applicationrem D-H |
Fee Paid_JO.W)Application for Tenet tPermit
Building &Codes Office ~Town of Queensbury 742 Bay Road Queensbury,NY 12804 F 1CDemaJUL012005PO0,°°Notes:
ions /Requirements for a IN OF QUEENSBURY
Fill in all applicable spaces and submiggvt)Q))}ot scale,showing lot boundaries with dimensions and adjacent roads/streets.
Show all existing structures on the property and indicate which are to be demolished.Indicate on the plot plan the location of all utilities.
Signature of Applicant
sAppiieant TTS]OwnersSESE |Person Responsible is
Rarchacd Selkiod [Richard Selica [Precision Const.“Pete,Shuck
WS Newport Se WS Newport de @B Conner Dewe
DA Neove\,SY _oasn|Nonoct,Wy toast IS.Glens Fas,NY 12803
|BAS CAN -3899 BAS -624-3899 96-1S\\
IS4S"2ug-Bv Bus -34-31
Location of demolition:\SSB_aKe “PacKusof 3,
Y
Where will demolition material be disposed of?Noe Gountey Cod
Asbestos Information
‘A copy of Asbestos Removal Report must be filed with our office before demolition begins.
a,Is there any asbestos within the building to be demolished?[Yes who
If YES,our office needs the following information:
b.Name of firm removing asbestos:_os
¢.License number of firm:_aed.Indicate location where asbestos material will be disposed ekeeStructureInformation
a.Indicate which eu will be demolished:
Diresidence;(garage;[storage building;(business;(Jother __.b,—Sizeofstructure:QO ftby AY ft
c.Number of stories_]
4.Foundation type:Ciilcettar;[eraw!space;[asfab
e Foundation:ili be removed;—_[_Jwill not be removed
f,
—
Structure(s):[illbe replaced Chwill nat be replaced
Utilities Information
Indicate utilities for this structure:
Cgas (electric (propane —_[Jonsite well-water pump.
Cpublic water [public sewer
Have you notified the Town Water Dept.
far
public water and public sewer disonnect?[]Yes tute
Have all utilities been disconngoted?(Yes
Date:6-40 -dS