AST-0122-2018 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-0122-2018 Date Issued: Wednesday, July 25, 2018
This is to certify that work requested to be done as shown by Permit Number AST-0122-2018
has been completed.
Tax Map Number: 289.17-1-47
Location: 153 BIRDSALL RD
Owner: Catherine Barry,Kerry Barry
Applicant: Keny Barry
This structure may be occupied as a: Replacing Dock 508 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-0122-2018
Tax Map No: 289.17-1-47
Permission is hereby granted to: Kerry Barry
For property located at: 153 BIRDSALL 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
Tvne of Construction
Owner Name: Catherine Barry Dock $10,000.00
Owner Address: 153 BIRDSALL RD Total Value $10,000.00
Queensbury,NY.12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Kerry Barry
153 Birdsall RD
Queensbury,NY 12804
Plans&Specifications
Replacing Dock 508 s.f.
$ 100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 4,2019
(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.)
e**M—il
Dated at the Town Queen 4,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
.6 I ACCESSORY STRUCTURE Permit#: +,:SJ - 012-7-^ 2016
�' C PERMIT APPLICATION Permit Fee:$ 7DC7
7'uwn oftjucet:slaury>
742 Bay Road,Queensbury,NY 12804 Invoice#: 0'2-20
P:518-761-8256 www.aueensburv.net
Project Location: �' � °"' �� �� �� :5 /LP Y ` 2-00 Y
Tax Map ID#: 52-5 41,90 2-11,17 y"7 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): ✓� -
Mailing Address, C/S/Z: / /Y 1-.2:�-o Y
Cell Phone: ( fit 4s ) d3' Land Line: ( SJCS ) ��/ d 4& q
Email: CL C i J 1C Q) V-PI
• Primary Owner(s):
Name(s): S;_1 VVV e o "C ot- &'-4-
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Contractor(s):
Business Name: av,-�t.
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line:
Email: I Ic P- IN n V I ';
UL= %W _ '
• Architect(sl/Engineer(s): MAC 21
Business Name:
Contact Name(s): ' OW- N®F QUF-F.NS0URY
Mailing Address, C/S/Z: BUILPIN,U UUM-1t)
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Building& Code Compliance: V.,,,-vY,.o
Cell Phone: ( ) Land Line: f ) J
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
y'
" PROJECT INFORMATION:
TYPE: Commercial V Residential
WORK CLASS:
_Deck,Open Porch _Solar Panels(w/o rafter upgrades) ,_/Carport _Cell Tower
Shed _Pavilion, Pole Barn,Canopy V Dock _Gazebo
Detached Garage /�_))Boathouse(with or w/o sundeck) _3-Season Porch
�ther(description: Do C k- )
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2n1 floor:
Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ (l f00 0
2. If Commercial project,what is the proposed 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. 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 I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of certificate of occupancy.
I have read and agree to the above:
PRINT NAME: �A` Z
SIGNATURE: `/'� O ` ` ��` '�--�" DATE: u M-v- )
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
Erosion Control Notes
r _
Double Silt Fence at lake, to remain in '
place for duration of project
"-` Construction silt fences; portions i
E •• at work areas to be opened during N
active work operations, reinstalled
upon daily work completion. Portions LL
a s° along propoerty lines to remain in place
�w for project duration
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Drawing:
Scale: 1 - 16'-0
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