RC-000638-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
` -- Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: RC-000638-2016 Date Issued: Thursday, July 6, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000638-2016
has been completed.
Tax Map Number: 309.10-2-50
Location: 8 RICHARDSON ST
Owner: Cynthia Warner
Applicant: Mike Schusteritsch
This structure may be occupied as a: Residential Alterations 286 s.f.
Replacing foundation to back of SFD only By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000638-2016
Tax Map No: 309.10-2-50
Permission is hereby granted to: Mike Schusteritsch
For property located at: 8 RICHARDSON ST
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Tvce of Construction
Owner Name: Cynthia Winner Single Family-Alteration $8,000.00
Owner Address: 150 Vosburgh RD Total Value $8,000.00
Mechanicville,NY 12118
Contractor or Builders Name/Address Electrical Inspection Agency
Mike Schusteritsch
24 LADY SLIPPER DR
Queensbury,NY 12804
Plans&Specifications
Residential Alterations 286 s.f.
Replacing foundation to back of SFD only
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,September 21,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Qu�e /) Wgdnes ey(S tember 21,2016
SIGNED BY: (\ G�Wf�l[// �VJ// for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION
Office Use Only
Received
Date: Tax Map ID
Permit No. C' �Q� - (b
Tax Map ID ���; (� '2" Permit Fee #�00, 1nwiu )056
Zone Rec Fee
Historic Site _Yes _ No Site Plan#
Subdivision Name Lot# Subdivision#
Project Location vo
TOWN BD. RESOLUTION 86-2013: $850 recreation fee for new dwelling units—single family,duplexes/two-family,
multiple family,apartments,condominiums,townhouses, and/or manufactured&modular homes, but not mobile
homes. This is in addition to the permit fee(s).
Applicant Owner
Address Address
ITL
Phone/E-mail Phone/E-mail
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
,,'Check all that apply New Addition Alteration In floor sf 2°d floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
If commercial or industrial pleasAtndicate of business
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
Proposed use of building or addition
Source of Heat (circle one) Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances & Chimneys
Are there structures not shown on plot plan? 4 J49
Are there easements on the property?
Site Information
a. Dimensions or acreage of lot 9 ki
b. Is this a corner lot?
c. Will the grade be changed as a result of construction _ Yes _ No
d. Public water or Private well
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $ rp;
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval.
3. I certify that the application,plans and supporting materials are a true and complete statement/description of
the work proposed,that all work will be performed in accordance with the NYS Building Codes,local building
laws and ordinances, and in conformance with local zoning regulations
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above: /J
PRINT NAME: �� 1 I J DATE: 6�xl (fk
SIGNA DATE: /
For office use only
Operating Permit Issued: _Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015