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RC-000237-2015 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-000237-2015 Date Issued: Tuesday, January 31, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000237-2015
has been completed.
Tax Map Number: 301.17-2-8
Location: 19 CHEROKEE LN
Owner: Thomas LaPier
Applicant: Thomas LaPier
This structure may be occupied as a:576 sq. ft.attached garage&60 sq.ft.
breezeway By Order of Town Board
AV No. 56-2015 approved by ZBA on 10/28/15. TOWN OF QUEEN/S�BURAY
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 QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000237-2015
Tax Map No: 301.17-2-8
Permission is hereby granted to: Thomas LaPier
For property located at: 19 CHEROKEE LN
in the Town of Queensbury,to constructor place at the above location in accordance with application t�[!e eE V I S E D
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 Address: 19 Cherokee LN Attached Garage-New $15,000.00
Queensbury,NY 12804 Total Value $15,000.00
Contractor or Builders Name/Address Electrical Inspection Agency
Thomas LaPier
19 Cherokee LN
Queensbury,NY 12804
Plans&Specifications
576 sq.ft.attached garage&60 sq.ft.breezeway
PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,October 30,2016
(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 expiraJ
tion date.)
Dated at the Town of Qup is T rsda , of ,2015
SIGNED BY: f\ /a/ for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APP TJ
,fir ;j ice Use OnON
l
eived
Date: G 9 2015 Map ID 30/./7- 2-
le it No. Rr-000a3 d_o i5
Tax Map ID - Pe it Fee /Z '2Aje,
Zone TOWN OF QUEENSBUR R Fee ;�/oo
v
BUILDING&CODES
Historic Site Yes No 1 e Plan#
SubdivisimrNb2&e 010/
Subdivision Name �es W 6e d— i�ka g 3 Lot# � �D a
Project Location I ', 61x r kee, 4&Ae1
TOWN BD. RESOLUTION 86-2013: $850 recreation fee for new dwelling units—single family,duplexes/two-family,
multiple family,apartments,condominiums,townhouses,and/or manufactured &modular homes, but not mobile
homes. This is in addition to the permit fee(s).
Applicant 7/lvAlaS G �2 Owner TliactRS G�b2
Address X7ero / _ _-e Address
-tifv,S cie
Phone/E-mail S8� 32 Phone/E-mail
Contact Person for Building&Codes Compliance: LA T1 E/L Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 1"floor sf 21 floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units
Townhouse
Business Office
Retail -Mercantile RC-000237-2015
Thomas LaPier
Factory-Industrial 19 Cherokee Lane
576 sq. ff. att. garage and breezeway 60 sq. ff.
Attached Garage /
(1, 2' 3, 4+) �6
Other
If commercial o industrial please indicate of business
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
Cmfd4-'�'P__ �j I'feZe un47"
Proposed use of building or addition r&re- v e kt Je_i0,0�C�
Source of Heat(circle one) Gas Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances & Chimneys 1 /4
Are there structures not shown on plot plan? �p
Are there easements on the property? ^t
Site Information
a. Dimensions or acreage of lot
b. Is this a comer lot? lies
c. Will the grade be changed as a result of construction _ Yes No
d. Public water or Private well h/�
y
e. Sewer or Private Septic System N
Value of all work to be performed(labor or materials) is ,$O o 0
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: /
PRINT NAME: 7�/y1�S rZ 4-t'/E2- DATE:
SIGNATURE: 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