RC-000209-2015 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: RC-000209-2015 Date Issued: Monday,November 7, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000209-2015
has been completed.
Tax Map Number: 296.17-1-4
Location: 12 GREENWAY DR
Owner: SHEILA PEASLEE
Applicant: SHEILA PEASLEE
This structure may be occupied as a: Egress window
By Order of Town Board
TOWN OF QUEENNSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, ((( vvfAAAI"' VVV
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: RC-000209-2015
Tax Map No: 296.17-14
Permission is hereby granted to: SHEILA PEASLEE
For property located at: 12 GREEN WAY 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
Tvce of Construction
Owner Address: 12 Greenway DR Single Family-Alteration $1,400.00
Queensbury,NY 12804 Total Value $1,400.00
Contractor or Builder's Name/Address Electrical Inspection Agency
SHEILA PEASLEE
12 Greenway DR
Queensbury,NY 12804
Plans&Specifications
Egress window
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 27,2016
(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 the Town of ury; on ) N em 2,2015
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only,
i '(`,! Receivdo ' ,
��iac�( a� �� lJ Tax Map rl
Date: U
TaxMapID oZ �1�,-- /�— — ��T 2 I'rjg17N G-000zo�- 2ols
I M Fe i20
Zone Q t o - I �Ct rrlt(h �� T�, Rec Fee Ft
e )
Site Yes ✓ No Site Plan#
Subdivision Name Lot# Subdivision#
Project Location la G(4egr)lA)�D11l*
TOWN 81).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 She,/e, ?,ec,51ze, Owner
Address /a 6�Qe� �L Address
Phone/E-mail CS/d '3 (o4(P Phone/E-mail
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 11 floor sf 2nd floor sf Total sf Height
Single Family { ✓ 330 42
Two-Family U
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 additionr'0_SS
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? N
Site Information
a. Dimensions or acreage of lot ; '31 &C(103
b. Is this a corner lot? N()
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. 1 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 l 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: h I T DATE: 1C) JaQ(5
SIGNATU . DATE: 6 L
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