2010-220 TOWN OFQ UEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100220 Date Issued: Monday, May 09, 2011
This is to certify that work requested to be done as shown by Permit Number P20100220
has been completed.
Tax Map Number: 523400-227-013-0002-024-000-0000
Location: 53 ROCKHURST Rd
Owner: THOMAS KUBRICKY
Applicant: THOMAS KUBRICKY
This structure may be occupied as a:
Dock
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the � '( /�r
`�pro
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.
if TOWN OF QUEENSBURY
Ffis 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100220 Application Number. A20100220
Tax Map No: 523400-227-013-0002-024-000-0000
Permission is hereby granted to: THOMAS KUBRICKY
For property located at: 53 ROCKHURST 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 Queens bury Zoning
Ordinance. Type of Construction Value
Owner Address: TIMOTHY HORRIGAN
JOAN CAMP &KELLY HORRIGA Dock $1,000.00
33061 SEAWATCH Total Value $1,000.00
DANA POINT, CA 92629-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-220
168 sq ft dock
$30.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,May 12, 2011
(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 eensbt ; \7 d sda , May 12,2010
SIGNED BY / j cif for the Town of Queensbury.
Director of Building&Code Enforcement
FICE USE ONLY
2Z.7. j� - 2-z40
TAX MAP NO. PERMIT NO. ,22 •
FEE PAID BLDG. &CODES APPROVAL ••
•
•
•
•
ACCESSORY STRUCTURE BUILDING PERMIT APPLICATION
Use this application for any structure other than the Principal Structure (house) to include, but not limited to:
garage, shed, greenhouse, dock, deck, etc. Refer to Informational Brochure No. 3 entitled Accessory Structures-
Sheds/Fences.
A PERMIT MUST BE-OBTAINED BEF)RE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT. NO 'NSPECTIONS WILL BE MADE UNTIL THE APPLICANT HAS RECEIVED
A VALID BUI
DING P 'MIT. - id
OWNER: g(,// �" MIL IA 1�Vi/ jt�STALLER/BUILDER:
ADDRESS: (p/PI LA/JD/XJ H(Lt.- G NDRESs:
PHONE NOS —� I-61.726 PHONE NOS.
KELLY 111
LOCATION OF PROPERTY: � � SLtBDI IS,ION NAME:
11 ' 7r04 ' ► '� F�jj
LOCATION OF PROPOSED CONST-UCTION AP )/OR INST'ALLATION: D(SC
HAS THERE BEEN A SITE PLAN REVIEW;VARI!.JCE OR SUBDIVISION APPROVAL? 0 YES A NO
IF SO,INDICATE APPLICATION NO.AND DATE't F APPROVAL:
ESTIMATED COST OF CONSTRUCTION: $ �) ANY OTHER ACCESSORY STRUCTURES ON PROPERTY? NO
IF YES,PLEASE LIST:
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: 7� J 2 � PHONE:
-7°11 — 72-11
1STFLOOR 2ND FLOOR TOTAL PROPOSED
PROPOSED CONSTRUCTION HEIGHT
SQ.FT. SQ.FT. SQ.FT. FT.&IN.
OPEN PORCI-,
DECK
3 SEASON,COVERED OR ENCLOSED PORCH*
BOATHOUSE
BOATHOUSE WITH SUNDECK
DOCK 1
SHED
� f
POLE BARN
DETACHED GARAGE(NO.OF CARS: )
OTHER ACCESSORY STRUCTURE:
*CONSIDERED FLOOR AREA & MUST COMPLY WITH FAR [FLOOR AREA RATIO] REQUIREMENTS IF THE
STRUCTURE IS LOCATED IN THE WATERFRONT RESIDENTIAL ZONE.
To the best of my knowledge, the statements contained in the application, together with the plans
and specifications submitted, are a true and complete statement of ail proposed work to be done
on the described premises and that all provisions of the Building Codes, 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. Further, it is understood that I/we shall
submit prior to a Certificate of Occupancy or Certificate of Compliance being issued, as requested
by the Zoning Administrator or Director of Building and Codes, an As-Built Survey by a licensed
surveyor, drawn to scale, showing actual location of all new
construction.
QUESTIONS? CALL 761-8256 OR EMAIL
rn.�ncnnnnnnch.....ns�
-Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518) 761-8256 .�v'l'` Arrive: am/pm Depart: /61Sam/pm
Date Inspection request received: I Inspector's Initials:
loLV h(s L k - 22.v
NAME: Y PERMIT#. U
LOCATION: r7 3 ('�c' t-'ll<: Hy( ;% A-15. DATE: LI /iiS) 1 I
TYPE OF STRUCTURE: r
Comments:
Yes No N/A
4" Building Number Address visible from road
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors
Handrail 4 or more risers
Guards at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more
Guard at deck, porches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches
Deck Bracing/Handicapped Ramp Compliant
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors/Carbon Monoxide Detectors
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: Battery backup:
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft.vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation/Insulation Certification/Sticker on Panel
Floor truss,draft stopping finished basement 1,000 sq.ft.
Emergency egress below grade
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum'/"Gypsum -
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/%hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles
Flex Gas Pipe Bonding
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C I C or C/0[Temporary/Permanent]
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008; Revised 6/26/08;Revised 12/22/10
•
STATE OF NEW YORK O` / J-6
LAKE GEORGE PARK COMMISSION
it � ? PO Box 749, 75 Fort George Rd
rmf � Lake George NY 12845 RECEIVED
tel518
(518)668-9347 fax(518)668-5001
�CL61°A www.l c.state.n .us info@lgpc.state.ny.us
gP y @ gpc.state.ny.us 'JUL 2 2 2010
NOTICE OF AVAILABILITY FOR REVIEW
NOTICE OF COMPLETE APPLICATION TOWN OF QUEENSBURY
PLANNING OFFICE
Date: July 21, 2010 Application: 5234-46-10
Applicant: Type: DN Minor
Joan Camp Et Al Wharf Construction
661 Landon Hill Rd
Chestertown, NY 12817
Project Location: Rockhurst Parcel#: 227.13-2-24
Project Description: Town of Queensbury
Construction of a 28' long, 6'wide stake-supported pier in accordance with plans attached
State Environmental Quality Review (SEQR) Lead Agency: None Designated
SEQR Determination: 1 -Type II Action, no further review under SEQR
TO INTERESTED PARTIES: Comments Due: August 05, 2010
This notice is being sent to allow you an opportunity to comment on the proposed project.
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 you do
not need to return this form.
Return this form and any comments to: Molly Gallagher
LGPC, Box 749, Lake George, NY 12845. Phone: (518) 668-9347.
Reviewer Comments: D. to Comments 0 Comments below or attached
cc:
Town of Queensbury Prepared by: Cret i6rtivinAdyi,Colc c�rso r .
'Koen c1 Address:
TOWN OF QUEENSBURY
E-mail: DEPT. OF COMMUNITY DEVELOPMENT
Telephone: ( ) ZONING OFFICE Date:
742 BAY ROAD
fl' U IENSBURY NY 12804
STATE OF NEW YORK
LAKE GEORGE PARK COMMISSION
;t. 4,,
,•i C - PO Box 749, 75 Fort George Rd
.' ,,R-_, Lake George NY 12845
RECEIVED
' `%' tel (518) 668-9347 fax (518) 668-5001
�
QEL6l9$ www.lgpc.state.ny.us info@Igpc.state.ny.us
'JUL 2 2 2010
NOTICE OF AVAILABILITY FOR REVIEW
NOTICE OF COMPLETE APPLICATION TOVVN OF QUEENSBURY
PLANNING OFFICE
Date: July 21, 2010 Application: 5234-46-10
Applicant: Type: DN Minor
Joan Camp Et Al Wharf Construction
661 Landon Hill Rd
Chestertown, NY 12817
Project Location: Rockhurst Parcel#: 227.13-2-24
Town of Queensbury
Project Description:
Construction of a 28' long, 6' wide stake-supported pier in accordance with plans attached
State Environmental Quality Review (SEQR) Lead Agency: None Designated
SEQR Determination: 1 - Type II Action, no further review under SEQR
TO INTERESTED PARTIES: Comments Due: August 05, 2010
This notice is being sent to allow you an opportunity to comment on the proposed project.
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 you do
not need to return this form.
Return this form and any comments to: Molly Gallagher
LGPC, Box 749, Lake George, NY 12845. Phone: (518) 668-9347.
Reviewer Comments: 0 No Comments 0 Comments below or attached
cc:
Town of Queensbury Prepared by:
Colc. cr'o
Qe►��� Address:
E-mail:
Telephone: ( ) Date:
STATE OF NEW YORK
,
„I-AFT G1c GEORGE s.AR COMMISS `tice, iT (f /�
It= '\ 75 Fort George Road, P.O. Box 749 ^ '
Lake George, New York 12845 w JUN 2 9 201C , I
0-)k(9DA1),rn TEL(518)668-9347 FAX(518)668-5001
w.lgpc.state.ny.us permits@lgpc.state.ny.us
AKP GE ogruk RA ^^!ON
APPLICAT ON FOR PERMIT FOR DOCKS, WHARFS 'A ` i v •'• = e
THIS APPLICATION IS FOR THE:
,Construction of a New Dock or Wharf ($200) ❑ Placement of a Mooring ($100)
❑ Modification to an Existing Dock or Wharf($50) ❑ Modification to an Existing Mooring ($50)
❑ Article 15 Excavation/Fill (Repair, removal, replacement or installation of cribbing as part of wharf construction)
APPLICATION FEE ENCLOSED: (check or money order only)
1. OWNER 0 INDIVIDUAL %PARTNERSHIP 0 ASSOCIATION 0 CORPORATION ❑ MUNICIPALITY 0 AGENCY
0 Mr. ❑ Dr. .0 Mrs. 0 Ms. Ruhg vgy
n
NAME -OktJ C P, ' fr RI j 11 ow 7 PHONE - - n zze
I /
CONTACT PERSON IF OWNER IS NOT AN INDIVIDUAL QA-k1 (lap
MAILING ADDRESS (di I I)Da.) H-ILL RD
CITY C,I - )j STATE ki y ZIP CODE j EMAIL jPiq toitkOthipia 6 AIL
If this is an association or if other parties have deeded or contractual access to this lakefront,please complete Addendum A
2. AGENT ME AS.OWNER ❑PRESIDENT OR CEO 0 CONTRACTOR ❑ATTORNEY 0 CONSULTANT 0 CONTACT PERSON
NAME PHONE
COMPANY
MAILING ADDRESS
CITY STATE ZIP CODE EMAIL
3. PROJECT LOCATION' - o2o99; /3 - 2 r 2- q
TOWN 0 TICONDEROGA 0 DRESDEN SECTIO. 2:7 BLO / LOT
O FORT ANN 0 HAGUE
O LAKE GEORGE 0 PUTNAM STRE ` - 1Oakfu� f�D
>UEENSBURY 0 BOLTON o\
LAKE FRONTAGE i/• feet NUMBER OF WHARFS AND MOORGS CURRENTLY ON PROPERTY
according to 0 Tax Map pl Survey(attach copy) 4 ()DOCKS I MOORINGS
4. PROJECT,DESCRIPTION
PROJECT 61'R/-'iiha- DO CK
TYPE OF CONSTRUCTION ) STAKE 0 CRIB 0 PILE 0 ARTICULATING ❑ OTHER
PROPOSED USE RESIDENTIAL 0 COMMERCIAL 0 ASSOCIATION ❑ PUBLIC
PROPOSED STARTING DATE L- 1 IO PROPOSED COMPLETION DATE LY ?--0/4
IS ANY PORTION OF THIS ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BEGUN OR COMPLETED?
e (if yes, please explain) /+/v ,f'1- j�t.v 017, ca til rr v7L- ex, z-
H:\forms\application forms\wharf mooring application.wpd 2/6/2008 Page 1 of 2
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)
5. ADJOINING LAKEFRONT PROPERTY OWNERS (available from your town or county real / _
property_ dept.)
NAME `� kJISVAIJAME cgtzt J I&-
TAX MAP# )3' /ice►-3 3 TAX MAP # /' f .)a 7. 13 ..i'
MAILING MAILING
ADDRESS 3 G S" S /72/9//I-' 57`- ADDRESS ,'C, .67c kk d `/
/c/c- !t/y /%S/ 3 C C
6. SITE INSPECTION
During the processing of this application Lake George Park Commission (LGPC) personnel may need to visit this site
for the purpose of inspecting, measuring and/or photographing any existing docks, cribs, moorings, property lines, or
other in-lake structures on the site.
I authorize Commission staff to conduct such a site inspection ❑ yes ❑ no
I wish to be contacted prior to any site inspection -yes ❑ no
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. 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.
SIGNATOF OWNER Note ti if signing for a corporation or association) DAT
WA, C �� ( ' -741/0
SIGNATU'F OF AGENT (Both signatures needed only if agent will act for owner) DATE
INCLUDE WITH THIS FORM:
❑ Application fee
❑ Site location map
❑ Project plans on 8%X 11-size paper-PLANS-MUST BE TO SCALE&SHOW ENTIRE LAKEFRONT
❑ Short Environmental Assessment Form if needed
The construction of a single residential dock, wharf or mooring and construction which alters, modifies,
enlarges or expands an existing dock, wharf or mooring, provided that the structure is not located in a
wetland, fish spawning area, an area of significant wildlife habitat,or an area of unique scenic, historic or
natural significance does not generally require this form.
❑ Addendum A Co-owner Signature Page (if lakefront is jointly or commonly owned)
O Addendum B Parties with deeded or contractual access to this lakefront
O Addendum C Statement of Intended Use of Residential Structures (if requested by agency)
O Addendum D Association Information (for Association owned parcels requesting a variance)
Failure to include any one of the required items will result in an incomplete notice and delay in
processing your application.
H:\forms\application forms\wharf mooring application.wpd 1/3/2008 Page 2 of 2
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TOWN OF QUEENSBURY Jr _____i .,....., i
BUILDING DEPARTMENT . . .._
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in , —
full compliance with the Building Codes of : - I1/4 I 1
New York State.
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'` Community Development Office
i � Town of Queensbury • 742 Bay Rd.
"�►"� Quetxnshury, New York •12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
A-
-.149E PROPERTY LINE
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1 SQUARE = S D PROPERTY
4 WA Ft4J 13 14-LTR 11-05