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DEMO-0633-2021 Office Use Only DEMOLITION APPLICATION Permit#: r� -�✓�►-� - Q� 33- `ZoZ Permit Fee:$ j tep S 00 D C E. s Invoice#: 742 Bay Road,Queensbury,NY 12804_ L� P:518-761-8256 www.gueen9burv. e Flood Zone? Y N . Reviewed By: AUG 2 5 2021 TOWN OF"ULILENSBUF� ' Demolition Locati Tax I { %t-'` J, II �o , TP) AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS" DEMOLITION INFORMATION: 1. Where will demolition material be disposed? C cknc� )OC c�16 O'S c,C� -tfOnS�C( station I C) - n FD � yl N`J 2. Type of structure to be demolished: Oyl �4 , a. Residence,)d d. Storage Building❑ b. Garage❑ e. Other: c. Business ❑ 3. What type of utilities are connected to the structure: a. Gas ❑ f. Well-Water Pump ❑ b. Fuel Oil ❑ g. Public Sewer❑ c. . Propane ❑ h. Other d. Electric❑ i. None e. Public Water❑ 4. Have ALL utilities (water, electric, etc.) been disconnected? ,Yes t�j , 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. . 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. have read an d agree to the above: PRINT NAME: C e 'Da SIGNATURE: DATE: ff za I. Demolition Application Revised December 2020 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): LP (� � 1 )e 1 aU S b Ur �1`I lay D Mailing Address, C/S/Z 58 �e 1�t: n 1(1,SY I Cell Phone: 5 ,g Land Line: Email: lcc 9ai I . (-on -) 9 • Primary Owner(s): Name(s): .P L) Ddkg9 e Mailing Address, C%S/Z: 59 J e n 6 o5v i 1 IC._R6 .,.QeN , Cell PhT e• Land ine- Email: IBS- 7c t(Q-?j6 U0 Check if all work will be-performed by property owner only • Contractor: (List all additional contractors on the back of this form) Contact Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: **Workers' Comp documentation must be submitted with this application** Contact Person for any questions regarding this project: Cell Phone: Land Line: Email: �C�I oil e ©�F C_ng wocxk 1 . L°-n i Demolition Application Revised December 2020 Charles Dyer From: Nick Daigle <daiglenick@yahoo.com> Sent: Wednesday, September 15, 2021 12:48 PM To: Charles Dyer Subject: 11 Moon Hill As discussed the other day the mobile home has be removed and relocated to service as a hunting camp Sent from Yahoo Mail for iPhone i