Project Notification Form PDF Details

The purpose of a project notification form is to provide a formal mechanism for communicating the start of a project and its key details to interested and affected parties. A well-constructed project notification form will help avoid surprises and ensure that everyone is aware of the new project and its potential impacts. By providing early notice, all stakeholders can begin to plan for and assess the potential ramifications of the new undertaking. This allows for an efficient, coordinated response should any issues or concerns arise.

This page includes details about project notification form. It could be beneficial to learn its size, the typical time to prepare the form, the fields you'll have to fill in, and so forth.

QuestionAnswer
Form NameProject Notification Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesny notification, ny asbestos notification, ny notification pdf, nysdol asbestos project notification

Form Preview Example

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

 

 

 

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 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?

No

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?

No

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:

No

Yes (If yes, complete lines below.)

Name __________________________________________________Asbestos Lic. No._______________________

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: ____________________________________

2

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

Friable linear feet

 

 

Friable square feet

 

 

 

 

 

 

 

 

Non-Friable linear feet +

 

Non-Friable square feet +

 

 

 

Total linear feet

=

 

Total square feet

=

 

 

 

 

 

 

 

 

 

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)

3

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

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