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application Office Use Only DEMOLITION APPLICATION Permit#: �► PylC�t��b � Permit Fee:$1 �.b Town of Qucensbury Invoice:#: 742 Bay Road,Queensbury, NY 12804 P: 518-761-8256 www.gueensbury.net Demolition Location: 1172 State Route 9 Tax Map ID #: 288.20-1-20 **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: _ C� It 5s°" � Y SiPrr �.[ • Applicant: Name(s): Great Escape Theme Park' LLC (Rebecca Wood) ! FEB 2 7 Zi a Mailing Address, C/S/Z: PO Box 511, Lake George, NY 12845 f._ Cell Phone:_( ) Land Line: (518)792-3500 TOWiI Ol=C�i.�e.L .�.: _;F:;y �_ BJiLF"ir Email: rwood@sfpt.com -� -- ` -' 0:3' • 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): Dean Hyatt Contractor Trade: Work to be completed by Great Escape Theme Park . Mailing Address, C/S/Z: Same as Above . Cell Phone: (518)812-9345 Land Line: (518)792-3500 Email: dhyatt@sfpt.com "List all.additional contractors on the next page Contact Person for Building&Code Compliance: Dean Hyatt Cell Phone: (518)812-9345 Land Line: (518)792-3500 Email: dhyatt@sfpt.com DEMOLITION INFORMATION: 1. Where will demolition material be disposed?Approved C&D Facility Demolition Application Revised January 2019 2. Type of structure to be demolished (check all that apply): a. Residence ❑ b. Garage ❑ c. Business 0 d. Storage Building ❑ e. Other ❑ (describe: _ _) 3. What type of utilities are connected to the structure (check all that apply): a. Gas ❑ b. Fuel Oil ❑ c. Propane ❑ d. Electric n 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. 1 Workers' Comp insurance information is required to be submitted with this application. Declaration:I acknowledge that no structure(s)will be removedfromthe parcel until the demolition application has been reviewed and approved bythe Town of Queensbury Building&Code Enforcement and Zoning Departments and a .permit has been issued. have read and agree to the above: PRINT NAM,F. _eigP__eQP n c)� SIGNATURE; DATE: Demolition Application Revised January 2019