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BOTH-000368-2015 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: BOTH-000368-2015 Date Issued: Tuesday,November 24, 2015 This is to certify that work requested to be done as shown by Permit Number BOTH-000368-2015 has been completed. Tax Map Number: 308.15-1-22 Location: 46 VAN DUSEN RD Owner: Robert Clark Applicant: Robert Clark This structure may be occupied as a: Demolition only 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, at��///(((�� 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 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: BOTH-000368-2015 Tax Map No: 308.15-1-22 Permission is hereby granted to: Robert Clark For property located at: 46 VAN DUSEN 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 Tyne of Construction Owner Name: Robert Clark Demolition $0.00 Owner Address: 92 Van Dusan RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications Demolition only $30.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Thursday,November 17,2016 (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 ween �;f, — / f A Mo r 23,2015 SIGNED BY: ` /vI for the Town of Queensbury. Director of Building&Code Enforcement Town of Queensbury Buildinq & Codes Office Use Only Received 77- 6oa�9b -------- -- DEMOLITION PERMIT APPLICATION Permit#: _ _ _�� 1 NO WORK MAY COMMENCE UNTIL PERMIT IS,)ISSUED Peritit Fee ---lt., ko.-e ------- fiJV 2 0 2015 Provide 2 plot plans drawn to scale, showing lot boundaries,gth.dimensions and adjacen roads/streets. Show all existing structures on property and indicate which are to be demolished. IridloLfhe location of all utilities Date --- /L__ Demolition Location 411, Vff 0 JH-le-'o k&9104 Tax Map ID APPLICANT -`�---11 // '\ --------- ----- OWNER __- Address _ �Zc_Y_'�1�S ��° __ _ _____ Address � 1/�v0a/' - _ - 'T ------ n --_- Phone __ ^Y_1 _—,y - Phone CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: 7�'( � _-�z-Lq--------- Phone: I. Person Responsible for Work 2. Where will demolition material be disposed? - � 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 S. 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 y c) Number of Stories d) Foundation Type e) Foundation QU p f) Structures) 9 7. Utilities Information a) Indicate utilities for this structure--- Gas Electric _-- Propane -'4 Public Water --- Public Sewer --- Onsite well water pump a) Have you notified the Town Water Department for public water and sewer disconnect? Yes _--- No b) Have all tiliti been disconnected? _ Yes ---- No 8. Signature Print Narrij.. _ U 2 Date 1 r 1 Signature: -------------- Date Town of Queensbury Building & Codes - Demolition Permit - December 2014 M r i t` h ,•U�1S Vji J` 1 /\aro FIL COPY zO � c 0 v i \ rn� p Y' t Jia 7 7Dp / 6 r � _ l� 's S � ILD oi- SITE PLAN REVIEW NEEDED ` i. VARIANCE NEEDED Yd' s