AST-000246-2017 TOWN 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-000246-2017 Date Issued: Thursday, July 6, 2017
This is to certify that work requested to be done as shown by Permit Number AST-000246-2017
has been completed.
Tax Map Number: 289.17-1-5
Location: 94 ASH DR
Owner: Lisa Doster,Russell Hilliard,Tyrer,Lyon,and Cerny,David Doster
Applicant: RUSSELL HILLIARD
This structure may be occupied as a: Removable Dock: 4 ft.width and 40 ft.
length By Order of Town Board
Total: 160 sq. ft. TOWN OF QUEENSBURY
Cross Ref. Site Plan Review No.P-SP-17-2017;P-SUP-3-2017;and Area
Variance Z-AV-15-2017
Issuance of this Certificate of Compliance DOES NOT relieve the (eJ 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.
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-000246-2017
Tax Map No: 289.17-1-5
Permission is hereby granted to: Russell Hilliard,Tyrer,Lyon,and Cerny
For property located at: 94 ASH 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
Tyne of Construction
Owner Name: Russell Hilliard,Tyrer,Lyon,and Cerny Dock $0.00
Owner Address: 79 Ash DR Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Removable Dock: 4 ft.width and 40 ft.length
Total: 160 sq.ft.
Cross Ref. Site Plan Review No.P-SP-17-2017;P-SUP-3-2017;and Area Variance Z-AV-15-2017
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 17,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o sbury; WeA sd1,Ma 17,2017
4Air
SIGNED BY: C / - for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ACCESSORY STRUCTURE Permit#: T 24b • 2
` -- PERMIT APPLICATION Permit Fee:$
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#: l -6
P:518-761-8256 www.queensbury.net
Project Location: 9t-/ �k Dc- £'--, N "
Tax Map ID #: ZO 1 -
Subdivision Name:
CONTACT INFORMATION:
• Applicant:Name(s): H ' 1 [o i-Cir—) Lyo Gac 1(l\/
Mailing Address, C/S/Z: 7f) Ty
(,` �r Cell Phone:j ) L nd Line:• J _ ) � -( C)
Email: ki(,SS k, I 1 1 ( \Gt[ I ,
• Prima r Owners :
Name(s): 6i61 £ C5 Do4ar
Mailing Address, C/S/Z: t L )5-t\
Cell Phone: ( ) Land Line: (.5 )
Email: l , o {Llat) Coo c:\ C V\ te1s21 -1
• Contractor(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
^
Contact Person for Building & Code Compliance: ,Q14 -5 Se( I It��
Cell Phone:J ' ) Land
Email: (LA-5
Vlllt
Accessory Structure Application Revised April 2017
Town of Queensbury Building&Code Enforcement
1
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PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
_Deck,Open Porch _Solar Panels(w/o rafter upgrades) _Carport Cell Tower
Shed _Pavilion, Pole Barn,Canopy VDock OS{ _Gazebo
Detached Garage Boathouse (with or w/o sundeck) _3-Season Porch
Other(description: ) 1-N1
SQUARE FOOTAGE OF STRUCTURE: 1 pn
1st floor: a
2ndfloor: � — (14e11
Total square feet:
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: �6S e \ Efhxd
SIGNATURE: DATE: - 1.2 ( 7
Accessory Structure Application Revised April 2017
Town of Clueensbury Building&Code Enforcement