AST-0026-2022 Office Use Oniv
ACCESSORY STRUCTURE
Permit#: itS� 002� " 7lJ22
PERMIT APPLICATION
Town_of Qucen b ry Permit Fee:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.4ueensburl.net Invoice#:
Project Location: 3� OlclSC�'arp KfJ
Tax map{D#: Subdivision Name: 1y �T
CONTACT INFORMATION:
• Applicant: `
Name(s): �ih �G�C�✓ v�'
Mailing Address, C/S/Z / �7�•z t y � YS
Cell Phone:„ ( S?� ) .��rl— lT t Land Line: .��)
Email:
Primary Owners : f
Name(s): AZo r en a on
Mailing Address, C/S/Z: 6 2 d 2 c
Cell Phone: 2.3 4 3 70 ® 0 4 Co Land Line:
Email: 340
❑ Check if all work will be performed by homeowner only
• Contractor(s)": Workers' Comp documentation mustbe submitted with this application
Contractor Name(s): Ac roLD 0 c1<%5 [-
Contractor Trade: i—D
Mailing Address, C/S/Z• 13C Arn_� .-��ao 00,s-e G ��ol9a yS
Cell Phone: ( 5G8 } 33 . — Land Line:
Email: o do Lis AAa.` C'o'V^
"List all additional contras ors on the back of this form
• Architects En ineer s : Rn
Business Name:
Contact Name(s):
Mailing Address, C/S/Z: > OF QUEENISR
Cell Phone:�_) Land Line: B fLDING&CODES
Email:
Contact Person for Buildin &Code Compliance: �Gy'7
Cell Phone: ( 18 ) � �" Land Line:
Email: ctGi!��n.�otJ�S i • Co
Revised February 2019
Accessory Structure Application
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
Deck,Open Porch r Solar Panels(w/o rafter upgrades) _Carport _Cell Tower
Shed —Pavilion,Pole Barn,Canopy Dock _Gazebo
_Detached Garage Boathouse(with or w/o sundeck) _3-Season Porch
Other(description: )
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 7
2nd floor: !c J'2— p
Total square feet: 6 l 2—
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$_ a o y D a o
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES NO Explain: oyl�
4. Are there any easements on the property? YES
DECLARAT[ON:
1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period,
2. ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
3. 1 certify that the application, plans and supporting materials are a true and 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.
4. 1 acknowledge that, prior to-occupying the facilities proposed I, or my -agents, will obtain a certificate of
occupancy.' .
5. 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:
I
PRINT NAME: e-, `S
SIGNATURE: DATE:�C3 12 Z
Accessory Structure Apprcation Revised February 20E9
2/1/22,8:18 AM View File
OW Lake George D E 0 V E
STATE Park Cormmission
BRUCE E.YOUNG DAVE WICK FEB U 1 102Z
0
Chairman Executive Director
02/01/2022 TOWN OF CtUEENS 11RY
Hayes Family Revocable Trust-Norman Hayes, Jr., Trustee BUILDING �� �
6207 Highcroft Drive
Naples FL 34119
Permit#: DWM22-000006 boathouse, boat lift
Parcel#: 239.12-2-2, Town of Queensbury
Dear Mr. Hayes,
Enclosed is your permit which was issued in accordance with the applicable provisions of the Park Commission's rules
and regulations(6 NYCRR 645 &646)and the Environmental Conservation Law. Please review the general and special
conditions included in the permit; these are intended to minimize any environmental disturbance associated with the
authorized activity.
Please note that it is the responsibility of the permittee and the permittee's agent to comply with all permit conditions.
Further, the permit is valid only for the activity expressly authorized.Work beyond the scope of the permit shall be
considered as work without a permit. The notice enclosed with the permit must be displayed in a conspicuous place near
the project site during the entire period of construction and must be suitable protected from the elements.Any failure to
comply with the terms of the permit may be treated as a violation of the Environmental Conservation Law. Questions
regarding this permit should be directed to the undersigned.
Should your plans change, you must contact this office to determine whether a modification to the permit is required
prior to initiating construction. Please note the expiration date of the permit. If further time is required to complete the
project, you must request renewal of the permit prior to this date. Your interest in maintaining the environmental quality of
Lake George is greatly appreciated by the Commission.
Sincerely, /
�JoeThouin
Deputy Permit Administrator
cc: Town of Queensbury, Devin Dickinson
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@lgpc.state.ny.us
hftps://www3.citizenserve.com/Admin/PermitController 1/7
2/1/22,8:18 AM View File ,
LGPC Permit Number <NTEW lake Geor a Issue Date
DWM22-000006 A E ParkColrnmission 02/01/2022
Type of Permit PERMIT Expiration Date
Modification Under the Environmental Conservation 02/01/2023
Law
FArticle 43, Title 1, 6NYCRR 646-1.1 ❑ Article 15, Title 5, 6NYCRR 608.5 Excavation and
Construction and Modification of Wharfs Placement of Fill in Navigable Waters
Article 43, Title 1, 6NYCRR 646-1.1 Article 43, Title 1, 6NYCRR 646-1.2
Placement of Moorings Operation/Modification of Class A Marina
❑ Article 43, Title 1, 6NYCRR 646-1.4 ❑ Article 43,Title 1, 6NYCRR 646-1.4
Recreational Use-New Recreational Use-Parasail
❑ Article 43, Title 1, 6NYCRR 646-1.4 ❑ Article 43, Title 1, 6NYCRR 646-1.4
Recreational Use-Seaplanes Recreational Use-Tour Boat
Article 43, Title 1, 43-0117 Operation of ferries and Article 43, Title 1, 6NYCRR 646-4 Stormwater
certain other boats, barges and vessels restricted. F] Management
❑ 6 NYCRR Part 608
Water Quality Certification
Permit Issued To Telephone Number
Hayes Family Revocable Trust-Norman Hayes, Jr., Trustee 239-370-0096
Address of Permittee Email Address
6207 Highcroft Drive bob3380@gmail.com
Naples FL 34119
Contact Person (if not permittee) Telephone Number
Facility Name Facility Address
Private Lakefront 31 Old Assembly Pt. Road
County Town Parcel#
Warren County Queensbury 239.12-2-2
AUTHORIZED ACTIVITY
Change footprint of the planned boathouse on an existing F-shaped, 36'x 40'stake dock, and add a boat lift in
accordance with plans attached.
By the acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the
Environmental Conservation Law, the Navigation law, all applicable regulations, and the General and Special Conditions
included as part of this permit.
Joe Thouin
Deputy Permit Administrator
Lake George Park Commission, P.O. Box 749, Lake George, NY 12845 1518.668.9347
Authorized Signature Date
/ Page 1 of 8
February 01, 2022
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GENERAL CONDITIONS
1.All activities authorized by this permit must be in strict 10. The permittee has accepted expressly, by the
conformance with the plans attached as Schedule A and execution of the application, the full legal responsibility of
made part of this permit. Modifications to the project all damages, direct or indirect, or whatever nature, and by
require prior approval in writing from the Commission. whomever suffered, arising out of the project described
herein and has agreed to indemnify and save harmless the
2. The permittee and any contractor, project engineer, or State from suits, actions, damages and costs of every
other person responsible for the overall supervision of this name and description resulting from the said project.
project shall read, understand and comply with this permit,
including all conditions to prevent environmental 11. The State of New York shall in no case be liable for any
degradation. damage or injury to the structure or work herein authorized
which may be caused by or result from future operations
3. The Commission and/or the Department of undertaken by the State for the conservation or
Environmental Conservation (the Department) may improvement of navigation, or for other purposes, and no
conduct such on-site surveys, investigations, claim or right to compensation shall accrue from any such
examinations, and evaluations from time-to-time as it damage.
deems necessary to ensure compliance with the terms and
conditions of this permit, and may conduct a final 12. Regulatory fees are due April 1 of each year for
inspection at any time after construction to determine docks.wharfs and moorings.
compliance with the permit.
13. Wharfs and moorings authorized herein are for
4.A copy of this permit must be available at all times at the residential use only and shall not be used for commercial,
project site during performance of the authorized activities. association or marina purposes.
Failure to produce a copy of the permit upon request by a
Commission or a Department representative is a violation 14. Disturbance to the bed and banks of Lake George shall
of this permit. be kept to the minimum necessary to complete the project.
5.The permittee is responsible for keeping the permit 15.All necessary precautions shall be taken to preclude
active by submitting a renewal application, including any contamination of any wetland or waterway by suspended
forms, fees or supplemental information which may be solids, sediment, fuels, solvents, lubricants, epoxy
required by the Commission, no later than 30 days prior to coatings, paint, concrete, leachate or any other
the expiration of this permit. environmentally deleterious materials associated with the
project.
6.Any change or modification in any of the activities
authorized by this permit is subject to prior review and 16. Heavy equipment, including bulldozers, backhoes,
approval by the Commission.Any modification of this payloaders, etc., shall not be driven in the water.
permit granted by the Commission must be in writing and
attached hereto. 17.Any material dredged in the prosecution of the work
herein permitted shall be removed evenly,without leaving
7. The permittee is responsible for obtaining any other large refuse piles, ridges across the bed of a waterway or
permits, approvals, land easements, and rights-of-way floodplain or deep holes that may have a tendency to
which may be required for this activity. cause damage to navigable channels or to the banks of a
waterway.
8. Granting of this permit does not relieve the permittee of
the responsibility of obtaining any other permission, Environmental Protection
consent, permit, or approval from the US Army Corps of 18.Any debris or excess materials from construction of this
Engineers, US Coast Guard, NYS Office of General project shall be immediately and completely removed from
Services, NYS Department of Environmental Conservation, the bed and banks of all water areas to an appropriate
NYS Department of Health,Adirondack Park Agency, or upland area for disposal.
local government which may be required.
19. There shall be no unreasonable interference with
9. This permit shall not be construed as conveying to the navigation by the work herein authorized.
permittee any right to trespass upon the lands or interfere
with the riparian rights of others in order to perform the 20. Wood treated with Creosote, Pentachlorophenol or
permitted work or as authorizing the impairment of any CCA(Chromated Copper Arsenate) is prohibited for in-
rights, title or interest in real or personal property held or water and above-water use.
vested in a person not a party to the permit.
LGPC Permit#DWM22-000006 Page 2 of 8
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GENERAL CONDITIONS
21. If upon the expiration or revocation of this permit, the 30. No rocks for use in construction are to come from the
project hereby authorized has not been completed, the lake bed.
permittee shall, without expense to the State, and to such
extent and in such time and manner as the Commission or The following specifications apply to the construction or
the Department may require, remove all or any portion of replacement of rock-filled cribs. Existing cribs may be
the uncompleted structure or fill and restore the site to its repaired.
former condition. No claim shall be made against the State
of New York on account of any such removal or alteration. 31. The size of any individual crib shall not exceed 8 feet
by 12 feet.
22. If future operations by the State of New York require an
alteration in the position or the structure or work herein 32. Spacing between cribs shall not be less than 8 feet.A
authorized, or if, in the opinion of the Commission or the minimum of 6 feet of open water shall be maintained
Department, it shall cause unreasonable obstruction to the between the shoreline and the first crib to allow for free
free navigation of said waters or flood flows or endanger circulation of water.
the health, safety or welfare of the people of the State, or
cause loss or destruction of the natural resources of the 33. Completed cribs shall be of the"open-sided"type
State, the owner may be ordered by the Commission or the construction and provide for at least 40% unboarded water
Department to remove or alter the structural work, contact area to the rock fill.
obstructions, or hazards caused thereby without expense
to the State. 34. If granted under 6NYCRR Part 608, the Lake George
Park Commission hereby certifies that the subject project
Wharf Construction Specifications will not contravene effluent limitations or other limitations or
The following conditions apply to all newly constructed standards under Sections 301, 302, 303, 306 and 307 of
wharfs which have not received a variance from any of the Clean Water Act of 1977(PL 95-217) provided that all
these limits: of the conditions listed herein are met.
23. The location of the mean low water mark must be field Moorings
verified prior to construction. In no case shall any part of 35. Moorings must meet the following minimum
the wharf extend further than 40 feet from the mean low specifications: the buoy shall be all white with a one inch
water mark. blue strip placed horizontally around the circumference
above the water line and a one inch strip of reflector tape
24. The maximum surface area of any dock or wharf shall placed around the upper part of the buoy; at least one
be seven hundred square feet, including any walkway. cubic foot of buoy is to be above the waterline.
25. The maximum width of any pier shall be eight feet and The following conditions apply to all new moorings which
the minimum width of any pier shall be two feet. have not received a variance from any of these limits:
26. The maximum width of any dock or wharf, including all 36. Moorings shall be placed so that vessels moored to
lateral projections, shall be forty feet. them, at the full swing of their mooring or anchor line,will
be no closer than twenty feet to the projection of the
27. No structure shall be constructed on a dock, wharf or property lines extended into the lake along the axis of the
mooring which exceeds sixteen feet in height above the property lines as they intersect the lake, or a line extended
mean high water mark and which is not in compliance with at a right angle to the mean high-water mark, whichever
local zoning. results in the greater setback.
28. Every dock or wharf constructed shall have a minimum 37. Moorings shall not be placed so that the full swing of
setback of twenty feet from the adjacent property line the vessel extends more than one hundred feet offshore
extended into the lake on the same axis as the property from the mean high-water mark.
line runs onshore where it meets the lake, or at a right Articulating Docks
angle to the mean high-water mark,whichever results in
the greater setback. 38.Articulating docks must remain in the lowered position
at all times between May 15 and November 1. Boat lifts
Crib Work and canopy frames shall be removed prior to lifting docks
29. Stone used for filling shall be clean (not contain any into the winter position.
material than can pass through a No. 8 sieve). The stone
shall not be less than six(6) inches in diameter.
LGPC Permit#DWM22-000006 Page 3 of 8
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PROPOSED ALUMINUM {r- N i
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EXISTING FLOATING KAYAK 1 A �ll�
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Qusensbury, Warren County Details 4
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Schedule A
Permit#DWM22-000006
Page 7 of 8
Vertical lift is measured at the aft end of the bunk rails from the
fully lowered position to the fully raised.position
1 44"
29" 55"—*
Bill
25"
Lift Capacity 7,800 1 bs.
Vertical Lift 56" 135"
Minimum Water Depth 29"
Standard Leg Length 48"
Frame Weight 714'lbs.
Weig Ship h c 935 1 bs.
Mono-Crystal Solar Charger 12 Watt 1171'
Remote Control Transmitter's 2
Stainless Steel Cylinders I
Standard Hose Length 27'
Submerged Hose Ends Stainless
3
Connecting Hardware Stainless
i Schedule A
Kayak Lift Permit#DWM22-000006
Page 8 of 8
Decking Option
Isometric View
MAY ®4 2021
BLai( hca.1 ork y �+
e Georye Park State
Commission
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,T PVC Deck Boards
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} 1"Thick 4
1 -1/4" Channel '
Frame to support
deck boards on ,
16" CtoC
A i PVC Deck Board
Side Skirts
1"Thick
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REV i DRAWN: C.DBlosio A. mr--tea' 'n
PART: 8' x 12' Slip Dock REF #: KD - 8X12 I SCALE: 1:20 ,CHECKED: j J.Hortlson �`�`
SHEET 4 o F 5 DATE: -D2/D2/16 Your First Choice for Floating Dock'Solutions
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ZWYORK
E OF
ORTUNITY
LAKE GEORGE PARK COMMISSION
NOTICE: A permit has been issued for wharf repair,
modification or construction at this site. For further
information, contact the Lake George Park Commission at
PO Box 749, Lake George NY, 128455 518-668-9347
Permit ID: DWM22-000006
Permittee: Hayes Family Revocable Trust-Norman Hayes, Jr.,
Trustee
Expiration Date of Authorization: 02/01/2023
This notice must be posted in a conspicuous place&protected from the elements during the period of construction.
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To the permittee:
Please sign, fold, tape shut and return upon completion of the project.
FOLD#2
Hayes Family Revocable Trust-Norman Hayes, Jr., Trustee
6207 Highcroft Drive
Naples FL 34119
Lake George Park Commission
PO Box 749
Lake George NY 12845
FOLD#1
Certification of Completion of Work Authorized by Permit#DWM22-000006
Issued on 02/01/2022 Parcel#239.12-2-2, , Town of Queensbury
Project: Change footprint of the planned boathouse on an existing F-shaped, 36'x 40'stake dock, and add a boat lift in
accordance with plans attached.
The project authorized by the above referenced permit was completed on
The dock was installed/constructed by
X
Owners Signature Date
An inspection will be made once form is received. The permit must be kept active during construction.
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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@lgpc.state.ny.us
02/01/2022
NOTICE
Owner: Hayes Family Revocable Trust-Norman Hayes, Jr., Trustee
Facility: Private Lakefront
Address: 31 Old Assembly Pt. Road
Parcel#: 239.12-2-2, Queensbury
Lakefront: 120 Account#: 2516
The enclosed permit#DWM22-000006
Once the permitted project is complete your annual registration fee will be: unchanged.
. For Commercial or Association properties, fees may need to be redetermined.
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