RC-000445-2015 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-000445-2015 Date Issued: Tuesday, January 31, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000445-2015
has been completed.
Tax Map Number: 315.6-2-27
Location: 27 MOCKINGBIRD LN
Owner: Amanda Demeter,Daniel Demeter
Applicant: Amanda Demeter
This structure may be occupied as a:garage addition 336 sq. ft.onto existing
attached garage By Order of Town Board
TOWN OF QUEENSSBUR%Y
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, GGGWWWi�" V
Variance,or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcmnent
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-000445-2015
Tax Map No: 315.6-2-27
Permission is hereby granted to: Daniel Demeter
For property located at: 27 MOCKINGBIRD LN
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: Amanda Demeter Attached Garage-Addition $10,000.00
Owner Address: 27 MOCKINGBIRD LN Total Value $10,000.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
garage addition 336 sq.ft.onto existing attached garage
$50.40 PERMIT FEE PAID-TIES PERMIT EXPIRES: Sunday,January 8,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury befojtheexiration date.
Dated at the Town ueens ryTh ovary 14,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Onty
Received
Date: la/36la:15 TaxMapID 31S.�-a a7
Permit C -
Tax Map ID — J—a-2-7 Permit Fee ¢ D00 ✓� /g�
Zone .lam P6L;t 41 d1
Historic Site _Yes _ No Site Plan#
Subdivision Name Lot# Subdivision# iq--Iggo
Project Location �7/�� nab,�L J int✓
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).
DEC 3 0 2015
Applicant (EL 0 EVALr94e- Owner
Address .L mo�o be)(eA WJ1 Address
V�� ivc4-
Phone/E-mail 2 _4119 1
Phone/E-mail
Irvc-�VDln Co IM
Contact Person for Building&Codes Compliance: 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
Factory-Industrial
Attached Garage 33�i
one-
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) D Gas Oil Propane Solar Other �o
Fireplace: Complete a separate application for Fuel Burning
Appliances& Chimneys N�
Are there structures not shown on plot plan?
Are there easements on the property? 00
Site Information
a. Dimensions or acreage of lot 0 2
b. Is this a corner lot? t)
c. Will the grade be changed as a result of construction o _ Yes No
d. ublic ater or Private well
e. Sewer rivate eptic System
Value of all work to be performed(labor or materials) $ t01 OOD
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.th,a above::
PRINTNAME: 1 F� 1 �IGIM DATE:
SIGNATURE: r DATE: L2
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
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
`•g. Main Office 176 Doc Run Road•Manhotm,PA 17545 .
?' MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No....., ...Cen.NQ 42314 Cuain Card No................:................
...
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Owner........................ ........................................................................................ ..
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Location..............n�.'z:_...t...E OG(LIn.4:_-b.dRLI..... ......:....Q s/,eCn.J.S G..P.:.. .._............-
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Installation Consisting ......... .Q0.L.7�!®."SSC.--------- ............:.
..
InstalledBy.....ti ................_........................................._Lie.No....................................
' The conditions following governed the issuance of this certificate,and anv certificate previously issued is
cancelled:• .
This cenifiratc 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 inspeetions at any time, and if its i
i
rules are violated,the Company shall have the right to revoke this certificate.
...
Date........g.71.'P.Q-J................ INSPECTOR �....)....... _./
.Lav� 4Y1�'L�-ts��'........,...
Member N.F.F.A.,I.A.E.I.
E0 39Cd m8Wf1W NON 089186L TZ:OT 910Z/9Z/01