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2015-070
TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 Q 1�', Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150070 Date Issued: Wednesday, April 01, 2015 This is to certify that work requested to be done as shown by Permit Number P20150070 has been completed. Tax Map Number: 523400-309-009-0003-032-000-0000 Location: 171 LUZERNE Rd Owner: WILLIAM E WILLIAMS Applicant: WILLIAM E WILLIAMS This structure may be occupied as a: Demolition By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the awPA property owner of the responsibility for compliance with Site Plan, /Vf Variance, or other issues and conditions as a result of approvals by the Director of Building&Co Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Vri$1 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150070 Application Number: A20150070 Tax Map No: 523400-309-009-0003-032-000-0000 Permission is hereby granted to: WILLIAM E WILLIAMS For property located at: 171 LUZERNE Rd in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: WILLIAM E WILLIAMS Demolition 171 LUZERNE Rd Total Value QUEENSBURY NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2015-070 Demo only removal of mobile home $30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 01, 2016 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date Dated at the To n of Q ens ;4 , • ••�•esday,April 01,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Town of Queensbury Building & Codes vz __ ,,, � tyzir D LE DEMOLITION PERMIT APPLICATION I �`�'"� NO WORK MAY COMMENCE UNTIL PERMIT IS ISSVE ! eRTiali..: 2015 15-01-0 O Fill in applicable spaces and submit two (2) plot plans, drawn to scale, sh wing lot boundaries with dimensions and adjacent roads I streets. Show all existing structures Permit Fee NSBURY re,zga on the property and indicate which are to be demolished. Indicate on the plot plan the JLDINU& CODES location of all utilities. /� / - Date / A�K IL- / S Demolition Location .L ('2l061/70 , 1:. Tax Map ID 3©9 ! —3 32- '7/ e Applicant _ / , „' Owner S;4.0` e Address /75 Lt 2c4kti e W‘clibl t^ uee�J5 leu i )�, , /7 JIG Phone O .6 Phone Contact Person for Building&Code Compliance: Day Phone: 5,41----.44 ( :, 1. Person Responsible for work: 77/ Z /11/1-2..-M-)11 s 2. Where will demolition material be disposed? /4/'e /v /-7`CW--C.�f/ 27e/11-1.i.... 3. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begins. a) Is there any asbestos within the building to be demolished Yes b) If Yes,our office need the following information: ,, ) • Name of firm removing the asbestos: �/L/ • License number of firm: • Indicate where the asbestos material will be disposed: 4. Structure Information a) Indicate the structure(s)to be demolished:_residence _garage business storage bldg. Other b) Size of structure: x c) Number of stories: f d) Foundation Type: full cellar / crawl space slab e) Foundation: will be replaced / will not be replaced f) Structure(s): will be replaced ( will not be replaced 5. Utilities Information a) Indicate utilities for this structure: / as V Electric Propane Public Water On-Site Well Water Pump Public Sewer b) Have you notified the Town Water Dept.for public water and sewer disconnect? TYes No c) Have all utilities been disconnected? Yes No 6. Signatures: - ' Print Name: o��ilii-- 7 - Signature: �4 _ 1 //�I// __ /4 c Date: /C —( S Town of Queensbury Building&Codes Demolition Permit 518-761-8256 Demolition Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: `)) am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �i)�L NAME: W 1\ ,cu n G-►'ylc PERMIT NO.: t c`©0 LOCATION: '1-1 t--une Q. INSPECT ON: I \% ) Comments and/or diagram Y N N/A Gas Shut-off Water Shut-off Electric Disconnected i Asbestos Removed/ Documentation v Property Cleaned Up and Graded Okay to Issue Certificate of Compliance L Demolition Inspection Report_11 27 12 1/