AST-0514-2021 i - -
Office Use Only
ACCESSORY STRUCTURE Permit#: 202-I
Town orQcc,bo;r,- PERMIT APPLICATION Permit Fee: $
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 wvivv.gueensbury.net
Flood Zone? Y Reviewed By:
Project Location: 441 LXWAe Mrn1 RD. UN tr 15
Ihk,C 645626E
J _
Tax Map ID #: a� '��Z , �'j—� Subdivision Name:
77Jc Me UO .
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower L7 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: C o �-
FZ
lst floor: N1+ 00 ,( j
2nd floor: 04 saVY McK GOc
POm r�
0 m
Total square feet: I A4 sarlr 0 W
jj
m in� i591i
Brief description of scope of project:
'(� OVAL OF ExISig 46 sECoN6 LZv DOC4C_ , I&YLAfk WIT4 illIFW.
"0 a f�-I LI N&S PLC 11-16 Ai-TAC tsf 0 P9J A l
�-� SIMA& AS I411.
J\Acce,,ory Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 11,
SCO-eo
2. Are there any structures not shown on the plot plan? OYES IJ NO Explain:
3. Are there any easements on the property? ❑ YES L/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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
i
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:
Accessory Structure Application Revised.January 2021
Y
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): I40R.1tsi2rJ C��2nJE�1_S N�)2S�
Mailing Address, C/S/Z: 3S ATNE-u- P (�Or2�
Q " J
Cell Phone: Land Land Line:
Email: n�P,vlvw t"iltfieeviLo1 d•Cow
Primary Owner(s):
Name(s): 11L&X eQM_crX - 44 � iG C-SG`ZS12 NfY
MailingAddress, C/S/Z:4*1 1,�GC.bQa�- rM'1�1 (�i0 T
Cell Phone:(1()2) Land Line:
Email:
❑ 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): No,&Thsf,� gV I L.Deds
Contractor Trade:
Mailing Address, C/S/Z:93 ATAJ614-VZO loQ►21C-2- 604A('G-tA AN 14V%
Cell Phon : (S(a) �tB-M4 Land Line:
Email: ft Y1GY� Z✓k) (I.COM
"Workers' Comp documentation must be submitted with this application"
• Arch itect(s)/Engineer(s): q [ -L�
Business Name: �✓1C��11�G �IN1� �A �l'`� (
Contact Name(s): 660� �Q
Mailing Address, C/S/Z: 7& WA -7-4 l
Cell Phone: Land Line: Sl
Email:
Contact Person for any questions regarding this project:
Cell Phone: (C DU", bEW" Land Line:
Email: I c0 lq to--&Gl
Accessory Structure Application Revised January 2021
Deck and Roof Design checklist
S Is deck freestanding or attached
S Footing
( S Sono tubes sized for posts 04 8" x "
Big foot or footing for roof load
Proper attachment to post and footing shown
-(� Proper flashing or waterproofing to structure shown
-(/SAttachment 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
*60ver 30" requires guards
0-e—bver 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
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