application Office Use Only
ACCESSORY STRUCTURE APPLICATION Received
DATE lq c cIE y _ p ID ,2-7 . l/ S
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TAX MAP ID 7 �'ll� : o 2.0I5 ��
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ZONING Dg 11111 SSP 1 0 ZO1 �j i eee
HISTORIC SITE Yes �No T
WN «- ppro als s [J 3&)
ENSB
SUBDIVISION NAME BI11d1NODE —
APPLICANT 02,37L, OWNER , p444-(E.
ADDRESS 'S &)APJ !I N! Ell ADDRESS
9
PHONE �I� ) I6�'02(9 PHONE tt
CONTRACTOR 4tlA'1r COST OF CONSTRUCTION(ESTIMATED): CX17)
li ADDRESS: BUILDING ADDRESS: ( d" CvAiCQ r
PHONE:
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE PHONE
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 1 s'floor sq.ft. 2nd floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck
Deck
Detached Garage(#of cars )
Dock
Pole Barn
Porch -open
** Porch—3 season,Covered,Enclosed
Shed 57 ) . f
Other Accessory Structure(s)
**Considered floor area&must comply with FAR(floor area ratio)requirements if located in the WR zone
DECLARATION: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the
application, plans and supporting materials are a true &complete statement description of the work proposed, that all work will be
performed in accordance with the NY State Building Codes, local building laws and ordinances; and in conformance with local
zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy. 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: �� Date:
Signature: ��. Date: 9/qI/T
1
Town of Queensbury Building&Codes Accessory Structure Application July 2014