application a Office Use Only
ACCESSORY STR a u ( "
CL U
PERlT APPLlC R W �,i Z.3
Town of Queensbury 742 Bay Road,Queensbury,NY 12804 L2!4 __7W
Project Location: 7to ['or;A f l� TOWN OF QUEENSBURY
�B[1tt DING& CODES
Tax Map ID #: 3/5, t o I (16 Subdivision Name: West Mountain
CONTACT INFORMATION:
• Applicant:
Name(s): Benjamin & Heather Marcantonio
Mailing Address, C/S/Z: 780 Corinth Road, Queensbury, NY 12804
Cell Phone: ( )518-451-0261 Land Line: (
Email:benjamin.marcantonio@gmail.com
• Primary Owner(s):
Name(s): Benjamin & Heather Marcantonio
Mailing Address, C/S/Z: 780 Corinth Road, Queensbury, NY 12804
Cell Phone: ( )518-451-0261 Land Line: ( )
Email:benjamin.marcantonio@gmail.com
0 Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
Contact Person for Building & Code Compliance: C\k� �
Cell Phone: ( ) Land ine: (
Email:
Accessory Structure Application Revised February 2019
x r
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
Deck,Open Porch Solar Panels (w/o rafter upgrades) Carport Cell Tower
VShed _Pavilion, Pole Barn, Canopy Dock Gazebo
Detached Garage Boathouse (with or w/o sundeck) 3-Season Porch
Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 192
2'floor:
Total square feet: 192
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 1500.00
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES NO Explain:
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 of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: Benjamin Marcantonio
SIGNATURE: / DATE: 4/22/2019
Accessory Structure Application Revised February 2019