2004-952 TOWN OF QUEENSBURY
742 Bay Road,_Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040952 Application Number: A20040952
Tax Map No: 523400-309-011-0002-022-000-0000
Permission is hereby granted to: MONICA RICKF,TSON
For property located at: 16 LUZERNE 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: MONICA RICKETSON
Demolition
8876�STATE ROUTE 40
Total Value
FORT ANN,'NY 12827-9671
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-952
DEMOLITION OF SINGLE FAMILY DWELLING
$20.00 PERMIT FEE PAID-THIS,PERMIT EXPIRES: Saturday, December 10, 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 Town of Queensbury; Friday, December 10, 2004
SIGNED BY 4 for the Town of Queensbury.
uil g nforcement
Pernut Q0
1114 Fee Paid V !Application for Demolition PWhLit
Building&Codes Office-Town of Queensbury 742 Bay Road Quy Y
(518) 761-8256
Notes:
Instructions/Requirements for a permit:
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 demolished. Indicate on the plot plan the location of all utilities.
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Name. rL,7(5/V G 15-
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2. Location of demolition: 1 (o L_U7-e�c fv 3. Tax Map No; `� � I ( —J R_ �
4. Where will demolition material be disposed of? �/�S
5. Asbestos Information
A copy of Asbestos Reinoval.Report must be filed with our office before demolition begins. �+f
a. Is there any asbestos within the building to be demolished? ❑ Yes i No , 0, r�
If YES, our office needs the following information:
b. Name of firm removing asbestos:
C. License number of firm:
d. Indicate location where asbestos material will be disposed
6. Structure Information
a. Indic which structure(s)will be demolished:
esidence; ❑garage; ❑storage building; ❑business; ❑other
b. Size of structure: ft.by ft. �
C. Number of stories
d. Foundation type: []full cellar; crawl space; ❑slab
e. Foundation: ❑will be removed; ❑will not be removed
ill be
f. Structure(s): replaced; ❑will not be replaced -�`- - ,/1%,uf
7. Utilities Information
Indicate utilities;eis
th ructure:lectric ❑propane ❑onsite well-water pump
Lter ❑public sewer
Have you notified the Town Water Dept. for public water and public sewer disonnect? ZYes [ONo
Have all utilities been disconnected? ❑Yes ❑No
Signature of Applicant: �� Date: 7
� PP -
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518)761-8256 Arrive: ��.2! am/pm , Depart: am/pm
Date Inspecti-an request received: Inspector's Initials: 20
-
, ,�L
NAME: PERMIT#:
LOCATION: DATE:
TYPE OF STRUCT
Comments
Y N N/A
Chimney Ht./"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumb Vent through roof minimum 6"
Roof Complete/Exterior Finish Complete (�✓Iv\
Guard 30 in.or more @ stairs,decks,patios
Guard at stairwell at 34 in. or more
Guard at deck,porches 36 in. or more
Exterior Finish Complete
Interior/Exterior Railings 34 in.to 38 in.
Platform at all exterior doors
Interior Handrails stairs 2 or more risers
Enclosed Stairs Sheetrock Underside minimum '/z"
Gypsum
Grade away from foundation 6 in.with 10 ft.
Handrail Termination at Newell Post or Wall
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18"above grade
Gas Furnace shut-off within 30 ft.or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valves installed/Heat Trap/Water Temp 110
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors:
Every level: / Every Bedroom:
Outside every bedroom area:
Inter Connected: / Battery backup:
Carbon Monoxide Detector
Bathroom Fans, if no window
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 sf
Emergency Emelgency egress below rade
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/'/e hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Attic access 30 in.x 22 in.x 30 in.(ht.)In accessible area
Crawl'S aces 18"x 24"access, 1 s . ft,150 s . ft.vents `)
BuildingNo./Address visible from road r� u Gil rs �;�teClk
Final Electrical
Site Plan /Variance required
Final Survey Plot Plan �{e--
As Built Septic System/Sewer Dept.Inspection Sticker
Flood Plain Certification, if required �4j // f� 474����^��
Okay to issue C/C or C/O Temporary/Permanent �,o J
L:\PamW\Building&CodesUnsvection Forms\Res. Final Insp. form 2.docLast printed 2/12/04