RC-000127-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000127-2016 Date Issued: Friday, January 20, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000127-2016
has been completed.
Tax Map Number: 301.13-2-57
Location: 4 WHISPERING PINES WAY
Owner: JAMES RAESLY
Applicant: JAMES RAESLY
This structure may be occupied as a: Residential Addition:
SFD 500 s.f By Order of Town Board
Deck 200 s.f. TOWN OF QUEENSBURY
Tyneswood Subdivision, Section 5
Issuance of this Certificate of Occupancy 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 QUEENSBUR.Y
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000127-2016
Tax Map No. 301.13-2-57
Permission is hereby granted to: JAMES RAESLY
For property located at: 4 WHISPERING PINES WAY
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 Name: JAMES RAESLY Single Family-Addition $30,000.00
Owner Address: 4 Whispering Pines Way Total Value 5+30,000.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical inspection Agency
Plans&Specifications
Residential Addition:
SFD 500 s.f. ---- ���
Deck 200 s.f.
Tyneswood Subdivision,Section 5
$140.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Saturday,March 11,2017
(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 Townuee ury; We sd h 16,2016
SIGNED BY: for the Town of Quccnsbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Received
Date: 3/jo /L Tax Map ID
Permit No. R� `�0.�4Z')-`�1�a
Tax Map ID .3®I. J3`2 ` 5� Permit Feefr(-
Zone U�k '�p4^-'�'� ` +r{ r deva Rec Fee
Historic Site Yes X No &0&,2 �h�. Site Plan#
�- � Subdivision#
Subdivision Name 1 Yni�6�✓OO t _ ,( e gLot#
Project Location q (,,, s��„�v, ,✓�y t-%44)Y
TOWN BD. RESOLUTION 86-2023: $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 I M F(Aa6 Owner e A.5 { ��
Address y wW p1w piN,`s WA-, Address
NY (2,601W
Phone/E-mail �,8s -8 Lwy Phone/E-mail
Sim W,5Le@ G,na+L_. ccs••,
Contact Person for Building&Codes Compliance: i I SS J� Phone ��3"8 q7
TYPE OF CONSTRUCTION
-./Check all that apply New Addition Alteration 1"floor sf 2nd floor sf Total sf Height
Single Family r
Two-Family
Multi-Family
(#of units
Townhouse
Business Office
Retail -Mercantile
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other I•k; )_00
1W -Zoo Sf �P1 �N�r1L5
If commercial or industrial please indicate of business
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
Proposed use of building or addition ',"4i PoAcu
Source of Heat(circle one) as Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances & Chimneys I,J1A
Are there structures not shown on plot plan? Mo
Are there easements on the property? NO
Site Information
a. Dimensions or acreage of lot O.48 Ac_�tC5
b. Is this a corner lot? No
c. Will the grade be changed as a result of construction Yes _K_ No
d. Public water or Private well Poac C_
e. Sewer or Private Septic System (2fVATC
Value of all work to be performed (labor or materials) $ 30,ow
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. 1 certify that the application,plans and supporting materials are a true and complete statement 1 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. 1 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: /1 E5 f 7 DATE: /o /
SIGNATU DATE: 3f/6,/b
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