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AST-0227-2020 Office Use Only ACCESSORY STRUCTURE PERMIT APPLICATION Permit#: �rST-_e2�-�"2Q2'i Town of Queensbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice#: Project Location: 12 Shore Acres Rd, Cleverdale, Lake George, NY 12804 Tax Map ID #: 227.17-1-11 Subdivision Name: CONTACT.INFORMATION: • Applicant: Name(s): Daniel and Meghan.Frazier Mailing Address, C/S/Z: 8 Connors Way. Saratoga Springs, NY 12866 Cell Phone: ( 518 ) 376-5302 Land Line: ( ) Email: megfrazier25@gmail.com • Primary Owner(s): Name(s): Daniel and Meghan Frazier Mailing Address, C/S/Z: 8 Connors Way, Saratoga Springs, NY 12866 Cell Phone: ( 518 ) 376-5302 _ Land Line: .( . ) Email: megfrazier25©amail.com El 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: P- Email: _ Et **List i **List all additional contractors on the back of this form JUN 09 2020 I I f I 6_ • Architect(s)/Engineer(s): �m - TOWiet OF OUEENSBURY Business Name: AdironDock's of Lake George, LLC I IUr fl'M R. r.,. Contact Name(s): Gary Zervas, Jr. — Mailing Address, C/S/Z: 136 Stone Schoolhouse Rd., Lake George, NY 12845 Cell Phone: ( 518. )361-8624. Land Line: ( ) Email:adirondockslg@gmail.com Contact Person for Building& Code Compliance:Gary Zervas,Jr. Cell Phone: ( 518 .).361-8624 Land Line: ( ) Email: adirondocksig@gmail.com Accessory Structure Application Revised February 2019 6I0Z Aienigaj pasinay uope3 Iddy amlanils Alossao3y :Ilew3 (—� :eull pUel ( ) :auoyd IIaD :Z/S/D `ssaappd Suiliew. :apeal aopea uoD. :(s)aweN aopea1uo3 uoilealiode siq u im pad;iwgns aq lsnw uoileluawmop dwoD ,saa)aoM :(s)aopea}uop • :Ilew3 O :aull pUel ( ) :auoyd IIaD :Z/S/j 'ssaappd�ulllelN :apeal aopea}uoD :(s)aweN ao45e4uoD uoile3!Idde siq gum pauulwgns aq Ism uoi;e;uawn3op dwop ,saa)IaoM :(s)aopeiluoj • :liew3 :aull puel ( j:auoyd Hap :Z/S/D 'ssaappv BulIleW :apeal aope.iluoD _ - :(s)aweN aopea4uoD uopeaudde siq; q;!M pa; iwgns aq Ism uol eluawnoop dwoD.,saa)IaoM :(sjaopea4uo3 • :Ilew3 (�— :aun pUel (�—:auoyd lla� :Z/S/J 'ssaappV 2ullleW :apeal aoPealuoD :(s)aweN aopeiTuoj uoilea!Idde siyo umm palliwgns-aq lsnw uoileluawnaop dwo3 saeJaoM :(s)aopea1uo� • :Hew3 (—y— :aull puel O:auoyd nap :Z/S/D 'ssaappv 2ullleW :apeal ao}yea}uoD :(s)aweN aopeaTuop uoge3lidde s!q4 q inn pal iwgns aq ;snw uoi;eluawnaop dump saa)IaoM :(s)aopeiluop • woo•ooueAc66T£9>Iaelos[ :Ilew3 ( j. :aull pUel 899Z-T9£ ( 8T5 :auoyd IlaD St8ZT AN '3oao99 a>121 'P21 TW )IMeuoN 88 :Z/S/D 'ssaappd SullleW JopeJ}uoJ IeaauaE repeal aopealuop u01pp11.14SUOD a)iaeD T :(s)aweN ao3oealuoJ uoi}ea!Idde s!q4 ywn pa;;iwgns aq Ism uoileluawn3op dump ,saa)poM :(s)aopea}uo) • PROJECT INFORMATION: TYPE: Commercial. X Residential WORK CLASS: Deck,Open Porch _Solar Panels(w/o rafter upgrades) _Carport _Cell Tower Shed _Pavilion, Pole Barn, Canopy _Dock _Gazebo Detached Garage X Boathouse(with or w/o sundeck) _3-Season Porch _Other(description: SQUARE FOOTAGE OF STRUCTURE: 1st floor: 2nd floor: 1164 sf Total square feet: ADDITIONAL PROJECT INFORMATION: 1. •Estimated Cost of Construction:$ 150,000 2. If Commercial project,what is the proposed use: 3. Are there any structures not shown on the plot plan? YES 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: Meghan M Frazier SIGNATURE: ---714-1-1� - DATE06/09/2020 Accessory Structure Application Revised February 2019 AdironDock's, LLC AdironDock's, LLC AdironDock's, LLC AdironDock's, LLC