DEMO-0848-2021 Office Use Only n
DEMOLITION APPLICATION Permit#:
Permit Fee:$ )�UFJ—
Town of Queensbury
Invoice#: Z
742 Bay Road,Queensbury,NY 12804 n r
P:518-761-8256 www.gueensbury.net Flood Zone? N Reviewed By: l V 1
Demolition Location: Tax Map ID#: 35 Louise Lane, Lake George.NY 12845 17.
AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? Waste Management, Gansevoort NY_
2. Type of structure to be demolished:
a. Residence X d. Storage Building❑ n
b. Garage ❑ e. Other: U IJ VIE
c. Business❑
3. What type of utilities are connected to the structure: NOV 30 zoz}
-a. Gas ❑ f. Well-Water Pump❑ TOWN OF QUEENSSURY
b. Fuel Oil ❑ g. Public Sewer❑ BUILDING& CODES
c. Propane ❑ h. Other
d. Electric❑ i. None Q
e. Public Water❑
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes Q No❑
ADDITIONAL INFORMATION:
1. Two inspections maybe 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: Mary Sicard
SIGNATURE: _ DATE: lI&4 2-
Demolition Application Revised December 2020
V'
P.O.INK22 2
key �
�...�w.W�. ®ate• � � V
NOV 3 0 2021
TOWN OF OUEENSBURY
BUILDING&CODES'
10 Whom It my t:=ftSeM,
•R!e>uM!!R•iN�Itii�ftpit t tt�M Irnd lfto proA�f1 a'<i��tt�t#t�d on ths.aleololer!t�tt a�mioen • ..
r+cndam Mom. i terra eltrt#fte �a I�tt�tc8tade e�a+�ed�lt� .
Befit WWI trry twod" trtnact >the Istrare#�ry a� eaf� Mto�tbrn>I!>.sut�at p�
arty.11tbre WM no abem-asnt MIN MEW*WNW tt im an ft F+ot *(WW totter W1.
t#e tl�iaed ay�� A�rdb' t,��my trtt� tdlr►;a 1ha1~�tbtleatta arsY+md���ar
I �non ai ttM tltpl►Qf tRr �tom! tiro plo�rgr a mr�gi.p�ooeed wfl�n�odeljs�p ar'
�ntheawneft��
._...__....__.._.,�_;.... .. . ...,�..._..._.__..._.._..__.,_.-,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 York State.
,
IURU 289.6-11.47.6 DEMO-0848-2021
Sicard, Mary
35 Louise Ln
Demolition of SFD
Pre-Demolition Asbestos Building Survey
35 LOUISE LANE
LAKE GEORGE NY 12845
INTRODUCTION
u� ON OCTOBER 1 OF 2021 MARY SICARD OF 11 GEORGE STREET IN
LAKE GEORGE NY 12845 retained: Michael J. Stevens to preform an
asbestos survey of the property located at 35 LOUISE LANE IN LAKE
GEORGE N.Y 12845 this is a single family residence
The BUILDING is located on 35 LOUISE LANE IN LAKE GEORGE NY
12845 The building is a SINGLE FAMILY structure of approximately
700 square feet on a 86,400 square foot lot (construction date is
approximately 19 10 according to warren County records). The
residence consists of wood frame construction, WOOD siding and a
metal AND ASPHALT SHINGLE ROOF
The purpose of this survey was to complete a,pre-demolition asbestos
survey in accordance with Industrial Code Rule (ICR) 56.At the request
of the client destructive sampling techniques( i.e. breaking through
sheetrock walls, removing tiles, etc.) were utilized.
The remainder of this report describes building inspection procedures,
a summary of the results, conclusions and recommendations. A site plan
and building specific sampling locations are depicted.
Michael J. Stevens assumes no responsibilities for the implementation
or enforcement of the procedures, work practices, engineering controls,
or other asbestos-control methods recommended, required or
mentioned in this document.
4
Pre-Demolition Asbestos Building Survey
35 LOUISE LANE
LAKE GEORGE NY 12845
Summary Of Results
A material is considered.by the EPA to be Asbestos-containing if at least
one sample collected from the.homogenous area shows asbestos
present in an amount greater than 1%. Based on review of the
Laboratory results, none of the submitted friable and non--friable ACM
samples analyzed contain,asbestos.
Survey
Building Inspection Procedure
Mr. Michael J. Stevens, a New York State Certified Inspector
Certification #72900) conducted an asbestos survey of the building(s)
on OCTOBER 1 2021 which included both the interior and exterior
portions of the BUILDING .
Mr. Stevens visually inspected the residence for suspect asbestos
containing materials (ACMs). The roof of the residence was.accessed
with a ladder. Methodologies used were generally consistent with
USEPA publications: "Guidance for Controlling Asbestos Containing
Materials in Buildings" (June 1985) and "Asbestos in Buildings:
Simplified Sampling Scheme for Friable Surfacing Materials" (dated
October 1985). The documents were used for their asbestos survey
concepts, such as-identifying homogenous materials, quantifying
materials,-and evaluating friability(potential to crumble with hand -
pressure) and condition (good, damaged or significantly damaged).
Over 3,000 products are currently known to contain asbestos..Although
no comprehensive list of ACMs exists, Mr. Stevens utilized.the USEPA's "
Sample List of Suspect Asbestos-Containing Materials" as a general
To arrive at a preliminary evaluation of ACM, Mr. Stevens considered '
the following in its assessment: 1) location of the ACM; 2) condition of
the material, such as damage and severity of damage; 3) accessibility to
building occupants; 4) the potential for disturbance; 5) known or
-� _____ sirspectett causes of damage; and-6-fpreven afive measures that migYt-'---
eliminate the likelihood of future damage.
Pre-Demolition Asbestos Building Survey
35 LOUISE LANE
LAKE GEORGE NY
12845
OCTOBER 19 2021
LABORATORY RESULTS
. p� .Atnerl9ci Job it-2200&MB
Ghent NAM . WSW J.Stevens Pie 2 of�
os
�. ..._
•: _ _ LOiTISE L 1�E DIY
y
Cron#No./HGA �L���.///a���///�bA Na � 6 _
_..�_ A....�.. y .. 22a�Q9366F:•05 . � • - ,...•..,r.....�.�..•_....,..._ .`!�..y..-
Lownan: Bathroom Floor-Vinyl Flowing (try W"MAP't138:e)
Ma" y�� M,., o�i�z�:OfI3:12':1.
. •^ • � �: brows Bulk Materiel -'tS=.:;;3;• t.+y.�,a
fibs .Horns en0ous,Non-FI
Asbesw Types:
Odw Matodel:.Non-fibrous 1.6 9�
6A NA
Locavon: Bedroom Z wall-Compound`tneuii men_t Mete W eutww d For
Preperalton"
Anstyst Dandptton:Bulk trial
ybbeatas Types:
O#ror Mata�a{: '
7A �.,�. . ._ . . ., ,220083688-fli
l ocation'I(ltchen Floor ®rout {bjr aw 19m).
on.
Analyst 0 o». Homogeneous.Nan-Fibrous,Ce nwMous.Sulk Waderlal
�, QfnoB�
Asbastos Types:
Other Materht: Non-fibrous 100 Rb
8A 2200M6-08 No NAD
Loaetton: Fogndetlon-Cemeat .._. (t�I►t!Il E1,/►P 196.4).
r o lut ::::y
Analyst O=c f*tbn,Qraey,Homogeneous,Non-Fibrous,CementitToubk Bulk Metsdai
Ashados Types:
O#Ior 9511errfeh.Nonfibrvus.100%
--
88 220083666-09 NA
Location: Living RookrtWall='Compound"insutfIdent LWeriel SufsmUd For
pnapardtion"
Analyst DQscr"o»:Bulk{SUM"
Asbsstaa Typos: _
OtltW lieter�l:
See Reporting rtOw on last page
w ;..AM91i4d Job M 220083EiB6 Page 4 of 4
Client Name: Michael J.Stevens
it R -por
VaUTS.E LANE ICY
Client No./HCA Lab No. Asbestos Present Total%Asbestos
15B 220.083666-15 No NAD
Location: Pati4h Roof-As halt Roofing (by NY3 FLAP 198.6)
Wool t3trtr'"'..
�natystbD imlption:Black,Homogeneous,Non-Fibrous,Bulk Material
Asbestos Types:
Other Material: Non-fibrous 39:2%
j
(1)'This PLM job was usin 6p7iot Poi Scope SIN 9S4314
Analyzed by.8a 3urr
'NAI)MSD onq asbestos de cted;NA snot enalyzad;NA/AS=net gnalyxedlpositiva stop,(SOP-V)=Sprayed On Fireproofing containing Vermiculite;
Et?M-V)a Sur[eat�MateHa) ontatning.Vennta►tite;PLM Sulk Asbestaa Anstyais by Appd E to Subpt E,.40 CPR M(NVtAP 200546.0),EtAP PLM
Method 198.1 far NY trdeWe samples,which(nc;tudes th@ tdentifir ion and quantitation of vermiculite or SLAP 198.E for NOB samples or EPA 4CC pt ct
by EPA 61}0-N14-82-020(NY EIAP Lpb!148D);Note P1.M is not aonsistentiy reftabbfa in d�cift asbestos.in floor covongs am sfmuw nen-fdwe
orgaNcalty bound materials. tYAq orTrflCe results by PLM are Inconclusive,TEM Is currently fhe only method that can be used m determine If this
material can be considered or boated as non asbestos-containing in NY State(also we EPA Advisory for floor tile,FR 69,146,389T0,811f94)National
Institute of Standards.and Technotegy Accreditation requirements mandate that this report must not be reproduced except in full without the approvel of
the lab.Thls PLM Mates ONLY to Items tested.AIHA-LAP,LLC Lob ID 102849,RI Cart AAL494,CT Can PH-0188,Mass Cott AA000064.
Reviewed By: END OF REPORT,_,_____,,,__
r '
� ,„�„AmetlSC3 Jab it MMM Page of 4
Oljattt NOMIC Whad J.SW GAS
P ;ulk �Q
r •
_—_l�i�at�Ho +A�i---.. __ _-_W_-_--tab-�+1o..-__�._:_.._ s � • •", -�- �--
. •• taattan:•eetnnaomm Ftaar-v� e �y� ,
N ibmUs.bufk MOM
`iiss�t�idn:C3:eY.Hnma��oe�, ..
Qttuir�rgtlsl::N�1.6'�
NA
Pntparel2a�' .
Antes i ice:9Wk MOWWI
111Gttat�at•l . ......_ ••.•-r-•
22•B AP�`�r ZZOQ886B earl
•t�aa�lans•Kitc�ren FtaaT-i�r>wt . .. .. ` �;..r� )' .
Des�1�lort:c�ro]F�kloreot:s.NonFi�aus.C�rten�E�a �t�c lt�t+erf�f
Asbad='tWO.
other MOWN:No"bmm NO�
'23� 22p�' 866-06 No MAD
F,ounctation-Demerit ((�y MIS- 108.1)
J r1n>: tlb>act[p3�a:ti rey,HnmaPenaoue.Non•F%mLt%Cemen09%Bu[k Materiel
Asbe$WTVPM
OShK tYtaterm: wwv4bv a tog f6 . •
14A
220063898-Q9
B ; S
Uv�itp Raok�"rfVa "RnsutEt+aiartit C�atert� tet Mined For
x Auer D"W"M SUk Maid W
Other`(��ht•
8eo R1tr�Wotan on feet q�e .
�rC P
. AnteriSd Jab 2Qt3836B8 Page 4 oN
C!tellit Nance: Michael J.5tetrprts
ort
- Ellett No.I NGA Lab No. Asbestos Present Total WAsbestos_
_220083666-15 ----- . Na 14AD
Location: P.Orch Red-MOO Radno (by NVS SLAP 1e8:®)
ono;=f r3= '
Anstyst ptlon:Stack,Homogeneous,Nora-Fibrous,Bulk Material
Asbestos Tww:
OM4 Material: Noti flbmus 39.2.%
,.
' N� war•
Reporting MeteAM
.
(1) Thia PLM lit prfiut Poi 800pe S/N 9S43I4
AnalyZed br.008u
•NA13/Nso ono eab ;NA=riot analyzed;NAIPS=not ertslysed/poeltHrs atop.(SOF-V)a Swept!On Fireproofing WrOlning Vonnhau te(SM-V)a Sutfedpg ft Vom tarilbe;PLM Bulk Asbgatoa Analysts.by Appd E.to Subpt E,40 CFFt TO(NVLAP 2CO5484},ELAR PLM
Mo tod 128.1 for NY tdabla samples,Which Includes the IdwOoallon ad gttanDoAlon of vermicuilte at EW IOU for Moo eamples at EPA 400 pt et
by EPA 80044'82-W(NY SLAP Lab 1 U80).Note:PLM is not consiatei►tly relbsble M detectire sabastoa In boar coverings end•elmllar nonfi 9
organleaily bound materials. NM or-MVOs tr O*by PLM are Inmdugv%TEM Is ourmady the miry mood cast ern b8 usait to daWadne 8 this
meteft can be cortsidwed or treated.anon aabMa-ConWi ft In NY Slab(also see EPA Ad,#48w far flaot Nter FR GM48.38970011N)Nallanat .
Inatltuto of 8tieatdmde slid Technology Aecraditattan mquhar mle mendete tt►at this deport must Rot to NPtoduced q»ept In fo!!%iffaauft appraval of
Me tab.Thla.PLM retabea'ONLY to Items tested.AINA•tAP,LLC Lab IR 102543,Rl Cert AAL4)1K CT Cott PH4188,Niaarr Cert AA000ti84.
c
Ravlemd Nir, 0 OF REPORTA ___,_.l
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eriSci Job P. 220083666 Page 1 Of 2'
Client Name: Michael J.Stevefis
Table , is `
}1,. A —Results ;
Ained8d HG liilelgf t• zenm ve solublo NowAsbestos "AsbestoO.%by "'Asbastm%by
Sample a Cllem sampW Area. (gram)' Organic% bwrgarft X-, le�ngantc% PLMIDS TRM
01 1A — — --- NAD NA
Location: Living Room Calling-Joint Compound
02 2A ._ ._._ — Y .NAD NA
Location: Living Room Walt-Joint Compound
03 3A 0.244 49.4 2.7- 47.8 tW4D NAD
Location: Living Room Wag-Insulation y"
04 4A --- -- — KA NA
Location: Bedroom Waf-Compound-insuffidi t Material Submitted;For Preparadon"
05 5A ome 49-6 49.5 1.6 MAD NAD
L ation: Bathroom Floor-Vinyi Flooring
06 0A .... — -- NA NA
Location: Bedroom 2 Wall-Compound"Insufficient Material Submitted For Preparation"
07 7A -- -- -- -- NAD NA
Location: K tc1hen Floor-Grout
08 BA -- NAD NA
Location: Foundation-Cement
09 98 —. _.._ — NA NA
Location: Living Room Wall-Compound"Insuflident Material Submitted For Preparation"
10 10B 0.147 76.5 7.6 16.0 NAD NAD
Location: Ki CI=Waft-Compound
11. 118 0.175 48.9 50.0 1.1 PLED NAD
Location: Bath 2 Floor-"Flooring i
12 128 ---- — .— MID HA
Location; Bedroom 1 Ceiling-Compound
13 13B ---- --.- .... — MAD HA
Location: Bedroom 2 Ceifing-Compound
14 148 0.506 54.3 17.0 28.7 NAD NAD
Location: North Side Roof-Asphalt Stiingle
15 15B 0.343 48.3 12.5 39.2 NAO NAD
Location: Porch Roof.-Asphalt Roofing
:s
So Reporting notes on last page
UPDATED NOTES OCTOBER 15 20 21
STRUCTURE IS A SINGLE STORY BUILDING
ROOF METAL AND ASPHALT SHINGLE WITH NO UNDERLAYMENT
WINDOWS ARE VINYL REPLACEMENT NO CHALKING
MAN DOORS ARE WOOD-NO GLAZING FOR THE GLASS
INSULATION IS BARE FIBERGLASS NO VAPER BARRIER
HEAT IS ELECTRIC. NO WRAPPED DUCTWORK
AGE OF STRUCTURE POSTED AT 1950
ALL DRAIN AND WATER PIPES ARE PLASTIC OR COPPER
NO FOUNDATION OR BASEMENT
SIDING IS WOOD WITH NO UNDERLAYMENT
WINDOWS ARE ALUMINUM
=r PROTECTING INFRASTRUCTURE
Ticket Status Notification
To: CHARLES FRIEDMAN EXCAVATING
Email: LAURIE@FRIEDMANEXCAVATING.COM
Below lists utilities that were statused by USIC.Please note there may be other Utilities which include private facilities that
may be present in the work area and are NOT the responsibility of USIC to locate or mark.
You are receiving this notification because your contact information is listed on the above ticket from the One Call System.
if you have any questions regarding this notification, please contact USIC at 1-800-762-0592.
Ticket Address
11241-000-248 35 LOUISE LN,QUEENSBURY,NY
utdit Locate Date statiaset i
Charter-Time Warner Cab 11/24/21 10:47 AM Not Marked Excavation Site Clear*
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N1
Nationalgrid
300 Erie Boulevard West
Syracuse,New York 13202
DATE 11/22/2021
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 from 35.Louise Ln., Lake George. The work was
processed on work request 036478436. If you have any questions or need further
assistance,please feel free to contact us at 800-260-0054.
Sincerely,
Lydia Styb ESR3
Customer Connections UNY
nati n l ri