AST-000267-2017 TOWN OF QUEENSBURY
Y-_ 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: AST-000267-2017 Date Issued: Wednesday, June 21, 2017
This is to certify that work requested to be done as shown by Permit Number AST-000267-2017
has been completed.
Tax Map Number: 302.14-2-35
Location: 16 NORTHUP DR
Owner: Jason Bly
Applicant: Ron Baker
This structure may be occupied as a: Deck 168 s.f.
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r
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
qL 742 Bay Road,Queensbury,NY 12804-5904 (5 18)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: AST-000267-2017
Tax Map No: 302.14-2-35
Permission is hereby granted to: Ron Baker
For property located at: 16 NORTHUP DR
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
Tvce of Construction
Owner Name: Jason Bly Deck $3,000.00
Owner Address: 16 Northup DR Total Value $3,000.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Ron Baker
136 Lick Springs RD
Greenwich,NY 12834
Plans&Specifications
Deck 168 s.f.
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 7,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration
Adate.)
Dated at the Town of eensb ed s ne 7,f,2017
SIGNED BY: !V1 for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRU --
PERMITAPPLIC � � T e :$ "O• W
Town o(Queensbury
742 Ba Road,Queensbury,NY 12804L ) i
P:518-761-8256 www.aueensbury.net
SOWN OF QUEENSoUF,Y
Project Location: 1 1� !f 0 IZ[ J V
Tax Map ID#: 3 0 2 . 14— Z .3 S Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): Rom cv-k
Mailing Address, C/S/Z:t'? t. � t �. tc pR��+ fti RQ�TR� nJ �LC111kt1.
Cell Phone: ( SIG Land Line:
Email: TI72KR !�" Q!� harMAlL . LoAoI\
o Primary Owner(s):
Name(s): Tr4 S tZ L
Mailing Address, C/S/Z: 14P A/D P-M40 P P R
Cell Phone: S ) t b IR E3 2 Land Line:
Email:
• Contractor(s):
Business Name: R n ✓ A LL t:F-
Contact Name(s): 'Ro KI S3 A k e R-
Mailing Address, C/S/Z: 13 (o L t c, r< S E!R t N(g 5 ESP, G2 a—(E-bi t(, L+ ry tF GZ23 3�
� T
Cell Phone: ( Siff ) 6'8 0 - Zi as Land Line: � )
Email: R B K R . Cg-�, N 0-1'1-A R 11, Gunn
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line: 1 )
Email:
Contact Person for Building & Code Compliance: R-
Cell Phone: (9116Land Line: �_)
Email: 1ZL3f� d� i� L( d^rV�At � C,c�rn
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
✓Deck,Open Porch —Solar Panels(w/o rafter upgrades) _Carport —Cell Tower
Shed —Pavilion, Pole Barn, Canopy —Dock —Gazebo
Detached Garage —Boathouse (with or w/o sundeck) _3-Season Porch
Other(description: )
SQUARE FOOTAGE OF STRUCTURE:
1st floor: (v $
2nd floor:
Total square feet:
ADDITIONAL.PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 00
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES NO xplain:
4. Are there any easements on the property? YES NO
DECLARATION:
I. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. Ifthework is not completed 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 and/or
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. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
5. 1 also understand that[Ave 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: b nJ Q A k tra
SIGNATURE: �+Yl k7o�G�a _ _ _ DATE: t7
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
302.14-2-35 AST-000267-2017
Bly, Jason
16 Northup Drive 1
,
Deck
168 s.f.
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IMPORTANT NOTICE AND DISCLAIMER
THIS MAP AND INFORMATION IS PROVIDED AS IS AND
WARREN COUNTY MAKES NO WARRANTIES OR
'.j GUARANTEES,EXPRESSED OR IMPLIED,INCLUDING
1 inch 50 feet
WARRANT ESOFTIT N THAT FF FN EENT,
p MERCCUL,IR PURPOSE
AND THAT OF FRNESS FOR A
PARTITHE
INFORMATION
CONTAINED
HEREIN.
THIS MAP AND
THE I MESA L RIS CONTAINED HEREIN.USER
ASSUMES ALL RISKS AND RESPONSIBILITY FOR
DETERMINING WHETHER THIS MAP IS SUFFICIENT FOR
PURPOSES INTENDED.
GIS MAPS ARE NOT LAND SURVEYS!