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TOWN OF QUEENSBURY
dia 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-000418-2016
Tax Map No: 301.17-3-53
Permission is hereby granted to: Collette Construction Inc.
For property located at: 25 CAITLIN DR
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: Jonathan Demers Single Family-Alteration $10,000.00
Owner Address: 25 CAITLIN DR Total Value $10,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Collette Construction Inc.
38 Collette LN
Hudson Falls,NY 12839
Pians&Specifications
Residential Alterations 350 s.f.
$ 60.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, JUN 14. 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 e expiratio at )
Dated at the To of Que bury T e , July 19,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Received
Date: ,rQ f I Tax Map ID
Permit No.
Tax Map ID '. _ ]. 2016 Permit Fee
Zone Rec Fee
Historic Site Yes No Site Plan#
Subdivision Name Lot # Subdivision #
Project Location
TOWN E313. 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 ] ,1� !1 �_e 1 bL Owner J01 10i Rrr Ap NS
Address 3F 1�P 41 Address � 01 f-t,�, 64
U P 4g � ,fly I Sfi`I
Phone/E-mail Phone/E-mail
Contact Person for Building&Codes Compliance: ,v' ,70 11 Phone 3
TYPE OF CONSTRUCTION
(Check all that apply New Addition Alteration Is'floor sf 2nd floor sf Total sf Height
Single Family �I ��
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 S'r 'A ,� I�t +,
Source of Heat(circle one) a 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 It C.
e. Sewer or Private Septic System S
Value of all work to be performed(labor or materials) $ 10
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
constricted facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above: jj
PRINT NAME: zy t r I%1� DATE: 6( 2 6 l6
62,4116
DATE: �
SIGNATURE:
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