RC-000401-2015 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-000401-2015 Date Issued: Tuesday, July 26, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000401-2015
has been completed.
Tax Map Number: 288.16-1-11
Location: 77 NORTHWOOD DR
Owner: Joseph Geroski
Applicant: Joseph Geroski
This structure may be occupied as a: Residential Addition 192 s.f.
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the /Jproperty owner of the responsibility for compliance with Site Plan, 4k--
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
6— ow 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000401-2015
Tax Map No: 288.16-1-11
Permission is hereby granted to: Joseph Geroski
For property located at: 77 NORTHWOOD DR
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
Tyne of Construction
Owner Name: Joseph Geroski Single Family-Addition $18,000.00
Owner Address: 77 NORTHWOOD DR Total Value $18,000.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency p
*/2)( g, r�f0
Plans&Specifications
Residential Addition 192 s.f.
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,December 2,2016
(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 date)
Dated at the Town f Queen {/ // T s ecember 8,2015
SIGNED BY: (((...www.. __VVV /� for the Town of Queensbury.
Director of Building&Code Enforcement
r
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Received
Date: 43Z16-l6- Tax Map ID
Tax Map ID a2 96. 16 -/-/I DEC 0 3 Z e it Fee a -000 Ql' 2-o(5P rtFee 100 �hvnica l
Zone Rea Fee
Historic Site _Yes C No L Site Plan#
Subdivision Name Lot# Subdivision#
Project Location
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 Jd ..d, Owner Jtne
AddressQ./AG�eoc� (a Address
Phone/E-mail CsN -198 /aZ/ Phone/E-mail jm74Sk'Q_ roc,:l7runtitr,46M
Contact Person for Building&Codes Compliance: "TG2 Phone 749 - lam
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 1"floor sf 2'floor sf Total sf Height
Single Family e Z �5 Z 12-
Two-Family
ZTwo-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 3
Source of Heat(circle one) Gas Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances & Chimneys
Are there structures not shown on plot plan? All
Are there easements on the property? 14/1
Site Information
a. Dimensions or acreage of lot /5-0 y 7- 'A
b. Is this a corner lot? n
C. Will ade be changed as a result of construction _ Yes )0 No
d. tblic w or Private well
e. Sewer o nva Septic System
Value of all work to be performed(labor or materials) $__ZZLO". 6b
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: JcaSt i DATE: - 3 " I )7
SIGNATURE: DATE:
For office use on v
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
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheirn,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
O
Permit .... .............Cert. N2 29176 Cut-in Card No.....................................
. . .
Owner, 2.........
...... .... ............
Location......7...-1... ........�Fi
Installation Consisting
.........................................................................................
....................................................................................................................................................................................
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InstalledBy................g..Xe.t.L....................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:- 7
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making intions at any time, and if its
rules are violated,the Company shall have the right to rev k is CeT,! e.!f�j
Date......6:.�..�57Kk............ INSPECTOR.... ................61................................................ .......
Member N.F.P.A.,I.A.E.I.