AST-000247-2017 011111Ke
TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: AST-000247-2017 Date Issued: Tuesday, November 20, 2018
This is to certify that work requested to be done as shown by Permit Number AST-000247-2017
has been completed.
Tax Map Number: 297.7-1-26
Location: 65 HICKS RD
Owner: Stephen Richards, DEBORAH RICHARDS
Applicant: Stephen Richards
This structure may be occupied as a: Shed 400 s.f.
Converting carport to storage shed (partial constructed at time of building permit By Order of Town Board
application submission) TOWN OF QUEENSBURY
Cross Ref. Area Variance 43-2017 approved 12/20/17. One-year extension of A)
approval granted 9/20/2018.
Issuance of this Certificate of Compliance DOES NOT relieve the ( 444.04
310t.
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.
Wit. " TOWN OF QUEENSBURY
--- 742 BayQueensbury,
Road,Q ury,NY 12804-5904 (518)761-8201
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Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-000247-2017
Tax Map No: 297.7-1-26
Permission is hereby granted to: Stephen Richards
For property located at: 65 HICKS 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: Stephen Richards Shed<300 s.f. $1,200.00
Owner Address: 65 HICKS RD Total Value $1,200.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Shed 400 s.f.
Converting carport to storage shed(partial constructed at time of building permit application submission)
Cross Ref. Area Variance 43-2017 approved 12/20/17. One-year extension of AV approval granted 9/20/2018.
$ 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,November 19, 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 Quee bury; /� M. , .,/ . ember 19,2018
SIGNED BY: YY , " for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
✓ �� 4 /-
ACCESSORY STRUCTURE
Permit rr: o)
PERMIT APPLICATION Permit Fee:$ `T0
TMVn of Queensbury
742 Bay Road,Queensbury,NV 12804 invoice#:! l a)-
P:518-761-8256 www.queensbury.net
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Project Location: flS H1CK a
Tax Map ID #: L4-7• 7-! Subdivision Name:
Z-AJ- 3 .2o I1 51,e NOil " Lij
CONTACT INFORMATION:
sN OF (° -5Y
• Applicant:
�--� 'UNITY s° T
Name(s): s *
Mailing Address, C/S/Z: \-\\<\,;S ci AA \ V 60_
Cell Phone: ( ) Land Line: ( ) (U, ' '.5
4.8
Email:
• Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Contractor(s):
Business Name: t�
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
® Architect(s)/Engineer(s):
Business Name: A
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Building & Code Compliance: CSItA. °rsc..
Cell Phone: ( ) Land Line: ( SVA ) ( 3(o say$
Email:
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
• PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS: RBI/A-
Deck,Open Porch —Solar Panels(w/o rafter upgrades) art Cell Tower
/'► Shed L'e) ', Pavilion, Pole Barn, Canopy Dock Gazebo
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Detached Garage —Boathouse (with or w/o sundeck) 3-Season Porch
Other(description: )
SQUARE FOOTAGE OF STRUCTURE:
7,4 -fe"( t-4:-
1st floor: 421-14ki.0 x cloy' ,4z," i,
1 it '1 /4-4'li
2nd floor:
Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ k1,06 ,CO
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: 5 by tic , ,05
SIGNATURE: {)4ti2_., cs�i`2l DATE: ll' CY
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
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FILE COPY
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Carolina Carports,. Inc. Number
Quality,Customer. Service,and Best Prices 84598
Dealer Rep Run# Sequence#. install Date Order Date Installation
Joe's Cycle Repair JCR NY60 01 5/4/2017 12/5/2t)16 Steve Richards
65 Hicks Rd.
Installer: Home Phone Work Phone Cell Phone Queensbury, NY 12804
Warren
Mario S Ulloa 518-636-3258
Size Gauge Style Top Color Side!End' Trim Color Certified Surface Electricity •
20.21.6 12 Regular White White 130/50 Ground Yes
Qty. ; Item Customer Note
Price Each Amount
1 20.21.6 Pa Style 2'braces See Shop 1,595.00 1,595.00T
Customer did not purchase Jtrim.CCI not responsible
•
Total amount purchased before dealer commission and tax, 1,595 00
Commission The down payment collected by the dealer. 12.00%0 -191.40
•
Directions Attached
•
Thank you for your recent purchase of a carport from o
Carolina Carports, Inc. We a Sales `fax (7.0/o) $111.65
p appreciate your and
hope that both the transaction and the carport have Total - $1,515.25
exceeded your expectations. In the event you have
experienced any,problems,please contact us immediately at
800-670-4262.
{ •
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Credit Card# Exp Date: / / }
- - - V Code#
Check# Ck.Amount •
Customer Signature: ' Installer Signature., ' - - Date: /_
- dome Office
vuvvw.carolinacarportsinc.com P.O.Box 1263 Toil Free:800 670 4262
cci@ccihq.biz - • 187 Cardinal Ridge Ti-. Local:(336)367-6400
Dobson,NC 27017 Fax:(336)367-6410
=thank you, Paula
5/12/20'17
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