AST-0174-2018TOWN 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-0174-2018 Date Issued: Friday, February 1, 2019
This is to certify that work requested to be done as shown by Permit Number
has been completed.
AST-0174-2018
Tax Map Number:
Location:
Owner:
289.19-1-2
2 BLACKBERRY LN
Richard Delsignore, Lynda Delsignore
Applicant:Dalaba Construction
This structure may be occupied as a: Deck 488 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
Planning Board or Zoning Board of Appeals.
Director of Building & Code Enforcement
TOWN OF QUEENSBURY
1
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
a
- Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0174-2018
Tax Map No: 289.19-1-2
Permission is hereby granted to: Dalaba Construction
For property located at: 2 BLACKBERRY LN
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: Richard Delsignore Deck $12,000.00
Owner Address: 2 BlackberryLN Total Value $12,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Dalaba Construction
116 Old Stage RD
Lake Luzerne,NY 12846
Plans&Specifications
Deck 488 s.f.
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 25, 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 To of Qu nsbu pri125, 2018
SIGNED BY: 4for the Town of Queensbury.
Director of Building&Code Enforcement
•
EC E Ir® filGe'Use Only
-N.w 4 I
ACCESSORY S CT URE P i #: J cf- U I7 v]-20C 4.K
PERMIT APP I � I
T On1PR ) 7 2018 3 . mi Fee:$ 1 Z v
Town orCbcenshury
742 Bay Road,Queensbury,NY 12804 TOWN OF QUEENSEUliWoic if: z 0 2-
P:518-761-8256 www.queensbury.net BUILDING&CODES
J
Project Location: F1/ c rn Li "
y
Tax Map ID#: l V 1' �SCibdivision Name:
CONTACT INFORMATION:
• Applicant: �y
Name(s): ; 1L)I D - ZY .� i( J/c JJorti
Mailing Address, C/S/Z: 2 F 1.6,0 ary 60ji 1 �ve).to b(. AY / 'I
Cell Phone: (,"�Z' )79/' 7 'YY ' Land Line: ( srrs' ) 192, we6s—
Email: .c)6 i.1- C'OM
• Primary Owner(s):
Name(s): 5y lQli 4C30 V/k
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Contractor(s):
Business Name: LJ9ZJJ3f/ Ce+/? tyC7/ew
Contact Name(s): da 2),01,L�B,
Mailing Address, C/S/Z: //4 aIr. srA6 eocd /An z ,e-d ; A 1 Y Age94
• Cell Phone: (_ 7 ) 7'9/, O33J Land Line: (Sit, ) '9I "5:W7
Email: 41,,41, A.9/4; '/9WOO 0/1
•. 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: 1:0cA,4 ._ Li.
Cell Phone: ( ) -5 / i45 /9."r�,1*` Land Line: ( )
- Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial IK Residential
WORK CLASS:
Deck,O en 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: 76
2nd floor: �,/
Total square feet: f er
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ /9,000
2. If Commercial project,what is the proposed use: 74
3. Are there any structures not shown on the plot plan? YES eoExplain:
4. Are there any easements on the property? YES
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. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
3. I 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of ..
occupancy.
5. I 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: /C p Da/ 761{/t9 i("6
SIGNATURE: - DATE:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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, DelSignore, Richard & Lynda TOWN OF QUEENSBURY _I tc-_514 '‘.1
i Deck
2 Blackberry Lane BUILDING & COD S EFT o - . ' -
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