application Office Use Only
tItt ACCESSORY STRUCTURE
PERMIT APPLICATION Permit#:
Thwrn of Cyiurn,bt;rt Permit Fee:$ l ✓
742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice#: (+CoD-
Project Location: 39 Glenmar Drive
Tax Map ID#: 290.6-1-51 Subdivision Name:
CONTACT INFORMATION: I I
• Applicant: 1 U II APR 2 5 2019
Name(s): Jeffrey Soldato/Erica Soldato
Mailing Address, C/S/Z: L 24'6' s `y3pi ��i= F,r rtd 3'
39 Glenmar Drive ,��,,,� vs� � / ¢ ( � t� r3 f ::�:;� 71"
Cell Phone: (413 ) 347-7793 Land Line: ( 518 ) 636-5563
Email: jeffsoldato@gmail.com
• Primary Owner(s):
Name(s): Same as applicant
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
El Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): Garden Time
Contractor Trade: Sheds/Garages
Mailing Address, C/S/Z: 652 Quaker Road Queensbury,NY
Cell Phone: ( ) Land Line: ( 518 )793-8555
Email: dan@gardentime.inc
**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: •?\0c' 1�
Cell Phone: ( ) Land Line:' (
Email:
Accessory Structure Application Revised February 2019
PROJECT INFORMATION:
TYPE: Commercial X Residential
WORK CLASS:
Deck,Open Porch _Solar Panels(w/o rafter upgrades) _Carport Cell Tower
Shed Pavilion, Pole Barn,Canopy _Dock _Gazebo
X Detached Garage _Boathouse(with or w/o sundeck) _3-Season Porch
Other(description: )
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 336
2nd floor:
Total square feet: 336
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 1Q,000.00
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES . 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: Jeffrey Soldato
SIGNATURE: � 4/24/2019
►1U,,„t ys d DATE:
Accessory Structure Application Revised February 2019