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RC-000387-2015 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 i Community Development-Building&Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-000387-2015 Date Issued: Wednesday, March 22, 2017 This is to certify that work requested to be done as shown by Permit Number RC-000387-2015 has been completed. Tax Map Number: 289.10-1-1 Location: 371 GLEN LAKE RD Owner: Bill Benson Applicant: Mike Schusteritsch This structure may be occupied as a:Rafter upgrades for new roofing By Order of'fow Board TOWN OF QUEENSBURY 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-000387-2015 $P 20 15 Tax Map No: 289.10-1-1 REVISED Permission is hereby granted to: Mike Schusteritsch For property located at: 371 GLEN LAKE 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 Name: Bill Benson Single Family-Alteration $4,000.00 Owner Address: 3 Orient RD Total Value $4,000.00 Brookhaven,NY 11719 Contractor or Builder's Name/Address Electrical Inspection Agency Mike Schusteritsch 24 LADY SLIPPER DR Queensbury,NY 12804 Plans&Specifications Rafter upgrades for new roofing $60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,December 3,2016 (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 date.) Dated at the Town of Que ury; edn y, e r 9,2015 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement PRINCIPAL STRUCTURE APPLICATION Office Use Onlv Received Date: / 07 / Tax Map ID ' (TJ - TaxMapID 2 �o ��� �^ 1 2 75 Permit No. '0003®'}- to 15 " Permit Fee O iyjv . IAS Zone Rec Fee Historic Site _Yes VNo Site Plan# Subdivision Name Lot# Subdivision# Project Location 2z 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 Owner AddressAddress Phone/E-mail / 3 ©zz Phone/E-mail 3 �— Contact Person for Building&Codes Compliance: J Phone Z[ TYPE OF CONSTRUCTION ✓Check all that apply New Addition Alteration 1"floor sf 211 floor sf Total sf Height Single Family Two-Family Multi-Family (#of units_) Townhouse Business Office Retail-Mercantile Factory-Industrial Attached Garage (1, 2, 3, 4+) Other 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 Source of Heat(circle one) Gas Oil ro Solar Other Fireplace: Complete a separate application for Fuel Burning Appliances& Chimneys Are there structures not shown on plot plan? p Are there easements on the property? Site Information _ a. Dimensions or acreage of lot b. Is this a corner lot? 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 Value of all work to be performed(labor or materials) $ DECLARATION.- 1. ECLARATION.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: 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