DEMO-0164-2022 Office Use Only
DEMOLITION APPLICATION Permit#:
Permit Fee:$
Town of Queensbury
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y �A! )' Reviewed By:
Demolition Location: Tax Map ED 18--
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? �
2. Type of structure to be demolished: �.�._.
a. Residence_ d. Storage Building D E C IE 0 IE
b. Garage�� e. Other:
c. Business APR 0 6 2022
3. What type of utilities are connected to the structure: TOWN OF QUEENiISBURY
a. Gas . f. Well-Water Pump BUILDING&CODES
b. Fuel Oil g. Public Sewer
c. Propane h. Other
d. Electric i. None
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes No
ADDITIONAL INFORMATION:
1. Two inspections are required: an inspection to determine that utilities are
disconnected, 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: 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: (sue 7i
Demolition Application Revised February 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 4 C
Mailing Address, C/S/Z: L.® P62 QUEG 12 1 Z84
Cell Phone: ll$ q&p Land Line: &JA
Email: m U2,e,e v1 6 W q j� Ge_ ,via!(, c�c3 rv1
• Primary Owner(s):
Name(s): — 5;�, •�:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Check if all work will be performed by property owner only
• Contractor: (List all additional contractors on the back of this form)
Contact Name(s): ,4Z ,L- C,4-1A L-'-
Contractor Trade: -3ejlc®.r�E ,C
Mailing Address, C/S/Z: 24::f3 &1'/i0c>r-J1 4� _
Cell Phone: �i 0. 734,1 76, Land Line:
Email: vl'c_f�c�s�bv�r� �ts� &I Kr- Ur
**Workers' Comp documentation .must be submitted with this application**
r .,6j5 &T' -fc�,-xr&s
Contact Person for any questions regarding this project: 14/,�i:-o'- <:7�
Cell Phone: o 444 Lo �(=L-Z, Land Line:
Email:
Demolition Application Revised February 2022
TOWN OF OUEENSLIURY
BUILDING & CO E DEP T
Reviewe,Vk 13
Date'
APR 0 6 2022
TOWN OF QUSSNSBURY
Asbestos SurvC y BUILfOfNG & CODES
Michael Crotty
19 Fitzgerald Rd
Queensbury, NY 12804
Inspection date: 3/26/2022
TOWN OF 0,1JEF-NS13kJRy
BUILDING DEPAR11AENIT
Based on our limited examination,compliance
with our comments shal, not coristrued �s
Ications are in
indicating the plans and s ec ing codes of
with tie ul
full compliance \1
Tom Callahan /TC Inspections New York State.
1 Knolls Dr
Queensbury,NY 12804
Inspector# 17-42926/Contractor# 109425
ceL[# 518-832-9750
289-18-1-17 DEMO-0164-2022
Crotty, Michael &Alice
19 Fitzgerald Rd
Demolition of garage
Summary of Inspection
At the request of Michael Crotty an asbestos survey was
performed on the garage located at 19 Fitzgerald Rd Queensbury,
NY .
Scope of the Inspection/Survey is to determine if the garage
contains any asbestos materials prior to demolition.
Suspected Asbestos containing materials were removed and sent
out for sampling. The following samples were removed -and sent
out for testing.
Homogeneous areal( non friable) Roof shingles (no asbestos
detected)
Homogeneous area 2 (non friable) Tar paper(no asbestos detected)
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.
f
Conclusion
No Materials were identified as containing more than 1% asbestos
material. Therefore no asbestos abatement is required.
A copy of this report should be kept at the work site.
A copy of the sample analysis is attached to this report
l
k' Neuv York State'-yDepartrnent of;Labor;;
Division of Satety.end Health,'
License and C,e`rtiticate'llnit'
State Cainpus,Building 72
Altiany,NY,.12240
.,. ,:.'�°i'..;;':':•, + -',:,:_^;pry:,�);�' ;:
'•'ASBESTOS HANDLING LICENSE,:
Thomas,M.Callahan'dba TC inspectibits: :FILE NUMBER: 18=109425
ri.. LICENSE NUMBER:`
-1 Knolls"Drive LICENSE CLASS: RESTRICTED.;
DATE,OF ISSUE: 01121&22
Q ueensbUry NY 12804. EXPIRATION DATE: 01/3'112023
{? qn
Duly�Authbrized'Representative Thomas`Callahan:
-!.tom y?i: ,p . .•�:r-�> •:1.:',•;.3.•r,._.`.':'.i ;'.-- -
'fhis'lioense has,been issued in accordaiice4ith'applic ble proyts�ons;oEArticle,30.'of th_e Labor Law"of New York State and of:
the Neiv York State Codes,Rules and Regulations(12NYCRIi P rt 56) It is subject to suspension or revocation'for a(1)
sernous violation of state,federal or local laws withregadt n projc,or(2)demogstrated1ack of" e
responsibility in the conduct of any<jot imvolvirig`asbcsfos or.5sbesto"s aiatenat. :'
�.
This license is:zyalid only,for the contractor named-above and-thi0icense or'a`photocopy must.be pcdmin6ily displayed'-at the
asbestos project vorksite;rThis'-if nse.verifies(liar all',persons employed by:,the licensee on afi as&stos$roject in-New York
State have been"•issued an?lsbcsios Certi>icafe,appropriate for the ty pe of work they perform,by the New York State
Department of Labor,
Amy Phillips,Director
SH 432(8t12) _ ; issioner of Labor
STATE OF,NEW YOR ,
K DEPAPTMENT OF LABOR .(
A56ESFOS r-ERTIFICA7E'v•.
FHOMASWCALLAHAN.
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tv1USTiBE'CAI?I21ED;ON;MBES
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EMSL Analytical; Inc. EMSL Order: 062205976
Customer ID: TCN929
528 Mineola Avenue Carle Place,NY 11514
Tel/Fax:(516)997-7251/(516)997-7528 Customer P�:
hltpil/wvrv.EMSL.COm/carleplacelab@emsl.com Project ID:
Attention: Tom Callahan Phone: (518)832-9750
TC Inspections Fax:
1 Knolls.Drive Received Date: 04/01/2022 1:46 PM
Queensbury,NY 12804 Analysis Date: 04/05/2022
Collected Date: 03/26/2022
Project: 19 Fitzgerald Rd,,Queensbury
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID .RS1 Description Roof Shingles
0622059,76-0001 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM"NYS.198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 04/05/2022 Gray/Black 5.40%Glass 94.60%Other Inconclusive:None Detected
TEM NYS 198.4 NOB '04/05/2022 Gray/Black 100.00%tither None Detected
Sample ID RS2 Description Roof Shingles
062205976-0002 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 998.6 NOB 04/05/2022 Gray/Black 7.50%Glass 92.50%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 04105/2622 Gray/Black 100.0.0%Other None Detected
Sample ID TP1 Description Tar Paper
062205976-000.3 Homogeneity Homogeneous
PLM NYS 198A Friable Not Analyzed
PLM NYS 198:6 VCM Not Analyzed
PLM NYS 198.6 NOB 04/05/2022 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 N013 04/05/2022 Black 100.00%Other None Detected
Samplef0 TP2 Description Tar Paper
062205976-0064 Homogeneity Homogeneous
PLM NYS 196.1 Friable NotAnalyied
PLM NYS 198.6 VCM Not Analyzed
P.LM NYS 198.6 NOB 0410512022 Black 100.00%Other Inconclusive:None Detected
TENT NYS 198.4 NOB 04/05/M2 Black 106.00%Other None Detected
Initial report from•04/05/2022 14;27:23
A56_i96x_tl009_0041 Printed 415/2022 2;27:26PM Page 1 of