Application Office Use Only
ACCESSORY STRUCTURE Permit#: AST 'v4�S- •2�Z(
8
rown rdcLinn. ry RMIT Permit Fee: $ S. o p
p 742 Bay Road,Queensbury,NY 128 IECIEud1E0 Invoice#: 3 R 9� 3
P:518-761-8256 www. ueensbur . JUN 22 1� Flood Zone? Y N Reviewed By:
TOWN OF QUEENSBURY
BUILDING&CODES
Project Location: Vy', 4.0,1kly Qd, Q1ielx5 /vey 1Vy /7Vf ,
Tax Map ID #: 296 • ?y, 1_ 1 Subdivision Name:
PROJECT INFORMATION:
TYPE: A Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo Xpavilion ❑ Pole Barn ❑ Porch ❑ Ramp
❑ Shed (<300 s.f.) ❑ Solar Panels (w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: Zik)
2"d floor:
Total square feet: Zsj6
Brief description of scope of project: l
Poo W1# �{ ut'�'Zf d RS � S�a'� a�'tR ate+ � `i4�vJT
/Z11 .5,0no 4 it 4f/IkJS TO �7C padlGd (/oi� If�L G �' / u �DS /S�tO)
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Accessary Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ vj 062• 0
2. Are there any structures not shown on the plot plan? ❑YES iii 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: cVd ®r '7 �►'•
SIGNATURE: _ DATE: G//O ZaZf
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:Name(s): Z6,4,gdCrJ 0i It`L
Mailing Address, C/S/Z: -71f Kog/"Xy �Q� � Q✓ctns�jl/J�/ , /V K, 17 ro
Cell Phone: S-/Y- 7<- DZoS" Land Line: 41114 /
Email: rte4orkz 7C' ,f*tall edwt
Primary Owners :
Name(s): �iL�iAr �k ol Z ',e QrJiZ
Mailing Address, C/S/Z: y$' /j%w ,lOvl 18C1/JJe.&1xA ►1V , A/y, /ZPDG/
Cell Phone:,s-1$1- Land Line:
Email: S1Y-320-ogfZ ( Acit)
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):
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:
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:
Email:
Accessory Strut ure Application Revised January 2021
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised January 2021
I -r, ?�.3L
Deck and Roof Design checklist
d~' Is dXcck freestanding or !ached
Ai Footing
ASono tubes sized for posts 44 8" x6 12"
tile'"` Big foot or footing for roof load
14 Proper attachment to post and footing shown
PPP Proper flashing or waterproofing to structure shown
6 Attachment to structure shown on plans
J&Galvanized or stainless steel bolts shown NO ZINC COATED
Iti 1 Hex headed bolts NO CARRIAGE BOLTS
Diagonal bracing shown for deck over 24"
Floor joists parallel to carrying beams
14Deck post to beam attachment shown
0 Over 30" requires handrail
Over 30" requires guards
Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"