DEMO-0081-2018 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-0081-2018 Date Issued: Wednesday, May 2, 2018
This is to certify that work requested to be done as shown by Permit Number DEMO-0081-2018
has been completed.
Tax Map Number: 308.6-1-67
Location: 34 WARREN LN
Owner: Michael LeBlanc
Applicant: Michael LeBlanc
This structure may be occupied as a: Demolition only of garage (per Dave H., no
asbestos survey needed) 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.
A�I�I
. TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: DEMO-0081-2018
Tax Map No: 308.6-1-67
Permission is hereby granted to: Michael LeBlanc
For property located at: 34 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
Michael LeBlanc
34 Warren LN
Queensbury,NY 12804
Plans&Specifications
Demolition only of garage(per Dave H.,no asbestos survey needed)
$ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,March 2,2019
(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 e ury; rid ch 2,2018
for the Town of Queensbury.
SIGNED BY: 6K
Q ury•
Director of Building&Code Enforcement
Office Use Only
ON Permit#:flu
D s
Permit Fee:$ 0.
'own of Qjueensbury i J)
FEB 2 8 2D18 Invoice:#: / V
742 Bay Road, Queensbury, NY
P: 518-761-8256 www. ueen ur N OF QUEEN5BURY
BUILDING&CODES
Demolition Location:} Wi RK et,� t 4nj c. Tax Map ID#: -3 08-,
I
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
CONTACT INFORMATION:
• Applicant:
Name(s): m', c E Le&A�3L
Mailing Address, C/S/Z: 34 w Ak,p-e-W L6KAf
Cell Phone: ) 7 55 91 �8' Land Line: (.519 ) `NO - a 317
Email: ' C.-to c GCS C Ai t CODA -
• Primary Owner(s):
Name(s): YY1
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Contractor:
Business Name: SAlr,e-
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance: Ab6yk
Cell Phone: _( ) Land Line: _( )
Email:
Demolition Application Revised June 2017
*� ---
DEMOLITION INFORMATION: )
1. Where will demolition material be disposed? dL
2. Type of structure to be demolished:
a. Residence
b. Garage
c. Business
d. Storage Building
3. What type of utilities are connected to the structure:
a. Gas
b. Fuel Oil
c. Propane
d. Electric
e. Public Water
f. Well-Water Pump
g. Public Sewer
h. Other
i. None
4. Have ALL utilities been disconnected? Yes OK No
ADDITIONAL INFORMATION:
1. Two inspections may be required: an inspection to determine that utilities are disconnected, if
necessary, and a final inspection, after the structure is removed and the site is cleaned up and graded.
2. Twenty-four(24) hour notification is required for inspections.
Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application has
been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a
permit has been issued.
I have read and agree to the above:
PRINT NAME: 1' �1 0 e 6 1,L
SIGNATURE: // � DATE:
Demolition Application Revised June 2017