2012-404 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120404 Date Issued: Tuesday, September 11, 2012
This is to certify that work requested to be done as shown by Permit Number P20120404
has been completed.
Tax Map Number: 523400-289-017-0001-043-000-0000
Location: 121 BIRDSALL Rd
Owner: P3 REALTY, LLC
Applicant: JOHN & PAMELA CEMBROOK
This structure may be occupied as a:
Demolition
By Order of Town Board
TOOWWNN OF QUEENSBURY
'
Issuance of this Certificate of Compliance DOES NOT relieve the / ) /
property owner of the responsibility for compliance with Site Plan, I \
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Pisan Road,Q uccnAaury,NV 12804-5902 (518) 761-8201
Community Development- Building & Cods (518) 761-8256
BUILDING PERMIT
Perlrlit Number: P20120404 Application Number: A20120404
T.ix Ntap No: 523400-2.89-017-0001-043-000-0000
Rurmission is hereby granred to: JOHN & 13AM1 LA C EMBR.00K
[,'or prc:rperty locmed at: 121 BIRDSALL FOCI
in Harr"Z'oaa-ta of Quccnsburyw, to ronstruet or placer
a( the above location in accordance with supplication together with plot plans incl other information hereto filed
and approved d and in coinphance with the NYS Uriiforn-i Building(:odes and the Queensbury Zoning;
Ordinance. Type of Construction Value
Owncr,Wdress: JOHN & PAMELA CEMBItOOK Demolition
31 T'OWER. MC)lJl`*TAIN Lir Totralw7a1ue
BERNARDSVll,l,E, NJ 07924-0000
Contractor or Builder's Name/ :\ddress Electrical Inspection.Ag enc)
KINGSLEY EXCAVATING
518-644-2306
NY 12804-0000
flans & Specifications
2012-404
Demolitiort ol'2 story residence mid garage
To be replaced
$30.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, August 22, 2013.
(1f 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 dame.)
Dated at the Town of Queenstittry; 4aw"eduestlay, August 22, 2012
SIGNED BY for the Town of Quet-.mbur�.
Director of Building& Code Iknforccmcnt
.US
TAX MAP NO. �� 0_ [_� PEFRMIT NOE ONLY/04 _7D`/ FEE PAI ,
Permission is hereby granted to the above named Applicant to demolish the building(s) Ffirts
1.1Y1
-described herein as set forth in the Application below. AUG
Director of Building&Codes Date tt HG 1 6 20I2
-ram! a
APPLICATION FOR DEMOLITION PERMIT: �I� ., `
Fill in applicable spaces and submit two(2)plot plans,drawn to scale,showing lot boundaries with
dimensions and adjacent roads/streets. Show all existing structures on the property and indicate which
are to be demolished. Indicate on the plot plan the location of all utilities.
John and Pam Cembrook John and Pam Cembrook
APPLICANT/BUILDER: OWNER:
ADDRESS:121 Birdsall Rd.. Queensbury ADDRESS:'Zt 7nt.t z n' t n .axdcl¢ 3,1f
PHONE NOS908-415-7882 PHONE: 908-415-7882 0-7clac(
PERSON RESPONSIBLE FOR WORK:Kinaslev Excavatina PHONE: 518-644-2306
LOCATION OF DEMOLITION: 121 Birdsall Rd., Queensbury, NY
WHERE WILL DEMOLITION MATERIAL BE DISPOSED?Plattsburgh, ny
ASBESTOS INFORMATION: ✓
I Is there any asbestos within the building to be demolished? YES NO
✓ If YES,our office needs the following information:
o Name of firm removing the asbestos:
o License number of firm:
o Indicate where the asbestos material will be disposed:
NOTE: A copy of Asbestos Removal Report must be filed with our office before demolition begins.
STRUCTURE INFORMATION:
✓ Indicate which structure(s)will be demolished: RESIDENCE V GARAGE V BUSINESS
5c2 S Sc STORAGE BLDG. OTHER
✓ Size of structure: X 0
✓ Number of stories: 7
✓ Foundation type: FULL CELLAR ✓ CRAWL SPACE SLAB
✓ Foundation: WILL BE REPLACED ./ WILL NOT BE REPLACED
✓ StruCtUreS(S): WILL BE REPLACED ✓ WILL NOT BE REPLACED
UTILITIES INFORMATION:
✓ Indicate utilities for this structure: GAS ELECTRIC I/ PROPANE PUBLIC WATER
ONSITE WELL-WATER PUMP PUBLIC SEWER
Have you notified the Town Water Dept.for public water and public sewer disconnect? YES NO
Have - s been • connected: YES NO QUESTIONS? CALL 761-8256 OR EMAIL
codese bqueensbury.net
I
SIGNATURE OF APPLICANT VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
ra Town of Queensbury • Community Development Office• 742 Bay Road, Queensbury, NY 12804
•
Queensbury Building & Code Enforcement - Residential Final Inspectidn)
Office No. (518)761-8256 7',l/ Z Arrive: an /pm D art:1(� : '6am/pm
Date Inspection request received: f' Inspector's Initials: /�
n l/
NAME: CQ„n, b f 0/A -- PERMIT#: J1t0
LOCATION: l l i\, — t{. la-i ( 12.1 DATE: --�
TYPE OF STRUCTURE:
Comments:
Yes No N/A_
4° Building Number Address visible from road
Chimney Height/'B"Vent/Direct Vent Location
Fresh Air Intake Di-117 (7
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete Platform at all exteri• d•••-
Handrail 4 or more : -rs
Guards at stairs, • -,pati•: more than 30 inch-: above grade
Guard at stairwel at 34 in :: or more
Guard at deck, ••rches 36 in• ,s or more
Handrail Termi :tion at Newell •ost or Wall
Interior/Exteri• Railings 34 inch. to 38 inches
Deck Bracin. /Handicapped Ra • Compliant
Grade away • foundation 6 i .!es with 10 =
6 inch clea .nce to sill plate
Gas Valve :hut-off exposed/regu : or 18 i _. above grade
Interior p ' =cy/trim/doors/main - tran• 36 inches
Bathroom Kitchen watertight
Safety gl: 'ng/Window in stairwells =: : glazing
Interior S oke Detectors/Carbon M• • I de Detectors
Every ley:I: _ Every Bedroom:
Outside e ery bedroom area
Inter Con ected: Battery ba. •:
Attica..- - 30 inches x 22 inches x 3,• i • es(height)in accessible area
Crawl S18 inch x inch a• 1 :•.ft.-150 sq.R.vents
Bathroomans,if no window
Plumbing res
Foundati• insulation to floor/Sti•,er on P:nel
Duct work -- :ledproperly/Blowe DoorT-:• Certification
Floor truss, raft stopping finishe• basement 1,000 sq.ft.
EmergencyasFua . ut-oss ff
✓ F
Gas Furnace . hdoff within 30 ':-t or within h = of site J
Oil Furnace - off at entran• to furnace are:
Fumace/Hot : er Heater o;-rating
Low water shut • boiler
Relief Valve(s)i : :lled/ -:t Trap/Water T- • 110
Enclosed Stairs • - - . Underside minimum Gypsum
Basement stairs •-argr se>4 inches
Garage Floor Pitch-•
Garage fireproofing/%hour fire door/door dose
Gas Logs in Sealed or Glass Enclosure
Final Electrical; Energy Saving Light Bulbs 50%
Final Survey Plot Plan
Am Fault Breaker Habitable Spaces/Tamper Proof -eceptades
Flex Gas Pipe Bonding
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C/O[Temporary/Permanent]
L:\Building&Codes Fomhs\Building&Cadeanspection Forns\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008;Revised 6126/08;Revised 12/22/10,Revised 04/13/11
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j v TOWN OF QUEENSBURY
5 BUILDING DEPARTMENT
'% <,9, Based on our limited examination,compliance
'J[,• with ouTcomments shall not he construed as
aE SNE ;J%t S� indicating the plans snd specifications are in
;-41cE Et>•-v v (� S s9-e ar a full compliance with the Building Codes of
_/,6;'2011 - 393.22) `.JY13't
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BUS • >.EPT. . ���
Reviewed .8;"0.
'- ' 4 ,p :3 �r�
Date: --— -cS / gilt fence to be installed as noted. •
•<' _ ., installation must be completed&inspected
- iris to beginning demolition.
Laos NA- Or
. MOO5,1iUOGER
• - Please contact this office to schedule an
- -
(e�. , inspection of the site prior to an,demolition.
dil° Yv'�/ ti PLAN
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SCALE: SEE GRAPHIC SCAM
CRAP
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