2002-051 TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518)761-8256
CER)'i'IFICATE OF COMPLIANCE
Permit Number: P20020051 Date Issued: Monday, January 28,2002
This is to certify that work requested to be done as shown by Permit Number P20020051
has been completed.
Tax Map Number: 523400.278.000-0001-029-000-0000
Location: `J11 STATE ROUTE 149
Owner: THOMS&YVONNE KOCZWARA
Applicant: THOMS&YVONNE KOCZWARA
'This structure may be occupied as a:
By Otder.of Town Board
Shed/Storage Sheds- TOWN OF QUEENSBURY
Director of Building&kdercerment
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020051 Application Number: A20020051
Tax Map No: 523400-278-000-0001-029-000-0000
Permission is'hereby granted to: THOMS & YVONNE KOCZWARA
For property located at: STATE RQUTE 149
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 Value
Owner Address: THOMS &YVONNE'KOCZWARA Shed/Storage Sheds 4,000.00
341"1 LAKE SHORE Dr PO BOX 74 Total Value 4,000.00
LAKE GEORGE,NY 12845
Contractbr'or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2002-051
288 SQ FT STORAGE SHED AS PER PLOT PLAN SPECIFICATIONS
$20.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,January 25,2003
(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'To Quee u F ' a ,January 25;2002
SIGNED BY for the Town of Queensbury.
Director of Building Code Enforcement
Building Permit Application
Town of Queensbury—Dept of Community Development, 742 Bay Road,Queensbury,NY
(518)761-8256
. a.aoa- t�l_
A permit must be obtained before beginning construction. Permit File No.-
No inspection will be made until applicant has received a Fee Paid (` ---
valid building permit. All applicants' spaces on this Rec.Fee Paid
application must be completed and must appear on the application form. Reviewed B y �---
Applicant: Owner: zolyfl '
Address: Address: 5/ .,4 --. /5ft?
Phone#{_) Phone
-Property Location: i G 9 I House Num-bei-~ I
Subdivision Name:_ ^'_ Tax Map Nurnber:. .
t
F Q�` ' •,U
New Building: resid "pial !t_' Estimated Market Value'of Construction: $ Q20
❑ Addition: residen 1 ercial If an Addition,what will use of new addition be?
❑ Alteration: residence/ commercial
❑ No change to exterior size: residence f com'l
❑ Other work(describe )
Check Occupancylnformation 1"Floor 2" Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
❑ Single family dwelling
❑ Two family dwelling
❑ Townhouse
❑ Multifamily dwelling
#of units
❑ Office .
❑ _Mercantile
❑ 1 car detached garage
❑ 2 car detached garage
❑ 3 car detached garage
❑ 1 car attached garage
❑ 2 car attached garage
❑. 3 car attached garage
❑ torage building-
commerciai
Storage building
residential 1 t c
❑ Other
What is the proposed height of the structure feet _inches
Will any second-hand or ungraded lumber be used? If so,for what?
Type of Heating System: electric/ oil / gas I wood. /forced hot air/ baseboard/other: ✓/'
Number of Fireplaces to be installed / Number of Woodstoves to be installed /
List below the person(s)responsible for supervision of wort as regards to building codes:
Name Address Phone Number
Builder
Plumber
Mason
Electrician
Declaration: please sign below after you have carefully read the statement:
To the best of my knowledge the statements contained in this application,together with the plans and specifications
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all
provisions of the Building Code,the Zoning Ordinance and all other laws pertaining to the proposed work shall be complied
with,whether specified or noted,and that such work is authorized by the owner. Further,it is understood that Uwe shall
submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or Director of Building and Codes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual
a nJ
tnlocation olw
Signature- owner,owner's agent,architect,contractor
TOWN dF QUE:nmSF3URY
nu S LD S NG & CC)nE: ENF'dR(--EMENT
42A� 742 BI1Y RdUAD
QUE:ENSSURY NY 12804
(518) 761-8256
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