BOTH-000505-2016 AWAkk
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000505-2016 Date Issued: Friday, June 16, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000505-2016
has been completed.
Tax Map Number: 308.14-1-52
Location: 183 PITCHER RD
Owner: FOREST PARK MHC,LLC
Applicant: FOREST PARK MHC,LLC
This structure may be occupied as a: Removal of mobile home at 15 Gregwood
Circle By Order of Town Board
Home to be hauled away intact,no demolition to be done TOWN OF QUEENSBURY L
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
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 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000505-2016
Tax Map No: 308.14-1-52
Permission is hereby granted to: Combs Trucking,FOREST PARK MHC,LLC
For property located at: 183 PITCHER 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
Owner Name: FOREST PARK MHC,LLC Demolition $0.00
Owner Address: 183 Pitcher RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Removal of mobile home at 15 Gregwood Circle
Home to be hauled away intact,no demolition to be done
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 29,2017
(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�expi/rJation d t
Dated at the To of Qu n bury;(� /1 day,August 3,2016
SIGNED BY: (�✓yt' V for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received ___________________
DEMOLITION PERMIT APPLICATION Permit#: 10h=-'2-05=2-Q-k-a
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee �'30t�Y1�Qjl f�5,)S2
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 demolished. Indicate the location of all utilities /1
Date _'11��.�i�___ Demolition Location LTclreawIV
Tax Map ID ______________ J
APPLICANT �p�CeStp ____ OWNER
Address �� p1e.� ----------- Address ---------------------------
-NU-L2&q ---------------------------
Phone _�Hiz.3-1I _________________ Phone
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: !/J) ` Qi,Q_ aarion--___-_____ Phone:-145-22-1(r
_
1. Person Responsible for Work �harliee
2. Where will demolition material be disposed?
3. All buildings to be demolished require an Asbestos Survey
ew My-
4. Anv 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 -N_f Residence ___ Garage ___ Business
__Storage Bldg. Other
b) Size of Structure
c) Number of Stories
d) Foundation Type r W
e) Foundation one-
f) Structure(s)
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 ____No
b) Have all utilities been disconnected? ____Yes ____No
8. Signature
Print Name: _ L _-i _ kL --Q q___ ____-____ Date
Signature: ------------- Date q �_
Town of Queensbury Building&Codes •Demolition Permit- December 2014
Aug. 2. 2016 12:47PM No. 2119 P. 1
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