RC-0011-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
lot
-- NWIF Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: RC-0011-2018 Date Issued: Monday, June 4, 2018
This is to certify that work requested to be done as shown by Permit Number RC-0011-2018
has been completed.
Tax Map Number: 226.16-1-20
Location: 55 MASON RD
Owner: M Dream, LLC
Applicant: Great Day Improvements LLC
This structure may be occupied as a: 175 sq. ft. 3-season porch
Cross Ref. Area Variance By Order of Town Board
Z-AV-74-2017; Z-AV-15-2018 and P-SP 21-2018 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.
a 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-0011-2018
Tax Map No: 226.16-1-20
Permission is hereby granted to: Great Day Improvements LLC
For property located at: 55 MASON 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: M Dream,LLC Porch-3 Season,Covered,Enclosed $37,000.00
Owner Address: 175 Broad ST,238 Total Value $37,000.00
Glens Falls,NY 12801
Contractor or Builder's Name/Address Electrical Inspection Agency
Great Day Improvements LLC
8 Access RD
Albany,NY 12205
Plans&Specifications
175 sq.ft.3-season porch
Cross Ref. Area Variance
Z-AV-74-2017;Z-AV-15-2018 and P-SP 21-2018
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,May 1, 2019
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of QueenItyry before t expiration d te.
Dated at the Town f Quee s ury; 4Tu s ay 1,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: RC U -�t0 a'
APPLICATION Permit Fee:$
Town of(Lccnsbun �ty,
742 Bay Road,Queensbury,NY 12804 Invoice#: Wo1C—)
P:518-761-8256 www.gueensbury.net
Project Location: 05 A0.`ags v-1 K11 RD
Q.,:" '- j W
Tax Map ID#: a�Ci • Subdivision Name: JAN 12 2018
CONTACT INFORMATION: TOWN OF QUEENSBURY
• Applicant: COMMUNITY DEVELOPMENT
Name(s): Gv- 1L)n. Zm�we�v�n�n�S LLC
Mailing Address, C/S/Z: S A f2e-S VQ8 At v 1, ti V laaos
Cell Phone: 18 ) S ICK - 5 7(-=,'7 Land Line: ( 51 8
Email:
I h�Tc�f dQ ,.-( v��r��., -f s . c •-�
• Primaryi3Owner s
Name(s)� M,tcE czSE' � c�
Mailing Address, C/S/Z: 66 M lb—sr,. . Af Y IdLEC:�"4
Cell Phone: Land Line: _(6/ S ) C.55c-=--
Email: P'f�L2S idv�y►1' ro '5" �c�ram►
• Contractor(s):
Business Name: L_LC.
Contact Name(s):
Mailing Address, C/S/Z: q t24 /Allo v Q lii iaaC-S
Cell Phone: I$ ) 9,lC�- 5 7�� Land Line: --518 ) 4Vdq--51o1
• Arch itect(s)/Engineer(s): �1 j
Business Name: �jt✓�cdx f-t55o�ea'��"� AycJ--Je-r--4 s
Contact Name(s): 'cN ,,,rdx
Mailing Address, C/S/Z: P,® tt Qs
Cell Phone: ( Land Line: 1%3
Email: -51Wa=C XAIAE A---ET N01
Contact Person for Building& Code Compliance:
Cell Phone:_) oi!O - 67c,=1 Land Line:
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial J Residential
WORK CLASS:
11 Single-Family —Two-Family _Multi-Family(#of units )
Townhouse Business Office _Retail
Industrial/Warehouse _Garage(#of cars ) _Other(describe 5�-- ✓cx�^�► )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 4ICQ 1st floor:
2nd floor: 2nd floor:
3rd floor: 3"floor:
4tb floor: 4tb floor:
Total square feet: /_j_iC3, 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 CPro an Solar Other
Fireplaces need a separate Fuel Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? YES NO)Explain:
S. 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. Will the grade be changed as a result of the construction? YES
d. What is the water source? LI PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? `&-w�
Town of aueensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
M
-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 tothe above:
PRINT NAME:
SIGNATURE: DATE: ? g
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
7
Great Day Improvements LL'
JAN 12 2018
mMEN
�i
Owner Authorization for Permit Application
T UA),A-rvq as owner of the subject
-6 <,I k'c� !VA /Q 2-�'l
property located at S /l/*, Y �, (
hereby authorize Great Day Improvements LLC
in Albany NY to act on my behalf in all matters
relative to work authorized by this building
permit application.