AST-0330-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
CER.TIFICATE OF COMPLIANCE
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Permit Number: AST-0330-2018 Date Issued: Tuesday, June 26, 2018
This is to certify that work requested to be done as shown by Permit-Number AST-0330-2018
has been completed.
Tax Map Number: 308.7-1-51
Location: 63 RICHMOND HILL DR
Owner: Raymond Humphreys
Applicant: Raymond Humphreys
This structure may be occupied as a: Deck 140 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
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
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0330-2018
Tax Map No: 308.7-1-51
Permission is hereby granted to: Raymond Humphreys
For property located at: 63 RICHMOND HILL DR
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: Raymond Humphreys Deck $5,000.00
Owner Address: 63 RICHMOND HILL DR Total Value $5,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Oleks Jaworsky
Plans& Specifications
Deck 140 s.£
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,June 13, 2019
(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 th expiration d e.)
Dated at the Town fQuee ury; 4we y, June 13, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
i
f s Office Use Oniv
ACCESSORY STRUCTURE Perrnit#: NCT- 3'iS0- 2015
PERMIT APPLICATION Perrnit Fee: $ 12 5
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#: &!�c 13
P:518-761-8256 www.gueensbury.net ��yy
Project Location: 6'9 , //�� / ��, "�fg�i�S,�3 /�y 129Py
Tax Map ID #: g . '� — 1 --Cj� Subdivision NameJ.4 PA'u195r. 4;X//TS, 5L-0'-%'et'r4
CONTACT INFORMATION:
• Applicant:
Name(s): Y/�f®r115
Mailing Address, C/S/Z:
Cell Phone: ( w Land Line:
Email:
• Primary Owners :
Name(s): � OX//, /Yi#AC-
Mailing Address, C/S/Z: 4.
Cell Phone: 5(9 ) y?g- '�Lo `-* Land Line: � )
Email:
• Contractor(s):
Business Name:
Contact Name(s): F rpi FP (Z�Z 12 V
r
Mailing Address, C/S/Z:
Cell Phone: �_) Lark)Lin : 1UN 0 7 2p18 ° "P '
r
Email: BUILDIVNIG
• Architect(s)/Engi nee r(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line:
Email:
Contact Person for Building & Code Compliance: k5
Cell Phone: -a t t ) t6' �T 2 5 1 Land Line:
Email:
ag e-AY(tyu-1 rt,R"r ifF f y S(d 77 2- 0 J
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial X 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: )
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2nd floor:
Total square feet: ( Ya SCE ,FT,
,
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 I O1 Explain:
4. Are there any easements on the property? YES NO
DECLARATION:
l. 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: PGF,ka V I r_V
SIGNATURE: - ���� DATE: .d?
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
MAP REFERENCE:
SUBDIVISION MODIFICATION
SUBDIVISION PLAN
THOMAS SCHIAVONE
DATED:JANUARY 9, 2003
LAST REVISED:DECEMBER 17, 2009
BY.,NACE ENGINEERING P.C. and '
Ydcxartc As PaR MAP Rraaaaa�s
VAN DUSEN&STEVES LAND SURVEYORS
r
NOTE:
1. PARCEL IS SUBJECT TO EASEMENTS
AND RESTRICTIONS OF RECORD.
mond _ r
Hill Drive _
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105.00,
ib
' 1-Story
3 Wood Frame
LOT 5 eeJy House '
0 o rr
$� -1-.1
p� i3 ty
0
LOT 4 ^� LOT 3 TTO
' AREA ti V
' 20,475.0 sq. ft. t
I HEREBY CERTIFY THAT THIS MAP WAS PREPARED ' 0.47 acres t
FROM AN ACTUAL FIELD SURVEY. /
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS ,
FOR WHOM THE SURVEY WAS PREPARED, AND ON THEIR J U1
BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY
AND LENDING INSTITUTION OSTEO HEREON. i
CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL O
INSTITUTIONS OR SUBSEQUENT OWNERS. 1
CERTIFIED T0: RAYMOND E. HUMPHREYS AND LORA J. HUMPRHEYS
GLENS FALLS NATIONAL BANK
ITS SUCCESSORS AND/OR ASSIGNS AS THEIR rN UT_77
INTERESTS MAY APPEAR i'
TITLE RESOURCES GUARANTY COMPANY �N (�
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LANDS
CERTIFIED BY: l i S it N/A GOF AA40H WK p
JASON �� 50605OAR CORP,
DATED: October 09, 201
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169 Haviland Road Queensbury, New York 12804 �' W K'� 04RATDWM MM A"D Town of Queensbury, Warren County, New York 1 11/03/17 CER77FICA77ONS ADDED
Humphreys
(518) 792-8474 New York Lie. No. 50135 NO. DATE DESCRIP77ON DWG. NO. 02080-4
PERMIT PLOT PLAN
I HAVE PERSONALLY MEASURED THE DISTANCE
FROM THE PROPERTY LINES TO THE
PRO OSED RUCTURE(S)OR SIGN(S)
308.7-1-51 AST-0330-2018 7.3'0/
Humphreys, Raymond SIGNATURE DATE
63 Richmond Hill Drive
Deck 140 s.f.