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RC-000288-2015 ' TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804.5904 (518)761-8201 Community Development-Building& Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-000288-2015 Date Issued: Wednesday, May 4,2016 This is to certify that work requested to be done as shown by Permit Number RC-000288-2015 has been completed. Tax Map Number: 297.13-1-5 Location: 200 MEADOWBROOK RD Owner: ROBERT KELLY Applicant: ROBERT KELLY This structure may be occupied as a: Bathroom alteration By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the JW 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 at Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: RC-000288-2015 bQ 2015?� Tax Map No: 297.13-1-5 ^ �71, /��C D Permission is hereby granted to: ROBERT KELLY K �Y/ L For property located at: 200 MEADOWBROOK RD 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 Type of Construction Owner Address: 200 Meadowbrook RD Single Family-Alteration $1,865.00 Queensbury,NY 12804 Total Value $1,865.00 Contractor or Builder's Name/Address Electrical Inspection Agency ROBERT KELLY 200 Meadowbrook RD Queensbury,NY 12804 Plans&Specifications Bathroom alteration PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 4,2016 (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 m xpirationWeDated at the To of Quee ury; f/ 10,2015 SIGNED BY: (/ for the Town of Queensbury. Director of Building&Code Enforcement TOWN OF QUEENSBURY ela to 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150342 Application Number: A20150342 Tax Map No: 523400-297-013-0001-005-000-0000 Permission is hereby granted to: ROBERT W KELLY For property located at: 200 MEADOWBROOK Rd 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. Type of Construction Value Owner Address: ROBERT W KELLY 200 MEADOWBROOK Rd Residential Alteration $1,865.00 QUEENSBURY NY 12804-0000 Total Value $1,865.00 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications BP 2015-342 Residential Interior Alterations to second floor; renovate the second floor 1/2 bathroom to add a shower/tub combo. Moving a wall on second floor. $75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 10,2016 (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 d te./ Dated at the Twn of ee u4 L„\ay,August 10,2015 SIGNED BY /// for the Town of Queensbury. Director of Building&Code Enforcement • PRINCIPAL STRUCTURE APPLICATION Office Use Only Received Date: JUL�' 3 t 1 S I Tax Map ID ..Lir?, 13—i —g C �— ���5 Permit No. 20 — , (2.— Tax Tax Map ID D 77, 1 Permit Fee � ll Zone OWN OF QUEENS&_ Rec Fee BUILDING& COD Historic Site Yes x No Site Plan# Subdivision Name Lot# NO- Subdivision# TOWN BD. RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS - SINGLE FAMILY, DUPLEXES/TWO-FAMILY, MULTIPLE FAMILY, APARTMENTS, CONDOMINIMUMS, TOWNHOUSES,AND/OR MANUFACTURED&MODULAR HOMES,BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE. Applicant Owner the_ Address Address 2c t Me<<&a:o bre.oksl y delle 12 o-I Phone/E-mail ` Phone/E-mail Contact Person for Building&Codes Compliance: Phone TYPE OF CONSTRUCTION ✓Check all that apply New Addition Alteration 1"floor sf 2"d floor sf Total sf Height Single Family c'iGC7f � 'b�+�raor•. � Two-Family Multi-Family 1 � 1, (#of units ) �3 G 0 Townhouse k Business Office Retail -Mercantile Factory-Industrial Attached Garage (1, 2, 3, 4+) Bob Kelly BP 2015-342 200 Meadowbrook Road Residential Interior Alterations to 2nd floor- bathroom Other Town of Queensbury Building&Codes Principal Structure Application Revised September 2014 • If commercial or industrial please indicate of business x.1/14 Proposed use of building or addition she /T b o4 4:-.1 4o e- * } ».thrrx,�. Source of Heat(circle one) Gas Oil Propane Solar Other Fireplace: Complete a separate application for Fuel Burning Appliances & Chimneys �1'q Are there structures not shown on plot plan? No Are there easements on the property? N o Site Information a. Dimensions or acreage of lot 2 S b. Is this a corner lot? nio 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 �� t l:c .5 Q.. - r Value of all work to be performed (labor or materials) $ i,S(01- DECLARATION: 0SDECLARATION: 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: PRINT NAME: gobQ( K`Z '� DATE: 73‘•-‘ SIGNATURE: DATE: -7"3i-1s 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 2014