RC-000478-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000478-2016 Date Issued: Tuesday, August 15, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000478-2016
has been completed.
Tax Map Number: 289.8-1-35
Location: 983 BAY RD
Owner: Raymond Lortie
Applicant: Raymond Lortie
This structure may be occupied as a: Residential Addition 94 s.f.
Mud Room By Order of Town Board
TOWN OF QUEENSBBURY
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 Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TO" OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-000178-2016
Tax Map No: 289.8-1-35
Permission is hereby granted to: Raymond Lortie
For property located at: 983 BAY 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
Tuve of Construction
Owner Name: Raymond Lortie Single Family-Addition $3,000.00
Owner Address: 983 Bay RD Total Value $3,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Raymond Lortie
983 Bay RD
Queensbury,NY 12804
Plans& Specifications
Residential Addition 94 s.f.
Mud Room
$ 100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,July 28, 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 t ,)
Dated at the Town o Queen ry; I ue ugust.. 2016
SIGNED BY: ,�] for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Date: Permit No.
Tax Map ID jUL • ,Pepp ee 1065, co ' 120
Zone Historic? _YesN0 Rec Fee
Subdivision Name Lot# Site Plan
'4 Subdivision#
Project Location
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).
Primary Owner(s)
Address
Phone/Email ? 3 ��
Applicant
S'
Address
Phone/Email
Contractor
511 /Lit �
Address
Phone/Email
Contact Person for Building& Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration I"floor sf 2H 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 ,�� �' f
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
If commercial or industrial please indicate name of business
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? Yes No
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well(circle one) Public Private
e. Sewer or Private Septic System (circle one) Sewer Private
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 I 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 I
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 1 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: 4 f`� ` DATE: 2 A-
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
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