CC-000292-2015 AdIffilk TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
qw— Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CC-000292-2015 Date Issued: Wednesday, December 9, 2015
This is to certify that work requested to be done as shown by Permit Number CC-000292-2015
has been completed.
Tax Map Number: 296.19-1-29
Location: 357 BAY RD
Owner: Old School House L.L.0
Applicant: Glens Falls Optometry
This structure may be occupied as a:Commercial Alterations
By Order of Town Board
TOWN OF QUEENSBURY
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 o Building&Code Enfor ement
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: CC-000292-2015
Tax Map No: 296.19-1-29
Permission is hereby granted to: Glens Falls Optometry
For property located at: 357 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
Tyne of Construction
Owner Address: 2546 State Rte 9L Business Office-Alteration $0.00
Queensbury,NY 12804 Total Value $0.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Old School House L.L.0
2546 State Rte 9L
Queensbury,NY 12804
Plans&Specifications
Commercial Alterations
PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 5,2016
(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 Qunas
Fr ay4efol
15
SIGNED BY: heTown of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION
Office Use Onlv
Received
Date: Tax Map ID
Permit No. 201
Tax Map]D Permit Fee 7 a
Zone Rec Fee
Historic Site _Yes No Site Plan#
Subdivision Name Lot# 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).
Applicant G' S L�5 �j ��f Owner
Address js Z �� S� fL Address U
lt8o
Phone/E-mail -71-1- 3304- Phone/E-mail
Contact Person for Building&Codes Compliance: b K 1\ W t au 5 Pho�e�l S` 3 �- 13 l 3
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Iteration V floor sf 24d floor sf Total sf Height
")54le Family
o-Family
7i-Family
( of units
wnhouse
Business Office
Retail-Mercantile
tory-Industrial
tta ed Garage
X3, 4+)
r
If commercial or industrial please indicate of business
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
If commercial or industrial please indicate of business
Proposed use of building or addition Q(� tCa,Q
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?
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. 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: t 1��^ 11 DATE: a a�
SIGNATURE: r DATE: D S
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 2014