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20220621 29 Waterbury Area Variance Application
"HANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED" [FOR OFFICE USEI TOGA CITY OF SARATOGA SPRINGS (Application#) a ZONING BOARD OF APPEALS F = CITY HALL-474 BROADWAY (Date received) SARATOGA SPRINGS, NEW YORK 12866-2296 TEL:518-587-3550 X2533 �C0 PORATU� N'1 www.saratoga-springs.org (Project Title) APPLICATION FOR: ❑ INTERPRETATION, USE VARIANCE, Check if PH Required AREA VARIANCE AND/OR VARIANCE EXTENSION Staff Review APPLICANT(S)* OWNER(o ffnot ATTORNEY/AGENT Maddy Zanetti Name Zachary Novick 29 Waterbury St Address Saratoga Springs, NY 12866 518-587-0666 Phone 518-810-3871 mzanefti@impressionssaratoga.com Email znovick@gmail.com Primary Contact Person: OApplicant Owner E]Attomey/Agent An applicant must be the property owner, lessee,or one with an option to lease or purchase the property in question. Applicant's interest in the premises: 0 Owner ❑ Lessee ❑ Under option to lease or purchase PROPERTY INFORMATION 29 Waterbury St 165 43 1 4 1. Property Address/Location: Saratoga Springs, NY 12866 Tax Parcel No.: - - (for example. 165.52—4—37) 10 DEC 2018 UR-2 2. Date acquired by current owner: 3.Zoning District when purchased: Primary Residence UR-2 4. Present use of property: 5.Current Zoning District: 6. Has a previous ZBA application/appeal been filed for this property? ❑Yes(when? For what? ) 0 No 7. Is property located within(check all that apply)?: ❑ Historic District ❑Architectural Review District ❑500'of a State Park,city boundary,or county/state highway? We intend to demolish our existing 18'x 36'Garage(built in 1923)due its to its serious state of decay with insufficient 8. Brief description of proposed action: structural support beams, large holes in roof and back wood wall 2'below grade resulting water damage/wood rot throughout the structure.These issues were known (albeit less severe)at time of purchase in 2018, but we have not had the budget to address it until now.The proposed replacement detached garage is 24'x3O'.The new s ruc ure Is desinged to-meet all the zoningibuilding requirements for su ace area and permeability. However,we would Me to - build it in a similar footprint as the old garage(inside the 5'offset)because of the narrow lot&driveway alignment. 9. Is there an active written violation for this parcel? ❑Yes 16 No 10. Has the work, use or occupancy to which this appeal relates already begun? ❑Yes 0 No 11. Identify the type of appeal you are requesting(check a//that apply): ❑ INTERPRETATION(p.2) ❑VARIANCE EXTENSION(p.2) ❑ USE VARIANCE(pp. 3-6) E2 AREA VARIANCE(pp.6-7) Revised 01/2021 ZONING BOARD OFAPPEALSAPPL/CAT/ON Fmm PAGE2 INTERPRETATION—PLEASE ANSWER THE FOLLOWING(add additional information as necessary): 1. Identify the section(s)of the Zoning Ordinance for which you are seeking an interpretation: Section(s) 2. How do you request that this section be interpreted? 3. If interpretation is denied,do you wish to request alternative zoning relief? Dyes ❑No 4. If the answer to#3 is"yes,"what alternative relief do you request?❑ Use Variance ❑Area Variance EXTENSION OF A VARIANCE—PLEASE ANSWER THE FOLLOWING(add additional information as necessary): 1. Date original variance was granted: 2. Type of variance granted? ❑ Use ❑Area 3. Date original variance expired: 5. Explain why the extension is necessary.Why wasn't the original timeframe sufficient? When requesting an extension of time for an existing variance,the applicant must prove that the circumstances upon which the original variance was granted have not changed. Specifically demonstrate that there have been no significant changes on the site, in the neighborhood,or within the circumstances upon which the original variance was granted: Revised 01/2021 ZONING BOARD OFAPPEALSAPPL/CAT/ON FoRM PAGE.3 USE VARIANCE—PLEASE ANSWER THE FOLLOWING(add additional information as necessary): A use variance is requested to permit the following: For the Zoning Board to grant a request for a use variance, an applicant must prove that the zoning regulations create an unnecessary hardship in relation to that property. In seeking a use variance,New York State law requires an applicant to prove all four of the following "tests". 1. That the applicant cannot realize a reasonable financial return on initial investment for any currentlYpermitted use on the property. "Dollars¢s"proof must be submitted as evidence.The property in question cannot yield a reasonable return for the following reasons: A. Submit the following financial evidence relating to this property(attach additional evidence as needed): 1) Date of purchase: Purchase amount: $ 2) Indicate dates and costs of any improvements made to property after purchase: Date Improvement Cost 3)Annual maintenance expenses:$ 4)Annual taxes:$ 5)Annual income generated from property:$ 6)City assessed value: $ Equalization rate: Estimated Market Value:$ 7)Appraised Value:$ Appraiser: Date: Appraisal Assumptions: Revised 01/2021 ZONING BOARD oFAPPEALSAPPL/CATION FoRM PAGE 4 B. Has property been listed for sale with ❑Yes If"yes",for how long? the Multiple Listing Service(MLS)? [[]No 1)Original listing date(s): Original listing price:$ If listing price was reduced,describe when and to what extent: 2) Has the property been advertised in the newspapers or other publications? ❑Yes ❑No If yes,describe frequency and name of publications: 3) Has the property had a"For Sale"sign posted on it? ❑Yes ❑No If yes, list dates when sign was posted: 4) How many times has the property been shown and with what results? 2. That the financial hardship relating to this property is unique and does not apply to a substantial portion of the neighborhood. Difficulties shared with numerous other properties in the same neighborhood or district would not satisfy this requirement. This previously identified financial hardship is unique for the following reasons: Revised 01/2021 ZONING BOARD OFAPPEALSAPPL/CAT/ON FoRM PAGES 3. That the variance, if granted,will not alter the essential character of the neighborhood. Changes that will alter the character of a neighborhood or district would be at odds with the purpose of the Zoning Ordinance. The requested variance will not alter the character of the neighborhood for the following reasons: 4. That the alleged hardship has not been self-created.An applicant(whether the property owner or one acting on behalf of the property owner)cannot claim"unnecessary hardship"if that hardship was created by the applicant,or if the applicant acquired the property knowing(or was in a position to know)the conditions forwhich the applicant is seeking relief.The hardship has not been self-created for the following reasons: Revised 01/2021 ZONING BOARD OFAPPEALSAPPL/CAT/ON Fmm PAGE G AREA VARIANCE—PLEASE ANSWER THE FOLLOWING(add additional information as necessary): Residential Zoning The applicant requests relief from the following Zoning Ordinance article(s) Compliance Chart-Area and Dimensional Requirements District Requirement Requested UR-2 Minimum Distance Side Lot Line to Accessory Building 5 Feet 2.5 Feet UR-2 Minimum Distance Rear Lot Line to Accessory Building 5 Feet 2.5 Feet Other: To grant an area variance,the ZBA must balance the benefits to the applicant and the health,safety,and welfare of the neighborhood and community,taking into consideration the following: I. Whether the benefit sought by the applicant can be achieved by other feasible means. Identify what alternatives to the variance have been explored(alternative designs,attempts to purchase land,etc.)and why they are not feasible. Alternative placement of the replacement garage to meet the offsets has been plotted on the survey plan. The narrow lot, location ot principal building and large trees create issues. Meeting the location ot the ottsets causes an exess amount of driveway required to park cars in the garage. It elimnates much of the backyard grass area and is too close to the large(+24"diameter) 3-trUnkedtree. 2. Whether granting the variance will produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. Granting the variance will not create a detriment to nearby properties or an undesirable change in the neighborhood character for the following reasons: The existing garage is already within 2 feet of the property line and about to fall down. We would like to rebuild a safe structure ottset 2.b trom the property lines in the back lettcorner. I nere are no other structures within about ee is area-Just tencing along the rear lot line. The new garage roof would still be within the propery limits so water will run-off within our property limits. The lot is also vitel ied towards waterbury street. AI iy rui iuff will rai i toward utir property. Revised 01/2021 ZONING BOARD OFAPPEALSAPPL/CAT/ON FoRM PAGE 7 3. Whether the variance is substantial. The requested variance is not substantial for the following reasons: The variance is not substantial. It replaces an existing garage with a similar area,on a similar footprint. 4. Whether the variance will have adverse physical or environmental effects on neighborhood or district. The requested variance will not have an adverse physical or environmental effect on the neighborhood or district for the following reasons: The proposed replacement garage meets all other zoning/building requirements regarding area and permeabiility. The location of new garage would be offset from the lot lines more than the current deteriorating garage. There are no structures within about 30' the property limits in this corner,and is very unlikely that any will be built because of the neighbor's existing driveway&garage layouts. Minimal fire risk-only a wooden fence runs along the rear lot line offset slightly to the rear neighbor's property. Our property contours grade slightly downhill from the rear lot line to the front lot line so water runs towards our lot, not the neighbors. Gutters can be added to the garage if need be. This replacement needs to happen to have a safe,stable useable strucure,and it will be asthetically pleasing for the look of the neighborhood It is a x1ePA mar desmgn to a garage that is down the Street fmm us 5. Whether the alleged difficulty was self-created(although this does not necessarily preclude the granting of an area variance). Explain whether the alleged difficulty was or was not self-created: We are simply trying to replace a garage built in 1923 that does not meet current building standards, and is beyond repair. The water damage has rapidly increased since we purchased the property in 2018. We have not had the budget, however,to do anything but minor mitigating repairs to keep it standing until now. The layout of the property makes it difficult to replace this garage with a similar structure without placing it within the offset requirements. The main house is centrally located leaving just enough room for the driveway on the left side. The current driveway already widens a lot to allow for 2 cars to park, but would still not be wide enough to park our cars in the current garage even if the garage bays were big enough(depth&height),and safe enough o do so. I he replacement garage already requires a wider driveway to park the cars In the garage. It Is also a deeper structure(24'instead of 18'). This means a driveway that makes it possible to park in the garage will have to turn around the house sharply and be wider. We would have to pave over another—400 sf of grass area on top of losing 10 feet or so distance between the current front of the garage and the main house compared to the replacement garage. Revised 01/2021 ZONING BOARD OFAPPEALSAPPL/CAT/ON FoRM PAGE B DISCLOSURE Does any City officer,employee,or family member thereof have a financial interest(as defined by General Municipal Law Section 809)in this application? 0 No I❑Yes If"yes",a statement disclosing the name,residence and nature and extent of this interest must be filed with this application. APPLICANT CERTIFICATION I/we,the property owner(s),or purchaser(s)/lessee(s) under contract,of the land in question, hereby request an appearance before the Zoning Board of Appeals. By the signature(s)attached hereto, I/we certify that the information provided within this application and accompanying documentation is,to the best of my/our knowledge,true and accurate. I/we further understand that intentionally providing false or misleading information is grounds for immediate denial of this application. Furthermore, I/we hereby authorize the members of the Zoning Board of Appeals and designated City staff to enter the property associated with this application for purposes of conducting any necessary site inspections relating to this appeal. Date: F;ignigngg M nature) Date: Fi9n/9n99 (app a t 'gnature) If applicant is not the currently the owner of the property,the current owner must also sign. Owner Signature: Date: Owner Signature: Date: Revised 01/2021 oGI sA� CITY OF SARATOGA SPRINGS 1 ZONING BOARD OF APPEALS d v� a,i fy Hatk - 474 r3roaA%v-4j U So ray oga.SrwL4,.gs., Ne w-York/12866 Tel,- 518-587-3550 X2533 /Nc�RPQRA5E0 wrww.yara"a.-.ppr,-gyorg INSTRUCTIONS APPEAL TO THE ZONING BOARD FOR AN INTERPRETATION, USE VARIANCE,AREA VARIANCE AND/OR VARIANCE EXTENSION APPLICATION REQUIREMENTS 1. ELIGIBILITY:To apply for relief from the City's Zoning Ordinance, an applicant must be the property owner(s) or lessee, or have an option to lease or purchase the property in question. The Zoning Board of Appeals (ZBA) shall not accept any application for appeal that includes a parcel which has a written violation from the Zoning and Building Inspector that is not the subject of the application. 2. COMPLETE SUBMISSIONS: Applicants are encouraged to work with City staff to ensure a complete application. The ZBA will only consider properly completed applications that contain 1 original and 1 digital version of the following: ❑ Completed application pages I and 8,the pages relating to the requested relief(p. 2 for interpretation or extension, pp. 3-5 for use variance, pp. 6-7 for area variance), and any additional supporting materials/ documentation. "HANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED" ❑ Completed SEQR Environmental Assessment Form—short or long form as required by action. http://www.dec.ny.gov/docs/perm its_ej_operations_pdf/seafpartone.pdf ❑ Detailed "to scale" drawings of the proposed project—folded and no larger than 24"x 36". Identify all existing and proposed structures, lot boundaries and dimensions, and the relationship of structures to the lot dimensions.Also, include any natural or manmade features that might affect your property(e.g., drains, ponds, easements, etc.). ❑ Photographs showing the site and subject of your appeal, and its relationship to adjacent properties. 3. APPLICATION FEE (NON-REFUNDABLE): Make checks payable to the "Commissioner of Finance". REFER TO THE CURRENT FEE WORKSHEET INCLUDED IN THIS DOCUMENT. Check City's website (www.saratoga-springs.o for meeting dates. Revised 01/2021 ZONING BOARD APPEAL APPUCATIoN INSTRUCTIONS PAGE2 PUBLIC HEARING ADVERTISEMENT The Zoning Board of Appeals is required to hold a public hearing on each submitted application within ninety(90) days from when it is determined to be properly complete by City staff. City staff will prepare a legal notice for the public hearing and arrange to have the public hearing announcement printed in the legal notice section of a local publication at least 5 days before the hearing. PROPERTY OWNER NOTIFICATION Applicants are required to mail a copy of the public hearing legal notice to all property owners within the following distances from the boundaries of the land in question: Type of variance Distance for property owner notification Use variance 250 feet Area variance& Interpretation 100 feet This notice must be sent at least 7 days but not more than 20 days before the date of the public hearing. City staff will email a copy of the"property owner notification letter"to the applicant.The applicant must then send the notification letter to the nearby property owners.Applicants may not include any other materials in this mailing. The mailing must be certified by the U.S. Post Office. Prior to the public hearing,applicants must present the Post Office "certificates of mailing" to the ZBA. If"certificates of mailing" are not presented prior to the hearing, the hearing will be cancelled. Revised 01/2021 2021 LAND USE BOARD FEE WORKSHEET OPED Fees Type 2021 Fee Application to Zoning Board ofAppeals[1][2] TOTAL #VARIANCE Use Vari an ce $1100+$50/app AreaVarlance-Residential 450 2 $275/var+$50/app+$125 each add'Ivariance Area Variance-Multi-Family,Comm,Mixed-Use $660/var+$50/app+$200 each add'I variance Interpretations $550+$50/app Post-Work Application Fee Add 50%Appfee+$50/app Variance extensions 50%ofAppfee+$50/app Application to Design Review Commission[1] TOTAL #STRUCTURE Demolition $385 Residential Structures Principal $55 Accessory $55 Extension $35 Modification $55 Multi-Family,Comm,Mixed-Use Structures Sketch $165 Principal $550 Extension $200 Modification $330 Multi-Family,Comm,Mixed-Use Accessory,Signs,Awnings Principal $140 Extension $75 Modification $140 Post-Work Application Fee Add 50%Appfee Application to Planning Board[1] TOTAL #STRUCTURE Special Use Permit[2] $990+$50/app Special UsePermit-extension $330 Special UsePermit-modification[2] $450+$50/app Site Plan Review-incl.PUD: Sketch Plan $330 Residential $330+$200/u nit Residential-extension $200 Residential-modification $400 Non-residential $660+$130/1000 sf Non-Residential-extension $300 Non-Residential-modification 1 $650 Subdivision-Ind.PUD: TOTAL #LOTS Sketch Plan $330 Preliminary Approval[2] Residential:1-5 lots $660+$50/app Residential:6-10 lots $990+$50/app Residential:11-20 lots $1320+$50/app Residential:21+lots $1650+50/app Residential-extension $330 Final Approval[2] Residential $1320+$175/lot+$50/app Non-Residential $2000/lot+$50/app Final Approval Modification[2] Residential $330+$50/app Non-Residential $550+$50/app Final Approval Extension Residential $135 Non-Residential $330 Other: TOTAL #LOT/ACRE Post-Work Application Fee Add 5U%Appfee Lot Line Adjustment $350 Letter of Credit-modification or extension $440 Letter of Credit-collection upto 1%ofLoC Recreation Fee $2000/lotorunit Land Disturbance $660+$55/acre SECtRA EIS Review(Draft&Final) TBD Legal Noticing if PB requires Public Hearing $50/app [1] Fees are based on per structure,except where noted. $450.00 TOTAL DUE [2] Legal ad required;includes City processing and publishing ForAdministmtive Use Total Paid at Intake Revised Fee Balance Due ��_Balance Paid Staffapproval , 4 {r} g • an �$$ �" �t •• 0 logI 1 yy� a so � ! s III J ' i ,...CI V W U V) N f0 LL ID LL 0 O/ (�') (p LL t L T O c .0 O O U- <` U) U L N uj O X..:. •— p .. o `� CO Z) a CO ° 0 cn O _ V) I— L) _ U (D N - 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- - - - - - - ------ A7Z: —d-0 M-3-0-01—OMS Nvw t4ouqnsj.GNO,�, 'J.N9W9,9V N-- S doV�1oo IR 9991ANas 9t4lj.:jvNa 01 NOUICOV 80 NOU—a—d— AN J-D D H S 'SE)NII]dS VE)OJLVIIVS 'IS AunsimIVM 6Z 6LVL-Zgg(M):Hd 39VIIVD NWAON AN'E)NINdS VE)OiVMVS 'S'-l'd 'R'3'd'3-lVW,N-in d DIV(] :N011dl'dDS9(1 ID910%dd cl u) Lu Ll LL, //q z43 Z <LLI to a- 0 u) 'D u) -u cl M 8 11 7< c., o'I), , i--F:2;� Lu 0 z OF:'D o �) �q F:7, m Z w 0 m 6 Fbo Q(3 28o m a:LR Gr 'o V- �9.oR �, LL, L P cl 0 X W.u),, z Q z ID LLI LLI z m Lu < w c, LLI w()- V U)V-LLI Q,Lu w m D u) z LLI- L, u)T 12 X— >�! c, L 0j) QlL L.9 Jlle,a L 371G 11.0 L 37 < < rz LU 0 C) 0- w < EL m < C, co $ U) Of w LLI 0 (D < ) \ < 2 2 U)0 In R < < 31, %D r, ea z LL, rz V u) u) c, w LL, LU u) v: zoo 1) mr 0 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1.. Responses become part of the application for approval or funding,are subject to public review,and play be subject to further verification. Complete Pact 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Information Name of Action or Project: Garage Replacement Project Location(describe,and attach a location map): 29 Waterbury Street, Saratoga Springs,NY Brief Description of Proposed Action: Demolition of existing 18'x 36'garage built in 1923 due to hazardous state of deterioration and major structural concerns. Build replacement 24'x 30'garage in similar footprint. Name of Applicant or Sponsor: Telephone: 518-587-06661518-810-3871 Maddy Zanetti&Zachary Novick E-Mail: mzanetti@impr,essionssaratoga.com Address: znovrc gmar .com 29 Waterbury Street City/PO. Saratoga Springs State: NY Zip Code: 12866 1. Does the proposed action only involve the legislative adoption of a plan, local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that x may be affected in the municipality and proceed to Part 2. if no, continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: City of Saratoga Springs - Building&Zoning Departments x 3.a. Total acreage of the site of the proposed action? 0.175 acres b.Total acreage to be physically disturbed? 0 1 7. acres c. Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.l75 acres 4. Check all land uses that occur on,adjoining and near the proposed action. a Urban ❑ Rural(non-agriculture) ❑ Industrial ❑ Commercial rX Residential(suburban) ❑ Forest ❑ Agriculture ❑Aquatic ❑ Other(specify): ❑ Parkland Page 1 of 4 5. Is the proposed action, NO YES NIA a.A permitted use under the zoning regulations? Permit applications in process x b. Consistent with the adopted comprehensive plan? x 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? x 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Enviromnental Area? NO YES If Yes, identify: X 8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES x b. Are public transportation service(s)available at or near the site of the proposed action? x bus stop down the street c.Are any pedestrian accommodations or bicycle routes available on or near S'te of he o ose gt'on? x 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: x 10. Will the proposed action connect to an existing public/private water supply? NO YES [If Yes,does the existing system have capacity to provide service? ❑NO ❑YES] If No,describe method for providing potable water: x 11. Will the proposed action connect to existing wastewater utilities? NO YES [If Yes,does the existing system have capacity to provide service? ❑NO ❑ YES] If No,describe method for providing wastewater treatment: x 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? x b. Is the proposed action located in an archeological sensitive area? x 13. a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? x b. Would the proposed action physically alter, or encroach into,any existing wetland or waterbody? x If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid-successional ❑ Wetland © Urban ® Suburban 15. Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? x 16. Is the project site located in the 100 year flood plain? NO YES x 17. Will the proposed action create stor€n water discharge,either from point or non-point sources? NO YES If Yes, x a.Will storm water discharges flow to adjacent properties? ❑ NO ElYES b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑ NO❑ YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g. retention pond,waste lagoon,darn)? x If Yes,explain purpose and size: 19.Has the site of the proposed actionn or an adjoining property been the location of an active or closed NO YES solid waste management facility? x If Yes,describe: 20. Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed) for hazardous waste? If Yes,describe: x I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicantlspo tne: Maddy Zanetti&Zachary Novick Date: 6/22/2022 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Pail 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1, Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a. public 1 private water supplies? b. public 1 private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No, or Moderate small to large impact impact may may occur occur I0. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Pala 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action inay or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 SMITHMain Dice MailingAddf•ess L�.c 112 Spring Street PO Box 65 Saratoga Springs,NY 12020 Saratoga Springs,NY 12866 Office 518.581.8028 Facsimile 518.478.8781 16 June 2022 CASmith Project No. 0110322 Mr. Zachary A.Novick Owner 29 Waterbury Street Saratoga Springs,New York 12866 Via Electronic Mail Only Subject: Asbestos Pre-Demolition Survey 29 Waterbury Street Saratoga Springs,New York 12866 Saratoga County Tax Parcel No. 165.43-1-4 SW1S No. 411501 Dear Mr.Novick: As requested, CASmith, LLC performed an asbestos assessment of building materials at a garage structure located at 29 Waterbury Street, Saratoga Springs,New York 12866 (Subject Structure). This report documents the survey activities performed, supporting documentation and results. EXECUTIVE SUMMARY This Asbestos Materials Assessment did not identify materials containing asbestos by regulatory definition. REPORT NARRATIVE Project Scope of Work-This survey addresses the visual survey, research and sampling of building materials on the interior and exterior of the Subject Structure. Location -The Subject Property is located on the north side of Waterbury Street two blocks north of Van Dam Street and US Route 9. The location of the Subject Property is presented in Figure 1, Site Locator. Background—This Subject Structure is recorded as a 612 sf(Approx.) two story four bay garage (Ref. Attachment 6). According to Saratoga County Real Property records accessed on June 2022 the structure was constructed in 1920, A copy of the real property records are included in Attachment 6. Z:1CASmith\Clients\Environmental\Novick,Zac 401103221Report\Report.doc This structure is in very poor condition but was accessible for review and sampling. Construction Features—This structure has the following features: • Foundation- Piers • Basement-None • Crawlspace-None • Primary construction- Wood framing with wood roof rafters • Exterior- Wooden beveled siding, some asphalt shingle coverings ` Sub roof wood slat E Roof Asphalt shingle • Interior building materials- Wood stud Wall finishing-None E • Heat-None • Air conditioning-None • Hot water-None • Sump pump system-None Insulation- o Fiberglass- None o Thermal Systems Insulation-None o Ves--rniculatc-None o Cellulose-None • Windows- o Original-Aged with limited remaining glazing (see Site Specific Recommendations) o Contemporary-Front windows are removed,plexiglass • Doors- Wood • Flooring systems- Slab on grade concrete • Kitchen-None • Bathrooms-None exterior, each is masonry block construction. • Utilities- o Electric-National Grid service in area o Natural gas-None o Fuel oil-None o Fuel cell-None o Solar-None o Telephone/cable- Present in area o Septic-Not connected to structure, present in area o Sewer-Not connected to structure, present in area Pi•esent Condition —The structure is presently used for storage and will be demolished. A visual survey was performed on all interior and exterior areas of the structure. The structure is in very poor condition. Z:ICASmithlClients\Environmental\Novick,Zw 90110322aeportlCteport.doo Historical Use—Prior garage. Regulatory Statics—Compliant. Figures,Images and Documents- Figures and images of the Subject Property are presented in Attachment 2. Applicable licenses and certifications are included in Attachment 4. Referenced documents are included in Attachment 6. Pre-demolition Asbestos Survey-The asbestos sampling program was performed on all interior areas of the structure. All sample locations are identified in the accompanying i figures in Attachment 2. E This pre-demolition asbestos survey was performed in general conformance with New York State Department of Labor (NYSDOL) Code Rule 56 requirements, specifically Section 1.9- Building Demolition Survey. With the exception of the areas listed in the Sampling Notes Section and Conditions and Limitations (Attachment S), all areas of the structure were accessible and available for this assessment. Existing building information was reviewed prior to fieldwork to obtain a general history of the facility with regard to building eras and the suspect materials contained. A walk through of the building was completed to identify, quantify and assess the accessible suspect asbestos-containing building materials. Suspect materials were classified into homogeneous areas based on color,texture, apparent use and construction era. Asbestos Containing Material Definition - A material is considered by the EPA (40 CFR Part 61; National Emission Standard for Hazardous Air Pollutants; Asbestos NESHAP Revision; Final Rule) to be asbestos containing if at least one sample collected from the homogenous area shows asbestos present in concentrations exceeding 1% by weight. A material is considered to be asbestos containing, under OSHA regulation 29 CFR 1926.1101 (b), if it is demonstrated, through laboratory analysis, to contain greater than one percent (>1%) asbestos or if it is a presumed asbestos-containing material (PACM). A PACM is defined as thermal system insulation (TSI) or surfacing material in a building constricted no later than 1981, which has not been demonstrated as ACM by the collection and analysis of representative bulk samples but is presumed to contain asbestos. Method of Asbestos Analysis- In New York State, bulk samples are divided into two categories: 1)Non-friable organically bound materials (NOBS) and 2) All other friable or non-friable materials. Non-friable organically bound materials (NOBS) include a wide variety of building materials embedded in flexible to rigid asphalt or vinyl matrices and include floor tiles, caulks, roof tars, adhesives, mastics, resins, etc. Bulk sample analysis of NOBs are analyzed in accordance with the New York State ELAP 198.1 protocol. Z:1CA5mithlClients\EnvironmentailNovick,Zae#01103221Reportaeport.doc Friable building materials are defined as those materials able to be crumbed by hand pressure. These were analyzed by PLM methodology using the EPA 600/R-93/116,7/93 Method, including the New York State stratified point count technique (NYS ELAP Manual Item No. 198.1). If PLM analysis of the residue is calculated to yield results greater than 1% asbestos, based on the initial sample weight, the sample is a positive indication for an asbestos-containing material. If this analysis indicates asbestos in concentrations of less than 1% asbestos, or no asbestos, the sample residue must be re-analyzed by a more sensitive method, Transmission Electron Microscopy (TEM), or the ELAP 198.4 protocol. TEM analysis will be the final determination of whether the sample indicates asbestos in concentration of greater than 1%. It is important to note that no NOB material may be handled as a non-asbestos-containing material unless it is demonstrated by gravimetric reduction or TEM methodology to contain less than 1% asbestos by weight. Testing Laboratories- Bulk samples of suspect asbestos-containing materials obtained were analyzed by Eastern Analytical Services, Inc. New York State Department of Health, Environmental Laboratory Approval Program (NYS-ELAP ID No. 10851) accredited laboratory Iocated in Elmsford, New York. Three types of tests are typically performed depending on the composition of the material sampled. Friable bulk samples were analyzed by Polarized Light Microscopy (PLM) methods. Non-Friable organically bound samples (NOBs, i.e., floor tile, mastic, adhesives, vinyl cove base) were weighed, heated to ash and digested in acid, reduced to a residue, re-weighed, and the residue was analyzed by PLM methods (PLM/NOB a.k.a. gravimetric reduction). NOB residues found negative PLM analysis, were analyzed via a more sensitive method-transmission electron microscopy (TEM/NOB), per New York State requirements. Laboratory Quality Control Program - Laboratories maintain an in-house quality control program which consists of blind re-analysis of ten percent of all samples, replicate analysis of samples, participation in proficiency testing programs to maintain New York State approval, participation in inter-laboratory and intra-laboratory sample exchanges, analysis of blank samples to check for laboratory contamination, laboratory air quality testing to check for laboratory contamination, equipment calibration, precision and accuracy controls, and use of standard bulk reference materials with known percentages of asbestos for use in training and sample comparison. Sampling and Results - Representative bulk samples were collected from each homogenous area by Peter C. Goutos of CASmith, LLC. The sampling days and number of samples obtained per day follows: Date Number of Samples 1 June 2022 4 Please refer to Attachment 1 for a definition of acronyms and definitions used in this report. Z:1CAsmith\Clients\EnvironmentalWovick,Zac 901I03221Report\Report.doc Site Specific Survey Notes—Visual review of the Subject Building did not identify thermal systems insulation, vermiculate or other suspect insulation materials. Survey Exclusions: The following features of the structure were not including in this survey: Contents Windows (see Site Specific Recommendaations) { Structural and non-structural wooden and metal material Conclusions— This Asbestos Materials Assessment dirt not identify materials containing asbestos by regulatory definition. Site Specific Recommendations— 1. Windows- This structure has aged ivavy glass multi pane fvindows in five locations. There is very little glazing remaining on these ivindofvs. These glazed fvindoivs fvill be removed by the owner•to be donated to a historic organization for rearse in historic renovations. 2. In the event that any building materials are encountered during this project that have not been represented in this survey report, sampling and analysis is required to remain in conformance with NYSDOL Code Rule 56 requirements. This may require further sampling of areas not previously surveyed for this assessment. 3. In all cases, if confirmed asbestos containing materials are identified they should be removed (abated) following applicable procedures and by licensed contractors as per the NYSDOL Code Rule 56 requirements. Removed materials should be containerized,transported, stored and disposed consistent with NYSDOL,NYSDEC and USEPA requirements. Administrative Requirements- 1. Site Copy - One copy of this report shall be kept on site throughout the duration of the demolition project and any associated demolition, renovation, remodeling, abatement or repair work. 2. Regulatory Copies - Per the New York State Department of Labor Code Rule 56, section 56-5.1(g), one copy of this report shall be submitted to the local governent m entity charged with issuing a permit of demolition, renovation, remodeling, or repair work. This report shall also be submitted to the appropriate Asbestos Control Bureau Office (Albany Asbestos Control Bureau, State Office Campus, Room 157, Albany, New York 12240). 3. Records Retention Requirements - In accordance Nvith the New York State Department of Labor Code Rule 56 requirements, this document must be retained by the property owner for 30 years. Z:1CASmith\Clients\Environmental\Novick,Zac 001103221Repo&Rep0rt.d0c Conditions rand Limitations- As in all asbestos surveys there exists the possibility that previously unseen building material is present which may contain asbestos. As a matter of protocol, if any suspect materials are identified during the demolition, sampling and subsequent analysis is required. Should asbestos containing materials be identified proper abatement and disposal of these materials in accordance with applicable regulations is required prior to demolition. Please see the Conditions and Limitations SumamaIT that applies to this project and report (Attachment 5). Thank you for the opportunity to provide this report. Please contact the undersigned directly if you have any questions or require fiirther information. E Sincerely, CASmith, LLC Peter C. Goutos President NYSDOL Asbestos certificate#08-05466,Inspector and Management Planner CASmith LLC Asbestos Handling License#37655 Copies Client (via hand delivery) Project Site (copy to client) Building codes (copy to client) File Attachments No. Description 1 Acronyms and Definitions 2 Figures and Images 3 Sample Results and Chain of Custody 4 Licenses and Certificates 5 Conditions and Limitations 6 Other Relevant Documents Z:1CASmithlClientslEnvironmental\Novick,Zac 90110322MeportlReport.doe Attachment 1 Acronyms and Definitions General Subject Property The real property that is the focus of this assessment HVAC Heating Ventilation and Air Conditioning (system or component) Sampling and Analysis PLM Polarized Light Microscopy NOB Non-friable organically bound material i TEM Transmission Electron Microscopy INC Inconclusive NAD No Asbestos Detected TIC INC Trace- Client requested TEM ----- Sample number not utilized or test not required LAB Indicates that a clarification from the Lab was required Check Mark- 0.0 asbestos PC- Point Count Method IS- Insufficient Sample NA- No Analysis Requested ILB- Intentionally Left Blank NOB PLM- NYS-DOH 198.6 NOB TEM- NYS-DOH 198.4 PLM/PLM with dispersion staining- EPA-600/M4-82-020 (Modified) PALM Presumed Asbestos-Containing Material Visual- Visual Examination (40 CFR Part 763, Sub. E, App. E/NYS-DOH 198.1 (PLM)) Regulatory Agencies NYSDOL New York State Department of Labor NYSDEC New York State Department of Environmental Conservation NYSDOH New York State Department of Health NYSDOT New York State Department of Transportation NYS-FLAP New York State Environmental Laboratory Accreditation Program NVLAP National Voluntary Laboratory Accreditation Program OSHA Occupational Safety and Health Agency USEPA United States Environmental Protection Agency Regulatory References CFR Code of Federal Regulations Code Rule 56 ASBESTOS Part 56 of Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York(Cited as 12 NYCRR Part 56) NESHAP National Emission Standard for Hazardous Air Pollutants Z:1CASmithlCliantslEnvironmentallNovick,Zac#01103221Repo&Repor1.doc E Attachment 2 Figures and Images Z:1CA5mith\ClienlsT-nvironmentallNovick,Zac 901103221ReportlReport.doc SXTE LOCATOR i rr N CI 1"1 fp Gar--RAL 1 f. r �' �fl j,a :e�1 r' Subject Property 1 -� ��¢ -•, � �,^ nlei � ;:�.� ��'(`��,����., -'� 'it ��r'��` 1��� �'��1�,,�_�,�•�..��r ' gyp j� f I E L lr i fir« t l' k L r- -��' ��, .-�I.a�,►�...d �s'�� 1 5� + r.,'...�.,.� ,�E��� ;fir � ��• �! ] +� ry � "r�l � � �'lf1 �� =�ti'�k� ` r �k 'rkr r � _ -.•r ..���ti.��� a.� C ti..^„='_a �'"-•-ry L-� y r 1 ,^' F•' �.- A'°`�`fl ` 1 •.fr ILL F Greenridg.03 cemetery d U1-In ITH= Project# 0110322 Site Locator CA%M_ 112 Spring Street Drawn By:CAS Project Name: Asbestos Material Survey Saratoga Springs,New'Stork 12866 PO Box 65 Date: ,Tune 2022 Address: 29 'Waterbury Street,Saratoga Springs,NY Saratoga Springs NY 12966 Ta'Y(iU 1 518.581.8028 ph Scale:none Prepared for: Mr. Zae Novack AERIAL r* �• i Subject Property 9 4 �► I a: I i SMITH. Project# 0110322 Aerial 112 Spring Street Drawn By: CAS Project Name: Asbestos Material Sur Vey Saratoga Springs,New York 12866 PO Box 65 Date: June 2022 Address: 29 Waterbury Street, Saratoga Springs,NY Saratoga Springs NY 12966 I- 518.581.8028 ph Scale:none Prepared for: Mr. Zae Novack FIGURE 2 I SITE LAYOUT N 'f W W 29-003 W 29-002 Wood Frame Loft (AS) (AS) Dimensions approximately 18'x 38' Brown Shingles—No Tar Paper W W 29-004 29-001 WF WF WF WF WF WF WF WF T Asphalt Shingles (reddish shingles) 3' WF WF WF WF WF WF WF WF 8' D D D D Front View LEGEND WF - Window frame only W - Window D - Split door Vertical Heights Noted AS - Shingles (reddish) C S KITHur Project# 0110322 Site Layout 112 sprprrng Street Drawn By: CAS Project Name: Asbestos Material Survey Saratoga Springs,New York 12866 Pa Box65 Date: June 2022 Address: 29 Waterbury Street, Saratoga Spt•ings,NY Saratoga Springs NY 12966 FIGURE, 3 518.581.8028 ph Scale:none Prepared for: 1Vir. Zaeh Novaek SMxTH- r 11 )•, S s r �. , a r I• Jr..4 �./K��+I r��J r J✓✓-of✓./�r �✓'J._f.J..J�r/1.1�� ��-.r J�w four-bay fou —Front south of garage. Image �'r Y Im g + .* ram-----�' �I F IF Image#2—Southwest corner showing asphalt shingles and plexiglass windows on garage doors. Asbestos.Materials Assessment for Demolition Images I June 2022 Zachary Novick CASmith Project No. 0110322 29 Waterbury St., Saratoga Springs, New York (AMMITH- Image#3—East faced of garage with asphalt shingle siding. 4: � 2 i ' f hnage#4—North face of garage showing one of five windows. Asbestos Materials Assessment for Demolition Images 1 Jame 2022 Zachary Novick CASmith Project No. 0110322 29 YYaterbalty St., Saratoga Springs, Neiv York 1 , I 'Vow IN .. • � OF r'• r ! ' f ' r r• r r I � �I1�1• +fj I r�v \� •�{ i • / ..I of � � 1 \ \ . 0 r r t— ' re• r 1 I r ` r• ' r Attachment 3 ,Sample Results and Chain of Custody Z:1CASmith\Clients\Environmental\Novick,Zac 901103221Report\Report.doc S111THUC Main Office 112 Spring Street Saratoga Springs,NY 12$66 An Environmental Consulting Company Office 518.581,8028 Facsimile 518.478.8781 Asbestos Sampling Sample Verification Sheet Project No. 0110322 Client Mr. Zachay Novick Date 15 June 2022 Reviewer Goutos Location 29 Waterbury Street, Saratoga Springs, New York 12866 Visual Point NOB NOB PLM/ IS NA Count PLM TEM PLM with 29 dispersion staining -001 -002 -003 -004 Intentionall Left Blank Legend Check Mark- 0.0 asbestos PC- Point Count Method IS- Insufficient Sample NA-No Analysis Requested ILB- Intentionally Left Blank ND-Non Detect NOB Plm-NYS-DOH 198.6 NOB Tem-NYS-DOH 198.4 Visual- Visual Examination(40 CFR Part763, Sub. E, App. E/NYS-DOH 198.1 (PLM) PLM/PLM with dispersion staining- EPA-600/M4-82-020 (Modified) Eastern Analytical Services, Inc. Phone(914)592-8380 4 Westchester Plaza Fax(914)692-8956 EIrnsford, Now York 1 0523-1 61 0 http://www.EAS[nc-com June 13,2022 Mr.Peter C.Goutos CASMITH LLC PO Box 65 Saratoga Springs,rizag � s NY 12866 RE: CPN 110322-Mr.Zac Novick-29 Waterbury Street-Saratoga Springs,NY-Entire Structure EAS Batch No. 2203985 Dear Mr.Goutos: Enclosed please find the laboratory results for the 4 bulk sample(s)received by Eastern Analytical Services,Inc.June 08,2022. The analysis was performed in accordance with NYS-DOH Item 198.6. Thank you for allowing EAS,Inc,to provide CASMITH LLC with professional analytical services. If you have any questions or require additional information or assistance,please feel free to contact me at the number above or e-mail Lab@EASInc.com. Sincerely, EASTERN ANALYTICAL SERVICES,INC. Paul Staseavage Laboratory Director PS:om Enclosures Electronically Transmitted June 13,2022 EAS Batch No. 2203985 Page 1 of 1 Eastern Analytical Services, Inc. Bulk Sample Results RE: CPN 110322-Mr.Zac Novick-29 Waterbury Street-Saratoga Springs,NY-Entire Structure Client CASMITH LLC Date Collected: 06/01/2022 PO Box 65 Collected By: Peter C. Goutos Saratoga Springs,NY 12866 Date Received: 06/08/2022 Date Analyzed: 06/10/2022 Analyzed By: George Htay Signature -- Analytical Method: NYS-DOH 198.6 NVLAP Lab Code: 101646-0 NYS Lab No. 10851 Samnlc ID Number 29-001 29-002 29-003 29-004 Layer Number Lab ID Number 2832717 2832718 2832719 2832720 Sample Location Roof Southwest Hip Roof Southwest Hip Side of Building Side of Building (Note-No Tar Paper) (Note-No Tar Paper) (Note-No Tar Paper) (Note-No Tar Paper) Sample Description Three Tab Shingle, Three Tab Shingle, Asphalt Shingle- Asphalt Shingle- Asphalt-Greenish Asphalt-Greenish Reddish Reddish Analytical Method NOB Plm NOB Ptm NOB Pim NOB Plm Appearance Layered Yes Yes Yes Yes Homogenous No No No No Fibrous Yes Yes Yes Yes Color Green,Black Black/Green Black/Red Black/Red Asbestos %Amosite ND ND ND ND Content %Chrysotile ND ND ND ND %Other ND ND ND ND %Total Asbestos ND Inconclusive ;>� ND Inconclusive ✓ ND Inconclusive ND Inconclusive Other %Organic 70.1 77.4 27.1 29.1 Materials Present %Carbonates 0.8 1.2 47.5 53.0 %Other Inorganic 29.1 21.4 25.4 17.9 Results Applicable To Those Items Tested.Report Cannot be Reproduced,Except Entirely,Without Written Approval of the Laboratory.Samples received in acceptable condition unless otherwise noted.ND—Not Detected. Liability Limited To Cost Of Analysis.This Report Must Not be Used by the Client to Claim Product Endorsement by NVLAP or Any Agency of the US Government. These Results Cannot Be Used To Claim That NOB Items Tested Are Non-Asbestos Containing(Unless"%Other Inorganid',As Reported Above,Is Less Than One Percent). This method does not remove vermiculite and may underestimate the level of asbestos present in a sample containing greater than 10%vermiculite. A114A LAP,LLC No.100263 Rhode Tsland DOH No.AAL-072 Massachusetts DOL No-A A 000072 Connecticut DOH No.PH-0622 lvlaine DEP No.LA-024 Vermont DOH No-AL-709936 4 Westchester Plaza Eimsford,New York 10523.1610 (914)592-8380 http,./Iwviw.EASIne.com Eastern Analytical Services, Inc. Chain of Custody Form EAS Client: CASMITH LLC EAS Batch No. 2203985 PO Box 65 Turn-Around: 72 Hr Saratoga Springs,NY 12866 Shipped Via: FedEx Analyte: Grav Plm State of Origin: NY Sample Disposition: Standard x No. of Samples 4 Return Received: No. of Samples 4 Analyzed: Client Project RE: CPN 110322-Mr.Zac Novick-29 Waterbury Street-Saratoga Number/Name: Springs,NY-Entire Structure Lab ID Numbers:2832717-2832720 Collected By: Peter C.Goutos Date: 06/01/2022 Signature Received By: Meghan A.Warner f�� r Date: 06/08/2022 Time: 1419 Logged In By: 7ohnathon Lapuebla Date: 06/08/2022 Prepped By: 7ohnathon Lapuebla Date: 06/09/2022 Analyzed By : George May Date: 06/10/2022 Time: 0846 Re-Analyzed By: Date: Checked By: Damien Warner Date: 06/13/2022 E-Transmitted By: Damien Warner Date: 06/13/2022 Time: 1049 Logged Out By: Date: Phone 914-592-9380 e-mail Lab@FASTne.com Fax 914-592-8956 n C co 0 C ++ Z O r E C m CO co t3D z W ►� CO iV C1" E .Fi CO Y` Z y-. T— T CV coi. a co co i Ur C9 N t co — p r if5 r Q. 1L 9 Q N C m O o 9 T N N -C p U Q N t3 v c a din © v, in vi z ow w � P� J! = ' c .� S a�10 N a? Z y bD E a +° -4 tun %a 4r c Flo w r uCL LA in 41 fl o � ru �' b 'r7 TS '.7 F fT] in Cl`1 �' �"" �( G[ J9 [L li .7^ CL ca. F I to N i-t C 41 N (D @ c yt C a Q a n u u o C: c a Q,1 Q} O O U Ln i H Q O 1; Z z tutp -y Q CL Q. O O N ~ CO c C 2 ? [4 u E n- > VI Q•F i C37 C7l a d Ol ! •7 Q �7 � � � � J G � a � (C ry fS1 10Y1 N O 0 O �- Yrq O O ,�_ vE w Calf.CZ in as F- ++ v� Co7 O O G o cn M c c a Eastern Analytical 5ervicesq Inc. Phone(914)592-8380 4 Westchester Plaza Fax (914)592-8956 Elmsford, New York 10523-1 610 http://www,EASlnc.com 3 June 13,2022 B Mr.Peter C.Goutos CASMITH LLC PO Box 65 Saratoga Springs,NY 12866 RE: CPN 110322-Mr.Zac Novick-29 Waterbury Street-Saratoga Springs,NY-Entire Structure EAS Batch No. 2203986 Dear Mr.Goutos: Enclosed please find the laboratory results for the 4 bulk sample(s)received by Eastern Analytical Services,Inc.June 08,2022. The analysis was performed in accordance with NYS-DOH Item 198.4. Thank you for allowing EAS,Inc.to provide CASMITH LLC with professional analytical services. If you have any questions or require additional information or assistance,please feel free to contact me at the number above or e-mail Lab@EASInc.com. Sincerely, EASTERN ANALYTICAL SERVICES,INC. 6;;�a5t�� Paul Stascavage Laboratory Director PS:om Enclosures Electronically Transmitted June 13,2022 iwr A IM w+ R� ANUMIEW 1♦-� EAS Batch No. 2203936 Eastern Analytical Services, Inc. Page 1 of 1 Bulk Sample Results RE: CPN 110322-Mr.Zac Novick-29 Waterbury Street-Saratoga Springs,NY-Entire Structure CIient CASMITH LLC Date Collected: 06/01/2022 PO Box 65 Collected By: Peter C.Goutos Saratoga Springs,NY 12866 Date Received: 06/08/2022 Date Analyzed: 06/11/2022 Analyzed By: Fahrudin Lalic Signature : -- Analytical Method: NYS-DOH 198.4 NVLAP Lab Code : 101646-0 NYS Lab No. 10851 Sample ID Number 29-001 29-002 29-003 29-004 Layer Number Lab ID Number 2832717 2832718 2832719 2832720 Sample Location Roof Southwest Hip Roof Southwest Hip Side of Building Side of Building (Note-No Tar Paper) (Note-No Tar Paper) (Note-No Tar Paper) (Note No Tar Paper) Sample Description Three Tab Shingle, Three Tab Shingle, Asphalt Shingle- Asphalt Shingle- Asphalt-Greenish Asphalt-Greenish Reddish Reddish Analytical Method NOB Tem NOB Tem NOB Tem NOB Tem Appearance Layered Yes Yes Yes Yes Homogenous No No No No Fibrous Yes Yes Yes Yes Color Green/Black Black/Green Black/Red Black/Red Asbestos %Amosite ND ND ND ND Content %Chrysotile ND ND ND ND %Other ND ND ND ND %Total Asbestos ND'Z ND ND ND Other %Organic 70.1 77.4 27.1 29.1 Materials Present %Carbonates 0.8 1.2 47.5 53.0 % Other Inorganic 29.1 21.4 25.4 17.9 Results Applicable To Those Items Tested.Report Cannot be Reproduced,Except Entirely,Without Written Approval of the Laboratory.Samples received in acceptable condition unless otherwise noted. ND=Nat Detected. Liability Limited To Cost Of Analysis.This Report Most Not be Used by the Client to Claim Product Endorsement byNVLAP or Any Agency of the US Government. UATHA LAP,LLCNe.100263 RhodeIslandDOHNo.AAL-072 MassachusettsDOLNo.AA000072 ConnecticutDOHNo.PH-0622 MaineDEPNo.LA-024 VermontDOHNo.AL•709936 4 Westchester Plaza Elmsford,Now York 10523-1610 (914)592-8360 http://www.EASine.com Eastern Analytical Services, Inc. Chain of Custody Form EAS Client: CASMI`I'H LLC EAS Batch No. 2203986 PO Box 65 Turn-Around: Seventy-Two Hr Saratoga Springs,NY 12866 Shipped Via: FedEx Analyte: Grav Tern State of Origin: NY Sample Disposition: Standard x No. of Samples 4 Return E_ Received: No.of Samples 4 Analyzed: Client Project RE: CPN 110322-Mr.Zac Novick-29 Waterbury Street-Saratoga Number/Name: Springs,NY-Entire Structure Lab ID Numbers:2832717-2832720 Collected By: Peter C.Goutos Date: 06/01/2022 Signature Received By: Meghan A. Warner f Date: 06/08/2022 Time: 1419 Logged In By: Johnathon Lapuebla Date: 06/08/2022 Prepped By: Johnathon Lapuebla Date: 06/10/2022 Analyzed By : Fahr-udin Lalic — Date: 06/11/2022 Time: 0020 Re-Analyzed By: Date: Checked By: Damien Warner Date: 06/13/2022 E-Transmitted By: Damien Warner Date: 06/13/2022 Time: 1049 Logged Out By: Date: Fax 914-592-8956 Phone 914-592-8380 e-mail Lab EASlnc.coan a N N +=� Z N eri C vj CI 'r i O w i 00 Mo � c CON O O N co d m �, Sr u7 4= a N N n1 a m O O 0. r Gp as �q LC C O co O k ems- 1 It.IL U. I s_ y � p N tll R t� C7 ml cr a U Z ry o v o o U 1 1 0tLc m ++ m N C G CO Gp a fn m `^ cc A w CL to G u - .::; LL cr f � Q. i i i to 00 � r z vi O c. Q. a C Q. 0 V) o s-L +. V V o. m c o c`4i f Q C (4 NIr4 a) N @ J N C7 O 41 W o a c it r+ z z �j N i .0 � ... tA i a"' C71 t31 '� O L 7 iz y� a� ! �J y "p at v, q N Qj O C) ° a te en I a a c �{ N w 0' cr ao c V m m w }' rn Q © r i rV M C7 0 C7 aw a v 9 i a ar -c to .C!5: s.ter@ PLM Analysis Memo Nan-Ruble Organically Bound(NOB)Materials-This term refers to a wide variety of building materials,such as vinyl or asphalt floor tile,resilient floor covering,mastic,asphalt shingle,roofing material,caulk,putty,etc.. Polarized Light Microscopy(PLM)analysis has limitations when NOB materials are encountered.These limitations,such as the inability to detect thin or extremely short fibers(less than 1 micrometer in length)generated during the milling process and/or the difficulty of separating asbestos fibers and bundles from the resinous matrix,may lead to false negatives or underestimates of the amount of asbestos fibers present in the sample. Recently,NYS DOH added Ceiling Tiles with Cellulose to the list of materials to be analyzed via the NOB methods. For these reasons,when analysis by PLM yields negative results for the presence of asbestos inNOB materials,The State of New York Department of Health(DOH)has issued the fallowing requirements as of April 8,2011:NOBS and ceiling tiles with cellulose must be analyzed by both of the gravimetric matrix reduction methods(FLAP Item 198.6 and 198.4)to be deemed negative for asbestos. EAS is approved by the NYS DOH to perform analysis of NOB materials via Transmission ElectranMicros copy(FLAP It 195.4). The superior resolution of Transmission Electron Microscopy can detect the presence of asbestos fibers well beyond the range of PLM. In can positively identify asbestos ' spectroscopy DS y fY D and ener dis eisrve py(E ) p addition,file use of selected-area electron diffraction(SAE ) gy p p fibers in the sample. NOB samples determined to contain less than 1%asbestos via the TEM method,must also be analyzed via PLM(198.5)to verity the absence of large ampblbole fibers which may not have been successfully transferred to the EM Grids. The State of New Jersey recently adopted amendincaN to their regulations requiring gravimetric reduction followed by PLM and TEM analysis for NOB building materials. The regulations can be found at 4,ttn lfl==Et.tnl state ni i�s/labor/lssellaw Asbegos.law him[#5a39. Recently(April 3,2011),Maine DEP revised their regulations to require gravimetric reduction of NOBS https:/fwwwl.main.aov/cien/wfaste/asbestos/documentslasbbulksam analysis rotochlsfoi-nIYenab Je4,Pclf Vermlculite-As of July 9,2013,NYS has issued new guidance on Vermiculite loose bulk materials and insulation materials which contain Vermiculite. The following quotes have been taken from their guidance letter: "tf material is attic fill,blockfrll or other loose bulk vermiculite materials,it must be designated rvid treate d as A CM.No approved analytical method currently exists to reliably cor1firm such vermiculite material as non-ACM" "Wiere thermal systems insulation(TSI), *, or other presumed ACM(PACM or miscellaneous suspectACMconfrain 10%vermiculite or less,certified laboratories may use EL4P Certification Manual Item 198.1 to determine the asbestos content of the meter lal. Wliere TSI, # or other PACMor misceil meotrs swpecfACMcontain greater&ui 10%vermiculite,Item 198.6 may he used to evaluate the asbestos content of the material;provided ho)vever,that any test results using this method must be reported with the following conspicuous cUsclarmer: "lids giethod noes not remove verndeadite and 194Y Autderestiaatcde the level qf asb estos present in a shngle eontabibig greater tFieoa 10%verudei rite" See the EPA lvebsite at h pwxepa eovlasbevtoslt)LOt—ect-vour-fkwlibLaLbe—s—tOs-eorataminaled vermiculite-irztulutiora *Surfacing Material Containing Vermiculite-As of May 6,2016,NYS has issued new guidance regarding Surfacing Material containing vermiculite(essentially expanding the previous requirements for spray-obi fireproofing to apply to all surfacing materials). If a surfacing material contains any vermiculite,it must be analyzed via NYS-DOH Method 198.8(or Rt Lee Group Method 055)to be deemed negative for asbestos. Surface Wipe Samples-Due to the fact that a large percentage of asbestos fibers released from deteriorating asbestos-containing materials or from improperly performed abatement activities are on the order of 5 micrometers or less and are near or below the resolution of a Polarized Light Microscope,Eastern Analytical Services,Inc.recommends that negative surface wipe samples be confirmed utilizing Transmission Electron Microscopy. Point Counting-New York State Department of Health regulations require quantification,of asbestos via the"Stratified Point Count" Method for all bulk samples originating from New York State. please indicate the state of origin on the Chain of Custody form for all samples submitted to the laboratory.There is no additional charge for quantification using this method. Layered Samples-NESHAP policy regarding layered bulk samples has changed. In the past, laboratories were required to analyze individual layers of multi-layered bulk samples separately,but report the results in terms of quantity of asbestos for the composite sample. This policy change requires that the layers be analyzed separately and reported as such. Additionally,materials are to be characterized as asbestos or non-asbestos based on the results of the individual layers. As a result of this policy,EAS will be reporting the results of the individual layers of multi-layered bulk samples submitted for asbestos analysis UNLESS COMPOSITE RESULTS ARE SPECIFICALLY REQUESTED BY THE CLIENT. Additional layers for all bulk samples will be billed as separate samples. If you have any questions concerning the above,please feel free to contact EAS. 4 Westchester Plaza Elmsford,New York 10523.1610 pl,t)592.8380 http://r/vvNi.EASIrio.coiii i E Attachment 4 Licenses and Certifications CASmith, LLC Asbestos Handling License Peter C. Goutos Asbestos Certificate Laboratory Licenses and Certifications Z:1CASmithlClients\Fnvironmental\Novick,Zac#01103221ReportlReport.doc 1IlllMRfflm NEW YORt( Department STATE OF �1 ,py 11111111111 l l I l OPPORTi3NITY of Labor 01213 006064726 01 f PETER C GOUTOS 168 DENTON RD SARATOGA SPRINGS NY 12866 f i Enclosed is your now card. NYS Department of Labor The Department of Labor is happy to provide this improved card. We welcome your comments: nysdol@labor.ny.gov or call (518) 457-2735 YOUR NEW CARD STATE Of NEW YORX-UEPAuIMIN T GE LAROR A59ESClS CERTIFICATE PETEH C C OUTQS CLASS(FOIRES} 0 INSP(05122) E MGPL(05I22] MUST BE CARRIED ON ASBESTOS PROJECTS nruuuor nmrrinrr►� IIII�If�11111 l 11�1 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 CA Smith, LLC FILE NUMBER: 08-3765'5 LICENSE NUMBER: 37665 P.G. BOX 65 YY` LICENSE CLASS: RESTRICTED DATE OF ISSUE: 12/17/2021 Saratoga Springs, NY 1;2866.- EXPIRATiQN.DATE: 12/31/2022 4 i �� � ,Itir � r �z7llltr7tttic ,f! � �r�f, � i Duly Authorized Representative,.-J,Peter Gpwto ,�^= ' 1 � � •• � ,Atits �5 � 1 This license has been issued in ac6ordancd With,dpplicabJ6 pr'ot,tsi`ons of.'* 61 ©ftho Labor Law of New York State and of the New York State Codes,Rules'mid RegulatW&';-�12 NY(RRPa'&S6j: -ft!s.§tlbjr;et to su pension or revocation fora(1) serious violation of state,federal or local lad=!s jvii h,hgard?to-the condtict of aA!as estou'pro.ect,or(2)demonstrated lack of responsibility in the conduct of any job 401VW9,4sbestbs or;asbestos material. A.Tl�is license is valid only for the contractor name d:above and this License or aplaotdQpy,must be priozninently displayed at the asbestos project worksitc. 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 foir the type of work they perform,by the New York Statc Department of Labor. t J Amy Phillips,Director SH 432(8112) For the Commissioner of Labor CD CRI _ro o ccv oQ oQ � ro C*4 0 W a . ® 0oN s, >1 A ZZ 0 -0 col- m q = WCO Cr3 ► v - �, ro t r EL o poi ZZ . ° D gym ° : LL (v '� c 0 al C, WNW D o ;w b N ro z m o o 0 v co o ■� y U ti r National Voluntary Laboratory AGGreditation Program SCOPE OF ACCREDITATION TO ISOIIEC 17025:2017 Eastern i s Analytical Se�v�ce , Inc. 4 Westchester Plaza Ehnsford,NY 10523-1610 Ernest Sanchez Phone: 914-592-8380 Email: ernies@easino.com http://www.EASIne.com ASBESTOS ME ANTAEYSIS SAP LAB CODE 101646-0 Bulk Asbestos Analysis Code 3esc i )2don 18/A01 EPA--40 CFR Appe di—x E to Subpart E of Part 763,Interim Method of the Deterrm ination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600IA 93/116:Method for the Determination of Asbestos in Bulk Building Materials Airborne Asbestos Analysis Code Desj�r j 18/A02 U.S.EPA`s"Interim Transmission Electron Microscopy Analytical Methods-Mandatory and Nonmandatory--and Mandatory Section to Determine Completion of Response Actions"as found in 40 CFB,Part 763, Subpart E,Appendix A. � � t For the National Voluntaly,t. boraOQ�Acoreditation Program Effective 2021-10-01 through 2022-09-30 Page 1 of 1 U O tS o N CD lad p G 4 C� G O SI � a N U G7 0 +�• fir, 'G ` �qq o Ci M o tjID n O Cv � z11 O M. m l4 s 46 r� Cv r9 � y m� y: eGi `n p ;,t 1siJf� .Ad� ea rA N �4y14 `V r, El El ca U ` / A •�. Si p � P� } w {Y 77 NpN � Jrf N O u C T 1 Q o �. r r •� c; a bo N f i t• O US n 0 O y) •7rS 119 't •� � G 1 ��`"Q ►., rr� 'wlry r!"i h 4y :,•�..�,_.y....fi.,R:!-' i L•,i„, T' . i'R�r� ,�•- A_IHA Progrpfps, LL0j ATFIA Laboratory Accreditation Programs, _J C SCOPE OF ACCREDITATION E, rift -n Analytical servict;s, Inca LaboratoryID: 100263 4 Westchester Plaza,Elmsford,NY 10523-1610 Iss€ze Date;08/30/2019 The laboratory is approved for those specific field(s)of testineroethods listed in the table below.Clients are urged to verify the laboratory's current acoreditation status for the particular field(s)of testing/Methods,since these can change due to proficiency I status,suspension and/or withdrawal of accreditation. The EPA recognizes the AMA-LAP,LLG ELLAP program as meeting the requirements of the National Lead Laboratory Accreditation Program(NLLAP)established under Title X of Residential Dead Based Paint Hazard Reduction Act of 1992 and includes paint,soil and dust wipe analysis.Air and composited wipes analyses are not included as part of the NLLAP. Euviromental Lead Laboratory Accreditation Program (ELLAP) halal A.ceredi+abon Date: 003011999 Field of Testing(FoT) Technology sub-fie/ J WlethodDescription etbor±Detector (for intei° al methods only) : EPA SW-846 3050B Paint EPA SW-846 7000E EPA SW-846 3050E a S oR EPA SW-M6 7000B EPA SW-846 3050E Bottled Dust by Wipe EPA SW-846 7000B Airborne Dust I NIOS�I 7082 EPA SW-846 3050B Coinposited Wipes EPA SW-846 70008 A complete listing of currently accredited Environmental Lead laboratories is available on the AMA-LAP,LLC website at: Effective: 10/14/2016 Scope ELLAP R7 Page IofI N Rrooram-�t 1. Af-TA. Laboratory .Accreditation Programs, LLC SCOPE OF ACCREDITATION F,astern Analytical SeMces, Tue. Laboratorym: 10.0263 I 4 Westchester Plaza,Elmsford,NY 10523-1610 Issue Date:08/30/2019 r The laboratory is approved for those specific field(s)oftesting/methods listed in the table below. Clients are urged to verify the laboratory's current accreditation.status for the particular field(s)of testinglMethods,since these can change due to proficiency status,suspension aud/or withdrawal of accreditation. hdastrlai Hygiene Laboratory Accreditation Program (MAP) hi dal Accreditation Date' 0410111990 ;, TAP FFI:e�ld of TestLug(FoT) tech rology P ablshed Reference Mafhadl�escrlptlorr (F0'-,s;coVUr an hub-iyffe1 i °u1�Irre�i�- r;89pe,c-fr(o)metry ry (fo7 intei~al methods relevant 1H matrices) Detccto-r house Method oral C"AA NIOSH 6009 NIOSH 7013 f NIOSI�7024 NIO,SH 7027 NIOSH 7029 f Core Atomic Absorption FAA NIOSH 7030 N10SH 7048 NIOSH 7056 NIOSH 7082 NIOSH 7901 GFAA NIOSH 7105 Polarized Light EPA 6001R 931116 Microscopy(PLM) NYSDOH 198.1 Phase Contrast NIOSH 7400 Asbestos/Flber- Microscopy(PCM) 1�Iicrosco Care EPA AIIERA Method pY (40 CFR 763,Subpart E, Transmission Electron :EPA AHERA-40 CFP� Part 763 Appendix A,Mandatory Microscopy(TEN. Method NSOSH 7402 NIOSH 0500 PI°Iiscellarreaus Ccxe Gravimetric NIOSH 0600 A complete listing of currently accredited Industrial Hygiene laboratories is available on the AIILA-LAP,LLC website at: Effective: 04/10/2015 100263 Scope HILAP_2019—08_30 Page I of I MEW YORK STATE DEPARTMENT OF HEALTH _ WADSWORTH CENTER Expires 12:01 AM April 01,2023 Issued April 01,2022 CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE issued in accordance wilh and pursuant to soCtion 502 Public Heallh Law of Now York State f' MR.PAUL STASCAVAGE NY Lab Id NO:10851 EAS INC-E45 TERN ANALYTICAL LSERVICES INC 4 WESTCHESTER PLAZA ELMSFORD, NY 10523-1610 E is hereby RPPROVLb as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE All approved subcategories and/or analytes are listed below., Miscellaneous Asbestos in Friable hfaterial item 198.1 of Manual EPA 800IM4182/020 Asbestos in Non-Friable Material-PLM item 198.6 of Manual(NOB by P1.M) Asbestos in Non-Friable Matedal-TEM item 108.4 of Manual Asbestos-Vermiculite-Containing Material Item 198.8 of Manual -Land in Dust Wipes EPA 70008 Lead In Paint EPA7000B Sample Pteparatiun Methods EPA 3050E Serial No., 64479 Property of tlu New York State Departrrrent at Health. Cedlllcato&are valld only at the address shwa,must be consplcuaysly posted,and era printeed on,secure paper. Contlnued accreditaklon depe+ids on successful ongoing part'r¢lpatlon in The Program. Cansurners are urged to call(518)485-5570 to verify the labc(atohys accreditallon status, Page 1 of 1 NEW YORK STATE DEPARTMENT OF HEALTH �• - WADSWORTH CENTER Expires 12:01 AM April 01,2023 _ Issued April 01,2022 i x• CERTIFICATE.OI+APPROVAL FOR LABORATORY SERVICE - !&sued in oixordsace with and pursuant to seclian 502 Public Health Law of New York State mR,I'A UL STASCAVACE NY Lab Id No., 10651 EAS INC-E4STERNANALYTICAL SERVICES INC 4 WESTCHE'STER PLAZA I[ ELMSFORD, NY 10523-1610 is herebyAPPROVED as an Environmental Laboratory for the category ENVIRONMENTAL.ANALYSES AIR AND,EMISSIONS All approved subcategories and/or analytes are listed below., Metals 1 Lead,Tolai = NOSH 7082 Miscellaneous. - A-bestos 40 Or"783Aa:A:d0.'.li YAMATE,AGARWAL GISB N105H 7402 Fibers NIOSH 7400 A MULES Serial No.: 64481 Property-of the New York stale Department of Health. Cerdtteatesare valid only at the address shown,must be conspkuousty pasted.and are printed on sxure paper. Continued accreditation depends on successful ongoing participation)n the Program. Consumers are urged to cell(518)Q5-6670 to ve0j the laboratorys aocre-ditation status. Page 1 of 4 NEW YORK STATE DEPARTMENT OF HEALTH_ WADSWORTH CENTER Expires 12:01 AM April 01,2023 Issued April 01,2022 1't CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance with and pursuant to section 502 Public Heald►Law of New York State MR.PAUL STASCAVAGE NY Lab Id No f0861 EAS ING-EASTERN ANALYTICAL SERVICES INC ' 4 WESTCHESTER PLAZA - ELMSEORD, NY 10523-1610 _ is herebyAPPROVED as an Environmental Laboratoryy in conformance with the National Environmental Laboratory Accreditation Conference Standards(2018)for the category ENVIRONMENTAL ANALYSES POTABLE WATER All approved analytes are listed below. = Metals i Copper,Total SM 21-23 31i1 B{-98} trort.Total SM 21-23 3111 D(-99) Lead,Total ' EPA 200.0 Rev.2.2 Miscallaneous Asbestos EPA 100.1 = P PA 100,2 Serial No.: 64476 vti it Property of w r4evrYork stale Deoftrnum of Heaith. o6ri[ticates are valid only at the address st1c715'r},must be wns icuou5 posted,and art printed on secure paper, Continued eccrediiatlon depends IYPo p Pt on su xessrui ongoing partirlpation In the Program, Consumers are urged to Call(519)486-5570 to , verify the taboretWs aareditation status, S Page 1 of 1 Attachment 5 Conditions, Limit�.tons end Information Asbestos Materials Surveys (Asbestos Testing) /� �Yf �f �ilh�!� 1 G[�Lf GG4�p LLtLu1J a ". l.ryLelLLIJ tL p!A`c�iiJ eILL ��1���/� requirements and the requirement of Mztnicipalities to request an asbestos assessment for renovations and demolitio:ts) Conditions and Limitations for Asbestos Assessments (Includes report dissemination and recordkeeping requirements) CASmith LLC General Terms and Conditions (March 2018) ZACASmith\Envirormcntai ResourceslAsbestos\Reports\Report AttachmentsWtach 4-Nov 2021 Cover Sheet Only.doe Main 7e bi6dress 112 Spring Street Po pox CA6—M-1 LW Saratoga Springs,New York 12866 Saratoga Springs,New York 12866 r[n Lnvirotrnrental Cansrrlldng Company PCtcr C.Goutos office 518.581.8028 518.316.4445 Facsimile 518.478.8781 PRqum rr cpsmItftlI co» Asbestos Materials Surveys (Asbestos Testing) Asbestos surveys are reglired by the New York State Department of Labor prior to the issuance of a municipal permit for demolition or renovation projects. This is a statewide requirement. Municipal Code Enforcement Officers are required by the NYSDOL to request these surveys. Code Enforcement Officers and Building Departments have not been granted the authority to tivaive this requirement. Further,a municipality can be held responsible for not requiring the surveys. Typical Questions What is an asbestos material survey?-Surveys include the physical assessment of the materials in a structure,selection of materials to be tested,sampling,analysis of samples and report preparation. What materials inay Contain Asbestos—`Include but not limited to mastics,floor tiles,street linoleum, pipe insulation,hard wall exterior shingles(Transite),tars,joint compounds,shectrock, insulated siding, heat shield material,caulks and,glues. What is an Asbestos Containing Material?-Material(s)containing asbestos in excess of 1%by weight. Can an asbestos material be identified by sight?—Lab analysis is required for definitive results. However,pipe insulation(thermal systems)and Transite may be assumed with reasonable accuracy. Schedule?-Typically Wo weeks;Testing-clay 1,Analytical Results-day 6*,Report-day 8. (*Analytical sohedule needy be accelerated by laboratvi f at increased'l b foo). Survey Report Contents?-The report identifies materials tested,locations,results,quantity of asbestos containing materials and removal options(abatement). What if Asbestos Materials are identified?-The asbestos containing materials mu-si be removed (abateeo by a licensed abatement firm prior to demolition. Depending on the type of asbestos and quantity the abatement project may require air monitoring,project monitoring and in some instances a variance from the NYSDOL. Costs? -Dependant on the number of materials requiring testing. For further information,please contact: Peter C.Contos,Environrucutal Engineer 518,31.6,4445 President, CASmitb,LLC pgoutos@castniihllc.com castniihlic.corn MSDOL Asbestos C rf(cafe 4 08-05465,Inspector and Maria want Planne• CASWIh LLCAsbestos Handling License 113765J Reliahle,F fidrnt,Schesijale driven,36 yeties L'xperdence,questlomAnsivered and Fstimales at No Goss References Statute-New York State Department of Labor,Code Rule 56(Cited as 12 NYCRR Part 56) Part 56 of Title 12 of the Official Compilation of Codes,Rules and Regulations of the State of New York Web search:NYSDOL Corte Rule 56 Regulatory Excerpt-56-5.1 Asbestos survey requirements for building/structure demolition,renovation, remodeling and repair.(a)Asbestos survey required An owner or an owner's agent, e:Ycepi the owner of one and Ave family dwellings who contracts for, but does not direct or control the work, shall cause to be eonducted,an asbestos survey completed by a licensed asbestos contractor using inspectors cettylled in compliance with section 56-12(to of this Part,to deterinine whether or not the btldding or structure,or pordo"(s)thereof to be demolished,renovated,remodeled,or have repair work,contains ACAI,PA CH or asbestos material, This asbestos survey shall be completed and submitted as hulicated in subdivision(g)of this section,prior to Co111111er1eing nvork I Z:1CASmithll;nvironmenta[tRcsourceMsbestosiAsbestos Survey Fact ShectslCASmith Asbestos material Survey Fact Sheet Oct2020.doc LLC rim G'r:vn•orturertttrl Constrltin,5=Cottrn�ttt}� Conditions and Limitations for Asbestos Materials Assessments The following conditions and limitations apply to this project and report. 1. The observations in this report are valid on the date of the investigation. This survey was performed exclusively in the areas described in this report. Where access to portions of the Subject Property was unavailable or limited and in any other area of the structure not identified as a demolition,CASmith renders no opinion as to the presence of potential asbestos containing materials in that portion of the structure. Inaccessible portions,if present on the Subject Property are described within the body of the report. In addition,CASmith renders no opinion as to the presence of,or indirect evidence relating to, asbestos containing materials where direct observations of the Interior wails,floor,or ceiling of the structure were obstructed by objects or coverings on or over these surfaces. 2. This survey excludes heating=plumbing,sprinkler and electrical systems including wiring and devices; doors,wood trim,wood casing,fivniture,tenant materials and stored materials;paint coatings and fluids;structural and roofing materials and elevator systems. 3. Determinations of suspect asbestos containing materials within the building were subject to the accessibility ofthe individual areas or spaces, We accept no responsibility for the content of building materials within areas that were unkmown to or not reasonably accessible. d. In the event that renovation or demolition exposes uu-assessed materials in the building that were unable to be sampled,hidden or encased inside hard barriers such as materials hidden between walls and between floors,per the Neiv York State Department of Labor Code Rule 56,section 56-5.10),all activities shall cease in the area the asbestos is found and the Asbestos Control Bureau shall be notified by telephone,followed with a written notice. 5. This sur--.,w"%�?t L�rducted ii,a,:corilari -:vitii est:NIshed US EpA AHER—A(Agb-cstris Hm-M)t« Emergency Response Act)protocols,as required for public schools. The survey was performed by an AHERA certified asbestos inspector following general industry practices to identify those asbestos containing materials present in the structure€ter veyed. 6. All quantities of asbestos reported herein,if applicable are provided as required by law and are believed to be accurate. This report and the quantities herein are not Intended for use for estimation or bidding purposes. The estimator or bidder is required to verify the quantities identified herein. 7. Conclusion and recomunendations provided in this report are based on the assumption that the materials identified are homogeneous throughout their application. 8. This project and report have been prepared for the exclusive use of the client. 9. Per the New York State Department of Labor Code Rule 56,section 56-5.1(g),one copy of this report sliall be submitted to the focal government entity charged with issuing a permit of demolition,renovation,remodeling,or repair work. This report shall also be submitted to the appropriate Asbestos Control Bureaa office(Albany Asbestos Control Bureau,State office Campus,loom 157,Albany,Now York 12240). one copy of this report shall be kept on site throughout the duration of the demolition project and any associated demolition,renovation, remodeling,abatement or repair work. 10. The client is responsible for abiding by all administrative requirements set forth by the NYSDOL,local and state governments and all permit granting authorities. This includes submission of this report to all appropriate governmental agencies prior to the indication of demolition or abatement activities. 11. In accordance with the Now York State.Department of Labor Code Rule 56 requirements;this document must be retained by the property owner for 30 years. 12. Survey of fire affected strUcture5 is subject to varied Interpretations by the NYSDOL. CASmith assesses affected building only vvhen representative samples can be obtained and only when there is a though verifiable building material history. Due to the interpretative status of the NYSDOL we snake no representation or warrantee to the acceptability of surveys of fire affected structures by the NYSDOL. 13. CASmith's General Terms and Conditions dated 2013 apply to this project and contract. ZACASmillikEnvirannientnl i2esnurcaslRlshcstoslRepurlslrtepcxr AunchmentsWiLichmenl5 11.17-20 Final.doc CA.SKTHLLC General Terms and Conditions March 2018 I. Unforesecrr Conditions/Occurrences Cost and schedule profits or any other indirect, special, incidental or consequential commitments contained in CASmith,LLC(CASmith)proposal shall damages of any nature whatsoever. be subject to renegotiation for unreasonable delays caused by the client's failure to provide specified facilities or information or for b. Client shall indemnify and hold harmless CASmith and its delays caused by unpredictable occurrences such as fires, floods, directors, officers, employees, and agents from and against all strikes,riots,unavailability of labor or materials or services,process liability,claims,suits,losses,damages,costs and demands,including shutdown,acts of God or of the public enemy,or acts of regulations reasonable legal expenses and attorney's fees connected therewith,on of any governmental agency. Work stoppage or interruption caused account of personal injury, including death, or property damage, by any of the above may result in additional cost(requiring a change sustained by any person or entity not a party to any agreement in scope) beyond that identified in CASmith's proposal for between CASmith and client and arising out of or connected with the performance of the Project,entitling CASmith to an adjustment to the performance of such agreement,to the extent such injury, death or cost and schedule. damage is caused by the sole or contributory negligence or willful misconduct of client or its contractors or their respective employees, 2. Payment erms Invoices will be submitted on a monthly basis officers and agents;provided that such injury,death or damage is not unless otherwise stated in the CASmith proposal. All invoices are occasioned by the sole negligence of CASmith or its subcontractors due upon receipt. All unpaid balances outstanding over thirty days or their respective employees, officers and agents; and provided will incur an interest charge of 1.5%per month or the maximum further that client's obligation hereunder shall not extend to permissible under state law. CASmith reserves the right to suspend indemnification or holding harmless of a party indemnified hereunder service, with 7 days advance written notice, until all outstanding for any claims of loss of profits or any other indirect, special, invoices are satisfied. In the event that CASmith is required to incidental or consequential damages of any nature whatsoever. pursue payment through retainment of counsel or a collection service, reasonable costs of collection will be incurred by and be the c. Client acknowledges that CASmith has neither created nor responsibility of the client. contributed to the creation or existence of any type of hazardous or toxic waste,material,chemical,compound,or substance,or any other 3.Termination Any agreement may be terminated in whole or in part type of environmental hazard, contamination, or pollution,whether in writing by either party in the event of substantial or material latent or patent,or the release thereof or the violation of any law or failure by the other party to fulfill its obligations under such regulation relating thereto,at the site of the Project or in connection agreement through no fault of the terminating party,provided that no with the performance of the Project, and it is understood that such termination shall be effective unless the other party is given(1) CASmith shall have no liability for any such condition, and client not less than ten calendar days written notice of intent to terminate shall indemnify CASmith for any and aU loss, cost, or damage and (2) an opportunity for consultation with the terminating party actually sustained and incurred by CASmith in connection therewith prior to the effective date of such termination.A final invoice will be calculated on the first or fifteenth of the month(whichever comes d.The provisions of Paragraph 5 shall survive the complet an of the first)following the effective date of termination. Project or the expiration, cancellation or termination of any agreement behveen CASmith and client. 4. Insurance CASmith shall maintain policies of insurance for the following types of coverage, each (with the exception of Workers Compensation)with a limit of liability of$1,000,000.00 combined 6.Standard of Care single limit: a. CASmith will perform its services using that degree of care and Workers Compensation(statutory)and Employer's Liability; skill ordinarily exercised under similar conditions by reputable Comprehensive General Liability;and members of the environmental engineering and consulting profession Comprehensive Automotive Liability. performing the kind of services and practicing in the same or similar locality at the time of service. CASmith shall, at the client's request, provide the client with a certificate of insurance or other satisfactory evidence that such b.Except for the express promise set forth in subparagraph(a)above, insurance has been obtained and that such policies are maintained in regarding CASmith's standard of care,CASmith neither makes,nor force throughout the period in which CASmith provides services to offers, nor shall CASmith be liable to client for any express or the client under any agreement. implied warranties with respect to the performance of CASmith's services. Estimates of cost, approvals, recommendations, opinions, 5.Indemnification and decisions are made on the basis of CASmith's experience, a. CASmith shall indemnify and hold harmless the client and its qualifications, and professional judgment and are not guaranteed. directors, officers, employees, and agents from and against all CASmith shall not be regarded as a guarantor with respect to any liability,claims,suits,losses,damages,costs and demands,including work product provided to client. THE IMPLIED WARRANTIES OF reasonable legal expenses and attorney's fees connected therewith,on N ERCHANTABILITY AND FITNESS FOR A PARTICULAR account of personal injury, including death, or property damage, PURPOSE ARE HEREBY WAIVED BY CLIENT. sustained by any person or entity not a parry to any agreement between CASmith and client and arising out of or connected with the c. In no event shall CASmith and CASmith's officers, directors, performance of such agreement,to the extent such injury,death or employees, agents, independent professional consultants, and damage is caused by the sole or contributory negligence or willful contractors be liable to client and/or anyone claiming by,through or misconduct of CASmith or its subcontractors or their respective under client, including client's insurers, for any lost, delayed, or employees,officers and agents;provided that such injury, death or diminished profits, revenues, or opportunities; losses by reason of damage is not occasioned by the sole negligence of client or its shutdown or inability to utilize or complete work at the site of the contractors or their respective employees, officers and agents; and Project; or any other incidental, special, indirect, or consequential provided further, that CASmith's liability under this indemnity damages of any kind or nature whatsoever resulting from CASrnith's provision shall be limited to and not exceed the insurance coverage's performance or failure to perform services pursuant to any agreement. and associated limits of liability which CASmith is required to secure d. CASmith and CASmith's officers, directors, employees, agents pursuant to Paragraph 4 hereof;and provided further that CASmith's and independent professionals and contractors shall not be liable to obligation hereunder shall not extend to indemnification or holding client and/or anyone claiming by,through or under client,including harmless of a party indemnified hereunder for any claims of loss of client's insurers, nor shall CASmith be liable to indemnify client pursuant to Paragraph 5,hereof,in an amount which exceeds either I of 2 TFAVS&COND177ONS.DOC W $100,000.00 or the total compensation value to CASmith of the c.Because computer-based applications are inherently complex and Project,whichever amount is less,if the claims of client or client's may not be completely free of errors,it is the client's responsibility insurers against CASmith are not covered by the insurance coverages to: verify the data within the Software; confirm the accuracy and and associated limits of liability which CASmith is required to completeness of the reports generated by the Software;and to make maintain pursuant to Paragraph 4 hereof, backup copies of the Software. In no event will CASmith be liable or (ii) the amount of coverage afforded by CASmith's insurance for indirect, special, incidental, tort, economic, cover or coverage as described in Paragraph 4 hereof if the claims of client or consequential damages arising out of the use or inability to use client's insurers against CASmith are covered by the insurances and CASmith software products or services,including,without limitation, associated limits of liability which CASmith is required to maintain damages or costs relating to the loss of profits,business,goodwill, pursuant to Paragraph 4 hereof. The client hereby forever releases data or computer programs,even if advised of the possibility of such CASmith and its off€ccrs,principals,employees and agents from any damages. In no case shall CASmith's liability exceed the amount liability for losses or damages sustained and incurred by the client in paid by the client for the Software out of which such claim arose. excess of such amount. d. For use, duplication or disclosure by the United States E e.As used in this Paragraph 6,the term"liable"or"liability"means Government, CASmith software and/or user documentation is ( liability of any kind, whether in contract (including breach of provided with RESTRICTED AND LIMITED RIGHTS. Use, warranty), in tort (including negligence, whether of CASmith or duplication or disclosure by the Government is subject to restrictions others),in strict liability,for indemnity,or otherwise,for any and all as set forth in FAR 52.227-14 (June 1987)Alternate IN(g)(3)(June injuries,claims,losses,expenses or damages whatsoever arising out 1987), FAR 52.227-19 (June 1987), or DFARS 52.227-7013 of or in any way related to CASmith's services from any cause or (c)(1)(ii) (rune 1988), as applicable. In the event the Government is causes whatsoever,including but not limited to the negligence,errors, seeks to obtain the Software pursuant to standard commercial 7. omissions, strict liability or breach of contract of CASmith and/or practice,these Terms and Conditions,instead of the noted regulatory CASmith's officers, directors, employees, agents and independent clauses,shall control the terms of the Government license. professional consultants, or any of theta. The provisions of this Paragraph 6 providing for limitations of and protections against 10.Promotion Client agrees that CASmith may use client's name CASmith's liability shall survive the completion of the Project or the and general description of the Project as a reference for marketing to expiration, cancellation, or termination of any agreement between other prospective clients. CASmith and client, and such provisions shall apply the full extent permitted by law. 11. SubuoerigQcpositions If CASmith personnel are called or subpoenaed for depositions,examination,or court appearances in any 7. Hazardous Materials Client recognizes that, when it is known, dispute arising out of the Project,CASmith shall be reimbursed on a assumed or suspected that hazardous materials exist on or beneath the time and material basis in accordance with this agreement for such surface of the site of the Project or within any structure Viereon, matters,including all out-of-pocket cods incurred in connection with certain sampling materials,such as drill cuttings and drilling fluids or such matters. asbestos removed for sampling,should be handled as if hazardous or contaminated. Accordingly,when sampling is included in the scope 12.Severabili If any of these General Terms and Conditions shall of services and when determined by CASmith in its sole and be finally determined to be invalid or unenforceable in whole or in exclusive judgment to be necessary based on CASmith's assessment part,the remaining provisions hereof shall remain in full force and of the degree of contamination, hazard and risk, CASmith will effect and be binding upon the parties. The parties agree to reform promptly inform client that containerization and labeling will be the contract between them to replace any such invalid or performed; will appropriately contain and label such materials;and unenforceable provisions with a valid and enforceable provision that will leave the containers on site for proper,lawful storage,removal, comes as close as possible to the intention of the stricken provision. transport and disposal by client. Client waives any claim against CASmith, and agrees to indemnify, defend and hold CASmith 13. Priori and lntetrration Once Lhe client has signified its harmless from any claim or liability for injury or loss which may acceptance of CASmith's proposal,the express terms of CASmith's arise as a result of the drill cuttings,drilling fluids or other assumedly propoW to client and these General Terms and Conditions shall hazardous materials being left on the site of the Project after their constitute the complete and exclusive statement of the terms of the containerization by CASmith. agreement between the parties and are intended as a final expression of the terms of such agreement and will supersede all prior and 8. Documents All correspondence, written reports and supporting contemporaneous agreements,representations or conditions,express documents provided under this agreement are for exclusive use and or implied, oral or written. No provision of CASmith's proposal or reliance by the client, Client acknowledges that these documents will these General Terms and Conditions may be waived, altered, or not be used or relied upon by entities other than the client and may modified in any manner,unless the same shall be set forth in writing not be used or relied upon in any prospectus or offering curriculum. and signed by a duly authorized representative of CASmith. Client may use its standard business forms (such as purchase orders) to 9 CASmith Software administer any agreement between CASmith and client,but use of a. CASmith services may include the development of customized such forms shall be for convenience purposes only, and any typed computer applications for clients,hereinafter the"Software." provision in conflict with the terms of CASmith's proposal or these b.CASmith retains intellectual rights to all Software techniques used General Terms and Conditions and all pre-printed terms and to develop computer-based applications for clients. CASmith retains conditions contained in or on such forms shall be deemed stricken all associated rights not expressly granted. and null and void. 2 of 2 rcRws Cavnrnoms.noC E E Attachment 6 Other Relevant Documents Real Property Records Image Mate Z:1CASmith\ClientslF-nvironmental\Novick,Zac 901103221ReporAReport.doc 6122122,3:17 PM Property Details-Image Mate Online 1�00,� _ 1 v} 5 y 1 ., ,' image Mate Online I79i Navigation GIS Map Tax Maps DTF Links Assessment Info Help Contact Us Log In Photographs hotographs i Municipality of City of Saratoga (C[ick on photo to enlarge it.} Property Info Springs, Inside r OwnerlSales� _ Inventory SWIS: 411501 1 Tax ID: L165.43-1-4 j` Improvements p Tax Info Improvements •.._,>� Report Structure Size Grade Condition Year Ccmparables Porch- 6 x 5 Average Normal 1865 Photo coverd Gar-1.0 34 X 18 Economy Normal 1920 Notes det Documents Porch- 400.00 sq ft Average Normal 1980 View Notes open/dock No documents found for this parcel Porch- 5 x 19 Average Normal 1865 coverd Maps View Tax Map Pin Property o�Map View in Goggle Maps View in Bing Maps Map Disclaimer https:llsaratoga.sdgnys.com/propdetaii.aspx?swis=411501&printkey=16504300010040000000 111 6/22122,3:16 PM Property Details-Image Mate Online Image Mate Online 17CA [Navigation GlS Map Tax.Maps DTF Links Assessment Info Help Contact Us Lag In i Residential Photographs Municipality of City of Saratoga Springs, r (Click on photo to enlarge it.) Property Info Inside Owner/Sales Inventory SWIS: 411501 Tax ID: 165.43-1-4 4r _ 1 1 ix r Improvements w,,F,a � Tax Info Tax Map ID / Property Data Report Status: Active Roll Section: Taxable Comparables Address: 29 Waterbury St Photo Property 210- 1 Family Site 210-1 Family Class: Res Property Res Notes CI`ns'' Documents Ownership View Notes Code: No documents found for this parcel Site: Res 1 In Ag. No District: Maps Zoning Code: UR2- Bldg.Style: Old style Neighborhood: 15180- School Saratoga View Tax Map District: Springs F-- Property S-06 B-B L-3 Pin Property on GIS Map Description: Total Equalization Acreage/Size: 0.18 Rate: View in Goggle Maps 2022 -Tentative 2022-Tentative View in Bing Maps Land $56 700 Total $206,300 Assessment: 2021 -$56700 Assessment: 2021 - , $206,300 map Disclaimer 2022-Tentative Full Market $375,091 Value: 2021 - $338,197 Deed Book: 2018 Deed Page: 36863 Grid East: 681910 Grid North: 1550367 Special Districts for 2022 (Tentative) Description �#l Units Percent Type Value SE010-County sewer dir0 0 0 Special Districts for 2021 Description Units Percent Type Value https://saratoga.sdgnys.com/propdetail.aspx?swis=411501&printkay=16504300010040000000 112 6/22/22,3:16 PM Property Details-Image Mate Online SE010-County sewer dist 91 10 0% 0 Land Types Type �0,18 Primary https:llsaratoga.sdgnys.com/propdotall,aspx?swis=411501&printkey=16504300010040000000 212 6122/22,3:17 PM Property Details-Image Mate Online Al 4. A6G.A 0Wis Mil 1 Image Mate Online Navigation GIS Map Tax Maps DTF Links Assessment Info Help Contact Us Log In Residential Photographs Municipality of City of Saratoga (Click onphoto to enlarge it.) Property Info Springs, Inside Owner/Sales _ Inventory SWIS: 411501 Tax ID: 165.43-1-4 I Improvements i Tax Info Structure � N Report Building Style: Old style Comparables Number of Baths: 1 (Full)- 1(Half) Photo Number of Bedrooms: 3 Number of Kitchens: 1 Notes Documents Number of Fireplaces: 0 View Notes Overall Condition: Normal No documents found for this parcel Overall Grade: Average Maps Porch Type: Porch Area: Year Built: 1865 View Tax Map Eff Year Built: Pin Property on GIS Map Basement Type: Partial Basement Garage Cap.: 0 View in Google Maps Attached Garage Cap.: 0 sq.ft. View in Bing Maps Area Map Disclaimer Living Area: 1,666 sq.ft. First Story Area: 945 sq. ft. Second Story Area: 721 sq.ft. Half Story Area: 0 sq.ft. Additional Story Area: 0 sq. ft. Three-Quarter Story 0 sq. ft. Area: Finished Basement: 0 sq. ft. Finished Rec Room: 0 sq. ft. Finished Area Over 0 sq. ft. Garage: https://saratoga.sdgnys.comlpropdatail.aspx?swis=411501&printkey=16504300010040000000 112 6/22122,3:17 PM Property Details-Image Mate Online Number of Stories: 2 Utilities Sewer Type: Comm/public Water Supply: Comm/public Utilities: Gas &elec Heat Type: Hot air Fuel Type: Natural Gas Central Air: No E E E httpsalsaratogasdgnys.comlpropdetail.aspx?swiss411501&printkey=16504300010040000000 212 ., ,. City of Saratoga Springs BUILDING DEPARTMENT 474 BROADWAY-SUITE 32 SARATOGA SPRINGS, NY 12866 518-587-3550 X 2510 KATHI.BEEN.FARONE@SARAI-OGA-SPRINGS.ORG APPLICATION FOR ACCESSORY STRUCTURE PERMIT (Na HABITABLE SPACE: DETACHED GARAGE,SHED,POOL House..,) 1. APPLICATION MUST BE FILLED OUT COMPLETELY INCLUDING ALL SIGNATURES. 2. The permit fee of$150.00 plus $.251SF (check made payable to Comtrussioner of Finance) must accompany application. 3. ,Any roof construction other than conventional"ridgeboard& rafter"will require engineering (trusses). 4. No permit is required for structures with a maximum square footage of 144 sq. ft. 5. A plot plan is required to be submitted to comply with all Zoning area requirements. Location Information JOB SITE ADDRESS ! WO�LC6,r* TAX MAP ID# fir.�� "I_I ZONING DISTRICT " a TOTAL COST OFWORK$ I ARCHITL.CTURAL REVIEW DISTRICT YES Q D.R.C. DECISION BATE HISTORIC REVIEW DISTRICT YES (PLEASEATTACH COPYOF DECISION) IS J013 SITE IN A FLOOD PLAIN? YES �10/ H.O,A.APPROVAL DATE �J (PLEASE ATi ACH COPY 01-APPROVAL) OWNER INFORMATION / CID# OWNER'S NAME - Ic PHONE 's 19" S (O '" 0 9 1 ADDRESS I to UM S EMAIL 4 N o\1�c K ekw,.(• C-O m �? a OWNS S SIGNATURE DATE APPLICANT INFORMATION APPLICANT 45A M, ' PHONE ADDRESS EMAIL :5 I APPLICANT'S SIGNATURE. DATE CONTRACTOR INFORMATION CID#COMPANY NAME�I�K r�0 11 ti ! �' PHONE S� U. 7 7 ADDRESS co a!) 3 l c, l l/T ff"Ct, EMAIL CONT CTOR'S SIGNATURE DATE FOR STAFF USE ONLY: lFILE# DATEAPPLIED RECEIVED BY I APPLICATION# PFRMIT ft DA:rE ISSUED REVISEL)1-1-21 i SPECIFICATIONS & MATERIALS LIST AND CALCULATION OF PERMIT FEE GEnNERAL... SEZE :MATERIAL .:'SPECIFICATIONS :.OTHER:... .. FOUNDATION: FOOTINGS a( SLAB(400 SQ FT, ` ENGINFRRING REQD) BLOCKS,ETC FLOORS: SLAB(SEE ABOVE) � ~-- JOISTS Z �." (]E-C-/L-1-V+.45-5 i'A 7, ,& .--- DECKING —G s /3 WALLS: - SILLS " wood _ _ — STUDS HEADERS 2x/u woo SHEATHING 1116 ROOF: RIDGE BOARD RAFTERS Z,)C tvLv TRUSSES Wv� i!o is -- (ENGINEERING REQD SHEATHING UNDERLAYMENT: ICE PROTECTION kF HEATED _ FELT PAPER VENTING HEATING(IF ANY): ENERGY CODE COMPLIANCE TYPE FUEL VENT MATERIAL INSULATION(IF ANY) FINISH WORE SIxE. . MA7I=FilAk':: UNDERLAY OTHER. ..... INTERIOR CEILINGSIWALLS ROOFING le WALL SIDING :SIZE MATERIAL MISCELLANEOUS OTHHFZ , PEE CALCULATION BASIC FEE-$150.00 150.00 CALCULATION BY SQUARE FOOTAGE: � $.251 SQ.FT.X Z 0 -_ 90, , I AREA IN SQ.FT. �r f TOTAL FEE AMOUNT = �� 0 i (MAKE CHECK PAYABLE TO COWMiSSIONER OF FINANCE) REVISED 1-1-21 f f APPLICATION FOR ACCESSORY STRUCTURE PERMIT THE FOLLOWING INFORMATION MUST BE PROVIDED: 1. Detailed drawings to include (but not limited to): (a) foundation; (b) floor and wall framing; (c) roof rafters or trusses; (d) roofing materials; (e) energy code compliance path, if conditioned space. a) Unit to be built to withstand Ground Snow Load of 50 psf and wind speed of 115 mph (ultimate), 2. The attached plot plan must be filled out completely. Include a survey (if available), showing garage location as well as location of (including and additions), any accessory structures, swimming pools, etc. and all yard dimensions. I 3. AN APPROVED ELECTRICAL INSPECTION AGENCY MUST INSPECT AND PROVIDE A CERTIFICATE OF COMPLIANCE FOR ANY ELECTRICAL WORK. 4, LIABILITY INSURANCE.COVERAGE. (a) For general contractors acting in the capacity of a general contractor: a Certificate of I Insurance on an ACCORD form with Commercial General Liability Insurance of One Million Dollars ($1,000,000) per occurrence aggregate naming the City of Saratoga Springs as an Additional Insured and Certificate Holder; (b) For homeowners acting as general contractor—see Homeowner Insurance Requirements (attached), (c) All applicants must provide proof of NYS Statutory Workers Compensation (form C105.2) and Disability Insurance (form 013120.1) or a waiver of same as determined by the NYS Workers Compensation Board (Homeowners—form BP-1; Contractors—farm CE-200). The information that we re wire is as follows: I Foundation(if any) Slab/Patio Blocksletc: Size, Material Type Floors - Joists: Size, Spacing, Material Type - Decking: Size, Material Type, Attachment to Joists Walls - Sills: Size, Material Type - Studs: Size, Material Type, Spacing I - Headers_ Size, Material Type - Sheathing: Size, Material Type Siding: Material Type Roof/Ridge Board i - Rafters: Material Type, Spacing LL Trusses: Material Type, Spacing(Engineers Stamp Required) E - Sheathing: Size(112" min.), Material Type ' Covering: Material Type r Underlayment: As required by covering material type - Ice Protection: From eave edge to at least 24" inside exterior wall line - Felt paper: As required by slope { Venting: As required by covering material type Design Criteria - Unit to be built to withstand Ground Snow Load of 50psf and Wind Speed of 115mph (ultimate). Lot Placement - Area Requirements of property Zoning District to be followed and noted on a plot plan or survey. i Additional information may be required by the reviewing inspector as deemed necessary. REVISED 1-1-21 PLOT PLAN AND LOCATION INFORMATION Locate main building (including additions), any accessory structures, swimming pool, etc. Give all yard dimensions. REAR LOT LINE 151 FT 21F-FT REAR YARD FT FT LEFT YARD RIGHT YARD LL FT FROM HOUSE r O Lu r_ z z � rn o � LL LL J h n MAIN BUILDING FRONT LOT LINE 51 FT HOLD HARMLESS: The Individual filing this application, to the fullest extent provided by law, shall indemnify and save harmless the City of Saratoga Springs, its Agents and Employees(hereinafter referred to as"City"), from and against all claims, damages, losses and expense (including, but not limited to,attorneys'fees), arising out of or resulting from the performance of the work covered by this building permit application, sustained by any person or persons, provided that any such claim, damage, loss or expense is attributable to bodily injury, sickness, disease, or death,or to injury to or destruction of property caused by the tortious act or negligent act or omissUs/o�n of Applicant, its contractor or its employees or anyone for whom the Contractor is legally liable or Subcontractors. 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Q0OxS r�lG.rJk r Ac �^�'r ko4 tiJati`V' � �G1t�nUQ��c,z'. k5 Client#:32873 JOHNOMA /31/ AC®RG., CERTIFICATE QF LIABILITY INSURANCE D 5 IDO/YYYYj /31/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ann Maher NAME: Amsure S&T PHONE 518 584-5300 FAX 51$584-7306 A!c No,Exi: A/C No 31 Church Street ADDRESS: AMaher@amsureins.Com Saratoga Box 336 INSURER(S)AFFORDING COVERAGE NAIC A Saratoga Springs, NY 12866 INSURER A:Main Street America Assurance Co. 29939 ENSURED John O'Malley III INSURER B: INSUREA � _ DBA John O'Malley Enterprises C:— 639 Stark Terrace INSURER 1) Ballston Spa, NY 12020 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL SUER POLICY EFF POLICY EXP LTR, TYPE OF INSURANCE INSR WVD POLICY NUMBER_ MMIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MPU8676U 8/02/2021 08/02/2022 EACH OCCURRENCE $1 000 000 CLAIMS-MADE �OCCUR PREMISES a occur°nce $500 000 MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000 000 _ POLICY D JECTPRO- LOC PRODUCTS-COMPIUPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY MPU8676U 8/02/2021 08/02/2022 =ostNGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person( $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY{Per accident) $ _ HIRED T, NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAS CLAIMS-MADE AGGREGATE $ DE O RETENTION$ $ WORKERS COMPENSATION PER DTH- AND EMPLOYERS'LIABILITY Y/N _._JSTATUTEANY PROPRIETORIPARTNEFUFXECUTiVE OFFICERIMEMBER EXCLUDEW n NIA E.L.EACH ACCIDENT $ (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERAT€ONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 29 Waterbury St, Saratoga Springs NY 12866. The Certificate Holder is Additional Insured as respects to General Liability,when required by written contract that is executed and signed by the Named Insured prior to any loss. CERTIFICATE HOLDER CANCELLATION City of Saratoga Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 474 Broadway ACCORDANCE WITH THE POLICY PROVISIONS. Suite 32 Saratoga Springs, NY 12866 AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S340623/M335664 JS 2 ZYNRATE W Workers' Certificate of Attestation of Exemption K Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which,you are requesting a permit,license or contract. This Certificate will not he accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit John J O'Mallev III DBA•011blalley Enterprises From:City of Saratoga Springs 639 Stark Ter Ballston Spa,NY 12020-3070 The location of where work will be performed is PHONE:518-852-3476 FEIN:XXXXY1146 29 Waterbury Street,Saratoga Springs,NV 12866. Estimated dates necessary to complete work associated with the building permit are from August 1,2022 to July 31,2023. The estimated dollar amount of project is over$100,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is owned by one individual and is not a corporation. Other than the owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) 1,John J.O'Malley,am the Sole Proprietor with the above-named legal entity. I affinn that due to my position with the above-named business i have the knowledge,information and authority to make this Certificate of Attestation of Exemption. 1 hereby affinn that the statements made herein are true,that I have not made any materially false statements and 1 make this Certificate of Attestation of Exemption under the penalties of perjury, 1 further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affinn that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately fin-nish proof of that coverage on forms approved by the Chair of the Workers'Come tion Board to the gol,cr it entity listed above. SIGN A) HERE Signature l Dater Gxe�mptxbn C�crtlrlir alto Nurnbeh � � tRecciy�ecl t, 2022-037602 Mciy 301 2022 NYS Workers"Compeusatiolt Board,Eff CE-200 0112018 City of Saratoga Springs BUILDING DEPARTMENT CITY HALL- 474 BROADWAY- SARATOGA SPRINGS, NY 12866 PHONE 518-587-3560 EXT, 2510 KATHLEEN.FARONE a@SARATOGA-SPRINGS.ORG APPLICATION FOR DEMOLITION PERMIT 1. APPLICATION MUST BE FILLED OUT COMPLETELY. Signatures of property Owner, applicant(if different than owner) and contractor are required, Kermit is valid for one year from date of issuance. 2. The demolition permit fees: check made payable to Commissioner of Finance must accompany application. Residential primary structure $175.00 Residential accessary structure $75.00 Commercial structure $250,00 _ Location Information f y tI JOB SITE ADDRESS wG z 6jf4 ,6 l TAX MAP 1D4 L4 g ZONING DISTRICT VIZ r COST OF DEMOLITION _.... CONSTRUCTION TYPE '96,,"J 4CC-t-Ko- 4 5z-.+&k'cLJSE OF BUILDINGS)No. OF BUILDINGS BEING DEMOLISHED 1 1"'FLOOR AREA,.Y-s NO.OF STORIES �C NAT'L REGISTER OF HISTORIC PLACES YES I ARCHITECTURAL REVIEW DISTRICT YES D.R.C. DECISION[LATE_ -- HISTORIC REVIEW DISTRICT YES (PLEASE ATTACH COPY OF DECISION) IS JOB SITE IN A FLOOD PLAIN? YES H.O,A. APPROVAL DATE(IFANY) (PLEASE ATTACH COPY OF APPROVAL.) 18 PLANNING BOARD APPROVAL REQUIRED? YES ( P.B. DECISION DATE (PLEASE ATTACH COPY OF APPROVAL) PROPERTY OWNER INFORMATION CIC1# OWNER'S NAME' }p`I°i' ' . �� #' .�, �, PHONE ADDRESS 6ty a�er EMAIL_ NuV"-�<. Lo'h �11A��� d20-2 NEReSTURE DATE APPLICANT INFO,,ttR�I��4,,i�ATI N(IF APPLICABLE) , APPLICANT PHONE�_-- ADDRESS EMAIL, I APPLICANT'S SIGNATURE DATE CONTRACTOR INFORMATION j CID# COMPANY NAME, IJ�1 YV { C _ PHONE 3 lam_ ' �•! r ADDRESS 5 JL,l1ti�LL ,EMAIL l zS- 2 CONTRACTOR'S SIGNATURE DATE FOR STAFF.USr ONLY; FILE# DATE-ITwE APPLIE.D__ RECENEd flY _ APPLIGAMON f —._ PERMIT-H _._. DATE ISSUED__..__._ REVISED 1-12-21 HOLD HARMLESS: The Individual filing this application, to the fullest extent provided by law, shall indemnify and save harmless the City of Saratoga Springs, its Agents and Employees (hereinafter referred to as "City"), from and against all claims, damages, losses and expense (including, but not limited to, attorneys' fees), arising out of or resulting from the performance of the work covered by this building permit application, sustained by any person or persons, provided that any such claim, damage, loss or expense is attributable to bodily injury, sickness, disease, or death, or to injury to or destruction of property caused by the tortious act or .Negligent act or omission of Applicant, its contractor or its employees or anyone for whom the Contractor is legally liable or Subcontractors. INITIAL DEMOLITION PERMIT APPLICATION REQUIREMENTS THE FOLLOWING INFORMATION MUST BE PROVIDED: Insurance requirements: 1. Demolition contractor must provide: a) Certificate of liability insurance showing a minimum one million dollars per occurrence, with the City of Saratoga Springs listed as additional insured and certificate holder. The following language should appear in the "Description of Operations'; "City of Saratoga Springs is an additional insured for the permit application process". b) Certificate of workers compensation insurance, on either the State approved C-105,2 form or the U-26.3 form. c) Certificate of disability insurance, on either the State approved DB-120.1 or DB-155 form. d) City of Saratoga Springs Hold Harmless agreement. 2. Applicant must submit the following: a) Letter from Dept. of Public Works (Utilities), stating water and sewer hookups have been disconnected. b) Letter from National Grid, stating both gas and Electric have been disconnected. c) Asbestos SURVEY in accordance with NYSDOL Industrial Code Rule 56 REVISED 1-12-21 Acc R CERTIFICATE OF LIABILITY INSURANCE FDATEIYYYJ 11r08/202oa1zozl THIS C�.RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED,the poliay(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Meghan Salmon -NAThe Heritage Group PHONE (518)782-0001 FAx (518)782-9908 (Ale, le No Ext: AlC,No 1184 Troy-Schenectady Road EMAIL ADQRESS: Suite 9 102 €NSURERIS1 AFFORDING COVERAGE NAIC# Latham NY 12110 INsuRERA: Main 91rect America Assurance 29939 INSURED INSURER B: NGM Insurance Company 14788 DM Wardell Inc INSURER C 325 SANDHILL RD INSURER D: INSURER E GREENFIELD CENTER NY 12833-1117 INSURIERF: COVERAGES CERTIFICATE NUMBER: 2021-2022 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIC€ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADULIUUBR POLICY FFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER KW0DIYYYY) JMMIDDtYYYYJ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 N-0 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,DOD MED EXP(Any one person) S 10,000 ..� A Y MPU1263N 10/0112021 10/01/2022 PERSONAL&ADV I NJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _ X ANY AUTO BODILY INJURY{Per person)�..» $ B OWNED SCHEDULED Bi U 1263N 10/01/2021 10/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ [�EXCE,98LIAB CLAIMS-MADE AGGREGATED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE Eft ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.L EACH ACCIDENT ... $ OFFICERIMEMBER EXCLUDED? - — (Mandatory In NH) E.L,DISEASE-EA EMPLOYEE $It yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMiT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is requtred) (Certificate Holdar)islare named additional insured with regard to the General Liability policy by work done by the named insured as required by written contract per attached general liability coverage form Subject to the insurance policy terms,conditions and exclusions CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Saratoga Springs Dept of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 474 Broadway AUTHORIZED REPRESENTATIVE Saratoga Springs NY 12866 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ldoi% NYSIF New York State-Insurance Fund PO Sox 66699,Albany,NY 12206 j nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) � 177 ^^A A A 100007323 A TERPENING&ASSOCIATES INC , TIBIA THE HERITAGE GROUP 1184 TROY-SCHENECTADY RD#102 ' LATHAM NY 12110 SCAM TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER D.M.WARDELL INC CITY OF SARATOGA 325 SAND HILL RD 474 BROADWAY GREENFIELD CENTER NY 12833 SARATOGA SPRINGS NY 12866 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A1124 950-5 770981 08/19/2021 TO 08/19/2022 6/1/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1 1 24 950-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:I/WWW.NYSIF.COM/CERT/CERTVAL,ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. DAVID M WARDELL-PRESIDENT" SOLE OWNER/OFFICER OF DM WARDELL INC THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. 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