AST-0319-2018
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-0319-2018Date Issued: Tuesday, January 8, 2019
This is to certify that work requested to be done as shown by Permit Number
AST-0319-2018
has been completed.
301.20-1-51
Tax Map Number:
5 LANCESTIRE DR
Location:
CHARMAINE LONG
Owner:
CHARMAINE LONG
Applicant:
This structure may be occupied as a: Shed 168 s.f.
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.
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-0319-2018
Tax Map No: 301.20-1-51
Permission is hereby granted to: CHARMAINE LONG
For property located at: 5 LANCESTIRE 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
Tyne of Construction
Owner Name: CHARMAINE LONG Shed<300 s.£ $4,300.00
Owner Address: 5 Lancestire DR Total Value $4,300.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Garden Time
652 QUAKER RD
Queensbury,NY 12804
Plans&Specifications
Shed 168 s.f.
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,June 8,2019
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury befo the expira ' e.)
Dated at the To of Q e nsbu June 8, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
X
office Use oniy
ACCESSORY STRUCTURE Permit: �'ylQj • 2Q1�
PERMIT APPLICATION Permit Fee:
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 I Invoice#:
P:518-761-8256 www.gueensburV.net
Project Location: -, ; /f��� eA,'
Tax Map I® #: Z)o I , ZO r�"`�1 Subdivision Name:
CONTACT INFORMATION:
• Applicant .
Name(s): '
Mailing Address, C/S/Z: 11 l"
Cell Phone: (S1f')A&t) - _ Land Line:
Email:- C' ; nJ OJ-1.6 a . CA'V�
• Primary Owners :
Name(s): A q,
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line:
Email:
• Contractor(s):
Business Name: cedar`.
0
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: 15 t ) Q a g
t t
Email:
A
cow
• Architect(s)/Engi nee r(s): µ � ...
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line:
Email:
Contact Person for Building & Code Compliance: 4-001► e,�,�
Cell Phone: J ) Land Line: J _)
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial iX Residential
WORK CLASS:
Deck, Open Porch _Solar Panels(w/o rafter upgrades) _Carport _Cell Tower
XShed del;Vexed _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:
2"d floor:
Total square feet: X ) S-�
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ /,# 300 , 00
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES N 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.
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 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:
SIGNATURE: • DATE: N
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
�IlAP.REFE'RENCE: I HERESY CERTIFY To
• JOHN N. k CHARMAINC PUTNAN
AMERICAS wHoLESAIE LENDER. •
WOODMERE, SUBDIVISION J� }_ Irs succEssoRs Asst6Ns, AS THEIR UNTEREST WAY APPEAR
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