RC-000768-2017TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5904 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000768-2017 Date Issued: Monday, February 25, 2019
This is to certify that work requested to be done as shown by Permit Number
has been completed.
RC-000768-2017
Tax Map Number:
Location:
Owner:
289.12-1-5.2
19 MAID MARION WAY
William Gill
William GillApplicant:
This structure may be occupied as a: Residential Alteration 587 s.f.
Enclosing open patio 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
Planning Board or Zoning Board of Appeals.
Director of Building & Code Enforcement
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-000768-2017
Tax Map No: 289.12-1-5.2
Permission is hereby granted to: Tony Poulos
For property located at: 19 MAID MARION WAY
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: William Gill Single Family-Alteration $15,000.00
Owner Address: 19 Maid Marion Total Value $15,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Tony Poulos
16 Windy Ridge DR
Glens Falls,NY 12801
Plans&Specifications
Residential Alteration 587 s.f.
Enclosing open patio
$ 88.05 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,February 9,2019
(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 the expiration date.)
Dated at the Town o ueen rid a 9,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office use Oiiiy
ADDITION/ALTERATION PERMIT PerrriY t: � � '�y ��� 2-D(Z
,W—L
APPLICATION Pernnit Pee:$
Towyn of Queensbury
742 Bay Road,Queensbury,NY 12804 voice#: 2—
P:518-761-8256 www.gueensbury.netn n/] E
Project Location: a b 8 2Q17
kDEC
Tax Map 1® : 29� . t2- t - �. N me: -a- �
TOWN OF UU
BUILDING&CODES
CONTACT INFORMATION: l
Applicant:
Name(s): WIWI4*'A GrtU--
Mailing Address, C/S/Z: Jot hAP410 MA1UOV,1 USA-t C UWC=NS0J*K hS� MeO'�
Cell Phone: �_) Land Line:
Email:
0 Primary Owner(s):
Name(s): W�LUAYY) 1A LL
Mailing Address, C/S/Z:. 01 MALD VA41UCX4 WA&-(. 62UOa�, P<
Cell Phone: Land Line:
Email:
® Contractor(s):
Business Name:
Contact Name(s): !J 1RA ?0LLU%7t>
Mailing Address, C/S/Z: 1l, W Ir4Q'f F—I06tr-- tiOWe f &t.�s"T6 ftt fz� (y'( 12�
Cell Phone: ( 02W&_) Z? — l2 Land Line:
Email:
® Architect(s)/Engineer(s):
Business Name: ►?-uUnls�-,4 !Jw .pie�lT oe-
Contact Name(s): Q.
Mailing Address, C/S/Z: 15A Vk k i� `( 12801
Cell Phone: ( Land Line: (51$ ) 141 02(vg
Email: ie,oMAlk 1IUG4 rr' CO✓YI
Contact Person for Building & Code Compliance: "A� AAU
Cell Phone: ( Land Line: 5( 1$ )'41 "07-49
Email: ,off q 1,� n !Ac4 P . er. Coyn
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
PROJECT INFORMATION:
TYPE: Cont-omercial Residentiai
WORK CLASS-
V/ 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: C55-1Ap
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: $ I Ji 000
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propane Solar Other N ��
Fireplaces need a separate Fuel Burning Appliances & Chimney Application
4. Are there any structures not shown on the plot plan? YES (.O)Explain:
5. Are there any easements on the property? YES
6. SITE INFORMATION-
a. What is the dimensions or acreage of the parcel? I • ?A
b. Is this a corner lot? YES NO
c. Will the grade be changed as a result of the construction? YES
d. What is the water source? P_UB'Ll CPRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? FVLVp_V1r-,
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
DECLAR TION:
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: Ail �AvL - UwtltorA
SIGNATURE: DATE: S1• Zt�l7
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
INSPECTION WORKSHEET (001137-2019)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number:RC-000768-2017 Case Module:Permit
Inspection Date:Mon Feb 25, 2019 Inspection Status:Passed
Inspector:Mark Smith Inspection Type:Residential Final Inspection
Job Address:Parcel Number:19 MAID MARION WAY
Queensbury, NY 12804
289.12-1-5.2
Contact Type Company Name Name
Primary Owner Gill, William
Applicant Gill, William
Agent Rucinski-Hall Architecture
Granted Permission Poulos, Tony
Contractor Poulos, Tony
Checklist Item Passed Comments
General Comments NO
Feb 25, 2019 Page (1)
Smith, Mark (Inspector)