2015-322 Town of Queensbury Building & Codes Office Use Only
Received
105—• �-Z
DEMOLITION PERMIT APPLICATION Permit#: a00
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee
Provide 2 plot plans drawn to scale,showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and indicate which are to be demolisIndicate the location of all utillti
UU JUL 2y n ii/il ,
Date '1 -62q- 1.6 ion Location 53 (762 ,t 0d_LL fC k-
a8-M- _5� T°�'�'OFQuEk
Tax Map ID BUILDING& co"DEgRY
APPLICANT f Q1e-I Pas )c__01 -IL,,,f CL _ OWNER Q S C_q2 'C, lgl-I *1(,G
Address _11 3 p11C .iY',�_,--d_, Address _? ITh
Phone (5I 7(4S` -7-1 L Phone (.5-/ fir-/5 7? (.0
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CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: 1'_I l2 1 ii C-2aL?r1C0 Phone: 711,x- --1-7-7 l5
1. Person Responsible for Work ii i e , vii--1-
2. Where will demolition material be disposed? , «m 10\"Ib O
3. All buildings to be demolished require an Asbestos Survey
4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begin
a) Is there any asbestos in the building to be demolished ____ Yes _ ✓ No
b) If Yes,our office needs the following information ____ Yes ____ No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished (Residence ___ Garage ___ Business
___ Storage Bldg.___ Other
b) Size of Structure I 9 I x 70'
c) Number of Stories 1
d) Foundation Type CffLVI 5 C(
e) Foundation LO v' n0 YLQ p lacQ4
f) Structure(s) (,, \1\ n 0 l_ _P Y ?laced
7. Utilities Information
a) Indicate utilities for this structure ___ Gas _✓ Electric _✓Propane _Public Water ___ Public Sewer
___ On-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? ____ Yes _A/.No
b) Have all utilities been disconnected? _✓ Yes ____ No
8. Signature
Print Name: in01.4i�_��l.�l�']r1�L"� Date _vJ Jq. j5
Signature: -IN /pGU7,i2CE7u Date -7-ST- /S-
Town of Queensbury Building& Codes - Demolition Permit - December 2014
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:
Name: 7Z- at �� Inspected on: V3k
Location: Sj 6/yo.„J CrW, Arrive: /6,1,011 a.m./p.m.
Permit No.: /f" 322- Inspector's Initials: /-
Comments and/or diagram
Y N N/A
Gas Shut-off ✓/
Water Shut-off
Electric Disconnected V 4'. t "Lie 4
Asbestos Removed /Documentation ✓ 'serf COi' 1 A'y
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliancet/ n, cl-g,,,4 --
c.,4 /2/4._
Demolition Inspection_11 20 12
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