DEMO-000680-2017 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-000680-2017
Tax Map No: 303.16-1-4
Permission is hereby granted to: OMall Family Limited Partnership
For property located at: 393 DIX 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
Tvpe of Construction
Owner Name: O.A Boychuk Demolition $0.00
Owner Address: 35 ORCHARD DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Daigle Construction LLC
90 Honeyhill LN
Granville,NY 12832
Plans&Specifications
Demolition Only(house)
Asbestos Report Received
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 1,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of reeonsli Wedk7for
r 1,2017
SIGNED BY: the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
la DEMOLITION APPLICATION Permit#: D.e 40 -O0(i& "AUL-7
Permit Fee:$ d
lawn of(Zuccnsbur),
Invoice:#:
742 Bay Road, Queensbury, NY 12804
P: 518-761-8256 www.gueensbury.net
Demolition Location: / 4�� Tax Map ID #: ---
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMI NS**
D CE9WIE
CONTACT INFORMATION: OCT 3 0 2017
TOWN OF QUEENSBURY
COMMUNITY DEVELOPMEN
• Applicant:
Name(s):
Mailing Address, C/S/Z: �J'
Cell P h o n e: 0 Land Line:
Email:
* Primary Owners :
Name(s): e,
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Contractor:
Business Name: %
Contact Name(s): <�
Mailing Address, C/S/Z: ¢.p, <
Cell Phone: _( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance: `
Cell Phone: _( ) Land Line: _( )
Email:
303.16-1 -4 DEMO 680-2017
Omall Family Ltd Partnership
Demolition Application 393 Dix Avenue Revised June 2017
Demolition - house
a
DEMOLITION INFORMATION:
1. Where will demolition material be disposed?
2. Type of structure to b 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
c. Propane
d. Electric '
e. Public Water
f. Well-Water Pump
g. Public Sewer
h. Other
i. None
4. Have ALL utilities been disconnected? Yes 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:
SIGNATURE: DATE: �
Demolition Application Revised June 2017
303.16-1-4 DEMO-000680-2017
Omall Family Ltd. Partnership
393 Dix Avenue
Demo Only (asbestos report recv'd)
Pre Demolition Asbestos Survey
At
Single family home
393 Dix Ave
Queensbury, NY 12804
A
E
s.
a
V
Prepared for:
Mr. Al Boychuk
102 Quaker Road
Queensbury, NY 12804
Prepared by:
DVD Environmental Inc.
PO Box 2152 D FE C IE 9 V E
Cliffside Park, NY 07010
212 260 9818 OCT 3 0 2017
TOWN OF September 10, 2017 COMMUNITY DEVELO MEN
Dix Ave,Queensbury
Asbestos survey
DVD Environmental Inc.9/17
TABLE OF CONTENTS
Section Page No.
1.0 Project Fact Sheet 2
2.0 Executive Summary—Homogeneous materials, Listing by Floor 3
3.0 Introduction 4
4.0 Building Description and Space Use 4
5.0 Survey Procedures and Guidelines 4
6.0 Analytical Methods 5
7.0 Reporting 5
8.0 Discussion—Regulatory Review 6
9.0 Certification
10.0 Sample results
Dix Ave,Queensbury
Asbestos survey
DVD Environmental Inc.9/17
1.0 PROJECT FACT SHEET
Project Title: Pre Demolition Asbestos Inspection Report
Project Location: 393 Dix Ave, Queensbury,NY 12804
Building: 393 Dix Ave
Prepared For: Mr. Al Boychuk
Owner: Mr. Al Boychuk
102 Quaker Road
Queensbury,NY 12804
Contacts: Mr. Al Boychuk 347 266 8911
Consultant: DVD Environmental, Inc.
PO Box 2152
Cliffside Park,New Jersey 07010
212-260-9818
Inspector(s): Tim Donohoe
m e
Tim Donohoe
NYS Certified Asbestos Inspector
EPA Certified Asbestos Inspector
NYCDEP Investigator
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2.0 EXECUTIVE SUMMARY
DVD, INC. was contracted to provide environmental support to Mr. Al Boychuk for the
building at 393 Dix Ave in Queensbury,NY. This contract required the performance of a
building inspection for asbestos-containing building materials. This data will be used for
reporting only.
DVD's EPA certified inspector performed the asbestos inspection on September 2, 2017.
The entire building was surveyed. This asbestos inspection survey report includes a
listing of all materials suspected to contain asbestos, analytical methods, limitations and
results, and an area by area inventory of ACM. An investigation of accessible spaces was
performed at the property to identify all suspect ACBM.
Section 2.0 Listing of Suspect Asbestos Containing Materials
HOMOGENEOUS MATERIALS & ACBM CONFIRMATION LIST
H 4 HG Material Description F/NF Analysis ACBM ACM Type
1 Sheetrock Walls F PLM N
2 Joint compound on walls F PLM N
3 Vinyl flooring NF TEM N
4 Plaster walls F PLM N
Window caulk NF PLM Y Assumed ACM
6 Textured laster ceilin s F PLM N
Summary of accessible areas inspected for asbestos containing materials:
Location Asbestos Material Description Approx.Qty. % FN
Functional Space TLF SF EA. Damage
393 Dix Ave
Basement/Crawls ace
Entire None
1ST Floor
Entire None
Attic/2nd floor
Entire None
Exterior
Wood windows Window caulk < 10 10%
3.0 INTRODUCTION
An inspection for asbestos containing materials was performed at the 393 Dix Ave
Building in Queensbury, NY. The scope of the inspection was to locate, sample,
quantify, and report asbestos containing materials in all areas within the structure.
4.0 BUILDING DESCRIPTION AND SPACE USE
The property consists of a 1000 square foot home with a converted attic. The HVAC
system consists of a boiler and radiators throughout the house. The building was
constructed prior to 1900. The building is a currently unoccupied single family home.
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Asbestos survey
DVD Environmental Inc.9/17
5.0 SURVEY PROCEDURE AND GUIDELINES
The survey was performed according to the Environmental Protection Agency
recommended procedures found in EPA 560/5-85-024. These procedures call for the
visual inspection of the building for suspect asbestos containing material and analysis of
representative samples of such materials. In addition to the required visual inspection,
fiberglass insulated systems were penetrated to determine the substrate in several
locations.
The survey and sampling was performed by Timothy Donohoe, All procedures meet the
above requirements. All accessible areas were inspected for three basic types of asbestos
used in building materials:
1. Surfacing Material that is sprayed-on, troweled on or otherwise applied to
surfaces, such as acoustical plaster on ceilings, fireproofing materials on structural
members, or other materials for acoustical, fireproofing or decorative purposes.
2. Thermal System Insulation applied to pipes, fittings, boilers, breaching, tanks,
ducts, or other structural components to prevent heat loss or gain, water
condensation, or for other purposes.
3. Miscellaneous ACBM means building materials on structural components,
structural members or fixtures, such as floor and ceiling tile, transite wall panels,
transite pipe, roofing shingles, roof flashing and many other materials that are
exclusive of surfacing or thermal system insulation.
SOURCES OF INFORMATION - Survey Information was collected by means of visual
inspection, interviews, sample collection, and sample analysis.
6.0 ANALYTICAL METHODS
POLARIZED LIGHT MICROSCOPY (PLM) is the EPA recommended method (EPA
method 40 CFR 763, subpart F, App A) for determining the presence of asbestos in building
materials. These materials include, but are not limited to, pipe and boiler insulation,
acoustical coatings, spray-on fireproofing, plasters, ceiling tiles, and floor tiles. The PLM
procedures involves taking a small amount of the suspect material, isolating the fibers
present, and identifying them based on the crystalline properties observed. All asbestos
types are crystalline materials and as a result can be identified by specific optical
properties observed in the polarized light microscope. In addition, non-asbestos fibrous
materials can also be identified including: glass, mineral wool, cellulose, gypsum, and
synthetic fibers.
Results of the analysis are reported as a percentage of the total sample. The PLM method
is sensitive to concentrations of asbestos down to 1%. Each sample was first examined
under the stereo microscope. The analyst looked for layering, colors, friability, fibrosity
and general appearance. Approximately 0.5mg of each unique layer of each sample was
immersed in refractive index oil and was observed in the microscope at 40-400X. The
sample's components were then identified by six different optical criteria to determine
fiber type and visual percentages. The optical criteria determined include: morphology,
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Dix Ave,Queensbury
Asbestos survey
DVD Environmental Inc.9/17
pleochroism, birefringence, extinction, sign of elongation, and refractive index parallel
and perpendicular to elongation. Non-friable, organically bound (NOB) material (floor
tiles, roofing, mastic flashing) determined to be negative for asbestos by PLM analysis
are considered positive by the NYS Environmental Laboratory Approval Program until
proven negative by transmission electron microscopy (TEM) - (NYS ELAP Protocols
198.1/198.4). Therefore, TEM analysis was performed on all NOB materials where no
asbestos was detected using PLM.
7.0 REPORTING
HOMOGENEOUS MATERIALS & ACBM CONFIRMATION LIST- is a summary list
of each building material that was tested. Note that each material was assigned a
homogeneous material number (HA No.) in the first column of the list. The second
column is the material description, the third column indicates if the material is friable (F)
or non-friable (NF), the fourth column is a code assigned to each homogenous material
for purposes of classification and recording on sample log sheets (Chain of Custody
form). The fifth and sixth column is used in categorizing each for the existence of
asbestos (Y-Yes, N-No). Positive materials contain greater than one percent (>1%)
asbestos as per OSHA 29 CFR Part 1926.1101.b, (Subpart Z). Any material not sampled
is considered Presumed Asbestos Containing Material-PACM is material has not been
tested by a certified laboratory to confirm asbestos content. Material must be treated as
ACM until laboratory results confirm otherwise. The last column is for footnotes specific
and unique to the each building.
8.0 DISCUSSION
This report is designed as a database of all ACBM discovered during the asbestos survey.
Accordingly, the USEPA, NYSDOL and NYC DEP require the building owner to
provide an asbestos inspection prior to building demolition or demolition and notification
prior to abatement. This process requires a detailed review of plans and specifications in
order to determine the extent of construction influence that might extend to areas that
contain ACBM.
OSHA Asbestos standard 29CFR1910.1001 applies to all occupational exposures to
asbestos in all industries covered by the Occupational Safety and Health Act, except
construction work and ship repairing, shipbuilding and shipbreaking employment and
related employments.
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New York State—Departme a
40P Division of Safety and 4 alth
License and Certfica ' {J ;
State Campus Buildtl 12' „
F`°' Albany,NY 12240 1
ASBESTOS HANDLING LICENSE
DVD Environmental, Inc. �'; �' FILE NUMBER: 06-0631
LICENSE NUMBER: 28545"''" l,,.
P,0. Bo2152 LICENSE CLASS: RESTRICTED ,1
DATE OF ISSUE: 07/26/2017
' .CIi#tsi*Park,NJ 07010 Ile
EXPIRATION,DATE: 07/31/2018
�q<� W
Duly Authorized Representative—Timothy Donohoe: µ _
q
is license has been issued in acdance with applicable provisions of Arttcle of the Lahr Law of New Yorks ad of
New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is sul ct to suspension or revocation for a(1)
s 'oit vio ation of state,federal or local laws with retard to the conduct of an as�iestos profi t,or(2)demonstrated lack gf
r onsibilfty in th 'f nduct of any job involving asbestos or asbeitos material
„y
This licensON e i o for the contractor named above and this license or a phots tpy must ,*omi " tly displa�i at the
asbestos pro'ec i This license verifies that all persons emplo}ed by the licepsee on ad'*best , ro Y
State have a ed a bestos Certificate,appro to fox the,type of work they perform,by th , Yo tatef k
Department o or. W"
\ q
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11
141
t een M.Franko, Director
SH 432(8/12) For the Commissioner of Labor
Dix Ave,Queensbury
Asbestos survey
DVD Environmental Inc. 9/17
10.0 Sample Results
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MMETRO V I I I ASBESTOS ANALYSIS of BULK SAMPLE
ANALYLICAL LABORAFORIES by POLARIZED LIGHT MICROSCOPY and
255 West 36th St., Suite#101
New York,NY 10018 TRANSMISSION ELECTRON MICROSCOPY
p: (212)695-0165 f: (212)695-0183
Client: DVD Environmental Contract: 393 Dix Avenue Metro Lab ID#: B17090054
Address: PO BOX 2152 Client Job#:
Cliffside Park NJ 07010 Location: 393 Dix Avenue
P: (212)260-9818 F: (201)941-8739 Sample Received: 09/05/2017
Queensbury NY PLM Analysis Date: 09/07/2017
Contact Tim Donohoe Sampled By: T.D. TEM Analysis Date: 09/06/2017
M: Sampled Date 09/02/2017 Reported By: Trenaise Lance
E: T.denoh:::=(c;d--lervironmental.a;ti� Turnaround Time: 72 hrs Report Date: 09/08/2017
Summary of Analysis
LAB ID# Client Sample Description Test Fibrous Material Non-Fibrous Material Asbestos Total
Sample# Asbestos
Grey/White Inhomogenous Granular NY FLAP 1981. 3% Cellulose 97% Non-Fibrous None Detected
1 01 PLASTER WALLS-PLASTER NY FLAP 198.6
NY FLAP 1984.
Grey/White Inhomogenous Granular NY ELAP 198.1 8%Cellulose 92%Non-Fibrous None Detected
2 02 PLASTER WALLS-PLASTER NY ELAP 198.6
NY ELAP 198.4
Grey/White Inhomogenous Granular NY ELAP 1981. 5%Cellulose 95%Non-Fibrous None Detected
3 03 PLASTER WALLS-PLASTER NY ELAP 198.6
NY ELAP 198.4
White Homogenous Granular NY FLAP 198.1 100%Non-Fibrous None Detected
4 04 JOINT COMPOUND ON CEIL&SHEETROCK- NY ELAP 198.6
JOINT COMPOUND NY FLAP 198.4
White Homogenous Granular NY ELAP 198.1 2%Cellulose 98% Non-Fibrous None Detected
5 05 JOINT COMPOUND ON CEIL&SHEETROCK- NY ELAP 198.6
JOINT COMPOUND NY FLAP 198.4
White/Brown Inhomogenous Fibrous NY ELAP 198.1 30%Cellulose 70%Gypsum None Detected
6 06 JOINT COMPOUND ON CEIL&SHEETROCK- NY ELAP 198.6
JOINT COMPOUND NY ELAP 198.4
White/Brown Inhomogenous Fibrous NY FLAP 1981. 20%Cellulose 80%Gypsum None Detected
7 07 ATTIC-SHEETROCK NY FLAP 198.6
NY ELAP 1984.
White/Brown Inhomogenous Fibrous NY ELAP 198.1 35%Cellulose 65%Gypsum None Detected
8 08 1ST FLOOR CEIL-SHEETROCK NY ELAP 198.6
NY ELAP 198.4
Beige Homogenous NOB NY ELAP 198.1
9 09 KITCHEN-VINYL FLOOR MASTIC NY ELAP 198.6 Inconclusive None Detected
NY ELAP 1984. None Detected
Beige Homogenous NOB NY ELAP 198.1
10 10 KITCHEN-VINYL FLOOR MASTIC NY FLAP 198.6 Inconclusive None Detected
NY ELAP 1984. None Detected
Comments
q — _-1 �� X �� NYS ELAP ID#12003
Zlatan Dimitrijevic Michael Issa/Sylvia Choi Xi Chen/Zlatan Dimitrijevic NVLAP Lab Code 500081-0
Laboratory Director PLM Analyst TEM Analyst
1/2
METROrMReport Notes
ANALYTICAL LABORATORIES
255 West 36th St., Suite#101
New York,NY 10018
p: (212)695-0165 f: (212)695-0183
General Notes and Disclaimers
•The samples analyzed in this report were not collected by this laboratory-they were received from the client, or an agent of the client, in good condition, unless otherwise noted.
•All results are calculated based on client-provided measurements.
•The report shall not be reproduced,except in full,without the written approval of the laboratory.
•This report relates only to the samples tested. It may not be used by the client to claim project endorsement by NVLAP, NYS ELAP,or any other government agency.
•All samples will be properly disposed of after 60 days.
•Quality Control data(including 95%confidence limits, laboratory/analysis accuracy and precision)is available upon request.
Notes Regarding Asbestos Testing
•Air Sample Analysis by Phase Contrast Microscopy(PCM)adheres to Method NIOSH-7400. Results<7 fibers/mm2 are statistically insignificant.
•Percentages are calculated using the EPA equivalent Stratified Point-Count Method.
•Bulk Sample Analysis by Polarized Light Microscopy(PLM) Friable adheres to EPA/600/M4-082-20 or NYS ELAP 198.1.
•Bulk Sample Analysis by Polarized Light Microscopy(PLM) NOB adheres to NYS ELAP 198.6. This method does not remove vermiculite and may underestimate the level of asbestos present in a sample
containing greater than 10%vermiculite.
•All inhomogeneous layers of the bulk samples were analyzed separately.
•Analytical results are sometimes based on the residue percentage(s)provided by the client along with the filters. Trace denotes asbestos detected at< 1%. Smiliarly,samples below quantitation limit(RL)
are reported with a less than sign(<).
•Polarized Light Microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials. Quantitative TEM is currently the only method that can be
used to determine if this material can be considered or treated as non-asbestos containing.
•Bulk Sample Analysis by Transmission Electron Microscopy(TEM)NOB adheres to NYS ELAP Method 198.4.
•Air Sample Analysis by Transmission Electron Microscopy(TEM)adheres to Method EPA CFR Part 763 Final Rule(AHERA).
•Air Sample Analysis by Transmission Electron Microscopy(TEM)Worksheets are available upon request.
2/2
DVD Environmental, Inc.
PO Box 2152, Cliffside Park, NJ 07010
Phone: 212 260 — 9818
Fax: 201 941 — 8739
E-mail TdonohoeCadvdenvironmental.com
Bulk Sam le Chain of Custody l Data Sheet
Laboratory: Address: JO ft.
#:10C(CUA
Project Information: Analysis Turnaround TimeComments:
3
l Type 6-8 hr 12 hr 24 hr 48 hr 72 hr 5 day other Positive stop for all
C FLAP PLM
materials.
�(-; ,+ Al ELAP TEM
f ELAP PLM/rEM Inconclusive NOBS(only)
Sampled B Tim Donohoe TEM/later should go directly to TEM.
TEM/Chatfield
Number: PLM
Manager: LEAD
Site: OTHER T-7 rl
esults to: tdonoho dvdenvironmentai.eom Return Sam les Yes X No
nvoice to: DVD Environmental Inc. hone#: 212 260 9818
ritten Report to: DVD Environmental,Inc. Fax#: 201 941 8739
omments: Read for V Positive of each material Other#:
Sample .D Sample Location Material Type Results Homogeneou
Di PLM TEM s area/Quant.
DU
ri c
/'e ( 'rL / 'A-
a
Relinquished By: Date 1 Time Received By: Dated Time:
Dix Ave,Queensbury
Asbestos survey
DVD Environmental Inc.9/17
11.0 Photos
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w
Rear wall of house
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Basement entrance
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fid
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Rear wood siding on wood
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Living room
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Side room 1st floor
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Dix Ave,Queensbury
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Pi�'i ,{ lill
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Attic stairs
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Closet
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Attic bedroom
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Am
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Boiler
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Basement Ceiling
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Mr
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Fiberglass insulation on heating system
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