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.
| 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 notification, ny notification pdf, nysdol asbestos project notification |
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)
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
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.
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Method of notifying |
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Written |
Phone |
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Initial |
At least 10 calendar days prior to project |
Does not apply |
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start date |
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Renewal |
Within the last 30 days of a project that |
Does not apply |
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will extend beyond 12 months |
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notificationofType |
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Amended |
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At least 3 calendar days prior to new start |
At least 1 calendar day prior to |
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Postponed |
date and at least 1 calendar day prior to |
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initial notification start date |
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initial notification start date |
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Cancelled |
At least 1 calendar day prior to initial |
At least 1 calendar day prior to |
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notification start date |
initial notification start date |
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Note: Amended phone notification requires written |
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You cannot change the completion date beyond one year from the start date. |
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Within 3 working days of telephone |
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Emergency |
notification and approval of emergency |
As emergency situation arises |
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status by the Asbestos Control Bureau |
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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
•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
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 |
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project starts. |
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Renewal |
Complete all sections. Submit with fee within the last 30 days of a project that will extend |
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beyond 12 months. |
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Amended |
Submit amended notification with all sections completed and amended item(s) circled. |
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Cancelled |
Complete Section G and attach copy of initial notification or complete all sections. |
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Emergency |
You must first call |
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complete and return this form including: |
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Emergency reference # __ __ __ __ __ __ __ __ |
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B. Contractor information |
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Provide all information requested below. |
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1. FEIN |
2. Asbestos license number __________________ |
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3. Contractor name and address |
4. Mailing address (if different) |
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___________________________________________ |
___________________________________________ |
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___________________________________________ |
___________________________________________ |
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___________________________________________ |
___________________________________________ |
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___________________________________________ |
___________________________________________ |
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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. |
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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
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: ____________________________________
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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
Friable linear feet |
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Friable square feet |
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Total linear feet |
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Total square feet |
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E. Fee schedule
This fee is
Check one box for linear feet and one box for square feet.
20. Fee schedule: |
a) Linear feet |
b) Square feet |
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0 – 259 ………..….…($0) |
0 – 159 ………………($0) |
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260 |
– 429 ………….. ($200) |
160 – 259 |
……………($200) |
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430 |
– 824 ………….. ($400) |
260 – 499 |
…………… ($400) |
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825 |
– 1649 …………. ($1,000) |
500 – 999 |
…………… ($1,000) |
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1650 or more ………. ($2,000) |
1000 or more ……… .($2,000) |
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21. Total fee due for project $ ____________________________ (add 20a and 20b)
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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 |
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Print name of the Contractor or Duly Authorized Representative |
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Date |
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