RC-000732-2017 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-000732-2017
Tax Map No: 289.12-1-22
Permission is hereby granted to: KYLE ALEXY
For property located at: 4 BERRY PATCH DR
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: KYLE ALEXY Single Family-Alteration $6,000.00
Owner Address: 4 Berry Patch DR Total Value $6,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Alteration(sliding glass door)
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,November 21,2018
(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 ueens21,2017
SIGNED BY: ues a for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
i
ADDITION/ALTERATION PERMIT Permit#:
APPLICATION Permit Fee: $
"town of Qeensbury
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensburV.net
Project Location: i 1IUl,
f
Tax Map ID #: 2,2 Subdivision Name:
CONTACT INFORMATION:
•
Applicant:
Name(s):
�+
Mailing Address, C/S/Z:
Cell Phone: "` ) (p D Land Line: fel ) 7
Email: lt. , L6-
• Primary Owner(s):
Name(s): � 1 �-
Mailing Address, C/S/Z:
Phone: ( ) Land Line:
Tail:
• Contractor(s): NOV 2 1 2017
Business Name: T1°��
Jul
Contact Name(s): TOWNOF
Mailing Address, C/S/Z: IBUILDING&CODES
Cell Phone:_) Land Line:
Email:
• Architect(s)/Engineer(s):
Business Name: - C�,-,��,
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: � ) Land Line: � )
Email:
Contact Person for Building & Code Compliance: `3r� ,nt
Cell Phone: �_) Land Line:
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
i. ,IPE: 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:
CIDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ � i U v�
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propa r� Solar Other.
Fireplaces need a separate Fuel Burning App lances & 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 eage of the parcel?
b. Is this a corner lot? YES NO
c. Will the grade be change as a result of the construction? YE NO
d. What is the water so,
Wce? PUBLICRIVATE WE
e. Is the parcel n SEWE or a PRIVATE SEPTIC system?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLARATION:
. I 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:
INT NAME: KYLE- ALEXY
SIGNATURE: AC DATE:
(J
L)
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017