DEMO-000380-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: DEMO-000380-2017 Date Issued: Wednesday, September 27, 2017
This is to certify that work requested to be done as shown by Permit Number DEMO-000380-2017
has been completed.
Tax Map Number: 295.10-1-31.2
Location: 1088 WEST MOUNTAIN RD
Owner: DAVID LEHMANN
Applicant: Whitney Russell
This structure may be occupied as a: Demolition Only
Barn 28'x 33' By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the �,J
property owner of the responsibility for compliance with Site Plan,
v
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 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: DEMO-000380-2017
Tax Map No: 295.10-1-31.2
Permission is hereby granted to: Storied Boards,LLC
For property located at: 1088 WEST MOUNTAIN 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
Owner Name: DAVID LEHMANN Demolition-Residential $0.00
Owner Address: 1088 W Mountain RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Storied Boards,LLC
30 Big Hollow RD
Lake George,NY 12845
Plans&Specifications
Demolition Only
Bam 28'x 33'
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 29,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of ueensbu ( / �hurs a 017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use A�—��OOnllye�,,-�
DEMOLITION APPLICATION Permit#: — � 'ZOI
Permit Fee:$ 2" p W
Town ofC�eens ury 1�Q Z
Invoice:#: CJ�.�
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.oueensbury.net
Demolition Location: /O S $ tits Tax Map ID#: 02 95.-Io ^ .31• .Z
**ASBESTOS REPORT IS REQUIRED FOR STRUCTURES BUILT PRIOR TO 1974**
CONTACT INFORMATION:
• Applicant:
Name(s): Svtn r rI e2 ,Qdctv.LS �- L
Mailing Address, C/S/Z: 3n act Lalze GcD!tt 4't1'-2-w5
Cell Phone: ( 5/13 ) 530- 726V Land Line: ( S/S ) oZYB - +io25Qi 7
Email: ti.4-me-y 0 Sl-a✓jeeQbocwolS • Cn/yi
a
• Primary Owner(s):
Name(s): 'DGJI'd -3-- 1-e4 0,atan
Mailing Address, C/S/Z: /o �t!a &Ae
Cell Phone:_( ) Land Line: _( S/ft
Email:
• Contractor:
p E C E a V E
Business Name: cr CL G
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_�) Land Line:
Email:
Contact Person for Building & Code Compliance: ,e VS ' 4z
Cell Phone: _( S/R ) S3R - 7707 Land Line: _( Ste) b36 - 3og'3
Email: ��"W'y Q Ai-o reed b-oRralS , rz>
Demolition Application Revised May2017
DEMOLITION INFORMATION: n
1. Where will demolition material be disposed? ) /� �t4-/S jd;j1 10,e
2. Type of structure to be demolished:
aPn o28 k -33
a. Residence
b. Garage_
c. Business_
d. Storage Building
ADDITIONAL INFORMATION:
1. Two inspections are required. A rough-in inspection, prior to installation and a final inspection,after
installation.
2. Manufacturers installation manual must be available at the time of inspection.
3. Masonry fireplaces&chimneys require plans to be submitted.
4. Twenty-four(24) hour notification is required for inspections.
Declaration:Construction/installation must conform to NYS Fire Prevention&Building Code and/or manufacturer
requirements. The applicant or owner agrees to comply with all applicable laws,ordinances, regulations and all
conditions that are part of these requirements and also will allow the inspector to enter the premises to perform the
required inspections.
I have read and agree to the above:
PRINT NAME: yl.Gt� f�1 eco ✓SST
SIGNATURE DATE: G azo /7
Demolition Application Revised May2017
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TOWN OF QUEENSBURY
BUILDING DEPARTMENT FILE COP
Based on ourlimited examination,compliance Y
with our comments shall not be construed as
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