Project Notification Form – Fill Out and Use This PDF

Project Notification Form – Fill Out and Use This PDF

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Project Notification Form – Fill Out and Use This PDF

The Project Notification form serves as a critical tool for contractors working in New York State, ensuring that the Asbestos Control Board is informed about the specifics of asbestos removal projects that exceed a certain size. Contractors must file this notification when dealing with more than 260 linear feet or 160 square feet of asbestos or asbestos-containing material in a building. To initiate an asbestos removal, encapsulation, enclosure, or disturbance project, or to handle materials containing asbestos that may release fibers, view the detailed process and requirements for submission by clicking the button below.

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Project Notification Form PDF Details

In New York State, managing asbestos involves meticulous planning, beginning with the essential step of filing an Asbestos Project Notification form with the Division of Safety and Health at the Department of Labor. Before the commencement of any project that disrupts more than 260 linear feet or 160 square feet of asbestos-containing material, it is a mandatory procedure to alert the Asbestos Control Board. This notification process, laid out in detail for both initiators and ongoing project managers, aims to ensure that asbestos removal, encapsulation, enclosure, or any disturbance is conducted safely, minimizing the release of hazardous asbestos fibers into the environment. Various types of notifications — including initial, renewal, amended, postponed, canceled, and emergency — cater to different project stages and conditions, each with specific filing timelines ranging from at least 10 days before the project starts to as soon as an emergency situation arises. Alongside the practical steps of how and when to file these forms, the required notifications ensure the welfare of both workers and the public by strictly regulating how asbestos is handled, welcoming transparency, and enforcing accountability across all asbestos-related projects within the state.

Question	Answer
Form Name	Project Notification Form
Form Length	5 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 15 sec
Other names	ny notification, ny asbestos project notification, ny asbestos notification, sbestso notiicastion to tenants nys

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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

To file 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	Phone

		Initial	At least 10 calendar days prior to project	Does not apply
		Initial	start date	Does not apply
			start date

		Renewal	Within the last 30 days of a project that	Does not apply
		Renewal	will extend beyond 12 months	Does not apply
notificationofType			will extend beyond 12 months

	Amended		At least 3 calendar days prior to new start	At least 1 calendar day prior to
			At least 3 calendar days prior to new start
		Postponed	date and 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	initial notification start date
			initial notification start date

		Cancelled	At least 1 calendar day prior to initial	At least 1 calendar day prior to
		Cancelled	notification start date	initial notification start date
			notification start date	initial notification start date

		Note: Amended phone 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

You must send a new notification and project fee 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, you must file an amendment within the period specified above. Once a starting date is determined, you must file another amendment at least 3 calendar days prior to that date.

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

•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.ny.gov.

SH 483 (08/11)

New York State Department of Labor

Asbestos Project Notification

Building 12, Room 161B

State Office Campus

Albany, NY 12240

A. Type of notification

Check only one type of notification below.

Initial	Complete all sections. We 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)
___________________________________________		___________________________________________
___________________________________________		___________________________________________
___________________________________________		___________________________________________
___________________________________________		___________________________________________

5.Workers’ Compensation Policy #____________________ or WC Exemption Certificate

#____________________

Number of your employees you expect to be on project: _____________

NOTE: If you intend to have employees at the site, you must have proper workers’ compensation before the

start of the project.
Will temporary workers be used?	Yes	No. If yes, name of temporary agency: ___________________

C. Project site information

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

6.Project dates: Starting date _______________________ Completion date ____________________________

If amended: Starting date _______________________ Completion date ____________________________

7.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 _______________

8.Building information

Current use _________________________________________ Year built ______________________________

Prior use ___________________________________________ Building size _______________________sq. ft.

Is this a Federal building?

Yes

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

Supply all of the information requested below about the specifics of asbestos removal.

10. Is this a phased project?

Yes

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

Start date End date

Location

Scope

10. Will sub-contractor(s) be used:

Yes (If yes, complete lines below.)

Name __________________________________________________Asbestos Lic. No._______________________

11. Do you anticipate doing:

Night work

Weekend work

Shift work

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).

Applicable variance number: ____________

Individual variance petition number: ____________

15.Procedures and type of equipment and ventilation system used (attach more 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: ____________________________________

16.Type of asbestos work (check all that apply)

Pipe related	Roofing/flashing	Caulking/Mastic	Clean up
Vessel covering	Siding	VAT	Sprayed on insulation

Other (specify) ______________________________________________________________________________

Demolition: if site survey was previously submitted, provide the reference: ______________________

17.Waste transporter name: _____________________________________________________________________

NYS DEC permit number: _______________________________________________________________

Address: _____________________________________________________________________________

City, Town or Village: __________________________________________________________________

State: __________________________________ or Province: ___________________________________

Zip Code: _______________________________

Phone number: _____________________________

18.Waste disposal site

Name _______________________________________________________________________________

Address: _____________________________________________________________________________

City, Town or Village: __________________________________________________________________

State: __________________________________ or Province: ___________________________________

Zip Code: _______________________________

Phone number: _____________________________

19. Type and amount of asbestos-containing material involved

E. Fee schedule

This fee is non-refundable. Refer to Item 19 to calculate your required fees.

Check one box for linear feet and one box for square feet.

20. Fee schedule:	a) Linear feet		b) Square feet
	0 – 259 ………..….…($0)		0 – 159 ………………($0)
	260	– 429 ………….. ($200)	160 – 259	……………($200)
	430	– 824 ………….. ($400)	260 – 499	…………… ($400)
	825	– 1649 …………. ($1,000)	500 – 999	…………… ($1,000)
	1650 or more ………. ($2,000)		1000 or more ……… .($2,000)

21. Total fee due for project $ ____________________________ (add 20a and 20b)

F. Remarks

Use this area to provide details. Attach more sheets, if necessary.

G. Signature

I certify that the information specified on this notification is true and accurate and that the project will be conducted in compliance with the requirements of Code Rule 56. (no cosigns or stamps)

Signature of the Contractor or Duly Authorized Representative		Date

Print name of the Contractor or Duly Authorized Representative		Date

How to Edit Project Notification Form Online for Free

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Prepare the nysdol asbestos project notification PDF by providing the content required for each individual section.

Enter the requested data in the space Check only one type of, Initial, Renewal, Amended Cancelled Emergency, Complete all sections We must, Emergency reference, B Contractor information, Provide all information requested, FEIN, Asbestos license number, Contractor name and address, Mailing address if different, and Workers Compensation Policy or.

The system will demand you to include specific relevant info to effortlessly complete the part Workers Compensation Policy or, Number of your employees you, No If yes name of temporary agency, Yes, C Project site information, Provide all information requested, Project dates Starting date, If amended Starting date, Project location County, Name of building, Room or other specific location, Bridge Projects only Bridge ID, Street address, City Town or Village State Zip, and Building information.

In section Current use Year built, Prior use Building size sq ft, Is this a Federal building, and Yes, indicate the rights and obligations.

Finish the template by looking at all these areas: Building representativesite, Supply all of the information, Is this a phased project, Yes, If yes list scope location and, Start date, End date, Location, Scope, Will subcontractors be used, Yes If yes complete lines below, Name Asbestos Lic No, Name Asbestos Lic No, Do you anticipate doing, and Night work.

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Friable linear feet

Friable square feet

Friable linear feet

Friable square feet

Non-Friable linear feet +

Non-Friable square feet +

Total linear feet

Total square feet