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application Office Use Only o-o� /- 202A ' DEMOLITION APPLICATION Permit#: M �i Permit Fee:$ \b© Town of Queerisb ny c�� Invoice:#: 30W 742 Bay Road, Queensbury, NY 12804 P:518-761-8256 www.queensburv.net Demolition Location: 44 Louise Lane Tax Map ID #: 289.6-1-17.5 *AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: '' E C I d • • Applicant: OCT 22 2020 Ito Name(s): Mary Sicard Mailing Address, C/S/Z: 11 George St, Lake George, NY 12845 TOWN OF QUEENSBURY Cell Phone: (518) 744-1888 Land Line: (518) 792-J9G3 G&CODES Email: msicard@glensfallshosp.org • Primary Owner(s): Name(s): Same as above Mailing Address, C/S/Z: Cell Phone: _( ) . Land Line: _( ) Email: ❑ Check if all work will be performed by homeowner only • Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): Charles Friedman Excavating Contractor Trade: Excavator Mailing Address, C/S/Z: 54 North St, Hudson Falls, NY 12839 Cell Phone: (518)361-1748 . Land Line: (518)747-9371 Email: cfriedmanexcavating.com **List all additional contractors on the next page Contact Person for Building&Code Compliance: Charles Friedman Cell Phone: (518) 361-1748 Land Line: (518)747-9371 Email: cfriedmanexcavating.com DEMOLITION INFORMATION: 1.` Where will demolition material be disposed? Waste Management, Gansevoort NY Demolition Application Revised January 2019