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1989-409 }e.S� "i . r i I f CER.TIFICATE %0`x COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Elate June 29 ;g 89 w23 I This is to certify that work requested to be done as shown by Permit No. i { has been completed. 1 ?his structure may be occupied as a Deck Location 7 R Cll d Mi 1 l Lane Owner Jai nes Whittaker i By Order Town Board 'rOWN OF QUEENSBURY Director of Bldg. & Code Enforcement i f w� >c r BUILDING PERMIT R TOWN OF QUEENSBURY No. � $9-409 . . WARREN COUNTY, NEW YORK 0 PERMISSION is hereby granted to ��S WHI A ER i.+ OWNER of property located at 1 A OLD MILL LANE Street, Road or Ave. in the Town of Queensbury, To Construct or place a DECK 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 . DWNER'S Address is r-� PANKRZ SANE �'n` 2. CONTRACTOR or BUILDERS Name C ROBERT BOLEN III rr u 3. CONTRACTOR or BUILDER 'S Address 16 NORMRR STREET LAKE. GEORGE% N . Y . 12545 4_ ARCHITECT'S Name r C G r 6. ARCHITECT'S Address C r�^^ 6. TYPE of Construction — (Please indicate by X) 7 ( ) Wood Frame I } Masonry I ) Steel I I 7. PLANS and Specifications No. 12 ' x 14 ' deck as per plot plan , specifications , and application - 8. Proposed Use deck R r c $ MOO PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 19 9a (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 this 12th Day of June 19 89 SIGNED BY � for the Town of Queensbury Budding and Zon I nspector OWN OF QUFFNSB URY APPLICATION FOR PORCHES - DECKS DOCKS BOATHOUSES A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING: The undersigned hereby applies for a Building Permit to do the following work which will be done in accordance with the description, plans and specifications submitted, and such special conditions as may be indicated on the permit, The Owner of this property is: r" "ti 1S t,.3 IvA % _Tr t;k K Sft:v- -- P .O. Address: Property lsocatiom k o O C"h Street number or building lot number Subdivision name (if applicable) I 1[pr-� t.a � z �. �-►_F4 THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES: Address: fY1f+�t �' A {� 'c f ! . Tel, 61c+t3 `07 BUILDING SPE(IFZCAJION_ �y: 2 4S5c1 � `t24 .r tr`�c- Gem Foundation Material Width ;!s r Thickness �L - Depth of footing below grade , (01, +_0 `{ Size of posts or studs ^x _x 5 Long ►a �t + + rTc _ +° +. { c� Size of floor joist x x_ 1�_Span Decking or flooring material " l s tC, #6 n How will parch or deck be fastened to building? ( 4< <� n, Lr 4 wti c. no-r 7a*r Ac-AL� Trc> � z - 1 any IF ROOF WILL BE INSTALLED ANSWER QU STIONS BELOW : Size of posts or studs x X. Long Roof Rafters x Spacing Span Roof Trusses Pre-Engineered spacing) Span Type of Roof - Sloped - Flat -- Shed - Other Material of Roof Type of siding (if any ZONING INFORMATION: TWO PLOT PLANS MUST BE PREPARED AND SUBMITTED, drawn reasonably to scale and attached hereto, showing clearly and distinctly all buildings, whether existing or proposed and indicate all set back dimensions from property lines. Give street and number or lot number and indicate whether interior or corner lot. Show location of water supply and location and configuration of septic disposal area. COMPLETE INFORMATION REQUIRED BELOW : Size of property 4MIK ft . x =. w ft . 5& u.3 • X [ ( (:: Ck frE p Existing buildin s) Size ft. x - Existing building(s) use rk, *n, ,,e,, Proposed building, distance from property line. xFront yard '? '7 ft. Rear yard_ } ft , Side yards_y � and - - .,71.] , - ft , If on corner setb c torn side street 'f'A' ft, DECLARATION To the best of my knowledge and belief the statements contained in this plication, together with the plans and specifications submitted, are a true and complete itement of all proposed work to be done on the described premises and that all provisions the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to proposed work shall be complied with , whether specified or not, and that such work uthorized by the owner . SIGNATURE ^-� Owner, Owner's Agent, Architect , Contractor ALBANY 12241 BINGHAMTON 13901 BUFFALO 14203 HEMPSTEAD 11550 NEW YORK 10047 R©CHESTER 14614 S ate CUSEfficeg13202 100 Broadway State Office Building State Office Building ilding Menands Hawley Street 125 Main Street 175 Fulton Avenue Two World Trade Center 155 Main Street W. East WeshI n gton St. STATE OF NEW YORK WORKERS' COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES THE HANDICAPPED ( � WITHOUT DISCRIMINATION. '• OFFICE AT •�cersla+i 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 C3bt �'..7t" + 1Jr> � r + L . R . No . Address lkr Y1c�i ,rY ► pr , �aC � C: ok=c,� �1 `I 123 �5 Office At 'fir ► r t C •A is P I'~ 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 work1T3 2 . Exact work to be performed J', Zc I4 pl c ti: 3 . Number of workers f Y�y S Sc ls'c 4 . Date work is to be (a) commenced (b ) completed La i"t" Q o E4z�rY%vj a3 R`( 1-'t1crn r► O ,Z 1r-l C e ❑ 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 . ❑ I do not need workers ' compensation insurance because : ❑ I have disability benefits insurance (certificate attached) . I do not need disability benefits insurance because status is Individual owner or partner with no employees and not a corporation . ❑ 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 . 80 of the Disability Benefits Law and that the foregoing statements are true . p Date Signed � _ � 2 19� Signature of Applicant Telephone No . � � - � `Q' 'Z �+ 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 , SUED . 80 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 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 . WORKER'S ' Co NS T ARD By Date : J (District Administrator or Supervisor of W . C . Enforcement) C-105 . 21 ( 7-83 ) TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 4 HAVILAND ROADS QUEENSBURY, NEW PORK 12BOLL TELEPHONE (518) 792-583.2 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION ,RECEIVED NAME le- DATE ZOCATX0W _Ld�_r - r ' PERMIT #_ APPROVED C, YES Na FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLCk7RS WALLS ILING NAL INSPECTIO CHIMNEY HEIG ROOFING SIDING EXTERNAL PO CHES/STEPS -- STAIRS-CLE RANCE & RAILS_____��_ PLUMBING xTURES/RELIER 'VALVE INTERIOR RI'MJPRIVACY DaB�RS FINISHED LOORS GARAGE F EPROOFING ' DOOR c PER (S) SMOKE DE ECTORS FINAL ELEC RICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED C RTIFICATE OF OCCUPANCY MUST BE OBTAINED F M THE BUILDING DEPARTMENT BEFORE THESE pREMI S ARE OCCUPIED;' REMARKSr INSPECTOR TOWN OF QUEENSBURY J '' r BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY' NEW YORK 0tb TELEPHONE (5 8 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME „qr LOCATION DATE V � PERMIT # � APPROVED YE NO 1 p ip�'XNG/PITsRS MONOL2TH'IC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELEC3'RICAL R H—IN INSULATIONS FOUNDATION ` FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST STArRS—CLEARANCE & IS VALVE PLUMBING FIXTURESLI S INTERIOR TRIM/PRIVACY DO FINISHED FLOOR GARAGE FrREPR PING DOOR CLOSER ( SMOKE DETEC RS FINAL ELECTR CAL INSPECTION FINAL APPRO AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR �f7wn C3 QueeniLpV B U I L D I N G & C O D E S D E P T , THE PLAINS SUBMITTED HAVE BEEN REVIEWED AND HAVE BEEN FOUND TO LACK SUFFICIENT DETAIL FOR PROPER PLAN REVIEW . WE HAVE ISSUED THIS PERMIT WITH THE FOLLOWING STIPULATIONS : 1 , THE WORK WILL BE INSPECTED AND MUST CONFORM TO ALL PROVISIONS OF PREVAILING CODES . 2 , IF DEFICIENCIES ARE FOUND THEY MUST BE COR - RECTED BEFORE WORK CONTINUES . 3 . FAILURE TO COMPLY WILL RESULT IN REVOCATION OF THE: BUILDING PERMIT z., Code Enforce?M/eentt Officer Da t� ed ,S;P- 9 Building Permit a COMMENTS : r I ,ems 1 , t`tCt� 2 ; t$ ©t 'mt �� i .�a •.tEi�� n � �,� twq : A?,��o—_ i i r i I � r lililir 6 II ' Ill � I i l I �IIr II � I � i fill ; ili i I i ' Ii � il � r r