AST-0349-2021 /r~ Office Use Only
ACCESSORY STRUCTURE Permit#: S1
Town ofQuc b ry PERMIT APPLICATION Permit Fee: $ fl
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By:
Project Location: q 1-0
Tax Map ID#: 2-'�)2 . b --`I—\ Subdivision Name:
PROJECT INFORMATION:
TYPE: i Residential ❑ Commercial, Proposed Use: D
MAY 12 2021
STRUCTURE: TOWN OF G&CODCS Y
BUILDIN
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ec
❑ 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:
2nd floor: Iq z SGLK (MX suews)
Total square feet: I a2 SW—
Brief description of scope of project:
SEcoN D LeVCL b set,. (Ze'VI.ftkL Of' FY-tST)NCT "C> '13UI l-O N&GJ ACCOAMN(-
Tb T*V. ' - TAC-b1Sb t�Mrs. OF 5�aSTp N( W 000
15 I D I N(:.r, AS NIP" . Awl FiWa0A--)o t4 i YPE VvOOV- LS Td 13aT oea-riem &o.
Coww s r'lr VIA A��ALvM . 12MLI N� S .
Accessory Structure Application Revised January 2021
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ �vl a ,W
/ 5rr�/P�.oT Pv1nl oN �i�
2. Are there any structures not shown on the plot plan? ❑ o
YES NO Explain:
3. Are there any easements on the property? ❑ YES IAO
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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certifythat 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:
SIGNATURE: DATE: S )126&'
Accessory Structure Application Revised January 2021
• s
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: J
Name(s): t)C�1N0 CQWT1EACPNG LL-.,! D$w' �b mcsea wuas
Mailing Address, C/S/Z: 33 A70e-L . D" FkTS2 C.OJEJV eS NY 17.R9 1
Cell Phone: 5lF IL16 W f Land Line: --
Email: ndeano@no(4h&, rbld.Cotn.
• Primary Owner(s):
Name(s): LISA rZMOALL
Mailing Address, C/S/Z: UNTr-4 l TOP OF Vg0eW LftE GEN sF, ICY 1? 4
Cell Phone: LW ;?01 SMI 00 Land Line: ---
Email: l MKda tTeig Ms ) ,caq
❑ 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): N)CIfOLAA 'DE AND
Contractor Trade: czNiL
Mailing Address, C/S/Z:33 ATrNUA- R-0" pbR-T&E CWN5S Ml 12M51
Cell Phone: 519'-Ra (O(Vlt Land Line:
Email: y1deA Itioo r)W+heyn61 J .Cory)
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engineer(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: 5le-709(o 1pt?14 Land Line:
Email: n&.on0 ylD�nd,COY)')
Accessory Structure Application Revised January 2021
Deck and Roof Design checklist
Is deck freestanding or"attached
Footing
Sono tubes sized for posts 4x4 .`6
Big foot or footing for roof load
Proper attachment to post and footing shown �r
=[±j- Proper flashing or waterproofing to structure shown
Attachment to structure shown on plans
Galvanized or stainless steel bolts shown NO ZINC COATED
Hex headed bolts NO CARRIAGE BOLTS
Diagonal bracing shown for deck over 24"
Floor joists parallel to carrying beams
Deck post to beam attachment shown
Over 30" requires handrail
TA!Over 30" requires guards
JKOver 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"