2014-587 ��` TOWN OF QUEENSBURY
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742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140587 Date Issued: Wednesday, December 03, 2014
This is to certify that work requested to be done as shown by Permit Number P20140587
has been completed.
Tax Map Number: 523400-239-012-0002-064-000-0000
Location: 4 HOLLY Ln
Owner: WILLIAM & PAMELA ROBERTS
Applicant: WILLIAM & PAMELA ROBERTS
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& Co. nfor ent
Planning Board or Zoning Board of Appeals.
1i1i{� TOWN OF QUEENSBURY
` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140587 Application Number: A20140587
Tax Map No: 523400-239-012-0002-064-000-0000
Permission is hereby granted to: WILLIAM & PAMELA ROBERTS
For property located at: 4 HOLLY Ln
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: WILLIAM & PAMELA ROBERTS Demolition
354 COUNTY ROUTE 45 Total Value
ARGYLE,NY 12809
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-587
DEMOLITION of main residence and guest cottage
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 14,2015
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Towo�f Qubu s (�' F a . • n ber 14,2014
SIGNFI)BY " for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received:
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.: j/_.j 4
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot 3 t��l}
boundaries with dimensions and adjacent roads I streets. Show all existing structures Perml ;
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities.
Date / 0 �F - !6/ Demolition Location /f i L
Tax Map ID X31 . 0 - d)--(o
Applicant (>-ki7AJ . ! '" Ocs., 9/4,, Owner (36-11-1 `-a; )1 /`le Qf`{S
Address 7� (-t ON a) L// t,). Address 3,5y (IC
(s-2 ni :1( til 7 !2 /307 / 3 c3b cr
Phone J l9 - (� G a-t f 3 61 Phone C.3 ✓ g q(0
Contact Person for Building&Code Compliance: 0C J Q Day Phone: 6-7$ - /yy..(.1s
1,
Person Responsible for work:
�� S
2. Where will demolition material be disposed? 1)- Q c-0.o^ fly Jy 9 t 1- OA)k)
3. Asbestos Information: The Asbestos Removal Report must be filed with our oIrce 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:_residence _garage _business _storage bldg. _Other
b) Size of structure: c> x 4-1,2 -+ 3 7 x q "
c) Number of stories: ( y
d) Foundation Type: full cellar ' crawl space slab
e) Foundation: v"-will be replaced will not be replaced
f) Structure(s): twill be replaced will not be replaced
5. Utilities Information
a) Indicate utilities for this structure:
Gas ,,ElectricV Propane
Public Water VOn-Site Well Water Pump Public Sewer
b) Have you notified the Town Water Dept.for public water and sewer disconnect? Yes '!No
c) Have all utilities been disconnected? Yes
6. Signatures:
Print Name: ( O.. A}-0 r
Signature: ` tIj" ,g_� 3kA 9-r Date: /6/l �E
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 T\'y am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:. ` ``)
NAME: N,, (2r S PERMIT NO.: r S g
LOCATION: 1D ( i�1� Q INSPECT ON: -‘e21
Comments and/or diagram
Y N N/A
Gas Shut-off 7
Water Shut-off '
l;✓;f
Electric Disconnected VI/
Asbestos Removed/ Documentation /
r
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection Report 11 27 12
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