AST-0732-2018 01. 1111* 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-0732-2018 Date Issued: Thursday, November 29, 2018
This is to certify that work requested to be done as shown by Permit Number AST-0732-2018
has been completed.
Tax Map Number: 289.10-1-53
Location: 366 GLEN LAKE RD
Owner: Gary Hillert
Applicant: Gary Hillert
This structure may be occupied as a: Dock 128 s.f.
By Order of Town Board
TOWN OF QUEENSBURY
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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
'" °-s 1 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
_ Community Development - Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0732-2018
Tax Map No: 289.10-1-53
Permission is hereby granted to: Gary Hillert
For property located at: 366 GLEN LAKE 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
Type of Construction
Owner Name: Gary Hillert Dock $6,000.00
Owner Address: 689 SW Bittern ST Total Value $6,000.00
Pale City,FL 34990
Contractor or Builder's Name/Address Electrical Inspection Agency
Best Built Docks
17 Ash DR
Lake George,NY 12845
Plans&Specifications
Dock 128 s.f.
$ 100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,November 26, 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 expiratio ,•:to,
Dated at the Town uee bury; 4 M, , •, ovember 26, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Oniy
0,,M•10, ACCESSORY STR Permit it: i'NS i— 073Z- Zia ( $"
PERMIT APPLIC W ( L 0 V F..e:$ 100. GAD
Torn of O)censbur%'
142 Bay Road,Queensbury,NV 12804 NOV 19 201� in 1 Ute
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P:518-761-8256 www.queensbury.netOF
Project Location: 3(e& 6t-erJ ►,,A P';, LDI G&ECODESRY
Tax Map ID #: 2-1'0 , f D -" 5 3 Subdivision Name:
CONTACT INFORMATION:
• A licant:
Name(s): + I___,
6 L LSYL 1
Mailing Address, C/S/Z: �C SC-c/ /3 t T Ttrsn-ry S /- /- q Le- FL 3Y99O
Cell Phone: (5-6/ ) ova--9$ 41 Q Land Line: ( )
Email: G—lC
• Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Contractor(s):
Business Name: 80. / 'iI i/e(/ (Fc,vn lv L V / c �� '5i;1- 1!
Contact Name(s): fix ow0r"f' d
Mailing Address, C/S/Z: I7 Ai n, , rLa 6t-tw �riL iJ
Cell Phone: ( c ) 34 i 5 ,. 5 Land Line: (
Email: 14 SELL,) ; IL-4(444 p ej AA.etAl , c�V►..
• 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:
Cell Phone: (, 6( ) Zdo2— ' 'L'5 _ Land Line: (
Email: ,- IC-� vF 0 e c — 4 l_ - Ga tom.,
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial / Residential
WORK CLASS:
Deck,Open Porch Solar Panels(w/o rafter upgrades) Carport er
Shed Pavilion, Pole Barn,Canopy Dock
Detached Garage —Boathouse(with or w/o sundeck) 3-Season Porch
Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2nd floor: 0. ✓
Total square feet: I sRtr `
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ C/ 000,
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. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and wil
completed within a 12 month period.
2. If the work is not completed by the 1 year expiration date the permit may be renewed, sub s
and department approval.
3. I certify that the application, plans and supporting materials are a true and complete star /or
description of the work proposed, that all work will be performed in accordance with the NYS Build ocal
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 cer
occupancy.
5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor o•
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: /(c L-- L- L 4
SIGNATURE: DATE: I / 1
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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H I LLERT DOCK: 4' X 32' .
TOWN OF QUEENSBURY
BUILDING & CODE D
Reviewed B :
Date: \ \ side view
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TOWN OF QUEENSBURY 1 ci oc
FILE COPY 3 2, BUILDING DEPARTMENT 0D 1591
Based on our limited examination,JompIiance )0 c
with our comments shah not be construed as 1 It i)
indicating the plans and specifications are in 1
full compliance with the Building Codes of
New York State.
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