RC-000190-2016 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-000190-2016 Date Issued: Monday, May 9, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000190-2016
has been completed.
Tax Map Number: 302.5-1-83
Location: 4 GREENWAY NORTH
Owner: CHARLES FRITTS
Applicant: CHARLES FRITTS
This structure may be occupied as a: Residential Alteration 348 s.f.
Converted attic space to bedroom 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 Direct Building&Code nforce nt
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 flay(toad,Queensbury,NY 12804-5904 (51.8)761-8201
Community I..)evelopment-Building& Codes (_51.8)761-8256
BUILDING PERMIT
Permit Number: RC:-000190-2016
"fax Map No: 302,5-1-83
Permission is hereby granted to: CHARLES I'Itl`I-FS
For property located at: 4 CsREF'NWAY NORTH
In the Town ofQucensbury,to construct or place at the above location in accordance with application together
with plot plans and other infirrmation hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
"I`ype of"Constru,ction
Owner Name: (11Al2.I F"S FRITTS Single]Family-,alteration S2,0410M
Owner Address: 641 Ralph RD Total Value $2,000.00
Lake Lucerne,NY 12846
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Alteration 348 s.1
Converted attic space to bedroom
560.00 l'1 'rM11 I f:,E PAID-11 US P1iirMIT'"EXPIRES: Monday,April 3,.2017
(If a longer period is required,an application for an extension must he made to the code Enforcement Officer
of the Town of'QueensburZ,belbre the ex ration date..)
Dared at theon o t)uceats 'rid
, !12M`6
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enlercement
PRINCIPAL STRUCTURE APPLICATION
Office 11sc�
Received
Date: ' �. Tax.Map ID
Tai Map ll t ��� �'t I ?:mo. C 0o0 no.N I w
w tt I
'one F.
AN 07 201[ "l I
Historic Site Yes No
Subdivision Marne I d"f' 7I' UE-1 l' ton
'
Project Location � � i ,a
TOWN BIS. RESOLUTION 86-2013; $850 recreation tee for new dwelling units--single family, duplexes/tvwro-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 Owner
Address � Address
Phone/E-mail Phone/E-mail
-35' 3 - 911
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
,/Check all that apply New Addition Alteration Int floor sf 2"'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
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
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) $ t5-L�:1
DECLARATION.-
1.
ECLARATION.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. 1 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: G' el f/0-5 TI 1DATE: �/ 1
SIGNATU DATE: `I
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