AST-0379-2019 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: AST-0379-2019
Tax Map No: 303.15-1-37
Permission is hereby granted to: Verizon Wireless
For property located at: 227 DIX AVE
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: Time Warner Cable Northeast Cell Tower $60,000.00
Owner Address: 7800 Crescent Executive DR Total Value $60,000.00
Charlotte,NC 28217
Contractor or Builder's Name/Address Electrical Inspection Agency
Verizon Wireless
1275 John ST,Suite 100
West Henrietta,NC 14586
Plans&Specifications
Antenna facility on existing cell tower
$ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday,July 27,2020
(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; /J Friday,July 26,2019
SIGNED BY: (� �d 4/X---
for the Town of Queensbury.
Director of Building&Code Enforcement
c
I
Office Use Only
_' ACCESSORY STRUCTURE 0 S _ 037� 2vCq
PERMIT APPLICA I Vre
Town ofQycensbury Perm t ��: $ 'c.J }
742 Bay Road,Queensbury, NY 12804 JUN 06 2019
P: 518-761-8256 www.queensbury.net Invoi eft!
^�f TOWN OF QUEEN tiuKY
Project Location: '221 Y ix fi 4e, BUILDING& CODES ._
Tax Map ID #: 3 d S• 13^ 1 - 3 `1 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): V c' 24,..0 t ) 1.c-e.1eSS
Mailing Address, C/S/Z: I2-15- Sdytn .St Ste, I00, 'Wes} 1•-{eznri'2} -c. , rJ `/ I '15$t0
Cell Phone: ( 315 ) 362- 3LH9 Land Line: ( )
Email: j v.300c\wG & e. 'y ravv:t a rlS, ay
• Primary Owner(s):
Name(s): j.N.e >i..) r A 4 r e-c.A)le. 06 4-4-V cs..5-V.
Mailing Address, C/S/Z: 1800 Crfsewv- txce_tv4.-;v g2 b i eHty., icrli.e. NC_ ZSi 17
Cell Phone: ( ) Land Line: ( )
Email:
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
\J Contractor Name(s): Ate' cNz.E,.4 \J <<Q-\Q.SS
Contractor Trade:
Mailing Address, C/S/Z: 1 Z16 -3-31..e• ', 5}t \OO , uJQ.Sk 1-le.cr r.e iti`I I y6-19 to
Cell Phone: ( ) Land Line: ( )
Email:
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
tr
Business Name: / / 34 TC Ei31A Qt,r't ,,, dervic.,eS
Contact Name(s): T * rcc.X._ Ct, r 5.2--Yr
Mailing Address, C/S/Z: ‘,.O`t5 ("1c,Lcs tea_ 17cj 54-e. SOU) Lc1 k.,rt1 1D 2101
Cell Phone: ( ) Land Line: ( 4.10 ) "Ii L - 704"2-
Email:
Contact Person for Building & Code Compliance: Ji.n. \Oo6v.,c_r
Cell Phone: (315 ) 3$Z. - 34y8 Land Line: ( )
Email: j iL.1 Bc:d.ward e- e tt r e.4 ("1 .. Lo.M
Accessory Structure Application Revised February 2019
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: Qn}�o+ta fo: \,44( 0A R.,A;4; 403 i V
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2'floor:
Total square feet:
ADDITIONAL PROJECT INFORMATION(211I.f::
1. Estimated Cost of Construction: $ , c)00
2. If Commercial project,what is the proposed use: Te..\42 CO 6r.A.,r•1/43C11
3. Are there any structures not shown on the plot plan? YES 0 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: ()ieStlx)c-r'C\
SIGNATURE: DATE: ) 1 ) Z019
Accessory Structure Application Revised February 2019
Tectonic
PRACTICAL SOLVT1011S.EACEPTIONAL SERVICE.
Town of Queensbury
Building&Code Enforcement
Attn: Dave Hatin
742 Bay Road
Queensbury, NY 12804
September 7, 2020
RE: CONSTRUCTION CERTIFICATION LETTER
VERIZON WIRELESS INSTALLATION, SITE NAME: GLENS FALLS EAST
SITE ADDRESS: 227 DIX AVE,QUEENSBURY, NY
PARCEL ID: 303.15-1-37
BUILDING PERMIT NUMBER: AST-0379-2019
TECTONIC W.O.: 9725.10
Dear Mr. Hatin:
Tectonic Engineering Consultants, Geologists & Land Surveyors, D.P.C. (Tectonic)-has reviewed
post-construction photographs and as-built redlines provided by the general contractor, Mike
Construction Services. Tectonic also performed a final site inspection to review post construction
conditions. The purpose of Tectonic's review and inspection was to ensure the work completed
under this permit was performed in general conformance with the Construction Drawings(dated
August 28, 2019) prepared by NB&C Engineering Services, LLC.. The conclusion of our review is
that,to the best of my knowledge,the site has been constructed in accordance with the approved
drawings.
If you have any questions, please do not hesitate to contact the undersigned.
Sincerely,
Tectonic Engineering Consultants, Geologists& Land Surveyors, D.P.C.
Digitally signed byM Steven Matthews � ®� ��
DN:cn=Steven Matthews c=US
Steven a=SMatthews@tedonicengineedng.com pQ
Matthews Reason:I am the author Otitis documentkv
6cA?. ip ai 0
• Location: Y_ E�'7
Date:2026-09-0715:50.10:00 C°P _ �/,1F
Steven M. Matthews, PE 41''co i,} w,
Director of Engineering rti_IV Mgt ,w
�`do9 08750i V<�
'8S4O�P-
Project Contact Info -
36 British American Boulevard,Suite 101 I Latham,NY 12110
518.783.1630 Tel 1518.783.1544 Fax
tectonicengineeri ng.com
Equal Opportunity Employer