AST-0080-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
4iL Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: AST-0080-2018 Date Issued: Tuesday, May 1, 2018
This is to certify that work requested to be done as shown by Permit Number AST-0080-2018
has been completed.
Tax Map Number: 227.13-2-30
Location: 65 ROCKHURST RD
Owner: MARY MCCOSLIN
Applicant: MARY MCCOSLIN
This structure may be occupied as a: Dock
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
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.
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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0080-2018
Tax Map No: 227.13-2-30
Permission is hereby granted to: MARY MCCOSLIN
For property located at: 65 ROCKHURST RD 4
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: MARY MCCOSLIN Dock $1,500.00
Owner Address: PO Box 4580 Total Value $1,500.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
MARY MCCOSLIN
PO Box 4580
Queensbury,NY 12804
Plans&Specifications
Dock
$ 100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,March 2,2019
(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 date.)
Dated at the Town o bury; riW2018
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SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE
Permit#: 2.0 t6
PERMIT APPLICATION Permit Fee:$ IOO '
Town of(2yecns ury
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensburV.net
Project Location: ®C, � �-s'1 • ✓� - `
Tax Map ID#: ��, Subdivision Name:
CONTACT INFORMATION:
• Applicant
Name(s): AIA 2L CCD L
Mailing Address, C/S/Z:
Cell Pho e: (�) ) ::� Land Line: )
Email: ,P'7
• Primary Owners :
Name(s): ,4
Mailing Address, C/S/Z: fz�-n't t A- S rcz-
Cell Phone: ( ) Land Line:
Email:
• Contractor(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: � )
Email:
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: � )
Email:
Contact Person for Building & Code Compliance: 1i
Cell Phone: Land Li e: � )
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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PROJECT INFORMATION:
TYPE: Commercial Residential
Irk, pen 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
FV-%
Other(description: E ® ) _
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2`d floor:
Total square feet:
ADDMONAL PROJECT INFORMA11044
1. Estimated Cost of Construction:$
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 O
DECLARATION:
1. 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. If the work 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 above:
PRINT NAME: Ac LDS -f
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SIGNATUR ��ZDATE:
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Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017