CC-000789-2017 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: CC-000789-2017 Date Issued: Thursday, March 29, 2018
This is to certify that work requested to be done as shown by Permit Number CC-000789-2017
has been completed.
Tax Map Number: 296.15-1-23
Location: 425 BAY RD
Owner: Mark Smith
Applicant: Mark Smith
This structure may be occupied as a: Commerical Interior Alterations 400 s.f.
(formerly The Diet Center) 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: CC-000789-2017
Tax Map No: 296.15-1-23
Permission is hereby granted to: Mark Smith
For property located at: 425 BAY 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: Mark Smith Business Office-Alteration $5,000.00
Owner Address: 3 PARK VIEW AVE Total Value $5,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Mark Smith
3 PARK VIEW AVE
Queensbury,NY 12804
Plans&Specifications
Commerical Interior Alterations 400 s.f.
(formerly The Diet Center)
$80.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,December 24,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the ex ' tion datk, mber
ue Dated at the Town of ensb 4rid 22,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Oniy
` Permit#:
ADDITION/ALTERATION PERMIT
GC' �J
APPLICATION Permit Fee:$ �
Town of(Lyeensbury
742 Bay Road,Queensbury,NY 12804 invoice#: '752-k
P:518-761-8256 www.gueensburV.net
Project Location: LI � _
Tax Map ID (o . irD 2-5 Subdivision Name:
CONTACT INFORMATION:
• Applicant: ✓
Name(s): "ckr
Mailing Address, C/S/Z: C-c e- J- "'-3( . t
Cell Phone: i f
% ) go �_ d� / -2 Land Line: ) ��/ /9 �,g,
Email: q,r I ire----
• Primary Owner(s):
Name(s): I S C- P P i Pr.n t—
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
• Contractor(s):
Business Name: _Scr,,p (1J C&r �!
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
• Architect(s)/Engineer(s):
Business Name: ea yvr..2. O's pD �i cC'
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contact Person for Building & Code Compliance:MC,,(Ac
Cell Phone: 6 j ) ) dJ y7 J f Land Line: � )
Email: (Y)C'r ( co l,"
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: t) 1st floor: r)
2nd floor: 2nd floor:
3rd floor: 3rd floor:
4th floor: 4th floor:
Total square feet: v Total square feet:
ADDITIONAL PROJECT INFORMATION:
f�
1. Estimated Cost of Construction: $ c/
S 00
2. If Commercial project, what is the proposed use: o ak n r\
3. Source of Heat (circle one): Gas Oil Propane Solar Other'as
Fireplaces need a separate Flue Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? YES (NO:)
O Explain:
5. Are there any easements on the property? YES ONO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? /0 0 - J d
b. Is this a corner lot? YES NO
c. Will the grade be changed as a resul the construction? YES NO
d. What is the water source? UBL PRIVATE WELL
e. Is the parcel on WER r 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 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: ry ► � _�k'v� �- �
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PEj!�AIT PLOT PLAN
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I HAVE P'L �Q AI_L r It EA�UREU THE DISTANCE 0
IE
FROW HE PROPERTY LIMES TO THE
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TAX MAP 61-1-41.2 296.15-1-23 CC-000789-2017
LAND5 OF ;l _
GARFIELD P. RAYMOND - ; Smith, Mark
i 425 Bay Road
TAX MAP No. G1-1-43 Comm. Interior Alterations 400 s.f.
LAND5 OF
KENNETH GREENE' : '
LAWN
4 DWARF -WINGED EUONYMUS
EUONYMU5 ALATU5 COMPACTA 30 3G"
I If
WOOD FRAME WOOD FRAME
1 BUILDING BUILDING
I --- _- ___ -_ 71
1 s v
NEW H.G. RAMP �POF,Gtt+51&RS .
- #
— EXI5TING ! Ttt>:5E PLANS HAVE BEEN APPROVED UNDER AUTffi0RITY
i - a DRIVEWAY
- ---- - Or A RESOLUTION_ADOPTED, 3/1002 BY THE PLANNING.
20 f - - BOARD OF THE TOWN OF=QUEENSBURY. MW YORK V(ITH
- -- + -
TYP. - . THE FOLLOWING CONDITIONS'
1. THE BULDING WILL BE ED TO A- SINGLE TENANT
PARKING
PACES
+ � REVISED 1.S1
473323-G-02 WILL P.E A5 GREEN. AND
- --_ --- --- - --' -- ws r G EW -;-- 3. SPACE 3 WILL BE TURNED INTO A HANDICAP SPACE. AND
- _- -- -
_ -
_
4. SPACES 4 + 6 WILL REMAIN A5 15. AND
5. AN"ADDITIONAL- SPACE WILL BE_ADDED. EITHER M THE
GARAGE OR NORTH OF.5PACE_6.F FEASIBLE
j.
ISAY
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-- Da tei DECEMBER_ 26, 2001
Revised: MARCH 6, 2002
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NACE ENG" INTE"ERING c - N
o� ® Revisedl MARCH 22, 2002
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