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DEMO-000722-2017 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 - Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: DEMO-000722-2017 Date Issued: Monday, June 4, 2018 This is to certify that work requested to be done as shown by Permit Number DEMO-000722-2017 has been completed. Tax Map Number: 278.-1-52 Location: 1269 BAY RD Owner: Geof Hoffman, Cheryl Hoffman Applicant: Gauthier Skilled Craftsman, LLC This structure may be occupied as a: Demolition Only(2010 residential addition) By Order of Town Board Asbestos Report Received TOWN OF QUEENSBURY 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 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: DEMO-000722-2017 Tax Map No: 278 4-52 Permission is hereby granted to: Gauthier Skilled Craftsman,LLC For property located at: 1269 BAY RD 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 Tvoe of Construction Owner Name: Geof Hoffman Demolition $0.00 Owner Address: 1269 Bay RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Gauthier Skilled Craftsman,LLC 30 Delaware AVE Hudson Falls,NY 12839 Plans&Specifications Demolition Only(2010 residential addition) Asbestos Report Received S30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,December 10,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town o ueens 4 Fri y D ,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement C E O W 2 Office Use Onl tl LI N APPLIIS ON Permit#: –000'7 2-Z—a-0 1"-7— NOV "/NOV 1 7 2017 Permit Fee: Town of(Zueensbury 742 Bay Road,Queensbury, NY 128rTWN OF QUEENSBURY invoice:#: ��UILDING&CODES P:518-761-8256 www. ueen �ec.f d"l� Demolition Location: I j A`i Q�� c� Tax Map ID#: )-7 — **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: • Applicant• P 30 p.LLG"� Name(s): Gerc tG Mailing Address, C/S/Z: 1 �. o Lc e , 2 Cell Phone: f S i 3 )_ 2- l C LanAd Line: ( C 1 r ) 7q-1 —07641 Email:_ J ej rt-,- t.. • Primary Owner (s): Name(s): Q ,.9 c,,JC der c► �� Mailing Address, C/S/Z: I 2 ,:� r c Y ►2 Cell Phone:_( i g )_Vl - Sjg Land line: Email: G eco �N 0_ 04 n cv. Q c-- • Contractor: ff 1 t Business Name: Contact Name(s): �ti� c� c.•• Mailing Address, C/S/Z: 3 G e5e . 9 J son I Z 8 3 `"i Cell Phone:_(Si% )A 3 2 =K G b _ Land Line: _( S I ) 7 4 �- 0� 6 1 Email: Sea r t, Contact Person for Building & Code Compliance: c, Cell Phone: _( S 3 ) �� 1Z IS 6�, Lanac�Line: _( 5 i$ }_ 7 (- �7 1 Email: Demolition Application Revised June 2017 1 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? 141 Cc, 2. Type of structure to be demolished: a. Residence b. Garage c. Business d. Storage Building 3. What type of utilities are connected to the structure: a. Gas b. Fuel Oil X_ c. Propane d. Electric _ e. Public Water f. Well-Water Pump g. Public Sewer h. Other S ,C L None 4. Have ALL utilities been disconnected? Yes X No ADDITIONAL INFORMATION: 1. Two inspections may be required: an inspection to determine that utilities are disconnected, if necessary, 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. 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: ��S� (,l �C:•��r\ �j� SIGNATURE: �l l DATE: I I /--wl 7 ,/ I� Demolition Application Revised June 2017 . t P.,p7.sov 1 vo4 SPECTRVAf (5110)3410-0,474(Phone) Envirenazeatal"dss®dwes, Inc. (618)MO-4002(Fax) *FXCVf'01*V Duo G hfNrh&PA'Cr4r10*S Of LONA MbCA'C6'' wtEfY 4spedownt com 278.-1-52 DEMO-000722-2017 Hoffman, Cheryl & Geof 1 269 Bay Road Demo (2010 res. addition only) ASBESTOS SURVEY/INSPECT"ION TOWN OF QUEENSBURY TOWN OF QUEENSBURY BUILDING DEPARTMENT BUILDING & CO ES D T. Based on our limited examination,compliance Reviewed with our comments shall not be construed as y indicating the plans and specifications are in FOR Date: `1' full compliance with the Building Codes of New York State. ADDI"T"ION ON BACKSIDE OF RESIDENCE 1269 BAY ROAD LADE GEORGE, NY 12845 SPECTRUM PROJECT No.: 17-594 NOVEMBER 30, 2017 pec PREPARED FOR: oEc o zo�7 TOWN OF QUEENSBURY BUILDING&CODES GAUTHIER, LLC 30 DELAWARE AVE. HUDSON FALLS, NY 12839 Environmental Consulting&Management Services•Health&Safety Training•Laboratory Services "r ABLE OF CONTENTS SECTION I o INTRODUCTION SECTION II -LIMITATIONS SECTION III -ASBESTOS SAMPLING SUMMARY ATTACHMENTS - TABLE 1 -ASBESTOS SAMPLING RESULTS TABLE 2-ASBESTOS FINDINGS -PHOT®ALBUM LOCATION MAPS LABORATORY REPORTS -LICENSING AND CERTIFICATION SECTION I-INTRODUCTION On November 20. 2017, Spectrum Environmental Associates, Inc. (Spectrum)conducted a survey for the presence of asbestos containing materials at the Addition on the backside of the residence located at 1269 Bay Road in Lake George,NY. Mr. James Edge (Asbestos Inspector#06-15641) conducted this inspection following procedures and guidelines commonly used and accepted by federal and state regulations. The objective of the survey was to identify the presence and approximate locations and quantities of suspect and/or confirmed asbestos containing materials. An initial walkthrough of the designated areas was conducted by an experienced asbestos inspector to observe and record materials used in the construction of the building. The inspector proceeded by assessing floors, walls, ceilings, surfacing materials, thermal systems insulation, roofing materials and other miscellaneous materials with the potential to contain asbestos. From observations, the inspector prepared a listing of building materials that are suspected to contain asbestos. The inspector selected these materials for inclusion in the inspection through professional experience and an understanding of the historical uses of asbestos. Generally speaking,if a building material within a structure could contain asbestos,the material was included in the inspection. Materials included in the survey were identified and recorded with respect to grouped homogeneous sampling areas. Representative bulk material samples were collected from locations within each homogeneous sampling area. Sampling information was recorded on chain of custody forms for documentation. Samples were individually preserved within a container and transported to an independent laboratory for asbestos analysis. Laboratory analysis of asbestos samples via polarized light microscopy(PLM)and/or transmission electron microscopy(TEM)was conducted by AmeriSci of New York,New York(ELAP# 11480, NVLAP#200546-0). Sample analysis was conducted as follows: o "Friable"Asbestos Samples—PLM o "Non-Friable" Organically Bound (NOB) Asbestos Samples—PLM and, if negative, TEM for confirmation as required under NYSDOH-ELAP regulations. ,SECTION II-LIHITA TIONS The information provided in this report was compiled from field and laboratory data obtained during the site visit. Observations noted and recorded are intended to represent the conditions that existed at the subject site at the time and date that the observations were made. Spectrum has not conducted its own analytical, but has utilized an independent NYS-DOH ELAP approved laboratory to provide the analytical results contained in this report. All discussions, findings, and conclusions are based on information that Spectrum received and understood to be factual. Determinations of suspect asbestos containing materials within the building were subject -to the accessibility of individual areas or spaces. Spectrum accepts no responsibility for the content of the building materials within areas or spaces that were unknown to us or not reasonably accessible. Spectrum assumes no liability for any buildings that were not identified by the client that may fall under state or federal regulations. All quantities of ACM provided in this report are provided as required by law and are believed to be accurate. If this report is to be used for bidding purposes, field verification of quantities is recommended by the abatement contractor prior to bidding. Conclusions and recommendations provided in this report are based on the assumption that materials identified are homogeneous throughout their application. This report has been compiled for the exclusive use of Gauthier LLC,its successors and/or assigns. This report and its contents represent confidential information and should not be duplicated without the expressed permission of the Gauthier LLC, its successors and/or assigns. SEC'T'ION III—ASBESTOS SAMPLING SUt4 MARY The results of the sampling are provided in Table 1 (Asbestos Sampling Results)and the asbestos findings are provided in Table 2 (Asbestos Findings) of the Attachments. The laboratory results and sample location map(s) are also provided in the Attachments. AT AC1H1I EN S TABLE I—AS'BEST'OS'S.41V1PuNG REsuLTs TABLE 2—ASBESTOS FiNDiNOS PIIOTOALRIINI LOcATIONMAPS LABORATORY REPORTS LIcENSINGANI)CERTIFICATION TABLE I — ASBESTOS SAMPLING RESULT'S 1269 Bay Road—Addition Only Spectrum Project# 17-594 Date Sampled:November 20,2017 Sample# Description Location/Area PLM Results TEM Results (% ) %Type) 01 Sheetrock Bedroom Wall NAD NA 02 Sheetrock Kitchen Wall NAD NA 03 Joint Compound Bedroom Wall NAD NA 04 Joint Compound Kitchen Wall NAD NA Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos. NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet 1-1ABLE 2 - ASBES ass FINDINGS 1269 Bay Road—Addition Only Spectrum Project# 17-594 Date Sampled:November 20, 2017 Limitations The following limitation/conditions were noted as part of the survey: o OSHA requires that an employer not expose its workers above the PEL and therefore specific training, work practices and/or respiratory protection may need to be a consideration when handling materials that are less than one percent. o The inspection was performed in accordance with New York State Industrial Code Rule 56 Section 5.1. It is the responsibility of the owner or its agent to forward a copy of this report to the local government entity charged with issuing a permit for such demolition, renovation, remodeling or repair work under applicable State or local laws as well as to the NYS Department of Labor Asbestos Control Bureau. Spectrum will not send this report to the NYSDOL without written permission from its client due to the sensitive nature of the information present in this report. o A copy of 56-5.1 is available upon request. o This report reflects the conditions found at the date and time of the inspection(s). Conditions of the area and materials may change due to external events, forces or influences. Re- inspection of the area may be required prior to the start of any work if an extended period of time has passed or if disturbances have occurred. o All asbestos locations on drawings are approximate. All quantities are estimated and must be field verified prior to use as part of a bidding document. Materials may extend or be hidden behind or within other materials or structural members. Any contractor or other user of this report is required to physically confirm the quantities and verify measurements of materials to be removed,to be bid for removal, or for any other purpose. Contractors are responsible to physically visit the site and confirm all quantities for bidding purposes. o This survey is only for demolition of the 24x28 addition on the backside of the house. o Spectrum did not inspect any exterior area below grade. Foundation sealers,buried piping and other items may exist below grade which may contain asbestos. SF—square feet,LF—linear feet,ea—each TABLE 2 — ASBESTOS FINDINGS 1269 Bay Road—Addition Only Spectrum Project# 17-594 Date Sampled:November 20, 2017 Material Location/Area Estimated Quantity* Condition/Damaged None of the materials tested were positive for asbestos according to USIEPA and New Fork State Department of Labor-Industrial Code Rule 56 VS ICR 56 *Quantities of identified ACM are estimates only and should be field verified prior to bid by the contractor or confirmed as part of an RFh or design specification. Please see the limitation listed above. SF—square feet,LF—linear feet,ea—each 1'HOTo ALBUM LIDZ "o)Z aiagluaia)A/\ONi :uioii pedlsuilboa aqe(] V66i'l Z # 1:a(o}aidl w, injilpadI& .,:))uill "saq,eilaossd IejUa) IUIO IIAU31 ua!nji!pads Aql aDua ) usaUilo uioiil ! ppv Pe,� )Ol�l A/F'R, �O; O wnqiv � 6,f9%, Z, ' T � 04,0q' d usols,@qsV z KTIOZOld1 £I Z Z OZB'd Pjp A c 3 ire ZT.ZZ�'Z8'd OLZZOZBd doppp l0- 'And m k fI r s Y LTZZOZBd i i 9L.ZZOZ/9d SZttOZBd k i € t i I € zz L®CA TION MAP(S) 17-594 1269 Bay Rd., Lake George, NY Asbestos surrey NTS 2,4 24x28 o 1,3 0 Sample Locations LABORATORY REPORTS _ . AmefiSd Now York 117EAST 3QTHST. MERINEVVYORK. NY 10010 - - TEL:(2i2)O7S-86UO°FAX:(2i3)678-311p, PLM �������� �=�� � - _—' _ _—' - '_____�~ , ~~�~~. � Spectru DlEnvronnmental Associates, Inc Date Received 11/21/17 AmeriScl Job # 217113297 Attn: EUU MaSsnQan Date Examined 11/25/17 P.O.# P.D.BOx1O24 ELAP# 11480 Page 1 of 2 M1T-594; 1268Bay Rd.. Lake George, House Addition Schenectady, NY 12301 Client No. / HGA Lab No. Asbestos Present Total % Asbestos 1 217113297-01 NO NAD 10 Location: Bedroom Wall'Sheobnck (by NYS ELAP 198.1) byPaul J. Mucha on 11/25/17 Analyst Description: OfWhite/Tan, Ho$orogenwouo, Fibmuu, Bulk Material Asbestos Types: Other Material: Cellulose 15%. Fibrous glass Trace, Non-fibrous 85'& 2 217113297-02 NO NAC) 1 Location: Kitchen Wall'Shnntmnk (by NYS ELAP 198.1) byPaul J. Mucha on 11/25/17 Analyst Description: OfWhite/Tan,Hetomgnneoum, Fibmuu,Bulk Material Asbestos Types: Other Material: Animal hair Trace, Cellulose 10%, Fibrous glass Trace, Non-fibrous 90% 3 217113297-03 No NAC) 2 Location: BedmomVVmU-JointCompound (by NYS ELAP1O8.1) byPaul J. Mucha on 11/25/17 Analyst Description: VVhda, Homnganwouo, Non'F|bmuu.Bulk Material Asbestos Types: Other Material: Cellulose Trace, Non-fibrous 1OOq& 4 217113297-04 No NAD 2 Location: Kitchen Wall'Joint Compound (by NYS ELAP188.1) byPaul J. Mucha on 11/25117 Analyst Description: White,Homogeneous, Non'Fibmuu.Bulk Material Asbestos Types: Other Material: Cellulose Trace, Non-fibrous 1OOY6 See Reporting notes onlast page flrner ci Job w: 2'17 3207 Pagecif t;ilani Name: Spe0irtlrn Envi6'©iSYenjai Asso%iaie9, Inc. PLM Bulk Asbestos Report 17-594; 1269 Saye Rd., Lake George, Huse Addition Reporting Notes: Analyzed by:Paul J.Mucha 'NAD/NSD=no asbestos detected; A not analyzed;NAPS=not analyzed/positive stop,(SOF-V)=Sprayed On Fireproofing containing Vermiculite; (SM-V)=Surfacing Material containi ermiculite;PLM Bulk Asbestos Analysis by EPA 600/M4-82-020 per 40 CFR 763(NVLAP 200546-0),ELAP PLM Method 198.1 for NY friable samples,which includes the identification and quantitation of vermiculite or 198.6 for NOB samples or EPA 400 pt ct by EPA 600/M4-82-020(NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials. NAD or Trace results by PLM are inconclusive,TEM is currently the only method that can be used to determine if this material can be considered or treated as non asbestos-containing in NY State(also see EPA Advisory for floor tile,FR 59,146,38970,8/1/94)National Institute of Standards and Technology Accreditation requirements mandate that this report must not be reproduced except in full without the approval of the Iab.This PLM report rela ON o the items tested.AIHA-LAP,LLC Lab ID 102843,RI Cert AAL-094,CT Cert PH-0186,Mass Cert AA000054. Reviewed By: END OF REPORT tel?.�m�PIl3?�41 scheffectdd s9 SPECTRViq � (598)340-637(Phoa 1 Environmental associates, Inc. > ���ve�ta�amm�nst� 'EXCEVVINC OVR CLIENTS EXPECTRTIONS OP EXCELLENCE' BULK SAMPLING CHAIN OF CUST®D (Rev.03/0712014) PROJECT INFORMATION Analysis Requested Turnaround P roject `, Buildin Nam C' '34 . /�d..L �J[�Q'g'gyC ,'_ d Y® Sampled: Area/Loc tion: /i A�.�,,®•b Bulk ® Paint E —ELAP 198.1 TEM—ELAP 198.4 ® RUSH 17 24 Hour —.—_ j L's e- /til j &r # Investigator. ® Soil ® Wipe - —ELAP 198.6 of SAMPLE IDENTIFICATION Sample Location Condition/Comment _J Sample ID#: Group#: Material 'Qc i s Unless otherwise stated please analyze each group to rust(r)positive result. omtnents: CHAIN OF OUST DY R eived By D e Time Method of Submittal elinquished By Date Time z U III Envirvnmenta8 CO"suftfaaag & Management Servaeeas H&aDtk & S afe$>y 7Pa°aaeaaaaa9 L a"F atory Serplees LICENSING AND CERTIFICATION P,[y,box f124 qChowerwy,AV 12,901 - SPECTRVA (918)841-600(Thane) ' E'�virllonmenial dsoclates. Inc. ��t�a 840-4009��,�� ° xssap� o Uac CG/ � xr c rrox'q op xoe-Z'V#Cu' r�nv.s�, x e� rrrrr�,canz State of New York— Department of Labor .Asbestos Certification 5TATF OF NEW YORK-DFPARTMFNT OF LABOR a, A56FST05 C,00FICATE N.Y.5 JAMES A EGGS AT (tf9i1s) INSF!(09110) M ( 1s) C�RTa as-15641 DMV# 110465269 MUST BE CARWO ON XiBESTO$PROJECTS fN!lf;tlift!d�IIIMtlNt 1$0 VOtWD MVJ" TO: p � ki1 � :SRC txpCil k6:1A i�& Xi�(;I 7, v Ili' $ to" STATS 0"IM CAMS Aix w t x�F4d N State of New York— Department of Lebon Codes Cerdf ication A Asbestos Handler B Restricted Handler- Allied Trades C Air Sampl!ng Technician D Inspector E Management Planner F Operations and Maintenance 4f G Su ervisor H Project Monitor I Project Designer Environmental Consulting R•Management Services • Health&Safety Training • Laboratory Services New York State—Department of Labor Division of Safety and Health License and Certificate Unit State Campus,Building 12 Albany,NY 12240 ASBESTOS HANDLING LICENSE Spectrum Environmental Associates, Inc FILE NUMBER: 99-0129 LICENSE NUMBER: 29081 P,O. Box 1024 LICENSE CLASS: RESTRICTED DATE OF ISSUE: 01/26/2017 Schenectady, NY 12301 EXPIRATION DATE: 02/28/2018 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. Eileen M.Franko, Director SH 432(8/12) For the Commissioner of Labor Expires 12:01 AICA April 01, 20 a 8 Issued April Oi, 2017 d ���YI I RTS OF APPROVAL FOR LABORATORY SERVICE Issued in accordance.with and pursuant to section 502 Public Health Laws of New York State MR. PAUL J. MUCHA NY Lab Id No: 11480 AMERICA SCIENCE TEAM NEW YORK INC 117 EAST 30TH ST NEW YORK, NY 10016 is hereby APPROVED as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE All approved subcategories and/or analytes are listed below: Miscellaneous Asbestos in Friable Material Item 1981 of Manual EPA 6001M4/82l020 Asbestos in Non-Friable Mated8l•PLM Item 198.6 of Manual(NOB by PLM) Asbestos in Non-Friable Material-TEM Item 198.4 of Manual Serial No.: 56034 Droperty of the New York State Department of Health. Certificates are valld only at the address snown.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 verity the laboratorys accreditation status. 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