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RC-0069-2018
TOWN OF QUEENSBURY 742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201 " M Community Development - Building& Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-0069-2018 Date Issued: Thursday, May 31, 2018 This is to certify that work requested to be done as shown by Permit Number RC-0069-2018 has been completed. Tax Map Number: 226.12-1-56 Location: 377 CLEVERDALE RD Owner: Jeanne Rollins, Chuck Rollins Applicant: Paul Bagley This structure may be occupied as a: Residential Alterations 1669 s.f. By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the A-- 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. "y 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-0069-2018 Tax Map No: - 226.12-1-56 Permission is hereby granted to: Leo Saede For property located at: 377 CLEVERDALE 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: Jeanne Rollins Single Family-Alteration $250,000.00 Owner Address: 330 N Main ST Total Value $250,000.00 Stonington,CT 06378 Contractor or Builder's Name/Address Electrical Inspection Agency Leo Saede PO Box 719 Old Mystic,CT 06372 Plans&Specifications Residential Alterations 1669 s.£ $ 500.70 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,February 26,2019 (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 ry; ;Wc!� 26, 2018 or the Town of Queensbury. SIGNED BY: Q D Director of Building&Code Enforcement Office Use Only I ADDITION/ALTERATION PERMIT Permit#: s r-- APPLICATION Permit Pee:$ Jy 0- Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Invoice#: dl 1 1 P:518-761-8256 www.queensbury.net Project Location: ,S?;; le le,,A Tax Map I® #: -2, 2 l - 5 Subdivision Name: CONTACT INFORMATION: Applicant: Name(s): leo -,>cc vo/e Mailing Address, C/S/Z: O n X 7 /q 60161 ?2 y -t C- G .- 06 3 77 Cell Phone:) Land Line: Email: A "g �D m y,-4/` -e-5+• C'�1"I Primary Owner(s): , Name(s): "1�1 yc lc by 0 �a,�►-► -e ayl b ►-vim Mailing Address, C/S/Z: :330 /V I'K -71z)n � C) � Cell Phone: (,91q ) Land Line: Email: \J V-6 h 2D co a CCU L" • Contractor(s): Business Name: "4c'p 5�eOle Contact Name(s): Xea J�e Mailing Address, C/S/Z: PO / 0 %� � C" c�63� Cell Phone: � ' ) 5 —�6� and Line: Email: le co eD 0-r7 • Architect(s)/Engi nee r(s): Business Name: 01"e- el,- `p er► Contact Name(s): r I Mailing Address, C/S/Z: /7 Cell Phone: A-1 Land Line: l ) 790 ! ,y Email: is AZ 7e-1 (�D Q*' Wai t, co 3'►7 - Contact Person for Building & Code Compliance: �ry 5ZF"'k- Cell Phone: ) Sj -�f Land Line: Email: .4eo Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017 PROJECT INFORMATION: TYPE: Commercial Residential V1/0 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: 4tb floor: Total square feet: Total square feet: ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: 2. If Commercial project, what is the proposed use: 4' 3. Source of Heat (circle one): Gas Oi Propane Solar Other Fireplaces need a separate Fuel Burning Appliances &Chimney Application 4. Are there any structures not shown on the plot plan? YE NO Explain: �Z7`' � 5. Are there any easements on the property? YES NO 6. SITE INFORMATION: a. What is the dimensions or acreage of the rcel? �a b. Is this a corner lot? YES N c. Will the grade be changed as a result oft a con YES d. What is the water source? PUBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? 1:r f�G Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017 if 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: 62' > � SIGNATURE. .--�� DATE: Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017 _ - 1�1.Y � � i � .,�, a,.....ie•S - .. '.:. _ �"'YfMi4iq.� - - , ., .L.www.„ ,..,•.-...•-.-»....,--..-�>.,.....,.�...... ,. .-- ,..-,a.>...,........_,..•-.++�+-...+-•r.•,...-.....,�...«. ,.. - � .,> - ,. - TO „ilial11101wow oil, i i Yet: .t! <�i+�r fiat ! _ 'user y S C, wllu 1 J f 8v6dzr+e � to.- 1 I r az,- to If L, , a, tc lI r ��',rYGYC1^4 F,a rt -+:a! � � _' "•_ ,> _.. 4 "`-."'�,--,..._.,..._,-.,.,.,... -.w..,.�.._,,,,�,�,-� t rs - ope - - Q•", - - -4� 4 __�t d,,, ! '-�S ,To 's�' � 1"' ..r �`1J' � `� _" �-e ,,. ��+�."..'�.""`""' -_« .n. - s ` ip Aga L 46. 10 15emb mark ave € t 3wo a.o W° GQroLgq3e Ftoor ilil II ._ III11 �II II II illl Ill II, I III III 3 I fP'�.'�1�" : 1 a Aa W C51 S Re\1. r t 1. K I x � E � FEB 15 2018 TOWN OF QUEENWURY 226.12-1-56 RC-0069-2018 BUILDING&CODE Rollins, Jeanne $ Chuck 377 Cleverdale Road Residential Alterations 1669 s.f. PERMIT PLOT PLAN I HAVE PERSONALLY MEASURED THE DISTANCE FROM THE PROPERTY LINES TO THE PROPOSED STRUCTURE(S)OR SIGN(S) DATE I-R. SPDX FOUND MAP REFERENCE: MAP EN77TLED "MAP OF A SURVEY OF 774E GLRF� LANDS OF GEORGE FERRIS CROWKHI TE• & JAMES R. CRONKHI7E` DATED NOV 13, 1964. PREPARED BY JOHIN B. VAN DUSEN, LLS FILED IN 774E WARREN COUNTY CLERKS OFFICE: © FEB 2 6 2018 J TOWN OF QUEENSBURY COMMUNITY DEVELOPMENT DEED REFERENCE: LANDS N/l=WILLIAM F. & LORRAINE M, DAWDSON CIF- KARL F KARL J KROETZ AS TRUSTEE Of* 7HE KARL C KROETZ LIBER 787 PAGE 90 REvocABLE 7RUST u/o/d JANUARY 2Z 1993 TO KARL J KROE77 AND VIRGINIA A WTLCOX DATED JUNE 30, 2003 LIBER 1327 PAGE 219 RETA LS WALLS A-PHA LT a►w / � T.O• MAG NAIL SET ,teoTnau) S86�100� 1 f4.lfi't w II= HsaalvwNc DANGLE/ROM FOUND CGNfCItE'JF � STEPS � © iYALJCWAY I.P.F. 190, AREA } NORTHERLY ALONG 774E a58-* ACRES MEAN HIGH WATER MARK F OF LAKE GEORGE 215` t AS IT WINDS AND TURNS v /'v /i, Vis• ohw LR.F. '/ %;�;'i' LRF IN 8 '/ COIVCRE7E El TEL PED. GBVDZ47VR 1 390, f = r.R.t: - 135 63' `Rf �gF• �/ N8435fj'0O"W MF. E CONCRETE I.R.F. HY Q CONCRETE k J STOCKADE / FENCE o� Q LANDS N11f- OF KIMBERLY M. LARSEN AS TRUSTEE OF THE MORRIS FAMILY IR EVOCABLE TRUST USER 4908 PAGE 278 rte. 11-4 ry V I HEREBY CER77FY T. 1) JEANNE L ROLL.INS & CHARLES J ROLUNS AS 7RUSMES OF 774E JL:ANNE L ROLUNS REVOCABLE TRUST. 2) GLENS FALLS NA77ONAL BANK AND TRUST COMPANY. 3) WEST OO4 LAND 77TLE INSURANCE COMPANY. THAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY COMPLETED ON OCTOBER 30, 201Z THIS SURVEY AND THE CER77RCATONS HEREON SHALL BE VAUD ONLY 70 THE PARTY OR PAR77£S HEREON NAMED AND ARE NOT 7RANSFERABLE TO ADDI77OVAL INS777U77ONS OR SUBSEQUENT OWNERS, OTHER THAN AS MAYBE OR EXPRESSLY STATED HEREON. IMAGNE'AC SOUNOM g UMER A9WALT e r RAN E BARDIN, LLS DATE,• to/3q2( vl-r N07ES- LEGEND 1) THIS SURVEY WAS PREPARED WITHOUT 7HE c MAP OF A SURVEY MADE FOR Et7T E AN ABSTRACT OF TITLE AND lS o I.R.F. IRON ROD FOUND of N� JEA 7HENNE L. ROLLINS` & ]HEREFORE SUBJECT 70 ANY EASEiVlENI;� o I.P.F. IRON PIPE FOUND ��Po pH E q ANYSA OR OFflCTONS OF RECORD o C.I.R.F. CAPPED IRON ROD FOUND CHARLES J. RQLLINS ANY TA7ETE ME7dT OF FACTS SUCH DOCUMENT o C.I.P.F. CAPPED IRON PIPE FOUND WOULD DISCLOSE o C.I.R.S. CAPPED IRON ROD SET 2 r AS TRUSTEES OF THE JEANNE L. ROLLINS REVOCABLE TRUST 2) UNAUTHORIZED ALTERATION OR AD0171ON TO A SURVEY UTILITY POLE n MAP BEARING A LICENSED LAND SURVEYORS, SEAL IS A STONE WALL O TOWN OF QUEENSBURY, COUNTY OF WARREN, STATE OF NEW YORK WOLA77ON OF SECRON 7209, SUB--DIVISION 2 OF THE BARBED WIRE FENCE lA NEW YORK STATE EDUCATION LAW, i 09 W.F.P. POINT FENCE POST L SND gVBARDIN LAND SUR MEWING, P. C. 3) ONLY COPIES FROM 7HE CRYGYNAL OF THIS SURVEY —chw OVERHEAD WIRES LICENSED LAND SURVEYOR MARKET? WITH ANO E OF THE LAND SURVEYORS of NOW CRETE MONUMENT FOUND 10 CARDINAL LANE, GANSEVOORT, NEW YORK 12831 FORMERLY SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES C.M.F. CO LOT NUMBERS PER RIPLEY RANDOLPH E BARDIN, JR. DATE: OCTOBER 30, 2017 SCALE: I" = 30' 4) UNDERGROUND UTILITIES AND OR S1RUC7URES NOT LOCATED. POINT SUBDIVISION N.Y.S. UC. N0. 51009 DATE: ID/36 rZo 1.7