CC-0094-2018TOWN 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-0094-2018 Date Issued: Tuesday, January 29, 2019
This is to certify that work requested to be done as shown by Permit Number
has been completed.
CC-0094-2018
Tax Map Number:
Location:
Owner:
289.19-1-16
685 BAY RD
Church of the King Inc
Church of the King IncApplicant:
This structure may be occupied as a: Interior Alterations (converting multiple
classrooms into one large youth room)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
f
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-0094-2018
Tax Map No: 289.19-1-16
Permission is hereby granted to: Church of the King Inc
For property located at: 685 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
Tvue of Construction
Owner Name: Church of the King Inc Business Office-Alteration $3,000.00
Owner Address: 681 Bay RD Total Value $3,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans& Specifications
Interior Alterations(converting multiple classrooms into one large youth room)
$ 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 uee ury; Frid ch . , 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit
APPLICATION Permit Fee:$ 1�-5
Town ofQuccnsbury
742 Bay Road,Queensbury,NY 12804 Invoice#: 15�
P:518-761-8256 1jvww.aueensbury.net
A
Project Location: � � � B k/
Tax Map I®4: Subdivision Name:
CONTACT INFORMATION:
Applicant:
Name(s): < ,rc k.'�
Mailing Address, C/S/Z: 5 1-3c f c . J 4e
Cell Phone: 5 i )K ) S Z 2 7 3? Land Line:
Email: 0614i Cf211 viz
G Primary Owner(s):
Name(s): �at �
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contractor(s):
Business Name: �� ,�„ 3 2018
Contact Name(s):
Mailing Address, C/S/Z: TOWN OE COPES
Cell Phone: �_) Land Line:
Email:
® Arch itect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contact Person for Building & Code Compliance: /y'A ctwV o I�o '--
Cell Phone: ( S I?� ) L'a '� �_3 -7 Land Line:
Email: 00 tee, o
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
INSPECTION WORKSHEET (BINS-000615-2019)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number:CC-0094-2018 Case Module:Permit
Inspection Date:Mon Jan 28, 2019 Inspection Status:Passed
Inspector:John O'Brien Inspection Type:Commercial Final Inspection
Job Address:Parcel Number:685 BAY RD
Queensbury, NY 12804
289.19-1-16
Contact Type Company Name Name
Granted Permission Church of the King Inc
Applicant Church of the King Inc
Primary Owner Church of the King Inc
Checklist Item Passed Comments
OK to Issue C/O YES 1/3/19 Final Inspection Not Approved
- Provide Fire Alarm Report
1/28/19 Final Inspection Approved - Ok to Issue CO!
Jan 28, 2019 Page (1)
O'Brien, John (Inspector)
'PROJU'T WIFORMAMN,
TYPE. f'°'ti Commercial Residential
WORD CLASS:
_Single-Family _Two-Family _Multi-Family (#t of units )
Townhouse Business Office Retail /I
Industrial/Warehouse Garage (# of cars ) f Other (describe
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
4th floor: 41h floor:
Total square feet- Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ ;
2. If Commercial project, what is the proposed use: f ou+k � e:'M
3. Source of Heat (circle one): 'Gas 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 NO Explain:
5. Are there any easements on the property? YES
G. 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
DECLARATION:
I. I 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: �n�hc�� Olsc�t
SIGNATURE: DATE:24Icl/ I?
� r
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
INSPECTION WORKSHEET (BINS-009072-2018)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
CC-0094-2018Permit
Case Number:Case Module:
Thu Jan 3, 2019Partial Pass
Inspection Date:Inspection Status:
John O'BrienCommercial Final Inspection
Inspector:Inspection Type:
685 BAY RD289.19-1-16
Job Address:Parcel Number:
Queensbury, NY 12804
Contact TypeCompany NameName
ApplicantChurch of the King Inc
Primary OwnerChurch of the King Inc
Granted PermissionChurch of the King Inc
Checklist ItemPassedComments
OK to Issue C/ONO1/3/19 Final Inspection Not Approved
- Provide Fire Alarm Report
O'Brien, John (Inspector)
Jan 03, 2019Page (1)