DEMO-0113-2018
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-0113-2018Date Issued: Tuesday, April 10, 2018
This is to certify that work requested to be done as shown by Permit Number
DEMO-0113-2018
has been completed.
289.16-1-5
Tax Map Number:
67 HAVILAND RD
Location:
Schermerhorn R.E. Holdings
Owner:
Schermerhorn R.E. Holdings
Applicant:
This structure may be occupied as a: Demolition of single family dwelling only
Asbestos report received
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
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: DEMO-0113-2018
Tax Map No: 289.16-1-5
Permission is hereby granted to: Schermerhorn R.E.Holdings
For property located at: 67 HAVILAND 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
Type of Construction `
Owner Name: Schermerhorn R.E.Holdings Demolition-Residential $0.00
Owner Address: 536 BAY RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Schermerhorn R.E.Holdings
536 BAY RD
Queensbury,NY 12804
Plans&Specifications
Demolition of single family dwelling only
Asbestos report received
$ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,April 10,2019
(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 ueens WV e s ji 10,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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Office Use Only
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1 DEMOLITION APPLICATION Perm it#:DEMO I'13-ao18
Permit Fee:$ t5
Town of Queensbwy
Invoice:#: dt9
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.gueensbury.net
Demolition Location: 107 r4 o : 1.q Tag Map M#:
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SU S� **
DEC
CONTACT INFORMATION:
TOWN OF QUEENSBURY
• Applicant: �2It�Bt i�°,�i 4� L9€�:9fi6T
N ame(s): 5c.1�et'+Avt e,t'1n o r N �o.�S-�0, e,-� ; o/�
Mailing Address, C/S/Z: 5 5 tp fA y gal Qj e e NS b,-; ry N i� 1 A go `1
Cell Phone: ( 51% } 3G[- a 7 A 3 Land Line: S 1 % } 72 $ r O(el y
Email: ri cln r-,-) 5o.14e_{uAe4- kopm 01 TS . C.s �.v1
• Primary Owner(s):
Name{s}: 5 4.44 f- )4 S A bo v -,
Mailing Address, C/S/Z:
Cell Phone:_( } Land Line: _{ }
Email:
• Contractor:
Business Name: S+4 v►^ e- a,S A ba -j e-
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( } Land Line: _{ }
Email:
Contact Person for Building & Code Compliance: ;'- 1Se�e{'wt t? f �no rAJ
Cel I Phone: _(sl$ ) :3�r"_YA7 3 Land Line: _(51 %
Email: ,(';c a SQ.1 4,P-CfAA P. C I-A o c' 01 :V%n . 0 c r,✓1
Demolition Application Revised June 2017
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DEMOLITION INFORMATION: CgSe/�1�}
1. Where will demolition material be disposed? UV A$l 2� All
6-F-F
2. Type of structure to be demolished:
a. Residence A
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 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: �'°� �c ��✓� e��a r�
SIGNATURE: DATE: 22, 2a/g
Demolition Application Revised June 2017