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Office Use Only ACCESSORY STRUCTURE ng Asepage iaessePERMITAPPLICATIONPermit#~p08S - To begs s742BayRoad,Queensbury,NY 12804 Permit Fee:$25D.02P:518-761-8256 www.queensbury.net Invoice #:24'S. Tax Map ID #:_208.12 -1-4S.Subdivision Name: CONTACT INFORMATION: ©Applicant:|| Name(s);Mics Grae jlo wus || Mailing Address,C/S/Z:_\Medios.(las,METH acne Ne 12 : Cell Phone:_()land Line:_(51 )B41. Email;___)Bonwerce MICHRAS GEOF,Com «Primary Owner(s): Name(s):__GQeEQ Erricu Mailing Address,C/S/Z:__24 WOOD EM LAN=,QveeNSuUSvey,He 230 4 Cell Phone:_()Land Line:_() Email: O Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):MACHseLs.Grour HOUSS|LLC Contractor Trade: Mailing Address,C/S/Z:__\_MMZIONS Way,MECHANOWILLE,Ny IZ Cell Phone:_()land Line:(Si )_€A4.Gs! Email:J BNVEF eC MICHAELS GizCUR.COn4 **List all additional contractors on the back of this form ¢Architect(s)/Engineer(s): Business Name: Contact Name(s):_WATH urea,P.e- Mailing Address,C/S/2: Cell Phone:_(S\S)SNA.2402 land Line:_() Email: Contact Person for Building &Code Compliance:__“TON~¢LeoCasuD Cell Phone:_(_2\)_TA4.290%Land Line:_() Email: necessary Sucre Appeation Revises February 2019, PROJECT INFORMATION: TYPE:_____Commercial _*__Residential WORK CLASS: XGecP,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:_SCzew=e>Foret ) SQUARE FOOTAGE OF STRUCTURE: 1st floor pe BAGH 2 floor:SUES Reco)112 4 Total square feet: ADDITIONAL PROJECT INFORMATION: 1,Estimated Cost of Construction:$,S,000 — 2.If Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES (GO Explain: 4,Are there any easements on the property?ves (WO) DECLARATION: 1.J acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within 2 12month period. 2.fthework is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval.|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.|acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy. 5.|alsounderstand that IAve are required to provide an as-built survey bya licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy. |have read and agree to the above: PRINT NAME:Atl ay ate laser SIGNATURE:DATE:2}eee fee Accessory Structure Appea.on evsedFebrry 2019