2013-446 iA 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: P20130446 Date Issued: Tuesday, February 11, 2014
This is to certify that work requested to be done as shown by Permit Number P20130446
has been completed.
Tax Map Number: 523400-226-012-0001-023-000-0000
Location: 89 MASON Rd
Owner: 89 MASON ROAD, LLC
Applicant: KATHRYN L TABNER REVOCABLE TRUST
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'1-° "ASt
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.
1
0.k TOWN OF QUEENSBURY
01 . 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130446 Application Number: A20130446
Tax Map No: 523400-226-012-0001-023-000-0000
Permission is hereby granted to: KATHRYN L TABNER REVOCABLE TRUST
For property located at: 89 MASON 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: KATHRYN L TABNER REVOCABLI Demolition
KATHRYN TABNER, TRUSTEE ET. Total Value
MICHAEL BOARDMAN &JODY Ti
2 RIVER FALLS Ct
POTOMAC MD 20854-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
MICHAELS GROUP
SUITE 1
10 BLACKSMITH Dr
MALTA,NY 12020
Plans&Specifications
2013-446
DEMOLITION 2-story house Cross Ref. AV 11-2013 Tabner
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,September 20,2014
(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 TowrefQuensbu ; Fr' y e mber 20, 2013
SIGNED BY (...4,..)tav for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received: (-
NO
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED PertriA No.: /3 -94/63.
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot
boundaries with dimensions and adjacent roads 1 streets. Show all existing structures Permit Fee: k_32)
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities.
Date ►!18'1 Demolition Location 89 M NGU1.1,. '17
Tax Map ID ZZC2, IZ-1 - Z3
Applicant Tl M1 LE-f A.a s C GL ' LLL Owner 9 M t X1.1 R] , Lt✓c
Address 1 b �-�- SM 111-► b1Z-►\lc. Address 2(2=>11
1\-1M-11-\c , iv.'-( 12020 01201A0 M N. '53 510
Phone 5►ce) f4,311 Phone `152, 4`1(0 . Oct 337
Contact Person for Building&Code Compliance: TO1*--11 L-oU'- C-t v Day Phone: 5th• `a5-1 •314 4
it
1. Person Responsible for work: " / )
2. Where will demolition material be disposed? G /11-1 �a� �o� 1-7G �1f 1 //
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 ?C No
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:X residence _garage _business _storage bldg. _Other
b) Size of structure: 2.o' x S�
c) Number of stories: 2
d) Foundation Type: x full cellar(FaQi7A.t.' crawl space slab
e) Foundation: X will be replaced will not be replaced
f) Structure(s): X will be replaced will not be replaced
5. Utilities Information
a) Indicate utilities for this structure:
Gas X Electric Propane
Public Water On-Site Well Water Pump Public Sewer
b) Have you notified the Town Water Dept.for public water and sewer disconnect? _Yes x No
c) Have all utilities been disconnected? X Yes No
6. Signatures:
Print Name: ♦ e c./ CA-5 L e
Signature: //7 A Date: /7/13
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: O am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initialsty W
NAME: a a\o n e r PERMITN6: 3 ` / 6°
LOCATION: $ T n(1 C , r-i`\ M INSPECT ON: .7,,A tI \A_'- s�t 11 �
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off
Electric Disconnected 7
Asbestos Removed/ Documentation 7-
Property
Cleaned Up and Graded Vi WkAI til" ""IAC)1
(1,,,)).35-4,-
Okay to Issue Certificate of Compliance V
Demolition Inspection Report 11 27 12
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