CC-000308-2015 . , 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: CC-000308-2015 Date Issued: Tuesday, November 24, 2015
This is to certify that work requested to be done as shown by Permit Number CC-000308-2015
has been completed.
Tax Map Number: 295.8-1-9 20A-rjb3
Location: 1130 State Rte 9
Owner: WAKITA PROPERTIES,LLC
Applicant: Cellco Partnership d/b/a Verizon Wireless
This structure may be occupied as a: Cell tower
By Order of Town Board
TOWN OF QUEENSBU,R99Y
Issuance of this Certificate of Compliance DOES NOT relieve the J
property owner of the responsibility for compliance with Site Plan, /d
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
6— ow 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CC-000308-2015 6P 2014 - 565
Tax Map No: 295.8-1-9 REVISED
Permission is hereby granted to: Cellco Partnership d/b/a Verizon Wireless
For property located at: 1130 State Rte 9
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 Address: 1130 State Route 9 Retail-Memantile-New $22,000.00
Queensbury,NY 12804 Total Value $22,000.00
Contractor or Builders Name/Address Electrical Inspection Agency
WAKITA PROPERTIES,LLC
1130 State Route 9
Queensbury,NY 12804
Plans&Specifications
PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 14,2015
(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 xpiration date.)
Dated at the To of Quee ury;. *' 6rr5er 14,2014
SIGNED BY: (((.••iJ_iIII/// for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Onlv
DATE ,1�,'-1 Received Cc,
Tax MapID
TAXMAPID
Permit Permitr+w 1 �
/' 11 ee
ZONING l�OrltiMe,/'f�l LA�1 Rec Fee G�
Site Plan If
HISTOPoC SITE Yes
No Subdivision #
SUBDIVISION NAME I I \ Lot#
TOWN BD.RESOLUTION 86-201 3. $850 RECREATION FEE FOR NEW DWELLING UNITS,INCLUDING SINGLE FAMILY DWELLINGS,DUPLEXES
OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR MANUFACTURED &
MODULAR HOMES,BUT NOT MOBILE
\HOMES.
1THIS IS IN
ADDITION TO THE PERMIT FEE. /'
APPLIlX.CANT o�Y'Pf�rl" I f��Q 1� />JI?O"lOWNER A� c
eS
ADDRESS ns: \ ADDRESS 1`
� lXvee,nS�V,�t � � }�
PHONEIE-MAIL g( WAJ) [�7�&'�PHONE/E-MAIL
CONTRACT4 COST OF CONSTRUCTION/ESDMATED): $�
ADDRESS: BUILDING ADDRESS:
��ee�s iJ�QY e
PHONE/E-MAIL `I l.�1 I(.��q
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: 1 ' `\G�JP.� —� IC. PHONE,_
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
New Addition Alteration is'floor sq. ft. 2ntl floor sq.ft. Total sq,ft. Height
Single Family
Two-Family
Multi-Family
(# of units_)
Townhouse
Business Office
Retail - Mercantile
Factory- Industrial
Attached Garage
(#Of_)
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of business L)
Proposed use of building or addition
Source of heat(circle one) Gas Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information
a. Dimensions or acreage of lot Dt1
b. Is this a corner lot?
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well cc
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $ 6G
DECLARATION-
1.
ECLARATION:1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed,subject to fees and department
approval.
3. 1 certify that the application, plans and supporting materials are a true and 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.
4_ 1 acknowledge that prior to occupying the facilities proposed, 1 or my agents will obtain a certificate of occupancy.
5. 1 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. 1
I have read and agree to the above: PRINT NAME: L DATE 11 I l
SIGNATURE: DATE
FOR OFFICE USE ONLY
Operating Permit Issued: —Yes _No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building& Codes Principal Structure Application July 2014