RC-000592-2017 TOWN OF Q.JEENSBUR.Y
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE CIF OCCUPANCY
Permit Number: RC-000592-2017 Date Issued: Thursday, June 28, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000592-2017
has been completed.
Tax Map Number: 301.8-2-25
Location: 25 COTTAGE HILL RD
Owner: Thomas Alberico
Applicant: Thomas Alberico
This structure may be occupied as a: Residential Interior Alterations 840 s1
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.
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-000592-2017
Tax Map No: 301.8-2-25
Permission is hereby granted to: Thomas Alberico
For property located at: 25 COTTAGE HILL 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
TVne of Construction
Owner Name: Thomas Alberico Single Family-Alteration $25,000.00
Owner Address: 44 Lincoln AVE Total Value $25,000.00
Glens Falls,NY 12801
Contractor or Builder's Name/Address Electrical Inspection Agency
Thomas Alberico
44 Lincoln AVE
Glens Falls,NY 12801
Plans&Specifications
Residential Interior Alterations 840 s.f.
$126.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,October 1,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Friday,September 22,2017
SIGNED BY: for the Town of Queensbury.
Dire of uilding&Code Qern
0-ifice use Oniv
ADDITION/ALTERATION PERMIT Permit#: ��-- - `5�j2 - 7-01+
APPLICATION Permit Fee:$ I2- 6. 0 a
Town of Queensbun
742 Bay Road,QueensbuvV, MY 12804 invoice #: 2-z-k, �
P: 518-761-8256 www.gueensbury.net
Project Locat►ono G t;I . �+� I�t
o wz Map ID #o Subdivision Marne-
CONTACT INFORMATION'.
Applicant
Name(s):
Mailing Address, C/S/Z: �
Cell Phone: ) '7 9� - SC d Land Line: (s/ 'A 1 - 1 70
Email:
o Primary Owner(s):
Name(s): s —
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: � )
Email:
® Contractor(s): FnD E [ 70 7V 1'�
Business name: (�•rM.�-
RD
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
BUILDING&C
o Architect(s)/Lngineer(s)a
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
PI10JECT INFORMATION:
q,VP"E.: Commercial Residential
WORD CLASS:
Single-Family _Two-Family _ Multi-ramily (,# of units )
Townhouse Business Office — Retail
Industrial/Warehouse _Garage (# of cars ) _Other (describe )
ADDITION SQUARE FOOTAGE, ALTERATION SQUARE FOOTAGE:
_�' 1st floor:
1st floor: ' �d
2nd floor: 2nd floor:
3rd floor: 3rd floor:
4th floor: 411 floor:
Total square feet. Total square feet:_ aLla
ADDITIONAL PROJECT INFORMATION: )J
1. Estimated Cost of Construction: $
2. If Commercial project, what is the proposed use: rJ
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 ,�2 Explain:
5. Are there any easements on the property? YES CN
6. SITE INFORMATION:
a. What is the dimensions or acreage of the paper I?
b. Is this a corner lot? YES NO
c. Will the grade be changed as a re o t construction? YES NO
d. What is the water source jLPUBB IC PRIVATE WELL
e. Is the parcel SEWER or RIVATE 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 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 ab ve:
PRINT NAME: a-y
SIGNATURE: DATE: � --?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017