AST-0071-2021 w
Office Use Only
ACCESSORY STRUCTURE Permit#: A<-T ^ 00-+l 2021
Town ofQ b z)- PERMIT APPLICATION permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: �
P:518-761-8256 www.gueensbury.net
Flood Zone? Y N Reviewed By:
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Project Location: 1l0 0ar1(v1-e\.7
Tax Map ID#: 30a , Iq ^3" Subdivision Name:
PROJECT INFORMATION: D E C E 0 V E
TYPE: Residential I] Commercial, Proposed Use: FE� 9 2021
TOWN OF QUEENSBURY
STRUCTURE: BUILDING&CODES
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower XDeck
❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp
❑ Shed(<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE.FOOTAGE OF STRUCTURE:
1st floor: Sao 50bFk 6�oX
2"d floor:
Total square feet: 2QD c%FTr----
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Brief description of scope of project:
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Accessory Structure Application Revised January 2021
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ kp'Q Q 0
2. Are there any structures not shown on the plot plan? OYES ONO Explain:
3. Are there any easements on the property? ❑ YES XNO
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will require
the submittal of amended plans,additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of
Queensbury.After 1 year from the initial application date, 100%of the fee is retained.
3. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are atrue and a 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.
5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. 1 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:
?K_hard PC CC,
SIGNATURE: DATE: 02 1 /000')
ell
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN-EMAIL
• Applicant,
Name(s): (:.7V IPU i-J1)ey .
Mailing Address, C/S/Z: 1(0 PO r K Vl e v Ave, a�eQ nsb� N
Cell Phone: 51g "7q 3a.I g . Land Line:
Email: 2a a r-t-v�sre a�o�ma�1 . Corn
• Primary Owners :
Name(s): I�\cha PoYtufs-e-
Mailing Address, C/S/Z: �k�, (--�,YI4v1-elw ! J
Cell Phone: Land Line:
Email: Y fiU C S� I(`nQ1 • Coyo
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❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contractor Name(s). —ThprYIO-S N brech a- 3f—
Contractor Trade: N M�bq CcrSt-vui- Ors C qq,,V11 Pv n�
rowl - G�oc�dl ►-IvdSUn 1 S,
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Architect(s)/Eneineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project:
Cell,Phone: Land Line: 0
Email:
Accessary Structure Application! Revised January 2021
� �►�``' N 0 S E FEB 19 2021
U TOWN OF QUEENSBURY
BUILDING&CODES
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Reviewed By:
Date:
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TOWN OF QUEENSBURY -
BUILDING DEPARTMENT _ <�
Based on our limited examination,compliance <�2 J� �' W1 9.YI-7
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of 5 � �
New York State.
A11 5 meted insGo y5�k 1'� I
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302.14-3-59 AST-007JL 2021
Portuese, Richard & Emily
16 Park View Ave
Deck expansion 224 s.f.