DEMO-0768-2020 > e Office Use Only
®�M0�8T90N APPLICATION
Permit#: - � �-ZaZa
1 "Permit Fee:$
Town of Qeensbury
Invoice:tt:
742 Bay Road,Queensbury,,NY 12804
P:518-761-8256 www.a-a-.ensbqrV.net
Demolition Location: 115 Vandusen Ind,Oueensbury,12804 'flax Map ID-#: 308.11-1-23
'**AN, : `� REPORT I :� UX D WITH ALL
DEMOLITION
pg{'���,} �� _ 'pip-[' _ P Cry' O r SUBMISSIONS*"
CONTACT INFORMATION: RE Ce
® Applicant:
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Name(s):'Maureen Conroy EC 0 2020
Mailing Address, C/S/Z: 36 Farmview Lane, Waterford, NY 12188
Cell Phone:_(518) 108-7440 Land Line:
Email: maureen@forbairdevelopment.com ---1.
® Primary Owner(s):
Names : Same as Above/ Foy 6m�' i
Mailing Address, C/S/Z:
Cell Phone:_{ ) Land Line: _( }
Email:
[] ,Check if all workwill be performed by homeowner only ;
m Contractor: Workers' Comp documentation must be submitted with this application
-Contact Name(s): Foothills Property Management, LLC
I Contractor Trade: General Contractor
Mailing Address,_C/S/Z: 24 Briwood Circle, CQueensbury, NY 12804
Cell Phone: (518) 812-498-1 Land Line: _( )
Email:foothillspropertymngmt@gmail.com �.
"Ust all.additional contractors on the next page `
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Contact Person for Building&Code Compliance:_Maureen Conroy
Cell Phone: ($18)708-7440 Land Line:_( )
Email: maureen@forbairdevelopment.com
DEMOLITION]N FORMATION:
1. Where will demolition material be disposed? Dumpster i
Demolition Application RevisedJanuary 2019 .
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DEMOLITION INFORMATION:
1. Where will demolition material be.disposed? �L S
2. Type of structure to be demolished:
a. .Residence-x_
b. Garage
i c. Business
d. Storage Building
3. What type of utilities are connected to the structure:
a. Gas
b.. Fuel Oil
c. Propane
d. Electric A
e._ Public Water A
f. Well-Water Pump
g. Public Sewer
h. Other
i. None
4. Have ALL utilities been disconnected? Yes No
ADDITIONAL INFORMATION:
1. Two inspections may be required: 'al. 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.
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Declaration:I acknowledge that no structure(s)will be removed from the parcel until the demolition application has
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been,reviewed and approved by the Town.of Queensbury Building&Code Enforcement and-Zoning Departments and a
permit has been issued.
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I have read and agree to the above:
PRINT NAME: rn0JLA"t1n
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SIGNATURE: DATE:
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Demolition Application Revised February 2019 t
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TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
Indicating the plans and s fications are in
full compliance with the uilding Codes of
New Yor k State. ;
A t Uri "S"
urvelff
Maureen Conroy
115Vandusen Rd FILE COPY
Queensbury, IVY
Inspection date:'10/27/2020
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Tom Callahan/TC Inspections RE
1 Knolls Dr
Oueensbury, NY 12804 f DEC 0 S 2020 j
Inspector# 17-42926/Contractor# 109425
cell# 518-832-9750
TOWN OF QUEENSBURY 308.1-1-23 DEMO-0768-2020
BUILDING & CODES DEFT. Forbair Development/Maureen Conroy
Reviewed By: 115 Van Dusen Rd
Date: Demolition of SFD only
0 N
At the request Maureen Conroy an asbestos survey was
performed at 115 Vandusen Rd Queensbury, NY 12804.
..,,Scope of the,..Inspection/Survey is to determine if the house
contains a-ny*,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 l( nonfriable) asphalt shingles (none
detected)
Homogeneous area 2 (nonfriable) tar paper (none detected)
Homogeneous area 3 (friable) vinyl floor (9x9) (7.1% Chrysotile)
approximately 20 sq . These tiles are located in the front room.
Homogeneous area 4 (friable) mastic (2.6% Chrysotile). This mastic
is the adhesive used under the 9x9 tiles in the front room. This
material covered approximately 420 sq'. The majority of the mastic
and tile have been removed prior to the asbestos survey.
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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
The 9x9 tiles and the mastic used to adhere there to the floor have
both been identified as materials that contain over 1% asbestos.
These materials will need to be remediated prior to demolition.
It is important to note that while due diligence was performed the
possibility does exist that other undisclosed materials may be discovered
that were not evident at the time of the original survey. In this event these
materials should be tested prior to demolition to insure the health of all
individuals involved.
A copy of this report should be kept at the work site.
A copy of the sample analysis is attached to this report
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`New-YoikState=;Department:of;Labor
-- ",a,r.-:� �Division ofStiferyend Health.' �;'�:•.. =;�; - _ I
UcenseandCetUfrr2tiiUM, t>1
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IIAN�LINGIICENSE--
Thomas M Cal i6h.d6'a TC ins i>clioft_ _ `` f4LE NUMBER: 18 109425 I
LICENSE NUMBER:`109d2ur,
I Knolls;Drive = .,1 = -i:LICENSE CLASS:-RESTRICTED,---'
DATE OF ISSUE: 12126f2019 ;
<bue nsbury NY 12804 F }EXPIRATION DATE: 01131I202'I
f3' - �G' •�. �-4,S1.. yr•'• .��J���� _ r}' V'k-',ri:-r .t. C.•
D61g,Autborized."Representative`=Thomas,Call8hafi:
`•lam_.•:.: :"- 'f-
This'ficeose`iias'bcen issued in accoidauce;K�tfiappiie5lile.provi'stons of>AiUe1e3Q'of the Labor_Iaty ofNeR Yolk state'aiid of-g
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the Ncty Yorl:State Codes,Rules and.R41ilations.(t2 f4YCRR Part�b)''It is subject to ttigpension or teweation far a(1) +sN'
serious violation of state,fedetat ocdiical lads with c ac'l,to the conduct-ofanjAcstos project,or(2)dmonsiral4tact:,6P
Mponsibilityit econductofany}ob'imiolvidg,astuatasorishestostbatcnaE.`� 7 J-, r,.
.;�;. ._- --'•5-jg.::v-=:^�'':tea':>"y":.:.~-.�-:�^'`-�M '•'�= .... .:`J: •.>,r-..T�.i. - �,
Tbisdiceose ia:valid onlyfor the contractor naited,aliopc and tliislteense ora phdtocopy.ntusCheirominently displayed at lltc
asbestos projec[rµorksite?Tors license verifea that- persons cmpl�d.by the licensee on ai asbestos projceri_n.New Y6ck i
State have tieed`issiied an tlsbestos Ccrtificate,'appropriatc foeihe'type;of-�cnA-d0y perform,by the Tlca Yoik State % '
Department ofUbor.._
'6ilecn Ni_3'7anko.,Director '
SH432(8112) •- ""�-•'""�J For tlte Commissioner ofLabor
STATE,DF:NEW YORK=DEPARTMENT OP IABOR�
ASBESTOSCEKnRCATE 'kl�Y.S',I
THOMAS.M.CAUARAN
-CLASS(EXPIRES), ;
0 WSP(121W), '
MUST BE CARRIED ON ASBESTOS PROJECT 5
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EIVISL Analytical, Inc. EMSLOrder' 062020433
528 Mineola Avenue Cede Place,NY 11514 'Customer ID: TCNS29
Tel/Fax:(516)997-72511(516)997-7528 -Customer PO:
httpJ/wwvl.EMSLcom/eadeplacol,nb'a,aniol.com_ Project ID:
Attention: Tom Callahan Phone: (518)832-9750
TC Inspections Fax:
1 Knolls Drive Received Date: 10/30/2020 12:14 PM
Queensbuly,NY 12804 Analysis Date: 11102/2020-11JO312020.
Collected Date: 10/2712020
Project: 115 Vandusen Rd(House)
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Dale Color Fibrous Non-Fibrous Asbestos
Sample ID HA1-RSI Description Roof stringle
062020433.0001 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS IW.6 NOB 11/0312020 Gray/Black 3.10%Glass 96.90%Other Inconclusive:None Detected
TEM NYS 198A NOB 11/0312020 Gray[Black 100.00%Other None Detected
Sample ID HAI-RS2 Description - Roof Shingle
062020433.0002 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 195.6 VCM Not Analyzed
PLM NYS 198.0 NOB 11/03/2020 Gray/Black 8.801 Glass 91.20°!Other Inconclusive:None Detected
TEp1 NYS 19B.4 NOB 11103/2020 Gray/Black 100.00%Other None Detected
Sample ID HA2-TP1 Description Tar Paper
062020433.0003 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM - Not Analyzed
eL61 NYS 108.6 NOB 1110312020 Black 100.00%Other Inconclusive:None Detected
rEM NYS 198.4 NOB 11/0312020 Black 1D0.00%Other None Detected
Sample10 HA2-TP2 Description Tar Paper
062020433.0004 Homogeneity Homogeneous
3LM NYS 198A Friable Not Analyzed
3LM NYS 108.6 VCM Not Analyzed
-LM NYS 198.6 NOB 11/0312020 Black 100.00%Other Inconclusive:None Detected
rEM NYS 198.4 NOB 11/0312020 Black 100.00%Other None Detected
iample 10 HA3FT1 Description Floor Tag 9x9
062020433.0005 Homogeneity Homogeneous
1LPd NYS 198.1 Friable NotAnnlyzed
'LM NYS 190.6 VCM Not Analyzed
'LM NYS 198.6 NOB 1110312020 Black/Green None 92.90%Other 7.10%Chrysotilo
rEM NYS 19BANOB Not Analyzed
Initial report from;11/031202013:28:00
1SR_108Y DOd>_0801 Pdnted 11/3/2020 1.28:04PM Page 1 of,
ENISL Analytical, Inc. EMSL Order: 062020433
528 Mineola Avenue Cade Place,NY 11514 Customer ID: TCNS29
TeUFax:(516)997-7251 1(516)997-7528 Customer PO:
htlp7A»nv.EAlSLcam!cadeplatelaUCn+amsf.cnm Project ID:
Test Report:Asbestos Analysis of Bulk Material
Analyzed
Non-Asbestos
Test Data Color Fibrous Nan-Fibrous Asbestos
Sample ID HA3-FT2 Description Floor Tile 9x9
062020433-0006 Homdgenelly
PLM NYS 198.1 Friable NotAnalyzad
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.8 NOB 1110312020 Positive Slop(Not Analyzed)
TEM NYS 198.4 NOB Not Analyzed
Sample ID HA4-M1 Description Mastic
002020433-0007 Homogeneity Homogeneous
PL61 NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 190.6 NOB 1 110 312 02 0 Black None 97.40%Other 2.60%Chrysotile
TEM NYS 198.4 NOB Not Analyzed
Sample ID HA4-M2 Description Mastic
00j0 20 4 33-000 8 Homogeneity
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM NotAnalyzad
PLM NYS'198.6 NOB 111D312020 Positive Stop(Not Analyzed)
TEM NYS 198.4 NOB Not Analyzed
Sample ID HAS-BFT1 Description Bath Floor Tile ,
'062020433.0009 Homogeneity Homogeneous
PLM NYS 19SA Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198,6 NOB 11/0312020 Beige 100.0096 Other Inconclusive:None Detected
TEM NYS 198A.NOB 1110312020 Beige 100.00%Other None Detected
Sample ID HAS-BFT2 Description Bath Floor Tile
C62020433-0010 Homogeneity Hamogencou3
PLM NYS 198.1 Friable Not Analyzed
PLM NY$198.6 VCM Net Analyzed
PLM NYS 198.6 NOB 1110312020 Bcige 100.UML Other Inconclusive:None Detected
TEM NYS 198.4 NOB 1110312020 Beige 100.00%Other "ono Detected
Sample to HA6-FL I Description Floor Leveler
062020433.001f Homogeneity Homogeneous
PLM NYS 198.1 Friable 1110212020 Gray 61-005'o Co Carbonate None Detected
7.001.6 Won-fibrous(ather)
32.001,6 Quartz
PLM NYS 198.6 VC61 Not Analyzed
PLM NYS 198.E NOB Not Analyzed
TF.M NYS 198.4 NOB Not Analyzed
Initial report from:1110312020 13:28:00
ASB 15IIx,00a0_06of Pdnled 11/312020 1:26.04PM Page 2 of 4
1
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EMSL Analytical, Inc. EMSLOrder: 062020433
Customer ID: TCNS29
528 Mineola Avenue Cade Place,NY 11514 "
Customer PO:
TeliFax:(516)997-7261 1(516)997-7628
htlp;Atvwtv.GM1tBL.coin l.radeptacelab[;onut.uim Project ID:
Test Report:Aspestos Analysis of Bulk Material
Non-Asbastos
Annlyxod
Test Dote Color Fibrous Non-Fibrous Asbestos
Sample ID HA6-FL2 Description Floor Leveler
06202o435.11M Hamaganelly Homogeneous
PLM NYS 196.1 Friable 11102,2020 Gray C0.00%Ca Carbonate None Detected
14.0096 Nan-fibrous(other)
26.00%Quartz
PLM NYS 198.6 VCMI Not Arullyzad
PLM NYS 198.6 NOS Net Analyzed
TEM NYS 198A 1105 Not Analyzed
Initial report from:11/03/202013:28:00
ir3B :90s 0004 toot Printed 1113/2020 1:28:04Pt4 Page of
P.0.Box 1024
SPECTRVA Schenectady.NV 12301
(518)346-6374(Phone)
Environmental dsseclates, Inc. (518)346-4062(Fax)
EXCEEDING OUR CLIENTS EXPECTATIONS of EXCELLENCE' www.4spectrum com
December 7,2020
Ms.Maureen Conroy 308.1-1-23 DEMO-0768-2020
Forbair Development,LLC Forbair Development/Maureen Conroy
(518)708-7440 115 Van Dusen Rd
moconrov36Rtrmail.com
Demolition of SFD only
RE: Front Room— 115 Vandusen Road
Spectrum Project Number: 20-6I1
Asbestos Final Visual Inspection(s)&Clearance Air Sampling
Dear Ms. Conroy:
Spectrum Environmental Associates,Inc.(Spectrum)is submitting this letter and attached documentation
as our report for the referenced asbestos project.
On December 2,2020,Mr.Eric Rath(AH406-08942)performed final visual inspection(s)and clearance
air samples. His final visual inspection form(s),and a copy of his certification and Spectrum's company
license are attached.
The scheduled asbestos containing materials for this project involved the removal of:
• —420 sf of floor tile&mastic from front room(12-2-20)
New York State Department of Labor Industrial Code Rule 56 requires a final visual inspection be
performed by a New York State Certified Asbestos Project Monitor who is independent of the asbestos
abatement contractor prior to the collection of the Clearance Samples. This was performed by Spectrum
and the associated documentation is attached. The final visual inspection is to confirm that all have been
removed and that the work area has been properly cleaned.
Therefore,based on the final visual inspection(s)passing and the final air samples that were collected and
analyzed on this project having met the New York State minimum requirement of less than 0.01 fibers per
cubic centimeter,the scheduled removal areas are considered clear and may be re-occupied.
If you have any questions concerning this report,please co tact our office at(518)346-6374.
Respectfully Submitted,
Robert J DeRuyter
VP of Opel•ations `_' tM a •� b )?�
Cc: file
Attachments: Final Visual Clearance Form(s)
Licensure and Certification
Environmental Consulting&Alanagement Services Health&Safety 711raining • Laboratory Services
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P.0.Box 1024
y Sdieneclady.Nf 1?,80I
-SPECTRU" (518)346-9Y74(Phone)
Environmrenlal Issociartes. Inc. (518)340-4062(rax)
*1J'*rrA/xC Oar Ce.rr".vrs t'xerr"rarwvs or excu.i'mscr.' ntvivgspedrum.rom
Final Visual Clearance Checklist
Project Name: Date:
115 Vandusen Rd 12/2/20
Work Area: Project Number:
Front Room 20-611
Material Removed: Quantity Removed:
floor tile& mastic —420 sf
Project Monitor: Certificate Number:
Eric K Rath 06-08942
Procedure or Activity Yes No N/A
Critical Barriers Intact ✓
Negative Air Machines Running
All Gross Material Removed From Work Area
Length of Waiting Period Observed
Visible Debris Present
All Bags and mist. equipment/tools has been removed
Visual Inspection per ICR 56.9.1(d)
"In accordance with ICR 56-9.1(d)the project monitor has visually inspected
the work area (all surfaces including pipes, beams, ledges,walls, ceiling and
floor,decontamination unit,sheet plastic, etc.) accompanied by the asbestos ✓
abatement contractor's supervisor,and has observed the scope of the
abatement as per the provided contract documents, and for the presence of
visible dust,debris,or residue is apparent on any surface within the work area."
Date of Inspection: Time of Inspection:
12/2/20 1400
Visual Inspection clear per ICR 56.9.1(d) ✓
Supervisor Logbook Signed y/
Sampling Conducted in Accordance with ICR"567.9.2(d)or Site Specific Variance
Pre-Sampling Agitation (5 minutes per 1000 ftZ of,floor space) ✓
On Going Agitation( 1-20" Fan per 10,000 ft3)
Your signature certifies that the aforementioned listed items are in compliance with all state&
federal rules and regulations.
Signature: Digitally signed by Eric K Rath Date: 12/7/20
' DN:cn=Eric K Rath,o,ou,
Erie K Rath email=erath@4spectrum.com,
C=us:,,
;t Date:2020.12.07 14:46:40-05'00'
Environmental Consulting&Management Services ■ Health&Safety Training • Labowtorr Services
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P.0.Box 1024
Schenectady.NY 12301
SPECTRVA
(518)346-6374(Phone)
Environmental ilsseclates, Inc. (518)346-4062(Pax)
'Exmmsa OUR Cuavrs EXPECWTIOX8 or EXCELLENCE' ivww.4spedmm.cvm
State of New York— Department of Labor
Asbestos Certification
IWVORLABOR%,
AS P,
TRICAMAT I:::.:
s. AES
ATEC(0412 1)
WOM '04/
DM 760\
MUST DN,�,S�PT05ROJETS-
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IF FOUND RETURN TO:•
EYES BLU. WYSROL — Lr.0 UNIT
C;$8 HAIR BAL ROOM 161A BUILDING 12
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RGT 5' 08" STATE OFFICE CAMPUS
ALBANY NY 12240
State of New York— Department of Labor
Codes Certification
A Asbestos Handler
B Restricted Handler-Allied Trades
C Air Sampling Technician
D Inspector
E Management Planner
F Operations and Maintenance
G Supervisor
H Project Monitor
I Project Designer
Environmental Consulting.&Management Services - flealfil&-Safety Training • Laboratory Services
"i N WY6rk Stat `Department_of.Labor
Division of,Safety and health
License and Certificate Unit
State Campus,' ilding 12
Albany,.NY_ 12240
;-- _ "• ��� �- '�
�'�ASBESTOS HANDLING LICENSES
Spectrum Environmental Associates,'Inc J 1 f FILE NUMBER: 99`0129`
:\ ,, �S7,,,•�:�:,`;�-��` LICENSE NUMBER:'429081---f
f "PO. Box 1024!� �,, LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 02/06/202'0
�Schenectady,,NY 12301 EXPIRATION DATE: 02/28/202A1 �}
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Duly,Authorized Representative,alWilliamLlMassmann
11��� I��`,���tY�`��:: �ils .!t���,}�fr `' .i ' 1.� >'
This`licens'e-has been issued in accordaiiceiwith;applicable,provisi'ons"o£Article 30'of the Labor Law of New York- and-arid of
1 1 1 (/!'i 1't r jl t I:11EaJ`" u i_. •�—_�� �i�i,�� i.J �
the Ne_w York-State Codes,Rules and Regulations,ll{12. Y,,CRR Part 56). "Iris-subject to suspension or revocationffor a(1) )} J
1 1. l- -.� Il i tl ;� ! � t• J
serious`violation of state,federal or local laws wi6h regard-to:the cond net�of an.asbestos project or(2)demonstrat4lack-of /
1 1 yl. n' l l \ 1' ` sl:i 7ryi or- .s s'U� atefi� rl �•,3, '
responsibility in the conduct of any job�involving'asbestos or asUesto`s matenaL i'' �,1
e �" ef' ,,i/i �
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Thi§Il'i�ense ts.yalid only for thecontractor named'aboye and'th�license or a�photocopymust_bepromrnently displayed atahe
asbestos project-wo ksite; NTliis license verifes that,aIrpersonsaemploy�d by he lioe�nsee on an asbestos,project inNewYork
State have been�issued an Asbestos Certificate;•appropriate fo�•the1type:f work they perform,by the New York State
Department of Labor.
1 I ti•\ 4
_---Eileen M.Franko, Director
SH 432(8/12) ~`^-"--- `- For the Commissioner of Labor
-- - - - --- -- --- --- - - -- - ------- -
NEW YORK STATE DEPARTM ENT-.OF HEALTH::_.- _W -
A-
_---DSWORTH_CENT.ER.
':- Expires_12:01-AM April-01,_202.1.
_ Issue - pril 01, 2020
-_ -- _
J" Revised,November 04;2020
_ CERTIFICATE OF?APPROVAL FOR LABORATORY-SERVICE
Issued in accordance with and ursuant to section 502 Public Health Law of New,' o— P rk-=State
__-_MS.'KATALINA_LI_:: . _._ NY Lab Id No: 19540_T__. -
SPECTRUM ENVIRONMENTAL ASSOCIATES INC.. -
=-2539 ALBANY=STREET
SCHENECTADY,-NY._ =12304-
is hereby APPROVED as=an:Environmental Laboratory for thetcategory..
ENVIRONMENTAL -EMISSIONS: _ -
_ AN approved subcategories-andlor.arialytes-are listed below- -
Miscglianeous - -
`- >- NIOSH 7406 A RULES,Fibers-.:Fibers=._ -.` ,: .. - :•---=_ __= -- - - - -
Serial No.-:-62243'-
Property of tl a New York State Department of Health.Certificates are valld.only_at the address'
shown;must be conspicuously posted,-and are printed nn_secure•paper. Continued accreditation depends
`on successful on oln articl ation in the Program.--Consumers are urged to call.518 485-5570 to'=
=_-verify thelaboratorysaccrdditatonstatus. -
P6ge.1 of 1 _ - -