RC-0765-2018TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development - Building& Codes (518) 761-8256
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BUILDING PERMIT
Permit Number: RC-0765-2018
Tax Map No: 302.11-1-43
Permission is hereby granted to: Sera Oliver
For property located at:21 GARRISON 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: Sera Oliver Single Family-Alteration 4,500.00
Owner Address: 21 Garrison RD Total Value 4,500.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Timber&Stone Construction LLC
35 River Crest RD
Gansevoort,NY
Plans&Specifications
Egress Window
200.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, December 6, 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 a.te.
414DatedattheTownQueebury; T Jr.. 1 cember 6,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Of ''op Use Only
ADDITION/4 n-pit#:
APPLp TIO@EC 0 4 2018 Pehmit Fee:$ ,-,
Town of Queensbury
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742 Bay Road,Queensbury,NY 12804
TOWN OF QUEENSBL RI,ivoi y-e
P:518-761-8256 ,n:w a BUILDING&CODES
Project Location: St Z/ 64/fiSu4 goad
Tax Map ID#: 3,02. . i I ` ( LI3 Subdivision Name:
CONTACT INFORMATION:
Applicant:
Name(s): 3;// LNia E I(
Mailing Address, C/S/Z: 35 give/ (/er1 Foal 600,3 vovol- Air /ZB3
Cell Phone: ( $78 ) 365-667 I Land Line: ( 5 r4 ) ?l3-
Email: 6)tit,' dell 10 IMf1z ,l .4 e7
Primary Owner(s):
Name(s): 7e14 Q/'Vtr
Mailing Address, C/S/Z:Z/ t0f/4.4 ,& I 0(40e/017 AI/; /Z84y
Cell Phone: ( 303 ) - 550 - ail Land Line: (
Email: Sem, d bar/e key, fool
Contractor(s):
Business Name: iy e/ s is LLC
Contact Name(s):B;I) L ;sclel/
Mailing Address, C/S/Z: 3S Wiutf (1113'I- 444 6o.f vtaffl NY
Cell Phone: (
Sft ?avr.
Land Line: (
Email: D
Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( Land Line: (
Email:
Contact Person for Building & Code Compliance: 3:// Lis4l/
Cell Phone: ( /d ) 3d 5 - ,%q I Land Line: (
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
PROJECT INFORMATION:
1
TYPE: Commercial Xesidential ecvess i/c6a.
or) l
WORK SS:
Single-Family Two-Family Multi-Family (#of units
Townhouse Business Office Retail
Industrial/Warehouse Garage (# of cars Other (describe
ADDITION SQUARE FOOTAGE: j ALTERATION SQUARE FOOTAGE:
1st floor: N /f
oor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space):Basement (habitable space):
Total square feet: Tota uare feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $y PM
2. If Commercial project, what is the proposed use:
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 xplain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or - - -.ge of the parcel?
b. Is this a corner lot? 11101° NO
c. Will the grade be changed as a re e construction? YES NO
d. What is the water source? PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVA E SEPTIC system? A)z 4'1
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.
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:
k /? &
il/* L4'sckf
SIGNATURE: DATE: ///2 6
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018