AST-0358-2018TOWN 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-0358-2018Date Issued: Tuesday, July 16, 2019
AST-0358-2018
This is to certify that work requested to be done as shown by Permit Number
has been completed.
239.18-1-31
Tax Map Number:
15 CLIFF HOLLOW RD
Location:
David Prol
Owner:
Adirondack Mountain Ridge Estates LLC
Applicant:
This structure may be occupied as a: Dock 684 s.f.
(LGPC approval)
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
m f Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0358-2018
Tax Map No: 239.18-1-31
Permission is hereby granted to: Adirondack Mountain Ridge Estates
For property located at: 15 CLIFF HOLLOW 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
Tune of Construction
Owner Name: David Prol Dock $20,000.00
Owner Address: 424 Indies DR Total Value $20,000.00
Orchid,FL 32963
Contractor or Builder's Name/Address Electrical Inspection Agency
Adirondack Mountain Ridge Estates
136 Stone Schoolhouse RD
Lake George,NY 12845
Plans&Specifications
Dock 684 s.f.
(LGPC approval)
$ 100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,June 27,2019
(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 the expiration date.)
Dated at the Town a sbury W ay,June 27,2018
, o 4
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE
Permit#: 0- i5
PERMIT APPLICATION Permit Fee:$ l�J
Town of(Quo bury
742 Bay Road,Queensbury,NY 12804 Invoice#: b�
P:518-761-8256 www.aueensbury.net
Project Location: IS- G ,
Tax Map ID#: G T 1 "—t Subdivision Name:
E 0 V t5
CONTACT INFORMATION: [EUN
14 2018
• Applicant: /►
Name(s): rn�nir,. Gc'UEE?.:'8BU"R!;
Mailing Address, C/S/Z: ' BUILDING&CODES
Cell Phone: Land Line: � )
Email:
• Primary Owner(s):
Name(s): -batik( P/-o i
Mailing Address, C/S/Z: 4Z4 Ln dt-e-s fir. de-cA M FL
Cell Phone: ) ?U/- lldb Land Line: � )
Email:
• Contractor(s): � L C
Business Name: 4-a- R�
Contact Name(s): ��
Mailing Address, C/S/Z: 1?6 G /'Y /mays-
Cell Phone: ( 576 ) ?3 Z' 9-V-S ) Land Line: � )
Email: d.eviN
• Arch itect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line:
Email:
Contact Person for Building& Code Compliance:
Cell Phone: ( -Q v ) ?�?Ld— -2y5-( Land Line:
Email: 6Je4z--) glee 1 0c'�Qa C ��•,�
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial 4LResidential
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: 6CT y
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 NO Explain:
4. Are there any easements on the property? YES NO
DECLARATION:
1. 1 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: DceVd r- P'-a
SIGNATURE: f/L�4 V DATE: 1 l
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017