AST-000839-2016 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: AST-000839-2016 Date Issued: Tuesday, December 19, 2017
This is to certify that work requested to be done as shown by Permit Number AST-000839-2016
has been completed.
Tax Map Number: 279.-1-48
Location: 1359 RIDGE RD
Owner: Centerline Communications LLC,John Kubricky& Sons Inc.
Applicant: Centerline Communications LLC
This structure may be occupied as a: Cell Tower
Tenant:AT&T By Order of Town Board
Cross Ref Z-UV-1-2017 TOWN OF QUEENSBURY
and P-SP-12-2017
ZBA and PB approvals February 2017
Issuance of this Certificate of Compliance DOES NOT relieve the �.i
property owner of the responsibility for compliance with Site Plan, V
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
OL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: AST-000839-2016
Tax Map No: 279.-148
Permission is hereby granted to: Centerline Communications LLC
For property located at: 1359 RIDGE 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: John Kubricky&Sons Inc. Cell Towers $50,000.00
Owner Address: 269 Ballard RD Total Value $50,000.00
Wilton,NY 12831
Contractor or Builder's Name/Address Electrical Inspection Agency
Centerline Communications LLC
95 Ryan DR,Suite I
Raynham,MA 02767
Plans&Specifications
Cell Tower
Tenant:AT&T
Cross Ref. Z-UV-1-2017
and P-SP-12-2017
ZBA and PB approvals February 2017
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 21,2018
(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 exp}(�ation��ppdate.I
Dated at the Town of ueensb { / /Frida , ,2017
SIGNED BY: /11J for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTVRE APPLICATION Office Use Only
415-11 -1
Date: I J 1 1 j abol .2j(
Permit No. l
Tax Map ID a-79 0-1 —4 Permit Fee 4 I D3
Zone (�(72 _ Historic? _Yes Ji No Rec Fe
Subdivision Name A �'�1 T(_j\k)-P r Lot# Sit an# �'1V� L2 L}
q S I
Project Location 13 J l �;(Ry(� O AT)l division#
TOWN BD.RESOLUTION 86-2013: $850 recreation fee for new dwelling units—single family,duplexes/two-family, multiple family,
apartments,condominiums,townhouses,and/or manufactured&modular homes,but not mobile homes. This is in addition to the
permit fee(s).
Primary Owner(s) r
'_YJ HK) �6fc -Uw f)? 1 - Iv06-j
Address
Phone/Email
Applicant r��
Address C r, Su(`,f'f t 2A �ll9a1
Phone/Email �C)S-_ g �_ a G - r w I i U ��7�'
Contractor
C-Q Ylw.Q CUwtwt w 3 C
Address c v P R A!'k Am mA oa?G
Phone/Email
Contact Person for Building&Codes Compliance: ?J +11 1 IIc n x➢ Phone �y X13- 35 6
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration IBI floor sf 2nd floor sf Total sf Height
Single Family
Two-Family
Multi-Family 279.4-48 AST-000839-2016
(#of units Centerline Comm., LLC/AT&T
1359 Ridge Rd. (Kubricky & Sons)
Townhouse Cell Towero
Business Office nn t133UILDIN.
Retail-Mercantile VFactory-IndustrialAttached Garage & CODES
(1, 2, 3, 4+)
Other W l t-(45iBuilding&
dl
Town of Queensbury Codes Principal structure Application revised January 2016
If commercial or industrial please indicate name of business
Proposed use of building or addition W r {G tSS (vwWIASJ CA-1 0w S
Source of Heat(circle one) Gas Oil Propane Solar COtheyala
Fireplace: Complete a separate application for Fuel Burning
Appliances& Chimneys tQ
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information:
a. Dimensions or acreage of lot
b. Is this a corner lot? _Yes No
c. Will the grade be changed as a result of construction _Yes _No
d. Public water or Private well(circle one) Public Q A- Private
e. Sewer or Private Septic System(circle one) Sewer j Private N 14
Value of all work to be performed(labor or materials) $
cw-
DECLARATION.
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. I 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 NYS
Building Codes,local building laws and ordinances,and in conformance with local zoning regulations
4. I acknowledge that prior to occupying the facilities proposed, I 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.
I have read and agree to the above:
PRINTNAME: 1 ROD 4^,,5 DATE:
SIGNATURE: 4T1We Cot,— DATE:
For office use only
Operating Permit Issued: _Yes —No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016