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2015-376 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 (aw Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150376 Date Issued: Friday, October 09, 2015 This is to certify that work requested to be done as shown by Permit Number P20150376 has been completed. Tax Map Number: 523400-295-019-0001-032-000-0000 Location: 16 PINEWOOD Ave Owner: MICHAEL LA POLLA Applicant: MICHAEL LA POLLA This structure may be occupied as a: Residential Alteration By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the 4 ak-� 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 nforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY VtroiES1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150376 Application Number: A20150376 Tax Map No: 523400-295-019-0001-032-000-0000 Permission is hereby granted to: MICHAEL LA POLLA For property located at: 16 PINEWOOD Ave 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 Value Owner Address: MICHAEL LA POLLA Residential Alteration $1,500.00 ASHLEY PLIMPTON LA POLLA Total Value $1,500.00 19 PINEWOOD Ave QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications BP 2015-376 60 sq. ft. residential alteration- change existing 6 ft. slider-door to an 8 ft. slider- change out header for opening. $60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 24,2016 (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 n of ens ; i`,( . ,August 24,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement • PRINCIPAL STRUCTUR -' ' -+ lin "0 1`v EOffice Use Only iReceived Date: (�' 2015Tax Map ID )-Q lel-1-3a ����� '� Permit No. Tax Map ID a2gs 3 iir + Permit Feei v� Zone TOOF QU,u DING&CODES Rec Fee Historic Site Yes Site Plan# Subdivision NameObt-ta4.4 /‘ec,ilpiA 3 Lot# Subdivision# TOWN BD. RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS - SINGLE FAMILY, DUPLEXES/TWO-FAMILY, MULTIPLE FAMILY, APARTMENTS, CONDOMINIMUMS, TOWNHOUSES,AND/OR MANUFACTURED&MODULAR HOMES,BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE. Applicant k � p D G 1 4 Owner 14 :1(e Address IC lel i1i P 14,000 4 V Address /6 1'like Waco Q Ave 67g 0,4A QaAy tiv Qctcrys lI ciRr �•y Phone/E-mail 7%/ 0 4 Phone/E-mail 7q/ - v' Io d Contact Person for Building&Codes Compliance: 7.3 ti W,�< <'j Phone 50-$57'3c53 TYPE OF CONSTRUCTION /Check all that apply New Addition Alteration 1$`floor sf 2nd floor sf Total sf Height Single FamilyoiLater ^ // Two-Family �o��� Gt^ r i ����, e_ Multi-FamilyCj•-49t7 kimer (#of units ) —� Townhouse Business Office Retail-Mercantile Factory-Industrial Attached Garage (1, 2, 3, 4+) Other Town of Queensbury Building&Codes Principal Structure Application Revised September 2014 If commercial or industrial please indicate of business Proposed use of building or addition Source of Heat(circle one) Gas Oil Propane Solar Other Fireplace: Complete a separate application for Fuel Burning Appliances & Chimneys Are there structures not shown on plot plan? Are there easements on the property? Site Information a. Dimensions or acreage of lot b. Is this a corner lot? c. Will the grade be changed as a result of construction Yes No d. Public water or Private well e. Sewer or Private Septic System Value of all work to be performed (labor or materials) $ DECLARATION: 1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. If work is not complete 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/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: J©S A w I G C r'o-- DATE: ✓` /e` /5 SIGNATURE: / Gr DATE: j /e ` /s For office use only Operating Permit Issued: Yes No Occupancy Type Construction Classification Assembly Occupancy Limit Special Conditions _ Town of Queensbury Building&Codes Principal Structure Application Revised September 2014