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applicationOffice Use Onh ACCESSORY STRUCTURE permit :_£dA 2020 ——PERMIT APPLICATION permit Fe:$.2.250 40) 742 Bay Road,Queensbury,NY 12804 » 24%2 P:518-761-8256 www.queensbury.net Invoice #:24> Project Location:201 Lockhart Mountain Road Tax Map ID #:Subdivision Name: CONTACT INFORMATION: ¢Applicant: Name(s):Joseph Allalouf Mailing Address,C/S/Z:24 Dutchess Drive Orangeburg NY 10962 Cell Phone:(845)570-3429 Land Line:_() Email:allalouf @optonline.net ¢Primary Owner(s): Name(s):Joseph Allalouf, Mailing Address,C/S/Z:24 Dutchess Drive Orangeburg NY 10962 Cell Phone:(845)570-3429 Land Line:_|) Email:allalouf@optonline.net O check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Dave Waterman Contractor Trade:Excavator/Carpenter Mailing Address,C/S/Z:306 Hess Road Fort plain NY 13339 Cell Phone:(518)332-0171 Land Line:_() Email:davidwaterman95@frontier.com **List all additional contractors on the back of this form *Architect(s)/Engineer(s): Business Nami Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_()Land Email: Contact Person for Building &Code Compliance: Cell Phone:_()Land Line! Email: Accessory Structure Application Revised February 2019 PROJECT INFORMATION: TYPE:O Commercial &Residential WORK CLASS: C1 Deck,Open Porch Ci Solar Panels (w/o rafter upgrades)Ci carport O cell Tower O Shed O Pavilion,Pole Barn,Canopy O Dock O Gazebo &Detached Garage CO Boathouse (with or w/o sundeck)(1 3-Season Porch O Other (description:) SQUARE FOOTAGE OF STRUCTURE: Ast floor:768 2"floor: Total square feet:768, ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$17,000 2.If Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES [no Jexptain: 4.Are there any easements on the property?(1 YES NO DECLARATION: 1.|acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12month period 2.Ifthework is not completed by the 1 year expiration date the pert and department approval. may be renewed,subject to fees 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 |,or my agents,will obtain a certificate of occupancy. 5,Lalso understand that [Ave are required to provide an as-built survey by licensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy. I have read and agree to the above: PRINT NAME:Joseph Allatou J SIGNATURE:4 :AY, Accessory Structure Apiication J DATE:_3//3/20. Revised February 2018