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RC-000804-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: RC-000804-2016 Tax Map No: 226.19-1-91 Permission is hereby granted to: Wayne Martin For property located at: 186 LAKE PKWY 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 Tvyceof Construction Owner Name: Nancy Monro-lcke Single Family-Alteration $75,000.00 Owner Address: PO Box 655 Total Value $75,000.00 Hague,NY 12836 Contractor or Builders Name/Address Electrical Inspection Agency Wayne Martin 2515 Pauline AVE,Schenectady NY 12306 Plans&Specifications Residential Alteration Support Floors,Replace Headers $60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,November 29,2017 (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 a nation daWe Dated at the Town Queens //Tur 29,2016 SIGNED BY: �yjY ,afor the Town of Queensbury. Director of Building&Code Enforcement PRINCIPAL STRUCTURE APPLICATION Office Use Only Received Date: OC- -1L o 6-e_y" Zp 1 Tax Map ID Permit No. (LC-^�pL� Tax Map ID Permit Permit Fee 1410 i� 0 Zone es, d-evb — eo_ta Rem �Ywgk �y )2 13 Historic Site _Yes No Site Plan# Subdivision Name Lot# Subdivision# Project Location J10(o L AL �a�kW�� l L_AXfK e-36' 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). Applicant Owner 2- rY � CA.Y1 ' 1'/\"&V-1RJ- �Ck-e Address _ "NE r Address p G55 SA I/. h1\ la$36 Phone/E-mail 12306 Phone/E-mail ,y 51 S-5 y 3 -boy NtitL r—_S I L"e \aevr�at1'c Eno" ¢1 L. Gdf`_t Contact Person for Building&Codes Compliance: V v O lk1^P, \^/kav H�-y Phone 9SS-81 TYPE OF CONSTRUCTION ✓Check all that apply New Addition Alteration In floor sf 21d floor sf Total sf Height Ingle Family{ 41 acts` Two-Family Multi-Family (#of units_) TownhouseRo 2 a E Business Office lSo 15 ; a Retail-Mercantile Factory-Industrial BUILDING&C DES 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 6 b. Is this a comer lot? N O c. Will the grade be changed as a result of construction _ Yes __),/ No d. Public water or Private well lc,_ e. Sewer or Private Septic System vv� Value of all work to be performed (labor or materials) $ d" 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: N AYE c.J M t k n.r n - I c Ke DATE: 0clo,be r 1,201 to SIGNATURE: DATE: For office use out 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 �����2��-� [ S � Z � �� �� �ST�� Pr"1�� C® � � © �= `� � � tr�ib � ,� l IA . 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