RC-000656-2017TOWN 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-000656-2017 Date Issued: Tuesday, February 5, 2019
This is to certify that work requested to be done as shown by Permit Number
has been completed.
RC-000656-2017
Tax Map Number:
Location:
Owner:
266.1-1-17
88 OAK VALLEY WAY
Yvonne Fuller, Nathan Fuller
Nathan FullerApplicant:
This structure may be occupied as a: Residential Addition 95 sq. ft.
converting existing porch into living space 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,
Variance, or other issues and conditions as a result of approvals by the
Planning Board or Zoning Board of Appeals.
Director of Building & Code Enforcement
!`^ 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-000656-2017
Tax Map No: 266.1-1-17
Permission is hereby granted to: Nathan Fuller
For property located at: 88 OAK VALLEY WAY
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: Yvonne Fuller Single Family-Addition $15,000.00
Owner Address: 88 OAK VALLEY WAY Total Value $15,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Addition 95 sq.ft.
converting existing porch into living space
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,November 5,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the exp' tion datek, e-r
(:nsbDated at the Town of 4rida 3,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
r
Office Use Oniy
ADDITION/ALTERATION PERMIT Pernlir
APPLICATION Permit Fee:$
Tonvn of Queensbury
742 Bay(toad,Queensbury,Fly 12804 Invoice#:
P:518-761-8256 www.gueensbury.net
Project Location: — 0—a(�
Tax Map I® #: —(`-17 Subdivision Name:is
CONTACT INFORMATION: I s E C E 9 V I
Applicant OCT 19 2011
Mailing Address, C/S/Z: VA t(. /fir TOWN OF QUEENSBI
Cell Phone: �"/K ) i Land Line: � / �' LOPI
� �.fes- 6 ss d ) 7y� - �� �
Email: /VY /=vzL E �� C�o�rF t/✓; f ,'( _ IiJCT
Primary Owner(s): +v-t -
Name(s): /��ar- z� XC)! VV /c
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: � )
Email:
9 Contractor(s): /
Business Name: /"✓(�"
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Architect(s)/Engineer(s)o �/�
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contact Person for Building & Code Compliance: luta 14 C' �v I/0
Cell Phone: S-1Land Line: 7113 - i 7-r
Email: /V Y �� �L f,Q �,✓�92f�M,4/l n/�?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
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: 9!S;7 1st floor: /
2nd floor: / 2nd floor: /
3rd floor: ` 3rd floor: /
4th floor: / 4th floor: /
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ S UG
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Ga Oil Propane Solar Other
Fireplaces need a separate Fuel Burning Appliances &Chimney Application
4. Are there any structures not shown on the plot plan? YES (!�q) Explain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel?
b. Is this a corner lot? YES �C
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PUBLICRIVATE WEL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? J���t1AT6'
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLAFdA 1 1ON:
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 priorto issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: M1_4 -cam Fu liar
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
JAN232019 1....)1
TOEWUN D NG&CODES Y
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COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main(Mice 176 Doe Run Road-Manhelnt,PA 17545
,`.' MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL •
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Permit No. Cert.N2 4 2 4 2 3 Cut-in Card No.
Owner ..efr/ Lira!/.3.v4 ..i'v in I-c-A
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Installation Consistirr� of . 4ts?/..T/.a.,s/,,...;,- .<;r�,�laa..k. - '-1 /Z c,.. ../..ci-i ,41.1,c
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• Installed By .. .,<4.r..r..1 fv.r Lie.No. .
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate oily 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 inspections at any time, and if its
• rules arc violated, the t`ompainy shall have the right revoke this certificate,.
•'i bate......../.::... :.. .:°..L.2......... INSPECTOR.... ''�r'c"'r..-le-
47 Member N.F.P.A.,I.A.E.I. t
TO 09tid OiSWf1W NONb85T86L 80:6T 6I0Z/EZ/T0