RC-0430-2018 'Y
ti TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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';. _ f -:. Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-0430-2018
Tax Map No: 296.13-1-73
Permission is hereby granted to: Derwin Crawford
For property located at: 73 MONTRAY 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: Derwin Crawford Single Family-Alteration $3,200.00
Owner Address: 76 Montray RD,Trailer 7 Total Value $3,200.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Derwin Crawford
17 E Holcomb ST
North Creek,NY 12853
Plans&Specifications
Residential Alterations 144 s.f.(storm damage)
Ord - .+•
$ 200.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,July 10,2019
(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 To of Que sbury j4 T • 4 a/Ju ,.. 0, 2018
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SIGNED BY: \ for the Town of Queensbury.
Director of Building&Code Enforcement
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i Office Use Only
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ADDITION/ALTERATION PERMIT Permit y° O �bc0•2QA
APPLICATION 1 Permit Fee:$ 200
Town of Queensbiiry
742 Bay Road,Queensbury,NY 12804 invoice#: j
P:518-761-8256 www.queensbury.net
Project Location: ro onn.a(A,W-t-.4
Tax Map ID#: 21 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): "be.r ;I Ata,h traw`Q6r
Mailing Address, C/S/Z: 3 .Ai or°‘,ra t3 6? t IR/R 7
Cell Phone: ( /9 ) i5 '16 SO Land Line: ( ) _ -�• '�
Email:cC,ert,.:, i cr4,A00219 4rau.,'��., CD,rn 0ttn
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B.• Primary Owner(s): 05 20
Name(s): 1
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( ) 9
Email:
• Contractor(s):
Business Name: claa:-art
Contact Name(s):Mailing Address, C/S/Z: tri E atace VY.b 740 r4 L a-eel inLL l 06_
Cell Phone: ( Sit_3 ) eta / 5 l'J Land Line: ( ) U
Email:
• 1ii3d:` 1' ;Gr'f>r . ):
Business Name: 0
Contact Name(s): '
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Building&Code Compliance: (2-Cl 1 00-A3 rc'
Cell Phone: ( . 75 ) el Z 1,9 2-4 Land Line: ( )
Email:
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Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
•
PROJECT INFORMATION
TYPE: Commercial Residential
WORK CLASS:
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_ Single-Family , Two-Family Multi-Family(#of units )
Townhouse Business Office Retail
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Industrial/Warehouse Garage (#of cars ) Other(describe )
ADDITION SQUARE FOOTAGE: - - ALTERATION SQUARE FOOTAGE: .
1st floor: •
1st floor: /O8
2nd floor: tv - let r: -.3 Co
3rd floor: • ' ' 3rd floor:
Basement(habitable space): • • Basement(habitable space):Total square feet: Total square feet: /
9
ADDITIONAL PROJECT INFORMATION:
1. . Estimated Cost of Construction: $ ,gc•D OCR,cYO
2. If Commercial project,what is the proposed use:
3. Source of Heat (circle one): Gas O' 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 plain:
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5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the pa cel?
b. Is this a corner lot? YES O
c. Will.the grade be changed as a result-of a construction? YES NO
d. What is the water source? (PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Vc Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
DECLARATION:
1. 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. If the work is,not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
3. I 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
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5. I 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: Iwe111 ire,
SIGNATURE: �� --. DATE:
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Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018