AST-000425-2017 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-000425-2017 Date Issued: Monday,November 20, 2017
This is to certify that work requested to be done as shown by Permit Number AST-000425-2017
has been completed.
Tax Map Number: 301.13-2-29
Location: 27 PEGGY ANN RD
Owner: Belinda Spinner
Applicant: Belinda Spinner
This structure may be occupied as a: Deck 168 s.f.
(pre-existing when applicant purchased home) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 4t
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
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: AST-000425-2017
Tax Map No: 301.13-2-29
Permission is hereby granted to: Belinda Spinner
For property located at: 27 PEGGY ANN 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: Belinda Spinner Deck $0.00
Owner Address: 27 Peggy Ann RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Deck 168 s.f.
(pre-existing when applicant purchased home)
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 24,2018
(if a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu re t;Ywcnd
ite.I
Dated at the Town of eensb ; 24,201SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
~ Office Use Only
EF 5
ACCESSORY STRIjI Perrpit*, A,;!—DOo V2 N-'WO
PERMIT APPLICb► JUL 14 201 Permit Fee: $ (V
Town of Ouccnsbury
742 say Road,Queensbury,NY 12804 -OWN OF O'vE ^'c Invoice#:
P:518.761-8256 www.aueensbury.net BUILDING r.
Project Location:27 PF-nay 471.,) Qd
Tax Map ID#: 7 Subdivision Name:
CONTACT INFORMATION:
• A IiC t: q
Name(s): I I n� 1 lri(L r
Mailing Address, C/S/Z: 2-7 Qlay Ifn ii
Cell Phone: ( ISC ) — Land Line: � ) i
Email: EY)G1CWc-,J0J4 (&uL(')GQ Cern
/
Primary Owner(s):
Name(s): I "?GGX SDI (lur
Mailing Address, C/S/Z:
Cell Phone: (�I )-301- MI Land Line: �)
Email: Mama Spin U 0) \,ah0a = rntr
• Contractor(s):
Business Name: NIA
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
• Architect(s)/EnQineer(s):
Business Name: N/�
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: �)
Email:
Contact Person for Building& Code Compliance: 1,r-
Cell Phone: (,�-K7 1 KZC2-GS06 Land Line
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commerciai 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
pOFSTRUCTURE:
1st floor: I G o
2ntl floor: /�J
Total square feet: lOn
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ AXI /) on purchase o Pro pef
CA 2.0
2. If Commercial project,what is the p oposed use:
3. Are there any structures not shown on the plot plan? YES NO Explain:
4. Are there any easements on the property? YES NO
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to Issuance of a valid permit and will be
completed within a 12 month period.
T. 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 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 abS above:
PRINT NAME: Belinda a in
SIGNATURE: DATE: 7-133 7
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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