DEMO-0162-2022 Office Use Only
r..
DEMOLITION APPLICATION Permit#:
/ Permit Fee:$ ) 1OFJ
Town of Queensbury Invoice#: Aq--\QrA-"
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? . Y Reviewed
Demolition Location: 1 �j ach' 'i 2z Tax Map ID #: 226. IQ 0
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? 'A-Y6wyR SI u" m rl
2. Type of structure to be demolished:
a. Residence_ d. Storage Building
b. Garage_ ('� e. Other: � �� �
c. Business ��
i
4 I
3. What type of utilities are connected to the structure: j APR 0 5 2022
a. Gas f. Well-Water Pump €
b. Fuel Oil g. Public Sewer T)VVN OF OUEENSBURY
c. Propane h. Other _. BUILDING= -CODES �u
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: t)
Demolition Application Revised February 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): U�,VIY1C1,�101V�
Mailing Address, C/S/Z: 1
Cell Phone: La rid Line: 3
Email:
• Primary Owner(s):
Name(s): �cAw,Q , Qr,00ltc�►,r�
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):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
"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 February 2022
278.-1-60 DEMO-0162-2022
Stranahan, Susan
j 1343 Bay Rd
Demolition of Garage
Asbestos
Susan Stranahan
1343 Bay Rd
Lake George, NY
Inspection date: 3/24/2022
EVER➢!
WP
FILE CAP i
Tom Callahan /TC Inspections .
1 Knolls Dr _
Oueensbury, NY 12804
Inspector# 17-42926 /Contractor# 109425
cell# 518-832 'WOF OUEENSBURY �l APR U 5 202
�UIL�3ING DEPARTMENT �1
Based on our limited examination,compliance �----with our comments shall not be construed as TpWN pF-
-",UEENSBURY
indicating the plans and specifications are in 6Ul DII.+G&CODES
full compliance with the Building Codes of
New York State.
TOWN OF QUIEE
BUILDING 'St
G
Raviewed By
Da Le:
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
Thomas M.Callahan dba TC inspections:,, -.FILE NUMBER 18-109425
- LICENSE NUMBER: 109425
1 Knolls Drive LICENSE CLASS: RESTRICTED.
DATE OF ISSUE: 01/08/2021
Queensbury,NY 12804 EXPIRATION DATE: 01/31/2022
Duly_Authorized.Representative=Thomas Callahan:
This license has been issued in accordance4ith of the Labor Law ol•Ncw fork State and of
the New York State Codes,Rulcs and Regulatigiis'.(12 NYC,RR Part 56): It is'stibjc:ct to suspension or revocation for a(1)
serious violation of state,federal or local laws witli'regard to the conduct ofan'asbestos project,or,(2)demonstrated,lack of
responsibility in th(cconduct of any job.imoiving..isbcsti>s i�r'asbcstos tiiatciial.`:"
This.licensc is valid only(irr the contractor nanicd-aibove atidThis.license or`woliotocopy must be prominently displayed at the
asbestos project worksitc. This license verifies that all persons employed by the licensee on an-asbestos project-in New York
State havc been issued an Asbestos Certificate,appropriate for the t)7te:of,work•they perlorm,by the New York State
Department of Labor_
. ate.
L"ilecn M.Franko. Director
SH 432(8/12) For the Commissioner of Labor
STATE OF NFW YORK:DEPARTMENT OF LABOR--
ASBESTOS CERTfFICAFE
THOMAS M.CALLAHAN
CLASS(EXPIRES)
D INSP(12/22)
nL _
MUST BE CARRIED ONASBESTOS PROJECTS _
ruma�u;to m.w
EMSL Analytical, Inc. EMSL Order: 062205705
Customer ID: TCNS29
528 Mineola Avenue carte Place,NY 11514
Tel/Fax:(516)'997.7251/(516)997-7528 Customer :
ID
hltp://www.EMSL.com/carleplacelab@crosl.com Project :
Attention: Tom Callahan Phone: (518)832-9750
TC Inspections Fax:
1 Knolls Drive Received Date: 03/28/2022 10:08 AM
Queensbury,NY 12804 Analysis Date: 03/31/2022
Collected Date: 03/24/2022
Project: 1343 Bay Rd,Queensbury,NY,
Test Report:Asbestos Analysis of Bulk Material
Non-Asbastes
Analyzed
Test Date Color Fibrous Non-Fibrous Asbostos
Sample ID RS1 Description Roof Shingle
062205705.0001 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 0313112022 Gray/Black 6.60%Glass 93.40%Other Inconclusive: one Dotected
TEM NYS 198.4 NOB 03(31l2022 Gray(Black 100.00%Other None Detected
Sample ID RS2 Description Roof Shingle
062205705-0002 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 0313112022 Grayl Black/ 11.00%Glass 89.00%Other Inconclus7 None Detected'
Green
TEM NYS 198.4 NOB 03/31/2022 Gray/Black/ 100.00%Other None Detected
Green
Initial report from:03/31/2022 16.03.54
ASL2 148x 0aw) 000f Printed 3/31/2022 4:03:56PNI Page 1 of