BOTH-000276-2016TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
4
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000276-2016 Date Issued: Tuesday,November 22, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000276-2016
has been completed.
Tax Map Number: 303.16-1-58
Location: 446 DIX AVE
Owner: Jay Salmon
Applicant: Jay Salmon
This structure may be occupied as a: Demolition of 3,300 sq. ft. building.
Cross Ref. SP PZ-60-2016 Cameron's Deli By Order of Town Board
TOWN OF QUEENSSBBURY
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.
yi
A 9M,WWrW mo ",n..
TOWN OF C UEEN BUR.
742 Bay Road, Queensbury,NY 12844-5944 (518)761-8241.
Community Development - Building & Codes (51 S) 761-8256
BUILDING PERMIT
Permit Number: BOTH-000276-2016
16
Tax Map No: 343.1.6-1-58
Permission is hereby granted to: Jay Salmon
For property located at: 446 DID 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
Type of Constraiction
Owner Name: ,lay Salmon Demolition $4.44
Owner Address: 451 Loackhart Mountain RD Total Value $4.44
Lake George,NY 12845
Contractor or Builder's Nance l Address Electrical Inspection Agency
Plans& Specifications
Demolition of 3,344 sq. 11. building,
Cross Ref, SP PL-64-2416 Cameron's Deli
S 34.44 PERMIT FEE PAID -THIS PERMIT EXPIRES: 'Thursday, May 4,,2417
(If a longer period is required,an application for an extension must be made to the code Enforcement 011icer
of tile Town of Queensbury before the expiration date.)
Dated at the Town o1' 7j and y 4l 6
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building' o��s�n ;� � office Use Onlv
P �rn�Receilee
ee
DEMOLITION PERMIT'IT APPLI 4 N PrrMi� t - a. L2 . = _
NM 201
NO WORK MAY COMMENCE UNTIL PE I I5SUEf) � --
g
.
�B4i
Provide plot cans drawn to scale, showing lot bound�rieswit " dsarazaeors
/streets. Show all existing structures
on;property and Indicate which are to be demolished. Indicate the location of all utilities
Date _— ' ----- Demolition Location '_ _A_
Tax Map Ib . , i C -0
APPLICANT CVIPNER
Address _ c .N, r _ — Address
Phone �.t --------
Phone ---- u� ,s ! _: ` _________
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE. _ mom° °� Phone
1. Person Responsible for Work �
2. Where will demolition materlal be disposed? �� r
3. All buildings to be demolished require an Asbestos Survey.
4. Any building substantial) dy damged lay fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begin
a) Is there any asbestos in the building to be demolished ____ Yes _ No
b) If Yes,our office needs the following information ---- Yes ---- No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished ___ Residence __._ Garage Business
___Storage Bldg. Other
b) Size of Structure
c) Number of Stories
d) Foundation Type SLA 7 co'c-t ,
e) Foundation
) SL 6
f) Structure(s)
7. utilities information
a) Indicate utilities for this structure Gas ,Electric ___ Propane Public dilater ___ Public Sewer
___On-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? _�_ Yes __-- No
b) Have all utilities been disconnected? — Yes No
8. Slgnature ::
- ..�
—
Print Name. ______ _ — _ ______-- Date
Signature: Date
Town of Queensbury Building&Codes - Demolition Permit - December 2014
MIC14AIlL J.STEVENS Ucensed,CertrUd WS Abestos
Moteriol Inspector
P.O. box 2262
Glens Palls,New York 12801
(518)656,3270
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To Whom It May Concern,
Please be advised that I 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 State 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 remodeling or
demolition as the owner sees fit.
Thank you,
Michael J'. Stevens
License Number:729116
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Please Reply To:
AmerfScl New York
117 EAST 30TH ST.
AmEwSci NEW YORK,NY 10016
TFL:(212)8794800•FAX:(2f2)879.3114
FACSIMILE TELECOPY TRANSMISSION
To: Michael Stevens From: Jared C.Clarke
Michael J.Stevens AmeriSei Job#: 216034070
Fax#: Sub jest: ELAP-PL M34 S day Resuhs
Cant Project: 446, 446 Dix Ave; 446 Dix Ave.,
Email: mikesoldcars@gmeil.com Queensbury'IVY
E
t
Date: Thursday,Manch.31,2016 Number of Pa .
Time: 14:39:20
(inctudEng shed}
Comments:
CONFIDENTIALITY NOTICE: unless otherwise indicated,dee information contained in this communication is confidential information intended for use
of the individual named above. if the reader ofthis communication is not the arum"recipient.you aro hereby notiRal that any dissemination,
distribution or copying of this communication is proh%ita if you bane received this communication in am.pkese immediately notify the sender by
telephone and return the original message to the above address via the LZ Postal Service at our expaesa Samples aro disposed of in 60 days or unless
otherwise instructed by the protocol or special instmedons in wri ft 'Ilion*you.
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AmedScl New York
117 EAST 30TH ST.
,ISMER!Sci NEW YORK,NY 10018 i
TEL:(212)679-8600•FAX:(212)679-3114 1
PLM Bulk Asbestos Report
Michael I Stevens Date Racelved 03/26/16 AnWdScl Job# 216034070
Attn: Michael Stevens Data Examined 03/31/16 P.O.#
PO Box 2202 ELAP# 11480 Page 1 of 3
RE:445; 446 Dix Ave; 448 Dix Ave.,Queensbury, W
Gens Fails, NY 12801
Client No./HGA Lab No. Asbestos Present Total %Asbestos
#1 216034070-01 No NAD
Location: Showroom,Wali-Sheetrock (by NYS ELAP 198.1)
by Jared C.Clarke
on 03131116
Analyst Description:OflWhIle/Brown,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material:Cellulose 10%, Non-fibrous 90%
#2 216034070-02 No NAD
Location: Showroom,Ceiling-Sheeftock (by NYS ELAP 198.1)
by Jared C.Clarke
on 03131/16
Analyst Description:OftWhWBrown,Heterogeneous,Flbrou%Bulk Material
Asbestos'types:
Odw Material:Cellulose 10%, NonAbrous 90%
#3 216034070-03 No NAD
Location: Showroom,Well-Drywall (by NYS FLAP 198.1)
by Jared C.Clarke
on 03/31116
Analyst DesMption:OflWhltelBrown,Heterogeneous,Fibrous,Bulk Materia!
Asbestos Types:
Other Material: Cellulose 10%, Non-fibrous 90%
#4 216034070-04 No NAD
Location: Showroom,Calling-Shestrock (by NYS ELAP 198.1)
by Jared C.Clarke
on 03/31/16
Analyst Description:OBWhitelBrown,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material:Cellulose 12%, Non-fibrous 88%
#5 215034070-05 No NAD
Location: O(floe wall-Drywall (by NYS ELAP 198.1)
by Jared C.Clarke
on 03131/16
Analyst Description:ONWhttelBrown,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material: Cellulose 10%. Non-fibrous 90%
See Reporting notes on last page
AmerlSci Jab#: 216034070 Page 2 of 3
Client Name: Michael J.Stevens
PLM Bulk Asbestos Report
446; 448 Dix Ave; 446 Dix Ave.,Queensbury, NY
Client No./HGA Lab No. Asbestos Present Total%Asbestos
#6 216034070-06 No NAD
Location: Office Ceiling-Drywall (by NYS ELAP 198.1)
by Jared C.Clarke
on 03/31/18
Analyst Dsserti►tlon:OflWhiteBmwn,Heterogeneous,Fibrous,Bulk Material
Asbestos Types:
Other Material:Cellulose 10%, Non-fibrous 90%
#7 216034070-07 No NAD
Location: Showroom Floor-Vinyl Flooring (by NYS ELAP 198.8)
by Jared C.Clarke
on 03/31/18
Analyst Description:Green,Homogeneous,Non-Fibrous,Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non4lbrous 33.7%
#8 216034070-08 No NAD
Location: Garage Wall-Drywall (by NYS FLAP 198.1)
by Jared C.Clarke
Analyst Description:OHWhite/Brown.Heterogeneous,Fibrous,Bulk Material an 03/31/18
Asbestos Types:
Other Material: Cellulose 12%, Non fibrous 88%
#9 216034070-09 No NAD
Location: Bathroom Floor-Vinyl Flooring (by NYS ELAP 198.8)
by Jared C.Clarke
Analyst Description:Gram Homogeneous,Non-Fibrous,Bulk Material on 03/31/18
Asbestos Types:
O#w Material: Non-fibrous 1 %
#10 216034070-10 No NAD
Location: Garage Roof-Asphalt Shingle (by NYS ELAP 198.8)
by Jarred C.Clarke
Analyst Description:Black,Homogeneous,Non-Fibrous,Bulk Materia! on 03131/18
Asbestos Types:
O#rer Materiel:Fibrous glass Trace, Non-fibrous 14.3%
#11 216034070-11 No WAD
Location: Main Butting Rear Roof-Asphalt Shingle (by NYS EIRP 198.8)
by Jared C.Clarice
Analyst Description:Black,H on 03/31/18
Homogeneous,Nan-Fibrous,Bulk Materia!
Asbestos Types:
Other Material:Fibrous glass 1.7%, Non-fibrous 31.8%
See Reporfing motes on last page
AmedW Jab#: 216034470 page 3 of 3
alent Name: Michael J.Stevens
PLM Bulk Asbestos Report
448; 446 Dix Ave; 446 Dix Ave:, Queensbury, NY
Client No.I HGA Lab No, Asbestos Present Total %Asbestos
#12 216034070-12 No NAD
Location: Main Budding Front-Asphalt Shingle (by NYS FLAP 198.6)
by Jared C.Clarke
Analyst Doscriptlon:8180,Homogeneous,Non-Fibrous,Bulk Material on 03131/16
Asbestos Typos:
Other Material:Fibrous glass Trace, Non-fibrous 34.4%
Reporting Notes:
Anatynad by:Jared C.Clarke
'NAD/NSD=no asbestos detected, zed:NAIPS=not analyzed/posi w stop:PLM Bulk Asbestos Analysis by EPA 800/M4.82-020 Aar 40
CFR 763(NVLAP 200548-0),ELAP P M d 198.1 far NY irlabte samples,which Inc kides the Idet0cation and quantttefieon of vermkxdite or 198.6
for N09 samples or EPA 400 pt ct by PA 8 IM4-82-020(NY FLAP Lab 11480):Nate:PLM Is not consistently reliable in deWc ft asbestos In floor
coverings and similar non-fifable orga cally ural materials. NAD or Trace results by PLM are Inconclusive,TEM Is currently the only method that car
be used to determine If title material ca raider ed or treated as nort asbestos.conte lning In NY State(aim see EPA Advisory for floor Vie,FR
59,148,38970.811194)National Institute of Standards and Tedmol%y Accreditation requirements mandate that this report must not be reproduced
WWW In lith wow the approval of the labmb PLM raw relates ONLY to the Items tested.AIM LAP,LLC Lab ID 102843.Rt Cert AAI.-094,CT
Cart PH-0188.Mass Cert AAo00084.
Reviewed SY END OF REPORT
New York State Department of Labor
DMWcn of Safety and Health
license and CWW1081e Unit
State Campus,Bulldtng 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Michael J Stevens FILE 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 ligase has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of
the New Yank State Codes,Rules and Regulations(12 NYCRR Part SS). 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 York
State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State
Department of Labor.
LJ
Eileen M.Franko, Director
SH 432(eii 2) For the Commissioner of Labor
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