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Office Use Only —_ob2DEMOLITIONAPPLICATION|*em*®EENO—00751 2029 Permit Fee:$_\%5Oacer(se aemmunanl Invoices:22D 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net. Demolition Location:_/2/Tobf.ff a)Tax Map ID #:30.-/-37./ **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** TH | CONTACT INFORMATION: ©Applicant: Name(s):pelrey So Cnglee IMailingAddress,C/S/z:_lo""T¥thl Reed,Quseasbury,WY 12804 Cell Phone:(Si)939 ae land Line:(5/6 _)_79.9 -5172 Email:_ing lee pak @ hedmal.cor e Primary Owner(s): Name(s):az chove Mailing Address,C/S/Z: Cell Phone:_(___)land Line:(____). Email: O Check if all work will be performed by homeowner only *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):Prwe Loved Contractor Trade:Lhd Exctaves Mailing Address,C/S/Z:470 LJest Meinbaix kare)Qeeushure,UY l2 94 Cell Phone:_(S/%__)_26/-07/Land Line:_() Email:howard 35—20000 Ye heo Com. **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:‘tay Ln,lee kK Cell Phone:(S/S)222-1375 Land Line:(Sif _)292-5120 Email:iaglee }ak O Deke!Com . Demolition Application Revised February 2019, DEMOLITION INFORMATION: 1.Where will demolition material be disposed?Caxducto~Lew!do La dLe/ 2.Type of structure Re seman a.Residence b.Garage c.Business d.Storage Building ___3.What type of utilities are connected to the structure: a.Gas___ Fuel OilPropane___ Electric p< Public Water___ Well-Water Pump 7PublicSewer___Other i,None =4.Have ALL utilities been disconnected?Yes J No. yRameaos 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 NAMI SlaySegehenSIGNATURE:UM pare:(/5/@?yfui’: Demolition Application Revised February 2019