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DEMO-0124-2018 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-0124-2018Date Issued: Wednesday, April 25, 2018 This is to certify that work requested to be done as shown by Permit Number DEMO-0124-2018 has been completed. 227.17-1-56 Tax Map Number: 135 SEELYE RD Location: Bernardo DeJesus Owner: WD Williams Construction, Inc. Applicant: This structure may be occupied as a: Demolition of single family dwelling Permit Condition: Silt fence to be installed and inspected prior to demolition. Bruce By Order of Town Board TOWN OF QUEENSBURY Frank 761-8226 cb 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 j 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: DEMO-0124-2018 Tax Map No: 227.17-1-56 Permission is hereby granted to: Crandall Excavating For property located at: 135 SEELYE 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 Tune of Construction Owner Name: Bernardo DeJesus Demolition-Residential $0.00 Owner Address: 27 Davison PL Total Value $0.00 Rockville Centre,NY 11570 Contractor or Builder's Name/Address Electrical Inspection Agency Crandall Excavating 63 WOODCHUCK HILL RD Lake George,NY 12845 Plans&Specifications Demolition of single family dwelling Permit Condition: Silt fence to be installed and inspected prior to demolition. Bruce Frank 761-8226 cb $ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 4,2019 (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 expirati a .) Dated at the To of Que bury e day,April 4,2018 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only ' DEMOLITION APPLICATION Permit#: f--'r"�- a12A'�i8 �—,-� Permit Fee:$ Town of Queens Invoice:#: D 271i. 742 Bay Road,Queensbury, NY 12804 P:518-761-8256 www.ciueensburv.net Demolition Location: !�U-5,le,o W. Z14krda1e,Tax Map M#: 7. / 7-/ -5r& **AN ASBESTOS REPORT IS REQUrMAR2 ALL DEMOLITION APPLICATION SUJ� � CONTACT INFORMATION: ,✓ TOWN oi=QUEENSBURY BUILD &CooEs • Applicant:, I/ Name(s): �N Wd(( )yL5 Mailing Address, C/S/Z: 'i7© 'tea �-�-� f , l°_��e ;�eQ �� ITV e 2-D Cell Phone: ( l ) `7q f-_? —�, � Land Line: ( s'l ' ) G� "'6 .t?,��9 Email: • Primary Owner(s)• Name(s): )ice:X4r 1.14 be__J�Su--15 Mailing Address, C/S/Z: �2'7 Dawsaft 'PlgO-e--r / ock vill'e Ce..�Y'e- A1Y Its 70 Cell Phone: ( 5149 a2°7,b 77 5— Land Line: ( ) Email: • Contractor: rr Business Name: Contact Name(s): ,�� Mailing Address, C/S/Z: Cell Phone:_( ` ) 4-1d— Imo,q4 Land Line: ( -5- Email: .�r .� /��tcr Ili d,. Contact Person for Building & Code Compliance: [ Idill;01715 Cell Phone: ( 57,E ) Yql- f-140 Land Linz (5� Email: G+� rt.��n� /lS �_ Af'1, Lolm Demolition Application Revised June 2017 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? 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 L 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: W'4Nt . W1t,tJAM-S ff SIGNATURE: � -��" DATE: ✓�[c � l r Demolition Application Revised June 2017