Loading...
AST-0196-2021 Office Use Only ACCESSORY STRUCTURE Permit#: t0 2©Z� PERMIT APPLICATION permit Fee: $ 8`J 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By: Project Location: 951} 5��,, —V-Jn 4,,,�� Tax Map ID#: �j02 1 _ 'Z _ z Z Subdivision Name: PROJECT INFORMATION: TYPE: �& Residential ❑ Commercial, Proposed Use: FH APR 0 7 20221 TOWN OF QUEENSBURY BUILDING&CODES STRUCTURE: ❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck ❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp j3(Shed (<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other: SQUARE FOOTAGE OF STRUCTURE: 1st floor: 192 2nd floor: MI P -- - -— Total square feet: Brief description of scope pf project: o .� Ui Il'�Q CAI door• ��, s;�z VL s; ►�5�� vn La,� c- on Accessory Structure Application Revised January 2021 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 6 0 2. Are there any structures not shown on the plot plan? ❑YES NO Explain: 3. Are there any easements on the property? ❑ YES NO 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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 certificate of occupancy. �1--havc-rcod®nd-�grec-to tho abov^• _ _ _ _—_ PRINT NAME: SIGNATURE: , DATE: `l S ) / Accessory Structure Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): P�Vc . Mailing Address, C/S/Z: D31 LDQe'9-r 5 � Cell Phone:s1'�s -`33% Land Line: IJ VA Email: • Primary Owner(s): Name(s): Span E Rs q1 OCD ve Mailing Address, C/S/Z: Cell Phone: Land Line: Email: l� Check if all work will b erformed b ro ert owner onl bee formed p Y �I'. • Contractor(s): (List all additional contractors on the back of this form) Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: "Workers' Comp documentation must be submitted with this application" • Architect(s)/Engineer(s): Business Name: con ac aiiic(s): — -- - - -- = - --- -- Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Contact Person for any questions regarding this project: Cell Phone: Land Line: Email: Accessory Structure Application Revised January 2021 NMI M- R" TOWN OF QUEENSBURY BUILDING DEPARTMENT TOWN OF QUEENSBURY - Based on-our-limited examination,compliance with our comments shall not be construed as BUILDING & CODES DEPT. indicating the plans and specifications are in full compliance with the Building Codes of Reviewed By- tpA) New York State. . Date: 4R1__L( c>r� mac,v IC �lU° Vc-5 )2- /Qu-(j , L�c i APR ®9 TOWN OF 10"ID BUS Q0 bve' 50 t b t r