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AST-0237-2021 j. w rh Office Use Only ACCESSORY STRUCTURE Permit#: PERMIT APPLICATION �J�•-. 7f 7��-� �Q2�,. Town ofQucensbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Invoice#: Project Location: CnS V ut Mi Roo a Tax Map ID#: 23 0 2-0(5.I3 1— 29 Subdivision Name: CONTACT INFORMATION: • Applicants Name(s): ?A—1 R 1 CK Mailing Address, C/S/Z: CAr15 Wt✓S i M+. ` Whp Cell Phone:( SAO ) '1Q 5 Land Line: (.5 16 ) '1 2 01 ►-1- Email• RC)VAS Primary Owner(s): Name(g,): JL1�,k C,K M. Oh UN Mailing.Addressj C/.S/Z: C(I5 Kk- TQA P Cell Phone: ( I )_ _qqC - '7O 13 Land Line: ( 6(13 Q S-_'2_014 Email: �10N5- 0`Check if all work will be performed by homeowner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(-s): -RA-ef, S�q TNC1 Contract or Trade: (L. IN LF- E) (W00 Mailing Address, C/S/Z: DEMU, .C D 80210 Cell Phone: Land Line: 860 ) (A'7 02 :S1 Email: "List all additional contractors on the back of this form • .Arch itect(s)/Eneineer(s): Business Name: Contact.Name(s): Mailing Address, C/S/Z: Cell'.Phone:_�) Land Line: Email:. Contact Person for Building&Code Compliance: `PA b CZ1 C1, Mp W�A ALE tA CeR Phone: I '-lq(o� "1013 Land Line: Email: Nogz 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 / V 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: lDO 2"d floor: Total square feet: ADDITIONALMOJECT INFORMATION: 1. Estimated Cost of Construction:$ (6.©g© 2. If Commercial-project,what is the proposed use: 3. Are there any structures not shown on the plot plan? YES N� 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 by a 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: oW L�Z W SIGNATURE: - Wh DATE: S 2 { Accessory Structure Application Revised February 2019 IN TB-700 SHED 10` 10 16` R '+,�df bF� X Lai T�;2�,°�..�t`tC� ...�, . �t*nc:�'w's.PST tl ukra�e*r�.tis.�: sfi.�§•,r4.a?`ea�:w.� •.m. • •aa:rTM'as !.travystt uavrtwSUNDANCE SERIES tltt&E•A«.L"'E F%4 ..M TF'SS .AuD 6G • Tl=ls::t>,z�• ,s :}ii'F,A'ta;.tCCC} _,.,.•...._,.:.,.,,,;,,,.- V +. s+1 el.�runs as:c+at n ra 2aT� <C RA kt):rkrs 12 .cis9 FC+ri S2i°f+L!iAi.(OFT - Ii 45J"(TJI:f�Spii.4 TYY4.TtE, 7.4*mrI?L't•r:r.3'i6CA 2, DEr *w.ii r.keSTEU. sr kii...tG75T5�'j 2R•GL' W9!.' �+c GCC'sizrYtt4a„ittf?.S;'tT_. 1^CttSr«. ?l•0-c WAD AD FaFf.�:"�i.3f lx'u"E .(§Sts5t37-0i97 ti. ) ° •3E'Ik.S.�`?.'.s:',I t3+iY:T7i;:'i,i.'i.Fa CIA., . 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N D E C E H . 295._►_8.I TOWN OF QUEENSBURY BUtLD(NG DEPARTMENT ��� � ���" Based on our limited�examination,compliance comments shall with our l not be construed as indicating the plans and s ' peclfications.are in ' TOWN OF.CQU�iENSBURY full compliance with,tfie Building Codes of UIL®9NG- 6CO€7ES New York state,. $ 86 u' 57" E 27. 13' IPF. I tiara e " _ S 86051,S 71114 �f osed 5�r _x. �S 03.°.04'.03",, W -+r 50..0b,' IPF 0 • Storie Waff' .. � � Stone Wall IPF IPF S 86°51 1.5711 E TOWN.OF QUEENSBURY BUILDING & CODES DEFT& 98: 7 ReliieWG' By. 1�+ S — Garage Mod Frame ' - Brtco <yy°. .. Arte-Story 295.13-127 AST-0237-2021 noo9e Whalen, Patrick 975 West Mwo ountain Rd '�?_ rf41 Shed 160 s.f. Pcx�r9t Area y ° 185105..Ot SSq.' Feet . ; 5t 4 2 Acres 4 ' E 3 y `:, : ' �•" m