AST-0710-2021 Office Use Only
ACCESSORY STRUCTURE Permit#: f6TT- O�Q- 2C1rL1
Town ofQuccs,bury PERMIT APPLICATION permit Fee: $
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net
Flood Zone? Y N Reviewed By:
' �-JGyy�� II
Project Location: 44I LUc y-� �1t� fto—f a-P-Ae-(U0y0) Vit..4 I
Lo�ce ems- `� -
N 1
Tax Map ID #:0)5�,SCI l _ l Subdivision Name P 4 11,e Wor�v
PROJECT INFORMATION:
TYPE: 5/ Residential ❑ Commercial, Proposed Use:
STRUCTURE: ��
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport El Cell Tower LV'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:
1st floor: No cww&e O �10�
2"d floor: D 0 V
Total square feet: �l SEP 2 4 2021
TOWN OF QUEENSBURY
BUILDING& CODES
Brief description of scope of project:
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Accessory Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 47r UUa
2, Are there any structures not shown on the plot plan? EYES Ei(NO Explain:
3, Are there any easements on the property? ❑ YES VN 0
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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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. 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:
SIGNATURE: DATE: fi,3/2,Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Nor&Tff1E" IWII.DCas
Mailing Address, C/S/Z: 33A-Tv6tL. -ftkD Ike-TEOCS C64VMS. NY 1246"'91
Cell Phone: (SIS-) 7%o-(cAA Land Line: r4/A
Email: v�dP�tr�tr�@V10y4-&n 614 ADO I
Primary Owner(s):
Name(s): MIG14AeL r21-C#15Z 1 9 f
Mailing Address, C/S/Z: 14( M� � �ft L 6 (�/VLi+ 1
Cell Phone:rNj)(.ws-&3� Land Line: MA-
Email: N(
❑ 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): NIGrLI-FIA 19UIW6?S
Contractor Trade: 13VIL DMJCb91-94C-TaR
Mailing Address, C/S/Z: 3S A W 6tJ:—0"ll �'e C0,2)V1a2S 1VK I SM(
Cell Phone:674W. -(QLA4 Land Line: 0-+
Email:
**Workers' Comp documentation must be submitted with this application**
COT-: Aef—, ON Fc L,6.
• Arch itect(s)/Engi nee r(s):
Business Name: E7464n 650JtJ ,- A-MbticA G'OtPA-NK
Contact Name(s): (I%LoQ6Fc— VA<,5NC1*1L
Mailing Address, C/S/Z: To WA-SHIN6��1 5T. S/-lOOR A SP24A16--%
Cell Phone: NIA Land Line: @(t 57Y7— (340
Email: J�oyc�yas?j�ya�wo.Ccxh
Contact Person for any questions regarding this project: I"Ic4�oLA-S �Orlt b
Cell Phone: (51��1gt� �14 Land Line: MA-
Email: viol ►(tOn rLoyAwA& cb' m
Accessory Structure Application Revised January 2021
Deck and Roof Design checklist
-4�� Is deck freestanding or attached
��� 19
#- fee
/ Footing &X(s4va .��, s
Sono tubes sized for posts 44
Big foot or footing for roof load
'Proper attachment to post and footing shown
Proper flashing or waterproofing to structure shown
cl 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
ever 30" requires handrail
Over 30" requires guards
Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021