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DEMO-0463-2023 Office Use Only DEMOLITION APPLICATION Permit#: le10 (tA - 20 2S i� Permit Fee:$ ‘O.S Town of Queensbury I� -t''U V--S4 Invoice#: l9 a 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Flood Zone? Y N Reviewed B• ;� ✓ Demolition Location: 68 Wisconsin Ave, Queensbury Tax Map ID#: 308.12-2-35 **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** DEMOLITION INFORMATION: 1. Where will demolition material be disposed?Albany Landfill 2. Type of structure ori•e demolished: a. Residen - d. Storage Building n 'C b. Garage U e. Other: c. Business • JUt 2? 7 3. What type & ilities are connected to the structure: 10�iv0 2023 a. Gas I I f. Well-Water P b. Fuel Oil g. Public Sewer Cp© URY c. Propan h. Othe� �cs d. Electric i. None I/ I e. Public Water n 4. Have ALL utilities (water, electric, etc.) been disconnected? Yes 1 7 I 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: Michael P. Cristo Jr. SIGNATURE: DATE: 7/25/2023 Demolition Application Revised June 2022 CONTACTINFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): M. Cristo Inc. Mailing Address, C/S/Z: 2425 Kraft Rd. Cell Phone: 518-365-2307 Land Line: N/A Email: mcristoinc@gmail.com • Primary Owner(s): Name(s): Deborah Nolan Mailing Address, C/S/Z: Cell Phone: 518-223-2174 Land Line: N/A Email: dnolandavis@icloud.com ❑ 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): Michael P. Cristo Jr. Contractor Trade: demolition/Asbestos Mailing Address, C/S/Z: 2425 Kraft Rd., Castleton, NY 12033 Cell Phone: 518-365-2307 Land Line: N/A Email: mcristoinc@gmail.com **Workers' Comp documentation must be submitted with this application** Contact Person for any questions regarding this project: Michael P. Cristo Jr. Cell Phone: 518-365-2307 Land Line: N/A Email:dnolandavis@icloud.com Demolition Application Revised June 2022 WE ARE YOUR D O L FILE (3PY Department STATE of Labor DIVISION OF SAFETY&HEALTH LICENSE AND CERTIFICATE UNIT,STATE OFFICE CAMPUS,BLDG. 12,ALBANY,NY 12226 ASBESTOS HANDLING LICENSE M..Cristo, Inc. 2425 Kraft Rd, Castleton, NY, 12033.. • License Number: 29047 License Class: FULL Date of Issue: 07/26/2023 Expiration Date: 07/31/2024 Duly Authorized Representative: Michael P Cristo Jr This license has been issued in accordance with applicable provisions of Article 30 of the Labor.Law of New York State and of the New York State Codes, Rules and Regulations (12 NYCRR Part 56). It is subject to suspension or revocation for a (1)serious violation of state, federal or local laws with regard to the conduct of an asbestos project, or(2) demonstrated lack of responsibility in the conduct of any job involving asbestos or asbestos material. This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos:project in New York State have been issued an Asbestos Certificate, appropriate for the type of work they,perform, by the New York State Department of Labor. . fr& Amy Phillips, Director For the Commissioner of Labor SH 432(12/21) 7/25/23,2:05 PM Asbestos Notification Home M.Cristo,Inc.29047 Asbestos Notification Home M.Cristo,Inc. 29047 [FI LE COPY District Information Questions or concerns regarding this project should be directed to the New York State Asbestos Control Bureau at the following district office: District: Albany District Phone Number: (518)457-2072 Notification Information Reference Number: 26907427 Date Submitted: 7/25/2023 Status: Notification Received Type of Notification: Initial Notification Date Received: 7/25/2023 Payment Status: Paid in full Project Information Project Start Date: 8/4/2023 Project End Date: 10/10/2023 Worker Compensation Information Worker Compensation 46-681097-01-05 Will temporary workers No Policy#: be used?: WC Exemption If yes,name of Certificate#: temporary agency: Number of your 3 employees you expect to be on project: Employer Information FEIN: 141491766 Asbestos License 29047 Number: Company: M.Cristo,Inc. Mailing Street 1: Apt/Suite: Mailing Street 2: Street 1: 2425 Kraft Rd. Mailing City: Street 2: Mailing Province: City: Castleton Mailing State: State: New York Mailing Zip: Zip: 12033 Duly Authorized Representative(DAR)Information Name: Michael P Cristo Jr President: Officer Phone Number: 518-365-2307 Email Address: mcristoinc@gmail.com Project Location Building Information County: Warren Current Use: Vacant Building Name: 68 Wisconsin AVe Prior Use: Residential-1 family Room or Location: Age of Building: 20 Street 1: 68 Wisconsin AVe Size(sq.ft): 800 Street 2: Federal Building: No City: Queensbury State: New York Zip: 12801 Building Representative/Site Contact https://wps.labor.ny.gov/Curam/ 1/2 7/25/23,2:05 PM Asbestos Notification Home M.Cristo,Inc.29047 Name: Michael Cristo E-mail Address: mcristoinc@gmail.com Phone Number: 518-365-2307 Cell Phone Number- same Phase Details Phase Start Date Phase End Date Phase Location Phase Type of Work Sub-Contractor Details Sub-Contractor Name Asbestos License Number https://wpslabor.ny.gov/Curam/ 2/2