AST-0401-2021 Office Use Only
ACCESSORY STRUCTURE Permit#: - X-2-)
4tPERMIT APPLICATION /1 �
town ofcZccnabury Permit Fee:$ 1��
742 Bay Road,Queensbury,NY 12804 Invoice#: 56FD Z.
P:518-761-8256 www.gueensbury.net
Flood Zone? Y Reviewed By:CLAP
Project Location: ( 3 L C1 4oa , 4 Y1 l l 12. 8 4 j
Tax Map ID#: 7 8, -a - 3 Subdivision Name: D VIE
PROJECT INFORMATION: MAY 2 ) 2021
TYPE: X Residential ❑ Commercial, Proposed Use: TOWN OF QUEENSB
BUILDING& COD`SRY
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower 09 Deck
❑ 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: 01®'�( act 00 'dglt
2nd floor:
Total square feet: 400 "6 tF
Brief description of scope of project:
Accessory Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 1 of,d C)O,
2. Are there any structures not shown on the plot plan? ❑YES KNO Explain:
3. Are there any easements on the property? ❑ YES 1� NO
DECLARATION:
1. I 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 a true 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.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE:
Accessory Structure Aoolication Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): MjchaczJ �-ddll EcAA n4erPri5e-S � �C
Mailing Address, C/S/Z: Fo (5o,Y ci A-}-4T;4 , `� 12-8 'v
Cell Phone: Land Line: S 18. 6 z- 3 , Zci "f
Email: mm eddy .1 d V�e r:2-on. .,ef
Primary Owner(s):
Name(s): M ar K Sc-kccchne r-
Mailing Address, C/S/Z: 13 z 4 P�ay 1ZA I
Cell Phone: Land Line:
Email:
❑ Check if all work will be performed by property owner only
• Contractods): (List all additional contractors on the back of this form)
Contractor Name(s): eold� �n �er�r SeS ZnC
Contractor Trade: den 6a t Co nsfr�C, ,10
Mailing Address, C/S/Z: 1°. o ( c X 9 A+ho I, 0,9 ' ►L 9 N
Cell Phone: Land Line: g bZ 3 2 c 1LI
Email: m m-eday 1 c. JcrI ion• ne F
"Workers' Comp documentation must be submitted with this application"
• Architect(s)/Enaineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project: M .'chae l S-ol dL1
Cell Phone: Land Line: Sig b Z 3 Z-c v-f
Email: ►Y�n-\2d1cky 1(2,f(x%2 n, n et-
Accessory Structure Aoolication Revised January 421
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Schnachner, Mark
1324 Bay Rd
400 S-f-
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pECEUVE
MAY 2 7 2021 °
TOWN OF QUEENSBURY
BUILDING&CODES
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