RC-00055-2017TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000557-2017
Tax Map No: 289.11-1-59.121
Permission is hereby granted to: Sherwood Acres Construction Corp.
For property located at: 66 Hall 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
TyW of Construction
Owner Name: JEFFREY ROBILLARD Single Family-Alteration 0.00
Owner Address: 66 Hall RD Total Value 0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sherwood Acres Construction Corp.
324 N Woods Club RD
Minerva,NY 12851
Plans&Specifications
Residential Alterations 2666 s.f.
basement renovations to include 2 bedrooms and a bathroom)
0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,September 20,2018
If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of QueensbUQjbefbre the a 'ration dat
Dated at the Town o Queens keoteptemrber20,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
t
Office Use Only
ADDITION/ALTERATION PERMIT Permit#:
APPLICATION Permit Fee: At 4 b • vD
Town of(Zueensbun-
742 Bay Road,Queensbury,NY 12804 Invoice#: 22 12-- T
P: 518-761-8256 www.gueensburV.net
Project Location: latla A4 L
Tax Map ID #: 7, f' , - J, ) 'a j Subdivision Name: Zk
CONTACT INFORMATION:
Applicant:
Name(s): S t E 1 r-,V c3 r,, 0
Mailing Address, C/S/Z:Me.) v JS L (, 9 91,mz tijlA/ A A)K
Cell Phone: IL X, a ( 'iS Ua, Land Line:Sl —6L 11-3
Email: Email:
Primary Owner (s):
Name(s): G ac hod po CI // /D a
Mailing Address, C/S/Z: 6 Het (/ R"01 vY
Cell Phone: 414 DO Land Line: 1.057
Email: OLJi`l Q @moi'1 ar /, c.,.,, j,e Poc-Pre 6,'l/a.-d ft na,%• co -7
Contractor(s):
Business Name:S•4 4:- R-LAJ e, _ 4 0
Contact Name(s): DA" i iE C, RA k 15 1 a,
Mailing Address, C/S/Z: -,?N :Zy /\/& o Loc->cs 0-S- CLU 9 ICO A 4k EA
Cell Phone: ) X01 ( " ncl Line: (. 'lam) 1—a ) ' 0-1
Email:
Architect(s)/Engineer(s):
I
Business Name:I
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: )
Email:
Contact Person for Building & Code Compliance: } N i /-- e b A 6
Cell Phone: ( gi/ ) Za I U=- Land Line:
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
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PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
Single-Family Two-Family Multi-Family (#of units
Townhouse Business Office Retail
Industrial/Warehouse _Garage (#of cars Other (describe
ADDITI N UARE FOOTAGE:
yy /
ALTERATION SQUARE FOOTA
r•
2nd floor:2nd floor:
3rd floor:3rd floor:
4th fl r:411 floor:
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
2. If Commercial project, what is the proposed use:
3. Source of Heat (circleone): s Oil ro a e Solar Other
Fireplaces need a separate Burning Appliances & Chimney Application
4. Are there any structures not shown on the plot plan? YES (:N O Explain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of th rcel?
b. Is this a corner lot? YES N \
c. Will the grade be changed as a result oft e cons YES ONO
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:
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. If the work 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 1, 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: OAAJ i C L )`, 14( ie
SIGNATURE: l DATE: -- I
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
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MAP REFERENCE
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AGENCY'AND LENDING INSTIIUTTON LISTED HEREON,AND
Sherwood Acres169HavilandRoadQueensbury, New York 1280-1 TO THE ASSIGNEES OF THE LENDING INSTHUTION.'
518) 792-8474 New York Lie. No. 5013;Town of Queensbury, Warren County, New York
NO. DATE DESCRIPTION DWG. N0. 01 U62_LotC
289.11-1-59.121