BOTH-000260-2016 TOWN OF QUEENSBURY
4W 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000260-2016 Date Issued: Monday, May 22, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000260-2016
has been completed.
Tax Map Number: 301.19-1-10
Location: 15 PASCO AVE
Owner: Carol Perkins,Ray Salvage
Applicant: Carol Perkins
This structure may be occupied as a: Demolition of Commercial Building due to
fire;March 8,2016. By Order of Town Board
Business: Ray Salvage TOWN OF QUEENNSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
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 12.804-5904 (518)761-8201
�a
Community DevelopmentBuilding & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTI-I-000260-2016
Tax.Map No: 301.19-1-1.0
Permission is hereby granted to: Carol Perkins
For Property located at: 15 PASCO AVE
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
"Fype of Construction
Owner Name: Carol Perkins Demolition $0.00
Owner Address: 15 Michael RD Total Value $0.00
Fort Edward,NY 1.2828
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Demolition of Commercial building due to fire;March 8,2016.
Business: Ray Salvage
$ 30.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: "T"hursday, May 4,2017
(Ifa 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 ate )
Dated at the Tow Que bury M t ay 92016
SIGNED BY; for the'Town of Queensbury.
Director of Building&Code Enforcement
Tena of Queensbury Building & Codes Office Use C)nl
Received
DEMOLITION PERMIT APPLICATION Permit
Permit Fee
NO WORK MAY COMMENCE UNTIL, PERMIT IS ISSUED , C7 AL 3.�..
Provide 2 plea plans drawn to scale,showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and indicate which are to be demolished. Indicate the location of all utilities
Date ��,�~ " �� �' �;�� ? Demolition Location
00
Tax Map ID __,aL _ Re, t o
D
APPLICANT _n_,,._PC— I a:�'l_ OWNER
Address . _ �"! _�` ® Address
Phone 1c ,,_� �_ _ �_.� Phone ___________________________
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: ;; °� �� Phone: �_�� � � 3��
1. Person Responsible for Work :: ,... TY)jw "
. Where will demolition material be disposed
3.. All build i 12miaR 9gr90aiwv wwuraiFnvive an_Asbestos Sura��v
4. Any IC iid1nwg tai lum Ry aV wm ,a a a u y�,fIire muist obtain ansbc-st s Removal i ermit...fror u the I gp tment of Ill i'
5. Asbestos Information" The Asbestos Removal Report must be filed with our office before + f4eg ,tion
a) Is there any asbestos in the building to be demolished ___ Yes ____ No
b) If Yds, our office needs the following information ____ Yes ____ No
Name of firm removing the asbestos MAII
License number of firm uIR,;
Indicate where the asbestos material will be disposed kaµ 11.'„1 Y;
. Structure Information
a) Indicate the structures)to be demolished ___ Residence ___ Garage — 1 Business
___ Storage Bldg. Other
b) Size of`structure �,>�� e e
c) Number of Stories
d) Foundation Type
e), Foundation
f) Structure(s)
T. Utilities Information
a) Indicate utilities for this structure___ Gas _Electric __— Propane Public Water ___ Public Sewer
On-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? _L„®_ Yes No
b) Have all utilities been disconnected? Yes No
8. Signature
Print Name: _ �_ �� . l ` Date —
_
12
Signature: - . ____ Date _ :_
Town of Queensbury Building&Codes- Demolition Permit- December 2014
John: O'Brien
From: Meacham,James (LABOR) <James.Meacham@labor.ny.gov>
Sent: Tuesday, April 26, 2016 1:18 PM
To: John O'Brien
Subject: 15 Pasco.Ave
Attachments: 15 Pasco Ave Queensbury NY- asbestos survey.pdf
John and Town of Queensbury,
Attached is the initial asbestos survey and requested supplementary information for the structure at
15 Pasco Avenue. The owner, Ms. Carol Perkins, provided the survey and' the process and content
for preparing an acceptable asbestos survey was discussed with Mr. Michael Stevens, the certified
asbestos inspector. The survey determined there was no asbestos containing materials in the
structure based upon; history, sampling and visual inspection.
This can be a guide, for future projects in your Town as minimum information to be submitted by a
certified asbestos inspector for an asbestos survey for consideration when issuing permits.
Feel free to contact me at anytime for information and assistance.
Thank you.
Jim
James R. Meacham, P.E. FILE Cop)
Acting Program Manager
Asbestos Control Bureau
New York State Department of Labor
Harriman State Office Campus TOWN OF QUE )B
Building 12, Room 154,Albany NY 12240 BUILDING & C DD -
P: (518)457-1255 1 C: (518) 795-5328 Reviewed By: .. .....
MICHAEL J.STNS Ucensed,Certified NYS Abestos
I Material Inspector
h;.
P.O. Sax 2202.
Glens Falls, New York 12801
(518)656-3270
r
MAY 02, 2016
��1 M 0
I.
DING
r ES
To Whom It May Concern,
Please be advised that 1 have Inspected the property on the date indicated on the enclosed report and taken
random samples as required. I have sent the samples to a New York Mate approved laboratory for testing.
Based upon my inspection combined with the laboratory test results for the samples taken from the subject prop-
erty,there were no asbestos containing materials(ACM's),found on the subject property or Identified in the sam-
ples tested by the laboratory. Accordingly,it Is my understanding that,subject to any and all applicable states or
locals and regulations at the time of the enclosed test report,the property owner may proceed with remode or
demolition as the owner sees fit, TOWN U µ
BUILDING ,.
Thank you; iewe l By,, .
, 21 6, '
Michael J. Stevens
License Number:72900
301 .19"-1 -10 BOTH 260-2016
MJS keg Carol A. Perkins for Ray Salvage
Enc. 15 Pasco Avenue
Demolition due to Fire Damage
Please Reply ro:
AmerlSci New York 4
117 EAST 30TH ST.
A E Sci NEW YO ,NY 10016
TEL:(212) - 8
-FAX(212)679-3114
�r Y
FACSIMILE TELECOPY TRANSMISSION
To: Michael Stevens From: Valente Voice
Michael I Stevens AmerE3cl Job#: 216033278
Fa:#: Subject: FLAP-PLMM!M 5 day Results
Client Pre ject: 15; 15 Pasco; 15 Pasco Ave.,
Ercall: m&mldcars@gmail.com Q buM N
Date: Friday,March 25,2016 Number of Pam _
Tim: 21:32:51 (bwhrdhrg Cover stint)
Commentst
CONFIDSMALTY tSO=L- Unless odw wino indicated,the information Cotmst in this Communfaird a is mal infoma w intarded for use
of tho fadivi W named abom iftho reads of this oommunfeation is not the iatardod recipient,you are hesvby notiHod That any dissentinatim
dismibutian or copying of this rmrmnuni Adm is pmbibited. if you have received this communication is-.m please immodidely notW the smiler by
tdophooe and reuam the anginal message to too above address via tho US Postal Saviaa at our expmso Samples are disposed of In 60 days or unless
oftwise inatructod by the protocol or special iastractiotss in writing. ?hank you.
Cert6d Ana(ysis Swwtee 24 SouraAlhp+7lkg+ A Weak Compeddm Prkes
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Amerft Job#: 216833278 Page 3 of 3
Client Name: Michael J.Stevens
ti
PLM Bulk Asbestos Report
15; 15 Pasco; 15 Pasco Ave., Queensbury, NY
i
i
Reporting Notes:
Anted by:Vatarlu Vofcu
NAWNSO am asbeatn detected;NA=t analyzed:NAPS-not anaVmYposI%*stop;PLM Sulk Asbestos Analysis by EPA 800tM4-82.020 per 40
CFR 783(NVLAP 200548-0),ELAP PLM Method 198.1 for NY Mable sempies.vMc:Includes the Iden and quantitation of vennloulibe or 198.8
tar NOS samples or EPA 400 pt ct by EPA 6000.82-020(NY ELAP Lab 11480};NotesPLM Is not consloWntty reEtable In detecting asbestos In Boor
coverings and stm0ar non-Mable orgardcelfy bound materials. NAD or Trete results by PLM are Inconclusive.TEM Is owentiy the only method that cwr
be used to determine 9 this materia!can be considered or bwed as non asbestos-contak"to NY State(also see EPA Advisory for floor tile,FR
69.148,38970.811/94)Naftwo institute of Standards and Thr Ac aeditation requirements mandate that fids mart must not be reproduced
except In full wtftW the approval of the iab.This PLM report relates ONLY to the Items tested.AIMA-LAP,LLC Lab ID 102843.RI Cert AAI.-094,CT
Cert P"188.Maes Cert AA000054.
Reviewed By END OF REPORT
AmerISd Job* 215033278 Paf�e 2 of 3
Client Name: MWhael J.Stevens
PLM Bulk Asbestos Report
15; 15 Pasco; 15 Pasco Ave.,Clueertsbury, NY
Client No.!HGA Lab No. Asbestos Pment Total,6 Asbestos
#6 216033278.06 No NAD
Location: Workshop wall-Sheebwk (by NYS FLAP 198.1)
by VeMu Volou l
on 03/26/16
Analyst Description:Brown/Grey,Heterogeneous,Fibrous,Bulk Material
Asbestos Typos:
Other Maternal: Cellulose 25%, Nan-fibrous 75%
i
#7 216033278-07 No NAD
Location: Workshop Celling-Cetiing The (by NYS ELAP 198.6)
by Valedu Volou
on 03/25/16
Analyst Description:WhitelBrown,Homogeneous,Non-Fibrous,Bulk Material
Asbestos Types:
Other Malarial: Non-fibrous 2.9%
#8 216033278-08 No NAD
Location: Workshop Wall-Shestrock (by NYS FLAP 188.1)
by Vatertu Volcu
on 03126116
Analyst Description:OflWhitwDrown,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material:Cellulose 20%, Non4brous 80%
#9 216033278-09 No NAD
Location: Workshcp Calling-Ceill ng Tile (by NYS ELAP 198.6)
by Valedu Volcu
on 03/25/16
Analyst Description:WhWSrown,Homogeneous,Non-Fibrous,Bulk Material
Asbestos Types:
Other Material: Nan-Rbrous 4%
#10 216033278-10 No NAD
Location: Workshop Wail-SheeirtO (by NYS FLAP 198.1)
by Valedu Volcu
on 03/25/16
Analyst Description:Brown/Grey,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material:Cellulose 10%, Non4lbrouw 90%
See Reporting notes on last page
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New York state Department of Lalsor
Division of Safety and Health
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Mlchael.J Stevens RILE NUMBER: 13.72900
LICENSE NUMBER: 72900
PO Box 2202 LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 09/25/2015
Glens Falls, NY 12801 EXPIRATION DATE: 09/30/2016
Duly Authorized:Representative—Michael Stevens:
This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of
the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1)
serious violation of state,federal or:local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of
responsibility in the conduct of any job involving asbestos or asbestos material.
This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the
asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in.New Yank
State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State
Department of Labor.
Ll ftw%'�
Eileen M.Franko, Director
SH 432(8112) For the Commissioner of Labor
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Amed8d New York
117 EAST 30TH ST.
AMEm ASCI NEW YORK,NY 10016
TEL:(212)679.8600-FAX(212)679.31 14
PLM Bulk Asbestos Report
Michael I Stevens Date Received 03/21/16 AmedScl Job# 216033278
Attn: Michael Stevens Data Exanilned 03125/16 P.O.#
PO Box 2202 ELAP# 11480 Page 1 of 3
RE:15; 15 Pasco; 15 Pasco Ave., Queensbury,W
Glens Pails, NY 12801
1
1
Client No.I HGA Lab No. Asbestos Present Total %Asbestos
#1 216033278-01 No NAD ,
Location: Waiting Room wail-Shestrock (by NYS ELAP 198.1)
by veleriu Volcu
on 03/25/16
Analyst Description:OflWhltefikown,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material: Ceikdose 20%, Non-fibrous 80%
#2 216033278-02 No NAD
Location: Walling Room Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Vaieriu Volcu
on 03W16
Analyst Description:Green,Homogeneous,Non-Fibrous,Balk Material
Asbestos Types:
other Material: Wn-fibrous 11.9%
#3 216033278-03 No NAD
Location: Of os,Well-Sheetrock (by NYS FLAP 198.1)
by Vaww Volcu
on 03125/16
Analyst Description:OtMlhitelBrown,Heterogeneous,Fibrous.Buck Material
Asbestos Types:
Other Material: Cellulose 18%, Non-fibrous 82%
#4 216033278.04 No NAD
Location: Office Calling-Sheetrock (by NYS ELAP 198.1)
by Valedu Volcu
on 03/26/18
Analyst Description:otiWhlt Mmwn,HeteraWaous,Fibrous.Bulk Material
Asbestos Types:
Other Material:Cellulose 25%, Non-fibrous 7S%
#6 216033278-05 No NAD
Location: Bathroom Floor-Vinyl Flooring (by MIS ELAP 198.6)
by Valedu Volcu
on 03125/16
Analyst Description:White/Bkm.Hornogermus.Non-Fibrous,Bulk Material
Asbestos Types:
other Mate": Non-fibrous 2.9%
See Reporting notes on last page
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