CC-000408-2016 :- TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CC-000408-2016 Date Issued: Thursday, September 15, 2016
This is to certify that work requested to be done as shown by Permit Number CC-000408-2016
has been completed.
Tax Map Number: 296.19-1-2
Location: 123 QUAKER RD
Owner: Glen Street Associates,LLC
Applicant: BBL Construction Services
This structure may be occupied as a:Commercial Interior Alterations
1,690 sq. ft. first floor By Order of Town Board
TOWN OF QUEENSBUR,Yt
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, /d A[
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.
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-000408-2016
Tax Map No: 296.19-1-2
Pennission is hereby granted to: BBL Construction Services
For property located at: 123 QUAKER RD
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: Glen Street Associates, LLC Business Office-Alteration $0.00
Owner Address: 100 Glen ST,3A Total Value $0.00
Glens Falls,NY 12801
Contractor or Builder's Name/Address Electrical Inspection Agency
BBL Construction Services
302 Washington AVE,Extension
Albany,NY 12203
Plans&Specifications
Commercial Interior Alterations
1,690 sq.ft. first floor
$ 338.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, July 8, 2017
(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 xpiration dat .)
Dated at the Town o Queen ry; Wrid a 016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office use Only
Date: d12�11 _ Permit No. e("
Tax Map ID 279. 0-1-2 Permit Fee 33 ,c>U 7`f
Zone Cz Historic? _Yes )�No Rec Fee j, -
Subdivision Name Lot# Site Plan
Subdivision#
Project Location 123 0ua]ker CJ
TOWN BD.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).
PrimarT Owner(s) p1�r HAv, f 4�n lrft-t A z+ta-,iS -//-C-
Address
//-G
Address 1� 6kn '5�f 5.A_*3A
Phone/Email
Applicant
Address CD2 rx- Alba,y) P V '2 203
Phone/Email 51Y-3�v-o' ��; e(andv (9)40"c.co,,,%
Contractor rr r J")
l,�Itm . ai Ap,, �plrcon7
Address
Phone/Email
Contact Person for Building &Codes Compliance: Tr_iL 4 d.r. Phone 91-SZ-06?
TYPi,OF CONSTRUCTION
✓Check all that apply New Addition Alteration 151 floor sf 2nd floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units )
To«•nhoiuse
Business Office
4'�nw�u+e
Retail-Mercantile
Factory-Industrial Community Gare Physicians
Attached Garage Vascular
(1, 2, 3, 4+) 123 Quaker Road
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
T
If commercial or industrial please indicate name of business
Proposed use of building or addition LGP me4lr. 4a1 �w 6u
Source of Heat(circle one) G Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances&Chimneys 's furr�a�G
Are there structures not shown on plot plan? VIA
Are there easements on the property? M A
Site Information:
a. Dimensions or acreage of lot 1100-5 !.0 ozw� !W
b. Is this a comer lot? Yes No
c. Will the grade be changed as a result of construction Yes X _No
d. Public water or Private well(circle ane) by Private
e. Sewer or Private Septic System(circle one) See Private
Value of all work to be performed(labor or materials) Is
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: DATE: •��
C_
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 January 2016