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2012-512 0111110h, TOWN OF QUEENSBURY 742 Bay RoadQueensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120512 Date Issued: Wednesday, December 19, 2012 This is to certify that work requested to be done as shown by Permit Number P20120512 has been completed. Tax Map Number: 523400-308-015-0001-058-000-0000 Location: 3 PINELLO Rd Owner: ESTATE OF MOHAMED BADRUDDIN Applicant: JAMES BURKE 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 4 l 41/9 . property owner of the responsibility for compliance with Site Plan, (7)/ 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,M'12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120512 Application Number' A20120512 Tax Map No: 523400-308-015-0001-058-000-0000 Pert-nission is hereby granted to: JAMES BURKE For property located at: 3 PINELLO Rd in theTown of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other infortnation hereto filed and approved and in compliance with the NYS Uniform Building(odes and the Queerisbury Zoning Ordinance. Type of Construction Value Owner Address: Es,rATE OF MOHAMED BADRUDI Demolition 22 ELIZABETH Ln 'Fatal Valne QUEENSBURY, NY 12804-0000 Contractor or Builder's Name / Address Electrical Inspection Agency Plans&Specifications 2012-512 Demo- Remove mobile home at Lot 7, Groorns Mobile Home Park $30.00 PERMIT FEE PAID -THIS PERMIT EXPIRES- Tuesday, November 05, 2013 (If a longer period is required,air application for air extension must be made to the code Enforcement Officer of the Tourn of Queensbury before the expiration date.) Dated at the Town of Queensbury; Monday, November 05,201.2 SIGNED BY for the Town(if Queensbury. Director of Building&(;ode Enforcement ONLY 1{7 TAX MAP NO.3 O '115-1 PERMIE NOE I '1� �` FEE PAID3 V Permission is hereby granted to the above named Applicant to demolish the building(s) 00 )A 102 described herein as set forth in the Application below. 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 I 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. /j APPLICANT/BUILDER: FS too OWNER: ,�y /3 339 ADDRESS:���ST/7TE Akec2f .. /(v ADDRESS: 27 P-,Pi"-, 4., L PHONE NOS. PHONE: ,54--I-- 37.E--X(D a i PERSON RESPONSIBLE FOR WORK: r-�714.),s ' / teiL PHONE: -_?)e- .'(3.a 1 LOCATION OF DEMOLITION: f/A6',/ C-C--) /A1 `ir ,c..x.-igeCet i(d*/ WHERE WILL DEMOLITION MATERIAL BE DISPOSED? /)10- ) /70.2. /14-.1./. 9 ASBESTOS INFORMATION: ( ,x,s___ ✓ Is there any asbestos within the building to be demolished? YES NO ✓ 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. OTHERAI l LJ= /71C:3M1`= ✓ Size of structure: X ✓ Number of stories: ✓ Foundation type: FULL CELLAR CRAWL SPACE SLAB ✓ Foundation: WILL BE REPLACED WILL NOT BE REPLACED ✓ Structures(s): WILL BE REPLACE WILL NOT BE REPLACED UTILITIES INFORMATION: ✓ Indicate utilities for this structure: GAS ELECTRIC PROPANE PUBLIC WATER k" ONSITE WELL-WATER PUMP PUBLIC SEWER Have you notified the Town Water Dept. for public water and public sewer disconnect? YES NO Have all utilities been disconnected: YES NOS( / \ QUESTIONS? CALL 761-8256 OR EMAIL ill cgdes(Aqueensbury,net A // . : VISIT OUR WEBSITE FOR MORE INFORMATION SIGN ` • •PLICANT www.queensbury.net Ms Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 Demolition Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm s Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: � ---) ) °L� NAME: 13L(rh PERMIT NO.: J . LOCATION: . P!'r1 6=1 (0 R d INSPECT ON: la7 Comments and/or diagram Y N N/A (7— Gas Gas Shut-off f\ i3-.6 .UC Q''kc ' . Water Shut-off > L'"-{) Electric Disconnected -+ 742: c� V Asbestos Removed/ Documentation 6,c2c "/ -L. lZ Property Cleaned Up and Graded Okay to Issue Certificate of Compliance /, Demolition Inspection Report_11 27 12 . • • PERMIT PLOT PLAN I HAVE PERSONALLY MEASURED THE DISTANCE - 4 • -.7-; .T.,.$•.It•r"-: -4 c!..4,....,Yt.... --.4.•••. .. ''' .• •.•. 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