RC-000214-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000214-2015 Date Issued: Thursday, December 17, 2015
This is to certify that work requested to be done as shown by Permit Number RC-000214-2015
has been completed.
Tax Map Number: 296.8-1-24.1
Location: 5 CHELSEA PL
Owner: RICHARD O'CONNOR
Applicant: RICHARD O'CONNOR
This structure may be occupied as a: SFD addition 192 s.f.
By Order of Town Board
TOWN OF QUEENSSBBUR/Yf
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, GGG211+++ V
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
RL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000214-2015
Tax Map No: 296.8-1-24.1
Permission is hereby granted to: RICHARD O'CONNOR
For property located at: 5 CHELSEA PL
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 Address: 5 Chelsea PL Single Family-Addition $19,000.00
Queensbury,NY 12804 Total Value $19,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
RICHARD O'CONNOR
5 Chelsea PL
Queensbury,NY 12804
Plans&Specifications
SFD addition 192 s.f.
PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,October 17,2016
(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 et nda , ct er 2015
y;
SIGNED BY: j for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION p� Office Use Only
Date: /a /s FOD � � � � 1'✓ a pID -O -ze
Tax Map ID - — q. A 1111
U 7 2015
i Fee 1(22 , 00
Zone e
Historic Site Yes �_ No TOWN OF —rN—SBLI 'te P n#
BUILDING CODE Subdi ision#
Subdivision Name /-1 deA L 'Plk, 0
Project Location 6P -2003- c,
TOWN ED. 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).
ApplicantC ti h t t Owner S q-7�
Address S G� e (lcir �jq Address
�
Phone/E-mail _(aoa Phone/E-mail f
0C- w k�e ,f iV
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
,/Check all that apply New Addition Alteration I floor sf 21 floor sf Total sf Height
Single Family v/
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 stq a6 su,u
Source of Heat(circle one) as Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances&Chimneys 4/0
Are there structures not shown on plot plan? Alo
Are there easements on the property?
Site Information
a. Dimensions or acreage of lot
b. Is this a corner lot? ^/p
c. Will the grade be changed as a result of construction _ Yes No
d u tc wate or Private well bi,
Sewe r Private Septic System e
Value of all work to be performed (labor or materials) $ o0 0
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. 1 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:
/ n � �/
PRINT NAME: /�i cGi e�+ !�. /1Jn/✓oma DATE: /v& /
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 September 2015