2014-082 TOWN OF QUEENSBURY
Fors 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140082 Date Issued: Tuesday, June 24, 2014
This is to certify that work requested to be done as shown by Permit Number P20140082
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 200 LUZERNE Rd
Owner: HOMESTEAD VILLAGE L P
Applicant: HOMESTEAD VILLAGE L P
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 �J
property owner of the responsibility for compliance with Site Plan, �/a/
Variance, or other issues and conditions as a result of approvals by the Director of Building& Code nforc ent
Planning Board or Zoning Board of Appeals.
`�` TOWN OF QUEENSBURY
� � 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140082 Application Number: A20140082
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: HOMESTEAD VILLAGE L P
For property located at: 200 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: HOMESTEAD VILLAGE L P Demolition
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014-082 17 Windsong Drive
DEMO mobile home
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,April 14,2015
(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 Town f Que bury 0.11V1u i la �� '' 14,2014
SIGNED BY � for the Town of Queensbury.
Director of Building& Code Enforcement
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received: ; ;; 0 i 2014
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.: /4/-0 P
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot ^< e
boundaries with dimensions and adjacent roads I streets. Show all existing structures Permit Fee: I l II
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities. /
Date f` /'7 Demolition Location /7 .Cast lson c Or . (- ` 4
Tax Map ID 0?. 9 `/
Applicant 22,,6 /7' I,tJrenc , owner t'40fvtS•-5 A. $ ; (t
Address it%Abandea Address 0710 Luze -vu.._ gel,
� , n1�' Ls (S;t' '0 12441
Phone C r'') 3o3 ' Set t I Phone ST3 `S d t(
Contact Person for Building&Code Compliance: Robes ry LAW ten<-4 Day Phone:C ) 303-...5-2) t
1. Person Responsible for work ? ed't' Lt. AGA-
2. Where will demolition material be disposed? —WMd0 5-1"....A
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 .kUo
b) If Yes,our office need the following information:
• Name of firm removing the asbestos:
• License number of firm:
• Indicate where the asbestos material will be disposed:
4. Structure Information
a) Indicate the structure(s)to be demolished:Nesidence _garage _business Aatu,nye bldg. _Other
b) Size of structure: 1 W x 44
c) Number of stories: 1
d) Foundation Type: —full cellar —crawl space _slab
e) Foundation: _will be replaced _will not be replaced
f) Structure(s): tC will be replaced will not be replaced
5. Utilities Information
a) Indicate utilities for this structure:
Gas x Electric ` _ Propane
x Public Water _OnSiite Well Water Pump _Public Sewer 1
b) Have you notified the Town Water Dept for public water and sewer disconnect? _Yes _No 4 /P
c) Have all utilities been disconnected? x. Yes _No ((
6. Signatures:
Print Name: 4beP't Lily 3red CO-- ft
Signature: o Date: yf ( y
.
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Demolition Inspection Report �/
Office No. (518) 761-8256 Date Inspection request received: �17t(rf(4
Queensbury Building &Code Enforcement Arrive: am/ m De art: am/pm
742 Bay Rd., Queensbury, NY 12804` Inspector's Initials: .4..
NAME: a"—CC r647 U1 l f\34C_ PERMIT N .: t b s( Z'
LOCATION: 17 d San) a9 INSPECT ON: AM
J Comments and/or diagram
Y / N NJA
Gas Shut-off V
Water Shut-off
Electric Disconnected V
Asbestos Removed/ Documentation
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection Report 11 27 12
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm epart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial
NAME: 4 IVA %1,Li lay- PERMIT NO.:
LOCATION: 1'1 W iiv.a.Q,@°It: 3 INSPECT ON:
Comments and/or diagram
Y N N/A
Gas Shut-off V
Water Shut-off
Electric Disconnected f
Asbestos Removed/ Documentation
Property Cleaned Up and Graded
; zr j
Okay to Issue Certificate of Compliance
-e-
4 4 v\� Q
Demolition Inspection Report 11 27 12
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TOWNIOF QUEENSBURY -„
N BUILDING DEPARTMENT 1 1
Based on our muted examination,compliance k i 1
with our comme is sha!!not be construed as
Q , indicating the plpns ana specifications are in N
full compliance;witty Building Codes of
0 New York State.} �`" N
NIJ1
THIS PLAN TO BE ON (PROJECT
SITE AT ALL TIMES FOR THE
DURATION OF CONSTRUCTION i
a_
.
NOTE
E s. 4,
ANCHORAV6{fF BILE HOME
FRAME iSR€Q1+(RED PER ii°
MANUFACTURERS tECIFiCATIONS
N
O
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