DEMO-0260-2023 Office Use Only
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DEMOLITION APPLICATION Permit#: -Ze23
Permit Fee:$ \n)
Town of Qucens6ury I
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed y
Demolition Location: t `�� �/�"� - Tax Map ID
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? &C-6— CAVAD' A
2. Type of structure to be demolished: i
a. Residence V\LW5q_ d.Storage Building
b. Garage J e. Other:
c. Business
3. What type of utilities are connected to the structure:
a. Gas f. Well-Water Pump
b. Fuel Oil g. Public Sewer
c. Propane h. Other
d. Electric L 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: rM �C� fr^�rn�� �t/!z✓
SIGNATURE: � „ DATE: �4n (- 2��3
Demolition Application Revised June 2022
l.i
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): zAfa-tict�w�
Mailing Address, C/S/Z:._ �o �� �D�vS� w �,,r,✓
Cell Phone: ?It- OT-V6 Land Line:
Email: �S�-yci obi o (3�j t
• Primary Owner(s):
Name(s): S✓ -c,
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
f$�Check if all work will be performed by property owner only
• Contractor: (List all ztdditibnal 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: C--n "�^
Cell Phone: B110- `2 11—o IYZ Land Line:
Email:
Demolition Application Revised June 2022
orporate Address
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ENVIRONMENTA
GROUPExpertEftcorn
Limited Pre Demolition Asbestos Survey Report
Property Location:
1347 Ray Rd.Queensberry,Ny 12804
Structure(s) Inspected:
Residential Structure
Conditions as of:
8/24/2020 .? -
Prepared for:
Dan Stranahan
Prepared by:
Expert Environmental & Construction Group -
Corporate Office: 620 Park Avenue, Suite 135
Rochester, NY 14607
278.4-61 DEMO-0260-2023
Stranahan Industries
1347 Bay Rd
Demolition of log cabin
.............................................................................................................................................................................
ROCHESTE' ; i � I 1 si 1 1 ;ING
M� �
ConstructionENVIRON
ONMENT
Construction Group &Construction Group &Construction Group Construction Group, &
1347 Bay Rd. Queensberry, Ny 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
TABLE OF CONTENTS
1.0 Executive Summary
2.0 Project Description
3.0 Limitations
4.0 Regulatory Compliance
5.0 Transmitta.(of Building/Structure Asbestos SurveyAd6rmation
6.0 Disclaimer Terms & Conditions
7.0 Summary of Findings
APPENDICES
Appendix A Chain of Custody, Analytical Report
Appendix B Sample Location Map
Appendix C Certifications
1347 Bay Rd. Queensberry, Ny 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
- i
4.0 REGULATORY COMPLIANCE
In New York State,there are multiple regulatory agencies that,have jurisdiction over ACM in buildings.Asbestos
survey requirements or specified by New York State Department of Labor(NYSDOL),the New York State Department
of Health (NYSbbH), the Occupational Safety and Health Administration (OSHA), and the United States
Environmental Protection Agency (EPA).
The NYSDOL established Part 56 of The Official Compilations of Code Rules, and the Regulations (cited as 12
NYCRR, Part 56)to address the proper identification, handling, removal, and disposal of ACM in buildings.Asbestos
survey requirements are specified in Subpart 56-5.1 "Asbestos Survey Requirements for Building/Structure
Demolition, Renovation, Remolding and Repair". The NYSDOL also works in conjunction with NYSDOH to establish,
and maintain asbestos safety training program requirements, and enforce personal certifications and licensing
protocol for asbestos contractors.
5.OTRANSMITTAL OF BUILDING/STRUCTURE ASBESTOS SURVEY INFORMATION.
Per New York State Industrial Code Rule 56-5.1(g), One (1) copy of the results of the building/structure asbestos
survey shall be immediately transmitted by the building/structure owner as follows:
(1) One (1) copy of the completed asbestos survey shall be sent by the owner or their agent to the local government
entity charged with issuing a permit for such demolition, renovation, remodeling or repair work under applicable State
or local laws.
(2) The completed asbestos survey for controlled demolition (as per Subpart 56-11.5) or pre-demolition asbestos
projects shall also be submitted to the appropriate Asbestos Control Bureau district office.
(3) The completed asbestos survey shall be kept on the construction site with the asbestos notification and variance, if
required,throughout the duration of the asbestos project and any associated demolition, renovation, remodeling or
repair project.
6.0 DISCLAIMER TERMS & CONDITIONS
The customer agrees to indemnify, exonerate, and hold Expert Environmental &Construction Group, LLC (EECG)
harmless against loss, damage, or.expense, by reasons of suits, claims, demands,judgements, and causes of action
for personal injury, death, or property damage rising out of or in any way in consequence of the performance of all
work undertaken by EECG except that in no instance shall the customer be held responsible for any liability claim
demand or cause of action attributable solely to the negligence of EECG. EECG is not responsible and does not
guarantee against present.or future damage to the building/property or contents or provide for the repair and
replacement thereof. The customer expressly releases EECG for liability for personal injury or property damage (to
include the structure or contents) caused by any sampling or survey activities. The Customer agrees that under no
circumstances shall EECG be liable for any amount greater than the amount paid for the service by the Customer to
EECG..In no event will EECG be responsible for consequential damages for loss of use of property.Any claim by the
Customer for damages must be made in writing within one (1) year of the incident at issue or it will be deemed
waived. Customer must allow EECG full and safe access to the identified property for any purpose to complete its
obligation under this survey. EECG is not liable for any breach if it is prevented from performing services because of
delays in transportation,shortages of fuel and/or materials, strikes, embargoes, fires, floods, quarantine restrictions,
war, earthquakes, hurricanes, or any other act of God or circumstance or cause beyond the control of EECG. EECG
is not responsible.for damage resulting from customer failing to give notice or disclose to EECG damages in
existence, EECG is not responsible for any third-party's failure to disclose existing infestation, damages,
environmental damage or structural damages prior to or after testing. EECG disclaims any liability and shall not be
responsible for indirect, special, incidental, consequential and/or loss of quiet enjoyment damages.
1347 Bay Rd. Queensberry, Ny 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
Asbestos Containing.Materials by Functional Space: t
a
Functional Functional Space Asbestos Containing Approximate Friability Condit
Space# Material Quantity ion
0001 Basement NAD
1001 First Floor NAD
2001 Exterior NAD
F=>Friable
NF=>Non-Friable
NOB=>Non-Friable Organically Bound
NAD=>No Asbestos Detected
Please Note: Quantities are approximate based upon surface area (square foot) or length of area (lineal feet). All
measurements are approximate and shall not be relied upon by contractors, field verification is encouraged.
Please Note: If Condition notes "Debris"it may require further contamination assessments and determination for
applicable site-specific variances of clean-up activities.
1347 Bay Rd. Queensberry, Ny 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
EMSL.Analytical,Inc. EMSLOrdrr 532001415
2975 tbiohwn Hendeut To. Line Rd`100 Cat 130.Rochester,NY 14623
Ct,lorn x1D: RCEN42
ImnnmFac (`.oq c�7-M1 pes)957-9t37 Cus:omaPO:
I A-: Brian Walloch plmnel (585)50' 3273
Expert Environmental Fa.:
i 620 Park Avenue Suite 135 Raeame: 6r62ao11�aM1
Rochester,NY 14607 -An ly�s Dam d3112020
COAcusa: 8/252020
1 Prolacl:' 1347 Bey Rd
,Test Report:Asbestos Analysis of Bulk Material
Analigad - Non Mimics
Test Deta Color Fibrous Non-Fibrous Asbestos
Sample ID SVL to Doscriptlorl' Kddm -Wivte Shed Yrgl
53"DON11,M)l Homogeneity Hcteetnyl '
PLM NYS 198.1 Friable -----_^_- _ Not Analyzed --
PLM NYS 19a.6 VCA7-- Nat Mslyzed
PLM NYS t96.6 NOB &?!1fM20 T7sVWouc 7.61+F�bttus(dJ1or) ?a.59G Other - _lnconciuslve:None Detected
3.-,%Glass
TEM NYS 198A NOB M112020 Tavela"; iW' Olnm None Detected
Sample 0 -SVL t0 Description K-hon_%Vhim Sheet Km}1
532Wf41.5.OW_' Homoganeny Halw qv -
PLM NYS 1911.1 Friable _ -�-- Not Malyud ,
PLM NYS 194.6 VCM ---T__-- Not Analyzed' '
PLM NYS 198.E NOB 8(19P..020 7arJ61acA 2.07e Fi[aous(o0va) 93.9%Wmr Inconclusive;Nons Detected
4.1%Glass -
TEM NYS 193.4 NOB 6,7112020 TxwTlock 1001A Other �JN—Detected?
Sample ID SPK 2A' Description Fesi Flax-Whew Jomt Compvsd
S7:J01415-000J Homogoneity Horrge+rnrs' ,
PLM NYS 193.1 Rtabls IL29r=20 v0cipo �16.0015 Ce Cattmrlalo Nano Oclacted
&5,00%Non-fibteus(cttus)
PLM NYS 198.6 VCM --_�-���`-'-_-- Not Analyzed
PLM NY5198.6 NOB-- Not Analyzed
TEM NYS 193.4 NOB ---__.._ -- Not Analyzed
Sample ID SPK 211 Description- Fssl Floa-W 11a Joint Corlrxwld -
5321of415-00674 Homogeneity Hanogoleala ,
PLM NYS 198.1 Friable &2W2;�_0 Owge -_10.00'A Ca Camuttaa .Norm Detected -
90.00%Non-ffbn s(othmr) .
PLM NYS 190.6 VCM——_-- Not Analyzed
PLM NYS 198.6 NOB .-- T _ Not Analyzed
TEM NYS 19&4 NOB - --_— � -- ---- - Not Matyzecl '
a
Initial Ra-1 From 08131f20 O 12:07:10
Tot Rc,at i9aVCId-7.30.0 Pride]:MIRD20 12:07:10 PM - Pago 1
1347 Bay Rd. Queensberry, Ny 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
EMSL Analytical,Inc. EIASL Order: 502001415
2975"hton Hnuletta Turn Line Rd,100 Ste 13e-Re h-Ler,l(1'I'm Cust-rl0: RCEN42
r' Fac (5S5)95T-9z7n IP-1)95r_r37 C-o- PO: 5.
Test Report:Asbestos Analysis of Bulk.Material
Non A testae
Teu Color Fibrous Mon-Fmrt Asbestos
Sample b FH 5A Description Bed Wm-1Zc12 Fhor Tide
532W105{011 Homogeneity HGcrogwou
PU4 NYS 192.1 Friable. ^ Not Analyzed
PLM NYS 198.6 VCM -_ -"-- - Not Analyzed _v
PLM NYS 198.E NOB ar24'1020 [ImmniIm1 -- -- ^--100%Ouxr �^ In-lual-None Detected
Sn•.all mnarm Of odhosrvoirn sbc pane..not scpmoble-
TEM NYS 199.4 NOB ^ar51=20 Bn wTon - 100%Otter Nona Demud
Sample 1D FH 5B Description Bad Rm-12a12 Flow Tdo
53207 14 7 5-0012 Homoganeity Holurogenooasl
PLM NYS 19&l Friable Not Analyzed
PLM NYS 198.6 VCM --- Not Analyzed ---
PLM NYS 198.E NOB 112920:'0 Brm VTsn --- '.00%ouw lnwnduaiw:None Datected
Small anent,d_adnoiir+ ,"bc prmom-I s p.Ablo.
TEM NYS 198.4 NOS 8)312020 Brmrdrm im OCux None Detected
SomplelD WIGGA. t.scr)ption EALrcr Wirsdox-Wbae Vlmd-Lazo -
53WO1415-0013 Homogeneay Hatxm,Aneous
PLM NYS 198.1 Friable�--�-^ Not Analyzed
PLM NYS 108.E VCM-. -~�-_ -�- Not Analyzed
PLM NYS 19A8 NOB 8 2?/2020 Willie 5.5%Fdaous(ooar) S4.5%Oeat Incondualm Nona Deteded
TEM NYS 198A NOB lV3li2V10 Whdo 1.6%Fibnzn(W-) 06.27.Otner None Detected
Sample ID WIG 6B Description Eztenor'Unaaw-While Wir o Glaze
5.17a1415-W I Homogeneity Hulwgalmus - .
PLM NYS 19M Friable --_~ - --Not Anaty"Cl
PLM NYS 193.6 VCfd --- - --^ -Not Analyzed
PLM NYS 193.6 NOD a292020 Wleb 5.41.4 Fdroua(othor) 94.8%OVW Incond-iw:Nona Detected
TEM NYS 196.4 N013 8131r-020 wMe 1.8%nblous(omm) 98.2%Offer - None Dateded
Sample 10 CLK 7A Doscription ErCuV Wo3-Tnn Cw&W a9
53..-Wl415{G15 Homogeneity 'Homc,mcoua
PLM NYS 198.1 Friable --` -_ _--^---_w-~"- --�NotAnalyzed
PLM NYS 198.6 VCM -��_^- Not Analyzed '
PLM NYS 198.6 NOB y &?rS/1020 &mn 1001.00 - -lnoonclmrry:None Detected
TEM NYS 198.4 NOB 8101r'020 Bronn 100%Other J None Detected
Sample 10 CLic 7B Doscrption Edmior Wry-Ton CaA Wag
5371e114%:MY5 Homogeneity Hornwgorants
PLM NYS 19E.1 Friable-- -- Not Analyzed
PLM NYS 195.6 VCM Not Analyzed�T-
PLM NY5198.6 NOD 8292020 Bann --i_-_ - 100%081or-- -Inconcimim None Detected
TEM NYS 123.4 NOB a'310M ik- 100%O-Mr Nona Detected
Wid Repat Fran 08701/2020 12.07:10 _
Tcel R pat 19aVCM-7.10.0 PriNu1:MI MO I2.0710 PM Pnle 2
1347 Bay Rd.Queensberry, Ny 12804-Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
crac=xD: s�zocinis
%,IHI fl VI VubcVU
Y CmrtarxvsoN,NJ 08077
EMSL Order Number bb we o ): NoxE(800)220-3675
53 ZW `I 1;5 F Vc(858)786 5914
Con m Nae:E un Expert Envlrwental J �1 EMSL Ciataner ID:RCEN42
9tratt:620 Park Ave - Mr. Rochester - State or Province:NY -
osta)Coda:14607 Cau Tele one/:555-510 003 Fax S:
Report To Name:Brian Walloeh Plnse ProviG Rntlb via: ❑Fax Email
email Address:Brix rtanv.c Purchaso Order Number:-
Client Pre t ID: EMSL Project H)YXvrW use
State or Province CoAected: I CT only Ej Commerdal/Taxable ResldantlalRu Exam
EMSL-Bill to:EJ Same U Ddtorwit-11M W2 ddereM f *4nxfxtbm N o m ea Thed sere§un erSMrizsiign 6cm PSd party
Turnaround Time(TAT)Op ae M*a Check
❑3 Hour ❑6 Hour ❑24 Hour ❑32 Horn' ❑48 Hour 72 How ❑ 98 Hour ❑1 Weak_ ❑2 Week
•32Fbv TAT6mAQe MrMl[7rHS oey, sop ee aP.At100Y if-10-
' N Iwexvd eLovaa '
PLM-Du(k frea ) Ikntt TEM-Burk _
_❑PLM EPA 80684E 18(<t%) - ❑TEM EPA NOB-EPA GWR-9WI 16 Section 25.5.1 '
❑PLM EPA NOB(<t%)�_--� ---• �FJY ELAP FAcY.W 198.4 fort-friable-NY
_Point cow,i❑A00(<025%)❑10M(w.1%j- _❑cnatftW Ptomml(semi-quareafrfo)
Pont Count'vdCravfrnfetrk❑4 W(<0.25Y.j❑10�(�_1%) - ❑7E1A%by Mass-EPA Erb.-931115 Section 2.5.52
❑NIOSH 0002(c�94} .__ _ ❑TEM QuAtative via Filtration Prep Terhequo_ -
NY ELAP Metirod 198.1-friable-NY. - _❑TEM Qualitative via Drap Mow i Prep T o
NY FLAP Method 195.8 NOS-non-kbabie-NY her Ise-I—
❑N_Y ELAP_Mathatl 198.6-VcrmiaARo Surfacng Material -
❑ SF ID-191 ModW*d — -----�-- ❑
❑EMSL Standard Add icn Method
Positive Stop-Clearly Identify Homogenous Areas(HA) Data Sam led: o
Samplers Name: - 'Samplers Sigma
Sample/ ){A p Sara Location Material DcscrioUon
KM Wb_
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Client Samplo t(a) Total A of Sam pies:
Reanquished by(Chant): •ec )�D Dafai C�]�^1 Tinto:
Recaived b (Lab): Date. 1� Time:•10:36
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1347 Bay Rd. Queensberry, NV 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
NEW YO'RK STATE DEPARTMENT OF HEALTH
WADStiWORTN CENTER
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Apri 01.2020
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CERTIFICATE:OF APPROVAL FOR LABORATORY 5ERVICE
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1347 Bay Rd. Queensberry, Ny 12804—Limited Pre-Demolition Asbestos Survey
Conditions as of 8/24/2020
Expert Environmental&Construction Group, LLC
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TOWN OF QUEENSBURY
BUILDING DEPARTMENT !
Based on our limited examination,compliance - ; ! + •
with our comments shali not be construed as I
imiicat�.ig the plans and s;ecifications are in
full compliance �:JII-, ihe.. r3uiiding Codes of
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