AST-0438-2018 , TOWN OF QUEENSBURY
x r 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: AST-0438-2018 Date Issued: Friday, November 9, 2018
This is to certify that work requested to be done as shown by Permit Number AST-0438-2018
has been completed.
Tax Map Number: 239.18-1-32
Location: 17 CLIFF HOLLOW RD
Owner: Sara Kelly
Applicant: Sara Kelly
This structure may be occupied as a: Dock with Sundeck 1568 s.£
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the rilia,40 4
41,07t
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
�+�" ' ' t 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0438-2018
Tax Map No: 239.18-1-32
Permission is hereby granted to: Curtis Dybas
For property located at: 17 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
Type of Construction
Owner Name: Sara Kelly Dock $75,000.00
Owner Address: 30 Oakwood DR Total Value $75,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Curtis Dybas
19 Deer Run RD
Lake George,NY 12845
Plans&Specifications
Dock with Sundeck 1568 s.£
$ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,July 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;+ e.
Dated at the Town Quee ; 4Frir a 1y 13,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
,
Office Use Only
lECEOVIE1
ACCESS° Y -TRITICTUR Permit#: A St — 0 L-131C-2--°[.
PERMIT P It A °NO92018 F e• ( CO.°D
Prt e $
...- •
Town of CZycensbury
742 Bay Road,Queensbury,NY 12804 TOWN OF OUEENSBURY !voice#: 6 Co-S
P:518-761-8256 www.aueensbur .ne BUILDING&cons I
Project Location: 17 GlArr1401,1451/ too
Tax Map ID#: 251 - I - Subdivision Name: i--1/6,
CONTACT INFORMATION:
* Applicant:
Name(s): 4) ZI J. vzi-v
Mailing Address, C/S/Z: SO ObtAiltX;Y:) raztkie.., our-ELAN...fa:1-P, al" (aso+
Cell Phone: ( 6i$ ) 144 i/M5 Land Line: (
Email: te-eu.)e. i.A.,-r 614/NAL
• Primary Owner(s):
Name(s): 144C., is4 AMACht.if
Mailing Address, C/S/Z:
Cell Phone: ( Land Line: (
Email:
• Contractor(s):
Business Name:
Contact Name(s): Let W•4247-44
Mailing Address, C/S/Z:
Cell Phone: ( ) 12/4 74b2 Land Line: ( ‘16 ) tAto S 4/4
Email: 1-W212445 84gg 12,0110V-A-4-1W--•C001
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s): C-0/Z{1 57-e154..3
Mailing Address, C/S/Z: 11 Mee. Pia L2e-e-Otz9126.E.10%-r (2.844-
Cell Phone: ( ) 606 4jt Land Line: ( SIB ) totsg- 6G4II
Email: e-12-(97)14 erwc . 4014
Contact Person for Building&Code Compliance: 413fr1e., M2e44.tigef
Cell Phone: ( Land Line: (
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application*Revised April 2017
PROJECT INFORMATION:
TYPE: Commercial X Residential
WORK CLASS: gGEa1peoe Ied of IC.- asi4e,to FiseiLirr
Deck,Open Porch ^Solar Panels(w/o rafter upgrades) Carport Cell Tower
Shed Pavilion, Pole Barn,Canopy ,�Dock tip'/ „Gazebo
Detached Garage _„Boathouse(with or w/o sundeck) ,^3-Season Porch
Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: IV
2nd floor: $e,,g
Total square feet: . . 146 '
•
ADDITIONAL,PROJECT INFORMATION: ,
, 1, Estimated Cost of Construction:$ 7(l .
2. If Commercial project,what is the proposed use: 1.-1/46
3. Are there any structures not shown on the plot plan? lan NO Explain: fjll _I1 IZT°
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: SfA N . , T��ZLy
SIGNATURE: (F-44LA) DATE:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
RED A*
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•.P,, DING& 2018 i,
`;'i,k*,b-.- "Hi-tirc'S''1T'1 A0l•'t6 4c4•',.-
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Weiffe0;1644,4 : „ 239.18-1-32 AST-0438-2018
Kelly, Sara
17 Cliff Hollow Road
AMR_ ,,, ' .., 1
Dock with sundeck 1568 s.f.
i ': /: • ' .', I .. ,
! : 03U1.4. 1,641
- ' toWP• 60.1Crie,
P_ERMIT PLOT rt..,AN .
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HAVE PERSONALLY MEASURED THE'DISTANCE
,;"
. FROM THE PROPERTY LINES TO THE
OR SIG ( )
CaMrtat)C4 *tW:
't:::.
tii attaripA, r.aortgior , , c:ri VIGNATURE. DATE
•. :1ALZ,1>L _/IL 117400
' 1h 'TOWN OF QUEENSBURY '-, :„...)
•
, .
LAU:MG & CODES DEPT.
• Reviewed By: . .
,
Date
T3
" ------------- - TOWN 0- t'UEENSBURY
-------- --....._—_,
tfltDtN&t ,-.PARTMENT .
...tS Based on our limited e'i _mination,compliance
cl ,
, FILE COPY with our comments si ii:,not.be construed as
indicating the oians a -1 locifications am in
full corriT3iiance with th i)uilding Codes of
New itric.State.
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