AST-000561-2017 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-000561-2017 Date Issued: Wednesday, May 30, 2018
This is to certify that work requested to be done as shown by Permit Number AST-000561-2017
has been completed.
Tax Map Number: 289.17-1-40
Location: 113 BIRDSALL RD
Owner: MAUREEN VALENTI
Applicant: MAUREEN VALENTI
This structure may be occupied as a: Shed (under deck) 144 s.£
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, VVY
Variance, or other issues and conditions as a result of approvals by the
Planning Board or Zoning Board of Appeals. Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
' 1 Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: AST-000561-2017
Tax Map No: 289.17-1-40
Permission is hereby granted to: MAUREEN VALENTI
For property located at: 113 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
Type of Construction
Owner Name: MAUREEN VALENTI Shed $700.00
Owner Address: 125 Miles ST Total Value $700.00
Alpine,NJ 07620
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Shed(under deck) 144 s.f.
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 26,2018
(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 ex 'ration date.)
Dated at the Town o ueensb /Thur er 6,2017
SIGNED BY: j� for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Oniy
ACCESSORY STRUCTURE Nermit;T: A6N
PERMIT APPLICATION Permit Fee: $ �0
Town of Oueensbury
742 Bay Road,Queensbury,Fly 12804 invoice#: 2 2-
7:518-761-8256 www.gueensburV.net
Project Location: )1 .S -111� �
Tax Map I® #: V), N I � Ll Subdivision Name:
CONTACT INFORMATION:
* Applicant:
Name(s): N Y O? 11
Mailing Address, C/S/Z: ) `z3 , V
Cell Phone: ) Land Line: ( %
Email:
0 Primary Owner(s):
Name(s): T'k)
Mailing Address, C/S/Z: Q'Y1 V S'i5
Cell Phone: Land Line: � )
Email:
® Contractor(s):
Business Name:
Contact Name(s): SEP 0 5 2017
Mailing Address, C/S/Z:
Cell Phone: Land Line: i
Email:
® Arch itect(s)/Pngineer(s):
Business Name: V\.A,
Contact Name(s): Ci
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contact Person for Building & Code Compliance:
Cell Phone: \5� ) GJ 6 gtz�P Land Line:
Email: N\ "Ny,!4 & d C R�\ • Ltr �
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
J
Y 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: SKe')
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2nd floor:
Total square feet: ~ _
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES Explain:
4. Are there any easements on the property? YES a
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. 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[/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: 14"9L-W A VIkt- I l
SIGNATURE: DATE:
/4 2 /
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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TOWN OF QUEENSBURY ( , � 1o
BUILDING & COD PT. __ �.� �;� o
Reviewer By: SEP 0 5 2017 i
Date: rJ L P a r
TOWN OF QUrt.;.,
O
BUILDING DEPARTMU..
Based on our limited ezamiri2tlen,comps' ,
with our comments shall not be constr1.,.:.,
indicatirt the plans and s fication(" �p
full compliance with the tiding Godeis yi ! C)
New York-State. 00
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