BOTH-000526-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000526-2016 Date Issued: Thursday, June 22, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000526-2016
has been completed.
Tax Map Number: 239.12-2-88
Location: 2780 State Rte 9L
Owner: Harold Gordon
Applicant: Morgan Gazetos
This structure may be occupied as a: Dock 281 s.f.
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the J 4
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
f Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000526-2016
Tax Map No: 239.12-2-88
Permission is hereby granted to: Morgan Gazetos
For property located at: 2780 State Rte 9L
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
Tvoe of Construction
Owner Name: HAROLD GORDON Dock $15,000.00
Owner Address: PO Box 275 Total Value $15,000.00
Cleverdale,NY 12820
Contractor or Builders Name I Address Electrical Inspection Agency
Morgan Gazetos
52 Chapman ST
Ballston Spa,NY
Plans&Specifications
Dock 281 s.f.
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 4,2017
(I f 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 ofeensbu • je
sd ,Au 16
k t
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
y
ACCESSORY STRUCTURE APPLICATION Office Use ON
Received
DATE - L� r l Tax Map ID
TAx MAP ID -7 d, Permit No. boT*k--52-tp - 2.0 t k,
ZONING Permit Fee 4 r-WI LO gles
Rec Fee
HIsTORIC SITE Yes No Approvals
SUBDIVISION NAME Lot#
APPLICANT OWNER ��• rr ✓`
•
ADDRESS yL.,— 51-- ADDRESS
PHONE 2 2? r /S_ 7"'� PHONE
CONTRACTOR COST OF CONSTRUC71ON ESTIMATED : $ / S 00 C
ADDRESS: BUILDING ADDRESS:
PHONE: �1
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE } i 0��C, `r PHONE 2�
-72
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 12t floor sq.ft Ffloor sq. ft. Total sq.ft. Height
Boathouse with Sundeck
Deck
Detached Garage(#of cars_j
Dock 2
ole Barn .:Jig ') ;1 2016
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: 1 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 Godes, 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: 0-✓cam P�� �ar ck ,� Date:
7
Signature:
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
239.12-2-88 BOTH-000526-2016
Gordon, Harold
2780 State Route 9L -
Dock 281 s.f.
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PROPOSED DOCK r\
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JUL 14 2017
. _ J!;,OT+- -cb,Z Io • 20 1(0
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
cee,W�A.;that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owner: Gordon Date: 06/28/2017
Occupant: Dock Location2780 Route 9L
Occupancy Queensbury, Warren Co. NY
Single Family Dwg.
Applicant: Lakeside Builders
42 Cotherman Drive y
Lake George NY 128 � ,�. .11D.,
'
Joseph A.Holmes
No. 18011
Equipment:.
4 - Receptacles; 3- Fixtures
ONAC
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This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and
above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership
inspection. No warranty is expressed or implied as to the mechanical safety,effi- of the property indicated above,this certificate shall be immediately null and void.
ciency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions,
be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department
system to which this certificate applies be altered in any way,including but not limit- Inspection Agency,Inc. An application for inspection must be submitted to Middle
ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc. to initiate the inspection and revalidation
any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service.