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Office Use Only s)y-202DEMOLITIONAPPLICATION|Pemt#Dane—o1/¥-2o1e Permit Fee:$__S 0.OO Town of Queensbury - Invoice:#:DUS 4 742 Bay Road,Queensbury,NY 12804 MAR 16 2020 P:518-761-8256 www.queensbury.net Demolition Location:7X Aardoin St Tax Map ID #:_5 23400 709.10-2-$2Ghieensbury/JOY.1aso4 **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: ©Applicant: Name(s):Barbara Ucodar 4 Mailing Address,c/s/z:74 loimdsowg De.Cueershucy ,Wy,ja for Cell Phone:_(51%)A3A-LYL 2 Land Line:_() Email.Darhshasda.©hoFma].Com ¢Primary Owner(s): Name(s):Same RS PLOVE Mailing Address,C/S/Z: Cell Phone:_()land Line:_() Email: x Check if all work will be performed by homeowner only *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: **List all additional contractors on the back of this form Contact Person for Building &Code Compliance: Cell Phone:_()Land Line:_() Email: Demolition Application Revised February 2019 DEMOLITION INFORMATION: 1.Where will demolition material be disposed? 2.Type of structure to be demolished: a.Residence_W_ b.Garage c.Business d.Storage Building 3.What type of utilities are connected to the structure: a.GasFuelOil___ Propane ___Electric Public Water ___Well-Water Pump ____Public SewerOther i,None ~~ 4.Have ALL utilities been disconnected?Yes_No FR mpaos 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. 3.Workers’Comp insurance information is required to be submitted with this application. Declaration:|acknowledge that no structures)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: SIGNATURE:DATE: Demolition Application Revised February 2019