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application Office Use Only ACCESSORY STRUCTURE Permit#: INST-- — 20220 PERMIT APPLICATION Town of Queensbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensburv.net Invoice#: '29C) l Project Location: 3 RidgeWood Court, Queensbury,NY 12804 Tax Map ID#: 2-b(0 y \ Subdivision Name: RidgeWood Estates CONTACT INFORMATION: • Applicant: Name(s): James Okeeffe Mailing Address, C/S/Z: 3 RidgeWood Court Cell Phone:_(_518 )_744-9560 Land Line: _( 518 ) 792-3600 Email: pureperfectionlandscaping@gmail.com • Primary Owner(s): Name(s): James Okeeffe Mailing Address, C/S/Z: 3 Ridgewood Court Cell Phone:_( 518_) 744-9560 Land Line: _( Email: ® Check if all work will be performed by homeowner only • 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: **List all additional contractors on the back of this form • Architect(s)/Engineer(s): D E C E - v Business Name: Contact Name(s): SEP 2 2 Z020 VN Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) T g pI JG&FNSBU�RY Email: C©C?�S Contact Person for Building & Code Compliance: \cm-it-- Cell Phone:_( ) Land Line: _( Email: Accessory Structure Application Revised February 2019 e a % PROJECT INFORMATION: TYPE: ❑ Commercial ® Residential WORK CLASS: ❑ Deck,Open Porch ❑ Solar Panels(w/o rafter upgrades) ❑ Carport ❑ Cell Tower l Shed ❑ Pavilion, Pole Barn, Canopy ❑ Dock ❑ Gazebo ❑ Detached Garage ❑ Boathouse (with or w/o sundeck) ❑ 3-Season Porch ❑ Other(description: SQUARE FOOTAGE OF STRUCTURE: t_ 1st floor: 288 0 2"d floor: Total square feet: 288 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 8000 ,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: James Okeeffe J G 6 ` .e- c C SIGNATURE: DATE:_9/16/20 Accessory Structure Application Revised February 2019