DEMO-0552-2020 i
SEP
Office Use Only
Permit#:
F MO�l1TrOIV�/��PLICATIOIV
BU1'ILDIE'�i; U63FS � Permit Fee:$ t !�P. 0C�
Town of Quccnsbury qc�
Invoice:#: .
742 Bay Road,Queensbury, NY 12804
P: 518-761-8256 www.gueensbury.net
41
Demolition Location: Pk/PXer �`'i' V&— Tax Map ID#:
**AN ASBESTOS REPORT TH ALL
DEMOLITION APPLICA NS**
r SEP 15 2020 I
CONTACT INFORMATION:
TOWN OF QUEENSBURY
• Applicant•
BUILDING&CODES
Name(s): r� �vl Gil Gtf''
Mailing Address, C/S/Z: a ( a 064V �.- Ma etS Y. l Z.�-U/
Cell Phone: ( 57(k ) 7 Land Line: (
Email: b I h a yWurol ® n4�vaol . com
• Primary Owner(s): , /
Name(s); -- wet #t --f- �GcY�ih 1�a War
Mailing Address, C/S/Z: 2 ( S kr to- ��ew
Cell Phone:_(Sit ) 7ft 6 SZy Land Line: _( )
Email: k�W f,- _ �1-l00k-
Check if all work will. be performed by homeowner only
• Contractor: Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
"List all additional contractors on the:back of this form
Contact Person for Building & Code Co pliance: Y—r—. A
52 �G�yy�Jai"tY
Cell Phone: _( /�' ) 7 f 6 '6 . Land Line: _( )
Email: b ( Ak Ycwar ace laak,- Com
Demolition Application Revised February 2019
DEMOLITION INFORMATION: /
1. Where will demolition material be disposed? Y-1-rAm
2. Type of structure to be demolished: l ao WA ba✓N Roster
a. Residence ��
b. Garage �jaHl�t�Gor �V•y
c. Business
d. Storage Building
3. What type of utilities are connected to the structure:
a. Gas
b. Fuel Oil
c. Propane
d. Electric 427
e. Public Water
f. Well-Water Pump
g. Public Sewer
h. Other
L None
4. Have ALL utilities been disconnected? Yes No�
7-A-c -a(c c'sTYI GAv l .S'e-VI GG IS f$i `J Ae. Q 06'e
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ADDITIONAL INFORMATION: /'�
1. Two inspections may be required: an inspection to determine that utilities are disconnected, if
necessary, and a final inspection, 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' Comp insurance information is required to be submitted with this application.
Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application bas
been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a
permit has been issued.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: ✓� /CrN �Y DATE: l `CzQ
Demolition Application Revised February 2019
E E
U,
1 SEP
TOWN OF QUE
BUILDING&COD
As, bestos ,O,*,)*urve% Mv
y
,UVVN OF QUEENSBURY
Brian Hayward BUILDING & CODES DEPT.
S Palmer Or Reviewed Sy: 'A-'2 - -
Queen-%-bury, MY 129-04
Inspection date, 9/1/2020
N3
Tom Callahan /TC Inspections
I Knolls Dr T "I 0�QUEENSBURY
2111LOING DEPARTMENT
Queens-bury,NY 12904 Based on Our fbited examination,compliance
with 6VOW90ft ghal!:101:I*construed as
indleating offm8arlds t1cations are In
Inspector# 17-42926/Contractor# 109425 full france with the ruililding Codes of
cell# 57,18-M-9750 New Yor�State.
FILE COPY
Summary of Inspection
Atthe.reque,st of Sri-an Hayward an -asbestos survey was
performed at 5 Palmer Dr Queensbury, NY
Scope of the Inspection/Survey is to determine if the house-
contains any asbestos prior to demolition
Suspected -Asbestos containing materials were removed and sent
out u-t for sampling, The following samples were removed and sent
out for testing,
Homogeneous area i( nonfriab-le) asphalt shingles (none .,
detected)
etec
Homogeneous area.20onfriable) tar paper (none detected)
Image-,s o structure
f-str ture o-
n the day of inspecotim
II
-----..........
Things to note
THIS REPORT SHOULD BE MADE AVAILABLE TO ANY NEIGHBORS.
THIS REPORT SHOULD ALSO BE READILY AVAILABLE AT THE.
LOCATION OF THE DEMOLMONMENOVATION FOR.ANY TRADES
PEOPLE EM.GAGED.TOCAPPYOUTREPAIRS oRbwou-nm or-
THE PROPM.TY.
Conclusion
No Materiais were.identified as containing more than 1% asbestos
material. Therefore-no a-sbentosabatement is required.
A copy of this report sho-uld, be kept of the Work site,
A copy of the -sample -analysis is attached—to this_report
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