RC-000253-2016 TOWN OF QUEEN BURY
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742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building& Codes (518) 761-82.56
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BUILDING PERMIT
Pen-nit Number:: RC-000253-2016
Tax Map No: 315.6-2-35
Permission is hereby granted to: 'Scott Hayden, Cristina Hayden.
For property located at: I l MOCKINGBIRD LN
In the Town of Queensbury,to construct or place at tlae 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 Name: Scott Hayden Single Family-Alteration $0.00
Owner Address: I1 Mockingbird LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Narne/Address Electrical Inspection Agency
Plans&Specifications
Residential Interior Alterations: 800 sq.ft.basement area converted to one bedroom, office space and laundry(this work has
already been done). New basement egress will be installed by new owner in October 2016 and that time an inspection will
be required. Other work includes 40 sq.f1.residential interior alterations to first floor;eliminated one bedroom and added
3i4 bathroom. I louse remains as a 3-bedroom borne.The number of bathrooms has increased by 304 as the first floor
renovations are completed. This permit is required for the current owners to sell this home. The new owners will complete
the construction in October 2016.
1.26.00 PERMIT FEE PAID -THIS PERMITEXPIRES: Monday,April 24, 2017.
(If a longer period is required,an application for all extension must be made to the code Enforcement Officer
of the Town of"Queensbury before the expiration date.)
Dated at the Town4 uea bury; Fri �a 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
ION.
PRhCP L STRUCTURE ,PPC C p u; Office Use Only
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'ceived
Date: ° ap ILS
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Tai Map ID Pe it Fee / ',r 00 'o 0
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Historic Sitees Nb� ".�" .I,,,,�°�N+� re � ��°` s i d71a �� �� it Ian#
Subdivision Name " Subdivision##
Project Location � ��. r" �� �C S
TOWN BD. RESOLUTION 86-2013: $Sats recreation fee 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 ('m�n(A &6*h
Owner
Address Address
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Phone/E-mail ' " Phone/E-mail m16
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Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
,"Check all that apply New Addition Alteration I"floor sf 2"d floor sf Total sf Height
Single Familyr '
Multi-Family �x
(#of units
Townhouse
Business Office
Retail -Mercantile
Factory-Industrial
Attached Garage
(l, 2, 3, 4 )
„k
Other ,M'l 1(t9p cq ay ille l pe "t-,, 431 .. ` 1
If commercial or industrial please indicate of business1
Town of Queensbury Building&Codes Principal Structure Application Revised septernba r 2015 " y„°
Proposed use of building or addition
Source of Heat(circle one) Gas (1Oil 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 comer 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) $
DECLARA TION.
1. 1 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 I 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. 1 acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. 1 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:
A
PRINT NAME: DATE: "24"
SIGNATURE: DATE:
For office use oril
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