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DEMO-0106-2020
Office Use Only permits Domo ~O Jule 2020 ne G Mens ren \|]Permit Fee:$__/SO.00 Town of Queensbury MAR 14 2000 iI]©|tnvoicest:2-4 A742BayRoad,Queensbury,NY 12804,_wy | |L____1P:518-761-8256 www.queensbury.net tT Demolition Location:/Z0 Aviation Road’tax map w#:295°-/S-/~73. **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: ¢Applicant:. Name(s):‘M+4ep Construction Mailing Address,C/S/z:__5/CRowWky Road ftudson Valls,Ny 7283 Cell Phone:_(5/8_)A29-$70 landline:(5/8 )778-033 © Email Cindy a.C WlltepConsthcuction te Com ¢Primary Owner(s) .np -.Name(s):L/pi7ed BE bral Palsy Pssociation of He Tei -loanties Ine Mailing Address,C/S/2:2X (orporate lJood §BJvd.577 Fpor Allan Cell Phone:_()Land Line:_() Email:, O Check if all work will be performed by homeowner only ¢Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):tee Construction Contractor Trade:General Pontra efor Mailing Address,C/S/z:5/7 (eocwsey Roa udson Falls NV /A&3CellPhone:(5/8 )QQ7-3 JOY landline:(5/8 _)725-033 ¥ Email:Cindy a ©hilltop Constructionco.Com **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:72 Albrecht Sie Cell Phone:_(4/5)Fa9-870 Land Line:_(575)“O35 Email:Cindya_@ fr /PapconstructionCo .Com Demolition Application Revised February 2013, DEMOLITION INFORMATION: ) 1.Where will demolition material be disposed? TaD Secured landfil2.Type of structure to be demolished: a.Residence b.eters docked c.Business d,Storage Building___ 3.What type ages are connected to the structure: a.Gas Fuel OilPropane Electric >< Public Water _6 Well-Water Pump. Public Sewer Other i.None 4.Have ALL utilities been disconnected?Yes No X FR me aoe 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. 3.Workers’Comp insurance information is required to be submitted with this application. Declaration:|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. Ihave read and agree to the above: PRINT NAME:Cind S All vecht SIGNATURE:—de a Q belt oar J/-2o Demolition Application Revised February 2019 FILE COPY TOWN OF QU BUILDING & TOWN OF QUEENSBUF BUILDING BEPARTHIENT Based on our limited examination,compliancefcommentsshallnotbeconsiruedicingtheplansandspecicationsarein jompliance with the i =me mplnce wih te Buldng Codes of Reviewed By+ Date:~Healthy Home U RE:160 Aviation Rd 295.18-1-73 DEMO-0106-2020 Queensbury,NY 12804 Association 160 Aviation Rd To Whom It May Concern:Demolition of SFD Adirondack Healthy Home,LLC (ADK)completed an asbestos survey of the residential structure,located at 160 Aviation Rd in Queensbury,New York on October 11,2018.The inspection was performed by a NYS-DOL Certified Asbestos Inspector,and in accordance with New York Department of Labor Division of Saftey and Health and the Environmental Protection Agency (EPA)Requirements. A detailed summary table of the sampling is included;however,this report should be read in its entirety. Area Description/Scope of Work: The structure,located at 160 Aviation Rd in Queensbury,New York is a two-story wood structure with a sloped shingled roof.ADK performed limited sampling at the structure on October 11,2018 in preparation for demolition activities. Inspection Strategy/Sampling Protocol: The inspection consisted of grouping suspect asbestos containing materials into homogeneous areas based on the color and texture of the material,and then performing representative sampling of the materials included in those homogeneous areas.NYSDOL has requirements for the minimum number of samples that can be collected from each homogeneous area (three samples of each miscellaneous material,three samples of each type of thermal system insulation,and the sample requirements for surfacing are based on square footage).Following completion of the on-site inspection/sampling,samples were submitted to an New York State accredited laboratory for analysis. Results: NYSDOL and the EPA recognizes a material as Asbestos Containing Material (ACM) if an asbestos content of greater than one percent asbestos is detected in a representative sample analyzed by polarized light microscopy. Every effort was made to identify all materials in accessible areas.There is the possibility that suspect materials were not identified in inaccessible areas.If any suspect material is discovered that is not included within this report,it should be sampled before it is physically disturbed. Please be advised that I have inspected the property on the date indicated on the enclosed report and taken random samples as required.|have sent the samples to a New York State approved laboratory for testing. Based upon my inspection combined with the laboratory test results for the samples taken from the subject property,there were no asbestos containing materials (ACM's),found on the subject property or identified in the samples tested by the laboratory.Accordingly,it is my understanding that,subject to any and all applicable states or locals and regulations at the time of the enclosed test report,the property owner may proceed with remodeling or demolition as the owner sees fit. poVAaStevenGrimaldi NYSDOL ASBESTOS INSPECTOR CERT#18-44782 NYSDOL ASBESTOS HANDLING LICENSE#110376 [6-10-19 PROJECT INFORMATION. ASBESTOS INSPECTION REPORT ABBREVIATIONS KEY aR aa SoeONELG=‘SAMPLE IDENTIFICATION "SG mn geek * ‘Codie ation Eel Functional |T TFs DamageFurcal] Homogeneous areas |Quant ace ca.pamage teal Foor -Wall Wee hat é E i Fe Ceiling SYearBen<é ‘a :tod —4/Other SHathac é E H ot zB Other SheetlOon {2 E t bow Other Sheet,Eo i Lge ae! Floor =e Wet Celia)Tle E fa %=F Ceiling Tae pet AFQDecyl£E Otter Coho Tite ?Ez =]Other eof ol Zz a Fleer =FR Lele d eco Ue E A ce t Zo3HEadiosLEEEAfi z ~ D TOter Godkhes dee OF fF oA ToBIOtheRvakativnteinCFFEAHgl Other Coa laten Qu LEI EA 1 Uf. Fis C Dasse E EAE 7 7 Sat Noor Glee BASSE EF E t 7 IYcetineLenelolurPatSFoFEALoess-zs Oiker Other a 7” Other Floor Gurpar Glue foose FEFWa Ceiling -a o mol5OtherCarpetOleBos—EA t afr Oihet Carat Ole dose fF EA 1 21 oe TI] Other Foor Wal ee = Ceiling Other Oiter “Other i i —““ \(eo fusca Qa AS ae HAYESMICROBIALCONSULTING 3005 East Boundary Terrace,#F Midlothian,VA_23112,USA” 804.562.3485 Fax:804.447.5562 contact@hayesmicrobial.com http:/nayesmicrobial.com/ HMC #18036945.. ‘Analysis Report prepared for Adirondack Healthy Home P.O.Box 4623 Queensbury,NY.12804 Phone:(518)744-0415 Job Name: Date Sampled: Date Analyzed: Report Date: 160 Avation Rd Queensbury,NY 10-11-2018 10-16-2018 10-16-2018 EPA Laboratory ID#VA01419 nvlag Apes. NVLAP Lab Code:500096-0 ‘Asbestos License:300435 License:#PH-0198 Page 1 of7 HAYES MICROBIAL CONSULTING 3005 East cet Terrace,#F S04 5523008 Foe 004A8562 HMC #18036945 Adirondack Healthy HomeP.O.Box 4623 ‘Queensbury,NY 12804 October 16,2018 Client Job Number: Client Job Name:160 Avation Rd Queensbury,NY Dear Adirondack Healthy Home, We would like to thank you for trusting Hayes Microbial for your analytical needs.On October 15,2018 we received 21 samples by FedEx for the jobreferencedabove.21 samples were receivedingoodcondition. ‘The results in this analysis pertain only to this job,collected on the stated date and should not be used in the interpretation of any other job.This reportmaynotbeduplicated,except in full,without the written consent of Hayes Microbial Consulting,LLC. This laboratory bears no responsibilty for sample collection activities,analytical method limitations,or your use of the test results.Interpretation andUseoftestresultsareyourresponsibility.Any reference to health effects or interpretation of mold levels is strictly the opinion of Hayes Microbial Consulting.In no event,shall Hayes Microbial Consulting or any of its employees be liable for lost profits or any special,incidental or consequentialdamagesarisingoutofyouruseofthetestresults. Atlan 71.Heyca- ‘Steve Hayes,BSMT(ASCP) Laboratory Director Hayes Microbial Consulting,LLC Page 207 H AY E Ss Adirondack Healthy Home NY ELAP 198.1 -PLMEPRGEEncP.O.Box 4623 Subsontracted Lab:Amerise-Lab 1D#10984 ‘3005 East Boundary Terrace,#F Queensbury,NY 12804 ilothian,USA 2MatonVA23112,USA Phone:(518)744-0415 HMC #18036945 [Job Number {Job Name:160 Avation Rd Daie Gollecied—10n018Collectedby:Steve Grimaldi Queensbury,NY Date Received:10/18/2018 Email info@adkhealthyhome.com oe Date Reported:10/16/2018 #|Sample |Name Description ‘Rabostos Fibers ‘Other Fibers___[Non Fibers 3%Cellulose fers 1 801 Sheet Rock Bulk Material /White/Brown (None Detected)92% 8%Callulose fibers 2 802 Sheet Rock Bulk Material /White/Brown (None Detected)92% 5%Calulose fibers 3 803 Sheet Rock Bulk Material /Gray/Brown (None Detected)95% 7%Cellulose fibers 4 804 Sheet Rock Buk Material /White (None Detected)93% 7%Caluiose fibers 5 205 Sheet Rock Bulk Material /White (None Detected)93% 2%Fiberglass | 1"ait Foundation Mortar Bulk Material /GrayAWhite (None Detected)98% 2%Fiberglass 12 ar Foundation Mortar Bulk Material /Brown/Gray (None Detected)98% ~We 2%Fiberglass 13 a13 Foundation Mortar Bulk Material /Brown/Gray (None Detected)8% 14 ane Foundation Mortar Bulk Material /Brown/Gray (None Detected)(None Detected)100% 2%Fiberglass681sFoundationMortarBulkMaterial/RediGray (None Detected)98% 4).Sorte:oS Date:1082018 Reviewed by:Date:_sonie018 Page 3017 HAYES MICROBIAL CONSULTING Adirondack Healthy Home P.O.Box 4623 NY ELAP 198.6 -PLM ‘Suboontracted Lab:Amerisi-Lab ID#10964asacoounanserahone:(510)744.0018, lothian,1;Phone:(518)744-0415Boase23485Fax:604.447 5862 er)HMC #18036945 [ob Naber ob Name:160 Avation Ra Date Colecied?TOR Ta078 Cotected by:Steve Grimala Queensbury,NY Date Recewved:—10/182018 Ema info@adkhealthyhome.com Date Reported:__tovte018 #‘Sample Name Description Asbestos Fibers ‘Other Fibers Non-Fibers|3%Forgas 6|a6 Cling Tie Buk Material /Wnitetown|(None Detect)05% 3%Foergiass 7|e7 Cling The Buk Material/WhteBrown|(None Detect)35% 3%Fbsigass 2|208 Celing Te Bulk Material/WhterBrown|(None Detectd)97% 3%Fbegass 0|208 Celing Te Buk Material/Wnitefown|(None Detectc)o7% 7%Fibeass0|810 Ceting Tie Buk Material whiterown|(None Detected)28% 15%Fibegass|oe Glue Flooring Buk Material /Of White (None Detected)25% 10%Fbergass|a7 Glue Flooring Bulk Material /RedGray (None Detect)0% 10%Fbeigiass|oe Glue Fring Bulk Material /Of White (None Detected)30% 10|ore Glue Carpet Bulk Material /Tan/Wite (None Detectea)(None Detected)100 % 2%Fbsigiass 20|820 Glue Carpet Bulk Matorial/Tanfwnite (None Detected)28 % |330 Fbergiass a]ee Glue Carpet Bulk Material /TanMWhite (None Detected)28% {. Signature:Lp Date:_10/16/2018__Reviewed by:8 Date;_10n62018 Page 4 017 Adirondack Healthy Home Asbestos -Additional InformationP.O.Box 4623, 3005 East Boundary Terrace,#F Queensbury,NY 12804 Midlothian,VA_23112,USA Phone:(518)744-0415804.562.3495 Fax:804.447.5562 HMC #18036945 All samples were received in acceptable condition unless otherwise noted on the report.This report must not be used by the client to claim product certification,approval,of endorsement by AIHA,NIST,NVLAP,NY ELAP,or any agency.The results relate only to the items tested.Hayes Microbial Consulting reserves the right to dispose of all samples after a period of 60 days in compliance with state and federal guidelines Al Polarized Light Microscopy (PLM)results include an inherent uncertainty of measurement associated with estimating percentages by PLM.Measurement uncertainty data can be provided when requested. ‘None Detected’-Below the detected reporting limit of 1%unless point counting is performed,then the detected reporting limit is .25%. Per NY ELAP198.6 (NOB),TEM is the only reliable method to declare an NOB material as Non-Asbestos Containing. ‘Any NY ELAP samples that are subcontracted to another laboratory will display the name and ELAP Lab Identification number in the report page heading of those samples.The original report provided to Hayes Microbial Consulting is avallable upon request. Signature:Date:_10/162018_Reviewed by:4 Date:10162018 Page 5 of 7 Company:HAYES MICROBIAL CONSULTING 3005 East Boundary Terrace,aF Midlothian,VA_23112,USA, 804.562.3435 Fax:804.447.5562 Job Number Job Name: dawcawcet ope ||LGC Auten ef GreenSbery Avy |.ADIRONDACK HEALTHY HOME \‘inert Py TULL RD. QUEENSBURY,NY 12904 Notes: de Calector S.C ty,Ema nk EF Lic bh iy, Asbestos -Chain of Custody Form v 101302.5, HMC # 036945 Woe Senpe?Saris ome neiyes Type]Vatume Tat eroapt [Pen Bop1[9st 2uh L L503|ei -2 z +___|2j___Ses|“.a L 3 ||Se |[-q Ll 4.5 {_[-i 5|__fae i =f ,|Wo a 2 nakarhe —t‘Analysis Type Description[or por Taser — |joc A Pow Cot ae i eT esNy|NYSDOH FLAP ioe -es 1 Day.?Day.t Day 5 Day.Pow [ecw NIOSH 7400 Tinie fay.#Day.2 Day,3 Day,5 Day |ew frewa [TEM a antay a 7 1 Day?Oay.8 Day.§Day L frewc—[rewsei non Tee Fes ay =IenginedbyLA[ow]eower(IG)(SUT Date [Pe |wn7HivesMicaConsingB00CalFinneyTeaseSard—wTaaN 2 BT TSA was Raia sors BIO EONAR Soo Page 6 of 7 -Chain of Custody *H AY E Ss Company:Asbestos aoe agora a 1 HO aA Forny 101302 5MICROBIALCONSULTING=MM py TUTE HMC # 305 Eas Boundary Terrace,HF SUEENEBURwv 12808 Midlothian,VA23112,USA —T 030945804862.3835 Fax:804.447 5562 - Job Number dob Name:Collector,FS.Ge,Email:Lee lle ont by, Date Cotected /O /-/F 1G 6 bentrer Rel Nokes s jneove KesenStouy vy Sample #Sample Nome _[__Anaiveis Type Volume TAT Grow fis|Mona Mote maces 24ns|3 SIG|Ge Ga Lae |SESS : Clee SDtGlee Mow foeCacput _4 -fCarret S cpa =V — Vv < ‘Analysis Type Avaliable Tarr Around Times [Taw nw TA GOO TTT :Say i |ec [TParomcinn ~= vino Day Guy 2 Day Pay 5Day nv NYSDOH ELAP 198 1 TE 7 pom lec NIOSH 7400 ~el ‘Same Day. 1 Day.2 Day.3 Day.$Day Tex [rewa|Temar(avERAD oy 3 Day.8 Day [reve [Teme(onameiay Fast 300 Date faye cna Cons 008 La Wry Tern.Sate 4 Taian re hayeueTaD Ca oSThayeSTN Oo can Page 7 of7