DEMO-0189-2023 Office Use Only
raw
DEMOLITION APPLICATION
Permit#:_PC—AA_0 D 19--7
Permit Fee: $ rae
Town of Qucens6ury D 3`]
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y IV Reviewed By:
Demolition Location: Loc k1larT Tax Map ID#: a��—a g•
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION: Hiram
/ 1
1. Where will demolition material be disposed? H i rangy Hollow) U"zwx yoor"
2. Type of structure to be demolished:
a. Residence X CPS. 6c l d. Storage Building ti, ��
b. Garage e. Other: ID E g
c. Business
APR 2 5 �23
3. What type of utilities are connected to the structure:
a. Gas f. Well-Water Pump X TOWN OF OUEENEmURY
b. Fuel Oil g. Public Sewer �'��r�®�N� �01�N
c. Propane X h. Other
d. Electric X L None
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes X No
ADDITIONAL INFORMATION:
1. Two inspections are required: an inspection to determine that utilities are
disconnected, 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: pa+ri&k 6 O,viln -r vnryneS
SIGNATURE: APV14 DATE:
Demolition Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): e- rk k 6-avrn A n nvS
Mailing Address, C/S/Z: A/ 1�g
Cell Phone: Land Line: 518- qW -G464
Email: gavtu hpkP-y-vna.I cvvn
• Primary Owner(s):
Name(s): ,hri-c k l avi N - ryp,.?5
Mailing Address, C/S/Z: 6S.e �s
Cell Phone: " Land Line:
Email: (�
V 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):
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: t4I rIA 6-6v l`n "�rmc'S
Cell Phone: S)9- `i 90-I qJq Land Line: 5440-- rt3 5
Email: QLLu `a �pk - q'i,, &IT (zml
Demolition Application Revised June 2022
Asbestos u
- Patrick
Gavin-Brynes
443 Lockha►t Mountain Rd
Queensburyf NY 128p4 2s..._o-
0 J202
e date*
/3
coon d __ - :n .:,�!::�',r.•:�
x •t': _ '�+F���.�;g6'h bfisrl, _r"=f.r 1
♦� v
.� TOWN OF QUEENSBURY
BUILDING DEPARTMEEN T
N�B1 JRY Based on our limited examination,compiia-7ce
Q 'E '` with our comments shall not be construed s,s
�F pE�j ®�� indicating the plans and specifications we n
G & r full compliance with the Building Codes or
�vILDI� I�7 New York State.
C{evlewea 2'�
®ate:
pr APR 25210
D
NY 12g04 -rovvra as � jky
Oueensbury, 42926/contractor# 109425
E3UlLDit�v �'DES
insp
ector# 17
cell# 518-832-97 50
C� _ 89'2023 .
001
252
FO1'� .2g,2 BEM k
pa; try
Gavi0-8 rt MrountatnRd
deuce
443 k-ock
,moliaon Of part of r
De
Summary of Inspection
At the request of Patrick Gavin-Brynes an asbestos survey was
performed at 443 Lockhart Mountain Rd Queensbury, NY.
Scope of the Inspection/Survey is to determine if the house
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( friable) Drywall -(no asbestos 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
New York State='Department of Labor;...;
- a Division of.Safety and Health,
".License and Certificatb,Unit'
Stale Campus,Building 12
Albany,NY.12240
ASBESTOS HANDLING LICENSE.
Thomas M.Callahan dba TC inspections: FILE NUMBER: 18,109425
LICENSE NUMBER: 109425
1 Knolls D rive --
e. LICENSE CLASS: RESTRICTED.
-
DATE OF ISSUE: 01/21/2022 ,.
:Queensburyi NY 12804, _ _ EXPIRATION DATE: 01/31/2023.
Duly,, uthorized Representative=Thomas Callahan:
This license has been issued in accordance-with:appheable provtstons,of Article-30 of the Labor Law of New York Statc and of,
the New,York=State Codes,Rules and Regulations(12 NYCRR Part 56): it is subject to suspension or revocation for a(I)
serious violation of stale,federal or local laws with,regard to,the conduct of an'asbcstos project,or(2)demonstrated.lack.of
responsibility in the conduct of any jobfinvolviog asbestos or asbestos material
This-liccnse.is valid only for the contractor nained'abode and this license or a photocopy most bepromincritly displayed at the'
asbestos projectmorksiie.'This license verifies that all persons employed by.thc licensee on an.asbestos project in New York
State have been issued an Asbestos Certificate,appropriate for the lypc:.o'work they perform,by the New York State
Department of Labor. .
fl
Amy Phillips,Director
SH 432-(8112) 'nissioner of Labor
STATE OF NEW YORK-DEPARTMENT OF LABOR :t
AS
CERTIFICATE
t` 1
THOMAS'M CALIAHAN
CLASS(EXPIRES)
01NSP(12122)
..''.'MUST BE'CARRIED ON ASBESTOS PROJECTSv+p''jll .
EMSL Analytical, Inc. EMSL Order: 062223251
528 Mineola Avenue Cade Place,NY 11514 Customer ID: TCNS29
TellFax:(516)997-7251/(516)997-7528 Customer PO:
htipJhvww.EMSL.com/carleplacelab@emsl'.corn Project ID:
Attention: Tom Callahan Phone: (518)832-9750
TC Inspections Fax:
1 Knolls Drive Received Date: 11/03/2022 1:52 PM
Queensbury,NY 12804 Analysis Date: 11/04/2022
Collected Date: 10/31/2022
Project: 443 Lockhart Mt Rd
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 1-DWi Description Dry Wall
062223251.0001 - Homogeneity Heterogeneous -
PLM NYS 198.1 Friable- 11/04/2022 Brown/Tan 3.00%Cellulose 112.00%Ca Carbonate None Detected
70.00%Gypsum
15.00%Non-fibrous(other)
PLM NYS 198.6 VCM - Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Samplo ID 1-DW2 Description . Dry Wall
062223251-0002 Homogeneity Heterogeneous
PLM NYS 198.1 Friable 1110412022 Brown/Tan 8.00%Cellulose 12.00%Ca Carbonate None Detected
- 70.00%Gypsum
10.00%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:11/071202212:18:22
ASS_195x_0009_0001 Printed 11/7/2022 12:18:25PNI Page 1 c
. '-'°'.,,•,E—'��,.����� � •� Pie, pj -1,
4� _ _ !ter :1,,:�3'.y: ."�-� f�-:�':•-�-•:' i
�S,i� � W�-e��;•'^,� mac=:. •.�It- -`-�
- `; 'ki Py`�✓ -apt°
' Y"DIY ■ ^a -!. sy� _
lrtltf C(r� . � ,i':�13-''►'F'Q'.'n���}f�_��-y
1 � -
,fv
. r
�sr
F-A � 2 5 201 3
TOWN OF OUEENSBURY z999 ll-I'Zg:ulXr.L
BUILDING � CODES �n'saa,eq,3so,
."9'LLZ
oZ .._
OOI .01, ,OZ,Oi .0 ,L19'E6L --
m
_ ,8L
.LZ4'99Z
zz
f dad
1'8Z-I'ZSZ:QI`�1
g 6e f'uowles
L'8Z-I'ZSZ Al xrl
Apauu»l n3wed'sm.Ug-mne9
J
NId.LN[l 1.L
.L2IV3H?00-17
N
V
N
I'8Z-NZSZ QI Xul
g 6e f'uowles