RC-000229-2017 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-000229-2017 Date Issued: Wednesday, December 13, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000229-2017
has been completed.
Tax Map Number: 309.10-2-44
Location: 131 FOURTH ST
Owner: Tammy Luther
Applicant: Tammy Luther
This structure may be occupied as a:200 sq. ft. Residential Alt.
Fire Damage By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy 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.
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aI 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-000229-2017
Tax Map No: 309.10-2-44
Permission is hereby granted to: Tammy Luther
For property located at: 131 FOURTH ST
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
Tyne of Construction
Owner Name: Tammy Luther Single Family-Alteration $2,500.00
Owner Address: 145 Robert Gardens,Apt.5 Total Value $2,500.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
200 sq.ft.Residential Alt.
Fire Damage
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,May 9,2018
(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 expiration date.)
Dated at the Town o ueen Tue d ,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
-tl re
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: t2,( -006 TI-7
APPLICATION Permit Fee: $ let, QJ
I-Own of(Luccn,bur i
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.queensbury.net
Project Location:
Tax Map ID #:
`=Subdivision Name:
MAY 0
CONTACT INFORMATION:
TOWN Of
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• Applican t:,
Name(s): am ry-� L-)L\l
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Mailing Address, C/S/Z: VQ7eerY;1z:rJn 72- CM
Cell Phone:
� (o lo'i Land Line:
Email:
• Primary Owner(s):
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Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
* Contractor(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
* Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Building & Code Compliance: 30�,,
Cell Phone: ( &0-1 ) q '--
9 93S— Land Line:
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
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: 2nd floor:
3rd floor: 3rd floor:
41h floor: 4th floor:
Total square feet: Total square feet:
sr
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): , Gas 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: GC1 -(G`
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel?
b. Is this a corner lot? YES NO.
c. Will the grade be changed as a result of the construction? YES NO
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. 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 thework 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:
PRINT NAME:
SIGNATURE.
DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
Certificate of Electrical Compliance
New York Atlantic-Inland, Inc.
997 McLean Road Ext.
Cortland, NY 13045
Certificate No.:616119 Building Permit No:
Issue Date: 12/5/2017 Building Permit Date:
Inspected By: Devin Pratt& Stan Matyka Occupancy: R-3
OWNER SITE ELECTRICIAN
John Reed 131 4th St EXT owner
957 Peck St Queensbury , NY 12804 957 Peck St
Jefferson , NY 12093 Town of Queensbury Jefferson , NY 12093
SCOPE
100AMP Overhead Service Reconnect From Fire
INSPECTION INFORMATION
Luminaires: 1 Luminaires
Outlets: 4 Receptacles, 1 Switches
Service: Service Size: 120/240V 10 100A, Service Type: Overhead
DE C E 0 V Ei
EEC2 2011
TOWN OF QUEENSBURY
BUILDING& CODES
- Z 1
This certifies that the process noted above was complete as specified at the time of inspection and any conditions not within the
scope of the inspection are excluded. Because there exists a multitude of proprietary specifications,the adherence to the relevant
Building Code of New York State is applicable to the electrical requirements on the above noted date and valid for one year
forward. In connection with areas at the time of inspection and docs not constitute areas that are enclosed,concealed or
inaccessible. Should the electrical system be altered in any way,including,but not limited to,the introduction of new electrical
equipment,this certificate shall be null and void. This certificate only applies to the occupancy use as stated. Changes in use,or
occupancy as indicated above,negates this certificate in its entirety.