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CC-0075-2018 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: CC-0075-2018 Date Issued: Monday, May 14, 2018 This is to certify that work requested to be done as shown by Permit Number CC-0075-2018 has been completed. Tax Map Number: 296.19-1-32 Location: 375 BAY RD Owner: 375 Bay Road LLC Applicant: Jersen Construction Group This structure may be occupied as a: Commercial Interior Alterations 200 s.f. By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the /f property owner of the responsibility for compliance with Site Plan, D-j 4 , -At 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: CC-0075-2018 Tax Map No: 296.19-1-32 Permission is hereby granted to: 375 Bay Road LLC For property located at: 375 BAY 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: 375 Bay Road LLC Business Office-Alteration $19,500.00 Owner Address: 6 Industry DR Total Value $19,500.00 Waterford,NY 12188 Contractor or Builder's Name/Address Electrical Inspection Agency Jersen Construction Group 6 Industry DR Waterford,NY 12188 Plans&Specifications Commercial Interior Alterations 200 s.f. $ 175.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,March 14, 2019 (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 th expiratie.) Dated at the TownfQ- uee 4W4e , arch 14, 2018 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only PRINCIPLE STRUCTURE_PERMIT Permit#: CC - © - 2p113 APPLICATION Permit Fee:$ 16 C -76 *Rec. Fee:$ 742 Bay Road,Queensbury, NV 12804 P: 518-761-8256 Invoice#: I Project Location: 375 Bay Road,Queensbury NY 12804 Tax Map #: ZE�Lo - I`1 t �L Subdivision Name: TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units: single family,duplexes/two-family, multiplefamily, apartments,condominiums, townhouses,and/or manufactured &modular homes,but not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: • Applicant: (Angela Cioffi) Name(s): Jersen Construction Group LLC Mailing Address, C/S/Z: 6 Industry Drive Waterford NY 12188 Cell Ph.: _ 518 779-7702 Land Line: _ 518 233-0600 Email: acioffi • Primary Owner(s): Name(s): 375 Bay Road LLC Mailing Address, C/S/Z: SAME AS ABOVE Cell Ph.: _{� Land Line: _ ,�. Email: nn & • Contractor(s): FEB 2 1 20 Name(s): Jersen Construction Group, LLC Mailing Address, C/S/Z: SAME AS ABOVE RHILDINQ CODES Cell Ph.: _(� Land Line: Email: • Arc hitect(s)IEnaineer(s): Name(s): Mailing Address, C/S/Z: Cell Ph.: _�) Land Line: Email: Contact Person for Building & Code Compliance: ��G "'i 4 '�l Cell Ph.: _(5�� )1-T} r 1.�0 Z. Land Line: Email: ToQ Building&Code Enforcement Principle Structure Updated December 2017 PROJECT INFORMATION: TYPE: X Commercial Residential WORK CLASS: Single-Family Two-Family _Multi-Family(#of ) Townhouse X Business Office __Retail —Hotel/Motel Industrial/Warehouse Garage(#of cars_} Other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 11T floor: �l S 15T floor: 2"d floor: 2"d floor: 31 floor: Total square feet: 4tn floor: Total squarefeet: tPoo ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 2. Proposed use of the building: Medical Offic 3. If Commercial or Industrial, indicate the name of the business: TBD 4. Source of Heat(circle one): Gas Oil Propane Solar Other: (Fireplaces need a separate Fuel Burning Appliances&Chimney Application,one per appliance) 5. Are there any structures not shown on the plot plan? YES NO Explain: 6. Are there any easements on the property? YES NO 7. SITE INFORMATION: a.What is the dimensions or acreage of the parcel? 3.39 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? SEWER Toq Building&Code Enforcement Principle Structure Updated December 2017 a -V DECLARATION: 1, 1 acknowledge that no construction shall coin mence prior to issuance of a va I irl !),ui I perm,-. and work will be completed within a 12 month period 2. If the work is not completed by the 1year 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 1, or my agents, will obtain a certificate of occupancy, 5. 1 understand that Me are required to provide an as-built survey by a licensed land surveyor of a 11 newly constructed facilities priorto issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: V SIGNATURE: DATE: ToQ Building&Code Enforcement Principle Structure Updated December 2017