2015-287 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(aw Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150287 Date Issued: Monday, August 22, 2016
This is to certify that work requested to be done as shown by Permit Number P20150287
has been completed.
Tax Map Number: 523400-301-012-0002-027-000-0000
Location: 368 DIXON Rd
Owner: JP GROSS PROPERTIES, LLC
Applicant: JP GROSS PROPERTIES, LLC
This structure may be occupied as a:
Demolition
By Order of Town Board
TOWN OFQUEENSBURY
k__
Issuance of this Certificate of Compliance DOES NOT relieve the ��({///J 4
property owner of the responsibility for compliance with Site Plan,
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
FOS,1
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150287 Application Number: A20150287
Tax Map No: 523400-301-012-0002-027-000-0000
Permission is hereby granted to: JP GROSS PROPERTIES, LLC
For property located at: 368 DIXON 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: JP GROSS PROPERTIES, LLC
27 SILVER Cir Demolition
QUEENSBURY NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-287
Demo
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,July 28,2016
(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 th expirationrda .)
Dated at the T wn of een ry�f ' . ay,July 28,2015
SIGNED BY V for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received
DEMOLITION PERMIT APPLICATION Permit#: ao15-Zb
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee _
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 3104 2001 I 11 JUL1 0 ,Demolition Location
>
Tax Map ID 39.1-12-2-z7
IL - ' ` `"-FISBURY
APPLICANT3 _ b - OWNER __ 0,1
Address _Sj!I4{�G __ _ Address
rolei
Phone 541.--;%I.7.-- -02 Phone
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: g '✓'JC1V e4 �` Phone: '41LL
1. Person Responsible for Work cVg5
2. Where will demolition material be disposed? tA I12•44/ 110 k4.014 " „tif•IS -
— . S
3. All dings to be demolisi Jire r asbestos Surveyaet tJ1, , `w r4�1 +
4. Any buildin�substantiallydamaged by fire must obtain an Asbestos Removal Permit from the Department of Labo , ( T
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 ____No
b) If Yes,our office needs the following information ____ Yes ____No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished _V Residence ___ Garage ___ Business
___ Storage Bldg. ___ Other
b) Size of Structure Q--O X 36
c) Number of Stories t ' 1" f' ,�/
d) Foundation Type 0 u C Ot' C MgS(114aatf
e) Foundation 11D Fla/Mot13
f) Structure(s) tA ititmcAuriGID JbYt
7. Utilities Information �,"
a) Indicate utilities for this structure Gas 44.Electric ___ Propane . Public Water x Public Sewer
___ On-site well water pump
a) Have you notified the Town Water Department for public water and sewer disconnect? Yes ____ No
b) Have all utilities been disconnected? _$4. Yes ____No
8. Signature //
Print Name: ...w.," ., �• I , 1 %%1 —�,, •� .. , - .
Da e
."-'411,
Signature: C� /;10 7 -
Date _g,_ [ 6
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Town of Queensbury Building&Codes - Demolition Permit- December 2014
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ZIPCODE 12845 � NR
PARCEL ID 301.12-2-22
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PARCADRNUM 368
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