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