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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�.............-.............................................................................................. .................. ��)) Location....5.�..r�. Z. (':. r .......CZ.p................................4�tLy /................... Inst lation Consisting of../.L��� c ✓TL!/f /O........................................... ...... ............................t:............................................................................................................................................ .................................................................................................................................................................................... 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.