CC-000288-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: CC-000288-2016 Date Issued: Thursday, May 26, 2016
This is to certify that work requested to be done as shown by Permit Number CC-000288-2016
has been completed.
Tax Map Number: 302.6-1-51.2
Location: 756 GLEN ST
Owner: Queensbury Plaza I,LLC
Applicant: Queensbury Plaza
This structure may be occupied as a: Deck 41.25 s.f.
Off back of Blue fm 9, Suite 14 (for deliveries) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance 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.
x TOWN OF Q,UEENSBURY
742 Bay Road,Queensbury,NY 128414-59414 (518)761-82411
Community Development - Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: CC-000288-2016
Tax Map No: 302.6-1-51.2
Permission is hereby granted to: Queensbury Plaza 1, LLC
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 Name: Queensbury Plaza 1, LLC Retail-Mercantile-Alteration $41.00
Owner Address: 44141 Andrews 5T, 500 Total Value $0,00
Rochester,NY 146414
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans& Specifications
Deck 41.25 s.f.
Off back of Blue fun 9, Suite 14(for deliveries)
$ 75.4141 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, May 13, 24117
(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 flee Town o1' ury richeror
4116
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SIGNED BY: the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Received
Date: Tax Map ID
Tax Map ID Permit No. c e)�- 2-0�( k o
Permit Fee , lnlv6kl
Zone Rec Fee
Historic Site Yes No Site Plan#
Subdivision Name Lot 4 Subdivision#
Project Location
TOWN 131). RESOLUTION 86-2013: $850 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 Owner
..............
Address Address U
ZA yoef) 7—
JWW czov, Al. Vk I
Phone/E-mail Phone/E-mail
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
v"Check all that apply New Addition Alteration I"floor sf 2 `u 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) $
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. 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. 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: p f—t DATE: L57 11
SIGNATURE: _ �.^ DATE: !
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