2013-417 olta, TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
i
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130417 Date Issued: Wednesday, December 10, 2014
This is to certify that work requested to be done as shown by Permit Number P20130417
has been completed.
Tax Map Number: 523400-303-020-0001-003-002-0000
Location: 364 DIX Ave
Owner: CLARK BRINK
Applicant: MCDONALD'S USA, LLC
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,
Variance, or other issues and conditions as a result of approvals by the ��
Director of Building&Code tnforc dicot
Planning Board or Zoning Board of Appeals.
064 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY.12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130417 Application Number: A20130417
Tax Map No: 523400-303-020-0001-003-002-0000
Permission is hereby granted to: MCDONALD'S USA. LLC
For property located at: 364 DIX Ave
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: CLARK BRINK Demolition
MC DONALD'S CORP. Total Value
50 SEWARD St
SARATOGA SPRINGS,NY 12866-0
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-417
DEMO portion of existing restaurant
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 04,2014
(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 Tow of Q nsb F i a / • :ber 04, 2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received:
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit NeeDIT [ I iJ
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot eft?
boundaries with dimensions and adjacent roads/streets. Show all existing structures Permit Fee: ,3v
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities.
Date 8/30/2013 Demolition Location 364 Dix Avenue
Tax Map ID 303.20-1-3.2
Applicant McDonald's USA, LLC Owner McDonald's USA, LLC
Address 690 Canton Street Address 690 Canton Street
Westwood, MA 02090 Westwood, MA 02090
Phone (781)461-4750 Phone (781)461-4750
Contact Person for Building&Code Compliance: Bohler Engineering Day Phone: (518)438-9900
1. Person Responsible for work: Francis Essien
2. Where will demolition material be disposed? Into a dumpster and taken off site
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*TBD
b) If Yes,our office need the following information:
• Name of firm removing the asbestos: TBD
• License number of firm: TBD
• Indicate where the asbestos material will be disposed: TBD
4. Structure Information
a) Indicate the structure(s)to be demolished:_residence _garage /business _storage bldg. _Other
b) Size of structure: 101÷/- x 33+/-
c) Number of stories: 1
d) Foundation Type: full cellar crawl space 1 slab Addition/renovation
e) Foundation: will be replaced 1/ will not be replaced Addition/renovation
f) Structure(s): will be replaced will not be replaced Addition/renovation
5. Utilities Information
a) Indicate utilities for this structure:
IGas Electric Propane
I 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? Yes J No
6. Signatures:
Print Name: Owen Sppeulstra, Bohler Engineering, as agent
Signature: Date: 8/30/13
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
Town Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received:
Name: 'I'\ pp nod S. Inspected on: --
Location: SCo N (-7. Arrive: / m.
Permit No.: / 3 -y1 ? Inspector's Initials:
Comments and/or siagram
Y N N/A
Gas Shut-off
Water Shut-off
Electric Disconnected
Asbestos Removed 1 Documentation
Property Cleaned Up and Graded
Okay to Issue Certificate of Compliance
Demolition Inspection_11 2012
Town of Queensbury (r7( 1,-;4,-4- •
742 Bay Road m
�
Queensbury, NY 12804
(518) 761-8232 Town of QyccnsI)ury
_ Permit Applicant _ Property Owner II
MCDONALD'S USA, LLC CLARK BRINK
NY 12804-0000 MC DONALD'S CORP.
50 SEWARD St
SARATOGA SPRINGS, NY 12866-0000
Tax Map#: 303.20-1-3.2 II
The permit listed below expired on : 10/04/2014
Application#: Permit#: Permit Type: Last Inspection Date:
A20130417 P20130417 Demolition 10/04/2013
Please contact the Town of Queensbury Building and Codes Office at 761-8256, to renew your permit.
Also, please contact us to update any inspections that may be required as part of this permit.
If the project is complete, please call for a final inspection so we may close out the permit, otherwise
there is a $50.00 permit renewal fee. This can be mailed to the Town of Queensbury in the form of a
check or money order payable to the Town of Queensbury.
Sincerely,
Town of Queensbury Building and Codes Department
"Home of Natural Beauty... A Good Place to Live"