application Jl
Office Use Only
Permit#:
DEMOLITION APPLICATION
Permit Fee:$
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 Flood Zone? Y N Reviewed By:
st
Demolition Location: Tax Map ID 9: 3 q0 0 3 01. -2
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS
DEMOLITION INFORMATION:
1. Where will demolition material be-disposed?
2. Type of structure to be demolished:.
a. Residence K d.Storage Building El
b. Garage 0 e.Other:
c. Business M
3. What type of utilities are connected to the structure:
a. Gas M f.Well-Water Pump
b. Fuel Oil[ g.Public Sewer❑
c. Propane F] h.other
d. Electric P i. None❑
e. Public Water
4. Have ALL utilities(water,electric,etc.) been disconnected? des[� NoE]
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.
3. Workers' Comp insurance information is required to be submitted with this application.
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:-
PRINTNAME: D"('A
SIGNATURE_. DATE: 6A A[
Demolition Application Revised December 2020
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• �:
CONTACT INFORMATION- PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: 11
Name(s): Wu'' d f�.• j"'1 d S eS f IVY /"Uy
Mailing Address,C/S/Z: 3 f /ye her'c+� L''`r• icce2�s b��y
Cell Phone; 4a-ffd-Line: .1574- b3$- A 5y6
Email:
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Primary Ow er s : 11
Name(s): ` X>q✓, & LJ . VWtuseS S Intry e, L . /4U Ses
Mailing Address,C/$/Z: S ��
Cell Phone: Land Line:
Email:
[]Check if all work will be performed by property owner only
• Contractor: (List a I additional cpntractors on the back of this form)
Contact Name(s): J O S L yPo r C f
Contractor Trade: H � C. 4CL1% am
MailingAddress,C/S/Z: 1.1cat-teo lq�e. T'ra�lefr IVY �2k3S
,—,- one: LandLine: S/�•�(96- 3 ¢�iS5111
Email: h n 0-f ru.cki-%s �r'Ockel'�^•ia� CC7 '"''
"Workers' Comp documentation must be submitted with this application**
Contact Person for any questions regarding_ this project:
Cell Phone: Land Line:
Email: �e (I S!rr• 53 �"� a 5y6
Muses
�o°' � Cell 6I�- 361 - 17c;?
Demolition Application Revised December 2020
31 Heinrick Circle Back Yard View
Fence PROPERTY LINE(APPROX 163 FEET)
27 feet (BACK PROPERTY LINE TO POOL)
H 90 feet (PLAY AREA TO POOL)
Play
area
Pool 32' x 12 ' BUIILLDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as D '
indicating the plans and specifications are in
full compliance with the Building Codes of 1�
+25 feet LEFT PROPERTY LINE TO POOL) New York State.
<-
( T0
52 feet POOL TO HOUSE
TOWN OF QUEENSBURY Cop �Y
BUILDING & CODES DEPT.
Reviewed BY:
Date: S z,
Deck 18 feet X 20 feet FILE COPY
House
301.12-2-47 DEMO-0322-2021
Moses, David
31 Heinrick Cir
Fill in inground pool