AST-0573-2021 Office Use Only
ACCESSORY STRUCTURE Permit#: �� 0 5 20 Z)
Town otCZ�b PERMIT APPLICATION permit Fee:$
742 Bay Road,Queensbury,NY.12804 Invoice#: 9 C\ '5
P:518-761-8256 www.aueensbury.net
Flood Zone? Y N Reviewed By:
Project location:
Tax Map ID#: Subdivision Name: 16
PROJECT INFORMATION: S�c?AP�JS �Pd
TYPE: Residential ❑ Commercial, Proposed Use: (eve Pp
y °
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower Deck
❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑.Ramp
••a.
❑ Shed(<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: S 1 61
` 2nd floor:
Total square feet:
Brief description of scope of project: + DLC
//y%amLc >,av AUG 02 2021
TOWN OF
URyILDING COD
/�a'Z'?, s sT
Accessory Structure Application Revised January 2021
4
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$A q 010. b b
2. Are there any structures not shown on the plot plan? DYES ONO Explain:
3. Are there any easements on the property? ❑ YES O-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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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: Sh;ekey
SIGNATURE: '-e, DATE: t7 oZ p d-60-1
Accessory Structure Application Revised January 2021
r
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): / Fa.J ,`ds4, Roe..l� &Ue'CwS61J Ky• lZBo`f
Mailing Address, C/S//Z: o76 st)2'OLT
Cell Phone:(,.,rj?) $JZ- BqZ? Land Line: I4/A
Email: wofte
Primary Owner(s):
Name(s): Sh;J-le� ro.O e b4 bash Ro41, veevsbvr�, lv'
Mailing Address, C/S/Z: a y
Cell Phones(%) $/2- 8q 77 Land Line: i\//A
Email: q/dgp
❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contractor Name(s): 5h-i e� �kc-b-W—
Contractor Trade:
Mailing Address, C/S/Z: a6. 0"k Ao&I , Qoeem by RY, ri(�, /9-s ioq
Cell Phone:�5($ S1 Z.S LJ7 7 Land Line:
Email:
*Workers' Comp documentation must be submitted-with this application"
• Arch itect(s)/Eneineer(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 Structure Application Revised January 2021
Deck Design h kli
and Roof c ec st
"6 Is deck freestanding or attached
Ct Footing
n�I J Sono tubes sized for posts 4x4 8" 6x6 12"
/_ Big foot or footing for roof load
Proper attachment to post and footing shown
P/& Proper flashing or waterproofing to structure shown
A4kAttachment to structure shown on plans
It'-_ Galvanized or stainless steel bolts shown NO ZINC COATED
Hex headed bolts NO CARRIAGE BOLTS
-r.rk Diagonal bracing shown for deck over 24"
Floor joists parallel to carrying beams
V:�_)Deck post to beam attachment shown
<_I Over 30" requires handrail
Over 30" requires guards
4/SOver 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
I
AST-0573-2021 [�� ((� E 0 V E.
309.5-11..1 D
Faulhaber, Shirley 021
26 Sugarbush Rd 1.28 s.f. FILE
_AUG .02 Copy
Deck TOWN OF QUEENSBURY
BUILDING&GODES _
TOWN OF QUEENSBURY
. . .�._ ---__.:.. . - .... .BUILDIAIGA.CODES DEPT... �
Reviewed y: �
L e.
-
:I Dat Z.
F
SBUNT
.TOWN OF Ql1EEN
_..._. � BUILDlNGD8pAR7ME -
,� !. ased on our limited examination,'com Hance-
yam, S vim- �. �-�.!. _..___. h.our-comments shall not be'conMrued as
�„ n icatin the plans and specifications:are in,.B
�;,,� d //�,� 's? .f� �•� .USPi� �. k:. . . ; ._ full complianc with- the - wilding Cotles bf New;York.State.
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