application Office Use Only
ACCESSORY STRUCTURE t# r�Gi('D
PERMIT APPL e E 11 CV
Qu Town ofeensbu/
742 Bay Road,Queensbury,NY 12804 —Per i Fee:$ 12-� `
P:518-761-8256 www.queensbury.net MAR 2 9 2019 Inv #:
Project Location: 1172 State Route 9 TOWN OF QUEENSBURY
BUILDING &CODES
Tax Map ID #: 288.20-1-20 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): The Great Escape Theme Park,LLC(Eric Gilbert)
Mailing Address, C/S/Z: PO Box 511,Lake George,NY 12845
Cell Phone: ( ) Land Line: ( 518 ) 792-3500
Email:
• Primary Owner(s):
Name(s): Same as Above
Mailing Address, C/S/Z:
Cell Phone: t ) Land Line: (
Email:
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): Dean Hyatt
Contractor Trade: Work to be completed by Great Escape Theme Park
Mailing Address, C/S/Z: PO Box 511,Lake George,NY 12845
Cell Phone: { 518 ) 812-9345 Land Line: ( 518 ) 792-3500
Email: dhyatt@sftp.com
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: JARRETT Engineers,PLLC
Contact Name(s): Robert U.Holmes II,P.E.
Mailing Address, C/S/Z: 12 East Washington Street,Glens Falls,NY 12801
Cell Phone: ( 518 ) 796-7381 Land Line: ( 518 ) 792-2907
Email: bholmes@jarrettengineers.com
Contact Person for Building & Code Compliance: Dean Hyatt
Cell Phone: ( 518 ) 955-0865 Land Line: ( 518 ) 792-3500
Email: dhyatt@sftp.com
Accessory Structure Application Revised February 2019
PROJECT INFORMATION:
TYPE: X Commercial Residential
WORK CLASS:
Deck,Open Porch Solar Panels(w/o rafter upgrades) —Carport _Cell Tower
Shed Pavilion, Pole Barn, Canopy Dock _Gazebo
Detached Garage ,Boathouse(with or w/o sundeck) _3-Season Porch
X Other(description: Staircase
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 505
2nd floor:
Total square feet: 505
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ $79,000.00
2. If Commercial project,what is the proposed use: Staircase-hillside access
3. Are there any structures not shown on the plot plan? ® NO Explain: Located in the Great Escape Theme Park
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 ofa certificate of occupancy.
I have read and agree to the above:
PRINT NAME: C I /1.-4--
SIGNATURE: DATE: ` �,
Accessory Structure Application Revised February 2019