 _K Residence --- Garage --- Business --- Storage Bldg. -__ Other b) Size of Structure 2� x 1 I 0 51= c) Number of Stories d) Foundation Type " J)WjJ ry C C Ae-AG / e) Foundation il�a Cc - /I G Zh f) Structure(s) 7. Utilities Information a) Indicate utilities for this structure --- Gas x Electric Propane --- Public Water --- Public Sewer Onsite well water pump a) Have you notified the Town Water Department for public water and sewer disconnect? ----Yes ---- No IN/A b) Have all utilities been disconnected? _ Yes ---- No 8. Slgnature Print Name: _ 1 _ ______________________ Date Signature: ----------------- Date -ZOO Town of Queensbury Building& Codes - Demolition Permit - December 2014 - � L7rUILDING DQUEENSBURYANSON &CODES GEOLOGIC & ENVIRONMENTAL CONSULTANTS VAN VLEET, LLC - ' LZ � } L Jp May 1,2017 dl Mr.Derrick Swift TOWN OF QUEENSBURY 266 Middle Road COMMUNITY DEVELOPMENT Lake George,NY 12845 -- 290.14-1-20 DEMO-000397-2017 RE: Pre-Demolition Asbestos Survey Swift, Derek 43 Martell Road 43 Martell Rd. Town of Queensbury, Warren County,NY Demo Only (asbestos report recvd) Dear Mr. Swift: Hanson Van Vleet, LLC conducted an asbestos containing material (ACM) survey of the residential structure at 43 Martell Road, Tax ID: 290.14-1-20 in the Town of Queensbury, Warren County, New York (See Figure 1). 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 April 18, 2017. 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 house 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 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 analyzed by PLM via NYS method 198.6 NOB. If the NYS method 198.6 NOB was inconclusive, the NOB materials were then analyzed by transient electron microscopy (TEM)via NYS method 198.4 NOB. Inspection Results The inspection revealed a two-story log-built residential structure, approximately 1,140 square feet in size. The structure was of log built construction, on a concrete crawlspace foundation, with an asphalt shingle roof. The exterior was exposed log construction with wooden trim, eves and soffits. The main roof of the house consisted of asphalt shingles over a plastic membrane underlayment. An addition at the 902 Route 146 (518)371-7940 Clifton Park, New York 12065 Fax(518)371-5885 ` Pte-Demolition ACM Survey 43 Martell Road Queensbury,NY Page 2 of 2 back of the house had a rolled rubber roof with no underlayment. Windows were of non-glazed aluminum construction. The interior construction consisted of exposed log walls, hard wood floors, ceramic tiled floors in bathrooms, and open wood framed ceilings. Suspect ACM materials identified on the exterior of the house included only asphalt roof shingles. No suspect ACM materials were identified on the interior of the house. Bulk samples were collected of the asphalt roof shingles. Asbestos Containing Material Sampling Results A minimum of three samples of each type of suspected ACM was collected. The samples and results are summarized in Table 1 below. The Analytical results and chain of custody are attached to this letter. Table 1 Asbestos Sampling Locations and Analytical Results 43 Martell Road Queensbury, NY Sample No. Type of Material Location Approximate Quantity Result (square feet S-IA Asphalt Shingle Exterior-Roof NA ND S-IB Asphalt Shingle Exterior-Roof NA ND S-1C Asphalt Shingle Exterior-Roof NA ND Conclusions Materials are considered asbestos containing if they contain 1 % or more of asbestos. No asbestos containing materials were identified within the structure at 43 Martell Road Queensbury,NY. No asbestos abatement is required prior to demolition of the structure. If you have any questions regarding this survey,please contact us at (518) 371-7940. Very truly yours, Hanson Van Vleet, LLC James Gironda NYSDOL Class D Inspector Certificate#07-05263 CC: NYSDOL O Qneida / 2 . • r il ����� /� �1) �� }l, •I� _�• sM rners �l•o �—.r,o ,� 3; �' �� , l .��'tcntF.ysttle''' � 1 .:j, 041 a 1• 1 `- /. / �.:bi' — Lake 1 (� Oneida �t . 4toTysi.dL ke Sunnyside ••Corners R � 3p0 S �li (IM 4G)1� ' UL l i1 3, 1 ( {/ 4) Il 5 x366 }00///�/�/! Q.Lv }Cmfimumty 00 gay roj � irk ri1 Ag1 49, j' v �a /' ,il- AIRPORT Ffle ds .,j )� Z � I$M3 ennt FIGURE 1: SITE LOCATION HATNSON w TERSUPPLY T/ 43 MARTELL ROAD vANVLEET, LLC ENVIRONMENTAL CONS.LTANT. QUEENSBURY, NY 902 ROUTE 146 CLIFTON PARK,NEWYORK 12065 (518)4]1-7940 FAX(518)371-5885 OrderID: 031710673 EMSL Analytical, Inc, Asbestos Bulk Building Material 307 West 38th Street ® Chain of Custody New York, NY 10018 EMSL Order Number( iPHONE:b use Only): (212)290-0051 EM6L pNp�Y.TICpt.INC. ,03 O 3 FAx:(212)290-0058 Campan ;Hanson Van VleetLLC nsolSwisIDIineenI IfatoIerentnote Idon ° m % Street:902 Route 146 Third Pal a BII(i re uiras written authorization from third art city,Clifton Park State/Province:NY ZiplPostal Code:12065 Count .US Report To(Name):James Gironde Tele hone#:5183717940 Email Address: Jgironda@hansonvanvieet.com Fax#: 5183717940 Purchase Order Project Name/Number: Please'Provide Results: ax ✓• Emafil Mail U.S.State Samples Taken: CT samples:I I Commercialfraxable ❑Residentialfrax Exem t Turnaround Time ATO tions*-Please Check ❑3 Hour 6 Hour 24 Hour ❑46 Hour ❑ 72 Hour ❑ 96 Hour XI Week ❑ 2 Week 'For TEMAIr 3 hr through 6 hr,please cell ahead to schedule.`There Is a premium charge for3 Four TEMAHERA or EPA vef 11 TAT. You will be asked to sign an authodration form forthis service Analysis com leledin accordance with EMSL's Terms and conditions located In the Ans4glcal Prue Gulds. PLM-Bulk(mportlnc limit) TEM—Bulk ❑PLM EPA 600/R-93/116(<1%) - _ ❑TEM EPA NOB-EPA 600/R-93/116 Section 2.5.5.1_ []PLM EPA NOB(<1%).___ _ NY ELAP Method 198.4(TEM) Point Count ❑400(<0.25%)❑ 1000(<0.1°k) ❑Chatf Id Protocol(semi-quantitative) Point Count w/Gravimetric❑400(<0.25%)❑1000_(<0.1°5) ❑TEM°o by Mass-EPA 600/R-93/116 Section 2.5_._5.2 ❑ NIOSH 9002 <1% ❑TEM ualitative via Filtration Prep Technique ❑� NY ELAP Method 198.1 (friable in NY) ❑TEM Qualitative via Drop Mount Prep Technique IN NY ELAP Method 198.6 N_ O_ B(non-friabltNY) _ _ _ Other ❑ OSHA ID-191 Modified ❑ Standard Addition Method ❑ ©Check For Positive Stop-Clearly Identify Homogenous Group Date Sam led:4/ /17 11. f Samplers Name:Jarnes Gironde Samplers Signature: Sample# HA# Sample Location Material Description SIA Roof Shingles S 1 B Roof Shingles S1 C Roof Shingles r. r o Client Sample#(s): Total#of Samples: Relinquished(Client: Date: I I Time Received(Lab): e: Timef Cpommerrt1ts/Soec n ucttons: alnconaudva=MIS N06. BU.:Hanan van waw LLC.902 Baum 146.C48on Pak,NY.12065,LIS Aeen54n:James GB da Pima:51837179409=1t Ja6ron°44na nv4eel mm Fdr ..OM..43 Mail R°ad Page 1 of pages n \klacln 1>u�1Y Page 1 Of 1 EMSL Analytical, Inc. EMSL Order: 031710673 307 West 38th Street Nero York,NY 10018 Customer ID: HANS22 Tel/Fax:(212)290-0051/(212)290-0056 Customer PO: http:/Av .EMSL.wm/manhattantab@emsi.mm Project ID: Attention: James Gironda Phone: (518)371-7940 Hanson Van Vleet, LLC Fax: (518)371-5885 902 Route 146 Received Date: 04/202017 11:00 AM Clifton Park,NY 12065 Analysis Date: 04/25/2017 Collected Date: 04/192017 Project: 43 MARTEL ROAD/ NEW YORK Test Report:Asbestos Analysis of Bulk Material Non-Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos SamplelD 81A Description ROOF/SHINGLES 031710673-0001 Homogeneity Heterogeneous PLM NYS 196.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 0425/2017 Black 3.70%Glass 98.30%Other Inconclusive:None Detected TEM NYS 198A NOB 04/25/2017 Black 100.00%Other None Detected SamplelD S1B Description ROOF/SHINGLES 031710673-0002 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04252017 Black 3.60%Glass 96.40%Other Inconclusive:None Detected TEM NYS 198A NOB 041=017 Black 100.00%Other None Detected SamplelD S1C Description ROOF/SHINGLES 031710673-0003 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/252017 Black 4.30%Glass 95.70%Other Inconclusive:None Detected TEM NYS 198A NOB 04252017 Bleck 100.00%Other None Detected Initial report from:041252017 15:33:34 ASB 198x 0009 0001 Printed4/25/2017 4:12:31PM Page 1 oft EMSL Analytical, Inc. EMSL Order: 031710673 307 West 38th Street New York,NY 10018 Customer ID: HANS22 Tel/Fax:(212)290-00511(212)290-0058 Customer PO: htfp:/Awvw.EMSL.com/manhatlanlab@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: 4/20/2017 Sample Receipt Time: 11:00 AM Analysis Completed Date: 4/25/2017 Analysis Completed Time: 12:41 AM Analvst(s): Shahmkur Mahmud PLM NYS 198.6 NOB(3) Sarah WcheyTEM NYS 198.4 NOB(3) Samples reviewed and approved by: !/James Hall,Laboratory ✓✓�LManager or OtherApproved Signatory NOB=Non Friable Organically Bound N/A=NotAppliceble 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 hhp:IAry .wadsworth.orgnabcertlelapmrUform4VernimlitelntedmGuidance_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 analyx by EMSLMaWal,Inc New YoA,NY We ELM 11505 Initial report from:04/25/2017 15:33:34 ASB 198x 0009 0901 Printed4/25/2017 4:12:31PM Page 2 of S"L"ATE OF NEW YORK DEPARTMENT OF LABOR ASKSTOS CERTIFICATE JAMES J GIRONDA CLASS(EXPIRES) D INSP(11/17) MUST BE CARRIED ON ASBESTOS PROJECTS rhlt�lrlulrir Mlritn It Or[ 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: 03/02/2017 Clifton Park, NY 12065 EXPIRATION DATE: 03/31/2018 Duly Authorized Representative:—D Kirby Vanvleet: This license has been issued in accordance with applicable provisions'of Article'3 0 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 anyjob involving asbestos or asbestosmaterial. 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. C�/�/► L Eileen M.Frranko, Director SH 432(8/12) For the Commissioner of Labor 1�j OFQUEEnationalgrid UNIrY DEvE 300 Erie Boulevard West Syracuse,New York 13202 Derek Smith RE: Service Removal for Building Demolition. To Derek, This letter is to confirm that,per your request,National Grid has confirmed electrical service and meters have been removed at 43 Martell Rd Queensbury,NY 12804. The work was processed on work order#24156539 and meter#27534191 was removed. If you have any questions or need further assistance,please feel free to contact me at 1-800- 260-0054. Sincerely, Customer Fulfillment nationalgrid JUL 0 5 2011 D TOWN OF QUEENSBURY BUILDING&CODES 290.14-1-20 DEMO-000397-2017 Swift, Derek 43 Martell Rd. Demo Only (asbestos report recvd) NOTTOSOILE MAP-tVOIES Lffilitvl'ole 1. and field ciiata captured ot2juneIZ2017 01-1w OFJW 011W - � � — — � — — 2. North orientation road bearirzo GaseperrLlap RcI Z. — r — — � \ _. ✓ it J ,. 3. T Vari-eii County Laxparcel 290.14-1-20. Site Location 0 4. The location of undciXround inpro veinet i ts or encroachments,if arty exist or as shown hereon,are not cardfied There Lnaj-be other underground utilities,the existence ofivilicli are unknown. Size andlocatio-n ofall undergroundatilities inustbe vetifiedh the MARTELL ROAD dpPropliateautbodfies. Ille L1ndet�,-roundhicjJj6cs 1i-otelive Otyanization inust benotifiedpriol-to conductlu,-test burings,excii-tution Ed,-e of Ila vem en t andconsti action. 5. this survey was prepared rvithoutillebetiefitofan tip to d'rte abstract-oftitle. L=30.78, R=25.00 4 011/41 6. Rep ro du ction oi-colyit i,-,of this docun ici i ta iq y be a viola Hot 7 of cqpjTiqh t la r I,i irdess pera iission of th e a u th or an d or cop I 1 111 Iron 1�od _rrj,-htl1,11dVr N07"51' 00"E 0 1) j Found,0.2' 11-0-n Rod _i�;obtained -10.04 froin Coiner. 553'30Vo,1L'0.5, from Corner 7 A cqpj,ofLhis docizinent ivitliout,�il)i-opei�appliciitio.t2 ofl!2e surveyor�5 eatbossetfseiilslioulcibeissuii2edto be an unauthorizedcopy: g & -L=118.63, R=50.00 Lands Now or Formerly of Lands Now or Formerly of David & Michele Della Monica Stephen & Phyllis Hudson Book 670 Page 703 Book 811 Page 266290.14-1-19 290.14-1-191 culvert .65 Area=2 39_±act-es Recovered F, CD Propane Yanks r--- C) 0 L-1 (".5 Shed 0 X Gra Ahip Reference I oovered Parkzh- 0 / j,t7ood Deck PV&l Area Bllco 11-6h POG/Found(Ifeld) Garage N. PVoodhaine Residence j > (to be Reiwovec GJ/ool Ly r 0 Deck Cl) 0 0 Several DEC Pfletland flags were Ir) CD 0 Q) I notrecovered duringoarfielo;le 0 _ i Cn data capture.Limits or i vetiancis Carden QN 00shoritzperDECmappfub 0 U) 0 Iron Rod supplied bjf client LU Found(flelc) _[roj2 CU S09Rod 0" W 0011 Found,0.2' C) froin Corner 41�.38 C4 Bea I iu,-310-12,-this line per Deed Referet ice L: _E i QQ) Alap References 1 2 use a bearing of 4 0 DEED 1?EFEREiVCT: -50954TV which creates a inatheinatical closure error for this12drcez C13 0 Y. Conveyance to Derek Swift by deed dated Octobei-30,2009,fileclia the Pb2trrcn cS E County Clerks Office on November 09,200,9inBook 3900ofDeedS atpa'-e 1194. CN C0 MAP l?8F61?ENCTS- Lands Now or Formerly of, 1. Map entitled°l-lijvjlatidAcres Suhclivisio-i7"'preparedby Van Dusen,dated PERMIT,;.PLOT PLAN li?hrt i a ry 24 1976,filed I it i the Warren ire.,i Count;,Clerks Office on July 7,1981 as map ap Aflebael & Jan 'Bardin I HAVE PERSONALLY MEASURED THE DISTANCE ,J n i in i ber Aolder D Ahp 663. 20FR - TI E PIROPFIRTY LINE,", TO THE Book 1026 Page 315" vI id1:-o CTURE(G) OR SIGN(S) 2 111p entitled'Map ofa I-roposed.5ubdivision made for Brian O'Connor','prepared �� wu b 1 K)t)-,v) by Van Du64m&5teves,dwedjune2b,1989, filed 290.14-1-34 Foe_ R. Ui�i ri� In the Will7lLn CoLtlltyClerk-S Office o-tij4ziiiiiii),31,19949iis,-t2iipiitiitiber,4-151. RE DATE I, - - R 9 U_= KRISTIN M. DARRAH DATE REVISIONS RECORD DESCRIPTION DRAFTER UNAUTHORIZED ALTERATION OR aBoundary5arvey TU Vi'l OF- (_��tJE_:E_N8BURY 050803 ma p of ADDITION TO THIS DOCUMENT ISA `0��Al VIOLATION OF SECTION 7209 C DEVELOPNIE SUBDIVISION 2 OF THE NEW YORK L an ds No w or Forn z erly of STATE EDUCATION LAW. © 2017 of Derek & A adrey,5wift Darrah Land Surveying, PLLC TOWNOF QUIEN,5,6URY WARREA1 COUNTY,NEW YORK A PPR 0 VED KMD GC8 DRAFTED. ing LLC -1 Darrah Land Survey P --- ---- _17043 -K CHECKED. A11D 3764 North Sh o re Roa c 1,Hadle NY 12835 PROf NO 17043 Voice: (518)798-4692 SHEET- 1 OF 1 "ONLY BOUNDARY SURVEY MAPS WITFITIIE SURVEYOR'S EMBOSSED SURVEYOR'S SCALE: 1 -40 SEAL ARE GENUINE TRUE AND CORRECT COPIES OF THE S ORIG IN AL WORK AND OPINION." DATE: 0612812017 PROJIVO 17043