AST-0653-2021 Office Use Only
IFF ACCESSORY STRUCTURE Permit#: PST-0 off--Zo21
Town ofQue 6 ry PERMIT APPLICATION permit Fee: $ )1�
742 Bay Road,Queensbury,NY 12804 Invoice#: !Air?o
P:518-761-8256 www.gueensburV.net Flood ZonQ? Y N Reviewed By:
Project Location: T o f 1� D Ajo-m / 1)o,,;, -
n
Tax Map ID#: 3� �—z— �. Subdivision Name: JAJl
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage (>300 s.f.) 4Dock ElGazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp
ElShed (<300 s.f.) ElSolar Panels
�`(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2"d floor: D IE C E 9 W I
Total square feet: SEP 0 Z 210 j j
i
TOWN OF QUE—E-NSCURY
BUILDING&COD'S
Brief description of scope of project: ` nS � ( `� 40 , 9 C-+<L —
Accessory Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ /L<-
2. Are there any structures not shown on the plot plan? ❑YES YNO Explain:
3. Are there any easements on the property? ❑ YES XZNO
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will require
the submittal of amended plans, additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of
Queensbury. After 1 year from the initial application date, 100%of the fee is retained.
3. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are atrue and a 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.
5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. 1 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:
SIGNATURE: �� DATE:
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
i
• Applicant: (�ODIC lac�� � C -C - C kel5 fa
Name(s):
Mailing Address, C/S/Z: NY (Z u x
Cell Phone: Land Line:
Email: AA02 CO3-e-,��bl,; J . �0r,- 4 Cc�.Sc�� � �Ct;( �t�t-
• Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contractor Name(s): 4d1'e 011C10c/, IS L(_o
Contractor Trade: DOC/C lo ��oLef� ✓��c.`�
Mailing Address, C/S/Z: )3& ,v- fGG,o o/A 0�cj-'(- 4d, Ic�ICz C co
Cell Phone: S 1 - Ceu - 3/ S Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project:
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised January 2021
TOWN OF QUEENSBURY
BUILDING bEPARTMENcompliance
Based on our litints shall not be construed as FILE C r i
with our c the plans and S�uildingaVlo0ons des of
indicating , with the
full compl►ame
NeW York State.
dj. r-c) n C iw P r-1
s
DOCK & BOATHOUSE BUILDERS
136 Stone Schoolhouse Road
Lake George, New York 12845
(518) 668-3159
(518) 361-8624
www.AdironDocksLLC.com
29 June 2021
D CCEOWE
PROJECT SEP 0 2 2C121
Steel Pile Dock - Assembly Point
TOWU OF OUEENSSLI
i3UILDR,,IG u CODES
CLIENT .—_..��.�.�__ _
Mr. Chris Abele TOWN OF QUEENSBURY
14 Bedford Circle
Mechanicville, New York 12118 BUILDING & CODES DEPT.
.
Reviewed By:
PROJECT SCOPE ®ate: 2
Design, fabricate and install galvanized steel 8' x 40' dock, as approved by the
Lake George Park Commission. Dock will be installed using 6" diameter,
galvanized steel pipes.
(Note: Price based on dock size as depicted on the Lake George Park
Commission Permit)
TERMS OF CONTRACT
1. The Contractor, Adirondock's LLC, agrees to build and install an 8' x 40'
galvanized steel dock at the above referenced property, per Lake George
Park Commission (LGPC) permit. Dock to be constructed using 6" channel
frame and 6" ID schedule 40 steel piles. Steel frame to be hot dipped
galvanized. Dock will be wrapped with premium pressure treated wood and
4x6" pressure treated dock posts. Decking to be 5/4" x 6" Trex composite
decking.
239.12-2-35.2 AST 0653-2021
Rockhurst LLC
10 Polk Dr
Dock Repair 320 s.f.
2. The new dock will be placed in the location and,orientation as permitted by
the Lake George Park Commission. Any survey work required to accurately
mark the location and orientation of the proposed docks will be at the
expense of the Homeowner.
3. The Contractor agrees to supply material necessary to construct the
galvanized steel dock, as shown. (Note: Dock size, location and configuration
to match LGPC permit.)
4. A dumpster will be supplied by the homeowner. If a dumpster cannot be
supplied, the contractor will handle waste removal and any fees associated
with the disposal of said waste will be the responsibility of the homeowner.
(N/A)
5. A Lake George Park Commission Permit will be supplied to the Contractor
prior to starting the project.
6. During the entire dock construction process one or more barges will be on
site. If the Homeowner requests the barges be moved off site, 72 hour notice
must be given to AdironDock's, LLC. A daily rate of$2200 will be charged to
the Homeowner for moving the barge(s) off site and again to move the
barge(s) back on site.
7.,-'A;p6rt-o-let;must',be'supplied and all fees associated with the rental and
maintenance,of said-port-o-let is the responsibility of the owner. Additional
fees will be discussed-with the Owner prior to the incurrence of such fees.
N/A
8. The Contractor will require access to at least (2) 15-20 AMP circuits and to
the circuit breakers. If there is no such access to a power source then the
Contractor will supply power through a gas powered generator. The Owner
will be required to reimburse the Contractor at a rate of$50 per day for
generator use.
9. DEMOLITION: Demolition and trucking of waste material is included in the
below price.
Ice Damage Disclaimer.AdironDock's of Lake George, LLC constructs and installs a
quality dock product, that is strong, long lasting and aesthetically pleasing. We take
measures to ensure that our structures can withstand the elements. However, we
cannot guarantee that a dock on Lake George is not susceptible to damage from flowing
ice sheets and other"Acts of God". AdironDock's of Lake George, LLC strongly
recommends all clients to install a bubbler or ice eater system during winter months.
Lumber Disclaimer.•AdironDock's of Lake George, LLC will not be held responsible for
discoloration, expansion, contraction, cupping, checking, etc. of wood products used in
the above project. AdironDock's of Lake George, LLC is not a re-seller of lumber
products and does not extend warranties on wood products used.
Composite Decking Disclaimer.•AdironDock's of Lake George, LLC will not be held
responsible for discoloration, expansion, contraction, cupping, checking, etc. of
composite products used in the above project. Composite decking tends to expand and
contract due to temperature and moisture fluctuations. This is typical behavior for
composite products. AdironDock's of Lake George, LLC is not a re-seller of lumber
products and does not extend warranties on wood products used.
PRICE SUMMARY
Galvanized Steel Dock=$45,740
(design, fabrication, galvanization, delivery & installation)
Note: Dock prices, as outlined above, are valid through July 31, 2021. Prices
subject to change after the above date based on fluctuations in material costs.
PAYMENT SCHEDULE
Payment 1: $15,000 due to secure contract and position in schedule. 'PAID Qa� 0A
Payment 2: $15,000 due upon completion of fabrication of dock. DUE 8-31-21 �l
Payment 3: $15,740 due upon completion of installation. W
b
Any additional fees incurred as outlined above will be due with final payment.
Available credits will be deducted from the final payment.
Please make checks payable to:
AdironDock's of Lake George, LLC
136 Stone Schoolhouse Road
Lake George, New York 12845
Gary D. Zervas, Jr. ar� I�5. Z,erVPs Jr.
Chris Abele .
Date: 29 June 2021
-a
Lumber Disclaimer:AdironDock's of Lake George, LLC will not be held responsible for
discoloration, expansion, contraction, cupping, checking, etc. of wood products used in
the above project. AdironDock's of Lake George, LLC is not a re-seller of lumber
products and does not extend warranties on wood products used.
Ice Damage Disclaimer. AdironDock's of Lake George, LLC constructs and installs a
quality dock product, that is strong, long lasting and aesthetically pleasing. We take
measures to ensure that our structures can withstand the elements. However, we
cannot guarantee that a dock on Lake George is not susceptible to damage from flowing
ice sheets and other"Acts of God". AdironDock's of Lake George, LLC strongly
recommends all clients to install a bubbler or ice eater system during winter months.
Composite Decking Disclaimer.AdironDock's of Lake George, LLC will not be held
responsible for discoloration, expansion, contraction, cupping, checking, etc. of
composite products used in the above project. Composite decking tends to expand and
contract due to temperature and moisture fluctuations. This is typical behavior for
composite products. AdironDock's of Lake George, LLC is not a re-seller of lumber
products and does not extend warranties on wood products used.
SURVEY PLAN �, >
o N
1" = 30' a�
co
�N
v r2N
DOCK#3 ON LGPC PERMIT FILE 0 Ix
a
8'' X 40' WOOD STAKE DOCK a "C;
TO BE REPLACED WITH a °�
8' X 40' STEEL PILE DOCK
y
Ro. o
MEAN HIGH WATER LINE (320.209 Q
4
DOCK STARTS @ MEAN l
HIGH WATER LINE (320.20') DOCK PROFILE
1" = 10'
h p
NN
NATURAL ROCKY SHORELINE o
TO BE STABILIZED AFTER CONSTRUCTION Q'
N c a
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GALV. STEEL DOCK FRAME 3I c°i o
A = in C
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40.0'
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4.0':t o ,J r,
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6"0 GALV. STEEL PILES
HYDRAULIC DRIVEN INTO LAKE BED
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9/20/21,11:29 AM Query results
YO K Lake George
STATE Park Commission
75 Fort George Road,P.O.Box 749,Lake George,NY 12845 1518.668.9347 Fax:518.668.5001 1 www.lgpc.state.ny.us info I pc.state.ny.us
NOTICE OF AVAILABILITY FOR REVIEW
Date: 09/20/2021
TO INTERESTED PARTIES: Comments Due: 10/05/2021
This notice is being sent to allow you an opportunity to comment on the proposed project below.Written
comments must be received by the"comments due"date above and should detail specific reasons for your
interest. support or opposition.
If you have no comments then no action is required.
Submit comments by email or mail to the analyst listed below:
Jason Kokkinos,jason@lgpc.state.ny.us
Applicant: Rockhurst LLC Application#: DWM21-000139 .
14 Bedford Circle Type: 01. Docks,Wharfs, and Moorings
Mechanicville NY 12118
Parcel#: 239.12-2-35.1
Project Location: 10 Polk Road Queensbury
Project Description: Replace wood stake dock with an 8'wide, 40' long steel pile dock.
State Environmental Quality Review Lead Agency: Not Designated
SEQR Determination: 1 -Type 11 Action, no further review under SEQR
cc: Queensbury, Adirondack Park Agency, all neighbors within 0.0 feet
https://www3.citizenserve.com/Admin/ReporiController 2/2
I
NEW YORK Lake George
STATE OF
OPPORTUNITY- Park Commission
i
75 Fort George Rd,PO Box 749,Lake George NY 12845 1518.668.9347 fax 518 668-5001 1 info@Igpc.state.ny www.lgpc.state.ny.us
i
APPLICATION FOR PERMIT FOR DOCKS, WHARFS AND MOORINGS
THIS APPLICATION IS FOR THE:(check all that apply)
❑ Construction of a New Dock or Wharf ($200) ❑ Placement of a Mooring ($100)
X 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 ❑Mr. ❑Mrs. ❑Ms. ❑Dr. ❑ INDIVIDUAL ❑ PARTNERSHIP ❑ ASSOCIATION
X CORPORATION ❑ MUNICIPALITY ❑ AGENCY
NAME Rockhurst, LLC EMAIL
CONTACT PERSON IF OWNER IS NOT AN INDIVIDUAL Chris Abele
MAILING ADDRESS
CITY STATE ZIP CODE PHONE 518-365-4989
"If this is an association or if other parties have deeded or contractual access to this lakefront,please complete Addendum A
2. AGENT . ❑NONE ❑PRESIDENT OR CEO ❑LLC MEMBER ❑ATTORNEY X CONSULTANT ❑CONTACT PERSON
NAME Devin Dickinson EMAIL adirondockslg@gmail.com
COMPANY
MAILING ADDRESS
CITY STATE ZIP CODE PHONE 518-339-7451
3. CONTRACTOR (If known)
NAME EMAIL
COMPANY
MAILING ADDRESS
CITY STATE ZIP CODE PHONE
4. PROJECT LOCATION
TOWN ❑ TICONDEROGA ❑ DRESDEN SECTION --TBLOCK 2 LOT
❑ FORT ANN ❑ HAGUE 239.12 35.1
❑ LAKE GEORGE ❑ PUTNAM STREET
X QUEENSBURY ❑ BOLTON 10 Polk Road
LAKE FRONTAGE 640' feet NUMBER OF WHARFS AND MOORINGS CURRENTLY ON PROPERTY
according to X Tax Map ❑ Survey(attach copy) 1 3 DOCKS 1 MOORINGS (Please fill in a number or 0 for each)
DOES LAKEFRONT CONTAIN WETLANDS? ❑ Yes XNo STREAMS?❑Yes XNo(If yes,show on project plans)
5. PROJECT DESCRIPTION
PROJECT DESCRIPTION Replace wood stake dock with steel pile dock. Location, configuration
to remain the same.
U:\SHARED\LGPC Program-Environmental Permits\Forms\Docks&Moorings\wharfmoo.wpd 10/11/16 Page 1 of
PROPOSED USE X RESIDENTIAL ❑ COMMERCIAL ❑ ASSOCIATION ❑ PUBLIC
TYPE OF CONSTRUCTION ❑STAKE ❑CRIB X PILE ❑ARTICULATING ❑OTHER
❑CANOPIED BOATLIFT ❑UN-CANOPIED BOATLIFT ❑PWC LIFT (include manufacturer specification sheet for all lifts)
PROPOSED STARTING DATE August 2021 PROPOSED COMPLETION DATE August 2021
IS ANY PORTION OF THIS ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BEGUN OR COMPLETED?
❑ Yes X No (if yes,please explain)
IF COMMERCIAL,IS THE FACILITY AND ITS ASSOCIATED LAND USES IN COMPLIANCE WITH APPLICABLE
PROVISIONS OF STATE AND LOCAL LAWS, ORDINANCES, RULES AND REGULATIONS?
❑Yes ❑No(if no,please explain)
6. ADJOINING LAKEFRONT PROPERTY OWNERS (available from your town or county real property dept.)
NAME Rockhurst, LLC NAME Brian Hogan
TAX MAP# 239.12-2-35.2 TAX MAP# 239.12-2-56
MAILING 4 Bedford Circle MAILING 34 Holly Lane
ADDRESS ADDRESS Y
Mechanicville, NY 12118 Lake George, NY 12845
7. CERTIFICATION
I 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 or their 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 from the said project.
SIGNAT E F OWNER(Note itle if signing for a corporation or association) AT
I .
PLEASE COMPLETE ALL ITEMS ABOVE AND INCLUDE WITH THIS FORM:
❑ Application fee
❑ Site location map
❑ Copy of survey If available
❑ Photographs of existing dock(for dock modification applications)
❑ Project plans on 8'/z X 11 size paper-PLANS MUST BE TO SCALE&SHOW ENTIRE(LAKEFRONT
❑ Short Environmental Assessment Form if project involves
• A new Association or Commercial dock or mooring
• More than one residential dock or mooring
• A dock or mooring to be located In a wetland,fish spawning area,an area of significant
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)
❑ 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 in processing your application. Permits
11 and approvals may be required from other agencies and municipalities
U:ISHAREDILGPC Program-Environmental PermitslForms%Docks&Mooringslwharfmoo.wpd 10/11/16 Page 2 Of 2
SURVEY PLAN o >
1" = 30' a�.
N .j �N
DOCK#3 ON LGPC PERMIT FILE 0 k
8' X 40' WOOD STAKE DOCK
TO BE REPLACED WITH
8' X 40' STEEL PILE DOCK
v
Ro. o
MEAN HIGH WATER LINE (320.20') Q
L_
DOCK STARTS @ MEAN
HIGH WATER LINE (320.20') DOCK PROFILE
1" = 10'
h o
Na
NATURAL ROCKY SHORELINE c
TO BE STABILIZED AFTER CONSTRUCTION „�� H 3
N m N
o
a
�. GALV. STEEL DOCK FRAME yl $ o
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40.0'
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6"0 GALV. STEEL PILES U y
HYDRAULIC DRIVEN INTO LAKE BED 4 j
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