RC-000130-2017 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-000130-2017 Date Issued: Friday, May 11, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000130-2017
has been completed.
Tax Map Number: 295.15-1-10 •
Location: 22 SHERWOOD DR
Owner: Jesse Hayes
Applicant: Jesse Hayes
This structure may be occupied as a: Residential Interior Alterations to
basement: By Order of Town Board
1 full bathroom, living room, (no sleeping quarters) TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
owner of the responsibility for compliance with Site Plan
04
property p Y p , I
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
QL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000130-2017
Tax Map No: 295.15-1-10
Permission is hereby granted to: Jesse Hayes ,
For property located at: 22 SHERWOOD DR
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: Jesse Hayes Single Family-Alteration $7,000.00
Owner Address: 22 Sherwood DR Total Value $7,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Jesse Hayes
22 Sherwood DR
Queensbury,NY 12804
Plans&Specifications
Residential Interior Alterations to basement:
I full bathroom,living room,(no sleeping quarters)
$150.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 21,2018
(If a longer period is required,an application for an extension most be made to the code Enforcement Officer
of the Town of QueenshUQLbefore the pati n da[
Dated at the Town f Queen W Fr ) it 21,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: 2e 130017
APPLICATION Permit Fee: $
Torm o(Queensbury
742 Bay Road,Queensbury, NY 12804 Invoice#:
P:518-761-8256 www.oueensburv.net
Project Location: �;,p
Tax Map ID #: -0 ,r 1 l- l 6 Subdivision Name: D E C E a
CONTACT INFORMATION: MAR 3 0 2017 D
TONIN OF OUEENSBURY
•
COMMUNITY DEVELOPMENT
Applicant:
Name(s): .Sf-5`JC- l-Alf-5
MailingAddress, C/S/Z: 2Z _bQ Qul's's&'✓Szk_ay tit/ IZ�OT_
Cell Phone: )__72 ? - 0et2Z Land Line: (
Email: f-1 V'ESS C" (-)A/ltl Shy £V76QPQISGS. [�
Primary Owner(s):
Name(s): SAA k
Mailing Address, C/S/Z:
Cell Phone: A Land Line: �)
Email:
• Contractor(s):
Business Name: CME-
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: A Land Line: �)
Email:
• Architect(s)/Enl;ineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:-( ) Land Line: �)
Email:
Contact Person for Building & Code Compliance:
Cell Phone:�_) Land Line: �)
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
7L Single-Family —Two-Family _Multi-Family (#of units )
Townhouse Business Office Retail
Industrial/Warehouse _Garage (#of cars ) _Other (describe )
�>Uls
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: $AS5-41 f{71
1st floor: 1st floor: /00
2nd floor: 2"d floor:
3rd floor: 3rd floor:
4tb floor: 411 floor:
Total square feet: Total square feet: Zave
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ `4C60
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propane Solar Other
Fireplaces need a separate urning Appliances& Chimney Application
4. Are there any structures not shown on the plot plan? YES NO xplain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the cel?
b. Is this a corner lot? YES O
c. Will the grade be changed as a result a construction? YES
d. What is the water source? PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system?
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. I 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 priorto issuance of a certificate of occupancy.
I have read and agree to the above: I
PRINT NAME: �1/�YCf3
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017