DEMO-0258-2022 Office Use Only
Permit#:MEMBER DEMOLITION APPLICATION
P Permit Fee: S--60
a-, E C E 0 W E $
Town of Queensbury Invoice#:
742 Bay Road,Queensbury,NY 12804 �,,IAY 10 2022 Food Zone?- Y N Reviewed By:
P:519-761-8256 www.6ueensbury.net
TOWN OF QUEENSBURY
BUILDING & CODES
Demolition Location: (0( C,44je_ gcr ) glq Tax Map ID #: '2 K6�' V-
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? 7Z4-e-% 15oda TZ s4a,4�
2. Type of structure to be demolished:
a. Residence d. Storage Building
b. Garage e. Other: A'
c. Business
3. Whattypeof utilities are connected to the structure:
a. Gas f. Well-Water Pump
b. Fuel Oil g. Public Sewer
c. Propane h. Other.
d. Electric L None
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes < No
ADDITIONAL INFORMATION:
1. Two inspections are required: an inspection to determine that utilities are
disconnected, 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: arisgo4e,
SIGNATURE: DATE.: (6, Z
Demolition Application Revised February 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: n�"iv' �1
Name(s): S13C� -C drl 9evyesr-0,
Mailing Address, C/S/Z:,Sr c.,,SILL� -Jo,-c PK 1$7-oz
Cell Phone: 1; 41 3o C-34 s 3 Land Line:
Email: :'� . ;Sc• " Sba �: e. . moo••• .
• Primary Owner(s):
Name(s): � 3,4
Mailing Address, C/S/Z: 3 "So Jdhs&A 1(4rcc� G.i r'f ke4 - hGrr >° P4 / 97o r
Cell Phone: '�;(01 3e-,,2 3V 53 Land Line:
Email: ram
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): Jac ws
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: 5a i4o-J 5ci
Cell Phone: 5&( 302 31TS-5 Land Line:
Email: "S,'L�r s cr ,� -5dR+5 i F 0 c a.►1
Demolition Application Revised February 2022
Mark Smith
From: s Joe Kaiser <JKaiser@sbasite.com>
Sent: Friday, February 24, 2023 11:05 AM
To: Mark Smith
Subject: 61 State Route 149 decom
Mark,
I have verified that the site work is completed here. Let me know if you need anything further from SBA._
Thank you,
Joe Kaiser
Manager,,Construction
SBA
SBA Communications Corporation
350 Johnson Street
Wilkes-Barre, PA 18702
561.302.3953+T
JKaisera-sbasite.com
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