AST-0784-2018TOWN 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-0784-2018Date Issued: Tuesday, July 30, 2019
AST-0784-2018
This is to certify that work requested to be done as shown by Permit Number
has been completed.
288.16-1-59
Tax Map Number:
102 MCCORMACK DR
Location:
Rebecca Herrick, THOMAS HERRICK
Owner:
Rebecca Herrick
Applicant:
This structure may be occupied as a: Shed 288 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
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
Via. Community Development - Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0784-2018
Tax Map No: 288.16-1-59
Permission is hereby granted to: Russell Zink
For property located at: 102 MCCORMACK 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: Rebecca Herrick Shed<300 s.f. $5,000.00
Owner Address: 102 MCCORMACK DR Total Value $5,000.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Russell Zink
0 Cottrell RD
Greenwich,NY 12834
Plans&Specifications
Shed 288 s.f.
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, February 20, 2020
(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 of Queensbury; Jf Wednesday,February 20, 2019
SIGNED BY: /a� ,� for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE Permit#: ��a=�\ \ 2-015
PERMIT APPLICATION Permit Fee:$
Town of Quoe mbury
742 Bay Road,Queensbury,NY 12804 Invoice#: y \ \
P:518-761-8256 www.queensburv.net
Project Location: /0 - 14c_ .oirrn o cJ( 11
Tax Map ID #: 11.0 - 1- 59 Subdivision Name: C j,-4 hovs
CONTACT INFORMATION: -�
• Applicant:
Name(s): 11;onv►4 S + Y?0--Le.c & uer-cu'c
Mailing Address, C/S/Z: /Oa MLCorm&c_k. vet Like Geo✓ e. N' la
Cell Phone: ( Si ) to$I - /01 Land Line: ( ) iota S i/4 D 1
Email: r her-,ri c J C.pct @ 5 rn ci I ( , C O 1r\
• Primary Owner(s): ll
Name(s): I /11 C + Re- c_L
Mailing Address, C/S/Z: /O; Cormac/( ve, Lake c,r-, e l'1>l /a$q5
Cell Phone: (57 8 ) 10Q* —1 O ,2 I Land Line: ( 51 £ ) iota $ 4401
Email: r`'he e-v c k e_pu 3 irv►a . C—u rV\
• Contractor(s):
Business Name:
Contact Name(s): A.ssei ( Z„' k
Mailing Address, C/S/Z: edi-Ye 1( toad lrree.nt iJs Ny 12.$3tA
Cell Phone: ( ) Land Line: ( 51 $ ) 6 9 Fs a5
Email:
• Architect(s)/Engineer(s):
Business Name: jfj DEC 1 12018
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Lin : (
Email:
Contact Person for Building & Code Compliance: 'R-Q �- \A-0v0 LiCs
Cell Phone: ( J� ) tO3-\ Land Line: ( 51 8 ) CAA t-1 b 1
Email: heir c_k C,i�c� v�cv►\ . c �v�
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017
s �
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: 2
2'floor:
Total square feet: .28 e
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 5c5c,
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES 4100 xplain:
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: ' 210-eCCc, S 1-+t r",ra_
SIGNATURE: ` � tit'�C DATE: i 1 i I j--0
Town of Queensbury Building&Code Enforcement Accessory Structure Application Revised April 2017