DEMO-000743-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: DEMO-000743-2016 Date Issued: Monday,November 14, 2016
This is to certify that work requested to be done as shown by Permit Number DEMO-000743-2016
has been completed.
Tax Map Number: 308.6-1-65
Location: 48 WARREN LN
Owner: Michael LeBlanc
Applicant: Michael LeBlanc
This structure may be occupied as a: Single-wide mobile home to be removed in
entirety.No demolition to be done. Single-wide to be replaced with double-wide By Order of Town Board
mobile home. TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the n
property owner of the responsibility for compliance with Site Plan, ZU7
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Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enfo cement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: DEMO-000743-2016
Tax Map No: 308.6-1-65
Permission is hereby granted to: Valued Homes
For property located at: 48 WARREN 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
Owner Name: Michael LeBlanc Demolition-Residential $0.00
Owner Address: 34 WARREN LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Valued Homes
1572 Route 9
Fort Edward,NY 12828
Plans&Specifications
Single-wide mobile home to be removed in entirety.No demolition to be done. Single-wide to be replaced with
double-wide mobile home.
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 3,2017
(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 o ueens n AThu y er 3,2016
SIGNED BY: (AY7K(/ /VJ for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received _
DEMOLITION PERMIT APPLICATION Permit#:
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee
Provide 2 plot plans drawn to scale,showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and indicate which are to/ Demolition Location demolished. Indicate the location of all utilities
Date _l 2,�_t L ro
_ _�___
Tax Map ID _ -JO�C_6_I/-(P� _
APPLICANT ____L�C �LC��l2 �/1 L OWNER --_-_-_-_-_-_-_-_-_-_-_-_-_-_--_-_-_--_-_-_-_-_-_
Address .�L�Zile�Q,QQ„` Address
�n S'h V-&--- ---------------------------
Phone --- -Q-S.(--Z------------- Phone
---------------------------
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: _______________________________ Phone:
1. Person Responsible for Work Valued 7b PS
2. Where will demolition material be disposed? 41eR —
3. All buildings to be demolished require an Asbestos Survey
4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begin
a) Is there any asbestos in the building to be demolished ____Yes ____No
b) If Yes,our office needs the following Information __-- Yes ____ No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished Residence ___ Garage ___ Business
__Storage Bldg. Other
b) Size of Structure D D
c) Number of Stories
d) Foundation Type
e) Foundation
f) Structure(s)
7. Utilities Information
a) Indicate utilities for this structure --- Gas Electric ___ Propane Public Water ___ Public Sewer
_- On-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? ____Yes -___ No
b) Have all utilities been disconnected? ,-)L Yes _ __No
8. Signature
Print Name: —---------- Date
----------- ------- --
Signature: - - - --- --------------- Date _ ¢Z�t ------
Town of Queensbury Building & Codes - Demolition Permit - December 2014
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