RC-000270-2015 TOWN OF QUEENSBURY
� 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000270-2015 Date Issued: Monday, June 11, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000270-2015
has been completed.
Tax Map Number: 295.15-1-10
Location: 22 SHERWOOD DR
Owner: Jesse Hayes
Applicant: Jesse Hayes
This structure may be occupied as a: Res. Alt. 454 sq. ft. & fireplace
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 Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
� Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000270-2015 �� r�Q \15— �>qb
Tax Map No: 295.15-1-10 REVISED
Permission is hereby granted to: Jesse Hayes
For property located at: 22 SHERWOOD DR
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 Address: 22 SHERWOOD DR Single Family-Alteration $15,000.00
Queensbury,NY 12804 Total Value $15,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Jesse Hayes
22 SHERWOOD DR
Queensbury,NY 12804
Plans&Specifications
Res.Alt.454 sq.ft. &fireplace
PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,October 29,2016
(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 Town of Que i W dries . , ve r 4,2015
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATIO `C fice Use Only
E C E t E It •ceived
Date: • Map ID �'
Tax MapID 2 5ti��—\—To AUG 31 2015 mit No. f8
': mit Fee .10
Zone ' Fee
WN OF QUEENSBURY
Historic Site Yes BUILDING &CODES t: Plan#
Subdivision Name \' C;'.y \ �r_iov, 9 Lot# Subdivision#
*k
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 " e5C:67 AYES\j Owner 4‘/\,e—
Address z-z < c`kr0e Address
A
Phone/E-mail '72 . Ei9 Z L Phone/E-mail
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 15`floor sf 2nd floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units )
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other. `" " 'A11-0 619464r G`CA
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 C- -Q-cv-r,(\
Source of Heat(circle one) (r-da-ss 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? /U
Site Information
a. Dimensions or acreage of lot
b. Is this a corner lot? /U
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well qtiAlq,
e. Sewer or Private Septic System SEQT<<
Value of all work to be performed (labor or materials) $ J U- 5-1
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: ' 6-55C NYC--5 DATE: E/3 l t s-
SIGNATURE: DATE: ( 3 1 p5-
For
l5_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
Fuel Burning Appliance & Chimney Application Office Use Only
eceived
DATE: DEGEBVE \ : m
. �Or —TAXMAPID: ;rmitFee I I vKv
ZONE: AUG 31 2015
TOBIOF NR:OWNER � �� �SS BUILDING&COD ,
-MAIL 777-- 8(�
ADDRESS 2 Z. 5 free i-x7c ) 6 at,Cle7ti P�' 1L' Y LZ94
INSTALLER/ PHONE/E-MAIL
BUILDER p
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE:
PHONE/E-MAIL BUILDING ADDRESS
ROOM OF INSTALL: C e6-AT 200W1 PLANNED INSTALL DATE: JFC ZC 5-
FUEL
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT REQUIRED.
FIREPLACE,FACTORY BUILT* NOTE:
MANUFACTURER'S
FIREPLACE,MASONRY
INSTALLATION MANUAL
FURNACE(GARAGE ONLY) MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: ; Model#:
Listed by: Number:
CHIMNEY INFORMATION
Masonry** (check one) BLOCK BRICK STONE
Flue TIE STEEL Size in inches
Material DOUBLE WALL TRIPLE WALL INSULATED
** If non-masonry provide manufacturer name: ; Model #:
DECLARATION: Construction/installation must conform to NYS Fire Prevention & Building Code and/or
manufacturer requirements. The applicant or owner agrees to comply with all applicable laws, ordinances,
regulations,and all conditions that are part of these requirements and also will allow inspector's to enter premises
to perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE:
PRINT NAME: AC,-).5C
DATE:
SIGNATURE: DATE: 0/3 i/S-
6
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014