2013-559 ` TOWN OF QUEENSBURY
cow742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130559 Date Issued: Wednesday, November 02, 2016
This is to certify that work requested to be done as shown by Permit Number P20130559
has been completed.
Tax Map Number: 523400-289-007-0002-001-000-0000
Location: 690 MOON HILL Rd
Owner: HAROLD & CAROL RATHBUN JR
Applicant: HAROLD & CAROL RATHBUN JR
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 ( 4v=0 4 ‘175t
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
i 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130559 Application Number: A20130559
Tax Map No: 523400-289-007-0002-001-000-0000
Permission is hereby granted to: HAROLD & CAROL RATHBUN JR
For property located at 690 MOON HILL 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: HAROLD & CAROL RATHBUN JR Demolition
601 HIGH ROCK Rd Total Value
W. COXSACKIE,NY 12192-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-559
DEMOLITION of mobile home
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,December 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 Town Quee sbury Th d , December 05,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
RX Date/Time 12/04/2013 13:56 P.002
DEC-4-2013 01:538 FROM: T0:7454437 P.2
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1111
Town of Queensbury Building & Codes Office Use Only ; l�
Received: (' 2013 `� I
'
DEMOLITION PERMIT APPLICATION ii1
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.: 3— 55.j' li
l
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 Permit Fee: t3 ' "
. :II
on the property and indicate which are to be demolished. Indicate on the plot plan the .l I i
location of all utilities. 'r '`
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Date Demolition Location 1
if
Tax Map ID
Applicant :�-v\ R1/4'vf-e—SV' ` (GAILY`(10.0ri 0 Werk6r1 It C- C .. \C--)U'f `t1 i l;I
Address 'Me_C 1ar ',C J1-- Address (0() - v 1 S 1C'XC -1 V\(- ii
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\1\1e-cl— e--(-)5CLC-Y- 1 -e- .) )Y oll. .$.-
Phone -4-k1 sag 1 Phone (51g) LC14-C)-1/3 'II i
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Contact Person for Building&Code Compliance: `�AV1� r{P,k Day Phone: Ng)1-11a—S---S� 1I
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1. Person Responsible for work: Sa
t� t ck ;,I,
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2. Where will demolition material be disposed? QG Q �� l , l� 1\ \)--\\Dan 1 N� , ;I
IIS
3. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begins. Ir
a) Is there any asbestos within the building to be demolished _Yes k No l•-• (3 tzS �NDS un a w(A n ;i ,
b) If Yes,our office need the following information:
Name of firm removing the asbestos: li
• License number of firm: I
i I
,)
• Indicate where the asbestos material will be disposed: { !I
4. Structure Information1 i•
a) Indicate the structures)to be demolished:'residence _garage _business _storage bldg. Other 'cS .p,,L ii ;
b) Size of structure: ax
c) Number of stories:
d) Foundation Type: ` full cellar _crawl space .,T slab ll ;
e) Foundation: _will be replaced X will not be replaced
will not be replaced il ;
f) Structure(s): will be replaced x it ,
I '
5. Utilities Information i
a) Indicate utilities for this structur : I.
Gas Electric Propane I
Public Water k On-Site Well Water Pump Public Sewer
f it
i. 1�b) Have you notified the Town Water Dept,for public water and sewer disconnect? _Yes 7(No II 1
;1
c) Have all utilities been disconnected? X Yes _..No `i `I
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6. Signatures: it I
t
Print Name: .--1C >C3—v\ -V7A-VP.S�- 11
it
Signature: �� Date: \�\�\v� r
II1i. ,i
ill:
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
;III
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Town of Queensbury Building &Code Enforcement Ji-ArZ,6
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:nn
Name: 0.t V)bi vYl Inspected on: t 114
Location: 106P 'lOC t\-» Arrive: " r a.m.!
Permit No.: 2-c l6~5c�1 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 45(
Demolition Inspection_11 20 12
NOthe: 0_15..g
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials
1"�
NAME: bLa-r0 PERMIT NOOOO.:: 3-- 5ci
LOCATION: (p ) Mr?), it [Q(1 INSPECT ON: I,?-9--t3
Comments and/or diagram
Y N N/A
Gas Shut-off �L"'s C:5-N. L
Water Shut-off //
Electric Disconnected
Asbestos Removed/ Documentation -
Property Cleaned Up and GradedV.
Okay to Issue Certificate of Compliance
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Demolition Inspection Report 11 27 12
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DURATION OF CONSTRUCTION
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