CC-000569-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Nlunber: CC-000569-2016 Date Issued: Monday, October 3,2016
This is to certify that work requested to be done as shown by Permit Number CC-000569-2016
has been completed.
Tax Map Number: 302.7-1-41
Location: 190 QUAKER RD
Owner: Hannaford#8360
Applicant: P&M Construction
This structure may be occupied as a: Commercial Interior Alterations 500 s.f.
Bottle Return Area By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the n
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the k7
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
z`
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
r� Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CC-000569-2016
Tax Map No: 302.7-1-41
Permission is hereby granted to: P&M Construction
For property located at: 190 QUAKER 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: Hannaford#8360 Retail-Mercantile-Alteration $40,000.00
Owner Address: 190 Quaker Rd Total Value $40,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
P&M Construction
1004 River RD
Mechanicville,NY 12118
Plans&Specifications
Commercial Interior Alterations 500 s.f.
Bottle Return Area
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,September 9,2017
(If a longer period is required,an application for an extension most be made to the wile Enforcement Officer
of the Town of Queensbury before the exxp�iration date.)
Dated at the Town o Queensb ; / / /�Frid e ,2016
SIGNED BY: GIS('/ /VJ for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRU TURE APPLICATION Office Use Only
Date: 917--11 l(,
Permit No. GG ' 20 I{�
Tax Map 11) Permit Fee 410
Zone Historic? _Yes X' No Ree-Fee 1 nQro i w q
Subdivision Name Lot# Site Plan#
Subdivision#
Project Location ),:Ip Qyci • ?-al.•
TOWN BD.RESOLUTION 86-2013: $8so 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). f
PrimaryOwner(s) 1 1 GnriA�a�c1 F6Jd c�✓�
Address 14S P(r.fn5411n4 .Ill Rd 5, .7cro k ME J'l v7LI
Phone/Email r2-0_7) 61 1 ` 0 6(6 s
Applicant
Address )Ji1 Hvelso" Giver Me ekr, 'c-Vd1,C NL 17_11 G
Phone/Email leS 18-
Contractor +M,
Address L-1
Phone/Email �r I g- 1 l S
Contact Person for Building&Codes Compliance: PA vC Cso rS kN Phone &SR - 76 Z
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 11 floor sf 2"a floor sf Total sf Height
Single Family
Two-Family
Multi-Family AUG i ; U 2016
(#of units
Townhouse
Business Office f
Retail-Mercantile 5J0 S
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
If commercial or industrial please indicate name of business 14aek vt c4o (
cl
Proposed use of building or addition V5 d+,Q {��
Source of Heat(circle one) Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances&Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information:
a. Dimensions or acreage of lot
b. Is this a corner lot? _Yes No
c. Will the grade be changed as a result of construction _Yes )< No
d. Public water or Private well(circle one) li Private
e. Sewer or Private Septic System(circle one) a Private
Value of all work to be performed(labor or materials) $ J o 0
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:
PRINT NAME: 122✓r c! �a rJ k'i DATE: z`i
SIGNATURE: DATE: L q
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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