2004-106 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040106 Application Number: A20040106
Tax Map No: 523400-316-005-0001-008-000-0000
Permission is hereby granted to: MARCTA PARKER
For property located at: 11 SPERRY 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 Value
Owner Address: CHARLES SICARD
11 SPERRY Rd Demolition
Total Value
QUEENSBURY, NY 12804
Contractor or Builders Name /Address Electrical Inspection Agency
Plans&Specifications
2004-106
DEMOLITION OF SINGLE FAMILY DWELLING
$20.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 23, 2005
(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 To Quee s i� March 23, 2004
SIGNED BY \ r for the Town of Queensbury.
Director of Building&Code Enforcement
Pemut
Application for Demolition Permit Fee Paid" �CJ ��L�✓ � "
Building&Codes Office—Town of Queensbury 742 Bay Road Queensbury,NY 12804
(518) 761-8256 Notes:
Instructions/Requirements for a permit: REC'E N E
Fill in all applicable spaces and submit two(2)plot plans,drawn to scale,showing lot boundaries with dimensions and adjacent roads/streets.
Show all existing structures on the property and indicate which are to be c' sl sd Ir?d� sje on the plot plan the location of all utilities.
1. TOWN OF QtjEENSBURY
BUILDING AND CODE
A ,liC,aYlt
f Add s zoo Y Motcl'
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Phone
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2. Location of demolition: 3. Tax Map No.
4. Where will demolition material be disposed of. ��lr/-zc- � " L-
5. Asbestos Information
A copy of Asbestos Removal Report must be filed with our office before demolition begins. /
a._ Is there any asbestos within the building to be demolished? ❑Yes ❑No
If YES, our office needs the following information:
b. Name of firm removing asbestos:
C. License number of firm:
d. Indicate locatio "lii-re asb s os materiap will e disposed
6. Structure Inforinatbo L '�� ✓� t'�i`J�, �a� }Vz
a. Indicate which ucthre(s —'will be de molished.
tilResidence; ❑garage; []storage building; ❑business; ❑other
b. Size of structure: ft.by 60
ft.
C. Number of stories Sl
d. Foundation type: 9 1 Oellar; ❑crawl space; 2<a
e. Foundation: will be removed- ❑will not be removed
f. Structure(s): ill be replaced; ❑will not be replaced
7. Utilities Information
Indicate utilities for this structure: J
�/ �r-nC '
❑ga electric L�Prane ❑onsite well-water pump
ublic water ❑public sewer
Have you notified the Town Water Dept. for public water and public sewer disonnect? Efes []No
Have all utilities been disconnected? ❑Yes ❑No AA5 '
J' Signature of Applicant: __r Get (� �Gv ezti Date: / z t-� ` _
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