RC-000136-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbw-y,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CE-f"\-'-IrIFIC ArrE OF COMPLIANCE I-XiL
Permit Number: RC-000136-2016 Date Issued: Friday, April 29, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000136-2016
has been completed.
Tax Map Number: 3 308.20-1-20
Location: 13 STEVENS RD
Owner: John Gillingham
Applicant: John Gillingham
t:-
This structure may be occupied as a: Deck 288 s.f.
Covered porch 168 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 Buildinc,&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
!� 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000136-2016
Tax Map No: 308.20-1-20
Permission is hereby granted to: John Gillingham
For property located at: 13 STEVENS 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 Queensbury Zoning Ordinance
Type of Construction
Owner Name: John Gillingham Attached Garage-Addition $3,500.00
Owner Address: 13 STEVENS RD Total Value $3,500.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Deck 288 s.f.
Covered porch 168 s.f.
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,March 19,2017
(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 exviration date.
Dated at the Town Queens ry; Th s arch 24,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
ACCESSORY STRUCTURE APPLICATION Received
DATE Tax Map Ib
TAX MAP lD gybe) . 20- ' Z c7 Permit No. • 13k� • 2Q i
Permit Fee
ZONING Rec Fee
HISTORIC SITE Yes No Approvals
SUBDIVISION NAME Lot#
APPLIcANr `I n i1 N K l'i LL 1 g&SIAM OWNER
ADDRESS 13 _51'01'jeays c' ADDRESS
PHONE _. C 1 _� PHONE
CONMAor-0- Cosr of co TED ., $
ADDness: BUILDINO A
MAR 15
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PHONE: yin QIP&MCSNS 't1
C0WACT PEROON FOR BUILDING&CODES COMPLIANCE 1"1\ I��I DEPHONE b ��
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 18t floor sq.ft. 2hd floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck
Deck 1��x. ,
Detached Garage(#of cars
Dock
Pole Barn
Porch-open
**Porch—3 season,Covered;- nclosed ►a x I q -
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: , (Z i �.f �'. � " Date: J '. 1
Signature: Date:
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
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