AST-0513-2020 V
Office Use Only
ACCESSORY STRUCTURE
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PERMIT APPLICATION Permit#: AST_. D5�
:lown ofQucensbuq Permit Fee:$�21
742 Bay Road,Queensbury,NY 12804
.P:518-761-8256 'www.gueensburV.net Invoice#: T flJ
Project Location: 25 131y ea j 013 9y15b/•S'AGUti y Al I
Tax Map ID#: zn fz . 3� Subdivision Name:
CONTACT-INFORMATION:
• Applicant:
Name(s): GoaQ;:>
Mailing Address, C/S/Z: s't''' Sc,� eZr„S,uA_-j r h
Cell Phone: ( G I K ) 4 2_0 157 Q::> 1 Land.Line:
Email: Q:V- I-AE VE I'AE\(ja CAcf_VEtC0 MPA A\J \&C,-CA wi
• Primary Owner(s):
Name(s): &cr tAlP_a'a
Mailing Address; C/S/Z: $' SwF�� ,� c�. CPu ,Cr Avg. AV
Cell Phone: (19 i H l Y(; I Land Line:
Email• _
EKheck if all work,will be performed by,homeowner only
• Contractor(s): Workers' Comp documentation must b_e s_ubmitted._with_this--a lication
Contractor Name(s): [„ W e
Contractor Trade: )) 7 �-----�'��
Mailing Address, C/S/Z: AU9 2 8 2i
Cell Phone:�_) Land Lin )
Email:
"Cl\f fiJ Chi �ii= i �i�t�f�Y
**List all additional contractors on the back of
• Arch itect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( � l� ) ','I- q — �' ® I Land Line: � )
Email:.
Contact Person for Building&Code Compliance: arsc-A\C IWA—
Cell Phone: ( ) Land Line:
Email:
Accessory Structure Application Revised February 2019
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
Deck,Open Porch _Solar Panels(w/o rafter upgrades) _Carport _Cell Tower
Shed _Pavilion, Pole Barn,Canopy _Dock _Gazebo
Detached Garage _Boathouse(.with or w/o sundeck) _3-Season Porch
Other(description: )
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 45,0
2"d floor: i /04
Total square feet: L4 :S
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ . —4 7S
2. _If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES Explain:
4.:. Are there any easements on the property? YES NO
DECLARATION:
1-. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
3. 1 certify that the application, plans and supporting materials are a true and 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.
4. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
5. 1 also understand that I/we are required to provide an as-built survey bya licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
have read and agree to the above:
PRINT NAME: FL1 C44 943� A MEZ 'Tl AW EW 4-7
SIGNATURE: DATE:
Accessory Structure Application- Revised February 2019
2-6 S4
Deck and Roof Design checklist
Jnsw,16,�J--� C16�4U&1�
Is deck freestanding or attached
Footing
Sono Sono tubes sized for posts 4x4 8" 6x6 12"
Big foot or footing for roof load
Proper attachment to post and footing shown
c Proper flashing or waterproofing to structure shown—vT r-J41 , e, l qed
( s'Attachment to structure shown on plans Uer� �►^�(�e��F�
Galvanized or stainless steel bolts shown NO ZINC COATED
-E— Hex headed bolts NO CARRIAGE BOLTS
ai Diagonal bracing shown for deck over 24"
Floor joists parallel to carrying beams
Deck post to beam attachment shown
Over 30" requires handrail Y
Over 30" requires guards
Itf Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021
96.18-1-35 AST-0513-2020
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TOWN OF QUEENSBURY Thevene , Richard
BUILDING DEPARTMENT 38 Sweet Rd
Based on our limited examination,compliance_
with our comments shall not be construed as ° Deck
indicating the plans and specifications are in (( 450 S.f.
full compliance with the Building Codes of i
New York State. y--6�_ —
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TOW OF QUEENSBURY
BUILE ING & CODES DEPT.
Revie ed By: -
Date: ?
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