2012-346 it.,.
TOWN OF QUEENSBURY
742 Bay Road.Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120346-39073 Date Issued: Tuesday,November 1, 2016
This is to certify that work requested to be done as shown by Permit Number P20120346-39073
has been completed.
Tax Map Number: 303.20-1-13
Location: 28 BOULEVARD
Owner: Alysia Monroe
Applicant: Shawn McKenna
This structure may be occupied as a: Demolition of 3 walls,rest of buiilding will
remain standing 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, /d
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.
- _oi TOWN OF QUEENSBURY
742 Bay Road,Q•
OW,
uccn bury,NY 12804-5902 S(5B18)U76111-82Y01
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120346 Application Number: A20120346
Tax Map No: 523400-303-020-0001-013-000-0000
Permission is hereby granted to: ALYSIAA MONROE
For property located at: 28 BOULEVARD
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: ALYSIA A MONROE Demolition
28 BOULEVARD Total value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
SHAWN MCKENNA
639-8683
NY 12804-0000
Plans&Specifications
2012-346
Demolition of 3 walls
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,July 19,2013
(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 rTB4bur)?tI Thu •a,,July 19, 2012
SIGNED BY a/ for the Town of Queensbury.
Director of Building&Co•e Enfo ement
TAX MAP NO. �� _•tel _I_J 3PERMIENO. ONLY i _3 C�(D FEE PAID
Permission is h- eby gr. t-d to a•• e na• :•• •� . - to demollisvh the building(s)
described herein as - •• , ••
0+ . •e • , cati . •-''i JUL 2012
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. Indicatei ' on the plot plan the location of all utilities.
APPLICANT UILD S V`(A n'1L _"
)k) / •-\, OWNER: /9/G��S/e /D/)l0 f-
ADDRESS: O W-e S�- I?} O0\ V / f qrJ A.An ADDRESS: / rq R4t.de vcze� Osif Nt
PHONE NOS. c) u- to 3 5)— 6 6 e 3 PHONE: 57 - 792- -1qI
PERSON RESPONSIBLE FOR WORK: Sk•-•,G\WA! A(,11 C. PHONE: (o/-. 'S2 .7
LOCATION OF DEMOLITION: 2 8 8 c�1 ev �U` �LRv s.Lu--,
WHERE WILL DEMOLITION MATERIAL BE DISPOSED? 4-7,e (c✓�j6) /elle I9 3 54-Aeln
ASBESTOS INFORMATION: J
✓ Is there any asbestos within the building to be demolished? YES NO JC-
✓ 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. Y OTHER
✓ Size of structure: X
,./ Number of stories: (
✓ Foundation type: FULL CELLAR CRAWL SPACE SLAB)‹
✓ Foundation: WILL BE REPLACED WILL NOT BE REPLACED X
✓ StrUctUres(S): WILL BE REPLACED WILL NOT BE REPLACED X
UTILITIES INFORMATION: Prov:nu;1 y AI (.- .nt�-A-t El
✓ Indicate utilities for this structure: GAS ELECTRIC ,N PROPANE PUBLIC WATER
ONSITE WELL-WATER PUMP PUBLIC SEWER
Have you notified the Town Water Dept.for public water and public sewer disconn�ct. AYES NO
Have all utilities b n disconnected: YES )( NO
QUESTIONS? CALL 761-8256 OR EMAIL
codesaqueensbury.net
GNATURE OF APPLICANT VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbumnet
Cle Town of Queensbury • Community Development Office - 742 Bay Road, Queensbury, NY 12804
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