2013-398 TOWN OF QUEENSBURY
742 Ba•Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130398 Date Issued: Monday, September 09, 2013
This is to certify that work requested to be done as shown by Permit Number P20130398
has been completed.
Tax Map Number: 523400-308-010-0002-013-000-0000
Location: 547 LUZERNE Rd
Owner: GEORGE RANNEY
Applicant: GEORGE RANNEY
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 (LTDavP41
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.
ifiek TOWN OF QUEENSBURY
F742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130398 Application Number: A20130398
Tax Map No: 523400-308-010-0002-013-000-0000
Permission is hereby granted to: GEORGE RANNEY
For property located at: 547 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: GEORGE RANNEY Demolition
BEVERLY RANNEY Total Value
547 LUZERNE Rd
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
BILL CAMP
NY 12804-0000
Plans&Specifications
BP 2013- 398
Demolition of SFD (27 ft. by 37 ft).; replacement will be with new modular home 28 ft. by 44 ft.
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 23,2014
(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 To of Qu nsbu Fr t , y/: st 23,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes
AU 4 •Pfice Use Only
DEMOLITION PERMIT APPLICATION Received:
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.: /3~3 e
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lotoG�
boundaries with dimensions and adjacent roads/streets. Show all existing structures Permit Fee: , �'
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities.
Date /��J
Demolition Location v�� C/A/Z7 ' i'&
Tax Map IDi ' ' "
Applicant �'/r >`I i/ ��� Owner eM/ 41.01�—e4,,x-,1/
Address �� eCi' el Address L- T Z /�� /6
10ee 6/ l Z
/
Phone ,/ 71. _,71/ Phone, v7i,5_- 5-7,/
Contact Person for Building&Code Compliance: 4// �y� f Day Phone: /5---4::94_ 1/
1. Person Responsible for work: V/// (//_/17/
t"
2. Where will demolition material be disposed? //� ?4,
3. Asbestos Information: The Asbestos Removal Report must be filed with our offi9e before demolition begins.
a) Is there any asbestos within the building to be demolished _Yes /No
b) If Yes,our office need the following information:
• Name of firm removing the asbestos:
• License number of firm:
• Indicate where the asbestos material will be disposed:
4. Structure Information
a) Indicate the structure(s)to be demolisl3ed:Zesidence _garage _business _storage bldg. _Other
b) Size of structure: ;�7 x f 7.
c) Number of stories: / /
d) Foundation Type: full cellar crawl space t/ slab
e) Foundation: ✓ will be replaced will not be replaced
f) Structure(s): / will be replaced • will not be replaced
5. Utilities Information
a) Indicate utilities for this structure:/
✓ Gas ✓ Electric Propane
,/ Public Water On-Site Well Water Pump Public Sewer
b) Have you notified the Town Water Dept.for public w ter and sewer disconnect? _Yes /No
c) Have all utilities been disconnected? _Yes ✓ No
6. Signatures:
Print Name: ei/-, A, / ;
Signature: Date: CC/r ��
AlliTrr:
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
i1 / .-,3
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m art ,a) am/pm
742 Bay Rd., Queensbury,buNY 12804 Inspector's Initials:
NAME: r , CZ vl n : PERMIT NO.: l 3-3 qg
LOCATION: 5 A(7 L-. u 2 or (\e INSPECT ON: _. 9-- -</--/-3
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off v B LLQ ed cam,
Electric Disconnected /
Asbestos Removed / Documentation
Property Cleaned Up and Graded N/
Okay to Issue Certificate of Compliance
Demolition Inspection Report11 27 12
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PERMIT PLOT PLAN
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