2003-621 TOWN OF QUEENSBURY~ r
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030621 Application Number: A20030621
Tax Map No: 523400-226-015-0001-009-000-0000
Permission is hereby granted to: MICHAFL GARCTU1,in
•
For property located at: 140 LAKE Pky
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 filled
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. fi Type of Construction Value
Owner Address: PAUL &ARLENE LOTTERS
6 UPPER LOUDON Rd Dock $2s, 00
Total Value $25,000. 0
00
LOUDONVILLE,NY 12211-0000
Contractor or Builder's Name /Address ,Electrical Inspection Agency
BOB SUTLIFF
747-2990
NOTRE DAME F,XT
NY 12804
Plans &Specifications
2003-621 MIKE GARGULIO
656 SQ FT DOCK AS PER PLOT PLAN SPECIFICATIONS
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 06,2004
(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 Queens ry; a esday,August 06,2003
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
n s�
4�
Porch, Deck, Dock, or Boathouse Permit Application
Town of Queensbury-Dept of Community Development,742 Bay Road, Queensbury,NY
(518)761-8256
A permit must be obtained before beginning construction, No Permit File No. 3—
inspection will be made until applicant has received a valid Fee Paid
building permit. All applicants'spaces on this application must be
Reviewed By:
completed and must appear on the application form.
JTC'Y rjYo -
Applicant: LOwner: ' G �23cliO
Address: t/ C0 90 A) CY- Address: 11s Le1�a1 dswC �
i2-9At/
Phone# (SIB ) - ;? Phone#(5�f') tzV- eT?.1'
Email Address: Smog Email Address: 57 - '4 "- "
Person Responsible for Supervision of Work as Regards to Building Codes:
Name Ir1g a2-t' �� Address: � darl f�s ��,-*Phone 66 g,-d,0 8 8
Property Location: Lot Number: / House Number /
Subdivision Name: 4A]1 (F 10Ar -k-w/,t% Tax Map Number:
Estimated Market Value of Construction: $ J
❑ Porch
❑ Deck RECEIVED
9 Dock
❑ Boathouse AUG p 5 2003
❑ Other work(describe
TOWN OF QUEEKS13URY
Size of structure to be built /0' square feet f3ljlLQINC a�f�10 CODEffi .
Submit along with this application:
I. Two plot plans drawn to scale,preferably using a survey map. Indicate proposed
structure showing setback dimensions from all property lines. Show location of
water supply and location and configuration of septic disposal area.
2. Two sets of structural drawings. Indicate size of posts or studs, floor joists,
decking or flooring material to be used. Show how the porch or deck will be
fastened to the building. If a roof will be constructed, indicate the size of posts or
studs,roof rafter spacing and span. Indicate type of roof: sloped, flat, shed, or
other. Indicate the type of material being used for the roof.
Declaration: please sign below after you have carefi ly read the statement:
To the best of my knowledge the statements contained in this application,together with the plans and
specifications submitted,are a true and complete statement of all proposed work to be done on the
described premises and that all provisions of the Building Code,the Zoning Ordinance and all other laws
pertaining to the proposed work shall be complied with,whether specified or noted, and that such work is
authorized by the owner.
Applicants signature: WA Date: f 2t3'24pZ
z
L:\,SueHemingway\Building.Permit.FORMS\Porch.Porch.Permit.doc 8/13/02 revised per DH
STATE OF NEW YORK
P 76 Fort George Road,P.0, Box 749
7845
Lake George,New York le
TEL(518'j668-9347 FAX(518)668-5001
A T APLIC i,TION FOR PERMIT'FOR 00Q!L$; WHARFS-AND MOORINGS
F
THIS APPLICATION IS FOR THE:
- Constatc0or•of a New Dock or Mart 1$200) - moment ota Mooring(WO)
, -Modification;to an Existing Dock or Wharf($50) - fi�1odffiwfiort to an Existing-Moodrig($50)
- -M;cle 15 Etcw�fiorAll(Repair,replacement or installation of aib*g as pert of wharf consUmfion)-Pao Fee
APPLICATION FEE ENCLOSED: (check or money order only)
I. OWNER 4NDIMDUAL - -PAPUNERWIP !'A�O�CJATJOil a <14RPOPATfON QttNK1FAL1TY..- -AGENCY-
PHONE 5_/8- L/q
MAtUNG ADDRESIS. Ir r tditods-etic'e
N Zip COL)e / 2-o I
CITY/�r S�eg,f STATE
If this isart zsodabrt orlother turtles have deeded orcontractug access to 11vs lakefront,Oeaseorovid-.naines and rmillog addresses of
J.1oveived parifesm a t-,Wamte shed.
2. AGENT - -SAME AS DWNER = -PRESVENTDR 6�0�GONTRACTOR -,ATTOAN 0 �ONSUL-fAW ONTACT.
PER;'.jj7N
NA m r; 4 PHONE
MAILING ADDRES',") f 610ky") elk
CITY i 0 A.)J ZIP CODE STATE q 12
PROJECT LOI�ATION
TOWN . -TICONDEROGA -DRESUEN SEC1110N BLOC LOT
FORT AW 44AGUE Ja
- -LAKE GEC;.GE • PUTRW STREET
_&QUEENSBUTY - -BOLTON
LAKE FRONTAGE ._.feet NUMSER OF WHARFS AND MOORMS CURRENTLY ON PROPERTY
4=09 to = aTa rDOCKS MOGRING8
SurvBv Ntacil W)
4. PROJECTOES- ClUPTION
13R FCT 4x) evf^S4-v zo x ff
ooc
I-147e
' PROPOSED E ER DIAL -ASSOCIATION -K4600,
MOPOSEDSTARIINGI)ATE ' PROPOSED COMPLETION DATE
M ANY pOR-11ON of;THIS AC-nVfrY FOR WHICH A PERMIT is SOUGHT NOW BEGUN OF?COMPLETED?
ayes Ra crf,
IF COMMERCtAL,4,13 THE FACILITY AND"ASSOCtATeD LAND USES IN CoMpLIANCE WITH APPLICABLE
PROVISIONS Of V.r.ATF-AND LOICALI_AWS.ORDINAMCES, RULES AND REGULATIONS?
jE;yes Cf too ff no,Pi Ra Ea WA P
in
tion r,-i-msVWrM rworirtg ikDP1tcaffon.wpd 8'2101 Page I of 2
5.AWOINING LA:Ot;6ll oNT'O.RoPEP_TY£IW�tR a
NAME
T TAXAP#MAILING MAILING
Z�,��
ADDRESS _ ADDRESS �
During the proc ossir,:y of this application Lake Greame Park Commission(LGPC)personnel may need to visit this sills
for the purpose of inspecting,measuring aa'fir photographing any existing docks,ciibs, moorings,property lines,or
other in-lake structures on the site.
i authoriza Commission staff to cionduct such a sites inspection s •�
t Wish to be contacted pr:ar to any site inspection �s A no
-
7. CERT-IFICAT 6N
l hereby that ti-e information on this form and all attachments submitted herewith is true to the best of my
knowledge and beliat-. As a condition to the issuance of a permit, the applicant accepts full legal responsiMlity for all
damage,direct and indirect,or whatever nature,and by whomever suffered, arising out of the project desodbed
herein and agrees to indemnify and save harmless the States from suits,actions,damages and costs of-ever/name
and description resul1rig from the said project.
NATURE OF OWNER(Mote title if signing for a corporation or modation) DATE
:iGt ATU ti` OF AGENT JBoth signatures needs my if a ent will act for ow or) DATE
7
JUCLUDE WITH THE FORM
•s��raj£s�t p-l;s�s 49tt�$�'/r�,t�•$�€�f�S -: . ' - • , . _ - - . .
• �amies�a lid legat mailing adldi6ises.o`All t6- n4>r;s`ai�par���i��h+d� or
cbntractUaf acceSS it0-tftia t*ant - -
..�t��a��rgt�i�nrn�d Ass�rai�nt�'��ifi•ne�:i`€� : . ' '• - . - _
The oonstruotion of-a single midentiaf doh,w�rila or: rir g rid:oari tr l tft3tt vhirh tt ;
rt`,* eSn entargss'or ex rids an,ax j'ng dock,v+v!%d or mootnt•ig,;provirde t thAt the 6truc ture•is
not 4c a#�:rd Ina wet], s#t ep `tiir, pt-ea,an Irdsi.si�f Y�ib �s frab la ar.�^t aria�t
untrue-s+::6n+c,hi-Stork',car tiatur�:Pa OnC8 does-'ri�-gener lty r rtt it h s forrri.'
Failare to i"tode-any-one of tie Fred ftem will Btr i fytOMO efe n fto a)id"a ah'P",
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