2012-553 .11111a TOWN OF QUEENSBURY
742 Bay Road, ueensbu NY 12804-5902 (518) 761-8201
3Q t7,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120553 Date Issued: Thursday, November 29, 2012
This is to certify that work requested to be done as shown by Permit Number P20120553
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
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ' ie(
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
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120553 Application Number: A20120553
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
4294 ROUTE 5 Demolition
CALEDONIA,NY 14423 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
2012-553
Demolition of Mobile Home at lot 169 Elmhurst Drive
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 28,2013
(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 of Queensbury; Wednesday,November 28,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
•
TAX MAP NO.3�,� PERMI E USE 0 /Y
�..S 1/4_3r FEE PAID 30 CV
Permission is hereby granted to the above named Applicant to demolish the building(s) NOV u 2012
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 / 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:90 Ler Lau.)ren cx_ OWNER: ((-1 1.-p(vi_ _
ADDRESS: ,i O LI)2_rr _ S ADDRESS: /SoS 51- 0.5-67741-07714
PHONE NOS.(551S- /
S ( I PHONE: 385-- 2 .�/n - �eU xi 3/4i
PERSON RESPONSIBLE FOR WORK: kc ere- r d}t.JPHONE:5 - `0,3
LOCATION OF DEMOLITION: 0004-e--5 \f% (,A 1-4)+//(
WHERE WILL DEMOLITION MATERIAL BE DISPOSED? . 0 n S
ASBESTOS INFORMATION:
✓ 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 X GARAGE BUSINESS
STORAGE BLDG. OTHER
V Size of structure: /4/ X 7()
✓ Number of stories:
✓ Foundation type: FULL CELLAR D CRAWL SPACE -- SLAB
✓ Foundation: WILL BE REPLACED WILL NOT BE REPLACED
✓ Structures(s): WILL BE REPLACED t/ WILL NOT BE REPLACED
UTILITIES INFORMATION:
✓ Indicate utilities for this structure: GAS ELECTRIC / PROPANE
PUBLIC WATER V 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 /NO
QUESTIONS? CALL 761-8256 OR EMAIL
SIGNATU E OF APPLICANT
r'; Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
Queensbury Building & Code Enforcement •- Manufactured / Modular Final Inspection
l )
Office No. (518) 761-8256 Arrive: am/pr}� Depart. ��c am/pm
Date Inspection request received: Inspector's Initials:
NAME: Z7(Yl(-1`._-;4--LC-�{ PERMIT#:-61-'62W-- S5
LOCATION: I(r.? [ 2-\ M \L((-.1. 't- DATE: //--Ad-I-)
Manufactured Home
Modular Home
Footings Foundation_ Backfill Framing
Comments:
Yes No ' N/A
Foundation support, pier s.a.ng, �, ^ ;.)
Per manufacturer /�J 1 �-
Anchoring per manufa.. rer 2' om ends `
Water line shut off
Sewer line support @/4 feet
Heating Crossover[ ublewide}o i grd.
l
Dryer vented outside
Skirting ventilated 1 sq.ft.per 1,500 sq.ft.
r
Hot water relief value piping outside 1.7-_____Th.....„.
Deck, porches, st ps, railing
Fumace/hot wate operating
Garage Fire proo ng
Fire Door/Door osers 1-7/\...i.
Plumbing Fixtur /3"Vent through r.if i odular]
Foundation insul tion[if applicable]
Smoke/Carbon Monoxide Detect.rs/In'.rconnected
Final Electrical
Variance requir•d
Data Plate oka
Manufactured UD seal oka
Warranty Sealfter Janua 1,2006
Installers Warr my Seal /
18"x 24"acce or 22" 30"attic access
Vapor retarder nder h me 6 mil poly or other
911 Street nu r
Okay to issue C r C/O[Temp./Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:1Pam Whiting120101Building Codes Forms\Manufactured Modular Final Inspection_03 04 10.doc
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MIT I'LOT P ail
'HAVE PERSONALLY MEASURED THE DISTANCE
FrA-11•' 02o �� / FROM THE
gle,ct
� Y /J�% . A �' �� OPERTY LINES TO THE�l i l� Applicant: {�X / ` /�' _ •p- „ ST" CA
Location: &,9 f'lirr 0,"5" Z UCTURE(S) OR SIGN(S)
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( Homestead Mobile Home Park —�
IGNATURE /Z
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