Form Sh 483 – Fill Out and Use This PDF

New York State Department of Labor

Division of Safety and Health

Asbestos Project Notification

Building 12-Room 161B

State Office Campus

Albany, NY 12240

(518) 485-9263

Asbestos Project Notification

Filing an asbestos project notification

Who must provide asbestos project notification

If the asbestos removal project is:

•located within New York State

•involves more than 260 linear feet or 160 square feet of asbestos or asbestos-containing material in a building,

you must notify the Asbestos Control Board before starting work on the removal, encapsulation, enclosure or disturbance of friable asbestos, or before handling material containing asbestos that may result in the release of asbestos fiber.

				Method of notifying
				Written notification	Telephone notification
		Initial		At least 10 calendar days prior to project	Does not apply
				start date
		Renewal		Within the last 30 days of a project that	Does not apply
				will extend beyond 12 months
notificationofType
	Amended			At least 3 calendar days prior to new start	At least 1 calendar day prior to
		Postponed		date and at least 1 calendar day prior to
					initial notification start date
				initial notification start date
		Cancelled		At least 1 calendar day prior to initial	At least 1 calendar day prior to
				notification start date	initial notification start date
		Note: Amended telephone notification requires written follow-up within 5 working days.
		You cannot change the completion date beyond one year from the start date.
				Within 3 working days of telephone
		Emergency		notification and approval of emergency	As emergency situation arises
				status by the Asbestos Control Bureau

When to file a notification

A new notification and project fee must be sent if any of the following occur:

•A different contractor becomes responsible for the project (excluding sub-contractors)

•The location of the project changes

•The completion date on the initial notification has passed and no amendment has been filed

For a postponed project with an unknown starting date, an amendment must be filed within the period specified above. Once a starting date is determined, another amendment must be filed at least 3 calendar days prior to that date.

If any of the information contained in the previous notification changes, an amended Asbestos Project Notification form must be sent. If the amount of asbestos increases an additional fee must be sent in with the amended notification.

How to file a notification

•Send the completed signed form to:

New York State Department of Labor

Division of Safety and Health, Asbestos Project Notification

Building 12-Room 161B

State Office Campus

Albany, NY 12240

•You must include the fee with the notification.

•Keep a copy for your records.

•Include a check or money order, payable to the Commissioner of Labor, for the fee due based on the project size as shown in item 19. The notification is not complete until the non-refundable fee is received by the Department of Labor.

For additional information see Part 56, Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York (12 NYCRR Part 56). You can see a copy on-line at www.labor.state.ny.us.

SH 483 (04-09)

New York State Department of Labor

Division of Safety and Health

Asbestos Project Notification

Building 12-Room 161B

State Office Campus

Albany, NY 12240

(518) 485-9263

Asbestos Project Notification

A. Type of notification

Check only one type of notification below.

Initial	Complete all sections. The Department of Labor must receive this notification and fee at least
	10 days before the project starts.
Renewal	Complete all sections. Submit with fee within the last 30 days of a project that will extend
	beyond 12 months.
Amended	Submit amended notification with all sections completed and amended item(s) circled.
Cancelled	Complete Section G and attach copy of initial notification or complete all sections.
Emergency	You must first call 518-485-9263 for prior approval of emergency status, then
	complete and return this form including:
	Emergency reference # __ __ __ __ __ __ __ __
B. Contractor information
Provide all information requested below.
1. FEIN	--	2. Asbestos license number __________________
3. Contractor name and address		4. Mailing address (if different)
___________________________________________		___________________________________________
___________________________________________		___________________________________________
___________________________________________		___________________________________________
___________________________________________		___________________________________________

C. Project site information

Provide all information requested below for the building/site where the asbestos project will be conducted.

5.Project dates: Starting date _______________________ Completion date ____________________________

If amended: Starting date _______________________ Completion date ____________________________

6.Project location: County _____________________________________________________________________

Name of building ___________________________________________________________________________

Room or other specific location ______________________________________________________________

Bridge Projects only. Bridge ID Number:

Street address _____________________________________________________________________________

City, Town or Village ________________________________ State ___________ Zip Code _______________

7.Building information

Current use _________________________________________ Year built ______________________________

Prior use ___________________________________________ Building size _______________________sq. ft.

8.Building representative/site contact: Name __________________________ Phone number (____) ____________

SH 483 (04-09)

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D. Project details

Provide all of the information requested below relating to specifics of asbestos removal.

If yes, list scope, location and starting and end dates for each phase below. If there are more than 4 phases, please use Section F to continue.

Name __________________________________________________Asbestos Lic. No._______________________

Name __________________________________________________Asbestos Lic. No._______________________

Days/hours_____________________________________________________________________________

______________________________________________________________________________________

12.The party you are doing the work for: Name ____________________________________________

Address __________________________________________

City, Town or Village _______________________________

State _____________________ Zip Code _______________

13.Dollar amount of contract between parties named in Item 3 and Item 12. $ __________________

14.If work is being conducted under a variance, check appropriate box and supply variance number.

Note: Forms AV 86 through AV 120 can no longer be used. Please refer to Part 56 of Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York (12 NYCRR Part 56).

15.Procedures and type of equipment and ventilation system used (attach additional sheets if necessary.)

a)Type of equipment and ventilation systems used: ___________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

b)Name of air monitoring firm: ___________________________________________________________

Asbestos license number:_____________________

c)Name of laboratory performing the analysis: _______________________________________________

ELAP Registration number: ____________________________________

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