DEMO-000748-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
at Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: DEMO-000748-2016 Date Issued: Thursday, December 1, 2016
This is to certify that work requested to be done as shown by Permit Number DEMO-000748-2016
has been completed.
Tax Map Number: 309.11-2-10
Location: 19 MAIN ST
Owner: RPS PROPERTY HOLDINGS,LLC
Applicant:
This structure may be occupied as a: Demolition
2-story building By Order of Town Board
TOWN OF QUEENSBBUURY�J
Issuance of this Certificate of Compliance DOES NOT relieve the (I (/ // A.
property owner of the responsibility for compliance with Site Plan, L������////000d^/dd !!IEEE" V
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 12804-5904 (518)761-8201
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: DEMO-000748-2016
Tax Map No: 309.11.2-10
Permission is hereby granted to: RPS PROPERTY HOLDINGS,LLC
For property located at: 19 MAIN ST
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
Tvce of Construction
Owner Name: RPS PROPERTY HOLDINGS,LLC Demolition-Commercial $0.00
Owner Address: 17 Main ST Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Abare Construction
1123 New Loudon RD
Clifton Park,NY 12047
Plans&Specifications
Demolition
2-story building
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 27,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu before ytheiration dateDated at the Town Queen Th October 27,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPL e
NO WORK MAY COMMENCE UNTIL P ISI D f ee
ucr 27 2016
Provide 2 plot plans drawn to scale,showing lot boun arles roa 1 streets. Show all existing structures
on property and indicate which are to be demolished. ndic B� i s G
Date -az MLO
_ Ull. Demolition Location RAAt y1'
2 : �/ — -----------------
Tax Map ID p�ZS__UL2_!0
APPLICANT 3� _�777!•^ 11 It p y,G OWNER _ r_ 1W= rAVK_w Ar
Address �1_P`J�N [ _ Address
---------------------------
---------------------------
Phone _ �__U��7______________ Phone
-----------,,—'�—(I----------,—..—�—'—J�
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: b Lli` (�t1 I AW A*one: Z �f
1. Person Responsible for Work 1* `V1' � &% a`
2. Where will demolition material be disposed? '1RIu
3. All buildings to be demolished require an Asbestos Survey
4. Any buildinq_substantiallV damaged bV 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 �. 2
b) If Yes, our office needs the following Information Yes ____ No
Name of firm removing the asbestos ljft<A"m V 1 QglYY19lTA� pg6
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 _ZBusiness
__ Storage Bldg.___ Other
b) Size of Structure
c) Number of Stories /J��
d) Foundation Type #j W1`� CoW,
e) Foundation
f) Structure(s)
7. 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 Depart ent for public water and sewer disconnect? Yes ____ No
b) Have all utilities been disconnected? __ Yes ____ No
e. Signature
Print Name: —
Date
------------ ---- — --------- -------
Signature: _________ Date _ �_1609 4
_
Town of Queensbury Building&Codes - Demolition Permit- December 2014
rBUILDING
v New York State—Department of LaborDivision of Safety and Health 016
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240 NSB RODES
ASBESTOS HANDLING LICENSE
Spectrum Environmental Associates, Inc FILE NUMBER: 99-0129
LICENSE NUMBER: 29081
P.O. Box 1024 LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 02/25/2016
Schenectady, NY 12301 EXPIRATION DATE: 02/28/2017
Duly Authorized Representative—William L Massmann:
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 York
State have been issued an Asbestos Certificate,appropriate for the type of work they perform, by the New York State
Department of Labor.
rl�
Eileen M.Franko, Director
SH 432(8/12) For the Commissioner of Labor
FILE COPY
TOWN OF*By:
BUILDINGReviewed
Date:
309.11 -2-10 DEMO 748-2016
RPS Property Holdings, LLC
19 Main Street
Demolition 2-story building
NEW YORK STATE DEPARTMENT OF HEALTH
WADSWORTH CENTER
Expires 12:01 AM April 01,2017
Issued April 01, 2016 --
CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued in accordance with and pursuant to section 502 Public Health Law or New YorkState
MR.JOHN B: VAN DENB RGH 111 - NY Lab Id No: 11540
SPECTRUM ENVIRONM NTAL ASSOCIATES INC
2539 ALBANY STREET
SCHENECTADY,''NY 12 04
is here y APPROVED as an Environmental Laboratory for the category
ENVIRONMENTAL ANALYSES AIR AND EMISSIONS
A approvad subcategones and/or analytes are listed below:
Miscellaneous -_
Fibers - NIOSH 7400A RULES -- -
CECGDiu WE -"
UC 1 2 7 2016 t11
T WN OF OUEENSB RY v
BUILDING&CODE-• J
309.11 -2-10 DEMO 748-2016
RPS Property Holdings, LLC
19 Main Street
Demolition 2-story building
Serial No.: 54318
Property of the New York Slate Department of Health. Certificates are valid only at the address -
shown,must be conspicuously posted,and are printed on secure paper. Continued accreditation depends
on successful ongoing participation in the Program. Consumers are urged to call(518)485-5570 to
verify the laboratorys accreditation status.
Page 1 of 1 - - _
SPECTRAq P 0.Box )
Schenectady.&F 12301
(518)340-037?(Phone)
EmIftnmental Rssedates. Inc. (518)346-4062(Fax)
'EXCUPINC OoX CLIBM EXPECTIMON3 or EXCELLENCE' www 4spedrum.com
October 26, 2016 D rz 2
Mr. Damon DiGovanni LS LS L
ABAR Construction UU 201
298 Troy Schenectady Road 27
Latham,NY 12110203 TOWN OF QUEENSBU Y
RE: 19 Main Street-Queensbury 3UILDING&CODES
Spectrum Project Number: 16-566
Asbestos Final Visual Inspection(s)with Clearance Air Sampling
Dear Mr.DiGovanni:
Spectrum Environmental Associates, Inc. (Spectrum) is submitting this letter and attached documentation
as our report for the referenced asbestos project.
On October 20,2016,Mr. Bruce Campbell Jr.(AH#15-11979)performed final visual inspections and
clearance air samples. His final visual inspection form(s),and air sample results are attached along with a
copy of his certification and Spectrum's company license.
The scheduled asbestos containing materials for this project involved the removal of:
• <200SF of Linoleum in Kitchen
• — 1600 SF of Roofing Shingle from upper and lower roofs
New York State Department of Labor Industrial Code Rule 56 requires a final visual inspection be
performed by a New York State Certified Asbestos Project Monitor who is independent of the asbestos
abatement contractor prior to the collection of the Clearance Samples. This was performed by Spectrum
and the associated documentation is attached. The final visual inspection is to confirm that all have been
removed and that the work area has been properly cleaned.
Therefore,based on the final visual inspection(s)passing and the final air samples that were collected and
analyzed on this project having met the New York State minimum requirement of less than 0.01 fibers per
cubic centimeter,the scheduled removal areas are considered clear and may be re-occupied.
If you have any questions concerning this report,please contact our office at(518)346-6374.
Respectfully Submitted,
A0410t(l AA0
Robert J DeRuyter
VP of Operations
Cc: file
Attachments: Final Visual Clearance Form(s)
Laboratory Results with Chain of Custody
Licensure and Certification
Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services
ox 1024
+:, „. D E E. u� 1`�t iiia P.O. V12301
SPE, Rv �, ectadp.Ni'IZ301
46-6374(Phare)
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Environmental Asodates9 Inc. OCT 2016 •4SpP.ClrTl: 34 ee ft (Fax)
ry 'EXCEEDIXG OLP CLIENTS EXPECTATIONS Of EXCELLENCE' la.COr77
TOWN OF Q EEN:a,-j RY
BUILDING&COG._5
ASBESTOS VISUAL
Project Number:/(„_ rL 6 Project Monitor: -
Contractor: M 1.1 Certification Number: In /0, 7
Building Name/Ad ess: ji� lt3 o � 5 ((0 e y„S1-) i 4 t
Scope of Work: S>, 'n c 10h�C'✓ ' Y n 1i!� i �� 'O ✓ �f>G-TS
Item Yes No N/A Comments
Floor
Walls Y
v Ceiling
ra Critical Barriers y
Decontamination Unit(s)
o
a Ledges _
x
. Beams _
Pipes,Joints,Etc.
A —
Fixed Objects
Scheduled Material Removed �(
t—
Exposed Edges Encapsulated
Waste Bags Inside Work Area
Equipment Cleaned&Removed
Pools of Liquid or Condensation X
Wait Period Observed —
Other:
Spectrum Environmental Associates,Inc.Declaration (check which apply)
PASSED*Visual Clearance: SEA's Representative hereby declares that he%she has accompanied the
Contractor on his/her visual inspection and affirms that this inspection
has been thorough and to the best of his/her belief, is true and honest.
FAILED Visual Clearance: SEA's Representative hereby declares that the deficiency(ies) identified
above need to be addressed in order to pass visual clearance.
Si;nature://Y'//' HI Date: I C '�U'I 6
Environmental Consulting&Management Services o health&Safety Training a Laboratory Services
CS ; ,14:lSE ( TG 23i 1
SP ECTRV- Af o
Environmental dss®c'iatesq Inco UC f 2 7 201 18) 62
'EXCEEOIXG OOP.CLIENTS EXPECTNTIONS GP EXCELLENCE' E m.Cem
T WNOFw ;i :v�r3 ) Y
BUILDING C: f -S
ASBESTOS VISUAL INSPECTION `
Project Number: /�I_ ) & Project Monitor: \� (C C t j
Contractor.M(. n Certification Number:
Building Name/A dress j r 2 f c
Scope of Work:� iOJ� t w7 V 1:1 1 1 t t i . 9
Item Yes No N/A Comments
Floor
Walls _
F
Ceiling _
A Critical Barriers _
° Decontamination Unit(s)
r
e
Ledges
« Beams _
' Pipes,Joints,Etc. _
a
Fixed Objects
Scheduled Material Removed _
Exposed Edges Encapsulated
Waste Bags Inside Work Area —
Equipment Cleaned&Removed —
Pools of Liquid or Condensation —
Wait Period Observed —
Other:
1 C e ) le2,l GUMC vCr 1 Cr1�1r� WJ(� f Ri(' �
Spectrum Environmental Associates, Inc. Declaration (check which apply)
PASSED'Visual Clearance: SEA's Representative hereby declares that helshe has accompanied the
Contractor on his/her visual inspection and affirms that this inspection
has been thorough and to the beat ahis/her belief, is true and honest.
FAILED Visual Clearance: SEA's Representative hereby declares that the deficiency(ies) identified
above need to be addressed in order to pass visual clearance.
Siguature&u Lt/LU + ( Date: 10'� 0,/ h
Environmental Consulting Management Services o health&Safety Training ^ Laboratory Services
SPECTRVA P U.Box 1°24
s j,,; 4 :NY 12901
D 1' 181 4(Phone)
Environmental Rssoclates. Inc. OCTy"q (918 2(RRX)
'EXCEEOLNO COR CLIENT$EXPECTOT ows OP EXCELLENCE' OC l G f [016 'gym
OFQUc
FINAL REPORT OF AN LILDING 8
NYS DOH E.L.A.P.# 11540
CLIENT: AGAR CONSTRUCTION PROJECT#: 19 MAIN ST.QUEENSBURY
298 TROY-SCHENECTADY RD.,STE 201
LATHAM,NY 12110 PROJECT: 16-566
SAMPLE TYPE: PHASE IIC(CLEARANCE) WORK AREA: KITCHEN
DATE COLLECTED: 10/20/16 DATE ANALYZED: 10/20/16
DATE RECEIVED: 10/20/16 DATE REPORTED: 10/20/16
LAB I.D. CLIENT LOCATION/DESCRIPTION L.O.D. t/CC VM1112
SAMPLE#
11920 21 Field Blank — — 0.0
11921 22 Field Blank — — 0.0
11922 23 IWA 1 0.002 0.002 7.6
11923 24 IWA 2 0.002 BDL 5.1
11924 25 IWA3 0.002 BDL 5.1
11925 26 OWA 1 0.002 BDL 3.8
11926 27 OWA 2 0.002 0.003 8.9
11927 28 OWA 3 0.002 BDL 6.4
ANALYTICAL METHOD: N.I.O.S.H.7400,"A"RULES PHASE CONTRAST MICROSCOPY
Microscope:Olympus CX21 Phase Contrast Field Area:0.00785 mm' BDL=Below Detection Level
11mm'=Fibers per Square Millimeter L.O.D.=Level of Detection OVL=Overloaded with particulate
pcc=Fibers per Cubic Centimeter L.O.D.=7 fibers per imn' OVLBL=Fibers exceeds QC limit
ANALYTICAL RESULTS DEPENDENT ON FIELD BLANKS SUBMITTED WITH SAMPLES
REPORTED ANALYTICAL RESULTS ARE BASED ON SAMPLE DATA PROVIDED BY THE CLIENT
Analyst: 17 Laboratpq Director,
aboratoty Precision(Sr): Q• Z` John B.Van Denburgh III
Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services
S 7A!iRSAMPLING
EGE ° VEO P° �t 1301Sdtottetfad y.Atlr 123018 (518)348-6374(Plmne)
A Env1SSVC1ates. I OCT 2 7 2016 (518)346-4062(fr)'excexpecrartoxs or excett ce www.4spedrumanm
B DI GUEENDESSB Y
C 14 ur
PROJECT INFORMATION SAMPLE TYPE TYPE OF ANALYSIS TURNAROUND
Project q: A-s'6 G Date Collected:I O '�O- C3 Phase IB(Background)IN PCM-NIOSH 7400 ❑ RUSH
Job SiteBuilding: r mm'S kh 'J ❑ Phase IIA(Prep) ❑TEM-NIOSH 7402 12 Hour
Room/Work Area: . r i/c-I,e 4, ❑ Phase IIB C3ur
(Removal) ❑TEM-AHERA 24 Ho
Rotameter#),4-3 {q_ Calibration Date: 1.Phase HC(Clearance) ❑ Other ❑ 48 Hour
Collected By(Print): a LAr L�(b', 0) t I.T/`- ❑ Air Quality C3 Other
SAMPLE IDENTIFICATION
Lab 11) Sample Pump Pump Air Adjust r
No. No. No. l.acffiion Odof Rete([,PM) Time volume LO-D. Count Result F/mm
NAE-N mAir Exhw M1rmn/6rmn eNOa Mu lila. lim Fa
/,v Field Blank --- --- --- --- --- -=- 10.0
q'4l .� Field Blank --- --- --- --- --- e•o --- e.0
qZL 3i�63 3�3o 3 \)lob e•p0� L.° bi 1,4
031 i
332 . /8 /b
1 9a5 6 0,14141 0�3� i� d g.40 901, 3•�
Q 0
J� I �� a 3JL d.1
ADDITIONAL INFO CHAIN OF CUSTODY
Report Results to: Relinquished: Date: (7-)0.46 Time: 171 t�
Phone)Fax: Received: Date: Time:
Comments: Sample Log-in: Date Time:
Sample Prep: Date: Time:
Analyzed: Date: Time:
QA/QC Review: Date: Time:
NOTE:,ftaerlrronfhv/mmaev/ol9.uafa/er./mo utilizes laboratories that meet the requirements setforlh byAHER140 FR 763.90(i)(2)fi)•
Rolameters are calibrated against a Dry Cal DC-Lite Primary Flow Meter manufactured by BIOS International Corporation.
Environmental Consulting&ManagementServices - Aealth&Safety Tmhgag • Laboratory Services
SPECTRUM (518)e34837�ti
EnOrmmental Rsseclates, Inc. (318)346-4062(fax)
•exclea Ne Cot CIKBrs 9xPecronoN9 of Excuiesce• "u4spedram com
State of New York — Department of Labc rD E C E 0 d E
Asbestos Certification OCT 27 2016 `:'• , t
TOWN OF QUEENSB RY
,�.JFn, P., '' Wi Dfr�,IP.IP11r.lrBUILDING&CODES _ j
BRUCE W CAMPBELL IR
CLASS(EXPIRES)
CATEC(05117) DINSP(05i17)
H PM (05117)
A
MIUSi BE CARRIED ON ASBESTOS PROJECTS
I I�INIIi�IIINIIIININII IIS
IF FOUND RETURN TO:
�r EYES GRN NYSDOL - LRC UNIT
.a BAIR SRO ROOM 161A BUILDING 12
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NOT 6' 00" STATE OFFICE CAMPUS
ALBANY NY 12240
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CO
State of New York — Department of Labor
Codes _ Certification
A Asbestos Handler _
B Restricted Handler- Allied Trades
C _ Air Sampling Technician _
D Inspector _
E Management Planner
F _Operations and Maintenance
G Supervisor
H Project Monitor
I I _ Pr�ct Designer
Environmental Consulting&Management Services • Health&Safety Training • Laboratory Services
VEMTJ—oc)O-79'3- 1L,
Nationalgrid
300 Erie Boulevard West
Syracuse,New York 13202
Date
RE: Service Removal for Building Demolition.
This letter is to confirm that,per your request,National Grid has confirmed electrical
service and meters have been removed from 19 Main Street Queensbury,NY 12804.
The work was processed on work request# 23000363. If you have any questions or need
further assistance,please feel free to contact us at 800-260-0054.
Sincerely,
Customer Fulfillment
nationalgrid
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