2014-213 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: P20140213 Date Issued: Thursday, March 03, 2016
This is to certify that work requested to be done as shown by Permit Number P20140213
has been completed.
Tax Map Number: 523400-226-019-0001-076-000-0000
Location: 256 LAKE Pky
Owner: GEORGE & PATRICIA PENSEL
Applicant: GEORGE & PATRICIA PENSEL
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 �.
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� TOWN OF QUEENSBURY
� e 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140213 Application Number: A20140213
Tax Map No: 523400-226-019-0001-076-000-0000
Permission is hereby granted to: GEORGE & PATRICIA PENSEL
For property located at: 256 LAKE Pky
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: GEORGE &PATRICIA PENSEL Demolition
2635 STATE ROUTE 9 Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-213
Demolition of 1 house and 2 sheds
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 13, 2015
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Ar
Dated at the Town f Que n bu /IF ' . 3,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
'----#.\
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received:
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit N�iY' _0 '"�t 4
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot ` n0_��
boundaries with dimensions and adjacent roads/streets. Show all existing structures Permit Fee:
on the property and indicate which are to be demolished. Indicate on the plot plan the .
location of all utilities.
Date 7 hl -[ -t Demolition Location 2-6 19 LA kZ VA¢ Q(
Tax Map ID 2 2(.0 . 1 ct - 1719
Applicant Do,;et t as Mc ( 1 1 Owner C eo cz_Gr�RaT2m:\A `l t=,N S 5 L
Address 1 Li Rf Co,.) r‘)k- Rx- 29 Address 2511, L.4KE ''a .v-w t '-?
No e...-NA, Ce k N 12-V 3 c e-eArvs gv2)4 ,NH 12 Ac`-t
Phone 51$- ZS 1 -36 I 9 Phone 5-I '3- 713- 5L)6-?—
Contact
Contact Person for Building&Code Compliance: ,,r�oc.)ct l vas VYIzCA Li Day Phone: 5/t?-744'-1-/q ctS
1. Person Responsible for work:14-M) VA?ALL.4 -• MC IV A-w•{ tit CP v 41-1.6#J
c
2. Where will demolition material be disposed? Cv. e to 21i N 6
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 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: sidence _garage _business —storage bldg. —Other
b) Size of structure: `{ x LW
c) Number of stories: t
d) Foundation Type: full cellar rawl space slab t, I
✓' . , alit terse to be •tn�t,., t i as nottf:
e) Foundation: will be replaced will not be replaced .; Irstailation mutA he completed &!.lspec ed 1
f) Structure(s): vnll be replaced will not be replaced
1 l;,rkil. Co beginning ,ier't:�litl�,n.
J
5. Utilities Information
a) Indicate utilities for this structure: _.....- Ple contact this cCtce to Kche?di�IP an
Gas r/Electri �a; ,
c Propane 1cSY„,t On Ct t;1e sjtfi mix to?►'; ter' I�`�ItttOn•
Public Water On-Site Well Water Pump Public Sewer .._____..._._--__
b) Have you notified the Town Water Dept.for public water and sewer disconnect? Yes---Ne VA
c) Have all utilities been disconnected? _Yes %o 2 .S,, 17e-0N c)-
6.
-6. Signatures:
Print Name: l�p U cf 14R s mc. C I l
Signature: '4. t'Yly(.-c,r?._ Date: 1 ` -1 `{
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:
Name: e.Y1 � Inspected on: 3/6'
D
Location: 25 P Cly Arrive: a.m.I p.m.
Permit No.: Zoll. -L►'J Inspector's Initials:
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off
s (2c\zt . i��) LQx-)s uc as--‘
Electric Disconnected
buts sry
Asbestos Removed /Documentation
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection_11 20 12
Oleki TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
61 Community Development- Building&Codes (518) 761-8256
Inspections per Permit
Permit# P20140213
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
06/05/2014 Miscellaneous Demolition STAFF
Misc 2014-213
permit app rec'd&entered
06/13/2014 Miscellaneous Demolition CRAIG BROWN Staff
Approved 2014-213
zoning approved
06/13/2014 Miscellaneous Demolition STAFF
Misc 2014-213
permit issued
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