RC-000510-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: RC-000510-2016 Date Issued: Tuesday, August 16, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000510-2016
has been completed.
Tax Map Number: 289.15-1-34.7
Location: 48 SURREY FIELD DR
Owner: Frank Atheam,Jackie Atheam
Applicant: Hilltop Construction
This structure may be occupied as a: Residential Alterations 48 sq.ft.
2 egress basement windows By Order of Town Board
and bathroom installtion in the basement TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, ayy(/ 66
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
1W Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000510-2016
Tax Map No: 289.15-1-34.7
Permission is hereby granted to: Hilltop Construction
For property located at: 48 SURREY FIELD 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
Type of Construction
Owner Name: Frank Atheam Single Family-Alteration $50,000.00
Owner Address: 48 SURREY FIELD DR Total Value $50,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Hilltop Construction
51 Crowley RD
Hudson Falls,NY 12839
Plans&Specifications
Residential Alterations 48 sq.ft.
2 egress basement windows
and bathroom installtion in the basement
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 11,2017
(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 the a/'fJ�ratio//nn dateOtsl
Dated at the Town 0,Queens f/ /J T'G ,2016
L / /p
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Date: �
Permit No. `' (—^ '
Tax Map lD Permit Fee $ i,., e e- 90 i
Zone Historic? _Yes No Ree Fee
Subdivision Name Lot# Site Plan#
#
Project Location yr6 Surrey Fietcts Subdivision
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).
Q nn � l ,
4 2016
Primary Owner(s) Frank �-\ -Ja4 i e it T►1 e-a r W
Addressg n sur✓'�e. Fie cQ lJrr v � Uee �u�
Phone/Email r13 -QO q j -�a 4�ea rn e /n i ra cf o r o o e • Con,
Applicant / I I I I fop Co n 5f rit_efir o t'1
Address 51 RR0,2-' 41 AAn son Fals
Phone/Email 79 03 3 $ C )n Q, e h i/lfv Lo»Sfro d vo eo . c om
Contractor
Address
Phone/Email n f
Contact Person for Building&Codes Compliance:-Tom �lp re e hf Phoneo?99- g7og
TYPE OF CONSTRUCTION
exnenk !AI ndotvs
,/Check all that apply New Addition Alteration I"floor sf 2"d floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2026
V
If commercial or industrial please indicate name of business
Proposed use of building or addition
Source of Heat(circle one) e K 154: n tr Gas Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances&Chimneys no n 2
Are there structures not shown on plot plan? rt o n -e-
Are
eAre there easements on the property? ri o n
Site Information: N 1}
a. Dimensions or acreage of lot
b. Is this a comer lot? _Yes _No
c. Will the grade be changed as a result of construction _Yes _No
d. Public water or Private well (circle one) e K i 5f'n q Public Private
e. Sewer or Private Septic System(circle one) ex i sti'o Sewer Private
Value of all work to be performed(labor or materials) $ O
DECLARATION. U rl c�
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. 1 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: I
PRINT NAME: C I hc(y S.
A 16 re e_k� DATE:
SIGNATURE: A ' L �1 � DATE: � eI-0�o
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 January 2016
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