AST-0364-2021 Office Use Only
ACCESSORY STRUCTURE Permit#:
Towe PERMIT APPLICATION Permit Fee:$
742 Bay Road,Queenstim y,NY 12804 Invoice#: _
P.518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By:
Project Location: �2 ��
�T
Tax Map ID#: 59-VA'OrO ad,V%-- 1-7 Subdivision Name:
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑Cell Tower ❑ 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: t0 0
2nd floor: Y1\A
Total square feet: S =
Brief description of scope of project:
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Accessory Structure Applicatlon Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 0,0,Q Sv c\ IS rf -U�4)
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2. Are there any structures not shown on the plot plan? DYES N0 Explain:
3. Are there any easements on the property? ❑ YES XN0
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 If,for any reason,the building permit application Is withdrawn,30%of the fee Is retained by the Town of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 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.
S. I 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: CM(Ry\gQ-kj&� 1Y\O`l \u>Av-0A
SIGNATURE: DATE: 5�I1'20 ZI
a
Accessory structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): ErnCAY,�U-Q\ck AkIm K\M\yon
Mailing Address,C/S/Z: -720 U jWY- SV\oz(mv\ Nit, ` utlZMLUIYIJ�] 12�C��
Cell Phone:�ZVO IA-940 - Ck23UI Land Line: �\p` 11
Email:
• Primary Owner(s):
Name(s): G\mogAu P-\o, I kji\c� k\V 4,t OV\ -:SQz k G GAev\y1 k\M\y0h
Mailing Address, C/S/Z: -720 \IppT *\efmck '\ Pvkk
Cell Phone:�s'��;'� 1A'%p--y2"I 4 Land Line: Y1\0,
Email: A\�v�0�_ loin&,(,JYI tQi jo too.conn
❑ 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): \ P--(-s We SAr\ek- GA.Ooa
Contractor Trade: nV\O-S
Mailing Address,C/S/Z: 60:4 Y2m.d3.cl , W (ti4t)rn N,y l2-�°3k
Cell Phone: v\XQ Land Line:
Email: a,,PQ ZtiRA-2.CAM G v\& S1neha.
**Workers' Comp documentation must be-submitted with this application**
Architects)/Engineer(s): Y1\c&
Business Name:
Contact Name(s):
Mailing Address,C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project: 4ZV\CkY k1elb� &\\1G 1<\AO(N
Cell Phone: C sR) 41%0 -(A234 Land Line: y1\0.
Email: C�•�iY�Ca _k,�c �Ot\a yoanoo,c,o�n
Accessory Structure Aopliration Revised January 2021
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Construction Spec_i C ions
:+ Cedar S.naees Snsoyres
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Rafters Roofing
Vents
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Rioge Vcnts-Shingleo O:•er or Alum�num Doutn:r fu„�•�! 1;2"Tbohsn'eld or Plywood Metal Roof 2's•I'miters-I6•on Center
Gable;Vents-Halt tdonn or Square YJcoden Vents Standing Scam Metal 2':s,I'Lalh-?U'Spacing A etaf Roof
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Stancimg Seam
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F:'QUEE SBURY
G DEPA MENT
Based 41exami lion,compliance
1 P F with.out
ts';shall n be construed as
indicatin s and s cifications are in
_ full compliance with the iilding Codes of ,
New York State,
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Foundation
Hinges Latch Side Walls
Fourdalion For Sheds Windows r g _
n'x *Pressure Treated Timoer
2-x 4-doisf-16'on Center _-___ __•-_ Standard!-tinges Standard Shed Latch Side Walls In Sheds
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Flooring
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® }f Strap Hinges
Flocau3g In Sheds
5/8'E,terior Ptw.00d
Exterior Siding
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8'Quawer Base 1
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10'Atl Styles Base
Board&Batten rR,iirncd f_o,7
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