1989-382 :=w'o.-:,-•:.i'r-yV:$4X�.W.ia.rwprtrr�grew. . . ry. .,,H..�•yy�r `°"ss•"ra�T"' , m .-. . .
CERTIFICATE D " COMPLIANCE
T+C3►'iWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
i
Bate. f��.a a:/ �iJ 19 �r
This is to certify that work requested to be done as shown by Permit No. 89- 382
has been completed.
This structure may be occupied as a Dock
l..rscarian _...
Birch Road
i
Owner Mr . & Mrs . Ken Searl es
By Order Town Board
TOWN OF QUEEN58URY
I
Director of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBUR''Y' No. 89- 3£32
I� WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to t Mr . & Mrs . Ken Searles
OWNER of property located at i Bi rch }load Street, Road or ,Ave.
in the Town of Queensbury, To Construct or place a Rebuild Existing Dock
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is V
m
Same
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2. CONTRACTOR or BUILDER'S Name Pq
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John Well
3. CONTRACTOR or BUILDER'S Address
RR#1 Box 174AA
Bolton Landing , N . Y . 12820
4_ ARCHITECT'S Name
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CM
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5. ARCHITECT'S Address c
6. TYPE of Construction — (Please indicate by X)
l ) Wood Frame ( 1 Masonry ; I Steel ; 1
7. PLANS and Specifications ;,
BBXXXXXXX Rebuild existing 26 ' x 11 ` Dock as per plot plan . o
specifications , and applciation r
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B. Proposed use r
Rebuild Existing Dock
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$ 30 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES February 1 1990
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the �
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury tM 25th Day of Jul y 19 89
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SIGNED BY P414for the Town of Queensbury
wilding and Zoni Spector
r'C3L43N OFUEENSI3UrY APPI. ICATTLIN FOR. BUTLDirrG AND ZONING PERMIT
Pa.te-
a P ee Lev ed TOWN UP OUEENSBURY
,;- - Reu.iewed RECEIVED
py MAY 31 x9$9
Fee Fcu.d � �_—
BUILUINC AND CODES DJJIJ MT-I.rf Date Tasued BLDG• & CODE DEFT.
DAY and IfAVILAND ROADS RD 1 Box 93
pUREMSBURY, NEW rO99 12804 PeAjnit No
Tel . ( 5I8) 792-5832 Ext �204
■ ,r ! t # * R w 1 ■ f w +■ ■ w r ■ W x w w ■ *■ r ■ w: w w r w w r w ■ 1w
A PEIMIT mus'r Dq OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTIONS
- VI LL BE: HARE UNTIL APPLICANT HAs RI» CEIVED A VALID BUI L.DTNC PERMIT .
All applicable spaces on this application must be completed and the
s •; Fgaturc of the applicant must appear on the reverse side of this sheeto
'k
'rhe owner of this property is : We It
P w O . Address
iroperty location {gr� v1 - � 'TAX MAP . NC1 .
tlas there been any split of this property since October 1 , 19r3 $ ? /,�X _
yes Ito
If yes , Planning Board Review is necessary .
SUBDIVISION NAME , IF APPL ? CT. BLC LOT NO .
'rhe Person responsible for su ,tfervi. sion of work as regards Building Codes is :
R . 1.t k'_.L 1 P, B, I -1 `{ r' a± Laj wi l'a44 - •� S` 7" L-----
NAML „F. (�t�t kept ! Wa. l7 P . O . ADDRESS TEL . NO *
_�
trame of builder W• rice Address—
t4"- me of Plumber T.ddress Tel
Name of Miason AddYess Tel
14ATURE OF PRDD'OCCD 601:F; : ZONING INi'01tAl.M1.'{' ION ( Office use on11 )
_ronsttruction of a stew building ZONING 0ESICNJVr1ON OF PROPERTY
AdaitiOn to a building r pERMMITTED PRINCIPAL PERMITTED ACCESSORY
�A1L4ar:ation to is Luilding " r
(,Io ciI•LILqu to uxcurior clitni_nsion: ) " REVIEW REQUIRED - PLANNING BOARD ZONING BOARD
Utlwr work 4 " SITE PLAN REVIEW # �APPRDVF:I3 DATE
r # i
Affl1 '-- -- �"��` . VARIANCE # APPROVED DATE
Gkoss AREA ov PROPOSEA4 :; `TScUC 'i' UftG
1st Floor sq ft * w Remarks :
? n d Floor sq f t . w CG►rnlar_L:'L`L IF11'a1 1�A'i'i{7N scL r?u l lcl O UiI L.kAJ+
.'size. of prolaterty
Other Floors sq f t ' rc .
( neat cellar or bds .:mene ) ;
TOTAL FLOOR AREA S f t r
G ��, i Lxi:: ting Lauil�.ting (:: ) Us+.
L' i4a or now ::truCturs �ft k 'i fC '
►'omAtdaC. ion-piar/::laL/crawl/Varcial/ full ' Yropo ;cd kauilraing , dia:tanQ : frtaau L.rQIAeCty lifsu
{circl. one ) ; Front yard ft Roar yard ft
Noo of atoriew Side yard:; ft and LTC
rluighC (Uradu to rldgw,: ) If on cornar , uc ru:aafc sCrata skdL4 streoc ft
If r.::aiduntial, no * of families _
tio6 of rooms { oxcluding baths ) OCCUPAN+:Y INFORMATION
tlo, of bedrooms � PRIMARY rsUILDINC Nov of bz:at,hroowu * Ono fancily dwelling
Laritnary hcsacirltl sy::t.:tu 'L'wo f;At"ly dwullinq
•ryjus of f UQI Multiple .Iwc:lling / Numtacr of units
No . of firQplacu:: to 1L�.t iltsLullt d w Varmmianeftt occupancy
Will :+ wuu.l stava= Lu in St..11uri? "
■, 'L'xans:iur�t OL'CLtjl;afIG7y
C"At:r:al Air conctitiunirtq'. U"sinuus
(iUlLDING STYLC, PRIMARY STRUCTURE ; lndusLrial
w Other
Lut►clt Concuusl,c,r:xy Len c:aluin Ifi :addition , wtr<ut; will u : r t7:s?
t;.Ai "d ranch Manui[.il taui'lwx '
kllalic 1"4-:l Old scyic t.sutusalow 'r
C.4pw cod cottages OCllur " Acc9ssORY BUILDINC-
CoLoni"I Row 'rowl� Crouse r LaQtachad g;ariag*/ona cur/ two czar/ car
{ CIRCLE ONE PL� A£G ) } Attvchuu g.:ar"gufotta cur/ two car/ Cues'
a w ■ ■ r a r s • w w w ■ r +■ a ■ LariViata: sLor"ga bullcaing
WSTIKA'TED MARKr•r VALUE OF w �—Ocha c
CON :;•r' RUC'L` IUN r?' � _ — `s � - - - - --�. '
j NVor'.btATTON ON AU ILDINC SPrCIF rCATIONS , ON REVURSE Slat OF T"S Irs""T, TO so C0 LC1`L:a !
Form DPA 10/88 v1
BUILDING PERMIT APPLICATION CONTINUED =
BUILDING SPECIFICATIONS :
Type of construction , wood frame', fire safe etc .
Will any second-hand or ungr.: :ied lumber be used? If so , for what ?
Foundation wall material Thickness
Depth of foundation below grade ( to bottom of footing )
Will there be a cellar ? Heated or unheated? Floor sq. footage sq ft
Will there be a basement? Will any portion be used as living space?
( If so , what portion? sq , ft , - - Type of use?
Type of roof - sloped/flat/shed/other Material of roof
Size , wood studs "x " spacing " o . c . length ft ,
Joists ( floor beams ) lst _ floor " X " spacing "o . c , span ft .
Joists ( floor beams ) 2nd . floor " x '" spacing "o . c _ span ft .
Overlays ( ceiling beams ) ''X spacing "o . c , span fc ,
Roof rafters " X " spacing o _ c _ span
Roof trusses (pre--engineered) spacing " o . c . span ft ,
Exterior wall finish Of what material?
Interior wall finish
if a garage is to be attached , describe materials to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door , enclosure , and self- closing device be provided?
Will a flue-lined chimney be installed? Height above roof ft ,
Depth of chimney foundation below grade ft ,
Depth of fireplace hearth ft . in ,
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft .
(A separate application is necessary for any repair or new installation of septic system )
DE {CLA RA 'TIC1N
To the best of my knowledge and belief 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 prow sio.)s of the BUILDING r' OD7. '1'I !?;' "GNIVQ ORMNANCF, and all
other laws pertaining to the proposed work shall be complied with, whether specified
or not , and that such work is authorized by the owner.
1
Signature
Owner, o er's agent, archi ect, contractor
Ar
SPECIAL CONDITIONS OF THE PERMIT :
B
ALBANY 12241 BINGHAMTON 13901 BUFFALO 14203 HEMPSTEAD 11550 NEW YORK 10047 ROCHESTER 14614 SYRACUSE 13202
100 Broadway State Office Building State Office Building State office Building
Menands Hawley Street 125 Main Street 175 Fulton Avenue Two World Trade Center 155 Main Street W. East WaShingtan St.
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
THIS AGENCY EMPLOYS AND
SERVES THE HANDICAPPED
I 1' WITHOUT DISCRIMINATION.
OFFICE AT
ROBERT STEINGUT STATEMENT THAT APPLICANT DOES NOT REQUIRE
CHAIRMAN WORKERS ' COMPENSATION OR DISABILITY BENEFITS COVERAGE
(Ref : Sec . 57 , WC Law; Sec . 220 , Subd . 8 , DB Law)
Applicant ' s Name zrJ'Jh/� Lf . R . No .
mill
Address +�� jo� I j7V AW - - _ Office At -
Business or Trade Name , if Different From Above
The above named applicant for permit subject to restriction under Section 57 of the
Workers ' Compensation Law , and Section 220 , Subd . 8 , of the Disability Benefits Law ,
makes the following statement for the purpose of establishing that he/ she does not
require coverage under these laws .
1 . Location of work. C,." L'LM1.4e-
2 . Exact work to be performed tk�
3 . Number of workers pry.
4 . Date work is to be (a) commenced o- -s s: c. o (b ) completed .7, $
❑ I have workers ' compensation insurance (certificate attached) .
I do not need workers ' compensation insurance because status is Individual
owner or partner with no employees and not a corporation .
Q I do not need workers ' compensation insurance because :
Q I have disability benefits insurance (certificate attached) .
LM I do not need disability benefits insurance because status is Individual
owner or partner with no employees and not a corporation .
0 I do not need disability benefits insurance because :
I hereby affirm, under the penalties of perjury , that I am the above named applicant
for permit subject to restriction under Section 57 of the Workers ' Compensation Law
and Section 220 , Subd . 8 , of the Disability Benefits Law and that the foregoing
statements are true .
7 {
Date Signed C] 19
Signature of Applicant
Telephone No . � _ (O4q' 25711 Title
TO STATE OR MUNICIPAL DEPARTMENT , BOARD , COMMISSION OR OFFICE REQUIRING CERTIFICATE
OF WORKERS ' COMPENSATION INSURANCE UNDER SECTION 57 OF THE WORKERS ' COMPENSATION
LAW AND UNDER SECTION 220 , SUBD . 8 , OF THE DISABILITY BENEFITS LAW
Based on the foregoing statements made by the above applicant :
The Board has no objections , at this time , to the issuance of the permit
'' '1 requested .
[] the applicant will be required to have a Disability Benefits insurance
policy effective not later than four ( 4 ) weeks after the employment of
one or more employees on each of at least 30 days in any calendar year .
It Is to be understood , however , that the Board reserves the right to request revoca-
tion of the permit if , after investigation , it is found that the applicant is required
to have workers ' compensation and/or disability benefits coverage for the work referred
to in the above application .
WORKERS ' ENS Tr
MAY 15 188D� By �
Date :
(District Administrator or
Supervisor of W . C . Enforcement)
C-105 . 21 ( 7-83 )
CL TOWN OF QUEENS B UR Y
Bay of Havr/ar►d Road Ck+eea7a6urS, NY 128 0 4-9 72 5-5 7B 792--5832
Building & Codes Department
S SNSPL�CTOR ' S REPORT�3Q
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PROPERTY LOCATION
OWNER OR TENANT } y
BUTIA31NG EWAGE SIGN THER
S
REMARKS :
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NTACT THIS OFFICE WITHIN
INSPECTO
"HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE"
SETTLED 1753
General Contracting ■ Wooden Boat Restorations
Windy Hi13 oad RR # 1 Trout Lake
LBox R1 74 AA
wnoo WORKS Bolton Landing, New York 12814
51 B-644-2571
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