RC-000489-2017 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-000489-2017 Date Issued: Thursday, March 8, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000489-2017
has been completed.
Tax Map Number: 301.13-1-90.1
Location: 552 WEST MOUNTAIN RD
Owner: KERRI MOSER
Applicant: KERRI MOSER
This structure may be occupied as a: Residential Addition 288 s.f.
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, V
4�t
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-000489-2017
Tax Map No: 301.13-1-90.1
Permission is hereby granted to: KERRI MOSER
For property located at: 552 WEST MOUNTAIN 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: KERRI MOSER Single Family-Addition $9,500.00
Owner Address: 552 W Mountain DR Total Value $9,500.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Addition 288 s.f.
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 22,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the eypiration(late.)
Dated at the Town<Qns Tu s 2,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: tC_!I�Q- 2Q V1
APPLICATION Permit Fee: $ lOp
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.guee/nss�bury.net,�y
Project Location:
Tax Map ID#: ' Subdivision Name:
CONTACT INFORMATION:
• Applicant: �
Name(s): ��?'"/ &7- 7-1
Mailing Address, C/S/Z: 6y,-) i/
Cell Phone: ( 5V'— 7�/�-3y3 7 Land Line:
Email: d DSS,' O/ Lrlr�
• Primary Owner(s):
Name(s): SY�?E J9S fd�i�
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
• Contractor(s): AUG IB 9 2017
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line: � )
Email:
• Architects En ine r s :
Business Name: _ &6IZ-2s"e
Contact Name(s): Z:lh a/i //
Mailing Address, C/S/Z: 13Y d1l d/ew.s 'le�-/lf
Cell Phone: ( ) Land Line: ( S/dam ) 711/–e•-41-2
Email: ePl� Q
Contact Person for Building & Code Compliance: ✓�'� / � / OS "�
Cell Phone: ',3113 7 Land Line:
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
'V Single-Family Two-Family _Multi-Family (#of units )
Townhouse Business Office Retail
Industrial/Warehouse _Garage (#of cars ) _Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: �jQ,YI�) 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
4t"floor: 4t"floor:
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propane Solar Other
Fireplaces need a separate Fue Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? YES (NQ:A xpIain:
5. Are there any easements on the property? YES ,N ?
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? v
b. Is this a corner lot? YES
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PRIVATE WELL
e. Is the parcel on SEWER orVAT�PTit system?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If the work is not completed 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 and/or
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: �///Ser
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
•
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Na 4 2 3 4 3 cutin card No.....................................
Pertntt No.,..���.:-.�.Qf...�.....-.Cert. w , "•
Owner.................... // ..............................................--
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Location............Ss ................ ...G ..�+.� ��5.. '! ..
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Installation Consisting of..... ....... t......
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,... ..........................................................•.............
InstalledB ......Lic.No.-................................................
The conditions following gbvam¢d the issuance ofthis certificatc.and any ccnificatc pr-vicrusly issued is
cancelled:-
j This certifte3te only covers the electrical equipment and installe conditions dc 1,(,.(inspoction,
of dais. Upon the
introduction of additional equipment or alterations,applicateon shshalll bbe promptly inn
Inspectot9 Of Ihlb Company shall have the privilege of making inspections At :trry (ilTte, and if its E
rules are violated,the Company shall have the right tv rcvolcC tbib certifwatr:.
`�ie .........................•......... ....
...�..�................ INSPECTOR .....- ....., •.
.------•-•• 1
Date........ ..- .IS!
Member N.i',1'•A.,!.A•t':.9.
D
E E 0 W E
FEB 12 2018 1
TOWN OF QUEENSBURY
BUILDING&CODES