2014-361 TOWN OF QUEENSBURY
Firew742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140361 Date Issued: Friday, November 21, 2014
This is to certify that work requested to be done as shown by Permit Number P20140361
has been completed.
Tax Map Number: 523400-289-007-0002-004-000-0000
Location: 12 MOON HILL PI
Owner: GARFIELD RAYMOND
Applicant: GARFIELD RAYMOND
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
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: P20140361 Application Number: A20140361
Tax Map No: 523400-289-007-0002-004-000-0000
Permission is hereby granted to: GARFIELD RAYMOND
For property located at: 12 MOON HILL PI
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: GARFIELD RAYMOND Demolition
421 BAY Rd
Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-361 * 30-DAY PERMIT * issued through 9/11/2014
Demo Mobile Home(fire damage)
$30.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, September 11,2014
(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 Que sbu tfi
M i 1 a/_• st 11,2014
4
SIGNED BY ,- for the Town of Queensbury.
Director of Building& Code Enforcement
4
Town of Queensbury Building & Codes Ioffice-use-only, U [t I
DEMOLITION PERMIT APPLICATION -,L) 'Received:`
Ln 3�l
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUER . `Perrfiii`l 0 $ 20.14 t —
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing(lot _ t ,217107)
boundaries with dimensions and adjacent roads/streets. Show all existing structures T'Permit Feed.1occNSBURY 3�
on the property and indicate which are to be demolished. Indicate on the plot plan the= BUILDING& GGGcc.
location of all utilities.
Date $/ 8/ /`l Demolition Location r a M00-1 Hill Ol
TaxMaplD on'
2 r 7 -2 -
Applicant _(:,,r-(1' et cP P, Ray-non) Owner ( x cr�r e(i ta� SP
Address 4 2 I £ay l2P '/ Address S 4 " P
,..,tez-„ c�vy v�ylifol
Phone St8 - 745- 6ak`f S r Phone
Contact Person for Building&Code Compliance: l/�ar( c( 0 1 49c,yo-7 0-1,9 Day Phone: 3-1r-7Yf-6t '
Cos
1. Person Responsible for work: l,`; Q�� e() ✓ R C.y.•n v
2. Where will demolition material be disposed? /g c ^•gct i^ er - Lam.tel
e,(
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:.Zresidence —garage business _storage bldg. Other
b) Size of structure: 17- x S !o
c) Number of stories: I
d) Foundation Type: full cellar ✓crawl space ✓slab
e) Foundation: will be replaced ✓ will not be replaced
f) Structure(s): 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.forfopublic water and sewer disconnect? Yes ✓No
c) Have all utilities been disconnected? ✓ Yes No
6. Signatures: q 1 f,/
Print Name: 1111:.I (b j w o v
Signature: 1 ii �l Date: F/e/l
Town of Queensbury Building&Codes Demolition Permit 518-761-6256
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received: 1
Name: 0-(Ar---c e i!c� il�K\0 nd Inspected on: // i7 y
Location: m n n n ci � Arrive: a.m./p.m.
Permit No.: / '4—3 t,/ 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