BOTH-000399-2016 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-000399-2016 Date Issued: Tuesday, October 3, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000399-2016
has been completed.
Tax Map Number: 289.17-1-56
Location: 0 Birdsall RD
Owner: Sereena Coombes
Applicant: Sereena Coombes
This structure may be occupied as a: Replace existing dock with a 144 sq. ft.
dock By Order of Town Board
4 ft. wide,36 ft. length TOWN OF QUEENSBURY
ZBA Approval: Z-AV-32-2017 5/24/2017
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 Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
OL Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000399-2016
Tax Map No: 289.17-1-39
Permission is hereby granted to: Sereena Coombes
For property located at: 0 Birdsall 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
Tvce of Construction
Owner Name: SereenaCoombes Dock $5,000.00
Owner Address: 15 FAIRWAY CT Total Value $5,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Glen Lake Dock Builders
21 Dineen RD
Lake George,NY 12845
Plans&Specifications
Replace existing dock with a 144 sq.ft.dock
4 ft.wide,36 ft.length
ZBA Approval: Z-AV-32-2017 5/24/2017
$40.00 PERMIT FEE PAID-TFBS PERMIT EXPIRES: Friday,June 8,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensb fore the expi. ion date.)
Dated at the Town of eensbu _ // Wars a 8,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
onl
ACCESSORY STRU
PERMIT APPLICA :2se
$Toon utQueensbury
742 Bay Road,Queensbury,NY 12804 TOP:518-761-8256 www.gueensbury.net COMLF p,�_�
Project Location: i' �(� �p�(X(,f/OSS [?vvv' (08 6fe4sa-u eca NW–"
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Tax Map ID #: ZD�,13 ) 3 Subdivision Name:
CONTACT INFORMATION:
WAAAmo- -Ai -37 7�
• Applicant:
Name(s): S
Mailing Address, C/S/Z: oe- 1 AIJ� r7.DA-D
Cell Phone: ( 'At ) '�21 3i 1 k Land Line:
Email: L C.o
Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: . L Land Line:
Email:
• Contractor(s): � r
Business Name:
Contact Name(s): KOuYI 6rzont IC.-C"
Mailing Address, C/S/Z: a1 I)I YlPe.11 (Z. Lfs)
Cell Phone: - ( ) 3b I Land Line: � )
Email: o�Jmie edoc 4tul&ks G�>�� C'Dvo
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email: rr ,
Contact Person for Building & Code Compliance: �-G9'I!yz'k C t_'J
Cell Phone: ;' `iIC1 Land Line:
Email: ��IP.fW�C2SYYI�14�5 (� Zsfi LO^^
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
_Deck,Open Porch _Solar Panels(w/o rafter upgrades) _Carport _Cell Tower
Shed _Pavilion, Pole Barn,Canopy 'Dock Gazebo
Detached Garage _Boathouse(with or w/o sundeck) _3-Season Porch
_Other(description: ) j^'SS Z _4101W(_
SQUARE FOOTAGE OF STRUCTURE: (J+ Z,AV- 3,.2 017
1st floor:
2nd floor:
�
Total square feet: LIJ
ADDITIONAL PROJECT INFORMATION: `
1. Estimated Cost of Construction:$ 6
sm
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES N6 Explain:
4. Are there any easements on the property? YES } NO 64U�Lfts �tdae-
1.
�DECLARATION: (,(CC21 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If the work 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:
PRINT NAME: Q.fQ2yfq �( it s
SIGNATURE: Cf Ont DATE: "I
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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j.D REFERENCE:
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1) JOHN M. COOMBES AND SEREENA C. COOMBES TO SEREENA C. COOMBES,
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FILED IN THE OFFICE OF THE WARREN COUNTY CLERK
IN-BOOK 5525 AT PAGE 311, DATED MARCH 15, 2017-
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MAP REFERENCE:
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1) "MAP OF A BOUNDARY LINE ADJUSTMENT MADE FOR LEISHA A. CUSHING
DATED JULY 12, 206�. PREPARED BY BOLSTER AND ASSOCIATES
PROFESSIONAL LAND SURVEYORS.
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2) NORTH ORIENTATION IS BASED ON DEED REFERENCE 1.
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]EREFORE SUBJECT TO ANY EASEMENTS, COVENANTS OR RESTRICTIONS OF RECORD
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4) SIJ13JECT TO EASEMENT AND RIGHT OF WAY IN COMMON NTH OTHERS OVER
THE BEACH LOT, AS DESCRIBED IN DEED REFERENCE 1.
5) SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN, COUNTY, AND STATE
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.8) UNDERGROUND UTILITIES, STRUCTURES AND FACIUTIES HAVE BEEN SHOWN FROM
SURFACE LOCATIONS AND MEASUREMENTS OBTAINED FROM A FIELD SURVEY.
.. ........ -7� TILITIES MICH THE EXISTENCE OF ARE NOT KNOWN. SIZE,
THERE MAY BE OTHER U
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TYPE AND LOCATION OF ALL UTIUTIES AND STRUCTURES MUST BE VERIFIED BY
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TIES PRIOR TO ANY AND ALL CONSTRUCTION. CALL DIG SAFE PRIOR
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I`HEREBY CERTIFY TO:
1)' !�EREENA C_ COOMBES
TITLE INSURANCE COMPANY, ISAOA
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lHAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD
SURVEY COMPLETED UNDER MY DIRECT SUPERVISION.
IJ11S SURVEY AND THE CERTIFICATIONS HEREON SHALL BE
TITUTIONS OR
VAUD ONLY TO THE PARTY OR PARTIES HEREON NAMED AND
A RE NOT TRANSFERABLE TO ADDITIONAL INS
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SUBSEQUENT OWNERS, OTHER THAN AS MAY BE OR EXPRESSLY
STATED HEREON.
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�RUSSELL E_ HOWARD NYSPLS# 050540
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MAP OF A SURVEY MADE FOR
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GRAPHIC SCALE C. COOMBF-J&D
SEREENA
20 0 10 20 40 80
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State of New York
lvum of Queensbury County of Warren
T2N' E.T 10
IWSSELL E. HOWARD
I inch 20
MCEMED L"D SURVEYING
342 Main Street, HuAclson Falls, New York f2839
ivx kap, #:'289.17-1-56
-d, PLS Ar.Y.S. Lic. No. 50540
Russe:L' lou,,ar i Date: 04107117 & 289.17-1-39
Date -Sealed: 0 t, Scale: I -inch 20 feet Rev-ised: Drawing 14060a