AST-0268-2018 3 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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.. Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0268-2018
Tax Map No: 302.8-2-56
Permission is hereby granted to: Ron Baker
For property located at: 7 Cline AVE
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: Mickey Rowell Deck $5,000.00
Owner Address: 7 CLINE AVE Total Value $5,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Ron Baker
136 Lick Springs RD
Greenwich,NY 12834
Plans&Specifications
Deck 448 sq.ft.
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,May 23,2019
(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 u sbury; 4 We I -s r/ ;..,L'-.y 23,2018
SIGNED BY: t \ for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only ,
ACCESSORY STRUCTURE 4jCI ',Z 6 cO I
Permit
PERMIT APPLICATION Permit Fee:$
Town of Queensbury
742 Bay Road,Queensbury,NY 12804
Invoice#t: 400
P:518-761-8256 www.queensbury.net
Project Location: lf in - y1"t u ln.skiv ��� !
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Tax Map ID#: ,�-�" Subdivision Name: - _
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CONTACT INFORMATION:
® Applicant: t
Name(s): , v i L. PO e , "�In S (NO, ,- �"l�rbfrt TOWN OF OUFFNS IJ V
Mailing Address, C/S/Z: 14 "1 .VI3 t i , ;�Pe o v'" r h1 . Oi �`I i 'iT4r r3':;}tj�':i.111 t��LI�T
Cell Phone: ( °aii ' ) S`30'' 4040 Land Line: ( , )
Email: a4roe'►,t 4-toodt koov Q ►4
Primary Owner(s):
Name(s): Cate t'i -o4,,' '
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Mailing Address, CA/Z. l i ��a� .
Cell Phone: ( ? ) `� Land Line: ( F , )
Email:. 1A \`,.weie,h.@ v-oft3.te-top► .:eke
• Contractor(s):
Business Name: ��,�---=-�- .�%�`� � ITSqdcl
Contact Name(s):
Mailing Address, C/S/Z
Cell Phone: (—rs'' ) ��3 0 teO Land Line: (
Email: cE-et E e vw
• 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: 04 e.) LGl Po11'4
Cell Phone: ( ) 1-30 ' 2, tt Land Line: ( )
Email: eke-Ott vt .d fl +
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial SL 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 OF STRUCTURE:
1st floor: X 1
cil
2nd floor:
Total square feet:
ADDITIONAL PROJECT INFORMATION:
1, Estimated Cost of Construction:$ t 00 0
2, If Commercial project,what is the proposed use:
3, Are there any structures not shown on the plot plan? YES' 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. 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: ot.
SIGNATURE:../` DATE: 5/1'1 he.
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Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017