application Office Use Only
ACCESSORY STRUCTURE APPLICATION Received
DATE _.374/v Imo, Xo/(.--- -- Tax Map ID
Permit No.
TAxMAP ID �a7.oL-l-l�} _� 7.o_G-/-/S }Prr� 1le 0° +P�
ZONING
Rec Fee
HISTORIC SITE Yes No Approvals
SUBDIVISION NAME Lot#
�' LM44ffCtJs o f T �cf cG c7W+ '✓
fj Cad(} rre dt�li" 4Z r— tiler as eAl LtC
APPLICANT ce a ews Q4VNER h ,
ADDRESS i>
�a 7�pX 4 s- ADDRESS Pa o 6 ws' `4F Slur f fZc ~�µy
�+ /4 ke / r,ec +' ,2sr�738
PHONE PHONE
CONTRACTOR COST OF CONSTRUCTION ESTIMA TED: $ /__ �<0 10 G
/� /p
ADDRESS: VulLDING ADDRESS: /S" 4�11 e h - ( ka ysI�,!k I!Ay
PHONE: - - ---
--------------—
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE[I�YD J l G� y"�S -_'_rn ___ PHONE
TYPE OF CONSTRUCTION
Check all that apply Please Indicate measurements as required below
Boathouse 111 floor sq.ft. 2"d floor sq.it. Total sq.ft. Height
Boathouse with Sundeck
i
Deck (5"')
Detached Garage(#of cars�)
Dock 6 9 (�
Pole Barn
Porch-open
i"Porch—3 season,Covered,Enclosed
Shed i4ndetr j7*,*i v'S -Yo
Other Accessory Structure(s) y? e3- X 3.
1 77
Considered floor area&must comply with FAR(floor area ratio)requirements If located in the WR zone
DECLARArroN: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. 1 certify that the
application, plans and supporting materials are a true&complete statement description of the work proposed,that all work will be
performed In accordance with the NY State Building Codes, local building laws and ordinances; and in conformance with local
zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy. l 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: Date: 7161-1-3-01 (o
Signature: Date: ;- / �/6
227.06-1-14 & 227.06-1-15 BOTH 452-2016 1
Town of Queensbury Building&Codes Joel Matthews (Thingvellir, LLC)
15 Allen Road
Dock 696 sq. ft. (Lake Geor Pk Comm.)