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applicationeve ice Use OniACCESSORY 7—hg te le-202oeaLicaTION[jtemee temo3-200TownofCuvensbry{|}MAR 27 2020 |‘Permit Fee:$_12 S00 \———742 Bay Road,Queensbury,NY 12804||||TET bie s_QYSYP:518-761-8256 www.queensbury.net Project Location:466 Luzerne Poy TaxMapiD#:308,/-|3 O Subdivision Name: CONTACT INFORMATION: .licant: Name(s):DAwel +Keen.OkeeFe Mailing Address,C/S/z:PO Boy 43/X Qycenshury NY i964CellPhone:_(S19 98-047 land Line:_(s/?)_@3(-3/94Email:_DTOkK (qs ©yshoo.com +Primary Owner(s): Name(s):DAW?|+Karen OKee Fe Mailing Address,C/s/z:BO Ro¥Usix Queeus bung WY 1ageyCellPhone:(S\%_)598-9044 landline:(S12 )"30-3194Emait_Dy ole tage @y whoo com (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: Cell Phone:_()Land Line:_() Email:, Accessory Sucre Appian Revised Febuary 2019 eure wr PROJECT INFORMATION: TYPE:____.Commercial 1 residential ‘WORK CLASS: Heck,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 __Other (description:) SQUARE FOOTAGE OF STRUCTURE: Ast floor:é 2. 2"floor: Total square feet:__|@() |ONAL PR’IRMATION: 0D1,Estimated Cost of Construction:OO 2.If Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES (S10)Explain 4.Are there any easements on the property?ves C®) DECLARATION: 1.Tacknowledge that no construction shail be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2.Ifthework 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 atrue and complete statement and/or descriptionoftheworkproposed,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. 4.1 acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of ‘occupancy, 5.lalso understand that I/we are required to provide an as-built survey by a licensed land surveyor ofall newly constructed facilities prior to issuance of acertificate of occupancy. \have read and agree to the above: PRINT NAME:amel T Keefe sionature:_@ Yow 2 |D faz pate:3-25)02-D ecessory Structure Aoptstion Revd February 2089