2015-442 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development Building&Codes (518).761-8256 -
BUILDING.PERMIT
Permit Number: P10150442 Application Number: A2.0150442 .
Tax Map No: 523400-226-019=00027024-000-0000
Permission-is hereby granted to: DANIEL&JERI CERUTTI
For property located at: 235 ASSEMBLY PT. 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 Value,
Owner Address: DANIEL&JERI CERUTTI . Deck $15,000:00
36 CENTRAL St Total value $15,000.00
WINCHESTER MA 01890-0000
Contractor or Builder's Name/Address Electrical Inspection-Agency.
Plans&Specifications
2015-442
Sunde& 320 s.f.
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:. Saturday, September 24,2016
(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 n of Bens ,September 24,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
-• ACCESSORY STRUCTURE APPLICATION Office Use Only
Received
DATE 'f 7 °W Tax Map ID
TAx MAP ID � /Q -2 -.2 y Permit No. '4o�5
Perm't F
ZONING
� ( OM ee
HISTORIC SITE Yes 1/No V als
SUBDIVISION NAME Lot#
StP 17 2015
APPLICANT DIE.�W Q l}H e&_ q-Tg al ee/`u///
TOWN OF QUEE BURY
ADDRESS ?/ ILIaINWD� ES
PHONE 7 6 Z PHONE
_C05T Q�CONSTRUCTION(EBTIMATEb1. $
ADDRESS.'
PHONE:
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE ��� G PHONE
TYPE OF CONSTRUCTION
Check all that apply Please Indicate measurements as required below
Boathouse 181 floor sq.ft. 2"d floor sq,ft. Total sq.ft. Height
-Boathouse with Sundeck /
Deck
Detached Garage(#of cars
Dock
Pole Barn
Porch-open
Porch—.3 season,Covered,Enclosed
Shed
Other Accessory Structure(s)
Considered floor area&must comply with FAR(floor area ratio)requirements if located in the WR zone
DECLARATION: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the
application,plans and supporting materials are a true&complete statement description of the work proposed,that all work will be
performed in accordance with the NY'State Building Codes, local building laws and ordinances; and in conformance with local
zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy. 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: 00 Date:
Signature: Date: �f
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
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OA -Based on our limited eraminat.c r—compliance —
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� { o F — mdi--ting the plans and s eci- ationa-are in
_full compliance with the Builaing Codes of—
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til: l°I IIF-N:+X,ttI ? State of New York
(� eorge-Park Commission
M• eor a Road P.
orge9 New York
SEP 17 2015 T 8)668-9347
2 .9 c.state.ny.us in gpc.state.ny.us
�f 1I AQ -7
APPLIC' �� R-D 4 .CKS,.WHARPS�. •D.:.MSJO.RINGS s
THIS APPLICATION 1S FOR THE:(check all that apply)
YPr�t{CCtrf,I15SIUr'�f
❑ Construction of a New Dock or Wharf ($200) ❑ Placement of a Mooring ($100)
l� Modification to an Existing Dock or Wharf($50) ❑ Modification to-an Existing Mooring ($50)
Article 15 (Repair, removal, replacement or installation of cribbing as part:of wharf construction)
APPLICATION FEE ENCLOSED: + ' (check or money order only)
1. OWNER pf Mr. ❑Mrs. ❑Ms: ❑Dr. ❑ INDIVIDUAL ❑ PARTNERSHIP..-0 ASSOCIATIOg-
❑'.CORPORATION ❑.MUNICIPALITY p AGENCY
NAME t'r: .- i EMAIL
CONTACT PERSON IF OWNER IS NOT AN INDIVIDUAL
MAILING ADDRESS ( em s S-T
CITY Z„g` CkLOSjef STATE 111A- ZIP CODID1 39 PHONE
**If this is an association or if other parties have deeded or contractual access to this lakefront,please complete Addendum A
2. AGENT ❑'NONE El PRESIDENT OR CEO ❑LLCMEMBER -❑ATTORNEY 11CONSULTANT ❑CONTACTPERSON
NAME '`C ° (4 EMAIL mi-v_Aecr ro 11 , W1
COMPANY C0
MAILING ADDRESS
CITYO 2 r- SL STATES ZIP CODE PHONE 3
& CONTRACTOR
NAME SOLm QcL5 Alonoe EMAIL
COMPANY
J
MAILING ADDRESS
CITY STATE ZIP CODE PHONE
4. PROJECT LOCATION
TOWN ❑ TICONDEROGA ❑ DRESDEN SECTION �Z to BLOCK :. LOT
❑ FORT ANN ❑ HAGUE
❑ LAKE GEORGE ❑ PUTNAM -STREET
DrQUEENSBURY ❑ BOLTON61ea�-
LAKE FRONTAGE IM feet NUMBER OF WHARFS AND MOORINGS CURRENTLY ON PROPERTY
according to Fox Map ❑ Survey(attach copy) DOCKS MOORINGS (Please fill in a number or 0 for each)
5. PROJECT DESCRIPTION .
PROPOSED USE 19 RESIDENTIAL ❑ COMMERCIAL ❑ ASSOCIATION 0 PUBLIC
TYPE OF CONSTRUCTION ❑STAKE N CRIB ❑PILE ARTICULATING ❑OTHER
❑CANOPIED BOATLIFT ❑UN-CANOPIED BOATLIFT ❑PWC LIFT
PROPOSED STARTING DATE PROPOSED COMPLETION DATE
Pi2OJECT DESCRIPTION
man gartl
IS ANY PORTION OF THIS ACTIVITY FOR WHICH A PERMIT 1S SOUGHT NOW BEGUN OR COMPLETED?
❑ Yes oNo (if yes,please explain)
r-0
F COMMERCIAL,IS THE FACILITY AND ITS ASSOCIATED LAND USES IN COMPLIANCE WITH APPLICABLE
ROVISIONS OF STATE AND LOCAL LAWS,ORDINANCES,RULES AND REGULATIONS?
Yes "o(if no,please explain)
6. ADJOINING LAKEFRONT PROPERTY OWNER$. (available from your town or county real property dept.)
NAME NAME
TAX MAP# 21 9 _ TAX MAP 2 a 1 1 — — - `f
MAILING MAILING
ADDRESS ADDRESS
7. CERTIFICATION
hereby affirm that the information on.this form and all attachments submitted herewith is true to the best of my
knowledge and belief.
I hereby consent to the Commission staff working directly with my agent,as designated on page 1 of this form,during
the review of this application.
During the processing of this application Lake George Park Commission (LGPC)personnel ortheir assigns may need
to visit this site to inspect,measure,make drawings and/or take photographs. I hereby agree that LGPC staff or their
assigns may enter upon and pass through this property in order to inspect the project site or facility,without prior
notice,between the hours of 8:00 a.m.and 5:00 p.m.,Monday through Friday,while the application is pending. In the
event that the project site or facility'is posted with any form of"posted"or"keep out"notices,or fenced in with an
unlocked gate,this permission authorizes LGPC staff or their assigns to disregard such notices or unlocked gates at
the time of inspection.
As a condition to the issuance of a permit,the applicant accepts full legal responsibility for all damage,direct and
indirect,or whatever nature,and by whomever suffered,arising out of the project described herein and agrees to
indemnify and save harmless the State from suits,actions,damages and costs of every name and description
resulting f the sal rojecL
SIGNAT I O NER(Note tit igning.foFa-cerpemtion or association) DATE
F
MPLETE ALL ITEMS ABOVE AND INCLUDE WITH THlt-PORM:
pplication fee
ite•location.map
opy of survey If available
roject•plans on,8.%X 11 size paper--PLANS-MUST BE TO SCALE•&'SHOW ENTIRE LAKEFRONT
hort Environrrrental.AssessmentForm if project involves-
A new Association or•Commercial dock ormooring
A dock or mooring to be located in.a wetland,fish spawning area,an area of signiffcanf wildlife
-habitat-or an area of-unique-scenic,historic or natural significance
❑ Addendum A Co-owner Signature Page(if lakefront is jointly or commonly owned)
17 Addendum-B Parties with deeded or contractual access to this lakefront
Failure to include any one-.of the required Items-will result In.an-incomplete notice and delay ih processing-
your application. Permits and approvals may be required from other agencies•arid municipalities.
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