RC-000685-2017 Office Use Only
HOME INSPECTION Permit#: k- b65- ?9V'}
APPLICATION Permit Fee:$ )IDE) -
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linen ut[Zirarnsbur
Invoice:#: 264 1
742 Bay Road,Queensbury, NY 12804
P: 518-761-8256 www.gueensbury.net
INFORMATION:
• Applicant:
Name(s): C\ �c��H-,��°r»eNv �✓�s �dcr,��s,�Q ECJc, wC�YY�r,co,�.r,�
Mailing Address, C/S/Z:
Cell Phone: ( 1t ) 3'11 - b132— Land Line: 51 ) q-k&l - (oDo'71-
Email: oya
• Agent:
Name(s): Nb„\4 1ry1\1eylte. - LkSk
Mailing Address, C/S/Z:
Cell Phone: 5f 10 Land Line: 5) 0032
Email:
• Proposed Owner(s):
Name(s): 1/'OA o' ,
Mailing Address, C/S/
Cell Phone:_( Land Line: _( )
Email:
• Property Location:
Street Address: 52- �� n�hd Vacs
Tax ID:
Contact Person for Building & Code Compliance: E4a��-1-,alor7-��J
Cell Phone: _( ) Land Line: )
Email:
Home Inspection Application November 2017
From-W amen County EAG' SIR 761 9053 10/31/2017 09.22 U134 P_004
Municipal / Building Department Letterhead
Certification of Code Compliance
Home Buyer: Kaly and Rvan Carl Project No.: HOME 15-017
Project Location: 52 Mud Pond Road, Town of Queensbury, Warren County, NY
As the Building Inspector and/or Code Enforcement Officer on behalf of the Town of
Queensbury, I have reviewed the residential property located at the address above that
is proposed for private purchase with assistance from the City of Glens Falls Gateway
Home Buyer Initiative.
Date of Inspection / Review:
This executed Letter represents that the subject Property is in compliance with
applicable State of New York Building Code regulations as of the date of this Review
and in accordance with the following statements, below:
- The home contains no health and safety violations.
- The home is free of code violations.
- The home meets applicable State and local codes and/or ordinances, at the time
of this Inspection and in lieu of the proposed sale of the Property to a new owner.
Building Inspector: Date:
(Signature)
(Print Name)
#11A—Codes Compliance—December 2016