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DEMO-0366-2021 r .y Office Use Only DEMOLITION APPLICATION Permit#: ��,Q Permit Fee:$ 1�05 Town of Queensbury J ' `6 Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By: 03) ?P Demolition Location: Tax Map ID #: **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** DEMOLITION INFORMATION: 1. Where will demolition material be disposed?_ir&Y_N�Fy1 2. Type of structure to be demolished: Residence d. Storage Building❑ b. Garage ❑ e. Other: . - `_...-.---- ` c. Business ❑ Err, 3. What type of utilities are connected to the structure: h �� 8 2021 a. Gas ❑ f. Well-Water Pump ❑ "I b. Fuel Oil 51 g. Public Sewer❑ TCWN OF QUEENSBURY c. Propane ❑ h. Other BUILDING&CODES d. Electric 191 i. None❑ e. Public Water[`�] 4. Have ALL utilities (water, electric, etc.) been disconnected? Yes rp 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 andogf ee to the above: PRINT NAME: SIGNATURE: DATE: �1 zl Demolition Application 1 Revised December 2020 Y CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): �Yv irvt�� Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Primary Owner(s): Name(s): L � � Mailing Address, C/ u- 1129 �(� fi?��� ►" (r Cell Phone: Land Line: (5-FO -a© -gO�e Email: ate- eck if all work will be performed by property owner only • Contractor: (List all additional contractors on the back of this form) Contact Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: "Workers' Comp documentation must be submitted with this application" Contact Person for any questions regarding this project: CWN V-J—V Cell Phone: Land Line: Email: Demolition Application Revised December 2020 ii 7 y D u � � Asbestos Survey MAY 18 2021 Tim Stark TOW OF G&EENSBURY CDDES 31 Sweet Rd Queensbury, NY Inspection date: 5/4/2021 ,-._ - ;`..� ffi�„bra:• II � t .. i4 r F krc}s J'{,•s�31�• j41'L4Y%'b, �,.."'bk« z f v vm TOWN OF QUEENSBURY BUILDING DEPARTMENT r Based on our limited examination,compliance with our comments shall not be const!" as full compliance)ithathesBuildngi Codes of Tom Callahan /TC Inspections New York State. 1 Knolls Dr Queensbury, NY 12804 TOWN OF QUEENSBURY Inspector# 17-42926/Contractor# 109425BUiLDING & Co ES DEPT. cell# 518-832-9750 Reviewed By: Date: 296.14-1-13 DEMO-0366-2021 Stark, Timothy 33 Sweet Rd Demolition of mobile home Summary of Inspection At the request of Tim Stark an asbestos survey was performed at 31 Sweet Rd Queensbury, NY . Scope of the Inspection/Survey is to determine if the dwelling contains any 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 1( nonfriable) Vinyl floor (none detected) Homogeneous area 2 (nonfriable) Ceiling tile (none detected) Homogeneous area 3 (nonfriable) Drywall (none detected) 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 No Materials were identified as containing more than 1% asbestos material. Therefore no asbestos abatement is required. A copy of this report should be kept at the work site. A copy of the sample analysis is attached to this report Now,York State -Zep Arrient-of La�ri< .> , Division of:4ety;t�nd Neaith % License end°Chrtilicatt Unit` State CiTT Lis,'Sbilding 12Albany,.NY 12240 ' 1 f: ."";""ASBESTOS HANDLING LICENSE Thomas.M. Calialian'c#tia TC inspections;:g ;; ;FILE NUMBER: 18-109425 LICENSE NUMBER: :1-09425�'.' " '1:Knnlls`brive `LICENSE CLASS: RESTRICTED. f V i DATE OF ISSUE: 01/08/2021 JQ Obhsbury NY 12804 '_ �EXPIRATION;DATE: 01/3/42022 _ , .. C i�iy,Authariz riS Representativ6',; hornas,'' t -' \ ..�/'::•_ aft€i (.. 4 ...../ Tlxis licensi leas been issued in ac0.ordanc6..with t ppiietible.pravisiaris ofArtiele, ot'ti, 1_:abbr.Law of New Y9rk'Starc<itjd of'' the New.l tt`rkMate.C;odes,RuIes'"and ReguIatioits"`(,12..NYC7Lit:i'art`St)�`ft"is`sti qJecI to suspension or revocation To a(I} ', serious vitil<ttio t of state,federal of local laws with renai d�.tn-the cctndiict'o�abl isliestos project,or(2)dernonstrat:d,.lack of rt,Ojisibilify in the.vonduct of an}"jti if itivolvint; sbestow-px:°asbcstos niiitertaF, ,�,ty >t:'`.`.: i.1S L�'.S' >^.;F•'4^ � :;",:/ aE{ _ ,'.r ..F This plicehse is:v,aiid only.for the contractor,name'8 above and,, fiis Jcense o�.`a photocopy tnust;bj�,�'piomineiitly displayed<at the asbesjas project,worksite -'This license verifies that-all,persons employed by,t(te licensee on ah bsbcstps:project_in New York State have becri_ts icd an Asbestos Certificate;ap{it©pri to fi r the,typC,afivc rk-they perforni,by the Nero York State Dcpartlx, t of JL/ or. 3` i 's Eileen M Franko. Director SH 432,(8/12) For the Commissioner of Labor STNFE OF NEW YORK-D PAlftMENT OF kAd09 "r ASBESTOS CE"11C'ATE .}•j.tt;.w . i THOMAS-M.CALI.AH'h CLASS(EXPIRES) D INSP(121Z1) MUST BE CANED ON ASBESTOS PgOjECTS . arttitEa�� �nsttsy EMSL An,alytical,.Inc. EMSL Order: 062108127 528 Mineola Avenue Cads Place;NY 11514 Customer Id: TGNS29 TeliFax:(516)047-7261/(516)997-7528 Customer PO: http iiw viJ,Ef iSl:com l cailoplace.lats@omsl.ca r' Project ID: Attention: Toro Callahan Phone: (518)832-9750 TC inspections Fax: 1 Knolls Drive Received Date: 051061,2021,11:45 AM Queensbury,NY 12804 Analysis Date: 05/0W2021-0511012021 Collected Date: 05/0412021 Pie ect! 31 Sweet Rd Test Report:Asbestos Analysis of Bulk Material Non�Asbestos Analyzed Teat pate Color Fibrous Non-Fibrous Asbestos Sam_pie ID 1-KVF1 Description Vinyl Ficor 062108127.0001 Nomogertoity Homogeneous, PLM NYS'168.1 Friable Not,Anatyzed PLM NYS 198.E VCM Not Analyzed PLM NYS 198.6 HOS 05109/2021 Tan 100.00%Other Inconclusive:None Detected TEM NYS 198A NOB 05110/2021 Tan 100.00`/o Other None Detected Sample lo' '14KVF2 Description. Vinyl Floor' OS2108127-0002 Hdmogeneity' - Homogeneous - PLM NYS 198.1 Friable Not Analyzed - PLM NYS 148.6 Vcm Not Analyzed - PLM NYS 198.6 NOB 0 5/0 912 0 2 1 Tan 100.00%Other Inconclusive:None Detected TEM NYS.198.4 NOB 05,101202, Tan 100,00%Other None Detected Sample10 2-CTC1 ,' Description CelfngTllo_ 0821U81x7=0003 Hamoganoity Hoiieaganeous PLM NYS'198.1,Friable. Not Analyzed' PLM NYS 198:6.VCM .. _ Not Analyzed PLM NYS:198.6 NOB 05/0912021, Tan 100.00%Other Inconclusive:Nona Detected TEM NYS-198.4 NOB' 0511012021 Tan 100.00%Other None Detected Sample ID 2-CTC2 Description. Coiling Tile 00 062108127� 0a Nomononeity Homogeneous' PLM NYS 198.1•Friable - �~ Not Analyzed PLM NYS 198.8 VCM Not Analyzed PLM NYS 198.6 NOB. " 05"0912021L Tan ' 100.00%Other Inconclusive:Nona Detected TEM NY5198.4 NOB 05/1612021 Tan' 100.00%Other None Detected Sample ID' .3-DWI Description Drywall 062IM127-MS Nornogenoity Homogeneous _ PLM NY6198A Friable OSIOM021 Brown/White 6.00°lo Cellulose 29:00%C6 Carbonate None Defected 60.00%gypsum 6.00%.Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS,198.4 NOB _ Not Analyzed initial report from;05110/2021 12:55:14 A5ft 138x ti009 00f/1 Pri{ltad'5110i2021 12;55:17E'A1 Page 1 of EMSL Analytical, Inc. Customer Order; 062108127 _ Customer ID. TCN529 528 Mineola Avenue Carle Place,NY 11614 Tel/Fax:(516)997-7251 1(516)997-7528 Customer PO: htlpJAvww.EMSL.corn 7 carleplaceias iemsl.c zit Project ID: Test Report:Asbestos Analysis of Bulk Material Non-Asbestos Analyzed . Test path Color Fibrous Non-Fibrous Asbestos Sample10 :3-DN2 .Description Urytva8 a6zrrrar2�.rw�e Homogeneity Heterogeneous PLM NYS 198.1 Friable, OW0812021 Br64vnt,Wbite 10.00%Cellulose 33.00%Ca Carbonate, None Detected 52.00;Gypsum 5.00%Non-flhAsus(other) PLM NYB'198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed: TEM NYS 168.4 NOB Not Analyzed In list report from:051102021 12:55:14 A Sf?.19ax 000ff 0401 Printed 5t10r2021 12:55:17P.M Page 2 of 3 D us t Z=t S 'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY NAP BEARING A LICENSED LAND SURVEYORS SEAL. IS A VIOLATION OF SECTION 7209, SUB -DIVISION 2. OF THE NEW YORK STATE EDUCATION LAW.' ONLY COPES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE LAND SURVEYORS SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES.' 'CERTIFICATIONS INDICATED HEREON SIGNIFY THAT THIS SURVEY WAS PREPARED IN ACCORDANCE VATH THE EGMNG CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. SAID CERTIFICATIONS SHALL RUN ONLY TO THE PERSON FOR WMOM THE SURVEY IS PREPARED. AND ON HIS BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY AND LENDING INST17UITION LISTED HERON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.' Timothy Stark