RC-000677-2017 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: RC-000677-2017 Date Issued: Monday, September 24, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000677-2017
has been completed.
Tax Map Number: 309.9-2-1
Location: 6 WINDSONG DR
Owner: Robert Ingraham
Applicant: Robert Ingraham
This structure may be occupied as a: Residential Alteration
(roof repair) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
(-114,40 4
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: RC-000677-2017
Tax Map No: 309.9-2-1
Permission is hereby granted to: Robert Ingraham
For property located at: 6 WINDSONG DR
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
Tvoe of Construction
Owner Name: Robert Ingraham Single Family-Alteration $0.00
Owner Address: 6 WINDSONG DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Red's on the Ground Services
54 McCrea ST
Fort Edward,NY 12828
Plans&Specifications
Residential Alteration
(roof repair)
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 1,2018
(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 expiration date.)
Dated at the Town bury; We sd ,.November 1,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code nforcement
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ADDITION/ALTERATION PERMIT
APPLICATION Permit Fee: $ 6,r3 . o0
Town of CZuccnsbw;v
742 Bay Road,Queensbury,NV 12804 invoice#: Z 2>b!F1
P:518-761-8256 www.gueensbury.net
Project Location: L1J i SSG �r �Cl ��tV �a.«- crn�I;o�. ..�t�6cs •
Tax Map ID #: Subdivision Name:
CONTACT INFORMATION:
Applicant:
Name(s): a �jP ' L•% va, �. �' �``� �:"� �. --#_ �
Mailing Address, C/S/Z: l�
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Cell Phone: Land Line: )
Email: v
O Primary Owner(s): �►, (`'�. oY'e. -L11ur-
Name(s): e.✓1- L • 9 ��`�` `1
Mailing Address, C/S/Z: ( LA) lly�' r te• )vef Li ! P I&LE OL(
Cell Phone: �_) Land Line: Ljat )-7qS -S-«o —7 '
Email:
® Contractor(s):
Business Name: K'Pd-S o ( 'Yo oAJ S ru�'c-pS
Contact Name(s): �lav ��<- l� Yvt r'�tGwz
Mailing Address, C/S/Z: cr;�s�,h`��c
Cell Phone: 5� ) Q :�_� �� �O '� Land Line:
Email:
• Architect(s)/Engineer(s):
Business Name: K`c_k s cin-iki,
Contact Name(s): Morr\( kCLV1
Mailing Address, C/S/Z: SL( P ".Lvec S4", �f war Ll �� y
Cell Phone: �_) �d Lie
Email:
Contact Person for Building & Code Compliance: e '� Q > \�^ �G�a
Cell Phone: �_) Land Line: ) (,
Email:
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: 1st floor:
2nd floor: 2nd floor:
311 floor: 3rd floor:
4th floor: 4th floor:
Total square feet: Total square feet-
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 60
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propane Solar Other a r6 Stns
Fireplaces need a separate Fuel Burning Appliances & Chimney Application
4. Are there any structures not shown on the plot plan? YES NO 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 NO
c. Will the grade be changed as a result of the construction? YES NO�
d. What is the water source? PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a,PRIVATE SEPTIC system?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
. DECi AR rION:
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. Ifthework 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 PAYS 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: )LO to V, t. -
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SIGNATURE: `'. z y - �ti, �1.�DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
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ased on our limited examination,compliance
ith our comments shall not be construed as
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ew York State.
TOWN OF QU
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ReViewed By.
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5182227667 BBB.
clarencemonahan.�a yahoo,com Roofs& Siding
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AGREEMENT SUBMITTED TO PHONE DATE
STREET JOB NAME
CITY,STATE AND ZIP CODE JOB LOCATION
ARCHITECT DATE OF PLANS FJ-O
PHONE
WE HEREBY SUBMIT SPECIFICATIONS AND AGREE TO:
1
OCT 2 6 2017
TOWN OF QUEENSBURY
309.9-2-1 RC-000677-2017 --- --
Ingraham, Robert
6 Windsong Drive
Residential Alteration (roof repair)
WE AGREE HEREBY TO FURNISH MATERIAL AND LABOR-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF:
DOLLARS ($ y' `
PAYMENT TO BE MADE AS FOLLOWS: >
AUTHORIZED SIGNATURE:
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SIGNATURE'.,' SIGNATURE:
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