DEMO-0834-2021 Office Use Only
y DEMOLITION APPLICATION
Permit
Permit Fee:$ �—'
Town of Queensbury Invoice#:��
742 Bay Road,Queensbury,NY 12804 ��
P:518-761-8256 www.gueensbury.net
Flood Zone?l% N Reviewed B
If bCNEErf Icy
Demolition Location: Tax Map ID#: (A K1 &F-cf&F fif I1, qE
**AN ASBESTOS REPORT IS REQUIRED WITH,ALL
DEMOLITION APPLICATION SU
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? NOV 19 2021
2. Type of structure to be demolished: TOWN OF QUEENSBURY
a. Reside ce d. Storage Building❑ BUILDING&CODES
b. Garage e. Other:
c. Business
3. What type of utilities are connected to the structure:
a. Gas ❑ f.Well-Water Pump ❑ '�A![ cbnnZG�"1�t�S ®(,Q
b. Fuel Oi� g. Public Sewer❑ 1 `r _
c. Propane h. Other � f&,5Td&jCt a
d. Electric i. None ❑
e. Public ater❑
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes[� No❑
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 has
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: DATE:
Demolition Application Revised December 2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): (fro �SS�oh f l�e Kej fabw L43agia -
Mailing Address, C/S/Z: 405g CeaMot �Ifovr,, Wopq NY I17-01$
Cell Phone: Land Line: Cft-9M-vgyy ONO 519-q5Z 1$3)
Email: )F12�PFEGZ AD L- �m
• Primary Owner(s):
Name(s): I?i4and 6EUz I
Mailing Address, C/S/Z: r+ D�CCIS
Cell Phone: Land Line: 519-G05- ZA76
Email: NIA .
❑Check if all work will be performed by property owner only
• Contractor: (List all additional contractors on the back of this form)
Contact Name(s): 1Pr6p6SOibnat ruu I?a[Drafidd SI-cvice
Contractor Trade:G(Jgre4-,
Mailing Address, C/S/Z: X53 Ceniq k) Nbbm( i,11 IZPS
Cell Phone: Land Line: b1g-gj5?- 1831
Email: pF`I!,S Jft a) P[tL.CoM.
"Workers' Comp documentation must be submitted with this application"
J Fne
Contact Person for any questions regarding this project:
Cell Phone: Land Line:
Email: Ll1z YYYI6 00 y1ro,P;Gd Ions
Cj 519-%6_09g4
d.ormc-Wol-og0fimt1-ei)M
Demolition Application V Revised December 2020
y
Lou dt' e1pc L.1,Ve no1r/ -
11/19/21,11:36 AM Mail-lyle darmetko-Outlook
;,
17 Dineen Road
Scott Loudis <Sloudis@greenbriar-Ilc.com> FILE COPY
COP
Fri 11/19/2021 9:55 AM
To: darmetkol@hotmail.com <darmetkol@hotmail.com>; David Johnson <dmjbess@aol.com>;johno@queensbury.net
<johno@queensbury.net>
2 attachments(920 KB)
NYS Asbestos License Exp April,2022.pdf;Sloudis 2021-2022 NYS Asbestos Supervisor.pdf;
Lyle,
John O'Brien with the Town of Queensbury will be handling the case for this project. I have copied him on this
thread.
Please submit the Demo application to his attention ASAP as we are looking to have this cleaned up before the
Holiday. I have already sent over the sample condemnation letter which we expect to have returned today.
Spectrum Environmental will be submitting their paperwork for the variance and the monitoring today upon
receipt of the Condemnation letter. I have attached our licensing to expedite the process. Let me know if you
need anything in the interim.
Best,
StdTT LOUDIS
PLIRTNIR
ALGA y,NV 12205
'GRE E MM A TC{ 881„621=65t2
C{JNSTRIJC.Tt91V.SERVICES'[:1;�.
S LO UD IS?7C QEEN8PlA P-L•LC,COM
www.greenbriar-Ile.com
Owww.facebook.com/ eenbriarconstruction
https:Houtlook.live.com/mail/O/inbox/id/AQQkADAwATEOYzQwLWUxMGMtNDQANjMtMDACLTAwCgAQAHJRG3Rwwkx%2Blr9WQs%2Ba2%2Fw%3D 1/1
\STAEOk+YR=@AT{NTO LABOR; ��
Tl \
! r ;
. (\«#o«#mR Z «
\zyd2.tm «
j 41
LASg%Pnl ES)"" d '. • [
§
m9<=.z:
�?'U7B\�RDQkM S,PRJECTS
..
«»�i eaamn
N.ew--York State pa Mertment�o
Division oflSafetyand Health Y r
License and Gem icate Wit
State Campus,Building 12
Albany,,NY 12240Xl
^""
BESTOS HANDLING LICENSE:
Greenbriar Construction Services, LLG� ` ''
-: LE NUMBER: 1`8=;1,11579
,!�' LICENSE NUMBER:`"1'11579�'.�`'
,�.. .
49 Wilshire Dnve" LICENSE CLASS: FULL_.. : t'
.s{, DATE OF ISSUE: 03/05/2021
Albany,NY .12205 rf�:;w, EXPIRATIQ.NiDATE: 04/30/2022 �
:.J jl d;f..:rti.• :� � l � T.
Duly Authorized',Representative,E4 Scott Loudiss •-� r
. '••. r�, '""' fi;ii t +'�rx='.�:�:•' :^;i�V,�1 �� ;f
This hcen e`h�as been issued in acco da7j1celwlth app icabKQ
le�p�ouisio o£Artier 30'bf me Labor Law of New YorkfSt 'd o ,
the Ne;Uciik State{{Codes,Rules and I eguiatiox�s i1 NYC`RR Part S.6): Iti st�uUject to suspension or revocation fora(1)
serous violation of state federal oryloca'1 aws a re a d-t the conduct'.o�,an asbestos!proaect or(2)demonstrated;lack:of
responsibility in the conduct of any-job in olvingga bes os o;asbeestos aterial. i;;; ;,.,
1t �t
t 7... efi '`s.
* ` a. 'ram Jr . ! :�+ � 1 .
This icense is valid onl for the contractor named:abo. e and thi license or-:a photocopymust_be=prominently displaQ�6edt the
asbestos project worksA' ,\This hgense verifies that�all persons-employed by the licensee on an-asbestosXprojecC in-New York
A.:.t,y.,... zr"_ Asbestos
+P"A""Trm tT ii'i r r `i'`s .✓ :-/ 'h�, „"" °'a^t j
State hgive.been issued an As estos Certificate;appropriate fo theatype of +ork-they perform,by the'New York State
De artment o L/abor.
P
IN V
t q J .� k,
Amy Phillips,Director
SH 432(8/12) For the Commissioner of Labor
E=COPY
STATE OF NEW YORK
DEPARTMENT OF LABOR
STATE OFFICE BUILDING CAMPUS
ALBANY, NEWYORK 12240-01001 U
OWNBUILDING OF &Q �®
G'
Reviewed By _
Variance Petition ate:
Of
File No. 21-1371
Spectrum Environmental Associates, Inc.
Petitioner's Agent on Behalf of DECISION
Richard & Beverly Bellizzi Cases 1-3
Petitioner
ICR 56
in re
Premises: Residential Property
17 Dineen Road
Lake George, NY 12845
Emergency Partial Demolition of Fire
Damaged Residence
The Petitioner, . pursuant to Section 30 of the Labor Law, having filed
Petition No. 21-1311 on November 19, 2021 with the Commissioner of Labor for
a variance from the provisions of Industrial Code Rule 56 as hereinafter cited on
the grounds that there are practical difficulties or unnecessary hardship in
carrying out the provisions of said Rule; and the Commissioner of Labor having
reviewed the submission of the petitioner dated November 19, 2021; and
Upon considering the merits of the alleged practical difficulties or
unnecessary hardship and upon the record herein, the Commissioner of Labor
does hereby take the following actions:
Case No. 1 ICR 56-9.2 (d)
Page 2 of 4 File Number 21-1371
Case No. 2 ICR 56-11.5 (c) (2)
Case No. 3 ICR 56-11.5 (c) (7)
VARIANCE GRANTED. The Petitioner's proposal for the partial demolition and
cleanup of the subject fire damaged residence in accordance with the attached 5-
page stamped copy of the Petitioner's submittal, is accepted; subject to the
Conditions noted below:
THE CONDITIONS
Full-Time Project Monitor:
1. A full-time independent project monitor shall be on site and responsible for
oversight of the abatement contractor during all abatement activities to
ensure compliance with ICR 56 and variance conditions and to ensure that
no visible emissions are generated. If visible emissions are observed,
work practices shall be altered according to the project monitor's
recommendations.
2. The Project Monitor shall perform the following functions during asbestos
abatement projects in addition to functions already required by ICR-56:
a. Inspection of the interior of the asbestos project work area made at
least twice every work shift accompanied by the Asbestos
Supervisor;
b. Observe and monitor the activities of the asbestos abatement
contractor to determine that proper work practices are used and are
in compliance with all asbestos laws and regulations;
C. Inform the asbestos abatement contractor of work practices that, in
the Project Monitor's opinion, pose a threat to public health or the
environment, and are not in compliance with ICR-56 and/or
approved variances or other applicable rules and/or regulations;
d. Document in the Project Monitor Log observations and
recommendations made to the Asbestos Supervisor based upon
the interior/exterior observations of the asbestos project made by
the PM.
3. The PM shall alert the local District Office of the NYSDOL Asbestos
Control Bureau whenever, after the PM has provided recommendations to
the Asbestos Supervisor, unresolved conditions remain at the asbestos
project site which present a significant potential to adversely affect human
health or the environment.
Perimeter Air Sampling:
4. In addition to the requirement of Subpart 56-4.9(c), air monitoring shall be
conducted daily at the perimeter of the work area.
Page 3 of 4 File Number 21-1371
5. A minimum of two upwind air samples shall be collected. The samples
shall be spaced 30 degrees apart from the prevailing wind direction.
6. A minimum of three. downwind samples shall be collected. The samples
shall be equally spaced in a 120-degree arc downwind from the source.
7. If more than one shift daily is required to accomplish the work, air
monitoring, within the .work area during abatement shall be performed on
each shift.
Work Practices:
8. Demolition work shall comply with ICR 56-11.5 except as modified by this.
variance.
9. For areas ,where compliance with the twenty-five : feet barrier/fence
requirement isn't possible, the areas shall be cordoned off to the
maximum' .distance possible, and a daily abatement air sample shall be
taken at the reduced barrier.
Soil%Earth/Dirt'Cleanup:
-10. After. demolition debris has been removed, the site,shall be inspected.
Any required cleanup. shall include all visible asbestos or suspect
asbestos debris. . Soil removal shall- meet ASTM 1368 (latest edition),
Section 9.1.1-9.1.5 inspection criteria.
11. No pieces of ACM shall be present on top of the soil.
12. Visibly contaminated soil or soil suspected of being contaminated shall be
removed down to the level where no visible.contamination is observed.
13. The Project Monitor shall write in the project log that the area has been
cleaned and has passed a visual inspection..
Final Clearance:
14. After removal .and cleanings are complete an authorized and qualified
Project Monitor shall visually inspect the work area as per ICR 56-9.2 (e).
If the area is determined to .be acceptable and the most recent daily
abatement air sample (including perimeter air samples) results meet 56-
4.11 clearance criteria, the final dismantling of the site may begin. All other
r
Page 4 of 4 File Number 21-1371
applicable provisions of ICR 56-4 shall be followed for the duration of the
abatement project.
15. Usage of this variance is limited to those asbestos removals identified in
this variance or as outlined in the Petitioner's proposal.
In addition to the conditions required by the above specific variances, the
Petitioner shall also comply with the following general conditions:
GENERAL CONDITIONS
1. A copy of this - DECISION and the Petitioner's proposals shall be
conspicuously displayed at the entrance to the personal decontamination
enclosure.
2. This DECISION shall apply only to the removal of asbestos-containing
materials from the aforementioned areas of the subject premises.
3. The Petitioner shall comply with all other applicable provisions of Industrial
Code Rule 56-1 through 56-12.
4. The NYS Department of Labor Engineering Service Unit retains full authority
to interpret this variance for compliance herewith and for compliance with
Labor Law Article 30. Any deviation to the conditions leading to this
variance shall render this variance Null and Void pursuant to 12NYCRR 56-
12.2. Any questions regarding the conditions supporting the need for this
variance and/or regarding compliance hereto must- be directed to the
Engineering Services Unit for clarification.
5. This DECISION shall terminate on February 22, 2022.
Date: November 22, 2021
ROBERTA REARDON
COMMISSIONER OF LABOR
Edward A. Smith, P.E.
Professional Engineer2(Industrial)
PREPARED BY:Edward A. Smith,P.E.
Professional Engineer2(Industrial)
REVIEWED BY: Ravi PilarP.E.
Professional Engineer 1 (Industrial)
of NEB FILE COPY
` G
TGWU! OF Q#Notifflion
BUILDING a
Reviewed By
Date:
Asbestos Pro
Project Reference Number: 26712143 Type: Emergency Notification
Status: Notification Received Notification Received: 11/23/2021
Payment Status: Paid in full Number of amendments: 0
Notification Entered By: Department
Contractor Information
FEIN:823675346
Greenbriar Construction Services,LLC Mailing Address
49 Wilshire Drive
Albany NY 12205
Asbestos License Number: 111579
Duly Authorized Representative
Scott Loudis, Officer
Phone Number: 518-621-6512
E-mail Address: sloudis reenbriar-Ilc.com
Project Information
Project Start Date: 11/22/2021
Project End Date: 11/30/2021
Project Location County: Warren
Worker Compensation
Worker Compensation Policy#: A 2446 183-2
WC Exemption Certificate#:
Number of your employees you expect to be on project: 3
Will temporary workers be used? NO
If yes, name of temporary agency:
Project Location
Building Name:
Room or Location: Garage/breezway
Bridge ID#:
Address Line 1: 17 Dineen Road
Address Line 2:
City Town or Village: Lake George
State: New York
Zip Code: 12845
Building Information
Current Use: Residential- 1 family
Prior Use: Residential- 1 family
Approximate Year Built: 2000
Size(sq.ft): 2000
Is this fee exempt project?: NO
Reason:
Building Representative/Site Contact
Name: Richard Bellizzi
Phone Number: 518-605-2470
E-mail Address:
Cell Phone Number:
Phase Details
Phase# Phase Start.Date Phase End Date Phase Location Phase Scope
Sub-Contractor Details
Name: Asbestos License Number:
Night/Weekend/Shift Work Details
Shift Number Work Days(Sat--Sun) From To
1 TWTF 06:00 AM 05:30 PM
Party for Whom Work is being Performed
First Name: Richard Last Name: Bellizzi
Organization:
Apt./Suite: State: NY
Address Line 1: 17 Dineen Road Zip Code: 12845
Address Line 2: Country: United States
City Town or Village: Lake George Province:
Contract Dollar Amount: $1.68 Party for whom Gov Entity: None
Variance Information
Individual Variance Petition Number: 21-1371
L
ocedures and T e of E ui ment and Ventilation S stems Used
f-Face Respirators, Remote Decontamination Systems, Lined Trailers,Amended Water, Drop cloths, Person
tective E ui ment
Air/Project Monitoring Firm
Name: Asbestos License Number:
Spectrum Environmental Associates, Inc. 29081
Laboratory Performing Analysis
Name: ELAP Registration Number:
Spectrum Environmental Associates, Inc. 11540
iy
Type of Asbestos Work
Pipe Related: No Siding: No
Clean up: Yes Vessel covering: No
Caulking/mastic: No Spray-on insulation: No
Roofing/flashing: No VAT: No
Demolition: Yes. Demolition Ref#:
Other-specify:
Waste Transporter
Name: SM Gallivan
NYS DEC or EPA Permit Number: 4A-639
Phone Number: 518-271-6100
Apt./Suite:
Address Line 1: 98 Niver Street
Address Line 2:
City Town or Village: Cohoes
Province:
State: NY
Zip Code: 12047
Country: United States
Landfill
Name: Finch Waste Co
Phone Number: 5186362141
Apt./Suite:
Address Line 1: 424 Peters Road
Address Line 2:
City Town or Village: Gansevoort
Province:
State: NY
Zip Code: 12831
Country: United States
Type and Amount of Asbestos Containing Material
Friable linear feet: 0 Friable square feet: 600
Non-friable linear feet: 0 Non-friable square feet: 0
Fee
Total linear feet: 0.0
Total square feet: 600.0
Total Fee: 1000.0
Project Fee Schedule
If the notification was submitted prior to 4/7/09,the actual project fee is one half of the amount shown on the fee
schedule
Linear Feet: Fee Square Feet: Fee
0-259 feet: $0 0-159 feet: $0
260-429 feet: $200 160-259 feet: $200
430-824 feet: $400 260-499 feet: $400
825-1649 feet: $1000 500-999 feet: $1000
1650 or more feet: $2000 1000 or more feet: $2000
Remarks ZZI
NewBYortk StateDeli rtment=q j Labor
Division o�Saf�ty and Health
License and Certtficate `Unit�
State CaampL �B�uildtng 12
Albany,NY 12240
ASBESTOS HANDLING LICE
Greenbriar Construction Services, LUC- ���3 —=FILE NUMBER: 8-- 111579
'� LICENSE NUMBER,611*5-
49sWilsh'Pe Drive LICENSE CLASS: FULL
+ DATE OF ISSUE: 03/05/2,021
Alba , NY 12205 �� EXPIRATION DATE: 04/30 2022
n
a
Duly Authorized Representative Sc ott'LO' dis :.. `;:'�;,,.� _ _ ;j
T is 1 ct use h s b n issued in accordanrcd1with aabllP rouisions o ifrc `U�tbf the Labor Law of New or1 S d of
New Yocktate Codes,Rules antI�eg��}}t�ttio2NY�CRtPart 5:6).-' isject to suspension ension or revocation or a(1)
serio s violation of state federal or local alx+s.w�t e a •t the co duct��asbestosl ro'eet or 2 demon ated ack of�
respons�bili'ty in t e conduct of any job in,olvip ashes os o�'Efsotos at a. ,
This license is al onhy��for �h1hecocontractor e-;a is�hcense o� op}cmust bey rominently displa a at the
asbestos prolec w.orksite'. :licenses se verifies tha�gal, ersons,_employed"by�he licensee on Aasbestos project•n Ne. rYo
State halveAsbes e een issued an tos Certificate,appropriate fo�hR,ty�e�ofv�o"rli<they perform,by the ew Yor tat
Department ofbLa or. -
r
Amy Phillips,Director
SH 432(8/12) For the Commissioner of Labor
- , STATE OF NEW YORK-DEPARTMENT OF LABOR i
ASBESTM CERTIFRCATE Yi.S
1 'SCOTT1,lV{LOUDIS�( J ~
-CLASS(EXPlRES),,'-V >`r
>CERTN.02!}09645
7697
MUST BE CARRIED ON ASBESTOS PROJECTS 4
ti
.1762_2pC�
I
FILE cp
�.' Home ofNatural Beauty:..A Good Place to Live
TOWN OF QUEENSBURY 742 BAY ROAD QUEENSBURY,NEW YORK 12804 518.761.8201 ,WWW.QUEENSBURY.NET
November 19, 2021
Richard & Beverly Bellizzi
17 Dineen Road
Lake George, NY 12845
RE: Letter of Condemnation 17 Dineen Rd Garage and Breezeway
Dear Mr. and Mrs. Bellizzi:
-Your single family dwelling at 17 Dineen Road was involved in a fire on November 3, 2021
which has left the structure's.garage and breezeway unsafe, and is condemned. The garage
and breezeway must be,demolished,and removed from the property as soon as possible.
Specifically there is no roof on the garage and breezeway leaving the structures open and
exposed to the elements, which will lead to further destruction and decay of the structures.
An asbestos_report from a licensed asbestos inspector..and variance to demolish the structure
from New York State Department of Labor(NYS DOL)will be required prior to demolition. You
will most likely have to hire an asbestos licensed contractor to demolish the structure.
A demolition permit must be filed along with all asbestos reports and NYS DOL paperwork with
the Town.of Queensbury prior to demolition.
The structure must remain secured and boarded until the structure is removed: Please advise .
us as to a timetable to demolish the structure. We would expect the structure to be removed
over the next 60 days. Please use this letter.to allow an expedited permit from NYS DOL to
remove the structure in its entirety.
Should.you have any questions, please do not hesitate-to contact me. Thank you for your
anticipated cooperation.
Sincerely
David atin
Director of Building and Code Enforcement
Town of Queensbury
Celebrating Our Sestercen tennial
1762-2012