RC-000167-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
t Community Development-Building& Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000167-2015 Date Issued: Monday,November 7, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000167-2015
has been completed.
Tax Map Number: 301.17-1-44
Location: 17 JOHN ST
Owner: DONALD ROTH
Applicant: DONALD ROTH
This structure may be occupied as a:Enclosed Porch 144 s.f.
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, 4d
4
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.
Amok TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
me
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000167-2015 $f 2O15'��vc7
Tax Map No: 301.17-144 REVISED
Permission is hereby granted to: DONALD ROTH
For property located at: 17 JOHN ST
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: Single Family-Addition $15,000.00
Total Value $15,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
DONALD ROTH
17 John ST
Plans&Specifications
PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,October 3,2016
(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 ueensb [ / /p but er 1,2015
SIGNED BY: /VJ for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FitiM
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150430 Application Number: A20150430
Tax Map No: 523400-301-017-0001-044-000-0000
Permission is hereby granted to: DONALD & JEAN ROTH
For property located at: 17 JOHN St
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: DONALD &JEAN ROTH Enclosed Porch $15,000.00
17 JOHN St Total Value $15,000.00
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
BALOGH CONSTRUCTION
793-6794
20 JOHN St
OUEENSBURY NY 12804-0000
Plans&Specifications
2015-430
Porch--3 season 144 s.f.
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 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 Q ensb , , 1 ctober 01, 2015
11.SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
F I_: - Onl
ACCESSORY STRUCTURE A ' • a!►, V
DATE gE / ' T 2. 0 SEP 14 2
• . ID + -
1 2-O;
TAX MAP ID =i7b ;r,� O.
OF QUEENS:U rmit ee , �� .8\
ZONING „ (DING& COD: ''ec Fe-
1
HISTORIC SITE Yes No c,I •pproi-Is
SUBDIVISION NAME /1 6 VA/ f V', 'Z ) Lot# / 2
APPLICANT `'vI A) I-' Rcr+1 - OWNER s�/ -! -'
ADDRESS f 7 Z-15 I-tN S7ti c --- r ADDRESS /I'
�rJ& t)s 3& -V, Ar /2'o'
PHONE / / v 6 / O lI(
PHONE
CONTRACTOR 191---0G.H CONS 11w OTC`C N COST OF CONSTRUCTION(ESTIMATED): $ /3;000
ADDRESS: 2 / ��
� ^ BUILDING ADDRESS: / 7 Li /o S/ },[5y.
1
Qvsvus 6U2 y, NK,Z-Q2
PHONE: 7 93 6 7 ?//
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE 7G) 6-7eT G40 PHONE 7?3-6 7?q
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 1s'floor sq.ft. 2nd floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck
Deck
Detached Garage(#of cars_)
Dock
Pole Barn
Porch-open
** Porch—3 season,Covered,Enclosed V /1-/If ,5f
Shed
Other Accessory Structure(s)
**Considered floor area&must comply with FAR(floor area ratio)requirements if located in the WR zone
DECLARATION: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the
application, plans and supporting materials are a true &complete statement description of the work proposed,that all work will be
performed in accordance with the NY State Building Codes, local building laws and ordinances; and in conformance with local
zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy. 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 occu.-ncy. C C
✓I have read and agree to the above: Print Name: EA-A) f /�/l Date: `
PISignature: Date: 65.
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
Feb, 16. 2016 11 :56AM MDIA No. 0358 P. 2/4
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
afrtfj lPed that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owner: Gene Ross Date:
02/0112016
Occupant:Addition Locatio
97 John St
OccupancySingle Family Dwg. 'Queensbury,Warren Co. NY
Applicant T
Marlow Electric
Robert D. Marlow
PO Box 448
LLake Luzerne, NY 12846 J
No. Joseph A.Holmes
001818196942EL
Equipment:
Switches; 5- Receptacles;2-Fixtures
Theis certificate applies to the electrical wiring to me electrical equipment listed immediately null and void. This cardficate applies only to the use,occupancy and
above and the Installafon inspected as,of the above noted date based on a Nsval ownership as indicated herein. Upon a change In the use,occupancy Or ownership
inspection, No warranty is expressed or implied as to me mechanical safety,effi- of the property Indicated above,this cartifcata shall be immediately null and void,
ciency or fimeas Of me equipmam for any pardcular purpose. This Certificate small In the event Met this cafrata becomes invalid based upon the above conditions.
oe valid for a period of one year from the above noted date. Should the electrical this certificate may be revelldated upon reinspection by Middle Department
system to which this Certificate applies be altered In any way including but not limit- Inspection Agency.Inc. An application for inspection muss be submitted to Middle
ed to.me IntrotluClion of eddalonal eleClrldel equipment and/or the replacement of Department Inspection Agency, Inc. to initiate the Inspection antl revalidation
airy of the mmponents installed as of me above oared date,this ceriiACate shall be praceas. A fee will be charged fof tnia service.
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