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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CC-000130-2015
Tax Map No: 302.6-1-51.2
Permission is hereby granted to: Jie Jiang
For property located at: 756 GLEN 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: 400 Andrews ST,500 Retail-Mercantile-Alteration $10,000.00
Rochester,NY 14604 Total Value $10,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Queensbury Plaza I,LLC
400 Andrews ST,500
Rochester,NY 14604
Plans&Specifications
blue fm 9,Suite 14
former: Old China Buffet
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(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 expiration da .)
Dated at the T of Q e sbury
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Ff%51; --6142 [j
PRINCIPAL STRIT(".TITRF APPLICATION u� J
Office Use Only Iin Ct
blue fin 9 BF 130-2015 Received td/M e
Date Queensbury Plaza _ Tax Map ID 30?.( -(-5/.,
Tax 756 Glen St., Suite 14 Permit No. CC-- —20)5
Zone
Commercial Interior Alterations — Permit Fee ' 7 i '�� t rlvBiutg
Rec Fee
Historic Site Yes No Site Plan#
Subdivision Name Lot# Subdivision#
Project Locatio1T-75- / ` , 561. 14
TOWN BD. RESOLUTION 86-2013: $850 recreatiGdfee for new dwelling units—single family, duplexes/two-family,
multiple family,apartments,condominiums,townhouses,and/or manufactured&modular homes, but not mobile
homes. This is in addition to the permit fee(s).
Applicant e J i Owner
GuLopAsbua PIa 2a
Address 7060l et/k*/ 146 Address
iWiafey
Phone/E-mail • r►�► Phone/E-mail
Jic4e44 nr=Yen mug 1.69/11
Jai ka,nnanYen a&< aJ( :Corr)
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 1st floor sf 2nd floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units )
Townhouse
Business Office
Ctail-Mercantile' 3- Wail 123 9f 1;3 S FT
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
If commercial or industrial please indicate of business
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
.' Proposed use of building or addition 4/0
Source of Heat(circle one) Gas Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances & Chimneys /V O
Are there structures not shown on plot plan? do
Are there easements on the property? iIo
Site Information
a. Dimensions or acreage of lot 6000 5f
b. Is this a corner lot? /U U
c. Will the grade be changed as a result of construction Yes y No
d. Public water or Private well }/JS
e. Sewer or Private Septic System YQS
Value of all work to be performed (labor or materials) $ 110000
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 I& I j DATE: AO V/5
SIGNATURE: � � DATE: f 0/l lS
4
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 2015