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applicationOffice Use Only ACCESSORY STRUCTURE ;AST -0219-2020PERMITAPPLICATIONPermittnannepermitFee:s 12>— 742 Bay Road,Queensbury,NY 12808 P:518-7618256 www.queensbur.net Invoice #:_2E>(0% Project Location:f Sherwood Deve Tax Map ID #:1.9,\9-\-9%Subdivision Name: CONTACT INFORMATIOI ©Applicant:a Name(s):Chmwrord fn.fla Mailing Address,C/S/Z:__9 She sous de Qozenibury MF 12 Go¥ Cell Phone:(5!_)_36/-/y/6 landline:(5/6)2y¥s-¥o97 Email:__e mv Ilav@ boatssy searge »Conn +Primary Owner(s): Name(s):Same af ayolcant Mailing Address,C/S/Z: Cell Phone:_()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): 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:_Same af abiye Cell Phone:_()land Line:_{) Email: PROJECT INFORMATION: TYPE:Commercial _/>Residential WORK CLASS: X 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 )__Other (description: SQUARE FOOTAGE OF STRUCTURE: 10"x35'=350 sq.ft.revised6/5/20201stfloor: 2"floor: Total square feet: ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:A 3200.00 2.If Commercial project,what is the proposed use: 3,Are there any structures not shown on the plot plan?YES nO Bia 4,Are there any easements on the property?ves DECLARATION: 1.acknowledge that no construction shall 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.Icertifythattheapplication,plans and supporting materials are atrue 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.lalso understand that lve 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. Ihave read and agree to the above: PRINT NAME:pestadSIGNATUREDATE:olsh™ Accessory Sucre Application eed February 2019