CC-0090-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
i
- Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: CC-0090-2018 Date Issued: Tuesday, May 8, 2018
This is to certify that work requested to be done as shown by Permit Number CC-0090-2018
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 Alterations (enclosing
vestibule and adding heat source) 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.
-- 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: CC-0090-2018
Tax Map No: 296.19-1-32
Permission is hereby granted to: Jersen Construction Group
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 $5,000.00
Owner Address: 6 Industry DR Total Value $5,000.00
Waterford,NY 12188
Contractor or Builder's Name/Address Electrical Inspection Agency
Jersen Construction Group
6 Industry DR
Waterford,NY 12188
Plans& Specifications
Commercial Alterations(enclosing vestibule and adding heat source)
$ 175.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, March 16,2019
(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 the expiration date.)
Dated at the Town o ueens 4rid ,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
t
Office Use Only
ACCESSORY STRUCTURE Permit#:
PERMIT APPLICATION Permit Fee:$ 17S
Town or Queensbury
742 Bay Road,Queensbury,NY 12804
Invoice#: C U
P:518-761-8256 www.gueensburV.net
Project Location: 375 Bay Road
Tax Map ID #: �'9�°- I 32 Subdivision Name:
r....
CONTACT INFORMATION:
Applicant: MAR 0 6 018
Name(s): Jersen Construction Group -Angela Cioffi
-,-,,, ! r F i UE,—NSBURY
Mailing Address, C/S/Z: ." t �, PIVENT
Cell Phone: ( 518 ) 779-7702 Land Line: ( 51 g) 23
Email: acioffi@jersen.com
• Primary Owner(s):
Name(s): 375 Bay Road, LLC
Mailing Address, C/S/Z: 6 Industry Drive Waterford NY 12188
Cell Phone: ( 518 ) 779-7702 Land Line:
Email: acioffi@jersen.com
• Contractor(s):
Business Name: Jersen Construction Group
Contact Name(s): Angela Cioffi
Mailing Address, C/S/Z: 6 Industry Drive Waterford NY 12188
Cell Phone: ( 518 )779-7702 Land Line: ( 518 )233-0600
Email: acioffi@jersen.com
Arch itects)/Engineer(s):
Business Name:
Contact Name(s): Jetf Doak
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Building & Code Compliance: Angela Cioffi
Cell Phone: ( 518 ) 779-7702 Land Line: ( 5181 233-0600
Email: acioffi0-wrsen_com
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: x Commercial Residential
WORK CLASS:
Deck, Open Porch _Solar Panels(w/o rafter upgrades) _Carport _Cell Tower
Shed _Pavilion, Pole Barn, Canopy _Dock _Gazebo
Detached Garage _Boathouse(with or w/o sundeck) _3-Season Porch
X other(description: Closing in existing porch )
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 20sf
2 ncl floor:
Total square feet.. 20
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 5K
2. If Commercial project,what is the proposed use: Entry Vesitbule
3. Are there any structures not shown on the plot plan? YES NO Explain:
4. Are there any easements on the property? YES NO
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. 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 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 to the above:
PRINT NAME: Angela Cioffi
SIGNATURE: 1 DATE:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
c " May. 10. 20180— 1 ; 29PMMDIA No. 3380 P. 3/8
1 MIDDLE DEPARTMENT INSPECTION AGENCY, INC
ea that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owner Date:
Jersen Construction 04/30/2018
Occupant
Comm. /Suite B 103 Location-
Occupancy.-Occupancy: 75 Bay Road
.-Non-ResidentialQueensbury, Warren Co_ NY
Applicani7
Crannell Elect, Design & Const
PO Box 4074
Queensbury, NY 12804"''
L J:
,
No.
Joseph A.Holmes
- - - 1.41.5541D1316EL
Equipment: _ - -
_._., ..........
9 - Switches; 12 - Receptacles; 12 - Fixtures; 8 - Emergency Lights: 3 - Exit Lights; 2-Exit/Emergency Light Combos.
�4• '"` f
This certificate Applies to the electrical wiring to the electrical eQuipment listed immediately null and void. This certificate applies only to the use,occupancy and
above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership
inspection. No warranty is expressed or implied as to the mechanical safety,effl- of the property indicated above,this certificate shall be immediately null and void.
clency,or fitness of the eQuipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions.
be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department
system to which this certificate applies be altered in any way,including but not limit- Inspection Agency, Inc. An application for inspection must be submitted to Middle
ed to,the Introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc. to initiate the inspection and revalidation
any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service.
ECEOVE
I MAY 1 1 2018
U
TOWN OF QUEENSBURY
BUIRDING&CODES