CC-000016-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: CC-000016-2017 Date Issued: Monday, January 29, 2018
This is to certify that work requested to be done as shown by Permit Number CC-000016-2017
has been completed.
Tax Map Number: 303.15-1-25.1
Location: 24 QUAKER RIDGE BLVD
Owner: Wal-Mart REBT
Applicant: Harrison French&Associates, Ltd.
This structure may be occupied as a: Commercial Alterations 2040 s.f.
Cash Wrap Area By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance 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.
r
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-000016-2017
Tax Map No: 303.15-1-25.1
Permission is hereby granted to: Wal-Mart REBT
For property located at: 24 QUAKER RIDGE BLVD
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
Tvne of Construction
Owner Name: Wal-Mart REBT Retail-Mercantile-Alteration $250,000.00
Owner Address: 702 SW Eighth ST Total Value $250,000.00
Bentonville,AR 72716
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Commercial Alterations 2040 s.f.
Cash Wrap Area
$408.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,January 26,2018
(If a longer period is required,an application for an extens'on must be made to the code Enforcement Officer
of the Town of QueensbuQ611vfore the a fy
atio date.)
Dated at the Town o ueensb �Th uary 26,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Date: 1/12/2017
Permit No.
Tax Map ID Permit Fee %O
Zone Historic? _Yes No Rec �
F ,�� Q c� _ 02-
Subdivision Name Lot# e Plan#
Project Location 4& Subdivision#
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).
Primary Owner(s) Wal-Mart REBT _;11
Address 702 SW 8th St, Bentonville, AR 72716
Phone/Email 479-273-4000
Applicant Leticia Martinez w/ Harrison French and Associates
Address 1705 S Walton Blvd, Bentonville, AR
Phone/Email 479-273-7780x 263 / leticia.martinez@hfa-ae.com
Contractor TBD
Address
Phone/Email
Contact Person for Building& Codes Compliance: Phone
TYPE OF CONSTRUCTION 2 B
,/Check all that apply New Addition Alteration I"floor sf 2'floor sf Total sf Height
Single Family
Two-Family
Multi-Family 2
(#of units_} D IE
Townhouse I JAI I
w
Business Office T01JVi` OF QUEENS llRY
Retail-Mercantile
'20 1A
l7 S -
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
If commercial or industrial please indicate name of business Walmart Store 4403
Proposed use of building or addition Mercantile
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?
Are there easements on the property?
Site Information:
a. Dimensions or acreage of lot
b. Is this a corner lot? Yes No
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well(circle one) Public Private
e. Sewer or Private Septic System(circle one) Sewer Private
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. 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: lelticlq lKqn�lZ DATE: Z 2a�7
SIGNATU DATE: / VI-7
For offic use onl
Operating Permit Issued: Yes o
Occupancy Type M
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016