2015-316 el TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150316 Date Issued: Tuesday, July 28, 2015
This is to certify that work requested to be done as shown by Permit Number P20150316
has been completed.
Tax Map Number: 523400-308-012-0002-004-000-0000
Location: 38 WISCONSIN Ave
Owner: RICHARD & ERWIN LUTZ
Applicant: LARRY CLUTE
This structure may be occupied as a:
Demolition
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the /'
property owner of the responsibility for compliance with Site Plan, /� )0t-
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Vitig
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150316 Application Number: A20150316
Tax Map No: 523400-308-012-0002-004-000-0000
Permission is hereby granted to: LARRY CLUTE
For property located at: 38 WISCONSIN Ave
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: RICHARD & ERWIN LUTZ Demolition
38 WISCONSIN Ave Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
BP 2015-316
Complete removal of existing mobile home off property. No demolition of mobile home materials onsite.
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 27,2016
(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 T n o ueen o f. ' ,July 27, 2015
SIGNED BY ' for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received t _1 1 Ali i'f S
DEMOLITION PERMIT APPLICATION Permit �i`° '
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit F�ep _ 1 -31 iso
Provide 2 plot plans drawn to scale, showing lot boundaries with dimensions and adjacent roads /streets. Show all existing structures
on property and indicate which are to be demolished. Indicate the location of all utilities
Date I'l t i Demolition Location 3 -S(ons l✓1
7
,74-c
Tax Map ID 3z2L .2 -),-`-i )
APPLICANT <--Ca-r C--U(e OWNElki /D1C-C— `''rt A&-
Addressr, Address Co
Phone Phone
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: ___ LOS- (t`-' ( -'> ,L- Phone:
1. Person Responsible for Work )--CX fCiu_,--C-.
2. Where will demolition material be disposed? (l' at,pielge Ren-)61-0a 6-1-17140k Le 4_14(__a —
3. All buildings to be demolished require an Asbestos Survey 1-101eletYX_ . L' )Ci
v oc `r" Cm Si k,
4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begin
a) Is there any asbestos in the building to be demolished ____ Yes __X_ No CD
b) If Yes,our office needs the following information ____ Yes n__ No co
Name of firm removing the asbestos c---elding (�° -tJ '.k , C` 2
License number of firm ---"C -----\... - r pA N I 'u)
Indicate where the asbestos material will be disposed m E o
6. Structure Information o
a) Indicate the structure(s)to be demolished ___ Residence _ Garage ___ Business o
___ Storage Bldg. _.6'_ Other P.-i h p f- e, a) j E
b) Size of Structure 7C> 4 x /,;2-� Ff. > E o
c) Number of Stories . . (3) c
d) Foundation Type U o o
e) Foundation
f) Structure(s) FORC,‹ SS'.f- )( L{ r J co o 0
7. Utilities Information
a) Indicate utilities for this structure +'_'_ Gas _w_ Electric ___ Propane _I' Public Water ___ Public Sewer
___ On-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? _ __ Yes ____ No n i
b) Have all utilities been disconnected? ___ Yes ____ No
8. Signature
f / /
Print Name: f ' -- Date _--4/1_,z 1_,Qz f
Signature: v_ ___ _ / __ Date __Z./1.Z 'l`)
7
Town of Queensbury Building & Codes • Demolition Permit - December 2014
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:
Name: C-AUS , Inspected on: -Ze l t J
Location: Z W\(xrL\r> Arrive: 91%�V[� a.m./p.m.
Permit No.: I5���� Inspector's Initials: I
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off 1/
Electric Disconnected t/
Asbestos Removed / Documentation
Property Cleaned Up and Graded
Okay to issue Certificate of Compliance
Demolition Inspection_11 20 12
Queensbury Web Map
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NR Reviewed y: � ti� 7 NR II
I Date: /Errr
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TOWN t'F QUEENSBURY III v
III BUII.DI G DEPARTMENT T
II Based on our limit:d examination,compliance Ill 11
I with our commenttEshall not be construed as II
indicating the plal8 and specifications are in
II full compliance we the Building Codes of i it
II New York State. II II
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