BOTH-000295-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000295-2016 Date Issued: Friday, October 14, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000295-2016
has been completed.
Tax Map Number: 309.15-1-30
Location: 200 FIFTH ST
Owner: MATTHEW CLARK
Applicant: MATTHEW CLARK
This structure may be occupied as a: Deck,384 s.f.,Enclosing approx. 174 s.f.
of deck space By Order of Town Bond
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the n
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
f Community Development - Building& Codes (518) 761-8256
BUILDING P E R M I T
Permit Number: BOTH-000295-2016
Tax Map No: 309.15-1-30
Permission is hereby granted to: MATTHEW CLARK
For property located at: 200 FIFTH ST
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
Tyne of Construction
Owner Name: MATTHEW CLARK Deck $8,000.00
Owner Address: 187 VanGuilder RD Total Value $8,000.00
Chestertown,NY 12817
Contractor or Builder's Name 1 Address Electrical Inspection Agency
MATTHEW CLARK
187 VanGuilder RD
Chestertown,NY 12817
Plans& Specifications
Deck,384 s.f., Enclosing approx. 174 s.f of deck space
$ 50.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, May 12, 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 expiration date.)
Dated at the Town2016
SIGNED BY: WTU*rr,fbr
the Town of Queensbury.
Director of Building&Code Enforcement
ACCESSORY STRUCTURE APPLICATION Office Use OnlyReceived
DATE Tax Map ID is_` -
TAX MAP ID , M S- Permit No. bo TV% - 71-.;,- t
Permit Fee %I
ZONING Rec Fee
Hrsromc SITE Yes No Approvals
SUBDIVISION NAME Lot#
APPLICANT MATT L►� f?WNER S SM
ADDRESS i f3'+ "Wae.v ' ADDRESS
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PHONE `alb- �q " �� M g '`I'�HONE
CONTRACTOR COSI OF CONSTRUCTION(ESTIMATE .
ADDRESS: Bt1ILbING AbbRl=SS:
-Z-oo r-
PHONE: _
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE Y_"V-_ C ,A,2,Y== PHONe Z c _ 5_
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 1e°floor sq,ft. 2M floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck
Deck $
Detached Garage(#of cars �)
Dock
Pole Barn MA16 2016
Porch -open
#Porch-3 season,Covered,Enclosed
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. 1 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: CLA a�Cj j��IAA-kf� Date: E 16
Signature: Date: I
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014
K0 Pro LMAY 16 2016 )
OWidCN= ( U+=Ef •`rt3Jr�Y
—BUILDING & CODES
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TOWN OF QUEENSSURY
BUIL.D)NG DEPARTMENT
Based on cur limited examination,complian e I
with out comments sl ail not be construed a --Ili, -rl
indicating the plans anu s�cmptions are i
full compliance with the wilding Codes of i roc., O
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TOWN OF QUEENSBURY
BUILDING & COD S PT. i rr .A° 'a
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Date: 7 z
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309.15-1-30 BOTH-000295-2016 57 15 X 7�1,) (,n-
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