RC-0008-2018 TOWN OF QUEENSBURY
4w 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-0008-2018 Date Issued: Thursday, December 27, 2018
This is to certify that work requested to be done as shown by Permit Number RC-0008-2018
has been completed.
Tax Map Number: 289.12-1-7.4
Location: 13 FIELDVIEW RD SOUTH
Owner: STEVEN MARSHALL
Applicant: STEVEN MARSHALL
This structure may be occupied as a: Residential Interior Alterations
Converting two rooms into one room By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the4/ACt--
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.
w 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-0008-2018
Tax Map No: 289.12-1-7.4
Permission is hereby granted to: STEVEN MARSHALL
For property located at: 13 FIELDVIEW RD SOUTH
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: STEVEN MARSHALL Single Family-Alteration $0.00
Owner Address: 13 Fieldview RD S Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Interior Alterations
Converting two rooms into one room
$ 100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, January 12, 2019
(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 th expkri
irration e.
Dated at the Town f Quee uary 12, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit#:
APPLICATION Permit Fee:$ it
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742 Bay Road,Queensbury,NY 12804 Invoice#: CJS I'(--D
P:518-761-8256 www.gueensbury.net
Project Location: fi; �� V;p,,l Qd S QvpprS 'r_l AA� fa(�,aq
Tax Map ID #: Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): 5 i P vPY I
Mailing Address, C/S/Z: Qvee igS "f'/
Cell Phone: ) 3C ,)1G Land Line: �)
Email: ./`la f-Thn /I Cl�Ll rs-0 hofimc. /• l Gr✓►
• Primary Owner(s):
Name(s): S c� yv4_ 6 S Ube v-e-
Mailing Address, C/S/Z:
Cell Phone: _�) Land Line:
Email:
• Contractor(s): JAN 12 2018
Business Name: Sa,vkQ V:"O v
Contact Name(s): F QUEENSBURY
Mailing Address, C/S/Z: ---
Cell Phone: Land Line: � )
Email:
• Architects En ineer s :
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Building & Code Compliance: S j P vP f1 /yAti r s
Cell Phone: Land Line: � )
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
1� 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: a i S S F
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 6 C/0
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil P;ropane Solar Other
Fireplaces need a separate Fuel Burning App ces & Chimney Application
4. Are there any structures not shown on the plot plan? YES eo
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 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 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: S �Pveo
SIGNATURE: LJii DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017