DEMO-0570-2023 Office Use Only
DEMOLITION APPLICATION Permit#: DrD -zfa f
Permit Fee: $ \��J
Town of(Lccnsbu y
Invoice#: (GFJ2S:\
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Flood Zone? Y N Reviewed By:
Demolition Location: 43 Canterbury Drive- Glen Lake Tax Map ID #: 289-17-1 -26
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? Disposal Facility __._
•
2. Type of structure • •e demolished: ()) _Y _--.-.-�.., _-
a. Residen d. Storage Building
b. Garage NI e. Other: SEP 1 1 2023
c. Business II _ -
3. What type cr—lilities are connected to the structure: L3Oi1_ °f`:t7 'OC`'a ''
a. Gas I I f. Well-Water Py�m __�_
b. Fuel Oil_ g. Public Sewer I
c. Propanq--- h. Othe
d. Electric I'' i. None
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes ✓ 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:
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Northern Builders - Nicholas Denno (General Contractor)
Mailing Address, C/S/Z: 33 Atwell Road Porter Corners NY 12859
Cell Phone: 518-796-6694 Land Line: 518-796-3774
Email: ndenno@northernbld.com
•
• Primary Owner(s):
Name(s): John & Mary Jo Sabia
Mailing Address, C/S/Z: 11 Naples Drive, Poughkeepsie NY 12603
Cell Phone: 845-380-8448 Land Line: N/A
Email: docsabia@yahoo.com
❑ 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): Northern Builders
Contractor Trade: General Contractor- Builder
Mailing Address, C/S/Z: 33 Atwell Road Porter Corners NY 12859
Cell Phone: 518-796-6694 Land Line: 518-796-3774
Email: ndenno@northernbld.com
**Workers' Comp documentation must be submitted with this application**
Contact Person for any questions regarding this project: Nicholas Denno
Cell Phone: 518-796-6694 Land Line: 518-796-3774
Email: ndenno@northernbld.com
.,
• ,
PP' „' r 18 Blackberry Lane
HEAL
''# Fr Queensbury, NY 12804
S. I ' '� ryan@clearvuinspections.com
INSPECTIONS
518.832.9213
Pre-Demolition Asbestos Survey
,_.....
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rE TOWN OF QUEENSBURY
BUILDING DEPARTMENT
\---
sEp 1 1 2023 Based on our limited examination,compliance
with our comments shall not be construed as �ti -�`�
full
the plans and specifictions s , firt`
TGWP� �� QUEENSBURY nce with the BuildingCod
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TOWN OF QUEENSBURY
BUILDING & CO ES DEPT. PROJECT NUMBER PREPARED FOR
Reviewed By: ' 10157 John Sabia
Date: 11 Naples Drive
SITE LOCATION Poughkeepsie, NY 12603
Single Family Deweling
43 Canterbury Drive PREPARED BY
Queensbury, New York 12804 Ryan Wild
18 Blackberry Lane
289.17-1-26 DEMO-0570-2023 Queensbury, New York 12804
•
Sabia, Mary Jo &John
43 Canterbury Dr
Demolition of Residence
,John Sabia,43 Canterbury Drive,Queensbury,New York,12804 •
Executive Summary
Asbestos-Containing Material Field Survey
•
Single Family Deweling•
43 Canterbury Drive
Queensbury, New York, 12804
I. SUMMARY OF FINDINGS
•
On September 22, 2022, an asbestos-containing material (ACM)field survey was conducted at 43 Canterbury Drive
located in Queensbury, New York(Site).The site was inspected to determine the presence of ACM in preparation for
renovation.The'ACM survey was performed at the request of John Sabia.
A summary of asbestos-containing materials is provided in the following table. However, this report should be read in
its entirety, including detailed information that is contained in other sections and appendices. A total of 34 samples
were collected from 13 suspect homogenous materials.
Summary Table of Asbestos-Containing Materials •
Sam Ie;ID - _ : S ace.:Name." Numerica Resul Material'Cate o Friabilit
No Asbestos Detected
***Electrical was on during the.survey and electrical insulation was not sampled***
Following the introduction, a table of ACM grouped by homogeneous areas is included in Appendix A of this report.A
table presenting those materials sampled which did not contain asbestos can be found in Appendix B of this report.A
complete listing of all suspect materials sampled is provided in Appendix C of this report. A photographic log is
provided in Appendix D of this report.The original chain of custody&laboratory analytical reports are located in
Appendix E of this report.
•
•
Page 2 of 10
'John Sabia,43 Canterbury Drive,Queensbury,New York,12804
INTRODUCTION GENERAL INFORMATION
ClearVU Inspections was retained by John Sabia to conduct a pre-demolition survey.All methods and procedures
employed in this survey were done in accordance with NYSDOL(New York State Department of Labor), OSHA
(Occupational Safety and Health Administration), and USEPA(United States Environmental Protection Agency)
regulations and protocol.
The information contained in this report has been collected in accordance with existing regulations. If this document
is to be utilized for bidding quotations, it cannot be held binding and must be field verified by those contractors
submitting bids.
PURPOSE
The purpose of this survey was to identify,document, and measure specified asbestos-containing materials in this
building,which may be disturbed during renovation/demolition/rehabilitation activities. Samples were collected of
suspect accessible asbestos-containing building materials.Should any materials be encountered that are not
identified in this report,they should be assumed asbestos containing until a representative number of samples are
collected to document these materials as non-asbestos containing.
LIMITATIONS&SCOPE OF SERVICES
Provide a visual inspection of all accessible building components to determine the presence of suspect materials.The
inspector physically assessed, quantified and conducted bulk sampling as required of suspect ACM (Asbestos
Containing Materials)which were accessible or exposed.This report represents the locations and quantities of ACM
(Asbestos Containing Materials) present as well as all sampled materials that tested negative for the presence of
asbestos and their locations. Bulk sample analysis was performed by a participating New York State Department of
Health Environmental Approval Program (NYSDOH-ELAP) certified laboratory. Buildings where power is connected,
electrical wire sheathing could not and was not sampled.
SAMPLING METHODOLOGY
During the visual inspection process, an inventory of suspect materials similar in appearance and composition was
created and grouped into homogeneous sampling areas.A homogeneous area is defined as a surfacing,thermal or
miscellaneous material that is uniform in texture, age, and appearance.A representative bulk sampling plan was
created in accordance with current USEPA(United States Environmental Protection Agency) requirements and
guidelines. Bulk samples were then collected of suspect ACM (Asbestos Containing Materials)to identify the presence •
of asbestos.
There are a number of materials,which rarely contain asbestos and are not specifically addressed in this report. Such
materials include but are not limited to metal,glass, rubber, cinderblock and mortar.
LABORATORY METHODOLOGY
The friable bulk samples were analyzed by Polarized Light Microscopy(EPA Interim Method: Appendix A to Subpart F
40CFR Part 763)at magnifications ranging from 10x to 400x, and New York State Department of Health ELAP Item
Number 198.1 (Polarized Light Microscopy Methods for Identifying and Quantitating Asbestos in Bulk Samples).The
estimated phase abundances are provided in weight percent and are accurate to within 10 to 15 percent of the
amount reported.These methods are sensitive to the detection of asbestos to less than one percent.
Page 3 of 10
.John Sabia,43 Canterbury Drive,Queensbury,New York,12804
All non-friable organically bound (vinyl flooring, caulking, etc.) bulk samples were analyzed by New York State
Department of Health ELAP Item Number 198.4(Transmission Electron Microscopy Method for Identifying and
Quantitating Asbestos in Non-Friable.Organically Bound Bulk Samples). NOB samples were first reduced by the
Gravimetric Matrix Reduction Method to determine if greater than one percent of material remained. If greater than
one percent of the NOB material remained by weight,the sample was analyzed by Polarized Light Microscopy by New
York State Department of Health ELAP Item Number 198.6 to determine if it contained greater than one percent
asbestos.
In accordance with New York State Department of Health regulations, Polarized Light Microscopy is not consistently
reliable in detecting asbestos in non-friable organically bound materials, and in cases of a negative result TEM analysis
is performed.This method is sensitive to the detection of asbestos to less than one percent by weight.A material is
considered asbestos containing if it contains more than 1%asbestos.
NYSDOL and USEPA regulations define asbestos containing material as containing greater than one percent (1%).
Materials found to contain asbestos at concentrations of less than one percent(<1%) by weight are classified as
containing trace amounts of asbestos. It should be noted, OSHA's definition of"asbestos containing" does not have a
one percent(1%) cut-off,therefore, asbestos that is present in percentages less than one percent(<1%) continues to
be covered by OSHA Construction Standard 29 CFR 1926.1101.
Eurofins CEI-Lab ID#12048, completed the analysis.
WARRANTY
The field and laboratory results reported are considered sufficient in detail and scope to determine the presence of
accessible and/or exposed asbestos-containing building materials.The findings contained within this report have been
gathered in accordance with existing regulations and industry protocol.
This survey and analytical methods have been used to provide information regarding the presence of suspect interior
asbestos-containing building materials existing at the time of the inspection.This report is limited to the information
available from the client at the time it was prepared. It is possible that conditions may exist which could not be
identified within the scope of the survey or which were not apparent during the site visit.
Page 4 of 10
John Sabia,43 Canterbury Drive,Queensbury,New York,12804
Appendix A:
ACM Homogenous Area Table
IVlater al ld.,. :;;`;Material` `.;:: 'Space Name: ,:';'Section,Narr e ' Friability` .`:, .Current Condition _ Result Quantity
There are no homogenous materials for this project that are assumed or have tested positive containing asbestos
Page 5 of 10
'John Sabia,43 Canterbury Drive,Queensbury,New York,12804
Appendix B:
Tested Negative Homogenous Material Table
Material: ' Material ` :Material: .` Space::Naiiie Section` Result
:Category.; :Id.-;: .'':= _'. •:::.:-• :Name.
Miscellaneous 001 001-Masonry Block(CMU) Exterior Dwelling Tested Negative by Lab
(No Asbestos Detected)
Miscellaneous 002 002-Masonry Block Mortar Exterior Dwelling Tested Negative by Lab
(No Asbestos Detected)
Miscellaneous 003 003-Caulk,Window Exterior Dwelling Tested Negative by Lab
(No Asbestos Detected)
Surfacing 004 004-Stone Foundation Mortar Exterior Dwelling Tested Negative by Lab
Material (No Asbestos Detected)
Miscellaneous 005 005-Roofing,Composite Shingle Roof Dwelling Tested Negative by Lab
(No Asbestos Detected)
Miscellaneous 006 006-Chimney Flashing Roof Dwelling Tested Negative by Lab
(No Asbestos Detected)
Miscellaneous 007 007-Roofing Paper/Felt Roof Dwelling Tested Negative by Lab
(No Asbestos Detected)
Surfacing 008 008-Textured Ceiling Material Upstairs Dwelling Tested Negative by Lab
Material (Popcorn) Bedroom (No Asbestos Detected)
Miscellaneous 009 009-Wallpaper Kitchen Dwelling Tested Negative by Lab
(No Asbestos Detected)
Miscellaneous 009 009-Wallpaper Upstairs Dwelling Tested Negative by Lab
Bedroom (No Asbestos Detected)
Surfacing 010 010-Ceiling Tile Kitchen Dwelling Tested Negative by Lab
Material (No Asbestos Detected)
Surfacing 011 011-Ceiling Tile Living Room Dwelling Tested Negative by Lab
Material (No Asbestos Detected)
`Miscellaneous 012 012-Gypsum Wallboard System Bathroom Dwelling Tested Negative by Lab
• (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
Miscellaneous 012 012-Gypsum Wallboard System Downstairs Dwelling Tested Negative by Lab
(Wallboard,Joint Tape,and Joint Bedroom (No Asbestos Detected)
Compound)
Miscellaneous 012 012-Gypsum Wallboard System Kitchen Dwelling Tested Negative by Lab
(Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
Miscellaneous 013 013-Vinyl Flooring Kitchen Dwelling Tested Negative by Lab
(No Asbestos Detected)
•
Page 6 of 10
,
-John Sabia,43 Canterbury Drive,Queensbury,New York,12804
Appendix C:
All Suspect Materials Sampled
Sample ID Space Name Section Material Analytical ' Regulatory Result
_ Name . 'Result
001A Exterior Dwelling 001-Masonry Block(CMU) 0% Tested Negative by Lab
(No Asbestos Detected)
OO1B Exterior Dwelling 001-Masonry Block(CMU) 0% Tested Negative by Lab
(No Asbestos Detected)
002A Exterior Dwelling 002-Masonry Block Mortar 0% Tested Negative by Lab
(No Asbestos Detected)
002B Exterior Dwelling 002-Masonry Block Mortar 0% Tested Negative by Lab
(No Asbestos Detected)
003A Exterior Dwelling 003-Caulk,Window 0% Tested Negative by Lab •
(No Asbestos Detected)
003E Exterior Dwelling 003-Caulk,Window 0% Tested Negative by Lab
(No Asbestos Detected)
004A Exterior Dwelling 004-Stone Foundation Mortar 0% Tested Negative by Lab
(No Asbestos Detected)
004E Exterior Dwelling 004-Stone Foundation Mortar 0% Tested Negative by Lab
(No Asbestos Detected)
005A Roof Dwelling 005-Roofing,Composite Shingle 0% Tested Negative by Lab
(No Asbestos Detected)
005E Roof Dwelling 005- Roofing,Composite Shingle 0% Tested Negative by Lab
(No Asbestos Detected)
006A Roof Dwelling 006-Chimney Flashing 0% Tested Negative by Lab
•
(No Asbestos Detected)
006E Roof Dwelling 006-Chimney Flashing 0% Tested Negative by Lab
(No Asbestos Detected)
007A Roof Dwelling 007-Roofing Paper/Felt 0% Tested Negative by Lab
(No Asbestos Detected)
007B Roof Dwelling 007-Roofing Paper/Felt 0% Tested Negative by Lab
(No Asbestos Detected)
008A Upstairs Dwelling 008-Textured Ceiling Material 0% Tested Negative by Lab
Bedroom (Popcorn) (No Asbestos Detected)
008E Upstairs Dwelling 008-Textured Ceiling Material 0% Tested Negative by Lab
Bedroom (Popcorn) (No Asbestos Detected)
008C Upstairs Dwelling 008-Textured Ceiling Material 0% Tested Negative by Lab
Bedroom (Popcorn) (No Asbestos Detected)
009A Kitchen Dwelling 009-Wallpaper 0% Tested Negative by Lab
(No Asbestos Detected)
009E Upstairs Dwelling 009-Wallpaper 0% Tested Negative by Lab
Bedroom (No Asbestos Detected)
010A Kitchen Dwelling 010-Ceiling Tile 0% Tested Negative by Lab
(No Asbestos Detected)
010E Kitchen Dwelling 010-Ceiling Tile 0% Tested Negative by Lab
(No Asbestos Detected)
011A Living Room Dwelling 011-Ceiling Tile 0% Tested Negative by Lab
(No Asbestos Detected)
011E Living Room Dwelling 011-Ceiling Tile 0% Tested Negative by Lab
(No Asbestos Detected)
•
012A Kitchen Dwelling Multi-layer Parent Material
Page 7 of 10
r.
John Sabia,43 Canterbury Drive,Queensbury,New York,12804
Sample ID Space Name. Section Material Analytical Regulatory Result
•'
- - ,:. ,, . :.Name,' , , ,. Result.
012A-Joint Kitchen Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Compound (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012A-Joint Kitchen Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Tape (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012A- Kitchen Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Wallboard (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012E Downstairs Dwelling Multi-layer Parent Material •
Bedroom
012E-Joint Downstairs Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Compound Bedroom (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012B-Joint Downstairs Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Tape Bedroom (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012B- Downstairs Dwelling 012-Gypsum Wallboard System ,0% Tested Negative by Lab
Wallboard Bedroom (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012C Bathroom Dwelling Multi-layer Parent Material
012C-Joint Bathroom Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Compound (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012C-Joint Bathroom Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Tape (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
012C- Bathroom Dwelling 012-Gypsum Wallboard System 0% Tested Negative by Lab
Wallboard (Wallboard,Joint Tape,and Joint (No Asbestos Detected)
Compound)
013A Kitchen Dwelling 013-Vinyl Flooring 0% Tested Negative by Lab
(No Asbestos Detected)
013B Kitchen Dwelling 013-Vinyl Flooring 0% Tested Negative by Lab
(No Asbestos Detected)
Page 8 of 10
'John Sabia,43 Canterbury Drive,Queensbury,New York,12804
Appendix D:
Photo Log -
All Location Photos
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Page9of10
•
'John Sabia,43 Canterbury Drive,Queensbury,New York,12804
•
Appendix E:
Chain of Custody&Laboratory Report
•
•
•
•
•
•
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Page 10 of 10
nationaigrid / 1 4.6
300 Erie Boulevard West
Syracuse,New York 13202
Sep ,
oi
September 19, 2023 `z '' `'7
NICK DENNO
RE: Service Removal for Building Demolition.
NICK DENNO,
This letter is to confirm that,per your request,National Grid has confirmed electrical
service and meters have been removed from 43 CANTERBURY DR QUEENSBURY,
NY. The work was processed on work order#30851629 and meter#27534114 has been
removed. If you have any questions or need further assistance, please feel free to contact
me at 315-468-7513.
Sincerely,
Mary Landers
Customer Fulfillment
nationaigrid
Ii: TiijiTf E ---'',
'�• °' ...IC SEP 1 1 2QZ3
GENERAL NOTES
•
MpNATDN vDNN Mrs DRATANC IS r.xd IR W
DRf°-f •wRHT oR•Taw ON BY vu<ws(x a MKS
• p as •' (;���rr��� �_4‘ ''' \ [ �1 f"-•"'"-'�'.•
g�+ y' -f:u<N floe Ea*-.14xi- J FGFND
y STA , TOWN N OF QUEENS{BU , imlfimual-w}.uixm
. `1m«T.u famenT of . BUILDING
.0 i 4 N!~ �I, CODES
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