RC-000438-2015 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-000438-2015 Date Issued: Thursday, January 18, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000438-2015
has been completed.
Tax Map Number: 302.14-1-1
Location: 11 HUGHES CT
Owner: Frances Parent
Applicant: Frances Parent
This structure may be occupied as a: Residential Addition 300 sq. ft.
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the 4t
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-000438-2015
Tax Map No: 302.14-1-1
Permission is hereby granted to: Frances Parent
For property located at: 11 HUGHES CT
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 Name: Frances Parent Single Family-Addition $10,000.00
Owner Address: II Hughes CT Total Value $10,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Addition 300 sq.ft.
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,December 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 Queensburybefore the ex tion date.)
Dated at the Town of ueensb /JV✓ed e eceml: 23,2015
SIGNED BY: /i�Vji' V for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION 201 -5-VI
Office Use Only
1 GSC 22 2015 Received
Date: Tax Map ID l
Tax Map ID 30 a.l LI -i -I Permit
Permit Feeo.Fee JR /a�O,,X
Zone Rec Fee
Historic Site _Yes No Site Plan#
Subdivision Name Lot# Subdivision#
Project Location 1( qoc- i+E5 (--�, /a( alp✓
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 Owner
Address Address /
Phone/E-mail Phone/E-mail 5�
Contact Person for Building&Codes Compliance: Phone
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration I'floor sf 2'floor sf Total sf Height
Single Family I
Two-Family c7(�
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
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? g k
aa
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:
l
PRINT NAME: �r W DATE: 1 ^�
SIGNATURE: DATE: ^Z 3
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
Fuel Burning Appliance & Chimney Application Office Use Only
Received
DATE: Tax Map ID
TAX MAP ID: 3C%a,14 — I —1 Permit No.
Permit Fee
ZONE:
OWNER PHONE/E-MAIL
ADDRESS
INSTALLER/ PHONE/E-MAB.
BUILDER
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE:
PHONE/E-MAIL BUILDING ADDRESS
ROOM OF INSTALL: PLANNED INSTALL DATE:
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT REQUIRED.
x FIREPLACE,FACTORY BUILT* \/ NOTE:
7�
MANUFACTURER'S
FIREPLACE,MASONRY
- INSTALLATION MANUAL
FURNACE(GARAGE ONLY)
MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: ;Model#:
Listed by: Number:
CHIMNEY INFORMATION
Masonry** (check one) BLOCK BRICK _STONE
Flue TIE STEEL Size in inches
Material _DOUBLE WALL _TRIPLE WALL _INSULATED
** 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 NAME: CL DATE: Z
SIGNATURE: DATE: is
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015