AST-0211-2020Office Use Only
ACCESSORY STRUCTURE Permit#: f}5T- I)2.11 - 20 ZD
PERMIT APPLICATION
town o((ijeenshur} Permit Fee: $
742 Bay Road,Queensbury, NY 12804
P: 518-761-8256 www.queensbury.net
Invoice #:
Project Location: 409 Dix Ave. Queensbury, NY
Tax Map ID #: 303.16-1-6 Subdivision Name:
CONTACT INFORMATION: D E.rC EII E n
Applicant: MAY 19 2020
Name(s): Shaun M. Rivers— Schoder rivers Associates
TOWN OF QUELNSBURYMailingAddress, C/S/Z: 453 Dixon Rd. Ste. 7, Queensbury, NY BUILDING&CODES
Cell Phone: (518) 937-3200 Land Line: (518) 761-0417, Ext. 11
Email: shaun@sraengineers.com
Primary Owner(s):
Name(s): John Harrington — Chief South Queensbury Volunteer Fire Department
Mailing Address, C/S/Z: 409 Dix Ave. Queensbury, NY 12804
Cell Phone: (518) 955-6167 Land Line: (
Email: rt.dufour@gmail.com
Check if all work will be performed by homeowner only
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Mike Rozell or Marcus Young
Contractor Trade: General Construction
Mailing Address, C/S/Z: Rozell Industries, 129 Park Road, Queensbury, NY 12804
Cell Phone: (518) 321-2095 Land Line: (518) 793-2634
Email: myoung@rozell ind.com
List all additional contractors on the back of this form
Architect(s)/Engineer(s):
Business Name: Schoder Rivers Associates
Contact Name(s): Shaun M. Rivers
Mailing Address, C/S/Z: 453 Dixon Rd. Ste. 7, Queensbury, NY
Cell Phone: (518) 937-3200 Land Line: (518) 761-0417
Email: shaun@sraengineers.com
Contact Person for Building & Code Compliance: Shaun M. Rivers
Cell Phone: (518) 937-3200 Land Line: (518) 761-0417 Ext. 11
Email: shaun@sraengineers.com
Accessory Structure Application Revised February 2019
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Ridge Homes, Inc.
Contractor Trade: Framing Roof and Siding
Mailing Address, C/S/Z: 140 Owen Ave. Queensbury, NY 12804
Cell Phone: _(518)361-4676 Land Line: (
Email: ridgewoodhomesny@gmail.com
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): O'Leary Overhead Door— Dan O'Leary
Contractor Trade: Overhead Doors
Mailing Address, C/S/Z: 1316 Saratoga Road, Gansevoort, NY 12831
Cell Phone: (518)321-2736 Land Line: (
Email: olearyohdl@yahoo.com
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Precise Painting—Jay Dickenson
Contractor Trade: Painiting
Mailing Address, C/S/Z: P.O. Box 2081 Glens Falls, NY 12801
Cell Phone: ( Land Line: (518)793-7365
Email: precise1073@yahoo.com
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Sweet Electric
Contractor Trade: Electrical
Mailing Address, C/S/Z: 12 Bush Street, Glens Falls, NY 12801
Cell Phone: _(518)796-2012 Land Line: (
Email: sweetelectricinc@yahoo.com
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Snyder's Drywall — Dan Snyder
Contractor Trade: Insulation/Drywall
Mailing Address, C/S/Z: 1555 Saratoga Road, Fort Edward, NY 12828
Cell Phone: ( Land Line: _(518)761-0979
Email: dan@snydersdrywall.com
Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: _( Land Line: _(
Email:
Accessory Structure Application Revised February 2019
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
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: Storage Building)
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 1225
2"d floor:
Total square feet: 1225
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 100,000.00
2. If Commercial project,what is the proposed use: Misc. Storage
3. Are there any structures not shown on the plot plan? 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: Shaun M. Rivers
SIGNATURE:„-e/10.11,4Gu4"" DATE: 5-18-20
Accessory Structure Application Revised February 2019