DEMO-0711-2022 i
Office Use Only
DEMOLITION APPLICATION Permit#: 1) 20 22_
Permit Fee:$ 1I >rD-
"Town of Queensbnn
Invoice#: " .l
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y / N J Reviewed By:
Demolition Location: 4 Onondaga Drive, Cleverdale, NY Tax Map ID g: 239.8-1-49
**AID ASBESTOS REPORT IS R,EQUIR,ED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? Construction �4r1.9�,L C
'2. Type of structure a demolished:
a. Residen d.Storage Building 2 2
b. Garage e. Other: D L� E 9 V�n
c. Business
3. What type Q�pities are connected to the structure: NOV 2 8 2022
a. Gas Li f. Well-Water P a TOWN OF QUEENSBURY
b. Fuel Oil g. Public Sewer BUILDING&CODES
c. Pro an h. Othe
d. Electric � i. None
e. Public Water 1>~ I
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:f/U I M yg B50,J
SIGNATURE:_—44 14 DATE:
Demolition Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): G� I c_� I ►'°1 r.,I d9 or3 2D�/7� TJr'I �- /,
Mailing Address, C/S/Z: /� X 4:5-
Cell Phone: S/ 'y 7 '6 07-3 Land Line: S /S &-5Z S77-3 i
• Primary Owner(s):
Mailing Address, C/S/Z: -� rS�P�c , ,2��'% Y'✓i i2 G a%>� r"1 `/ �-�
Cell Phone: 2 7 Zv9 3�9G / Land Line:
Email: 4--p vPF p2
❑ 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): %'�>ti'Ka��� I v� ' 1r�"� ��2 �, / +J":.
Contractor Trade: ,8 e-i/L j9,6 Az. / 2 ��n T Y r'? )4 rJ/} &-4- P,-
Mailing Address, C/S/Z: L `6✓Et23�
Cell Phone: A a l5 Land Line: .!10
Email: q r -P*-4
"Workers' Comp documentation must be submitted with this application"
Contact Person for any questions regarding this project:
.,Cell Phone: Land Line:
Email:
Demolition Application Revised June 2022
FILE f��JPY TOWN of QU
BUILDING & CODES
Reviewed S DEPT.
Asbestos Survey
Date: 7- S
��
William Mason
4 Onondaga Dr
Queensbury, NY 12804
Inspection date: 11/20/2022
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NOV 2 8 2022
Tom Callahan /TC Inspections
TO OF
1 Knolls Dr UN Y BUILDING&CODES
Queensbury,NY 12804
Inspector# 17-42926/Contractor# 109425
cell# 518-832-9750
239.8-1-49 DEMO-0711-2022
Finegold, Ruth & Robert
4 Onondaga Dr
Demolition of residence
Summary of Inspection
At the request of William Mason an asbestos survey was
performed at 4 Onondaga Dr Queensbury, NY.
Scope of the Inspection/Survey is to determine if the house
contains any asbestos 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 area 1( nonfriable) Bathroom vinyl floor (no
asbestos detected)
Homogeneous area 2 (friable) Drywall (no asbestos detected)
Homogeneous area 3 (nonfriable) Roof shingles (no asbestos
detected)
Homogeneous area 4 (nonfriable) Tar paper (no asbestos detected)
Homogeneous area 5 (nonfriable) Floor adhesive (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.
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
'F
New=York State,;.bepartrnent.of,Laboi,
Division of Safety and Health;
- '.License and CerUricate,Unit` =
State Campus;Building12"
Albany,.NY_12210 ••
HANDLING IN LICENSE~_,
Thomas..M.Callahan dba TC inspections;r.r; FILE NUMBER: 18=1t?9425
' "^ LICENSE NUMBER-,109425_
_1 Knolls Drive , ::'. LICENSE CLASS: RESTRICTED_
DATE OF ISSUE: 01/21/2022 .
., 4Queensbury,NY 12804, Y ;: :EXPIRATION DATE-- 01/31/2023
Du'ly.Authorized Representative`=Thomas Callahan:
This itcense.lias been issued in acdofdanicciWith appIicable.provisi6-ns°!f Att c1e 30 of the Labor Law of New YorkState and of. .'•
the New York State Codes,Rules i nd'Regulations;(12 NYCRR Part`56): I'j s sgbject to suspension or revocation'for a(])
serious violation of state,federal or local laws witli'regard;to the conduct;of ap-asbestos project,or(2)demonstrat4lack.of j!
responsibility in the.conduct of any:job`involving asii'esCos'or-as bestos riiaferial °'3. =, ti
This license is'valid only,for the contractor-named-iiboye and this,license oi`"aphotdcopy must.be,prominently displayed-at the
asbestos project jvorksite.This-license vcrieiies that alf..persons employcd•by:thc licensee on anasbestos project-in New York
State have becri%issued an Asbestos Certificate;appr`opnate•for itie.type.of work-they perform,by the New York State -
Department of Labor.
Amy Phillips,Director
SH 432(8/12) =:» issioner of Labor
STATPOF NEW YORK DEPARTMENT 0F.LA80R
A6BEST65 CERTIFICATE "
THOMAS M CALLAHAN
CtASS(EXPIRES)
D INSP(12122)
S PROJECTS
MUST BE CARRIED ON ASBESTO
--_ I�INIOIYiI �'BI c1A,
EMSL Analytical, Inc. EMSL Order: 062224376
528 Mineola Avenue Carle Place,NY 11514 Customer ID: TCNS29
TeVFax:(516)997-7251/(516)997-7528 Customer PO:
http:flwww.EMSL.com/cadeplacelab@emsl.com Project ID:
Attention: Tom Callahan Phone: (518)832-9750
TC Inspections Fax:
1 Knolls Drive Received Date: 11/22/2022 10:53 AM
Queensbury,NY 12804 Analysis Date: 1.1/23/2022-11126/2022
Collected Date: 11/20/2622
Project: 4 Onondaga Dr.
Test Report:Asbestos Analysis of Bulk Material
Analyzed Non-Asbestos
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 1-BVF1 Description Bedroom-Vinyl Floor
062224376-0001 Homogeneity Heterogeneous
PLM NYS 198.1 Friable NotAnalyzed
PLM NYS 198.6 VCM. NotAnalyzed
PLM NYS 198.6 NOB 11/25/2022 Brown/White/ 6.10%Glass 93.90%Other Inconclusive:Nona Detected
Black
TEM NYS 198.4 NOB 11/26/2022 Brown/White/ 100.001/6 Other None Detected
Black
Sample ID 1-8VF2 Description Bedroom-Vinyl Floor
0s2224376-0002 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 190.6 VCM NotAnalyzed
PLM NYS 198.6 NOB 11/25/2022 Brown/Gray/ ' 1.60%Glass 98.40%Other Inconclusive:None Detected
White
TEM NYS 198.4 NOB 11126/2022 Brown/Gray/ 100.00%Other Nona Detected
White
Sample ID 2-DW1 Description Drywall
062P24976-0003 Homogenolty Heterogeneous
PLM NYS 198.1 Friable 1112 312 0 2 2' Tan/White 4.00%Cellulose 36.00%Ca Carbonate None Detected
55.00%Gypsum
5.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB NotAnalyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 2-DW2 Description Drywall
062224376-0004 Homogeneity Heterogeneous
PLM NYS 198.1 Friable 11/23/2022 Tant White 6.0.0 Cellulose 34.00%Ca Carbonate None Detected
55.00%Gypsum
5.00%Non-fibrous(other)
PLM NYS 198.6 VCM NotAnalyzed
PLM NYS 198.6 NOB NotAnalyzed
TEM NYS 198.4 NOB NotAnalyzed
Initial report from:11/2612022 01:01:55
ASB 198x 0009_0001 Printed 11/26/,2022 6:09:23AM Page'I of
EMSL Analytical, Inc. EMSL Order: 062224376
528 Mineola Avenue Carle Place,NY 11514 Customer ID: TCNS29
Tel/Fax:(516)997-72517(516)997-7526 Customer PO:
http:/M1nnv.EMSL.com/cadeplace.tab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Non-Asbestos
Analyzed
Test Date. Color Fibrous Non-Fibrous Asbestos
Sample ID 3-RS1 Description Roof Shingles
05222437&0005 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 190.6 NOB 11/25/2022 Cray/Black 5.50%Glass 94.50%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/26/2022 Gray/Black 100.00%.Other None Detected
Sample ID 3-RS2 Description Roof Shingles
062224376-0006 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11125t2022 Gray/Black 3.00%Glass 97.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 11/26/2022 Gray/Black 100.00%Other None Detected
Sample ID 4-TPI Description Tar Paper
062224376-0007 Homogandity, Heterogeneous
PLM NYS 198.1 Friable NotAnalyzvd
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 168.6 NOB 11125/2022 Black 100.00%,0ther Inconclusive:None Detected
TEM NYS 198.4 NOB 11/2612022 Black 100.00%Other None Detected'
Sample to 4-TP2 Description Tar Paper
062224376-0008 Homogeneity Heterogeneous
PLM NYS 198.1 Friable NotAnalyzad
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.E NOB 11/2512022 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/26/2022 Black 100.00%Other Mono Detected
Sample ID 5-FA1 Description Vinyl Floor Adhesive
062224376-0009 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/2512022 Black/Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 1112 8/2 0 2 2 Black/Yellow 100.00%Other None Detected
Sample ID 5-FA2 Description Vinyl Floor Adhesive
062224376-00r0 Homogeneity Heterogeneous
PLM NYS 198.1 Friable _ Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/25/2022 Black/Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 1112612022 Black/Yellow 100.00%Other - None Detected
Initial report from:11/2612022 01:01:55
ASB_198x 0009.,0001 Printed W26/2022 9:09:23AM Page 2 of 3
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