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Office Use Only ACCESSORY STRUCTURE vermit:AST teowPERMITAPPLICATIONeemit°Town of Queensbury Permit Fee:$f742BayRoad,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net invoice:Le5WedArsKove, Project Location:Queene Wa V8ty Tax Map ID #:Subdivision Name: CONTACT INFORMATION: °Applicant: Name(s):Das\Searen ~Senren Condendns Malling Address,C/S/Z:S1X Creare Dead BoSNow WA \hoas Cell Phone:_(S(8_)S73-TAAB Land Line:_() Email:Qoamren@ WA CagQ-Ah Con «Primary Owner(s): Name(s):_“Soanre Tro\.. Mailing Address,C/S/Z:_&\W.SNen WWe Dee Qrecudoves,WY SOY Cell Phone:_(S \%_)__},.04 -349%land Line:_(Wy &), Email:_& O Check if all work will be performed by property owner only Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):_NoS Samren ~Corder de Contractor Trade:_bere-\G Sor Mailing Address,C/S/Z:41%Cod-careas Yrood Cell Phone:_(5'%_).a2 aS Land Line:_(Wo). Email: **List all additional cciinaors onthe back of this form ©Architect(s)/Engineer(s): Business Name:_\3 Qe Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person for Building &Code Compliance: Cell Phone:_()Land Line: Email: Accessory Structure Appleton fevised January 2020 PROJECT INFORMATION: TYPE:____.Commercial vw Residential WORK CLASS:ie Open Porch ___Solar Panels (w/o rafter upgrades)__Carport __Cell Tower __Shed __Pavilion,Pole Barn,Canopy ___Dock __Gazebo __Detached Garage __Boathouse (with or w/o sundeck)___3-Season Porch __Other (description:) SQUARE FOOTAGE OF STRUCTURE: 1st floor:AT 2*floor: Total square feet:_ ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$_\},O00 2.ff Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES Beatin: 4.Are there any easements on the property?ves RO) DECLARATION: 1.Lacknowledge 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.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,|acknowledge that prior to occupying the facilities proposed I,or my agents,will obtain a certificate of occupancy. 5.lalso understand that lAve are required to provide an as-built survey byalicensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy. Ihave read and agree to the above: PRINT NAME:v SX San SIGNATURE:0)LA DATE:6}u\x0