CC-000277-2015 TOWN OF QUEENSBURY
QL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CC-000277-2015 Date Issued: Tuesday, December 8, 2015
This is to certify that work requested to be done as shown by Permit Number CC-000277-2015
has been completed.
Tax Map Number: 296.19-1-32
Location: 375 BAY RD
Owner: 375 Bay Rd.,LLC
Applicant: Jersen Construction Group
This structure may be occupied as a:Parson's Child and Family
Comm. Int.Alt. By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the n
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.
Admikk TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CC-000277-2015
Tax Map No: 296.19-1-32
Permission is hereby granted to: Jersen Construction Group
For property located at: 375 BAY 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
Tvce of Construction
Owner Address: 6 Industry DR Business Office-Alteration $0.00
Waterford,NY 12188 Total Value $0.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Jersen Construction Group
6 Industry DR
Waterford,NY 12188
Plans&Specifications
Parson's Child and Family
Comm.Int.Alt.
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 5,2016
(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 inuli/pn dat )
Dated at the Town f Queen /1 Fr' vember 6,2015
SIGNED BY: V for the Town of Queensbury.
Director of Building&Code Enforcement
Sw4e a03 -
--------------------------______________----------------------------
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OFFICE USE ONLY -TAX MAP NO. /�o,I'T^I^,!,- PERMITNO.
,
FEES: PER#T� RECREATION ENGINEERING
(If applicable) ; N�U � b ���5
________________________________________________________________ _ _.__.---_-__-___
PRINCIPAL STRUCTURE: APPLICATION FOR ZONING APELOYA4 & BUILDING
PERMIT
A PERMIT MUST BE OBTAINED.BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW . _
BEFORE ISSUANCE OF A VALID PERMIT FOR CON �CONSTRUCTION.
APPLICANT/BUILDER: Imo,S/r7WCt70tiJ690c OWNER: 315 )sf e Za ,�L C_
ADDRESS: C 1AIZ)OSIMf 4. 4^/Arer4l�" ,Lr1,?QADDRESS:
PHONENOSfr/ PHONE NOS. 'O�ory
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE.ANJ.ELA �C^FF( PHONE �/� Z-�0' •D6o=+
LOCATION OF PROPERTY: 37 ' { �� shy -tat
r
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? ❑YES ❑ NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT p p
APPLY TO YOUR z i= � O � m W w
PROJECT qa O O0 w a = _
W u. ¢ (9 U
W 0 ti pLO z d HF- O O: W Z
Z Q Q U) N rn O U_ 2 of
SINGLE FAMILY
CC-000277-2015
TWO-FAMILY Parsons Child and Family
Jersen Construction Group - Angela Ciotti
MULTI-FAMILY 375 Bay Road, Suite 203
(NO.of UNITS_) Comm'I Alteration- relocating 2 doors
TOWNHOUSE
BUSINESS OFFICE k - ✓�/"^
RETAIL- -
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
OTHER
Town of Queensbury Community Development Office*742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
IF COMMERCIAL OR INDUSTRIAL—NAME OF BUSINESS. 'f64,1Vel3 _
ESTIMATED CONSTRUCTION COST..� OOO. FUEL TYPE:
HEAT TYPE:. *HOW MANY FIREPLACE(S): , A AND/OR WOODSTOVES(S):
ZONING CATEGORY: A/ A ARE THERE WETLANDS ON THIS SITE? X A
IS THIS A HISTORIC SITE? Nit
PROPOSED USE OF BUILDING OR ADDITION:
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? /V/
ARE THERE EASEMENTS ON PROPERTY? Al A
'Please complete a separate Application for'Fuel Burning Appliances&Chimneys"available in our office
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. 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 NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that 11we 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
etto the above. _
Signed
Director of Buildinq &Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Dec. 17. 20159-2:96 MDIA No. 9348 P. 4/8
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
�that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owner: parsons Childs Family Date: 11/17/2015
Occupant: :i
Locaton
Comm 375 Bay RD
Occupancy: Queensbury,Warren Co. NY
Jon-Residential
Applicant
Crannell Elect, Design &Const
PO Box 4074
Queensbury, NY 12804
L J
No. Joseph A-Holmes
141554196945LL,
Equipment:
-Switches; Relocated 2 Switches
This certificate applies to the electrical wiring to the electrical equipment listed Immediately null and void. This cenftale applies only to NB use.occupancy and
above and the installation inspected as of the above noted dale based on a visual ownership as indicated herein. Upon a change In Meuse,q=pancy or ownership
inspection. No warranty Is expressed or implied as to the mechanical safety.effi- of the property indicated above,this eortiricate shall be immediately null and void.
cfenby or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes Invalid based upon the above condidws,
of valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspectian by Middle oepartment
system to which this certificate applies be altered In any way.including but not limit- 'Inspection Agency.Inc. An application for Inspection must be submitted to Middle
ed to,the introduction of additional electrical equipment and/or the replacement Of Depaflmenl Inapeoilon Agency, Inc.IO initial0 the inspeCflOn and revalidation
any of the components installed ae of Inc eDove noted date,to o ceNOcate shall be Drgcese. A fee will be Charged for lhii ielvioe.
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