CC-000015-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CC-000015-2017 Date Issued: Tuesday, April 4, 2017
This is to certify that work requested to be done as shown by Permit Number CC-000015-2017
has been completed.
Tax Map Number: 296.11-1-32
Location: 527 BAY RD
Owner: Worlco Management Ser Inc.
Applicant: Chris Nelson
This structure may be occupied as a: Commercial Interior Alterations(walls)75
SX. By Order of Town Board
Business Office:Edward Jones Investment 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: CC-000015-2017
Tax Map No: 296.11-1-32
Permission is hereby granted to: Chris Nelson
For property located at: 527 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
Type of Construction
Owner Name: Worlco Management Ser Inc. Business Office-Alteration $15,000.00
Owner Address: 527 Bay RD Total Value $15,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Commercial Interior Alterations(walls)75 s.f.
Business Office:Edward Jones Investment
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,January 30,2018
(If a longer period-is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury befojthhe : tion date.)Dated at the Town ueens Mo ry 30,2017
SIGNED BY: 9 e for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
/ Received
Date: / k/ ZO( ( Tax Map ID
Permit No. —
Tax Map ID9 , /�— —3 Permit Fee 7 ,0
Zone
Historic Site _Yes No JrW
(Ee�I
Subdivision Name Lot#
Project Location d'7 F K�aa� JA
Ulf
TOWN OF QUEENSBURY
TOWN BD. RESOLUTION 86-2013: $850 recreation fee for newW(tTy ,moi LfW NIT exes/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 r� / Owner
Address $a / Address
Phone/E-mail e�nC / Phone/E-mail
151 LY - 338- 9-
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 11 floor sf 2"6 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 /✓:/ ht.,Ae e&W�����
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
Proposed use of building or addition C nerc.a / O�ice S
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? A10
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. 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. 1 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. 1 acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. 1 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:/"/,{1l<< S /V e 150✓I DATE:
SIGNATURE: //z/� 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