AST-000433-2017 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: AST-000433-2017 Date Issued: Wednesday, August 16, 2017
This is to certify that work requested to be done as shown by Permit Number AST-000433-2017
has been completed.
Tax Map Number: 301.17-1-19
Location: 2 CHEROKEE LN
Owner: Jeanne Mosher,Charles Mosher
Applicant: Charles Mosher
This structure may be occupied as a: Shed 384 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 Building&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: AST-000433-2017
Tax Map No: 301.17-1-19
Permission is hereby granted to: Shaw Contracting
For property located at: 2 CHEROKEE LN
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: Jeanne Mosher Shed $6,800.00
Owner Address: 2 CHEROKEE LN Total Value $6,800.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Shaw Contracting
3580 State Route 4
Hudson Falls,NY 12839
Plans&Specifications
Shed 384 s.f.
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 9,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury beforjthee ratio,/tn dakAugst9,2017
Dated at the Town oQueens /J We
SIGNED BY: VVVfor the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
OrD
ACCESSORY STR "- Permit#: -A5 T 3
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PERMIT APPLIC Permit Fee: $ , UD
Torm of Queensbury
742 Bay Road,Queensbury,NY 12804 JUL 19 20 1 invoice#: ;;L.UJ,:2
P:518-761-8256 www.oueensbury.net
TOWN i.
Project Location: lkeeL
Tax Map ID#: 301, 7-�'l9 Subdivision Name: e 7 j f Aa3e 3
F' 3a Fp
CONTACT INFORMATION: R -30)rt
51 DC- 5u.-hz 5 rt
• Applicant:
Name(s -Qk � , , U-,) NC75111PY'
Mailing Address, C/S/Z: a, Q\-letol-eP ( )A 1ep"S u'u A
Cell Phone:tel) 2k0 -QQ1kP Land Line: J51g )met fo�L12
Email:
Primary Owner(s):
Name(s): CU3 d MVW\e '(`(1MAW2 r
Mailing Address, C/S/Z: _'t. ftejUkffi ltA• Q�r-, I
Cell Phone:�_) Land Line: ( SIg ) 7fQ1-(ol�f 2
Email:
• Contractor(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z: 1 i
Cell Phone: ( 51% ) 'r- Land Line:
Email:
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Building & Code Compliance: C,1^e>rhe e Mz Z.V<X
Cell Phone: 51%b, ) 2,u t- go tb Land Line: J 5 + h )
Email:
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
•qO Detached Garage _Boathouse (with or w/o sundeck) _3-Season Porch
Other(description: )
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 345
2"d floor:
Total square feet: "%
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ I-L-0(
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES NO Explain:
4. Are there any easements on the property? YES NO
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within 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: (ChAt �2S • YY1txhP�
SIGNATURE: \' � �th DATE: 19
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
I k�r�c:e line
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301.17-1-19 AST-000433-2017 f
Mosher, Jeanne & Charles I
2 Cherokee Lane i
Shed 384 s.f. f �� r ° If M i- I
LJUL 19 2017
��RMIT PLOT PPPP�N _
I HAVE PERSONALLY MEASURED THE DISTANCE "i CiL1T1 C.i! QUEENSB;
FROM THE PROPERTY LINES TO THE !?UILD!NG&CO!:)
ROPOSED STRUCTURE(S)OR SIGN'S) �
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