2013-354 sealTOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130354 Date Issued: Wednesday, August 10, 2016
This is to certify that work requested to be done as shown by Permit Number P20130354
has been completed.
Tax Map Number: 523400-309-018-0001-018-001-0000
Location: 61 TWIN CHANNELS Rd
Owner: LELAND E. JAROSZ
Applicant: LELAND E. JAROSZ
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 ( a
���r/ 4 45te
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 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130354 Application Number: A20130354
Tax Map No: 523400-309-018-0001-018-001-0000
Permission is hereby granted to: LELAND E. JAROSZ
For property located at: 61 TWIN CHANNELS 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: LELAND E. JAROSZ
357 OPALKA Rd Demolition
FT. JOHNSON,NY 12070-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2013-354
DEMOLITION - garage
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,August 05,2014
(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 Tovcq `L.!nsbu d r • . _ust 05,2013
t
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes
office Use Onl
DEMOLITION PERMIT APPLICATION Received: _
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.:
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot -
I 3�3�,
boundaries with dimensions and adjacent roads/streets. Show all existing structures Permit Fee: ti Q.
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities.
Date 1,2 frj71 1.1.) �v"� 61 7`'W) C
Demolition Location —)(J ffl9mNs!
Tax Map ID
______20_741e2- / /Vi
Applicant /Eh0 1T R'
Owner .S/fm ea
Address W A)
- N Address 3r7 d' 1<.7gq v\fp
•
_ V cg�SBc//eV i11 V �l U
Ja,d Tr-
Phone �Ze - 7C
/ Phone _3"______78___z , a z
�c
Contact Person for Building&Code Compliance: 6 4 i},y Q £
^� r9/qct5`L Day Phone: -.37c5P-76.2 /74.
1. Person Responsible for work: O (EN e Z
2. Where will demolition material be disposed? 'N P F/C C✓
r, •61-2-05 11.1
3. Asbestos: The Asbestos Removal Report must be filed with our office beforademolition 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: •-,1
• License number of firm: r _
• Indicate where the asbestos material will be disposed: Al;i7 Q r
20132
4. Structure I I
a) Indicate the structure(s)to be demolished:_residence arage _business _storage bldg._-`Other._ ,. - wr . 43 '
b) Size of structure: AT x / 7
c) Number of stories:
d) Foundation Type: _full cellar _crawl space ab
e) Foundation: will be replaced will not be replaced
f) Structure(s): ilvill be replaced will not be replaced
5. Utilities Utilities Information
a) Indicate utilities for this structure
Gas
..._' Electric
Public Water —On-Site Well Water PumpPropane
Sewer
Sewer
b) Have you notified the Town Water Dept.for publi ater and sewer disconnect? Yes No
c) Have all utilities been disconnected? es No
6. Signatures•
Print Name:
Ls tip P g_ i nAO 5.2--=
Signature: j4fS . sr-
Date: CV oa a v�
Town of Queensbury Building&Codes Demolition Permit
518-761-8256
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received: 819 12-0A Sc,
Name: iavoS& Inspected on: —q_`ta
Location: (ol1wknCl-runes Arrive: 4,� a.m.
Permit No.: t3 3 ( , y) Inspector's Initials:
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off
Electric Disconnected
Asbestos Removed/Documentation
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection_11 20 12