AST-000364-2017 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: AST-000364-2017
Tax Map No: 239.7-1-25
Permission is hereby granted to: Lake George Docks LLC
For property located at: 139 ASSEMBLY POINT 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: ECY Trust Dock $34,000.00
Owner Address: 11001 Huntover DR Total Value $34,000.00
Rockville,MD 20852
Contractor or Builder's Name/Address Electrical Inspection Agency
Lake George Docks LLC
57 Chapman ST
Ballston Spa,NY 12020
Plans&Specifications
Boathouse w/Sundeck and Dock
1st level:680 s.f.
2nd level:864 s.f.
$115.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 7,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town oueens n trik,"n
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE Permit#: 1 ' 31�L1 ' ZDI�
PERMIT APPLICATION Permit Fee:$
'linin o((Lrecnobun' �.t
742 Bay Road,Queensbury,NY 12804 Invoice#: 1�"1
P:518-761-8256 www.aueensbury.net
Project Location:
Tax Map ID#: 23� — ' Z Subd o �
D
CONTACT INFORMATION: JUN 2 5 2017
• Applicant:
Name(s): of t TOWN OF QUEENSBURY
Mailing Address, C/9/Z: Sl 2 0 Z
Cell Phone: (.q s Land Line:
Email: nom., sr-, 6 • 1As (� l,,a wt•,e tl !— .
Primary Owner(s):
Name(s): F t `' k)ooite 4 Vp r,en Fe
Mailing Address, C/S/Z: I /y 1 #j%,�A ave r ^fir . %`,g c lc v.11 K_ . Eke # a 4 -� S 2
Cell Phone: (( 3%k ) i1 - uta Land Line:
Email: V q P� VA-A �e. 17 ... r ,.
• Contractor(s):
Business Name: /- (ca rSe e
Contact Name(s): M
Mailing Address, C/S/Z: 1- C4 ,,PA -41 , 1Mf(s S 4 1,2 12-.Z ,.
Cell Phone: ('�-11 ) ?mob 4 -1 X Land Line:
Email: M�u.-e
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email: P G
Contact Person for Building & Code Compliance:
Cell Phone: ( 5-19 �2 (o C—a Land Line: �)
Email: In,, "q,`6 (A'
.tet _—
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 41_�Ock —Gazebo
_Detached Garage V Boathouse(with or w/o sundeck) _3-Season Porch
—Other(description: J
SQUARE FOOTAGE OF STRUCTURE:
1st floor: GRU
I L
2nd floor: ld
Total square feet: /5-L�
ADDITIONAL PROJECT INFORMATIO-11
1. Estimated Cost of Construction:$ L7 o 0
2. If Commercial project,what is the proposed use: ��--
3. Are there any structures not shown on the plot plan? YES Nficplain:
4. Are there any easements on the property? YES
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed withln 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/:
PRINT NAME:
SIGNATURE:�� DATE: Z
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
ECEB E
JUN 2 6 2017 {
OF QUEENSBURY �-� � A S r � � l) r j ed
rowNBUILDINU 6, —
239.7-1-25 AST-000364-2017 TOWN OF QUEENSBURY TQWN of QUEENSBURY
BUILECY Trust BUILDTMENT
ING & CO��S�E Based on our lmmiedNG e examination.ompliano
139 Assmebly Point Rd. men with our comments shah t be construed as
indicating the plans and pecificalions are in
Boathouse w/Sundeck & Dock 1544 s.f. Daae: full compliance with the Building Codes of
r �.. New York State.
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