DEMO-0775-2021 Office Use Only
DEMOLITION APPLICATION
Permit#: L 1— 0' �— 2A21
Permit Fee:$V'a y
Toxat of Q
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By
CS� Se
Demolition Location: Tax Map ID#: r,50a.1� ,1
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
e
1. Where will demolition material be disposed? � a( �, f4
2. TynaRes
truc e to be demolished:
idence d.Storage Building❑
arage ❑ e. Other:��/(
c. Busiriess ❑
3. What type of utiliti are connected to the structure:
a. Gas [r] f. Well-Water Pump ❑
b. Fuel Oil ❑ g. Public Sewer❑
c. Propane ❑ h. Other
d. Electric[V L None ❑
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes o-__�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.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: �� DATE:
Demolition Application Revised December 2020