2012-380 ��� TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120380 Date Issued: Wednesday, December 10, 2014
This is to certify that work requested to be done as shown by Permit Number P20120380
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 200 LUZERNE Rd
Owner: HOMESTEAD VILLAGE L P
Applicant: ROBERT LAWRENCE
This structure may be occupied as a:
Demolition
Aly Order of Town Board
q O P' p i n e TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
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
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120380 Application Number: A20120380
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: ROBERT LAWRENCE
For property located at: 200 LUZERNE 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: HOMESTEAD VILLAGE L P Demolition
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-380
Demolition- 90 Alpine Ave.
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 08, 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 f Quee bury eve is;t. :. gust 08, 2012
SIGNED BY I > for the Town of Queensbury.
Director of Building&Code Enforcement
- VTAX MAP N0, 3 619 9 "p1--I PERMIENO. ONLY !p1 -0 ye,
FEE PAID
Permission is hereby granted to the above named Applicant to demolish the building(s)
described herein a leirtniNn the licatjon bel
l
Director ot�°B diff odes ...--
Date AUG 072012
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: ,,^Cpkj/ .Af i?(.e_ OWNER: 2
ADDRESS: a60 402P_A/Lt- 21 ADDRESS: 27.?0,5- „2/3- h a4-( it/V
PHONE NOS. /- 5-1{5-' 'O3-SaZ// PHONE: /-6-e-6---224 - 5'ch.0 /y5'L3
PERSON RESPONSIBLE FOR WORK: /2h9i1 / ,t1/,e,1 4-PHONE: /`v— -X03-5 (/
LOCATION OF DEMOLITION: /i� ! 1//'//;91.-e 96 46/3)il'' 4-C_
WHERE WILL DEMOLITION MATERIAL BE DISPOSED? J/1 /JJ 5 L
ASBESTOS INFORMATION:
✓ Is there any asbestos within the building to be demolished? YES NO x
✓ 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 X GARAGE BUSINESS
,/ Size of structure: / / X 70STORAGE BLDG. OTHER
✓ Number of stories: I
✓ Foundation type: FULL CELLAR CRAWL SPACE X_ SLAB
✓ Foundation: WILL BE REPLACED - WILL NOT BE REPLACED
✓ Structures(s): WILL BE REPLACED X WILL NOT BE REPLACED
UTILITIES INFORMATION:
✓ Indicate utilities for this structure: GAS ELECTRIC X PROPANE K
PUBLIC WATER x ONSITE WELL-WATER PUMP PUBLIC SEWER
Have you notified the Town Water Dept. for public water and public sewer disconnect? YES r NO •
Have all utilities been disconnected: YES - NO
QUESTIONS? CALL 761-8256 OR EMAIL
/jka
codes(n�Queensbury,net
4111 VISIT OUR WEBSITE FOR MORE INFORMATION
SIGNOF APPLICANT www•Queensbury.not
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
own of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:
Name: cA151 Inspected on: Z— 1 i
Location: D A\ (9- re Arrive: C Adr, gtit'.m.
Permit No.: ) g ;3 so Inspector's Initials: 1Pr41111
Comments and/or diagram
Y N N/A � I "e3
Gas Shut-off /'"�
Water Shut-off
Electric Disconnected
Asbestos Removed/ Documentation
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection_11 2012
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