BOTH-000406-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
s
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: BOTH-000406-2016 Date Issued: Friday, August 4, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000406-2016
has been completed.
Tax Map Number: 227.17-1-8
Location: 28 HILLMAN RD
Owner: Benjamin Campbell
Applicant: Benjamin Campbell
This structure may be occupied as a:288 sq.ft.screened-porch
Cross Ref. Area Variance PZ-0156-2016 By Order of Town Board
TOWN OF QUEENSSBURY
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
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
,.. Community Development - Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTH-000406-2016
Tax Map No: 227.17-1-8
Permission is hereby granted to: Benjamin Campbell
For property located at: 28 HILLMAN 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: Benjamin Campbell Porch-3 Season,Covered,Enclosed $5,000.00
Owner Address: 28 Hillman RD Total Value $5,000.00
Cloverdale,NY 12820
Contractor or Builder's Name/Address Electrical Inspection Agency
Benjamin Campbell
28 Hillman RD
Cloverdale,NY 12820
Plans&Specifications
288 sq. ft. screened-porch
Cross Ref. Area Variance PZ-0156-2016
$ 50.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,.lune 30,2017
(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 d te.)
Dated at the Town flueeMJ 4Tu*y--5, 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code l;nlorceinent
Office Use Only
ACCESSORY STRUCTURE APPLICATION
Received
DATE j - 1 Tax Map ID
TAxMAP ID � � ( 1-�- ( � Permit No. TI+ 46b-�kl,ii�
ZONING W Permit Fee
Rec Fee
HISTORIC SITE Yes x No Approvals. I
SUBDIVISION NAME Lot# V P2-
APPLICANT
Z �( �
APPLICANT5J ✓� 4�,iVl,!V ✓✓1 F� � OWNER
1j u ll
ADDRESS Z 8 }�i��+n'ZLi hi C ADDRESS
PHONE ��,O S i S PHONE
CONTRACTOR �'t ta-a i, ecl�''l/�7C �� COST OF CONSTRUCTION(ESTIMATED): $ 5,06 d
ADDRESS: BUILDING ADDRESS:
PHONE:
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE ✓ �G�✓�'1 J � PhfONI= V Za S
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 1't floor sq.ft. 2nd floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck
Deck
Detached Garage(#of cars`)
Dock
Pole Barn
Porch-open
**Porch-3 season, Covered,Enclosed
Shed ,
Other Accessory Structure(s)
*`Considered floor area&must comply with FAR(floor area ratio)requirements if located in the WR zone
DECLARATION. I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the
application, plans and supporting materials are a true & complete statement description of the work proposed, that all work will
be performed in accordance with the NY State Building Codes, local building laws and ordinances; and in conformance with
local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy. I 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: �Cry ,dt�� : ''1(7�L 4 Date: ZZ- Q¢
Signature: J W V Date: -
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
Warren County Department of Code Enforement
Unmarked Structual Lumber {' JUL2016
Certification
Mill Name: Mead Lumber Co., Inc.
Address: 1288 Vaughn Rd. Queensbury NY 12804
Phone: (518)798-4926
Fax: (518)798-1091
Purchaser: Ben Campbell
Project Location: Queensbury
Purchase Order# 5163E
i
a duly authorized representative of the
'k`--61bove n-i6ntione8 MiII;do certify to the Warren County Department of Code
Enforcement and the above named purchaser that:
The quality and safe working stresses of the unmarked structual lumber provided for
the Campbell Residence and under P.O. 51636 issued above mentioned is equal to or
exceeds No. 2 grade in accordance with the conditions set forth in the NELMA standard
grading rules for Eastern White Pine dimesion lumber and Timbers.