2001-329 s" TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20010329 Date Issued: Tuesday, October 30, 2007
This is to certify that work requested to be done as shown by Permit Number P20010329
has been completed.
Tax Map Number. 523400-279-019-0001-012-000-0000
Location: 75 JENKINSVILLE Rd
Owner. DAVID & HOLLY VAUGHN
Applicant DAVID & HOLLY VAUGHN
This structure may be occupied as a:
Pole Barn
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the < , \ ({
45t—
property owner of the responsibility for compliance with Site Plan, �fCy✓�/ '7
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
F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
estis
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010329 Application Number: A20010329
Tax Map No: 523400-279-019-0001-012-000-0000
Permission is hereby granted to: DAVID& HOLLY VAUGHN
For property located at: 75 JENKINSVILLE 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 Value
Owner Address: DAVID & HOLLY VAUGHN pole Barn 1,000.00
75 JENKINSVILLE Rd Total Value 1,000.00
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2001-329
384 SQ FT POLE BARN AS PER PLOT PLAN SPECIFICATIONS
$60.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,July 06,2002
(If a bnger 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 To of r� F a Ju 06,2001
SIGNED BY ee /� for the Town of Queensbury.
Director of Building&Code Enforcement
•
Building Permit Application .
Town of Queensbury—Dept of Community Development, 742 Bay Road, Queensbury,NY
(518)761-
. � --
N.
Apermit must be obtained before beginning constr 7
g g 2.`T 201I •nnit File Nee `,_ ] go
No inspection will be made until applicant has rece cc a Fee Paid $ .0 %1•- ?-?ea Y .
valid building permit. All applicants' spaces oti.aiig.N OF QUELtl:§1jPXe Paid $ �s GfC 4cd
application must be completed and must appear of t eDI�,G,c,telj� ieEwed By: r f / '—
application form.
Applicant v. � , ..,_ Owner:
Address: rJ ,- ,,.1�,.,.,., .1 Address: Si '--'-- ._
c ee. 1y
Phone# Me))9 - - �9 0 Phone#( ) - I,;
vo.NE
MAY 2'2 20m
Property Location: Lot Number: / House Number / _
Subdivision Name: Tax Map Number:: ) 0 DE
BUIL?OliEENSBURY
i AND CO
Building: residence /commercial Estimated Market Value of Construction: $ 'D&C)
KNew
Addition: residence/ commercial
If an Addition, what will use of new addition be?
❑ Alteration: residence/ commercial
❑ No change to exterior size: reside Ace/com'l
Other work(describe e e rer—.,--..—)
Check Occupancylnformation l'' Floor 2"Floor Other floor 'Total
Below sq.ft. sq. ft. sq.ft. Square Feet
❑ Single family dwelling
❑ Two family dwelling
o Townhouse
o Multifamily dwelling
#of units
o Office
o Mercantile
o Manufacturing
o 1 car detached garage
❑ 2 car detached garage
o 3 car detached garage .
❑ 1 car attached garage
•
❑ '2 car attached garage
❑ 3 car attached garage
❑ Storage building-
commercial —
❑ Storage building-
residentia l
)Other r t2cf,----sS✓�l I
Will any second-hand or ungraded lumber be used? If so, for what?
Type of I-Ieating System: electric/ oil / gas/wood /forced hot air/ baseboard/other:
Number of Fireplaces to be installed Number of Woodstoves to be installed
List below the person(s)responsible for supervision of work as regards to building codes:
Name . Ad ress Phone Number
Builder
Plumber
Mason C
Electrician .
Declaration: please sign below after you have carefully read the statement:
To the best of my knowledge the statements contained in this application,together with the plans and specifications -
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all
"provisions of the Building Code,the Zoning Ordinance and all other laws pertaining to the proposed work shall be complied
with, whether specified or noted,and that such work is authorized by the owner. Further, it is understood that I/we shall
submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or Director of Building an LCodes,an its Built Surveil by a licensed surveyor;drawn to scale,showing actual
location o l c • instruction.
\ Signature: owner,owner's agent,architect,contractor
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