2006-350 ��� TOWN OF QUEENSBURY
'� 11
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060350 Application Number. A20060350
Tax Map No: 523400-289-013-0001-055-000-0000
Permission is hereby granted to: CRESCENT PLACE LLC
For property located at: 69 BIRCH 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: ARTHUR & JANICE BROWN
69 BIRCH Rd Demolition
Total
Value
LAKE GEORGE, NY 12845
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2006-350
DEMOLITION OF 2500 SQ FT RESIDENCE AND GARAGE
$20.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,June 12, 2007
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o ee ury; Ion ,,+ _.r.__ 2, 2006
f�
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE
TAX MAP NO. /3-/ 5$PERMIT NO. O( FEE FAIL&O,
Permission is hereby granted to the above named Applicant zc demolish the building(s)
described herein as set forth in the Application below.
Director of Building&Codes Date
APPLICATION FOR DEMOLITION PERMIT:
Fill in 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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APPLICANT/BUILDER: De v1 1 c �v !► E OWNER:
ADDRESS: U?..), 2 v t4 S"<1e/CO
s�t.t.cyY-v7�
PHONE NOS. U/- -7 ---7 PHONE:
PERSON RESPONSIBLE FOR WORK: to 4-e �Q�� V IN) I v1 F c.I PHONE:
LOCATION OF DEMOLITION: G g B i b L ('<p�, I Lo._ ti:( L-EO Vr�p y /2f v
WHERE WILL DEMOLITION MATERIAL BE DISPOSED?To b2 <v tA^k e
--�- , �-�- d cry
ASBESTOS INFORMATION: Ca-11 . 4cOY' �\G1‹ \ c mes 1,-!cy:c�Ct.,y' 6;3'1" kg?
✓ Is there any asbestos within the building to be demolished? YES NO X
✓ If YES, our office needs the following information:
c Name of firm removing the asbestos:
o License number of firm:
o Indicate where the asbestos material will be disposed:
RECEIVED
NOTE: A copy of Asbestos Removal Report must be filed with our office before demoltfjn Illi LUo6
STRUCTURE INFORMATION: TOWN ur '•��: -.v�rsURY
BUILDING AND CODE
✓ Indicate which structure(s) will be demolished: RESIDENCE GARAGE X BUSINESS
`2_5&< S STORAGE BLDG. OTHER
✓ Size of structure: X
✓ Number of stories: )
✓ Foundation type: FULL CELLAR CRAWL SPACE x SLAB
✓ Foundation: WILL BE REPLACED WILL NOT BE REPLACED
✓ Structures(s): WILL BE REPLACED WILL NOT BE REPLACED
UTILITIES INFORMATION:
✓ Indicate utilities for this structure: GAS ELECTRIC Y., PROPANE
PUBLIC WATER ONSITE WELL-WATER PUMPPUBLIC SEWER
rr
7'1/A
Have you notified the Town Water Dept. for public water and public sewer disconnect? YES NO
Have all utilities been disconnected: YES_ NO
QUESTIONS? CALL 761-8256 OR EMAIL
codes a(�pueensbury.net
/ / VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
SIGNATURE OF APPLICANT
'.� Town of Qrr.eensbury • Community L eaelopwent Office • 742 Bay Road, Queensbury, NY 12804