1999-460 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 9qa60
TAX MAP NO. 110. —6-3 WARREN COUNTY, NEW YORK
30 31
PERMISSION is hereby granted to ROMER, DEAN & PAMELA
OWNER of property located at 453 DIX AVE. Street,Road or Ave.
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in the Town of Oueensbury,To Construct or place a DEMOLITION OF SINGLE FAMILY DWELLING
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t. S.VERROffets' lD
QUEENSBURY, NY. 12804 _..
2. CONTRACTOR or BUILDERS Name
3. CONTRACTOR or BUILDERS Address
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4. ARCHITECT'S Name .
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) DEMOLITION.:
( )Wood Frame ( )Masonry ( I Steel I I
7. PLANS and Specifications
DEMOLITION .OF .SINGLE: FAMILY._.DWELLING,.AS P,ER APPLICATION
No.
8. Proposed Use
DEMOLITION OF SINGLE FAMILY DWELLING
20 September 1 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
1 September . 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY A?Pe • for the Town of Queensbury
_
Building and Zoning Inspector
TOWN OF QUEENSBURY
742 Bay Road .
Queensbury, N.Y. 12804-9725
Application for DEMOLITION PERMIT -
Permit No. If), '
Instructions for completing the application Date: 1 -
Fee Paid: p. 0
1. All applicable spaces are to be completed.
2. Two plot plans are to be submitted, drawn to scale, showing: RFCRV
a. lot boundaries, with dimensions and adjacent roads and streets. N�
b. all existing structures, indicating which are to be removed. JUL 2 7 1999
c. location of all utilities.
3. Fee submitted per current fee schedule. TOWN OF QUEE 4 BuRy
_ BUILDING
�AND CODE
Owner of property:l)i& F •* q,„„Ae. S. t�M�� Property Location: 7�3 M f ✓:,. 614 L .x)
Mailing Address: 19 K,yi.e _5 p;„,,,;? Tax Map No. Section)1 0 , Block (1p ,Lot 3
QUr&7 ` �I ( iOL
Person responsible for work: Telephone No.
Mailing Address:
Where will demolition material be disposed of? C -71)
Is there any asbestos within building to be demolished? Yes / No
If YES, name of firm removing asbestos from structure, license number, and where asbestos will be disposed of:
NAME OF FIRM LICENSE NUMBER
LOCATION WHERE ASBESTOS WILL BE DISPOSED
* A COPY OF ASBESTOS REMOVAL REPORT MUST BE FILED WITH THIS DEPARTMENT BEFORE DEMOLITION BEGINS.
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The following building(s) located on property described above are to be removed:
Previous use of building (circle one): residence garage storage business other
Have all utilities been disconnected? gas Niej , electricY.s , propane i1, water )c,
Size of building(s):
1. ft. by ft. Location on property
2. ft. by ft. Location on property
3. Number of stories:
4. Foundation type (circle one): full cellar crawl space) slab
Foundation will REMAIN BE REMOVED V/
5. Another structure WILL WILL NOT fireplace this building.
NOTES: ( .
Signature of Applicant: 9 c --- -
owner, owner's agent,architect, contractor
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