BOTH-000630-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000630-2016 Date Issued: Tuesday, September 20, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000630-2016
has been completed.
Tax Map Number: 290.5-1-21
Location: 11 WAGON TRL
Owner: JOSEPH ORLOW
Applicant: JOSEPH ORLOW
This structure may be occupied as a: Demolition only(partial interior demo)
Not as a result of a fire By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the n /�
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 Building & Codes Office Use Only
Received
DEMOLITION PERMIT APPLICATION Permit#: Pte}} - '�__2C
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee `� ��rLgjcp.jL __
Provide 2 plot plans drawn to scale,showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and Indicate which are to be demolished. Indicate the location of all utilities
Date _ Stpre"C'l 19, 7-016 Demolition Location "//- U vziw f
�Gi
Tax Map ID �� l v0_� I _2 __
APPLICANT - JOS PH_ UaIWVJ --------- OWNER _J_a_sapir QA,or/ 4AC_NAd-L /(LWIQ
Address _� S(rN_ rftEAddress _
_ auT G 6�c7�a 4q_F�LGC�NY (LK�3 Zug Gt Ars_F�uC�N` Y28a3
Phone _S��--��� 1L5- ------- 2 Phone -3�Z�---------
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: W_I> ICY JGf49u G �Q _____ Phone:
I. Person Responsible for Work lkcSCL(, 7�0"S
2. Where will demolition material be disposed? rDC�S �� TR ) er STS ltd �i gv2y N
3. All buildings to be demolished require an Asbestos Survey
4. Any building substantially damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
5. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begin
6) Is there any asbestos in the building to be demolished ___ Yes -JK__ No
b) If Yes, our office needs the following information ___- Yes No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished _X Residence _-_ Garage _ _ Business
CPA1'r K pemp) Storage Bldg. ___ Other
b) Size of Structure 2-q X 2 51
c) Number of Stories I STaa.y
d) Foundation Type (Z AtsFD FO q r(PA11 J P1612- O. D a4wi
e) Foundation GaNU-ErC �6diiN6S .vcbp CImS.
f) Structure(s) SW 6 r.a Fgnt.r L I R-esr P eNu-
7. Utilities Information
a) Indicate utilities for this structure___ GasX Electric --- Propane --_ Public Water ___ Public Sewer
-26- on-site well water pump (TD GO- rALLcp
a) Have you notified the Town Water Department for public water and sewer disconnect? _--- Yes 2S__ No
b) Have all utilities been disconnected? ____ Yes _X_ No
8. Signature
Print Name: ------ ----- ----------------------- Date
----------
Signature: J oSt Pt1 OR g _W. rgKtfJtJ___/idLE tom. Date - -0 (t y/Pc
Town of Queensbury Building& Codes • Demolition Permit - December 2014
TOWN OF QUEENSBURY
BUILDING & S PT. FILE COPY 290.5-1-21 BOTH-000630-2016
Reviewed By: Orlow, Joseph
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