building permit TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-03 77-2019
Tax Map No: 289.10-1-34.1
Permission is hereby granted to: James Keller
For property located at: 15 FERNWOOD 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: James Keller Septic Disposal-Residential $0.00
Owner Address: 21 TWICWOOD LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Matt Baker Excavation
132 Sly Pond RD
Fort Ann,NY 12827
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, June 9, 2020
(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 of Queensbury; Monday, June 10, 2019
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement