application Permit No. 6 5----057
Building&Codes Office-Department of Community Development-Town of Queensbury Fee Paid LiQ D°
742 Bay Road,Queensbury,NY 12804
Dave Hatin,Director codes@aueensburv.net
Phone; (518) 761-8256 FAX: (518) 745-4437
4c, ccessoryStructure Building Permit Application
Application & Plans subject to review before issuance of a valid permit for construction.
Any structure other than the principal structure (i.e., house), typically a garage, shed, greenhouse, dock, deck, '
etc. (not necessarily limited to the list below). Refer to attached Informational Brochure No. 3
Instructions: A permit must be obtained before beginning construction. No inspections will be made until the
applicant has received a valid building permit. All applicants' spaces on this application must be completed and
_must appear on the application form.
Applicant/Builder • MIc/.acf Cohno,r Owner: ,c;.#C-h e At(-4 dal Co�,H,j-
Address: .W CG,, p.:.. (%?€r Address: 2`f a T-p ..,„ �'i-`4, Z o
(Qc,„_.,s 1 At,/ is goy �` ,,:„-...1tiG,� N y / g Y
Home Phone: '�5 2'�-c/u 5 3 Home Phone: 75 8-Y&r5
Email Address: me c�hh0- c...e4//64.,=. •ke-- Email Address: pp.c c4,..., c.c e(i. 4,4,•mot .
Cell Phone: f 7`1‘1-9 2Z1 Cell Phone: 7 rf`1`-5 z-2-1
FAX Phone: FAX Phone:
Person responsible for:supervision of work with respect to building and codes compliance:
,.i
Name: /rc�+a /r= C011 0
Address: Z4/ ('4,:ire,...,e_ C,is(,, Qucr•-•s hu,).JU7 Phone /2-f"!
Location of proposed'construction: Lot No. I34 Legal Address: It C � x.- cA
° e(„ rd-e-
Tax Map Number: 3d i' i 3 - )---) ? Subdivision Name: J0 O T►,ei, r SG4, `n`-
Niel. igVrf
Estimated Cost of Construction: $ "Li 1'0 ',jQ-dO 2.e,,��-Q
/ Lei 16/r)' )
Does an accessory structure currently exist on the property? _Yes / No F2 3o`
IIR' ac'` rsid4=Sim-•30r
If YES, list all existing accessory structures: ""`y- icy
Proposed Construction 1,i floor 2nd floor Total Proposed Height
sq.ft. sq.ft. Sq..ft. ft.&in.
Open Porch
Covered or Enclosed Porch 'EC8VED
(considered floor area.&must comply to FAR [Floor Area Ratio] •
requirements if the structure is located in the Waterfront JUL 1 c 2Q�5
Residential zone.
3-season porch is considered an enclosed porch. TOWN OF OA���S��P
Deck A-c18 BUH A IN DE
Boathouse
_ Boathouse with sundeck __
•
DOCK
Shed
Pole Barn
Detached Garage 1, 2, 3 car
Other Accessory Structure: -
Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review.
The Building and Codes Office will allow commencement of your proposed project only after
issuance of your permit. €€
Declaration: Please sign below after you have carefully read the statement: t
To the best of my knowledge, the statements contained in the application, together with the plans and
specifications submitted, are a true and complete statement of all proposed work to be done on the described
premises and that all provisions of the Building Codes, the Zoning Ordinance, and all other laws pertaining to the
proposed work shall be complied with,whether specified or noted, and that such work is authorized by the owner.
Further, it is understood that I/we shall submit prior to a Certificate of Occupancy or Certificate of Compliance
being issued, as requested by the Zoning Administrator or Director of Building and Codes, an As-Built Survey by a
licensed surveyor, drawn to scale, showing actual location of all new construction.
Date: 7 —13 _a> Applicant/Builder Signature: ''2/ L
The application of dated is hereby approved and!
permission granted for th construction, reconstruction or alteration of a building/and or accessory structure as jet
forth above. n,,
Date: 1 )0uthorized Signature: •ti'"\ ` 1"`‘a
L:\Sue Hemingway\Building.Permit.FORMS\Accessory Structure Permit Application.doc V:12/28/04