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2012-134 TOWN OF QUEENSBURYrftray 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120134 Date Issued: Monday, January 26, 2015 This is to certify that work requested to be done as shown by Permit Number P20120134 has been completed. Tax Map Number: 523400-308-005-0001-034-000-0000 Location: 622 LUZERNE Rd Owner: RICK RANDALL Applicant: RICK RANDALL 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 ( J property owner of the responsibility for compliance with Site Plan, - Ai 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. OFFICE C TAX MAP NO30 g 4 5 -' 31 PERMIT OE ONLY f 13 4/ FEE PAID 3D Permission is hereby granted to the above named Applicant to demolish the building(s) r described herein as set forth in the Application below. Director of Building&Codes Date TOWN OF QVEENSBURY. BUILDING & CODES 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. APPLICANT/BUILDER:Trademark Demolition OWNER: Rick & Ida Randall ADDRESS: 6 Mechanic St Hoosick Falls, I ADDRESS: 4505 Woodlark Place Roc PHONE Nos.518-478-5381 PHONE: 301-640-6412 PERSON RESPONSIBLE FOR WORK:David Forrest PHONE: 518-478-5381 LOCATION OF DEMOLITION: 622 Luzerne Rd Queensbury, NY WHERE WILL DEMOLITION MATERIAL BE DISPOSED?Rapp Rd Landfill Albany,NY ASBESTOS INFORMATION: ✓ Is there any asbestos within the building to be demolished? YES NO V ✓ If YES, our office needs the following information: o Name of firm removing the asbestos: o License number of firm: o Indicate where the asbestos material will be disposed: NOTE: A copy of Asbestos Removal Report must be filed with our office before demolition begins. STRUCTURE INFORMATION: ✓ Indicate which structure(s)will be demolished: RESIDENCE ✓ GARAGE BUSINESS STORAGE BLDG. OTHER ✓ Size of structure: 32.0 X 32.0 ✓ Number of stories: 1 ✓ Foundation type: FULL CELLAR CRAWL SPACE ✓ SLAB ✓ Foundation: WILL BE REPLACED WILL NOT BE REPLACED V ✓ Structures(s): WILL BE REPLACED WILL NOT BE REPLACED ✓ UTILITIES INFORMATION: • Indicate utilities for this structure: GAS ELECTRIC PROPANE ✓ PUBLIC WATER ONSITE WELL-WATER PUMP ✓ PUBLIC SEWER Have you notified the Town Water Dept.for public water and public sewer disconnect? YES NO V Have all utilit-s been disconnected: YES ✓ NO QUESTIONS? CALL 761-8256 OR EMAIL codesAqueensbury.net SI ATUE OF APPLICANT VISIT OUR WEBSITE FOR MORE INFORMATION www.queensburv.net Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804 Town of Queensbury Building & Code Enforcement Office 'Jo. (518) 761-8256 Demolition Inspection Report Inspection request received: _ Name: Q AcLQI j Inspected on: l/2��� Location: e 12,131_ Arrive: /c,J a.m./p.m. Permit No.: / a - 13 7 Inspector's Initials: M,) ' Comments and/or diagram Y N N/A Gas Shut-off C� Water Shut-off Electric Disconnected 1./ ;)/ Asbestos Removed/ Documentation / Property Cleaned Up and Graded 'J Okay to Issue Certificate of Compliance / Demolition Inspection_11 20 12 Queensbury Building & Code Enforcement - esid ntial Final Inspection Office No. (518) 761-8256 Arrive: //'3t) am/p Depart: am/pm Date Inspection request received: Inspectors Initials: // NAME: 1 ACIeZi( �� PERMIT#: J — 13c/LOCATION: L,i�'--t'r-r e r�r DATE: •— i c TYPE OF STRUCTURE: (')c \r,1 ,+(an Comments: Yes No N/A 4" Building Number Address visible from road Chimney Height/"B"Vent/Direct Vent Location g G � � Fresh Air Intake �,�L� 3 inch PlumbingVent through roof minimum 18 inches 1 f l Roof Complete/Exterior Finish Complete Platform at all exterior doors Handrail 4 or more risers Guards at stairs,decks,patios more than 30 inches above grade Guard at stairwell at 34 inches or more Guard at deck,porches 36 inches or more Handrail Termination at Newell Post or Wall Interior/Exterior Railings 34 inches to 38 inches Deck Bracing/Handicapped Ramp Compliant Grade away from foundation 6 inches with 10 feet 6 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18 inches above grade Interior privacy/trim/doors I main entrance 36 inches Bathroom/Kitchen watertight Safety glazing/Window in stairwells safety glazing Interior Smoke Detectors/Carbon Monoxide Detectors Every level: Every Bedroom: Outside every bedroom area: Inter Connected: Battery backup: Attic access 30 inches x 22 inches x 30 inches(height)in accessible area Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft.vents Bathroom Fans,if no window Plumbing fixtures Foundation insulation to floor 1 Sticker on Panel Duct work sealed properly/Blower Door Test Certification Floor truss,draft stopping finished basement 1,000 sq.ft. Emergency egress below grade Gas Furnace shut-off within 30 feet or within line of site Oil Furnace shut-off at entrance to furnace area Furnace/Hot Water Heater operating Low water shut-off boiler Relief Valve(s)installed/Heat Trap/Water Temp 110 Enclosed Stairs Sheetrock Underside minimum'/"Gypsum Basement stairs closed rise>4 inches Garage Floor Pitched Garage fireproofing/%hour fire door/door closer Gas Logs in Sealed or Glass Enclosure Final Electrical; Energy Saving Light Bulbs 50% Final Survey Plot Plan Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles Flex Gas Pipe Bonding As Built Septic System/Sewer Dept. Inspection Sticker Site Plan /Variance required Flood Plain Certification, if required ` � Okay to issue C/C or C/O[Temporary/Permanent] ✓ C / ://2/- /11y0 ecT/p/✓ L:1Building&Codes Forms\Building&Codesllnspection FomislResidential Final Inspection Form_reviseed_100405.doc;Revised January 7,2008; Revised 6/26/08;Revised 12/22/10, Revised 04/13/11 (2? DAti/201 ")aCWRCERTIFICATE OF LIABILITY INSURANCE U2 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,su bject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AME Reginald J Carignan Agency Inc LoVullo Associates,Inc. PHONE Ext1: (518)235-4303 {A1C,No):(518)235-0634 6450 Transit Road E-MAIL ADDRESS: Depew,NY 14043 INSURER(S)AFFORDING COVERAGE NAIC t! INSURER A:COLONY INSURANCE COMPANY 39993 INSURED David Forrest INSURER B: dba Trade Mark Demolition Service 6 Mechanic Street INSURER C: Hoosick Falls,NY 12090 INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR MSR WVD (MM/DD/YYYY) (MMIDDIYYYY) A GENERALUABILITY GL3924168 04/0412011 04/0412012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 T1 POLICY n.PIIRCf n LOC $ AUTOMOBILE LIABILITY (Ea SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY HIRED AUTOS _ AUTOS NON-OWNED (Per accident) DAMAGE $ UMBRELLA(JAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE r N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ If yes.desasbe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. /� AUTHORED REPRESENTATIVE I� _".,r616 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD