BOTH-000416-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: BOTH-000416-2016 Date Issued: Wednesday, October 12, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000416-2016
has been completed.
Tax Map Number: 308.6-1-1.1
Location: 596 LUZERNE RD
Owner: SCOTT CROSS,Adrienne Cross
Applicant: SCOTT CROSS
This structure may be occupied as a:Gazebo 367 s.f.
By Order of Town Board
TOWN OF QUEENNSSBU�RJY
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-000416-2016
Tax Map No: 308.6-1-1.1
Permission is hereby granted to: SCOTT CROSS
For property located at: 596 LUZERNE 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: Adrienne Cross Porch-Open $3,000.00
Owner Address: 596 LUZERNE RD Total Value $3,000.00
Queensbury,NY 12804
Contractor or Builders Name f Address Electrical Inspection Agency
Plans&Specifications
Gazebo 367 s.f.
$ 50.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Sunday,July 2, 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 date.)
Dated at the Townf Quec ury; Th s a , 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE APPLICATION Received
DATE 4/Zf (4 Tax Map ID
TAx MAP ID r0 — '" l . Permit No. r�O}��1'1 l `ca- 2-0 t tP
Permit Fee { Inv.
ZONING Rec Fee
HISTORIC SITE Yes _ No Approvals
SumylSIoN NAME ( , J M ty ei- „Lot#
APPLICANT S"A C�r C'S s OWNER SCC:L-� lr1&V t Q_A n i` ("-o.
ADDRESS 4,39 .., Lozeea�,jE I ADDRESS SCf(D Luac-- (�- (2-d
{ Q ce-":,a� -�-t .�,.C�,1. ►Z'&c-I D&U-in S ion
PHONE e _1 4`J - J 4'� PHONE
CONTRACTOR _ CosrOrCONSTRUCTION{ESTIMATEf),): $ 30C �~
ADDRESS: BUILDINGAmpESS:
PHONE:
CONTACT PILAR ONFOR BUILDING 4-CODES COMPLIANCE _..._... ... PHONE
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 1°`floor sq.ft. 211d floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck
Deck
Detached Garage(#of cars.._}
Dock
Pole Barn
Porch-open �., ,`7
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: l 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, 1 or my agents will obtain a certificate of
occupancy. I also understand that Vwe 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: <-�-� C�r � Date:
Signature: Date:
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
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