AST-0443-2018 _ 1 TOWN OF QUEENSBURY
I'll "°gyp I 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
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CERTIFICATE OF COMPLIANCE
Permit Number: AST-0443-2018 Date Issued: Thursday, July 19, 2018
This is to certify that work requested to be done as shown by Permit Number AST-0443-2018
has been completed.
Tax Map Number: 289.18-1-23
Location: 27 FITZGERALD RD
Owner: Don Bossow
Applicant: Raymond Lortie
This structure may be occupied as a: Screened Porch 480 s.f.
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (07.....- wpo 4
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.
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TOWN OF QUEENSBURY
i 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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''=..�. Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0443-2018
Tax Map No: 289.18-1-23
Permission is hereby granted to: Don Bossow
For property located at: 27 FITZGERALD 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: Don Bossow Deck $0.00
Owner Address: 27 FITZGERALD RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sherwood Acres Construction Corp.
PO Box 908
Minerva,NY 12851
Plans&Specifications
Screened Porch 480 s.f.
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,July 10,2019
(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 ensbury; Tu-s•ay July 10,2018
SIGNED BY: ' for the Town of Queensbury.
Director of Building&Co•-Enfo ment
Office Use Only
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Permit 44: iNS`- Q A �S ZOI6
ACCESSORY STRUCTURE
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PERMIT APPLICATION Permit Fee:$ l25
Town of Queensbury -—
742 Bay Road,Queensbury,NV 12804
Invoke it
P:518-761-8256 www.queensbury.net
Project Location: :-411 LAKE' -F ok
Tax Map ID #: 261 -'L 6 1 -26 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): /Of T 142,Afa ,& )7-(?
Mailing Address, C/S/Z: g-3 /34 K %149 4- s/3 vier' N'V Rao(/
Cell Phone: ( $78 ) 31 6,2 a 6 Land Line: (S ' ) 7 G' S &
Email:
• Primary Owner(s):
Name(s): Poi'( /sass OW
Mailing Address, C/S/Z: 2, 7 `Ci ,vu.),a
Cell Phone: ( ) Land Line: ( )
Email:
e .Contractor(s):
Business Name: ,S//4`/� oP c4 'S cpicar
Contact Name(s): ,1.4,( /9:f/34v
Mailing Address, C/S/Z: EoZ '7 //®A r'r?cJ®®pc c,t i ' RJ? flA4"---.4 - fr7/
Cell Phone: (92 Y) a. I 8 Land Line: (S%8 ) Z9 / 2�i 32.
Email:
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e Architect(s)/Engineer(s): D \;-
Ii7i) i
Business Name: f /}
Contact Name(s): / Q Li i JUL 1 0 2fhR_
Mailing Address, C/S/Z: TOWNLit c n _
Cell Phone: ( } Land Line: 1-( ) iN , C'`sY I
Email:
Contact Person for Building & Code Compliance: 1 0V�1�
Cell Phone: ( ) Land Li e: (
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
Deck,Open Porch Solar Panels(w/o rafter upgrades) _Carport Cell Tower
Shed _Pavilion, Pole Barn,Canopy _Dock Gazebo
_Detached Garage _Boathouse (with or w/o sundeck) 3-Season Porch
Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: g
2nd floor: & 7
Total square feet: L/v-``z
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$
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. 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. I 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
5. I 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: / AI/i'/ /tVP 1,0 V y
SIGNATURE: / �. ,�� DATE: j1 ►fl I)5
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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TOI I OF QUEENSBURY
U1LDING & CODES DEPT.
Reviewed By: C _. . TOM
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1..,-. 1 . Date: ' t 6 16,— BUILDING DEPARTMENT
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'Based on our limited examination,compliance
with our comments shai flot he contn,pr? ,.!
indica' p i ,It-INS' OnCi a;e,ci'cations are in
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