2013-366 TOWN OF QUEENSBURY
E^ � 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130366 Date Issued: Wednesday, December 03, 2014
This is to certify that work requested to be done is shown by Permit Number P20130366
has been completed.
Tax Map Number: 523400-308-011-0001-001-000-0000
Location: 81 VAN DUSEN Rd
Owner: PATRICIA ROBERTSON
Applicant: PATRICIA ROBERTSON
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 .�'
property owner of the responsibility for compliance with Site Plan, z}ql,
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
y 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
frs
777 Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130366 Application Number: A20130366
Tax Map No: 523400-308-011-0001-001-000-0000
Permission is hereby granted to: PATRICIA ROBERTSON
For property located at: 81 VAN DUSEN 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: PATRICIA ROBERTSON Demolition
ROY BLACKMER LE Total Value
16 ALLEN Rd
ARGYLE NY 12809-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans &Specifications
2013-366
DEMOLITION of shed 12'x 27'
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 09,2014
(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 T of een rf f /D- • •, ugust 09,2013
SIGNED BY , for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
17
DEMOLITION PERMIT APPLICATION Receiyed: r
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No::: ;' ' ` 13" 3 Ce I +
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot LI 'tj 0 7 201 `'. �J
boundaries with dimensions and adjacent roads 1 streets. Show all existing structures Permit Fele:
I ,
on the property and indicate which are to be demolished. Indicate on the plot plan the I -C -eY
location of all utilities.
Date ' - * In - 13 Demolition Location 8 1 t3 & use".Sen (aOk
Tax Map ID - 1 - (
• /
Applicant (e1i)1l�ii,, � r I let me ner
Address it 0 k ( (444 'fold Address
Prig le N' I ,;8cq
Phone 5)?-14nQi - n j Phone
Contact Person for Building&Code Compliance:(jQ 1^_ Day Phone:
1. Person Responsible for work: 'ltf.tKiPiIO`` 1'ln(�1-1-Sean
2. Where will demolition material be disposed? ti I rpt n-)
n l)G w
3. Asbestos Information: The Asbestos Removal Report must be filed with our office 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 demolished:_residence _garage _business _storage bldg. _Other
b) Size of structure: 1 ; x
c) Number of stories: I
d) Foundation Type: full cellar crawl space slab
e) Foundation: will be replaced will not be replaced
f) Structure(s): ?C 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 water and sewer disconnect? _Yes No
c) Have all utilities been disconnected? XYes No
6. Signatures:
Print Name: i7. lei Q. RObe r
Signature: GalAinallgaPiltaanDate: (3'(0 - (3
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection reque-.Abed:
Queensbury Building &Code Enforcement Arrive: \%3D a ler -+art: % /pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: //.��i*.
NAME: .7c1 !KID fr \te. O` PERMIT NO/ /3— 3La &
LOCATION: 1 D uSF 11 INSPECT Op..
VZ---
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off
Electric Disconnected
Asbestos Removed/ Documentation
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection Report 11 27 12
an of Queensbury Building &Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:
Name: f v LA
Inspected on: 1�-'�t-1-lt{
Location: &I V b u.S a,e Rd Arrive: tm 1 p.m.
Permit No.: 1 3 -3 le IP Inspector's Initials:
Comments and/or diagram
Y N N/A
Gas Shut-off
Water Shut-off
Electric Disconnected
Asbestos Removed /Documentation
Property Cleaned Up and Graded ✓ L
Okay to issue Certificate of Compliance y � S5 la�E !L�
UE Ct�thE� -S .
3 2_.t-}T\e
pl\oTbb 'MAV-E►J
Demolition Inspection_11 2012
a
Demolition Inspection Report
Office No. (518) 761-8256 Date Inspection r_equ ied:
Queensbury Building &Code Enforcement Arrive: 1=4Caa .irJaepart: Z-)D piS)
742 Bay Rd., Queensbury, rer-NY 12804 Inspector's Initials: / -
NAME: R (Abet-4-6011 PERMIT 9.: / 3 3 &ie
LOCATION: g 11)4!),1\ baSEr, rani INSPE •N: q-ec-1� c
Cd-p $M //y
Comments and/or diagram
Y N N/A
/ Al)✓ DEPR-Ab ENft1o•1
Gas Shut-off ✓/
Water Shut-off OF —Y-15-7VeJ6 � tJ j
�3C—
Electric Disconnected T I __E_N\-\z).1/4 'si)
Asbestos Removed/ Documentation
b�0 Cp o� �� �
� �E�
W
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance \-\\
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VAD—C165 \- e )2 B F F Al
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Demolition Inspection Report 11 27 12
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TOWN OF QUEE ,
BUILDING cr 1 -, Dr /T: h o v`3 c
Reviewed By: .11 I a,i
Date: Ar2 : T o ��
V
s
Vain Chi Se
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance 71
with our comments shati not be construed as
indicating the plans and specifications are in q 'I
full compliance with the Building Codes of
New York State. AUG 07 203 l JI
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