Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
801-2019
TOWN OF Q UEENSBURY � r ,a 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: DEMO-0801-2019 Date Issued: Friday, May 8, 2020 This is to certify that work requested to be done as shown by Permit Number DEMO-0801-2019 has been completed. Tax Map Number: 226.19-1-53 Location: 3 NORTH LN Owner: Tim Bechard Applicant: Tim Bechard This structure may be occupied as a: Demolition Only(seasonal camp) Asbestos Report Received By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, '2)a'P W �� 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 (518) 761-8256 . M —11 BUILDING PERMIT Permit Number: DEMO-0801-2019 Tax Map No: 226.19-1-53 Permission is hereby granted to: Tim Bechard For property located at: 3 NORTH LN 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 Type of Construction Owner Name: Tim Bechard Demolition-Residential $0.00 Owner Address: 7 IROQUOIS DR Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency North Valley Constructions Services 3 Maple DR Porters Corners,NY 12859 Plans&Specifications Demolition Only(seasonal camp) Asbestos Report Received $150.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,January 8,2021 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; Thursday,January 9,2020 SIGNED BY: �j�o/� 44:� for the Town of Queensbury. Director of Building&Code Enforcement (� C Li Office Use Only j l Permit# PrYYI U— DEC 2 3 2010 Fe } S� , CEO Permit e:$ � y �.E�ELI JL3(J "7 Invoice:#: DE6�/IO lT1O 1 AhPLI`C% T101tl 742 Bay Road,Queensbury,NY 12804 P:,518-761-8256 www.queensbury.net Demolition Location: 3 North Lane, Queensbury; NY Tax Map_11) #:.226.19-1-53-; **AN ASBESTOS DEPORT IS-REQUIRED-WITH ALL DEMOLITION APPLICATION SUBMISSIONS** !CONTACTINFORMATION: • APPlicant: Name(s):Tim & Kathy Bechard MailingAddress, C/S/Z: 7.Iroquo-is Dr., Queensbury, NY 12804 Cell Phone:_(518)_260-5576_Land Line: _(518)_832-7132 Email: tpbechard@.gmail:com. • Primary Owners); Name(s): Tim &Kathy Bechard Cell Phone:_(518)_260-5576_Land Line: _(518)_832-7132 Email: tpbechard@gmallxom.iling Address;.C/S/Z: 7 Iroqu.ois:,Dr.,.Queensbury,.NY.12804.- ❑Check if all work will be performed by homeowner only_ •- Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): North.Valley Constructions Services Contractor Trade: Coritruction Services Mailing Address, C/S/Z: 3 Maple Dr., Porters Corners, NY 12859 Cell Phone:_(518=701=5754) Land Line: _( ) Email: AdamCrosse@gniaiI.com *List all additional contractors on the next page Contact Person for Building&-Code Compliance: Bruce.Frank Cell Phone:_( . ) Land Line:_(518) 761-8226 Email: FrarikB@queensbury.met DEMOLItIa►U NFORf ATIO� 1 Demolition Application Revised January 2019 =e a• Residence❑ b• Garage❑ c. Business❑' d• Storage Building❑ e. other X�(describe:_Seasonaf Camp 3. What type of utilities are connected to the structure(check all that apply): a• Gas❑ b• Fuel Oil❑ c. Propane❑ d• ,electric X e. PublicwaterX Seasonal from May 1st to Nov. 1st f. Well-Water Pump-❑ 9. Public Sewer❑ h. Other i- None'❑ 4. Have ALL utilities been disconnected? Yes X Work Order: ESR no. 29333780 No ADDITIONAL INFORMATION: L 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: PRINTNAME:Timot y.'Bechard SIGNATURE: DATE: o� a b a D l 9 Demolition Application 'Revised January 2019 r I I EV E C lam' E FDEC � � i1019 C HANSON TON OF QL1E__!Nis"RURY . ill III nii i-_ ,, GEOLOGIC& ENVIRONMENTAL CONSULTANTS AN VLEET, LLC July 24,2017 226.19-1-53 DEMO-0801-2019 Mr. and Mrs. Tim and Kathy Bechard Bechard, Tim & Kathy 7 Iroquois Drive 3 North Ln Queensbury,NY 12804 Demolition Only RE: Pre-Demolition Asbestos Survey TOWN OF QUEENSBURY 3 North Lane BUILDING DEPARTMENT Based on our limited examination,compliance Queeinsbury,New York with our comments shall not be construed as indicating thf, plans and specifications are in full compliance` with the Building Codes of Dear Mr. and Mrs. Bechard, New York Stat6, Hanson Van Vleet, LLC conducted a pre-demolition asbestos containing material (ACM) survey of the residential structure at 3 North Lane, Lake Luzerne, Warren County, New York (See Figure 1), also known as tax parcel 226.19-1-53. HVV is authorized by the New York State Department of Labor under license 9 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. The sampling was- conducted on July 17, 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 throughout the entire structure. The samples were placed in double 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. 902 Route 146 TOVVN OF QUEENSSURY (518)371-7940 Clifton Park, New York 12065 U I L®I CO) ES E PT. Fax(518)371-5885 Revoewe yo� Date: C� 'Pre-Demolition ACM Survey 3 North Lane Queensbury,New York Page 2 of 3 Inspection Results The inspection revealed a wood framed two-bedroom, one-bathroom, single-story with loft, seasonal residential structure on a concrete slab.and pier foundation. The roof consisted of a single layer of asphalt shingles. The exterior was wood clapboard siding. Windows were wooden framed with glazing. The interior wall construction consisted primarily of a mix of open wood framed walls and wood paneling. Ceilings consisted of open framed wooden construction. The floors were a mix of carpet over wood subfloor, hardwood floors, sheet vinyl flooring in the bathroom, and sheet vinyl flooring in the kitchen/living area. Bulk samples were collected of the following suspect ACM materials identified at the property during the inspection on July 17, 2017: • Asphalt Shingle Roof • Window Glazing • Sheet Vinyl Flooring in Bathroom(No Mastic Present) • Sheet Vinyl Flooring in Kitchen/Living Area(No Mastic Present) Asbestos Containing Material Sampling Results Twelve samples of four types of suspected ACM were collected for analysis for possible asbestos content. A minimum of three samples of each type of suspected ACM was collected. Based on the size of each area,type of construction and observations, three samples of each type of a material was considered sufficient. The sample locations 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 3 North Lane Queensbury,New York Sample Type of Material Location Approximate Result No. Quantity (square feet S-lA Glazing Windows 100 Linear ND S-113 Glazing Windows 100 Linear ND S-1C Glazing Windows 100 Linear ND S-2A Asphalt Shingles Roof 1200 ND S-213 Asphalt Shingles Roof 1200 ND S-2C Asphalt Shingles Roof 1200 ND S-3A Sheet Vinyl Floor Kitchen/Living Area 50 ND S-3B Sheet Vinyl Floor Kitchen/Living Area 50 ND S-3C Sheet Vinyl Floor Kitchen/Living Area 50 ND S-4A Sheet Vinyl Floor Bathroom 35 ND S-413 Sheet Vinyl Floor Bathroom 35 ND S-4C Sheet Vinyl Floor Bathroom 35 ND Pre-Demolition ACM Survey 3 North Lane Queensbury,New York Page 3 of 3 Survey Results The results of the asbestos survey did not:identify any.asbestos containing inaterials. Conclusions No asbestos.:containing materials were identified within: the structure at 3 North :Lane, Queensbury, Warren County; 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):371-79.40. ::Very.truly yours; Hanson Van:V.leet,LLC James Gironda NYS.DOL-Class D Inspector Certificate# 07=05263 . CC: NYSDOL lit Speaker Heck Istand `»• ,' : L. Ott, �� ••-s«� „� :_ Of �1• •.y, T� 'RAM M R� •� U x a rris -- - -,n• • - 1 Bair ilF � � • Y 1• i - ', . ,,,td •,.., rg, si • �'• 3 • a islands 11 t0anda ' . - ,. Affid _. mc SITE LOCATION MAP FIG-1 ANSON WATER SUPPLY 8 3 NORTH LANE ENVIRONMENTAL CONSULTANTS QUEENSBURY, NEW YORK VANVLEET, LLC 902 ROUTE 146 CLIFTON PARK,NEW YORK 12065 (518)371-7940 FAX(518)371.5885 EMSL'Analytical, Inc. . EMSLOrder: 031721808 307 West 38th Street New York,NY 10018 Customer ID: HANS22 Tel/Fax:(212)290-0051/(212)290-0058 Customer PO: http://www.EM,9L.com/manhattanlab@emsl.com Project ID: Attention: James Gironda Phone:: (518)371-7940 Hanson Van Vleet; LLC Fax: (518)371-5885 , 902 Route 146 Received Date: 07'/18/2017 9:37 AM Clifton Park, NY 12065 Analysis Date: 07/22/2017-07/23/2017 Collected Date: 07/18/20.17 Project: 3:NORTH LANE/NEWYORK Test Report:Asbestos Analysis of_Bulk Material Non-Asbestos Analyzed Test Data Color Fibrous Non-Fibrous: : Asbestos Sample ID 81A Description EXTERIOR WINDOWS/WINDOW GLAZING 031721808-0001 Homogeneity Heterogeneous PLM NYS 198.1 Friable NotAnalyzed PLM NYS 198.6 VCM NotAnalyzed PLM NYS;198.6 NOB 07/22/2017 Gray ' 100.00%Other. Inconclusive:None Detected TEM NYS 198.4 NOB 07/23/2017 Gray None 100.00%Other <1.00%Anthophyllite <1.00%Chrysotile <1%Total. Sample ID 81B Description EXTERIOR WINDOWS/WINDOW GLAZING 031721808-0002, Homogeneity Heterogeneous PLM NYS 198.1 Friable NotAnalyzed PLM NYS 1913.6 VCM qNotAnalyzed PLM NYS 198.6 NOB 07/22/2017 Gray 100.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 07/23/2017 Gray None 100.00% Other <1.00%Anthoohyllite <1.00%Chrysotile <I%Total Sample.ID :SIC Description EXTERIOR WINDOWS/WINDOW GLAZING 031721608-0003 Homogeneity. Heterogeneous PLM NYS 198.1 Friable NotAnalyzed PLM NYS 198.6 VCM NotAnalyzed PLM NYS 198.6 NOB : 07/22/2017 Gray 100.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB- 07/23/2017 Gray None 100.00%Other <1.00%Anthophyllite <1.00% Chrysotile <1%Total Sample ID S2A Description ROOF/ASPHALT SHINGLES 031721808-0004 Homogeneity,, Heterogeneous PLM NYS 198.1 Friable NotAnalyzed PLM NYS 198.6 VCM NotAnalyzed PLM NYS 198.6 NOB. 07/2212 0 1 7 Black 100.006/6.0ther Inconclusive:None Detected TEM NYS 198.4 NOB 07/23/2017 Black 100.00%Other None Detected Sample ID S213 Description ROOF/ASPHALT SHINGLES 031721808-0005 Homogeneity Heterogeneous PLM NYS 198.1 Friable NotAnalyzed PLM NYS.198.6 VCM NotAnalyzed PLM NYS 198.6 NOB . 07/22/20.17 Black 160.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 07/23/2017 Black 106.00%Other None Detected Initial.Report From:07/23/2017 06:05:33 ASB 198x 0009.0001 Printed 7/23/2017 6:05:39AM Page 1 of 4 EMSL Analytical, Inc. EMSL Order: 031721808 307 West 38th Street New York,NY 10018 Customer ID: HANS22 Tel/Fax:(212)290-0051./(212)290-0058 Customer PO: htto://www.EMSL.com/manhattanlab@emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Material Non-Asbestos Analyzed Test Date Color. Fibrous Non-Fibrous ' Asbestos Sample ID .S2C Description ROOF/ASPHALT SHINGLES 031721808-0006 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed. ` PLM NYS 198.6 NOB 07/22/2017 Black 100.00%Other: Inconclusive:None Detected TEM NYS 198.4 NOB 0 712 3/20 1 7 Black 100.00%Other None Detected Sample ID S3A Description LIVINGROOM FLOOR/SHEET VINYL FLOORING' 031721808-0007 Homogeneity Heterogeneous PLM NYS 196.1.Friable Not Analyzed PLM NYS 198.6 VCM: Not Analyzed PLM NYS 199.6 NOB 07/22/2017 Tan 106.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 0 7/2 312 0 1 7 Tam 100.00%Other None Detected Sample ID S3B Description LIVINGROOM FLOOR/SHEET VINYL FLOORING 031721808-0008 Homogeneity Heterogeneous PLM NYS.198.1 Friable . Not Analyzed PLM NYS 198.6 VCM Not Analyzed - PLM NYS 198.6 NOB: 07/22/2017 Tan 100.00%Other Inconclusive:None Detected :TEM NYS 198.4 NOB 07/23/2017 Tan 100.00%Other. None Detected Sample ID SK Description LIVINGROOM FLOOR/SHEET VINYL FLOORING 031721808-0009 Homogeneity. Heterogeneous PLM NYS 198.1 Friable Not Analyzed . ..PLM NYS:198.6 VCM Not Analyzed: PLM NYS 198.6 NOB 07/22/2017 Tan 100.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 07/23/2017 Tan 100.00%Other None Detected. Sample ID S4A Description BATHROOM FLOOR/SHEET VINYL FLOORING 031721808-0010 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 07/22/2017 Tan 100.06%Other:: Inconclusive-None Detected TEM NYS 198.4 NOB 07/23/2017 Tan 106.00%Other None Detected Sample ID .S4B Description BATHROOM FLOOR SHEET VINYL FLOORING 031721808-0011 Homogeneity .Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.E NOB 07/22/2017 Tan 100.00%Other Inconclusive:None.Detected TEM NYS 198.4 NOB 07/23/2017 Tan 160.00%Other None Detected Initial,Report From:07/23/2017 06:05:33 ASB 198x 0009.0001 Printed 7/23/2017 6:0539AM Page 2 of 4 EMSLAnalytical, Inc. EMSLOrder: 031721808 Customer ID: :HANS22 307=West 38th Street New York,NY 100.1 a Tel/Fax:(212)290-0051 1(212)290-0058 Customer'PO: hftp://www.EMSL.com/manhattanlab@emsi.com Project ID: Test Report:Asbestos Analysis.of:Bulk Material Non-Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID .84C Description q BATHROOM FLOOR/SHEET VINYL FLOORING 031721808-0012 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.E VCM Not Analyzed PLM NYS 198.6 NOB 07/22/2017 Tan . 100.00%Other Inconclusive:None Detected .. TEM NYS 198AdNOB 07/23/2017 Tan p 100.00%'Other None Detected - Initial Report From:07/23/2017 06:05:33 ASB_198x 0009_0001 Printed 7/23/2017 6:05-39AM Page 3 of 4 E EMSL Order: 031721808 EMSL Analytical, Inc. 307 West38th Street New York,NY 1,0018 Customer ID: HANS22 Tel/Fax:(212)290-0051/(212)290,0058 Customer PO; http://www.EMSL.com/manhattanlab@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: 7/1 812 0 1 7 Sample Receipt Time: . 9:37 AM Analysis Completed Date: 7/22/2017 Analysis Completed-Time: 11:31 AM Analyst(s): .. KamelAlawawda FILM NYS 198.6 NOB(12) Sean Scales TEM NYS 198.4 NOB(12) . Samples reviewed and approved by: James Hall,Laboratory Manager ; or OtherApproved Signatory.: NOB=Non Friable Organically Bound N/A=Not Applicable 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 http://www.wadsworth.org/IabcerUelapcert/forms/VermiculitelnterimGuidance_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,NISI,or any agency of the federal government:This report may,contain data that is not covered by the NVLAP accreditation. Samples analyzed by EMSLAnalytical,Inc.New York,NY NYS ELAP 11506 , Initial Report From:07/23/2017 06:05:33 ASB 198x 0009 0001 Printed 7/23/2017 6:05i39AM Page 4 of 4 OrderID 031721808 307-West38th Street Asbestos=Bulk Building Material; ' Chain oft, ,ustb . y New York,NY 10018 EMSL':Order..Numbe.r��ab use on(y�: - PHQNE (212)290=0051 EMSIANALYT1CAl;INC_ - _ _ - . - - -- .. t=Ax:(212)290,-.0058 Hanson Van Vleet LLC EMSL-Btll.to E)Same ❑_Different COill an if 6iii to is Different note instructions'in'Comments Street:;902'ROute 146 Third Pa' -Billin re wires written authorization fromahird art ." State/Ctt "C�ifton Park, Province;NY, :: Zi /PostaiCode:120ti5 Re ort#To Name .James Gironda Telephone,# 5183717940 J iro Email Address 9 ..nda@hansonyanvleet com Faz°# 518371 -940 Purchase Order: ,. :Pro ect NarrielNumber 3 North Cane _ Please Provide°Results. ax' ✓. mail "- mall. . U.S.State Safi Ies Taken:`NY CT,Sam"less-❑Commercial/Taxable.'❑"Residentialfrax:Exem t, r Turnaround'Time`TAT O tions*-Please Check`.:" - - - ❑.3 Hour ❑'6 Hour ❑.24 Hour ❑48 Hour ❑'72 Hour ❑-.:96 Hour, ❑■ 1 Week ❑ 2 Week For TEM Arr 3;hrthroUgh 6 hr"please call ahead io schedule:'There rs e:premrum°charge for,3 Hour TEM AHERA or EPA Level IF:TAT";You wN be asked to sign fan authoii fi.form for this service Anal sis coni leied in accordance:with EMSt_s Terms and Conditions iocated in the"Anal ical!?nce"Gufde : - PGM=Bulk:(reporting limits TEM '`Bulk - ❑PL M EPA 600/R 93/116(<1%} ❑TEM EPA NOB EPA 600/R 93/116 Section 2 5 51 ❑PLM EPA NOB(<1%) ■ NY FLAP Method`198 4(TEM) Point Count ❑400(<0 25%}❑ 1000"(<0 1%) ❑Chatfield Protocol(semi-quantitative) i_ - - — _.T Point Count w/GravimetrI ❑400(<0.25%)❑ 100Q(<01%) ' ❑TEM%by Mass—EPA 600/R 93/118 Section 5: 1 ❑ NIOSH 9002(<i%) ❑TEM Qualitative via Filtration Prep Technique _ CJ t- ❑■ NY ELAP:Method 198 1 (friable In NY) ❑TEM Qualitative�ia_Dr6p Mount Prep Technique NY ELAP Method 198 6 NOB non fnable-NY ` ._.� Other •• s .. ❑ OSHA ID 191 Modified .. ❑ Standard Addition Method._ Check ForPositive Sto =.Clear) identi Horno enous Grou ., Date.Sam led Sam JAMES GIRONDA lets Name Samplers Signature Sample#.. HA# Sample'Location: Material Descr!�tion S1A EXTERIOR WINDOWS, WINDOWGLAZING_ - SIB EXTERIOR WINDOWS ... . .. .: WIN. _ DOW.GLAZING .. EXTERIOR WINDOWS , WINDQWa GLAZING _ S2A ROOF ASPHALT:SHINGLES S2B 'ROOF t1SPHALT:SHIN_GLES S2CROOF ASPHALT SHINGLES S3A LIVING;ROOM FLOOR SHEET-VINYL FLOORING.. 8. LIVING:ROOM FLOOR: SHEET VINYL FLOORING S3C LIVING ROOM FLOOR ' SHEET VINYL FLOORING- Chest Sam le# s : = Total#of Sam"less Relrnquished(Client): Date: . .. fiime:. Received(Lab). �,: Date: Time. 1 3 3,:,� Comments/Sp,e !Instructions:' IFANCONCLUSIVE RUN TEAL N08 A 9 Rage ,. Page s Paqe 1 Of 2 'OrderID 031721808 307 West38th Street ..Asbestos-Bulk Building Material =` Chain of Cust6. y New York;NY 10018 EMSL Orcier Number,(Lab use ohiy) PHONE EIA�Aw►urTidii;,MC; (212)290-0051 '(212)290-0058 Additional Pages of the Chain of Custody are only necessary4f neetled'for addifronal sample information HA# Sam le Location Material,Descri tion S4A LOO BATHROOM F R SHEET VINYL FLOORING SLB BAT QQM FLOQR SHEET VINYL FLOORING S4C BATHROOM FLOOR SHEET ANY FLOORING 1 C `Comments%Special Instructions: IF NC 4CLUSME RUN TEM NOB :"1 � F , age 2 of 2.. pages Page 2 Of 2 r j a STD, , F fief ' '' R E11,[PAR fir; L C 4 'JA ¢ - ° v ; ' $ 4 ' (E PIRES):t DP11 } j : 0 4,�W �DSPRO CQ of yv: - � f t - ' t s _ '��"New York State Deparmmer of,Labc r-, Division ofjSafety and Health y • � License and Ceitificate llnit� : '` - `'^,.'9 ` State Campus Building 12f : ,^� ~ �\ Aibany,,.NY 12240`__`_Z� !` � ._ASBESTOS HANDLING LICENSE--� j y t� —y y l•J' ( J , Han✓son_Van Vleet, L=LC FILE NUMBER 05 !s••'{ �. LICENSE.NUMBER:ti. 28463 ; ;r,-" .902 R a t .t LICENSE CLASS REST t r ;C DATE OF ISSUE: 03/02/2017 ' # ,• Clifton Park,rNY 12065 emu, �,1� EXPIRATION DATE: 03/31/2018 �1f5 k, �1 7. v� 1�.7 ``tt r '��t'. "•��4J f ti� � I •�1 r � Irt! 111�i�i� j Duly Authorized,Representative',D Kirby�V�anvleet= , ` "' f,. his hcense;has been issued in.accorda'f6ii rthtapplxcabl provisionscof Articl ,0 of the Labor Law of New T'ork.State and o = 1 t ie New Y Ir 'Stafe,�Codes,Rules hand Reguiat� ns112 NY;CRR Part 56). It is subject to susp,&siori:or revoca ion for a(1) 1� li is .,t r FFF serious violation of state,federal or local lames with regard to the conduct°ofnan,asbesto 'protect,or(2)demonstrated'lack of res onsibih m the conduct of an Y ob?in�olvm asbAl estos or asbestos water al / P� P tY Y YJt gf ,Jr, This license isavalid only for t ie contractor named,abo e and;th rs�lieense or a-pho ocopymust_be-prominently displayed at the asbestos projec orksite ��hi's'_I ense venfes tha;ali per ns_employ rdjbyAhe licc6 e on a a besto prof ct in-New Y,o k State liav�been.s sued an Asbestos Certificate,appropriate fohetyeof work-they"perform,by the'New York State r • Department of Labor. ,, _ Eileeri M.Franko, Director SH 432(8112) "` - —"�`J For the Commissioner of Labor FU WE D JAN 0 3 2020 nationalgrid --- 300 Erie Boulevard West r OWN ��Q�E�i�l��URY BUILDING&CODES Syracuse,New York 13202 i - 2© t� January 3, 2020 RE: Service Removal for Building Demolition. This letter is to confirm that,per your request,National Grid has confirmed electrical service and meters have been removed at 0 Honeysuckle Ln, Queensbury,NY. The work was processed on work order#29333780 and electric meter#29828116 was removed. If you have any questions or need further assistance, please feel free to contact National Grid at 800-260-0054. Sincerely, Laurie Green Customer Fulfillment nationalgrid