CC-000686-2016 `y 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: CC-000686-2016 Date Issued: Monday, January 9, 2017
This is to certify that work requested to be done as shown by Permit Number CC-000686-2016
has been completed.
Tax Map Number: 302.7-1-13
Location: 102 QUAKER RD
Owner: OMall Family Limited Partnership
Applicant: D.A.Boychuk
This structure may be occupied as a:Commercial Interior Alterations 990 s.f.
By Order of Town Board
TOWN OF QUEENSSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the l - r/ 4
property owner of the responsibility for compliance with Site Plan, L�/GGG����
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
` - i
BUILDING PERMIT
Permit Number: CC-000686-2016
Tax Map No: 302.7-1-13
Permission is hereby granted to: OMall Family Limited Partnership
For property located at: 102 QUAKER 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
Tvceof Construction
Owner Name: OMall Family Limited Partnership Retail-Mercantile-Alteration $1,000.00
Owner Address: 35 Orchard DR Total Value $1,000.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
Commercial Interior Alterations 990 s.f.
$198.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,October 11,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of eemb /lues y r 1,2016
SIGNED BY: /V1 for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION
Office Use On[v
Received
Date: Tax Map ID
Permit No. CC.- G b(p - 2-016
Tax Map ID Permit Fee 4 19b .00
Zone Reece 1 rs v o t.a, 11 m
Historic Site _Yes _ No Site Plan#
Subdivision Name Lot# Subdivision#
Project Location o Z,G AakK✓ &l,.
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).
r
Applicant Owner A kKC
AddressAddress r�x
.rEE.v1�Y fe_5W �
Phone/E-mail Phone/E-mail
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 1I floor sf 21 floor sf Total sf Height
Single Family
p
i
Two-Family
c,
Multi-Family BUI! : CODE J
(#of units )
Townhouse
Business Office
Retail-Mercantile ✓ p�
Factory-Industrial T
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 e%&111
Source of Heat (circle one) a Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances & Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information
a. Dimensions or acreage of lot
b. Is this a comer 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) $ 11 0 oO
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 I 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: d y L
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