DEMO-0007-2021 Office Use Only —
DENMOLITION APPLICATION Permit#: � 000
-.Permit_F_e $
Town of 0_ucens6uryION LI
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742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www:aueensbur t.net j
[ JAN 08
Demolition Location: 3 Z ISeA•w �� "l-%?' Tax Map ID#: iZ 7-7 . 1 0" 1` Z z
.11�-oT1Vo$ a
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DE OLIT ON APPLICATION SUBMISSIONS**
CONTACT INFORMATION:
Applicant: I r
Name(s): 'DovGLA s Ai.�
Mailing Address, C IS/Z: 14 Googv 'QT Zci A)OV IA (C2EV ie IU.Y, 12 $93
Cell Phone: 51 ) 74y, N 15- Land Line: S1 ) ZSI- 3,6l 1
Email: McCALFL. iek-POET. JET
• Primary Owner(s): !
Name(s): PF-cNg `( t 1?ETgQi Tow tlsrA)
Mailing Address; Cf S/Z: 1 6I3 oyi I q�N 146St S ouN75 XL_ 3 3 t/7s
C611 Phone._( 19&1 .) 30-71- 6 zz 5 Land Line: _( 77z ) ckSZ - 7 30-7
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Email: V�tyecoj!V i1ow4y,se Y 6MAti_ : Lund
❑ Check if all work will be'performed by homeowner only
• Contractor:Workers Comp 1 documentation must be submitted with this application
Contact Name(s): ou&L S W(ALL Ke-CALL Qnr�-1-��� �-r��N L t c-
Contractor Trade: i G eNeri At CoNry ACTnQ
Mailing Address, C%S/Z: 1y�S Noy_Nk e_¢rjgv_ kY. 12 893
Cell Phone:—( S/8 ) :7 Ll 14 Land Line: _( 518 ) 2 S - 3101 et
Email:-. Mc CA L l k CJ J.'ZC,i4T11<R NE 1.6)Ti_ •
**List all additional dontractors on-the back of this form
Contact Person for Building & Code Compliance: JbOLGLAS Mt- ALL
Cell Phone. .( S18 ). 7 y 4 9 S. Land Line:_(_El�) 251- I&15
Email: Me-(Alt ILA N , N��
Demolition Application Revised February 2019
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• Contractor(sl:INorkers' Comp documentation must be submitted with this application
ontraator Namll (s):_ L I-s b Q11� -* SdN 15X e-Av,p-t w,N
Contractor Trade: t�e-i t o
Mailing Address C/S/Z: >�VYI4�i A� N� IZ z-7
Cell Phone: .( ). Land Line: (S I A ) 7 9 z - `l z Y(o
Erriail:'�.r iin16VGG {�r.�L�,a.�oGW1 rmycAuA.-ri&V . C.be1
• Contractor(s):Workers' LnIpidocu-mentation must be submitted With this application
Contractor Name(s):
Contractor Tradin-
Mailing-Addressj C/S/Z:.
Cell-Phone: ( ) Land Line: � )
Email:
i
• .Contractor(s): orkers' Compidocumentation must be submitted with this application
Contractor Namie(s):
Contractor Tradg:
Mailing Address, C/S/Z:
Cell Phone: ) Land Line:
Email:
i
• Contractor.(s): . orkers' omp'documentation must be submitted with this application
Contractor Name(s):
ContractorTrade:_
Mailing Address C/S/Z:
Cell Phone: ) Land Line: �)
Email:
• Contractor(s): orkers' ompjdocumentation must be submitted with this application
Contractor Nam (s):
Contractor Trad :-
Mailing_Address C
Cell Phone: ) Land Line: �)
Email:
• Contractor(s): orkers' Compidocumentation must be submitted with this application
Contractor Nam (s):.
Contractor Trade:.
Mailing Address C/S/Z:
Cell Phone: ) _ - Land Line:
Email:
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Principle Structure Packet Revised February 2019
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DEMOLITION INFORMATION:
1. Where will demolition rn aerial be disposed? AC.r-- C(m-rt"V6
2. .Type of structure to be demolished:
a. Resid nce
b. Garage ✓
c.- Busini�ss
d. _Storage Building
3. What type of utilities are nnected to the structure:
a.-'Gas
b. Fuel Oil
c. - Propahe
d. Electric
e. Public'Water
f. : Well-Water Pum '
g. Public�Sewer
h. Other
I. None ✓.
4. Have ALL utilities been d sconnected? Yes ✓ No
ADDITIONAL INFORMATION..
1. Two inspections may be equired: an inspection to determine that utilities are disconnected,if
necessary,and a final ins�pection,.after the structure is removed and the site is cleaned up and graded.
2. Twenty-four(24)hour notification is required for inspections.
3. Workers'Co II p insuranc information is required to be submitted with this application.
I .
Declaration:I acknowledge that n structu're(s)will be removed from the parcel until the demolition application has
been reviewed and approved by th a Town of Queensbury Building&Code Enforcement and Zoning Departments and a
permit has been issued:
have read and agree to th above:
PRINT NAME: -�OU&LA s M e( ALL-
SIGNATURE: V DATE:
Demolition Application Revised February 2019
TOWN OF QUEENSBURY
Asbestos Survey BUILDING & CODES DEPT.
Penny Townsend Reviewed By:
32 Bean Rd
Date:
Kattskill Bay, NY
Inspection date:1/4/2021
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New Yodc State.
Tom Callahan/TC Inspections
1 Knolls Dr
Oueensbury, NY 12804
Inspector# 17-42926/Contractor# 109425
cell# 518-832-9750
(01.1 EE �!,Vil FEE�r,
l� FJAN_
12 22! 1
227.10-1-22 DEMO-0007-2021
+OpVZ] OF �''-�E��N831j Y Townsend Penny
L Lll9 L11S'? j w: 1
32 Bean Rd
Demolition of Detached Garage only
Summary of Inspection
At the request of Penny Townsend an asbestos survey was.
performed at 32 Bean Rd Kattskill Bay, NY .
Scope of the Inspection/Survey is to determine if the garage
contains any asbestos prior to demolition .
Suspected Asbestos containing materials were removed and sent
out for sampling. The following samples were removed and sent
out for testing.
Homogeneous area 1( nonfriable) asphalt shingles (none
detected)
Homogeneous area 2 (nonfriable) Asphalt under layment (none
detected)
Things to note
THIS REPORT SHOULD BE MADE AVAILABLE TO ANY NEIGHBORS.
THIS REPORT SHOULD ALSO BE READILY AVAILABLE AT THE
LOCATION OF THE DEMOLITION/RENOVATION FOR ANY TRADES
PEOPLE ENGAGED TO CARRY OUT REPAIRS OR DEMOLITION OF
THE PROPERTY.
Conclusion
No Materials were identified as containing more than 1% asbestos
material. Therefore no asbestos abatement is required.
A copy of this report should be kept at the work site.
A copy of the sample analysis is attached to this report
1111/2021 Temporary Rules for Licensing&certification:Maw York Slate Department of tabor
If an employee has proof that he-or she has-had the appropriate initial or renewal training within the past ninety
(90)days,and is awaiting a:mold worker's license hard card,a copy oft he Training Certificate indicating
successful completion.of an.approved=mold training program is acceptable proof of appropriate training.The
employee must also produce a photo identification card issued by an authorized government entity and,if
renewing,his ocher existing expired hard card.
_>A cations to Renew Your Asbestos Handling Certificate
Any person who has:an Asbestos Handling.Certificate in any.category)whose certificate(hard card)expired
April.30;2020 or'later may continue to work using their existing cards unfit April 30;2021.Check this notice
periodically for updated information about your Certificate's validity.
Applications for Initial Asbestos Handling Certificates
If an employee-has proof that he or she,has had the appropriate initial training within the past.ninety(90)days,
and is.awaiting the asbestos handling certificate,a student copy of the Asbestos Safety Training Certificate
(DOH 2832)indicating successful completion of an approved asbestos safety training program is acceptable
proof of appropriate training..The employee must also have a photo identification card issued by an authorized
government entity.
Any questions not.answered on this page will be answered by staff at the License&Certificate Unit.Call
(518)457-2735'oi-email Ucensii&certificafe@jabor.ny g�(mailto:License&ccrtiticatc(�a oa xgw).
- 1
;STATE'.O'F;'NEW-YORK-;<DEPART.ENT
4SBES1'OkTRTIFICATE
: THOMAS M:-CALLA-HAN -
.'GLASS(EXPIRES):
i
MUST BE CARRIED.ON:ASBESTOS`PROJECTS;`