RC-000624-2017 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-000624-2017
Tax Map No: 308.8-2-70
Permission is hereby granted to: Erdal Top
For property located at: 4 HERESFORD LN
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
Tvoe of Construction
Owner Name: Erdal Top Single Family-Alteration $3,000.00
Owner Address: 4 Heresford LN Total Value $3,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Charles West
42 Margaret DR
Queensbury,NY 12804
Plans&Specifications
Residential Interior Alterations 432 sq.ft.
Family Room
$64.80 PERMIT FEE PAID-TIES PERMIT EXPIRES: Friday,October 5,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town ofhudd, ,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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Office Use Ciriy
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ADDITIONjALTERATION PERMIT P2rfeai'[#: �,G �,Qa_�-1�>I^�_
APPLICATION Permit Fee:$
Tnwn of Queensbu'v
742 Bay Road,Queensbury,Fly 12804 invoice#: �q
P: 515-761-8256 www.gueensburV.net
Project Location:
Tax Map I® #0 3�5, g ,a��d Subdivision Named
CONTACT INFORMATION: H
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Applicant:
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Mailing Address, C/S/Z: A 0 <39
Cell Phone: _( Land Line: ) 72- ,r
Email: avElftoop — ca
Primary Owner(s1: QQ i
Name(s): �,'e�a I �D ✓�
Mailing Address, C/S/Z: /L H 4ef-eS = 1,r1 as/3 La
Cell Phone: Land Line: Si ) q 5 7� 7-2 P
Email: iP-rl o C'
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Contractor(s):
Business Name: L /�i�, � L-✓L�l' �
ContactName(s): �ZJL�Si
Mailing Address, C/S/Z:
Cell Phone: ,9 Z S-- ZL Land Line: ( S�"/ )
Email:
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Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contact Person for Building & Code Compliance: ErAaL_ ( 0
Cell Phone: ( 571�f ) 7 44 --7 S�'(o Land Line: 4755-77 7�,Z
Email: ef�QL_ — +Lig a L- cA^+
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:
4th floor: 4th floor:
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ `3_/�� (2 )
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propane Solar Other
Fireplaces need a separate Fue 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 the parcel?
b. Is this a corner lot? YES 7 NOS
c. Will the grade be changed as a re tie construction? YES NO
d. What is the water source? m?;P PRIVATE WELL
e. Is the parcel on SEWER or PRIVATE SEPTIC syste
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLAR r1O1`'ri:
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:
PRINT NAME: 42a 40I
SIGNATURE: DATE: 16
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017