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DEMO-0576-2018 ,400W. 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-0576-2018 Date Issued: Monday, October 29, 2018 This is to certify that work requested to be done as shown by Permit Number DEMO-0576-2018 has been completed. Tax Map Number: 295.18-1-40 Location: 42 WILLOW RD Owner: Paula Doty, Rob Doty Applicant: Rob Doty This structure may be occupied as a: Filling in an in ground pool By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the (-1741040 4 4,t,„, 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. ,films, TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: DEMO-0576-2018 Tax Map No: 295.18-1-40 Permission is hereby granted to: Ellsworth& Son Excavating For property located at: 42 WILLOW 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: Paula Doty Demolition-Residential $0.00 Owner Address: 42 WILLOW RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Ellsworth&Son Excavating 76 ELLSWORTH LN Lake George,NY 12845 Plans&Specifications Filling in an in ground pool $ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, September 12,2019 (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 xpiration dat-.) Dated at the Town o ueens ; e• ,e• ,, eptember 12,2018 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only DEMOLITION ,_e. ...FPrit, AT __�, Permit#: f�P/M O 576 �ZD(( .„< ._ .� . ._ - _a _. f I i, 9Permit Fee:$ f` �. Torn of Qyccnsbury SEP 10 2018 g z' Invoice:#: 0 742 Bay Road, Queensbury, NY 12804 P: 518-761-8256 www.queensbury.net r°'! ,�i ._ Demolition Location: Lk Z W t\\b LA CAS\ Tax Map ID #: 2-11` 1-/4C- *AN . 1B .T • E '' ART ` RE D! ► IRE6 H ALL DEM • ITION APPL "ATI I . 1 SU : ''' S ON CONTACT INFORMATION: • Applicant: Name(s): A PQk.kr . "bo Mailing Address, C/S/Z: 4 L \i3rl\o 0 Q-A Duee.n5 kOLA rL M 1 \28 O4 Cell Phone: ( Sty ) 321 — l'p l' Land Line: ( St i3 )- —7L 1 --b-7 R-7 Email: cxaL.AG TkInbo, c©M • Primary Owner(s): Name(s): V-No‘n -k 2Ct 'c T\ c-kj Mailing Address, C/S/Z: ‘-kZ W\\Not.-3 Qtveen' bxr j -i 28c Cell Phone:_( 5 A% ) ?a 1— t.Q©t L( Land Line: _( St% ) i(c Email: �(�tnc» . C. • Contractor: Business Name: E1\Smo0t A cC*C a\I a'i - c Contact Name(s): ''(Z e. oc- t t Mailing Address, C/S/Z: '1 L, i t t,J or L a (1 T �c#, Lo-tc--2 Cz e e r Iy r23 Cell Phone: J. 5(3 ) cl Z 9 24 c Land Line: _( ) Email: ,AAccc .-Nc C (2..\lswbr fi c a U c' .�5 = c m Contact Person for Building & Code Compliance: (p 0 Cell Phone: _( il' ) C)1 Lk Land Line: _( ctcg ) Email: {` a 0,n C No- r,A.Ar‘ X. C V$rw\ Demolition Application Revised June 2017 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? (,-0 c\`'r C (Ni`(,) '` `5 bF 2. Type of structure to be demolished: a. Residence �� b. Garage " c. Business d. Storage Building 3. What type of utilities are connected to the structure: a. Gas b. Fuel Oil c. Propane d. Electric k/ e. Public Water f. Well-Water Pump g. Public Sewer h. Other i. None 4. Have ALL utilities been disconnected? Yes No ADDITIONAL INFORMATION: 1. Two inspections may be required: an inspection to determine that utilities are disconnected, if necessary, and a final inspection, after the structure is removed and the site is cleaned up and graded. 2. Twenty-four(24) hour notification is required for inspections. Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application has been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a permit has been issued. I have read and agree to the above: PRINT NAME: . c)o,v`� !J� � n SIGNATURE: DATE: -` -t S Demolition Application Revised June 2017 111---1-- i i I i : . • I I , ! i : I : : • , • . : 1 • • ,, 295.18-1-40 \ DEM0-0576-2018 1 i i 4- t- 1-• . r 1 ' T- 1 !Doty, Paula & Rob . , v 0 ,,J, , , ,..44146hilUew 9 . r k ligM.F.LuR ,i. :! i 42 Willow Rd _eased On o Oinked 0 • •--- na I's Demo (filling in in-ground pool) f.,„,„.‘"Anourceownerits_,.xan 1 Plian' ce : 1 i i • "wft4RVIV the elenS and - —..: -00 -- , wuea as • _, • . -1---- ‘ 1 , 1 -I --T- --: -t- ---t- • I- ; 4 with_the, are in_ __,___ 1.___,__ i - , • . ,—t - T ---1- ----r-------4------.;•-- ... i_ t . : : IL is • . •1 1 1 1 ' 77 , •, • i .1_ .I_ _4 , , ± '-' --...-- • 7 - ---1----- !---- ••;-i- • : ., . . , .. • i i . . 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