91-508 .41
CERTIFICATE OF OCCUPANCY
TOWN 'OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date August 2419. 95
This is to certify that work requested to be done as shown by Permit No. 91 s08
- , has been completed.
This structure may be occupied as,a ALTERATION WITH ADDITION TO DWELLING
SEELYE ROAD
' Location
Owner. DELAPPA, DARWIN & CINDY
TAX MAP NO. 16-1-15. 2 By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg: do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. o�1-508
WARREN COUNTY, NEW YORK
I
cri
Darwin & Cindy is hereby granted to Dela a PP iv
OWNER of property located at Seelye Rd, Cleverdale Street, Road or Ave.
ro
in the Town of Queensbury,To Construct or place a Alteration with addition
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Star Route 210A
Queensbury, NY 12804 no
2. CONTRACTOR or BUI LDER'S Name =J.
Same �-
N
3. CONTRACTOR or BUILDER'S Address rD
fD
rD
4. ARCHITECT'S Name
C'!
rD
rD
5. ARCHITECT'S Address a
fD
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
No. 744 sq ft Alteration with addition as per plot plan specifications
and application
8. Proposed Use
New roof and addition to garage
$ 24.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 16, 19 92
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 16th Da of July 19 91
SIGNED BY _ /• for the Town of Queensbury
Building and Zoning I' ctor
TOWN OF QUEENSBURY
REVIEWED BY
41 r FEE PAID $ CO tyy t`;pp P
III OF `\:iUA.,E far' '':
�' PERMIT NO.
ItVi'-'' 7P\ eal 1j
BUILDING PERMIT APPLICATIONi.t ':
LI JUL 121991 +
•
BUILDING & CODE DEPT.
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO.INSPECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants spaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of this application.
• • • • • • • • • • • • • * • • • • • • • • • • • • • • • • • • • • • * • • • • •
The owner of this property is: Darwin & Cindy DeLappa
P.O. Address Star Route 210 A Queensbury, N.Y. 12804 Tel. 518-656-3035
Property Location Seelve Rd . Cleverdale Tax Map No. 16 /1 / 15 . 2
Has there been any split of this property since October 1, 1988? /XXX
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME, IF APPLICABLE LOT NO.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
Darwin DeLappa
•
NATURE OF PROPOSED WORK: ESI'IMATED MARKET VALUE OF •
•
Construction of a new building , CONSTRUCTION: S , 000 .00
Addition to a building * COMPLETE INFORMATION REQUIRED BELOW:
• Size of property 230 ft x �6 ft.
xxx Alteration to a building , • Existing Buildings(3) Size ft. x ft.
(no change to exterior dimensions)
" Proposed building - distance from property line:
---Other work (Describe) Remove 1 L0 • Front yard ft. Rear yard ft.
ti>ne pole shed and make one ' Side yards 20 . 5 ft. and 26 ft.
permanent peaked root garage roof •
GROSS AREA OF PROPOSED STRUCTURE • If on corner, setback from side street ft.
1st Floor 744 sq. ft. " OCCUPANCY INFORMATION
•
2nd Floor sq. ft. • - Primary Building -
Other Floors sq. ft.
" One Family Dwelling
(not cellar or basement a . Two Family Dwelling
TOTAL FLOOR AREA 744 sq. ft. • Multiple Dwelling/Number of units_
(glee of new structure ft x ft. - • Business
Foundation-pier'slab, crawl/partial/full •' Industrial
(circ e one) • Other
•
No. of stories (habitable space) 1 •
Height (grade to ridge) 20.t, ft. • If addition, what will use be? \)eiu' Renk
If residential, no. of families_ • c �J- i l v �- ( �0.�g,1
No. of rooms(excluding baths •
Accessory Building
No. of bedrooms 0 •
xxxxx Detached Garage ONE/TWO Car
No. of bathrooms 0 •
Primary heating system nr_ • ._ Garage_Attached ONE/TWO Car w
Type of fuel none ' __Private storage building
•
No. of fireplaces to be Installed none
• __ Other
Willa wood stove be installed n„
Central Air conditioning none •
OV•ER
ii
fi
TOWN OF QUEENSBURY
REVIEWED BY '
.. 1�� - FEE PAID $ OD
ki .IP. O tE a,3 m
�` PERMIT NO. — tg OF .al.�E �4: .
TS1f���\i� 1� 41, �:.I ,1BUILDING PERMIT APPLICATION
i Y
JUL 121991
• BUILDING & CODE DEPT.
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO.INSPECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants spaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of this application.
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
The owner of this property is: Darwin & Cindy DeLappa
P.O. Address Star. Route 210 A Queensbury, N.Y. 12804 Tel. 518-656-3035
Property Location Seelve Rd . Cleverdale Tax Map No. 16 /1 / 15 . 2
Has there been any split of this property since October 1, 1988? /XXX
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME, IF APPLICABLE • LOT NO.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
Darwin DeLappa
•
NATURE OF PROPOSED WORK: ESr;MATED,MARKET VALUE OF •
•
Construction of a new building , CONSTRUCTION: S 3 , 000 . 00
Addition to a building • COMPLETE INFORMATION REQUIRED BELOW:
• Size of property 230 ft x 76 - 5 ft.
xxx Alteration to a building , * Existing Buildings(3) Size ft. x ft.
(no change to exterior dimensions) •
Proposed building distance-from property line:
YYX Other work (Describe) Remove 1 a- o� • Front yard ft. Rear yard ft.
t-y-z � pole •
shed and make one • Side yards 20. 5 ft. and 26 ft.
permanent peaked root-garage roof •
GROSS AREA OF PROPOSED STRUCTURE a If on corner, setback from side street ft.
1st Floor ' 744 •
sq. ft. • OCCUPANCY INFORMATION
•
2nd Floor sq. ft. *
- Primary Building -
Other Floors sq. ft. • One Family Dwelling
(not cellar or basement • . Two Family Dwelling
TOTAL FLOOR AREA 744 sq. ft. • Multiple Dwelling/Number of units
• Business
size of new structure ft x ft. emir,
Foundation-pier'slab crawl/partial/fullit industrial
(circ e one) • Other
a
llo. of stories (habitable space) 1 •
Height (grade to ridge) 20.i ft. • If addition, what will use be? ) -
If residential, no. of families_ • "i- Pf))- i ti Avi. -47) ( srcc-k.
No. of rooms(excluding baths) • Accessory Building
No. of bedrooms n ' xxxxx• Detached Garage ONE/TWO Car
No. of bathrooms , o •
WO Cat
Attached Garage ONE/TWO Primary heath rystem n_ •
r k.
Type of furl none' • __Private storage building
No. of fireplaces to be Installed none • Other
Will a wood stove be installed r n •
•Central Air-conditioning none
OV• ER 7
TOWN OUEEN e6..;:'-,
BUILDING PERMIT APPLICATION CONTINCLD - Fy
BUILDING iPECIFICATIONS:
JUL 121991
Type of construction, wood frame, fire safe. etc. concrete slab to ex9 s_tB > IV90§ Cfp®m®EPT.
Wi11 any econd-hand r upgraded lumber be used? If so, for what?yes, for bracing) studding etc.
footing foundation footing -foundation
Foundation wall material cement b1 ork Thickness 18 inches 8inches
Depth of foundation below grade (to bottom of footing) 4 feet
Will there be a cellar? no Heated or unheated? unheated Floor sq. footage 744 sq ft.
Will there be-a basement? no Will any portion be used as living space? no
(If so, what portion? • sq ft. Type of use?
'Type of roof sloped/s at/shed/other Material of roof shingle •
Size,,.wood studs "x 4 " spacingl6 " o.c. length 10 ft. old section has 24" oc
Joists (floor beams) 1st floor "x " spacing . "o.c. span ft.
=-,Joist (floor-beams)" 2nd floor "x . ." spacing "o.c. span ft.
..- Overlays (ceiling beams) "x " spacing " o.c. span ft.
" Roof rafters 2- "x " spacing /1 o.c. spa 70 10 woo, 00 ri L O G •
—Roof trusses (pre-engineered) spacing . " o.c. span •. ft. - -
Exterior wall finish novelty siding wood of what: material?wood to match existing
Interior--wall finish none.
If a.garageis to be attached, describe materials to be used for FIRE SEPARATION:
Is there to he an opening between garage and dwelling? If so will a Fire-rated door, enclosure,
self-closing device be provided?
Will a flue-lined chimney be installed? no Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in..
Water supply - Municipal or private well none to garage private well to house
_SEPTIC-SYSTEM -Distance from ANY private well (including adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
FAME OF BUILDER. Darwin DeLappa ADDRESSsame as above TEL. NO. 518-656-3035
TAME OF PLUMBER _ ADDRESS " TEL. NO.
FAME OF MASON Darwin DeLappa ADDRESS same as, above TEL. NO. same as above..
FAME OF ELECT.RICIAN ADDRESS TEL. NO.
-7.'
DECLARATION
Toth best of_my knowledge and belief the statements contained in this application, together with the
lans;snd specifications"submitted, are s`true and complete statement of all proposed work to be dome on
te'described.premises and thatall proirisions of the BUILDING CODE, THE ZONING ORDINANCE, and
Ii other lima pertaining to thi proposed work shall be complied with, whether specified or not, and that
Bch-work is authorized byte owner.
_Signature
Owner-, owner's agent, architect, contractor
PECUL CONDITIONS OF THE PERMIT: � r'
'�. TOWN OF QUEENSBURY
'. BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
� (518)745-4447
ARRIVE: ///V) DEPART: `f/r-- INSP:�
FINAL INSPECTION REPOT - RESIDENTIAL
DATE INSPECTION RQUEST REC VIED: W-1 5
S.... )--(DO(N)C",
NAME 9 L`--ti�LOCATION c..12(7d�� 1 C') Cf��,
•DATE PERMIT fl q / -gOg
TYPE OF STRUCTURE , . -
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPT'C _ INSULATION
FINAL ELECTRICAL WODDSTOVE OR FIREPLACE
} v 2,4 J C '00 (; �'i��J N/A YES NO
CHIMNEY HEIGHT/B VNT EIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK PORCH STEPS i CGS
RELIEF VALVES
FURNACE/HOT WATER OPERATE G
INTERIOR TRIM/PRI ACY DOOR.
FINISH FLOORS:
BATH/KITCHEN W4TERTIGHT
OTHER FLOORS •WEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
4OKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN/VARIANCE REO.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C/C
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-/,15.y TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED 6,//+•
NAME 20tit,(JJ ; r Ce_472C4 , %f9/."z
LOCATION ?lets lye_
DATE Z f/7/'9 PERMIT I 9/-501
TYPE OF STRUCTURE a '. ald, f ,6,9
RECHECK APPROVED
N/A YES NO
-FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM/
FREEZING FOR 48 HOURS FOLLOWING i
THE PLACEMENT OF THE CONCRE1/E.
MATERIALS FOR THIS PURPOSE ON SITE/
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE I I
FOUNDATION/DAMPROOFING /
,_ACKFILL APPROVAL /
ROUGH PLUMBING /
PLUMBING VENT/VENTS IN PLACEI /
PLUMBING UNDER SLAB
,FRAMING:
JACK STUDS/HEADERS /
BRACING/BRIDGING / 1
JOIST HANGERS /
JACK POSTS/MAIN BEAM ;/
HEATING ROUGH-IN /
INSULATION:
FOUNDATION WALLS INTERIOR R- 1
FOUNDATION WALLS EXTERIOR R-
FLOORS /� R-
WALLS / R-
CEILING /' R- 1
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
� A � � 7/W
.e
ARRIVE 1---G-7 (' /�
DEPART % :/ r/j� -�
l_ U" ' INSPpCTOPt
(i'
TOWN OF QUEENSBURY 14'f
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME _ c.:.%;r- . i I Gt,�r,
` /J i
LOCATION SP'�r i &'� f2
DATE /Z ,9/ PERMIT 0 cJ/-S6j
TYPE OF STRUCTURE /({///'s. o. /�✓9c/�17r��
RECHECK ; APPROVED
V3/41-/
N/A YES NO
FOOTINGS/PIERS L' i ;)
MONOLITHIC POUR FORM /
REINFORCEMENT IN PLACE /.
THE CONTRACTOR IS RESPONSIBLE`
FOR PROVIDING PROTECTION FRO
O+
FREEZING FOR 48 HOURS FOLLO 3NG
THE PLACEMENT OF THE CONCRETt.
MATERIALS FOR THIS PURPOSE OF SITE
FOUNDATION/WALL POUR I
REINFORCEMENT IN PLACE/
FOUNDATION/DAMPROOFIN
BACKFILL APPROVAL / Y/.cif, (!
ROUGH PLUMBING /
PLUMBING VENT/VENTT& IN PLAC
PLUMBING UNDER SLAB
FRAMING: / ! . -
JACK STUDS/HEADERS
BRACING/BRIDG'ING
JOIST HANGERS
JACK POSTS/MAIN BEAM
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
.//(2.
Gi_.r,4o5, C C'66-Y,
ARRIVE f' .
DEPART I/ ‘2 -e '
NSPECT R
TOWN OF QUEENSBURY P/7)
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME 44t 9' 6.414
LOCATION ,1LifJGZ_ £1
DATE ri f iq f PERMIT #9/3:0/
TYPE OF STRUCTURE A W/ L2e14 4 &Bet
RECHECK APPROVED /�JJ
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF ' E CONCRETE.
MATERIALS FOR THI PURPOSE ON SITE
FOUNDATION/WALL P UR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPR00 NG
X(BACKFILL APPROVAL
ROUGH PLUMBING 1
PLUMBING VENT/VENTS kN PLA E •
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS 1
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM /%
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN ill \\
INSULATION: / 1
FOUNDATION WALLS NTERIO ; R-
FOUNDATION WALLS XTERIOR R-
FLOORS R-
WALLS / IR-
CEILING / 11-
DUCT WORK OR PhPING IN UNHEATED
SPACES /
REMARKS:
rr
ARRIVE 3 . ,vji
DEPART ,
'' INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED j// ( Vi
NAME / jut
6/44 z
LOCATION r ,pplp_ , digAittlQb
DATE f /3 /q/ PERMIT #
TYPE OF STRUCTURE Gd add
RECHECK / APPROVED
/ N/A YES NO
)(MONOLITHIC FOOTINGS/PIERS _
POUR FORM /
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPS1 ORIBLE
FOR PROVIDING PROTECTION/FROM
FREEZING FOR 48 HOURS FO LOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE '
FOUNDATION/WALL POUR ,"
REINFORCEMENT IN PLACE 4.
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL 1f
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE ./
PLUMBING UNDER SLAB I
FRAMING: - ;,"
JACK STUDS/HEADERS d '
BRACING/BRIDGING 11
JOIST HANGERS
JACK POSTS/MAIN BEAMA
FIRESTOPPING
WALLS ?1
CEILING / M
FIREWALLS
HEATING ROUGH—IN
INSULATION:
FOUNDATION WALLS INTERIOR R—
FOUNDATION WA1LLS EXTERIOR R—
•
FLOORS R—
WALLS R—
CEILING R—
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
1� C( 6 I `rt,UGM' L-I
jLhe S- 07
ARRIVE - Le)
DEPART 2=:- c—J — -
INSPECTOR
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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: BOTH-000051-2016 Date Issued: Thursday, May 17, 2018
This is to certify that work requested to be done as shown by Permit Number BOTH-000051-2016
has been completed.
Tax Map Number: 227.17-1-32
Location: 61 SEELYE RD
Owner: Cindy Delappa, DARWIN DELAPPA
Applicant: The Dock Doctors
This structure may be occupied as a: Sundeck, open-sided 339 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.
i TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
' - Community Development- Building& Codes (518)761-$256
BUILDING PERMIT
Permit Number: BOTH-000051-2016
Tax Map No: 227.17-1-32
Permission is hereby granted to: The Dock Doctors
For property located at: 6I SEELYE 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 fled and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Tvue of Construction
Owner Name: Cindy Delappa Boathouse with Sundeck $53,000.00
Owner Address: 61 SEELYE RD Total Value $53,000.00
Queensbury,NY 12804
Contractor or Builder's Name 1 Address Electrical Inspection Agency
The Dock Doctors
19 Little Otter LN
Ferrisburg,VT 05456
Plans&Specifications
Sundeck,open-sided 339 s.f.
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,February 2,2017
(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 ofeensb Mond F 2016
SIGNED BY: �Q1 for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE APPLICATION
/ q / Received
DATE Tax Map ID
I p
TAxMAPID 22� . - f 3� Permit No. > 6n-� -Q 0001--1 "Lotti'
� _
ZONING W(Z'ua � Permit Fee � ��, w��g kcn
4dF��lb
HrsraRlcSITE Yes � No 1
Approvals
SUBDIVISION NAME Loi:#
APPLICANT -Fkt U xt Ooeb rs OWNER Q4 W i K ti d �l k y
ADDRESS q t,%ff1e 6 #er L44.4- ADDRESS PC>&d
FCr1',%-l6VXj VT KgSl GuteeAsbAry , N"f LZS04
PHONE PHONE S 16- 65G 1035 0�r4 5-19-1? - W0q
CONTRACTOR ��¢ �Dvc per�fy�S COST OF CONSTRUCTION(ESTIMATED): $ 53 1000 00
ADDRESS: 7 Ls-
f t It O f[J er L a n j& BUILDING ADDRESS: 54KAC AS Alaav'C.
FerOsbwg, VT//Q!M(o
PHONE: 002--81-7-
CONTACT
02-Q - P-CONTACT PERSON FOR BUILDING&CODES COMPLIANCE (010 r&C 7 Or PHONE
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 1't floor sq. ft_ 2"d floor sq.ft. Total sq.ft. Height
Sundeck-OPev,. -s Gde� ^' 33 9 ^' 33 [ Il" W t II
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: I Da#e; 112�z�/�
Signature:
1
Town of Queensbury Building &Codes Accessory Structure Application July 2014
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JUL
12 M S IB VIEW
g1tLDIND & CODE DEPT.