RC-000091-2017 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-000091-2017 Date Issued: Monday, December 18,2017
This is to certify that work requested to be done as shown by Permit Number RC-000091-2017
has been completed.
Tax Map Number: 289.14-1-4
Location: 57 FITZGERALD RD
Owner: Kathy Liebetreu,DAVID LIEBETREU
Applicant: Phinney Design Group
This structure may be occupied as a:Residential Addition 120 s.f.
Residential Alteration 3800 s.f. By Order of Town Board
Gas Fireplace 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 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-000091-2017
Tax Map No: 289.14-1-4
Permission is hereby granted to: David Jarvis Carpentry
For property located at: 57 FITZGERALD 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
Type of Construction
Owner Name: Kathy Liebetreu Single Family-Alteration $400,000.00
Owner Address: 10244 Statfield DR Total Value $400,000.00
Collierville,TN 38017
Contractor or Builders Name/Address Electrical Inspection Agency
David Jarvis Carpentry
35 FITZGERALD RD
Queensbury,NY 12804
Plans&Specifications
Residential Addition 120 s.f.
Residential Alteration 3800 s.f.
Gas Fireplace
$720.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Wednesday,March 21,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu before ydUes
tion date.)
Dated at the Town of ueensbu 017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: 4G -
APPLICATION Permit Fee: $ �� 'OQ
Toxin of Queensbury
742 Bay Road,Queensbury, NY 12804 Invoice#: 15�(lJ
P:518-761-8256 www.gueensbury.net
Project Location: 57 FITZGERALD ROAD, QUEENSBURY,NY 12804
Tax Map ID #: 289.14-1-4 Subdivision Name: N/A
CONTACT INFORMATION: n
• Applicant: MAR 10 2017
Name(s): David Liebetreu
Mailing Address, C/S/Z: 10244 Statfield Drive Collierville, TN 3801 TOWN OF URY
Cell Phone: (901) 419-1999 Land Line:
Email: David.Liebetreu@ipaper.com
Primary Owner(s):
Name(s): _David and Kathy Liebetreu
Mailing Address, C/S/Z: 10244 Statfield Drive, Collierville, TN 38017
Cell Phone: (901) 419-1999 . Land Line:
Email: David.Liebetreu@ipaper.com & mommaliebs@gmail.com
• Contractor(s):
Business Name: David Jarvis Carpentry
Contact Name(s): David Jarvis
Mailing Address, C/S/Z: 35 Fitzgerald Road, Queensbury, NY, 12804
Cell Phone: (518) 932-9971 Land Line: (518) 793-5780
Email:
• Architect(s)/Engineer(s):
Business Name: Phinney Design Group
Contact Name(s): Brennan D. Drake, AIA
Mailing Address, C/S/Z: 142 Grand Ave. Saratoga Springs, NY 12866
Cell Phone: (518) 587-7120 ext 15 . Land Line: (518) 587-7120 ext 15
Email: BDrake@PhinneyDesign.com
Contact Person for Building & Code Compliance: Brennan D. Drake, AIA
Cell Phone: _ See Above Land Line:
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial X Residential
WORK CLASS:
_2L Single-Family —Two-Family —Multi-Family (#of units )
Townhouse Business Office Retail
—Industrial/Warehouse —Garage (# of cars ) —Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: -156 SF 1st floor: 1.:,00 2nd
2nd floor: +120 SF floor: 2,,600 3rd
3rd floor: n/a floor: &JtA 4th
41h floor:_ n/a floor: MIA, X576
Total square feet: -36 SF Total square feet: J,g00 SF
esu y
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 4400.oao
2. If Commercial project, what is the proposed use: n/a
3. Source of Heat (circle one): Gas Oil Propane Solar Other
Fireplaces need a separate Fuel Burning Appliances &Chimney Application
4. Are there any structures not shown on the plot plan? YES NO Explain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? —+/- 0.74 acres
b. Is this a corner lot? YES NO
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Private
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If the work is not completed 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 and/or
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. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. 1 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: A,v%1� E —tj .
SIG URE: DATE: 2— 21-
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
Fuel Burning Appliance & Chimney Application Office Use Only
Received
DATE: -� m u 7 Tax Map ID
TAX MAP ID: Iq- I-y Permit No.Permit Fee
ZONE: Wwtr�;Vn-I- 'R4&.&4IG1 (ty
OWNERaVld KN PHONE/E-MAIL
ADDRESS lo:�yy 15l.-&Fiell brtvt Gollltl- oll 38517
INSTALLER/ -zW
,ta •s0.,V15 '`47 PHONE/E-MAIL CSI�) 932-4y7�
BUILDER
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: G
PHONE/E-MAILCr�1K79k7-71;tV gMrirKBUILDING ADDRESS
ROOM OF INSTALL: �V��rG1�1p,I,t, ylOw"% PLANNED INSTALL DATE: ��17
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT REQUIRED.
FIREPLACE,FACTORY BUILT* X NOTE:
/� MANUFACTURER'S
FIREPLACE,MASONRY
INSTALLATION MANUAL
FURNACE(GARAGE ONLY
MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: Model#: y Z.ST
Listed by: U L Number: UL 3073
CHIMNEY INFORMATION D
Masonry** (check one) _BLOCK BRICK _STONE MAR 0 2017
Flue _TIE STEEL 0Size in inches
Material _DOUBLE WALL _TRIPLE WALL _INSULATED BULO NG & CODES
** If non-masonry provide manufacturer name: ; Model#:
DECLARATION: Construction/installation must conform to NYS Fire Prevention & Building Code and/or
manufacturer requirements. The applicant or owner agrees to comply with all applicable laws, ordinances,
regulations, and all conditions that are part of these requirements and also will allow inspector's to enter premises
to perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE:
PRINT NAM -' ' z DATE:
SIGNATU DATE:
Town of Queensbury Building&Codes Revised September 2014
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No........................................Cert. c. 44959 Cut-in Card No.....................................
Owner.....................l ! G'..t�.............-..............................................................................................
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Location....5.�..r�. Z. (':. r .......CZ.p................................4�tLy /...................
Inst lation Consisting of../.L��� c ✓TL!/f /O...........................................
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InstalledB ... ..e)....................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This
ancelled:-This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making ins ections at any time, and if its
rules are violated,the Company shall have the right-to rev a this c ate.
Date./. ...ZZ-)-(7.. .............. INSPECTOR....a........-.. ....�G .............................
Member N.FP.A..I.A.E.I.