DEMO-0320-2023 Office Use Only
DEMOLITION APPLICATION Permit#: bC`yyj0—
Permit Fee:$ I (n5
Town of Queens ub ry (o
Invoice#: L< 1 g
742 Bay Road,Queensbury,NY 12804 ''��,��
P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By(ir
Demolition Location: 81 Assembly Point Road Tax'Map ID#: 239.12-2-27
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? Ace Carting Facility - Rt. 149 Fort Ann, NY
2. Type of structure to be demolished:
a. Residence X d. Storage Building
b. Garage.✓ e. Other: n
c. Business
;110 ✓UN 0
3. What type of utilities are connected to the structure: 9
?
a. Gas f. WelkWater Pump e �0, QiF
b. Fuel Oil_j/ g. Public Sewer FNS
c. Propane h. Other Lake Water Supply c��cesRY
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: G. Thomas Moynihan,Jr. &Joan Moynihan
SIGNATUR . — DATE
Demolition Application Revised June 2022
DEMOLITION APPLICATION
SW
Submission Requirements:
742 aayR a
742 Bay Roadd,,Queensbury;Ni 12804 (RESIDENTIAL AND COMMERICAL PROJECTS)
P:S18-761-82S6 tvww.gueensbury.nell
1. Completed Demolition permit application (please print neatly or type)
2. Workers Compensation insurance information for ALL contractors involved in the project—this is REQUIRED
EVEN FOR SOLE PROPRIETORS
THREE (3) COPIES (either 1 pdf& 2 paper (min. 11" x 17") OR
3 paper (min. 11" x 17") OF THE FOLLOWING:
3. Plot plan, using a survey map, if possible, which includes:
a. Drawn to scale.(i.e. 1 inch= 30 feet)
b. Indicate the proposed structure to be demolished/removed
c. Include__all structures,on the property
77
d. Include the-loca.ti6r6,of water supply(well or water lines)
°,Include the,locationv&configuration of the septic system or sewer line
4.... Asbestos.report—this.is,a:NYS,requirement for all demolition projects
5. If as s'..cl Covered: a copy of the abatement report
-
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the approved plans prior to or during construction will require the submittal of amended plans,
additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn. 30%of the fee is retained by the Town of
Queensbury. After 1 year from the initial application date, 100%of the fee is retained.
Demolition Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
,Name(s): G.Thomas Moynihan Jr. &Joan Moynihan
Mailing Address, C/S/Z: 426 Sjc2-56. c3
Cell Phone:�lg--96;r' Land Line: S'/e
Email: pinehurst2005@gmail.com Pinehurstseven@gmail.com
• Primary Owner(s):
Name(s): same as applicants
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): J. Clarke Construction Crandall Excavating, Inc.
Contractor Trade: General Contracting Excavating
Mailing Address, C/S/Z: 88 Mohawk Mountain Rd. 12845 63 Woodchuck Hill Rd. 12845
Cell Phone: (518)361-2668 J.C. (518)470-4694 C.C. Land Line:
Email: isclarke3l99@yahoo.com
"Workers' Comp documentation must be submitted with this application"
Contact Person for any questions regarding this project: John Clarke, Chris Crandall
Cell Phone: (518)361-2668 (518) 470-4694 Land Line:
Email: isclarke3l99@yahoo.com
Demolition Application Revised June 2022
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TOWN OF QUEENSBURY
BUILDING DEPARTMENT
B on our limited examination,compliance
h�oow r comments shall not be construed as
TOWN OF � l�D � � n i ti g the plans and specifications are in
QUEENSBURY D u 1 pliance with the Building Codes of
BUILDING & CODES DEPT. o k State.
Reviewed B : JUN 0 9 2023 .
Date:
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Michael J Stevens
Licensed Asbestos Inspector
PO Box 2202 Glens Falls, NY
12801
MIKE STEVENS
RE: Pre-Demolition Asbestos Building Survey REPORT
81 ASSEMBLY POINT
LAKE GEORGE NY
12845
Dear MR MOYNIHAN
Please find the attached Pre-Demolition Asbestos Building
Survey Report completed for the Property Located at:
81 ASSEMBLY POINT LAKE GEORGE NY 12845
If you have any questions or require additional information,
please feel free to contact:
Mike Stevens @ 518-656-3270
Sincerely,
Michael J. Stevens
Pre-Demolition Asbestos Building Survey
81 ASSEMBLY POINT
LAKE GEORGE NY 12845
INTRODUCTION
ON MAY 14 2023 MR THOMAS MOYNIHAN OF 81 ASSEMBLY POINT
LAKE GEORGE NY 12845 retained: Michael J. Stevens to preform an
asbestos survey of the property located at 81 ASSEMBLY POINT LAKE
GEORGE NY 12845
The BUILDING is located AT 81 ASSEMBLY POINT LAKE GEORGE NY
12845 IS A structure of approximately 1500 square feet on a 1 ACRE
LOT(construction date is approximately 1955 according to County
records). ThE STRUCTURE consists OF WOOD FRAME construction
AND ASPHALT SHINGLE.ROOF
The purpose of this survey was to complete a pre-demolition asbestos
survey in accordance with Industrial Code Rule (ICR) 56. At the request
of the client destructive sampling techniques( i.e. breaking through
sheetrock walls, removing tiles, etc.) were utilized.
The remainder of this report describes building inspection procedures,
a summary of the results, conclusions and recommendations. A site plan
and building specific sampling locations are depicted.
Michael J. Stevens assumes no responsibilities for the implementation
or enforcement of the procedures, work practices, engineering controls,
or other asbestos-control methods recommended, required or
mentioned in this document.
z
-PRE-DEMOLITION ASBESTOS SURVEY
81 assembly point
LAKE GEORGE NY
12845
Background Information:
Buildings) Location:
81 ASSEMBLY POINT
LAKE GEORGE NY
12845
Party Performing Survey: Michael J. Stevens
PO Box 2202, Glens Falls, NY 12801
Laboratory Used For Sample Analysis:
Amerisci New york .
117 East 30th Street
New York, New York 10016
NYSDOH ELAP Laboratory ID # 11480
OWNERS INFO MIKE STEVENS
PO BOX 2202
GLENS FALLS NY
12801
Pre-Demolition Asbestos Building
Survey
81 ASSEMBLY POINT
LAKE GEORGE NY
12845
Conclusions & Recommendations
Conclusions
Based on the completion of the survey, No regulated asbestos materials
(>1%) were identified at the site based on materials sampled.
Recommendations
Based on the results of this survey, Mike Stevens has the following
recommendations at this time.
• Prior to any demolition activities, a copy of the asbestos survey
should be provided to the demolition contractor and local
asbestos control board.
• Maintain a copy of this asbestos survey with the property.
• If un-assessed suspect ACM is identified during demolition
activities, retain an asbestos building inspector to sample the
material(s).
• One copy of the-asbestos survey report should be immediately
transmitted by the building owner as follows:
1) One copy of this report must be immediately transmitted by the
building owner, or their agent, to the local government entity
charged with issuing a permit for such demolition, renovation,
remodeling or repair work under applicable NY Stat 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 NEW YORK STATE DEPARTMENT OF LABOR
Pre-Demolition Asbestos Building Survey
81 ASSEMBLY POINT
LAKE GEORGE NY 12845
JUNE 2 2023
LABORATORY RESULTS
81 ASSEMBLY POINT
LAKE GEORGE NY 12845
Please Reply To:
AmeriSci New York
117 EAST 30TH ST.
AMERI SCI NEW YORK,NY 10016
TEL:(212)679-8600• FAX:(212)679-3114
LABORATORYELECTRONIC TRANSMITTAL
To: Michael Stevens From: Bo Sun
Michael J. Stevens AmeriSci Job#: 223053650
Fax#: Subject: ELAP-PLM/TEM 5 day Results
Client Project: 81; 81 Assembly; 81 Assembly
Email: mikesoldcars@gmail.com
Point, New York
Date: Saturday,June 3,2023 Number of Pages:
Time: 02:46:43 (including cover sheet)
Comments:
NOTE:Attached report is to be considered preliminary until final review with accompanying analysis summary letter is issued.
CONFIDENTIALITY NOTICE: Unless otherwise indicated,the information contained in this communication is confidential information
intended for use of the individual named above. If the reader of this communication is not the intended recipient,you are hereby notified that
any dissemination,distribution or copying of this communication is prohibited. If you have received this communication in error,please
immediately notify the sender by telephone and return the original message to the above address via the US Postal Service at our expense.
Samples are disposed of in 60 days or unless otherwise instructed by the protocol or special instructions in writing. Thank you.
Certified Analysis Service 24 Hours Al Day•7 Days A Week Competitive Prices
visit our web site-www.amerisci.com
Boston•Los Angeles•New York•Richmond
AmeriSci New York
117 EAST 30TH ST.
AMERISCI NEW YORK,NY 10016
TEL:(212)679-8600• FAX:(212)679-3114
PLM Bulk Asbestos Report
Michael J. Stevens Date Received 05/31/23 AmeriSci Job# 223053650
Attn: Michael Stevens Date Examined 06/02/23, P.O. #
PO Box 2202 ELAP# 11480 Page 1 Of 6
RE:81; 81 Assembly; 81 Assembly Point, New York
Glens Falls, NY 12801
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
1 223053650-01 No NAD
Location:Living Room&Kitchen Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
2 223053650-02 No NAD,
Location:Living Room&Kitchen Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun on 06/02/23.
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
3 223053650-03 No NAD
Location:Living Room &Kitchen Ceiling-Compound (by NYS ELAP 198.1)
by Bo.Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
4 223053650-04 . No NAD
Location:Bedroom I Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
5 223053650-05 No NAD
Location:Bedroom I Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
See Reporting notes on last page
AmeriSci Job#: 223053650 Page 2 of 6
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
81; 81 Assembly; 81 Assembly Point, New York
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
6 223053650-06 No NAD
Location:Bedroom I Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
7 223053650-07 No NAD
Location:Bedroom#2 Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
8 223053650-08 No NAD
Location:Bedroom#2 Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
9 223053650-09 No - NAD
Location:Bedroom#2 Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
10 223053650-10 No L NAD
Location:Bedroom#3 Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
11 223053650-11 No NAD
Location:Bedroom#3 Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
See Reporting notes on last page
AmeriSci Job#: 223063650 Page 3 of 6
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
81; 81 Assembly; 81 Assembly Point, New York
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
12 223053650-12 No NAD
Location:Bedroom#3 Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
13 223053650-13 No NAD
Location:Bathroom Ceiling&Walls-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
14 223053650-14 No NAD
Location:Bathroom Ceiling&Walls-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
15 223053650-15 No NAD
Location:Bathroom Ceiling&Walls-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
16 223053650-16 No NAD
Location:Basement Rec Room Walls&Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
17 223053650-17 No NAD
Location:Basement Rec Room Walls&Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types: -
Other Material: Non-fibrous 100%
See Reporting notes on last page
AmeriSci Job#: 223053650 Page 4 of 6
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
81; 81 Assembly;- 81 Assembly Point, New York
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
18 223053650-18 No NAD
Location:Basement Rec Room Walls&Ceiling-Compound (by NYS ELAP 198.1)
by Bo Sun
on 06/02/23
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100%
19 223053650-19 No NAD
Location:Roof Shingle-Asphalt Shingle (by NYS ELAP 198.6)
by Bo Sun
on 06/02/23
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 21.3%
20 223053650-20 No NAD
Location:Roof Shingle-Asphalt Shingle .(by NYS ELAP 198.6)
by Bo Sun
on 06/02/23.
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 24.6% .
21 223053650-21 No NAD
Location:Roof Shingle-Asphalt Shingle (by NYS ELAP 198.6)
by Bo Sun
on 06%02/23-
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 37.2%
22 223053650-22 No NAD
Location:Roof Shingle-Asphalt Shingle (by NYS ELAP,198.6)
by Bo Sun
on 06/02/23
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 16.8%
23 223053650-23 No NAD
Location:Bath. Floor-Vinyl Flooring (by NYS ELAP 198.6) .
by Bo Sun
on 06/02/23
Analyst Description:Black/Gray, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 6%
See Reporting notes on last page
AmeriSci Job#: 223063650 Page 5 of 6
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
81; 81 Assembly; 81 Assembly Point, New York
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
24 223053650-24 No NAD
Location:Bath. Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Bo Sun
on 06%02/23
Analyst Description:Black/Gray, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 5.2%
25 223053650-25 No NAD
Location:Bath. Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Bo Sun
on 06/02/23
Analyst Description:Black/Gray, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 4.9%
26 223053650-26 No NAD
Location:Roof Paper/Underlayment-Roof Underlayment (by NYS ELAP 198.6)
by Bo Sun
on 06/02/23
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 2.3%
27 223053650-27 No NAD
Location:Roof Paper/Underlayment-Roof Underlayment (by NYS ELAP 198.6)
by Bo Sun
on 06/02/23
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 1.2%
28 223053650-28 No NAD
Location:Roof Paper/Underlayment-Roof Underlayment (by NYS ELAP 198.6)
by Bo Sun
on 06/02/23
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 1.2%
See Reporting notes on last page
AmeriSci Job#: 223063650 Page 6 of 6
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
81; 81 Assembly; 81 Assembly Point, New York
Reporting Notes:
Analyzed by:Bo Sun �jJ�..-� Reviewed by:Marik Peysakhov
Date:6/2/2023 �f
*NAD/NSD=no asbestos detected;NA=not analyzed;NA/PS=not analyzed/positive stop,(SOF-V)=Sprayed On Fireproofing containing Vermiculite;
(SM-V)=Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis using Motic,Model BA310 Pol Scope,Microscope,Serial#:1190000538,
by Appd E to Subpt E,40 CFR 763 quantified by either CVES or 400 pt ct as noted for each analysis(NVLAP 200546-0),ELAP PLM Method 198.1 for NY
friable samples,which includes the identification and quantitation of vermiculite,or ELAP 198.6 for NOB samples,or EPA 400 pt ct by EPA 600-
M4-82-020(NY ELAP Lab 11480);Note:PLM is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound
materials. NAD or Trace results by PLM are inconclusive,TEM is currently the only method that can be used to determine if this material can be
considered or treated as non asbestos-containing in NY State(also see EPA Advisory for floor tile,FR 59,146,38970,8/1/94)National Institute of Standards
and Technology Accreditation requirements mandate that this report must not be reproduced except in full-.without the approval of the Iab.This PLM
report relates ONLY to the items tested.RI Cent AAL-094,CT Cert PH-0186,Mass Cert AA000054,N1 Lab ID #NY031.
END OF REPORT
AmeriSci Job#: 223053650 Page 1 Of 3
Client Name: Michael J. Stevens
Table I
Summary of Bulk Asbestos Analysis Results
81; 81 Assembly; 81 Assembly Point, New York
Sample Heat Acid -Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos '*Asbestos%by **Asbestos%by.
Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
P Client Sample#
01 1 — — — — NAD NA
Location: Living Room&Kitchen Ceiling-Compound
02 2 — — — — NAD NA
Location: Living Room&Kitchen Ceiling-Compound
03 3 — — — — - NAD NA
Location: Living Room&Kitchen Ceiling-Compound
04 4 — — — — NAD NA
Location: Bedroom I Ceiling-Compound
05 5 — — — — NAD NA
Location: Bedroom I Ceiling-Compound
06 6 — — — — NAD NA
Location: Bedroom I Ceiling-Compound
07 7 — — — — NAD NA
Location: Bedroom#2 Ceiling-Compound
08 8 — — — — NAD NA
Location: Bedroom#2 Ceiling-Compound
09 9 — — — — NAD NA
Location: Bedroom#2 Ceiling-Compound
10 10 — — — — NAD NA
Location: Bedroom#3 Ceiling-Compound
11 11 — — — — NAD NA
Location: Bedroom#3 Ceiling-Compound
12 12 — — — — NAD NA
Location: Bedroom#3 Ceiling-Compound
13 13 — — — — NAD NA
Location: Bathroom Ceiling&Walls-Compound
14 14 — — — — NAD NA
Location: Bathroom Ceiling&Walls-Compound
15 15 — — — — NAD NA
Location: Bathroom Ceiling&Walls-Compound
16 16 — — — = NAD NA
Location: Basement Rec Room Walls&Ceiling-Compound
See Reporting notes on last page .
AmeriSci Job#: 223063650 Page 2 Of 3.
Client Name: Michael J. Stevens
Table
Summary of Bulk Asbestos Analysis Results
81; 81 Assembly; 81 Assembly Point, New York
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
17 17 - - - - NAD NA
Location: Basement Rec Room Walls&Ceiling-Compound
18 18 - - - - NAD NA
Location: Basement Rec Room Walls&Ceiling-Compound
19 19 0.365 24.4 54.3 21.3 NAD NAD
Location: Roof Shingle-Asphalt Shingle
20 20 0.248 21.9 53.5 24.6 NAD NAD
Location: Roof Shingle-Asphalt Shingle
21 21 0.352 22.3 40.5 37.2 NAD NAD
Location: Roof Shingle-Asphalt Shingle
22 22 0.315 23.1 60.0 16.8 NAD. NAD
Location: Roof Shingle-Asphalt Shingle
23 23 0.195 57.2 36.8 6.0 NAD NAD
Location: Bath.Floor-Vinyl Flooring
24 24 0.228 59.2 35.6 5.2 NAD NAD
Location: Bath.Floor-Vinyl Flooring
25 25 0.181 58.6 36.5 4.9 NAD NAD
Location: Bath.Floor-Vinyl Flooring
26 26 0.138 95.2 2.5 2.3 NAD NAD
Location: Roof Paper/Underlayment-Roof Underlayment
27 27 0.154 94.5 4.3_ 1.2 NAD NAD
Location: Roof Paper/Underlayment-Roof Underlayment
28 28 0.147 94.6 4.2 1.2 NAD NAD
Location: Roof Paper/Underlayment-Roof Underlayment
See Reporting notes on last page
AmeriSci Job#: 223053650 Page 3 Of 3
Client Name: Michael J. Stevens
Table I
Summary of Bulk Asbestos Analysis Results
81; 81 Assembly; 81 Assembly Point, New York
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos "Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
Analyzed by.Marik Peysakhov /G Reviewed by:Madk Peysakhov Date:6/3/2023 �f �f
"Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by Appd E to Subpt E,40 CFR 763 or NYSDOH ELAP 198.1 for New York friable samples or NYSDOH ELAP 198.6 for New York NOB samples,
TEM(Semi/Full)by EPA 600/R-93/116(or NYSDOH ELAP 198A for New York samples).Analysis using Hitachi,Model H7000-Noran 7 System,Microscope,Serial#:747-05-06.NAD=no asbestos detected
during a quantitative analysis;NA=not analyzed;Trace= <17o;(SOF-V)=Sprayed On Fireproofing containing Vermiculite;(SM-V)=Surfacing Material containing Vermiculite;Quantitation for beginning
weights of<0.1 grams should be considered as qualitative only,Qualitative Analysis:Asbestos analysis results of"Present"or"NVA=No Visible Asbestos"represents results for Qualitative PLM or TEM
Analysis only(no.accreditation coverage available from any regulatory agency for qualitative analyses):NVLAP(PLM)200546-0,NYSDOH ELAP Lab 11480,NJ Lab ID #NY031.
Warning Note:PLM limitation,only TEM will resolve fibers<0.25 micrometers in diameter.TEM bulk analysis is representative of the fine grained matrix material and may not be representative of non-
uniformly dispersed debris for which PLM evaluation is recommended(i.e.soils and other heterogenous materials).
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NOTES JUNE 3 2023
STRUCTURE IS A TWO STORY BUILDING
ASPHALT SHINGLE WITH NO UNDERLAYMENT
VINAL SIDING OVER SHEATING
MAN DOORS ARE WOOD AND METAL NO GLAZING FOR THE GLASS
BARE FIBERGLASS INSULATION
REPLACEMENT WINDOWS NO CALK
ALL WIRING UPDATED
AGE OF STRUCTURE POSTED AT 1955
ALL DRAIN AND WATER PIPES ARE PLASTIC OR COPPER
HARDWOOD FLOORS OVER SHEATING
NO OUTBUILDING
2 YEAR OLD HOT AIR HEATING SYSTEM
PORCH IS BARE WOOD UNFINISHED
Pre-Demolition Asbestos Building Survey
81 ASSEMBLY POINT
LAKE GEORGE NY 12845
Summary Of Results
A-material is considered by the EPA to be Asbestos-containing if at least
one sample collected from the homogenous area shows asbestos
present in an amount greater than 1%. Based on review of the
Laboratory results, none of the submitted friable and non-friable ACM
samples analyzed contain asbestos.
Survey
Building Inspection Procedure.
Mr. Michael J. Stevens, a New York State Certified Inspector
Certification #72900) conducted an asbestos survey of the building(s)
on AUGUST 9 2022 which included both the interior and exterior
portions of the BUILDING
Mr. Stevens visually inspected the residence for suspect asbestos
containing materials (ACMs). The roof of the residence was accessed
with a ladder. Methodologies used were generally consistent with
USEPA publications: "Guidance for Controlling Asbestos Containing
Materials-in Buildings" (June 1985) and "Asbestos in Buildings:
Simplified Sampling Scheme for Friable Surfacing Materials" (dated
October 1985). The.documents were used for their asbestos survey
concepts, such as identifying homogenous materials, quantifying
materials, and evaluating friability(potential to crumble with hand
pressure) and condition (good, damaged or significantly damaged).
Over 3,000 products are currently known to contain asbestos.Although
no comprehensive list of ACMs exists, Mr. Stevens utilized the USEPA's "
Sample List of Suspect Asbestos-Containing Materials" as a general
guide to identify and document suspect ACMs within the building, In
addition, in some cases, Mr. Stevens utilized their experience and the
knowledge obtained through training courses to identify suspect ACMs.
Mr. Stevens inspected all spaces of the building, including storage
rooms, utility rooms, and crawl spaces.
During the survey, the inspector classified each suspect ACM as one of
three types: 1) surfacing material applied by spray or trowel, 2) thermal
insulation on pipes, tanks, boilers and related features, 3) miscellaneous
not classified as surfacing material or thermal system insulation. The
inspector touched all assumed or suspected materials on all surfaces,
including walls, ceilings, structural members, and mechanical
equipment, to determine their friability, or the extent to which the
material, when dry, may be crumbled, pulverized, or reduced to powder
by hand pressure. In addition, the inspector assessed the condition of
each suspect ACM and classified the material as either 1) good 2)
damaged 3) significantly damaged. A suspect ACM is considered in good
condition if there are no visible signs of damage, is considered damaged
if the material contains less than 25% localized damage or less than
10% distributed damage and is considered significantly damaged if the
material contains greater-than 25% localized damage or greater than
10% distributed damage.
It should be noted.that.in accordance with the Occupational Safety and
Health Administration (OSHA), Asbestos Construction Standard 29 CFR
1926.1101, any thermal insulation, surfacing materials; floor tiles,
roofing felts and shingles found in buildings constructed no later than
January 1, 1981 are presumed ACMS
To arrive at a preliminary evaluation of ACM, Mr. Stevens considered
the following in its assessment: 1) location of the ACM; 2) condition of
the material, such as damage and severity of damage; 3) accessibility to
building occupants; 4) the potential for disturbance; 5) known or.
suspected causes of damage; and 6) preventative measures that might
eliminate the likelihood of future damage.
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nationalgrid
300 Erie Boulevard West
Syracuse,New York 13202 D OVE
JUN 0920723
TOWN OF QUEENSBURY
May 9,2023 L BUILDING& CODES
Tom Moynihan
RE: Service Removal for Building Demolition.
Tom Moynihan,
This letter is to confirm that,per your request,National Grid has confirmed electrical
service and meters have been removed from 81 ASSEMBLY POINT RD
QUEENSBURY NY 12804. The work was processed on work order#30781495 and
meter#29828098 has been removed.If you have any questions or need further
assistance,please feel free to contact me at 315-468-7494.
Sincerely,
7ayme Rivers
Customer Fulfillment
nationalgrid
Lands Now or Farmedy of I STORY Lands Now or Formerly of
°OG NORMA E. & EDWARD G. BAERTSCIII PAUL & CHERYL L4MPARELL4
N 0729 Book 1022 Page 158 S 777J00"£ J43'Mao TOTAL) Back 48J Page 420 N 777J00"If 1R
. . . - - - - - - -
7 S 7723 00" f 200.J.J' ua'P S 777300'E 109.48' TJQ87' Z
I - ,�• O 1 0
^ 4 _.._T._.__.. ......_._._.__.-_--- O .Lands Now or Formerly o/ o .
srnYE '� EUNICE K. KLICINS
9ccvN�,a wAEE '` = i✓T17J T8" Back 1148 Page 163,
N
.1 I RLb AREA: 17,63B S too, W4
Q. FT m ee,rora,
_ 62
s Z •. OFPR£S9aY 7£1j8 j. AREA: 1.665 50. FT g 1 tt
N Z.J 31 10.. -6,t /Vq ^2 w '� r N
N 1 J4.2?'•E
k ---- b , W
NG�1IA Loads Now or� '>>00" o
B &EDIy �Y ar N 7896'00'W h 151.79'
g°°k!O??qRD C.gAL JJ,.44: — — _" — — — — —
1, •�� 'Doge !60 RTSCjfI ]8 p8,O0,� w o N 7817600'W 19J.2J'(TOTAL O O) N 78VC'
'Lands Now°r FD'erly.of
_ as ORAfA E. & ED)YARD G. BAERTSCNI
Book 1022 Page 160
I
Loods$I,rQjfOC°dj'07
�tiQF B°°k /BD Aso ► JUN 0 9 2023 -17
P, s� '
DEED 1i OF-OUF=ENDURY I . ..
c
p I. £DINAR G. BAERf$C/I4W (�(Q�P�a�B.FB� TO NOR E BAERTSCNI
&£DIN RD C. BA 7119',AtPP��YYHH O/N THE I
a' f WARRE CD —A�T-PACE 160. I
s``q� a.oejrr
V 0 2. LYDIA ERNST TO EL RHO LLC, DATED SEPMUB£R 6, 2000
A�7,f6i N 1 �°�N• h AND W DEED RECORCE 1 N C WARR PAG£EN6COONTY CY£RKS OFFICE fN
BOOK~ `_ rse•nap �38J J. DAWD B. KROGIANN TO EDWARD A. MKINS JR, DATED D£CEMB£R 1J, 1999
AND RECORDED IN ME WARREN COUNTY CLERKS OFFICE IN
R(NEED;7-76-01 O7YENSOvS GV'[ATSl1NC DO7f
rR1 DEED BOOK 1140 AT PAGE 16J.
ALL RIGHTS RESERVED, COPY OR REPRODUCTION OF nos PWi MICHAEL CHRYS "" �•
THE 0R ANY PORTION,THEREOF IS PRONSITEU WITHOUT THE WTTEN a WA a WA
PERMISSION Of THE DESIGN ENGNECR.SURYCYOR,OR APMTEC7.
Chazen CHAZEN ENGINEERING LAND SURVEYING CO., P.C. UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING p
A LICENSED LAND SURVEYOR'S SEAL 16 A TAMOLATIONEDUCATION
OF SECAW. SURVEY MAP OF Dela1 aGPIC
A LICENSED
NSED LAND Z V THE NEW E YORK STALE EDUCATION 71O 11-IJ-OO 1 1.
COMPAtTIES I HEREBY CERTIFY THAT THIS SURVEY MAP IS BASED ON AN ACTUAL NO. 81 ASSEMBLY POINT ROAD
Dat9A.a CPvaty Off— Omnga C—ty Dffma- Capita!District off- FIELD SURYET COMPLETED NOVEBER 7,2000.AND THAT THIS SURVEY prakcl no.
Enginecn/SV.reypa Mmehecic Rd PO Bo.3K79 263 Rwle 17K 1407 R...9,B1a9.T 'WAS MADE BY ME OR UNDER MY DIRECTION,AND CONFORMS
PC—. PoVgh4eepaq,NY 12603 Newew4h New York 12550 C6Rm PmA,NY 17065 WITH THE MINIMUM STANDARD OF PRACTICE ADOPTED BY THE 30080.00
Endronmanbl Scicnlials Ph- (9TK)154-J960 Prime: (91�)567-1117 prime: (51B)371-065 NEW YORK STATE ASSOCIATION Or PROFESSIONAL LAND SURVEYORS.
TOWN OF QUEENSBURY west nN
NNCENT P.AUSFEID LS•9597 WARREN COUNTY, NEW YORK 1 OF 1