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applicationOffice Use Only Permit #;__R2Mo-0 62*(~20eO Permit Fee:$__LSC.6Q Invoices:27 Demolition Location:227/35"cendt&24 Tax Map ID#:__227,73 -2-287 **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: ©Applicant: Name(s):__Austy Squndlecs Mailing Address,C/S/Z:_/¢¢Keynolds Rd Ft.Eden 4,wW¥12529 Cell Phone:_(s'F )365-3735 Land Line:_() Email:rrsavn ders Q Verizon.ne F ©Primary Owner(s): Name(s):24 Savaders Orger ties Develeprnt £66 Mailing Address,C/S/2:4246 (@puo/Ld Ft kilo d WY (252 Cell Phone:_(_$75_)36s~3735-Land Line:_() Email:“gerber reitorae I O Check if all work will be performed by homeowner only ©Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):_MS.masonry Fi © Contractor Trade:7Za.s00-ae Mailing Address,C/S/Z:_/2£> dL.ch fewer k VC (2825 Cell Phone:_(__94")_36s*.373:Land Line:_() Email:__/rsaunde gO, vers 2ar.ast **List all additional contractors on the back of this form Contact Person for Building &Code Compliance: Cell Phone:_()Land Li Email: Demolition Application Revised February 2019 *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):theodore.paronstachnoy Contractor Trade:Asbes to Mailing Address,C/S/z:_44 Toh §+-Aibany,MY [2902 Cell Phone:(41 }_)+1 9-22.4 land Line:(S1®)280-$489 Email:theodore @ Aetorcorp.ony ©Contractor:Workers’Comp documentation must be submitted with this application Contact Name( Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: ¢Contractor:Workers’Comp documentation must be submitted with this application Contact Name(: Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Demolition Application Revised February 2019, DEMOLITION INFORMATION: 1.Where will demolition material be disposed?_Wton_/AY,AY 2.Type of structure to be demolished: a.Residence_+~ b.Garage i~c.Business d.Storage Building 3.What type of utilities are connected to the structure:Gas_Fuel Oil___PropaneElectric Public Water Well-Water Pump ___Public Sewer___ Other i.None___ 4.Have ALL utilities been disconnected?Yes_X No yRmeaoge 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. 3.Workers’Comp insurance information is required to be submitted with this application. :|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. |have read and agree to the above: PRINT NAME:Aus ionckrs SIGNATURE:bos a DATE: Demolition Application Revised February 2019