RC-000394-2017 TOWN OF QUEENSBURY
,w 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
r`
- = Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: RC-000394-2017 Date Issued: Friday, September 22, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000394-2017
has been completed.
Tax Map Number: 301.13-1-90.1
Location: 552 WEST MOUNTAIN RD
Owner: KERRI MOSER
Applicant: KERRI MOSER
This structure may be occupied as a: Concrete Foundation Only 288 s.f.
(to be used for addition at a later date) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance 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.
Aalk TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
ME
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000394-2017
Tax Map No: 301.13-1.90.1
Permission is hereby granted to: Paul Kruger
For property located at: 552 WEST MOUNTAIN 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: KERRI MOSER Single Family-Addition $4,000.00
Owner Address: 552 W Mountain DR Total Value $4,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Paul Kruger
PO Box 4869
Queensbury,NY 12804
Plans&Specifications
Concrete Foundation Only 288 s.f.
(to be used for addition at a later date)
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 7,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the ex/pAation date.)
Dated at the Town of ueensb • { / 4rida , /I yfQ
SIGNED BY: GaWXI/ I% %for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Oniv
ADDITION/ALTERATION PERMIT Permit#:4a APPLICATION Permit Fee: $
Trnn, ofQ uecnsbun
742 Bay Road,Queensbury, NY 12804oI'+
Invoice#:
P: 518-761-8256 www.gueensbury.net /
Project Location: �z2� I/jfiff aYl/
Tax Map ID #: ��l �✓'� ' Subdivision Nam ��' 'Jw' y
CONTACT INFORMATION:
• Applicant: /� /� /�J
Name(s): 2! ✓! /c7eA /1lvSe+'
Mailing Address, C/S/Z: G evezl /!e ,Muir 1 /ZFd
Cell Phone: ( 57F ) ? -.3 Land Line: �)
Email: D liZo�ei Qp/.Geri.
• Primary Owner(s):
Name(s): �flhlE i9S ,q6//�'
Mailing Address, C/S/Z:
Cell Phone: A Land Line:
Email:
• Contractor(s):
Business Name: f� �/,(�G//� C O/ZG'✓�7C�
Contact Name(s):
Mailing Address, C/S/Z: Q /20dz?f�
Cell Phone: Land Line:
Email: /!C/ 0T!'I
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: A ) 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
WO/RK CLASS:
v 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: 1st floor:
2nd floor: 211 floor:
311 floor: 3rd floor:
411 floor: 411 floor:
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 7 �d
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): (9 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 th�e cel?.
b. Is this a corner lot? YES '�'
c. Will the grade be changed as a res
u ft
construction? YES NO
d. What is the water source? UBL PRIVATE WELL
e. Is the parcel on SEWER orIVAT_E SEPTI system?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLARATION:
1. 1 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:
PRINTNAME:
SIGNATURE: �� ./y � DATE: �,/Z3/ZOI�
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
11
REQUIREMENTS FOR SUBMITTAL:
1. Completed Additions/Alterations permit application
TWO (2) COPIES OF THE FOLLOWING:
2. Structural drawings, which include:
a.Signed & sealed architect or engineer stamp IF the cost of construction is over $20,000
b.Floor plan
c. Foundation plan
d.Cross sections
e. Elevations
f. Window & Door schedules–printed on the drawings is acceptable
g.Calculation sheet for natural light, ventilation & emergency egress
3. Plot plan, using a survey map if possible, which includes:
a. Drawn to scale (i.e. 1 inch = 1-feet)
b.Indicate proposed changes, with setbacks
c. Include all structures on the property
d.Include location of water supply (well or water lines)
e. Include location & configuration of septic system or sewer line
4. REScheck (residential projects) or COMcheck (commercial projects), signed and stamped—
www.energycodes.gov
ADDITIONAL INFORMATION:
1. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
2. If, for any reason, the building permit application is withdrawn, 20% of the fee is retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
8 don our limited examination, om fiance
tuft
u�'as`.
indicating the plans and sppeecific tons are in
full compliance with the BulldI Codes of
New Yak State.
TOWN OF QUEENSBUR
yr114 BUILDING & C -
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Reviewed By:
i 51�ti Dd�t�e:
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JUL 03 2.617I D
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TOWN OF QUEENSBI. Ry
BUILDING&
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301.13-1-90.1 RC-000394-2017 —� - - --- --
Moser, Kerri
552 W. Mountain Rd.
Res. Add. (concrete foundation) 288 S.f.
i
i
DEED REFERENCES
1
LAND 0' PINES DEVELOPMENT, INC.
To
FREDERICK & JOAN WHEELER
DATED OCTOBER 22, 1982
IN DEED BOOK 649 AT PAGE 976
2
FREDERICK & JOAN WHEELER
TO
FREDERICK & JOAN WHEELER
DATED JULY 14, 2006
IN DEED BOOK 2987 PAGE 87 F
-=LOT 65
a 5Ecnorr a rNrD cr PErrE5
MAP REFERENCE
MAP OF SECTION 4 OF
LAND 0' PINES _ IRF
DATED JULY 8, 1982
BY COULTER & McCORMACK
SECTION. 5
LAND 0' PINES y
ti
7
J •r
?0.
(N110
IRF
r Yl. i
b'
,JCli •'�a �,\ � ter' .--
O �_.\
IYED
44,
--�\ s70/VE of U _ IRF
�. J % I
-..,
EVISED �
--LOT 6 - -- ;.� ------� --- -
� ,r Ecrua LAND o PrIE.,
26,272. 52 sq. ft.
ZS0.60 acres
IPF
-
CONC. MON.
DEED PEF."2 �+ 263l'571
8/ 08'41 W
SHED IRF" ' t{
- - - - 'Al
HEREBY CERTIFY THAT THIS MAP WAS PREPARED
FROM AN ACTUAL FIELD SURVEY. �:, , �•- " "
THIS CERTIFICATION SHALL"RUN ONLY TO THE PERSONS �- LEGEND:
FOR WHOM THE SURVEY WAS PREPARED, AND ON THEIR r 1 °
SECTION. 2
BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY ��. "
®4
AND LENDING INST1TU11ON LISTED HEREON. LAND 0' PINES ,' IPF = IRON PIPE-FOUND
CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL JUL 03 201
INSTITUTIONS OR SUBSEQUENT OWNERS. IRF = IRON ROD FOUND
`: .
}` OF aUEEN� )F}'Ute O = CONCRETE MONUMENT =
CERTIFIED TO: KERRI MOSER;•:..:., BU9 DI�, ODE
NBT BANK,! N.A:>
�
., = UTILITY POLE
IT'S SUCCESSORS TAND/OR ASSIGNr;
CHICAGO'TITLE INSURANCE COMPANY
E:"
�;'''•'�<�•.,: .:•.: `' ;'� ''`:�,i '" .. . .. . . = METAL FENCE LINE
ff' -
I i=�`ci:Illil l PLOT PLAN.
_ FIRE HYDRANT
it tiY
II -F ,:•�_�;=.��- Tt-'"' IPF � a
4 ; I HAVE PERSONALLY MEASURED TH'"'
301.13-1-90.1
CERTIFIED BY=� PROPERTY LIN fZC-000394-2017
FRO(V1 THE Moser, Kerri
IyMAT7HEW;C: sSTEVES,iLLS NYS 50135 'PRti7P(J�,CD WQCREf�; 9552 W. Mountain Rd.
DATED: AUGUST:1 � / � Res. Add. (concrete foundation) 288 s.f.
"SI NATURE —-. Cc
Dater MAY
24, 2007. .
_ D -�� Is UNAUTHORIZED ALTERATION OR AEDIDON TO A SURVEY "- - - - - - - -
,€ Wap of a Survey- made for
- - MAIC BEARING A LIC jlSED LAND SURVEYORS SEAL IS
-Scale
VTG}ATION OF SECIlgtj 7209.SUR-DIVISION 2.OF THE -
f NEIN CORK STAIE EDUCARON LAN." - - - - - - - - - - - - -
_ UNLY COPIES FgQ1,j THE ORIGINAL OF THIS SURVEY
S t r"'1A - 7 e s MdkY,ED WITH AN ORIGINAL OF THE LAND SURVEYOR - - ': - - - - -ti�1J•
U•P`-'.-/ e./ .AL-SHALL RE CO(;jjUEREU i0 RE VALID TRUE COPIES." 'T �� /^'�
V `5 SURVEY
WAS j;IUICAIED HEREON DANCE WHHTHATl l.l'RD T �\�(� \O E R
-
T145 SURVT_'f WAS PREPARED IN ACCORDANCE W17H THE- -- � .�'.1, �`Y 1 �`g V "
^^ '[' ��{T7 [m-y� EiIS IiNC CODE OF FE2ACRCE FOR LAND SURVEYORS ADOPTEDBY
AL
L u� - S vir Y• e J o r s LF.rtU THE
Nib CER11FEW YORK gikrE CG'AMN'S SHAtLORUN SIONLY - _ - �i CC'/• OC --
C/ T9 THE PERSON FCR I HOM THE SURVEY IS PREPARED,AND - - - -- - - - S7 E r f
C'Ij HIS BEHALF TO 11iE IITTE COMPANY,GOVERNMENTAL - -
AIiENCY AND LEt10jfj6INSTHUIHON LISTED HEREON,AND Town of Queensbury, Warren- County, New York -� g��g�pg " HOUSE LOCATION, MosER -C-1995 -
169 Haviland Road Queensbury, New York 12804 T9;HE ASSIGNEE$6F THE LENDING IN5HTUTION.'
(5"18) 792-8474 New York Lic. No. 50135
- N0. , DATE_ " DESCRIPTION ., ; „ Dwc. No,.07073, -