2013-570 ita TOWN OF QUEENSBURY
Firm 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130570 Date Issued: Friday, January 15, 2016
This is to certify that work requested to be done as shown by Permit Number P20130570
has been completed.
Tax Map Number: 523400-227-010-0001-017-000-0000
Location: 50 BEAN Rd
Owner: MICHAEL N HAVERLY
Applicant: MICHAEL N HAVERLY
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 4
‘1-&-
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.
0.k TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130570 Application Number: A20130570
Tax Map No: 523400-227-010-0001-017-000-0000
Permission is hereby granted to: MICHAEL N HAVERLY
For property located at: 50 BEAN 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: MICHAEL N HAVERLY Demolition
STEPHANIE A HAVERLY Total value
7 TOWNLINE Ln
CLIFTON PARK NY 12065-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2013-570
DEMOLITION of old dock & boathouse
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, December 12,2014
(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 To n of ens ;S/% i�u y,-Decemher 12, 2013
SIGNED BY I for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received: 3
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.: / " S '?•61
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot pc 1 1 Q13
boundaries with dimensions and adjacent roads/streets. Show all existing structures Permit Fee: .1} 3 L L . u 0
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities.
Date 12 / it /13 Demolition Location 3O Fekvt ld •
TaxMaplD 22.3.Ga — 1 — 1 F / )
Applicant Owner "', C 114Q,e I ncty ed-1
r
Address _ Address Tvwn(i.:)-i bla
Phone Phone eSS ?Ott q
Contact Person for Building&Code Compliance: f4 c(A t ] }6:4,v-or
Day Phone: 8S8-...?d? l
1. Person Responsible for work: &az y 7 e c v t-5
2. Where will demolition material be disposed? [ Ofs i fe
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 NNo
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 d4'7-feDVSS
a) Indicate the structure(s)to be demolished:_residence _garage _business _storage bldg.A Other DoC,k/
b) Size of structure: ZS x 3.-S—
c) Number of stories: __._
d) Foundation Type: full cellar crawl space slab C_1 11�j
e) Foundation: J( 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 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 (I No
c) Have all utilities been disconnected?4 Yes _No
6. Signatures:
Print Name: (`n t t-H-A do +4A\p 2-1-1
Signature: �� Date: 1 Z/ !L/�3
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
• Towii of Queensbury Building & Code Enforcement `7j-ZtinAs
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:
Name: 0j„YCVI41 Inspected on: 1
Location: Pbe.4s41 Arrive: <\�� a.m. J /
Permit No.: 'LD 16— )' Inspector's Initials: it ,
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off
Electric Disconnected /
Asbestos Removed/Documentation V
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance 1
Demolition Inspection_11 20 12
-.
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection request received: /71- / / 1/3
Queensbury Building &Code Enforcement Arrive: 12-7) am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 2804 Inspector's Initials:
NAME:
Pr PERMIT NO.: ,_ 1
./J l
LOCATION: � , 1� / INSPECT ON: MAN 3
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 Report 11 27 12