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DEMO-0424-2018 `^ rr._i 11 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 R� Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: DEMO-0424-2018 Date Issued: Wednesday, November 7, 2018 This is to certify that work requested to be done as shown by Permit Number DEMO-0424-2018 has been completed. Tax Map Number: 227.18-1-11 Location: 8 FISHING HOLE LOOP Owner: Teele Revocable Trust Applicant: MH IMPERIAL HOMES CORP. This structure may be occupied as a: Demolition of House and Shed attached to t house(slab on grade) By Order of Town Board Asbestos Report received TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the /J property owner of the responsibility for compliance with Site Plan, YYY 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-0424-2018 Tax Map No: 227.18-1-11 Permission is hereby granted to: MH IMPERIAL HOMES CORP. For property located at: 8 FISHING HOLE LOOP 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 Construction Owner Name: Teele Revocable Trust Demolition-Residential $0.00 Owner Address: PO Box 37 Total Value $0.00 Kattskill Bay,NY 12844 Contractor or Builder's Name/Address Electrical Inspection Agency MH IMPERIAL HOMES CORP. 1429 State Route 9 Fort Edward,NY 12828 Plans&Specifications Demolition of House and Shed attached to the house(slab on grade) Asbestos Report received $ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, October 23,2019 (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 I.to. Dated at the To f Que bury 4T 4.�.. : o.er 23,2018 SIGNED BY: ` for the Town of Queensbury. Director of Building&Code Enforcement . Office Use Only r DEMOLITION APPLICATION Permit#:� h1v � ��t x J p4-!d 7/ld' ya 1 t Permit Fee:$ � S CJ MUM c7f'Oueenshury _ Invo4ce:#: d-i 742 Bay Road, Queensbury, NY 12804 P: 518-761-8256 www.queensbury.net i a JUL 02201) i riF MEP' RV Demolition Location: S V51I4lOLE �pP '' IMap4 T 1 , - 1 - 11 **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: • Applicant: Name(s): 6e-E IJ Mailing Address, C/S/Z: I1{2aliTEt, 1-)^,e D1 ty 12328 Cell Phone: (5tv ) 112- - 2351 Land Line: (51B ) (( - 3457 Email: © ter►h i rnf e.r-' i c4 hdrneS . C.onn • Primary Owner(s): -T� Name(s): 11EJece y 1.iQ,L45T BLS t.E Mailing Address, C/S/Z:Pb rajls. 3� t 11TSt'��LJ-- 13y i t-.I I2 Cell Phone:_(51b ) _ 42.' 0y Land Line: ( I$ ) • 9311 Email: • Contractor: Business Name: MI-1 I rflPE Itau 1-lonneS Contact Name(s): (gam watzt.E1T Mailing Address, C/S/Z: SikrY16 AS k 1 £ Cell Phone:_( ) Land Line: _( ) Email: Contact Person for Building & Code Compliance: 5Z'1E.4 u) .E 1� Cell Phone: ( 518 ) &1- 3�7 Land Line: (51$ ) Z -2.1 S I Email: 3 (9rnhiM f.ec- ic,t hoV S C4)0°'> Demolition Application Revised June 2017 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? ACE. GA 0-ri PJEt -172 O5F — 10 2. Type of structure to)e demolished: a. Residence V b. Garage c. Business d. Storage Building •/ 3. What type of utilities are connected to the structure: a. Gas b. Fuel Oil c. Propane f J(y* d. Electric 7 /L4— CAt--- e. Public Water f. Well-Water Pump si P Cc14 g. Public Sewer h. Other i. None / 4. Have ALL utilities been disconnected? Yes v 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 abov : -... PRINT NAME: P.. �tv� T.. 5.01-w'i' ____ _f____,„ SIGNATURE: DATE: 6 Demolition Application Revised June 2017 I / 1 aDed 800T : I 8TOZ/Z/L Pa;uu 1 pa3£i; IN"s® 1 ONO 30N321333211d213N39 Joi s1 dew FILE COPY 1II 1, ‘6,A, TOWN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited examination,compliance with our comments shall not be construed as (L> indicating the plans and specifications are in j °L,311�� full compliance with the Building Codes of -- -- ¢ New York State. '2 0 E p4)1N 0NL `� 1—d00:1-3101-1•UNIHs1 — ---, I"r\ji :P, ,:. k'3 l ji, ,., , .„,..,, -0 / ENs ,./V c/gyp , et. DEVELOPMENT � OP EI T dr= n__..10- i Vli;°' \ lb ' —. 0 ‘s. --- _ / re_a4e 6-'1- if 1-t°5 �e ale um (AL)(...y b-L- r 10\4 ,.)14eA--0d I d °:4° i (7---. an bl-C`.' I HAVE PERSONALLY MEASURED THE DISTANCE 6( FROM THE PROPERTY LINES TO THE l 8 P'0'04 A IT ► URE(S)OR IG (S) T q l;')>I I Ail, El ----- 2.618 1 4)- a Y si (if D E 0 I.- Al/ L 1 I i'l , to 161D dew qaM A(angsuaanb FILE COPY ,► 8D Petra Lane Albany,NY 12205 (518)250-5658 Demolition&Environmental Services,LLC (518)252-3973(eFax) www.oriondes.com October 17,2018 Mr. Greg Hewlett Owner MH Imperial Homes a 't 1429 Route 9 Fort Edward, NY 12828 p) — 1 OCT182018 g u,. Project: 3 Fishing Hole Loop—Queensbury,NY Orion DES Quote#2018-169 nn.1rl K Mr. Hewlett: Orion Demolition&Environmental Services, LLC is pleased to provide the following lump sum proposal for the abatement services required at the above-referenced project. The following Scope of Work was developed during our site visit and in accordance with the specifications provided by the owner. This proposal is intended to be utilized by the owner for evaluating feasibility and costs associated with the downsizing, sale or redevelopment of the site and as an offer to perform the work. Scope of Work: • Notification and posting of Asbestos Abatement Project in accordance with NYSDOL minor project requirements. • Mobilization of labor,equipment, materials and supervision to and from site including required decontamination facilities. • Prep and abatement of approximately 6 SF of asbestos-containing cementitious piping only from the exterior of the above-referenced location. Excludes abatement of any other asbestos- containing materials or debris which may be present throughout the structure. • Removal and legal disposal of all generated asbestos-containing material to a certified landfill facility permitted to accept such material. • Includes required project closeout documentation per NYSDOL requirements. Exclusions: • Hazardous or regulated material abatement or remediation other than identified asbestos including but not limited to lead, mold, PCB, refrigerants, mercury, UST,oils, paints,etc. • Disconnection, relocation, isolation,termination or protection of utility services. • Municipal building permits or associated fees. • Temporary power and water sources. Additional charges will apply if contractor is to provide. • Third-party monitoring, consulting,testing, engineering or analytical services. Clearance air samples or inspections shall be provided by others with immediate turnaround time. • Temporary or permanent partitions, barricades or weather/dustproof enclosures. Lump Sum Pricing—Schedule of Values: Bid Item: Lump Sum Pricing: Mobilization $995.00 Asbestos Abatement $2,000.00 Lump Sum Total: $2,995.00 Accelerated Schedule Upcharge $500.00 Project Schedule: • Orion DES anticipates approximately ONE(1)day(s)for safe and successful project completion from a start date mutually agreed upon by the contractor and owner. Terms &Conditions: • Municipal building permits, if required,shall be obtained and paid for direct by the owner. • Relocation of stored contents and other furnishings, if present,shall be by the owner prior to contractor mobilization. Additional charges will apply if contractor is to provide. • The terms of this quotation shall be incorporated into and made part of any future contractual agreement between both parties. • Owner to provide Tax Exempt or Capital Improvement Certification otherwise applicable sales tax may apply. • Insurance furnished to the limits and coverages shown on the attached sample COI. • Net 15 payment terms apply; no percentage of payment shall be retained for any length of time. Any balances over 15 days will be charged interest at a rate of 2.5%per month. All major credit cards accepted at a rate of 3.5% per transaction. • Quote is based on current landfill,fuel, material,etc. cost at the time of estimate. Any increases after 30 days will apply on a cost-plus basis. Quote valid for 30 days from proposal date. • All work will be completed in an open shop environment during normal business hours, Monday-Friday, unless otherwise stated. Excludes state or federal prevailing wage rates. • All work to be completed under a single project mobilization unless otherwise stated. Each additional mobilization, if required,will be billed at a minimum value of$1,500. Please feel free to call or email with any questions regarding this proposal. Sincerely, ORION DEMOLITION & ENVIRONMENTAL SERVICES, LLC %/Mite 144414 Joseph Loudis President jloudis@oriondes.com (518) 669-3723 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 Orion Demolition&Environmental Services, LLC FILE NUMBER: 16-90965 LICENSE NUMBER: 90965 8D Petra Lane LICENSE CLASS: FULL DATE OF ISSUE: 02/20/2018 Albany, NY 12205 EXPIRATION DATE: 02/28/2019 Duly Authorized Representative-Joseph Loudis: 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 -- - - p 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. rLu. Eileen M.Franko, Director SH 432(8/12) For the Commissioner of Labor ACVR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/05/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ten Eyck Group NAME: Ten Eyck Group (AHONnE Ext). (518)464-0059 �a/c,No): (518)456-7076 1924 Western Avenue E-MAIL adavarizand@teneyckgroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Albany NY 12203 _INSURER A: Western World Insurance Company INSURED INSURER B: Progressive Casualty Ins Co Orion Demolition&Environmental Services,LLC INSURER C: 8D Petra Lane INSURER D: INSURER E: Albany NY 12205 INSURER F: COVERAGES CERTIFICATE NUMBER: CL182512638 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MMlDD/YYW) _ X COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 _CLAIMS-MADE X OCCUR _PREMISES(Ea occurrence) _$ MED EXP(Any one person) $ 10,000 A EVP1000445-00 02/04/2018 02/04/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 02894984-2 02/26/2018 02/26/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB ! CLAIMS-MADE EVX1000446-00 02/04/2018 02/04/2019 AGGREGATE _$ 5,000,000 DED RETENTION$ _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $1,000,000 $2,000,000 Professional Liability A Pollution Liability EVP1000445-00 02/04/2018 02/04/2019 $1,000,000 $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orion Demolition&Environmental Services,LLC ACCORDANCE WITH THE POLICY PROVISIONS. 8D Petra Lane AUTHORIZED REPRESENTATIVE Albany NY 12205 ,- Qfa, I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TYSIi New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914. 1 WATERVLIET AVENUE ALBANY,NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 811250005 f - TEN EYCK INSURING AGCY INC _I 1:11.11- ,r 1924 WESTERN AVENUE 0 17 ALBANY NY 12203 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ORION DEMOLITION&ENVIRONMENTAL ORION DEMOLITION& SERVICES LLC ENVIRONMENTAL SERVICES LLC 8D PETRA LANE 8 D PETRA LANE ALBANY NY 12205 ALBANY NY 12205 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2386 697-3 893249 04/09/2018 TO 04/09/2019 8/1/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2386 697-3, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND - -f_t_k_x_il—u-,,___H4(tQl'ile------ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:447148992 U-26.3 f T FILE COPY Asbestos MH Imperial Homes 3 Fishing Hole Loop Queensbury, N.Y.12827 -.*--,--4.-- ff - • Inspection date: 10/3/2018 x - ,�y } i- ftr. :d . s- max,•,+�. .f t• s .,o .«4_ .,' /(- ,��p* ♦ • `- �i r. z+ 4� ems: $ <' { s - .F r • ` \T;£ __ S§:.ram r " ` •gir + .- siL�- r ,$"} i SLY' t `•. ,'' . m -£ , 1, ' L i 1 „:77?„::::..;.,__::-.. ,,._,,,..,.,.„._,„„,,_ ,. -7 '.. _ r g ":, ili „....,„ _.,, ...,.. „„.... . „:....„ ,...„;•• ,,,,A1' *'-...'",i, ..*-*, - it is ::..-14--:-*4.,./.,,,-.,.,--,,,v--4,,,,t,„-;±-4.-4-f,- ,.4.- 4--L: . gau_r� >.eir 1----F—r h-7-7,z "3 :---1 11 Tom Callahan JTC Inspections , ; 1 1 Knolls Dr i OCT 18 2�1� Oueensbury, NY 12804 y .-. ;��A } „ ' Y cell# 518-832-9750 __ ___ _ --.��-: - xs t 9 Summary of Inspection At the request of MH Imperial Homes an asbestos survey was performed at 3 Fishing Hole Loop, Queensbury, NY. Scope of the Inspection/Survey is to determine if the home contains any asbestos prior to demolition. While due diligence was performed renovations have been done over the years and may prevent complete disclosure of the materials inspected. Suspected Asbestos containing materials were removed and sent out for sampling. The following samples were removed and sent out for testing. Homogeneous area 1( friable), shingle samples were collected from -Roof 860 sq' (tested negative) Homogeneous area 2 (friable) , ceiling tile samples were collected from -Ceilings in 3 rooms 394 sq' (tested negative) Homogeneous area 3 (non friable) Floor tile samples were collected -Kitchen floor 130 sq' (tested negative) Homogeneous area 4 ( non friable) Floor tile samples were collected 1 - Kitchen floor under the top floor 130 sq' (tested negative) Homogeneous area 5 ( non friable) Flooring tile was sampled -Bathroom flooring 42 sq' (tested negative) Homogeneous area 6 ( friable) Sheetrock was sampled -1430 sq' (tested negative) Homogeneous area 7 ( friable) Wall paper was sampled -Bathroom and kitchen 64 sq' (tested negative) Homogeneous area 8 (friable) Fake stone heat sink was sampled -From the wall 35 sq' (tested negative) Homogeneous area 9 (friable) Fake stone adhesive was sampled -From the wall 35 sq' (tested negative) Homogeneous area 10 (friable) Chimney pipe was sampled -From the chimney pipe for the furnace 6 sq' (tested positive 30.8% C h rysoti le). Any materials identified as positive for containing 1% asbestos must be contained and abated in a manor that is consistent with the local municipality regulations. Please consult your local building and codes authority and proceed in accordance with the guidelines set forth.lf a contractor is hired to abate the asbestos He or She can contact the State on your behalf. Things to note THIS REPORT SHOULD BE MADE AVAILABLE TO ANY NEIGHBORS. THIS REPORT SHOULD ALSO BE READILY AVAILABLE AT THE LOCATION OF THE DEMOLITION/RENOVATION FOR ANY TRADES PEOPLE ENGAGED TO CARRY OUT REPAIRS OR DEMOLITION OF THE PROPERTY. Conclusion The sample's from the furnace chimney came back positive (30.8% Chrysotile). STATE OE NEW YORK-DEPARTMENT OF LABOR ASBESTOS CERTIFICATE THOMAS M CALLAHAN CLASS(EXPIRES) D INSP 12`B1 MUST BE CARRIED ON ASBESTOS PROJECTS 101"I[1t11U111 1111 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 TC inspections FILE NUMBER: 18-109425 LICENSE NUMBER: 109425 1 Knolls Drive LICENSE CLASS: RESTRICTED DATE OF ISSUE: 01/12/2018 Queensbury,NY 12804 EXPIRATION DATE: 01/31/2019 Duly Authorized Representative—Thomas Callahan: 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(I 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 ssorksite" This license verities 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 Stare Department of Labor. roi:Lo u.litAir**14 Eileen M.Franko, Director SH 432(8/12) For the Commissioner of Labor EMSL Analytical,Inc. EMSL Order: 06 s2oszs EMSL CustomertD. 1 CNS29 528 Mineola Avenue,Carle Place,NY i 1514 [ Phone/Fax, (516)997-7251 i(516)997-7528 s CustomerPO: rttp-/rwtnv.EMSLcort carteotaceiabaemst.corn Projectl0: Attn: Tom Callahan Phone: (518)832-9750 TC Inspections Fax: 1 Knolls Drive Received. 10/11/18 11.05 AM Queensbury,NY 12804 Analysis Date. 10!1412018 Collected: 10/312018 Test Report:Asbestos Analysis of Bulk Material Analyzed Non Asbestos Test Date Color Fibrous Non-Fibrous Asbestos Sample ID HA 1-RS1 Description Roof Shingle 061820g/5-0001 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10114/2018 Brown/Gray/ 9.0% Glass Inconclusive:None Detected Black I TEM NYS 198.4 NOB '0/14/2018 Brown/Gray/ None Detected Block Sample ID HA 1-RS2 Description Roof Shingle e18209/s-0002 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Gray/ 10.2%Glass Inconclusive:None Detected Black TEM NYS 198.4 NOB 10/14/2018 Brown/Gray; None Detected Black Sample ID HA 1-RS3 Description Roof Shingle 0618209M-0003 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Gray/ 5.4% Glass Inconclusive:None Detected Black TEM NYS 198.4 NOB 10/14/2018 Brown/Gray/ None Detected Black Sample ID HA 2-CT1 Description Ceiling Tile 061820975-0004 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 0/14/2018 Brown/Tan Inconclusive:None Detected TEM NYS 198.4 NOB 'Oil 4/2018 Brovm/Tar. None Detected Sample ID HA 2-CT2 Description Ceiling rile 061820875-0005 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Tan Inconclusive:None Detected TEM NYS 198.4 NOB 10/14/2018 Brown/an None Detected ',Initial Report From 10/15/2018 07:56:37 Test Report 198VCM-7.30.0 Panted:10/15/2018 7:56:37 AM Page 1 EMSL Analytical,Inc. EMSL Order: 061820975 EMrJL 528 Mineola Avenue,Carle Place,NY 11514 CustomeriD: TCNS29 Phone/Fax: (516)997-7251/(516)997-7528 CustomerPO: httoilwww EA'S1.coo carieplacela letnsl con, ProjectlD: Test Report:Asbestos Analysis of Bulk Material Non Asbestos Test Color Fibrous Non-Fibrous Asbestos Sample ID HA 2-CT3 Description Ceiling Tile 96r820975-0006 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Tan Inconclusive:None Detected TEM NYS 198.4 NOB •11412018 Brown/Tan None Detected Sample ID HA 3-FTK1 Description Floor Tile 051820975-0007 Homogeneity Heterogeneous PLM NYS 198-1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown Inconclusive:None Detected Includes insurable adhes ve. TEM NYS 198.4 NOB '3114/20'8 Brown None Detected Sample ID HA 3-1=TK2 Description Floor Tile 061820975-0008 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed ------ PLM NYS 198.E VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown Inconclusive:None Detected Includes inseparable adhes ve. • TEM NY8198.4 NOB '0014/2018 Brown None Detected Sample ID HA 3-FTK3 Description Floor Tile 061820915-0009 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown Inconclusive:None Detected Includes inseparable adhesive. _.__. TEM NYS 198.4 NOB 10/14/2018 Brown None Detected Sample ID HA 4-FT1 Description Hoot r.ile 061820975-0010 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed - - PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Tan/CI Inconclusive:None Detected ear Includes inseparable adnesive. TEM NYS 198.4 NOB 10/14/2018 Brown/Tan/CI Norm Detected ear (initial Report From 10/15/2018 07:56:37 Test Report 198VCM-7.30.0 Printed:10/15/2018 7:56:37 AM Page 2 a - EMSL Analytical,Inc. EMSL Order. 061820975 EMS'L 528 Mineola Avenue,Carle Place,NY 11514 Cusiomerit). TCNS29 Phone/Far (518)997-7251/(516)997-i52t CuslomerPO: bet&.#_ tIM L , 1,40cel;iUr3etn.strxm ProjectiD: Test Report:Asbestos Analysis of Bulk Material Non Asbestos Test Color Fibrous Non-Fibrous Asbestos Sample ID HA 4-FT2 Description Floor Tile 961820975-rloit Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analysed PLM NYS 198.6 NOB 10/14/2018 Brown/Tan/CI inconclusive:None Detected Par Includes inseparable adhes ve- TEM NYS 198.4 NOB 0/14/2048 Brown/Tan/CI None Detected ear Sample ID HA 4-F T3 Description Floor Tile 061820975-0012 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2016 Brown/Tan/CI Inconclusive;None Detected ear Includes inseparable adhesive. TEM NYS 198.4 NOB 10/14/2018 Brown/Tan/CI None Detected ear Sample ID -IA 5-FTB1 Description Floor Tile 0618209/5-0013 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM 0 Not Analyzed PLM NYS 198.6 NOB 10114/2018 Brown/Gray/ Inconclusive None Detected Tan Includes inseparable adhesive. TEM NYS 198.4 NOB 10/14/2018 Brown/Gray/ None Detected Tan Sample ID HA 5-FTB2 Description Floor Tile 061820975-0014 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Gray/ Inconclusive:None Detected Tan Includes inseparable adhesive. TEM NYS 198.4 NOB 10/14/2018 Brown/Gray/ None Detected Tan Sample ID HA 5-FTB3 Description Floor Lie 061820975-0015 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 YCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Brown/Gray/ Inconclusive:None Detected Tan includes inseparable adhesive. TEM NYS 198.4 NO8 10/14/2018 Brown/Gray/ None Detected Tan Initial Report From 10/15/2018 07:56:37 Test Report 198VCM-7.30.0 Printed:10i15/2018 7:56:37 AM —�_ Page 3 t � [ EMSL Analytical,Inc. . EMI_ 061820975 f EI�I SIs Customert0 528 Manaa Avenue,Carle Place,NY 11514 TCNS29 m Phone/fax: (516)997-7251/(516)997-7528 CustornerPO: htt9 riwww EVSL rn' carlecl,tuclaeiemsl.com ProjectlD: Test Report:Asbestos Analysis of Bulk Material Non Asbestos Test Color Fibrous Non-Fibrous Asbestos ' Sample ID HA 6-DW1 Description Drywal 061820975.0016 Homogeneity Heterogeneous PLM NYS 198.1 Friable 10/11/2018 Brown/White/ 6.00%Cellulose 65.00%Gypsum None Detected 24.00%Ca Carbonate 5.00%Nan-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PUN NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analysed Sample ID HA 6-DW2 Description Drywall 061820975-0017 Homogeneity Heterogeneous PLM NYS 198.1 Friable 10/11/2018 Brown/White/ 7.00%Cellulose 50.00%Gypsum None Detected 38.00%Ca Carbonate 5.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID HA 6-DW3 Description Drywall 061820975-0018 Homogeneity Heterogeneous PLM NYS 198.1 Friable 10/11/2018 Brown/White/ 7.00%Cellulose 50.00%Gypsum None Detected 38.00%Ca Carbonate 5.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PUN NYS 198.E NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID HA 6-0W4 Description Drywall 0618209754019 Homogeneity Heterogeneous PLM NYS 198.1 Friable 10/11/2018 Brown/White &.00%Cellulose 55.00%Gypsum None Detected 34.00%Ca Carbonate 5.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PUN NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID HA 6-DW5 Description Drywall 0618209/5 0020 Homogeneity Homogeneous PLM NYS 198.1 Friable 10/12/2018 Brown/White 18.00%Cellulose 70.00%Gypsum None Detected 3.00%Ca Carbonate 0.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed Ptah NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Initial Report From 10/15/2018 07:56.37 . Test Report 198VCM-7.30.0 Printed:10/15/2018 7:56.37 AM Page 4 EMSL Analytical,Inc. EMSL Order: 061820975 CustomerlD: TCNS29 . 52a Mineola Avenue,Carte Place,NY 11514 CustomerPO: Phone/1-ex: (516)997-7251/(516)997-7528 ('ltp-llwvw.FI/SL.ixn carieplarrtahatemsl_corn - Pro tiD: Test Report:Asbestos Analysis of Bulk Material Non Asbestos Test Color Fibrous Non-Fibrous Asbestos Sample ID HA 7-WP1 Description Wall Paper 06/8 209 75-0021 Homogeneity Heterogeneous PLM NYS 19>O Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198-6 NOB '0/14/2018 Tan/WhiteNV Inconclusive:None Detected arious TEM NYS 198.4 NOB 10/14/2018 Tan/WhiteN None Detected serious Sample ID FIA 7-WP2 Description Wall Paper 461820975-0022 Homogeneity Heterogeneous PLM NYS 198..1 Friable Not Analyzed 1 PLM NYS 198.6 VCM �._._._ Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Tan/WhiteN Inconclusive:None Detected 1 arious TEM NYS 198.4 NOB 10/14/2018 Tan/WhiteN None Detected ar"saus Sample ID HA 7-WP3 Description Wail Paper ofi1820975-/023 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 10/14/2018 Tan/WhiteN Inconclusive:None Detected arious TEM NYS 198.4 NOB '7014 20'8 Tan,WhiteN None Detected anous Sample ID HA 10-P1 Description Chimney Pipe 061820975-0024 Homogeneity Homogeneous PLM NYS 198.1 Friable 10/1112018 Gray 20.00%Quartz 30.80%Chrysotile 35.00%Ca Carbonate 14.20%Non-fibrous(other) ___.___ PLM NYS 198.6 VCM Not Analyzed ._� PLM NYS 198.6 NOB Not Analysed TEM NYS 198.4 NOB Not Analyzed Sample ID HA 10-P2 Description Chimney Pipe 061820975-0025 Homogeneity PLM NYS 198.1 Friable 10/1112018 Positive Stop(Not Analyzed) PLM NYS 198.E VCM Not Analyzed PIN NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed —.P (Initial Report From 10/15/2018 07:56:37 Test Report 198VCM-7.30.0 Printed:10/1512018 7:56:37 AM Page 5 EMSL Analytical,Inc. 1 1\ EMSL Order: 061820975 528 Mineola Avenue,Carle Mace,NY 11514 Customerl 0: TCNS29 Phone/Fax: (516)997-7251/(516)997-7628 CustomerPO: htbliv.iww.EMSL.COM carkVacelabtlems1 CAM ProjectID: i Test Report:Asbestos Analysis of Bulk Material Non Asbestos Test Color Fibrous Non-Fibrous Asbestos Sample ID HA 10-P3 Description Chimney Roe 061820975-0026 Homogeneity - —— PUS NYS 198.1 Friable 10/11/2018 Positive Stop(Not Analyzed) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed -- ---------— — TEM NYS 198.4 NOB Not Analyzed Sample ID HA 8-SW1 Description Fake Stone 06/820975-0027 Homogeneity Heterogeneous PLM NYS 198.1 Friable 10/11/2018 Gray/White 35.00%Ca Carbonate None Detected 65.00°A,Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID HA 8-SW2 Description Fake Stone 06/820975 0028 Homogeneity Heterogeneous 1 PLM NYS 198.1Priabis 10111/2018 Gray/White 10.00%Quartz None Detected 35.00%Ca Carbonate 55.00%Nun-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed .. ___ ...... TEM NYS 198.4 NOB Not Analyzed Sample ID HA 8-SW3 Description Fake Stone 061820975-0020 Homogeneity Homogeneous PLM NYS 198.1 Friable 10/12/2018 Gray 20.00%Quartz None Detected 35.00%Ca Carbonate 45.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 1984 NOB Not Analyzed - , -- TEM NYS 198.4 NOB Not Analyzed Sample ID HA 9-SWA1 Description Stone Adhesive 081820975-0030 Homogeneity Homogeneous PIM NYS 198.1 friable 10/1 /20'8 Gray 55.00%Quartz None Detected 20.00%Ca Carbonate 25.00%Non-fibrous(other) Sample is mortar. Not"adhesive." PLM NYS 198.6 VCM Not Analyzed PLOA NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed !Initial Report From 10/15/2018 075837 — ----- Test Report t98VCM-7.30.0 Printed:10/1512018 7:56:37 AM Page 6 � A EMSL Analytical,Inc. (EMS-over: 06182097s EMSL. 528 Mineola Avenue,Carle Place.NY 11514 CustomeriD: TCNS29 F'honetFax: ;h'6)997-7251 1(516)997-7528 CustomerPO: carteclacelah: rnsl.com ProjectdD: Ji Test Report:Asbestos Analysis of Bulk Material Non Asbestos Test Color Fibrous Non-Fibrous Asbestos Sample ID HA 9-SWA2 Description Stone Adhesive oe f 820975-003 r Homogeneity Homogeneous PLM NYS 198.1 Friable 10/11/2018 Gray 60.00%Quartz None Detected 20.00%Ca Carbonate 20.00%Non-fibrous(other) Sample is mortar. Not"adhesive." PLM NYS 1611.6 VCM Not Analyzed PLM NYS 191.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID HA 9-SWA3 Description Stone Adhesive 06 1 8209 75-003 2 Homogeneity Homogeneous PLM NYS 198.1 Friable 10f12/2018 Gray 80.00%Quartz None Detected 20.00%Ca Carbonate 20.00%Non-fibrous other) Sample is mortar.Not"adhesive." PLM NYS 198.6 VCM tic*Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Analyst(s) _ Bien Russell Steve Jusczuk Jennifer Lovell /�/ Soaifuf Islam /Daniel Clarke,Asbestos Laboratory Manager or other approved signatory NOB=Non Friable Organically Bound N/A=Not Applicable VCM=Vermiculite Containing Material -In New York State.TEM is currently Me only method that can be used to detemrne if NOS materials can be considered or treated as non-asbestos containing. AG samples examined ku the presence of vermiculite when analyzed via NYS 198.1. NYS Guidelines for Vermiculite containing samples are available at httn:Airaw.wadswoeth.oreiabcerJeiaocertiformsNesmicu itetnlerimGutdance RnvO7013,pdf IEMSL maintains tiabdity limited to cost of analysis.This report relates only to the samples reported above and may not be reproduced.except in tuft,wittrout written approval by EMSL. IEMSL bears no responsibility for sample collection activities or analytical method limitations. interpretation and use of test results are the rasponsibiity of the client.Samples were Ireceived in good condition unless otherwise noted. IThis report must not be used by the client to daim product certification.approval,or endorsement by NVLAP,NIST,or any agency of the federal goverment.This report may contain (data that is not covered by the NVLAP accrexlilatxut. I samples analyzed by EMSI Analytical.Inc-Cade Race.NY NYS LLAP t t as ;Initial Report From 10/15/2018 07:56:37 Test Report 198VCM-7.30.0 Printed:10/15/2018 7.56:37 AM THIS IS THE LAST PAGE OF THE REPORT. Pane 7