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AST-0146-2022 ft" o Office Use Only ACCESSORY STRUCTURE Permit#: A, ' � ,� � ' 2©22- PERMIT APPLICATION Town ofQuccnsbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.gueensburV.net Flood Zone? Y Reviewed B ,�4? Project Location: k--L-oz Tax Map ID#: %3D .G— Subdivision Name: PROJECT INFORMATION: TYPE: /Residential ❑ Commercial, Proposed Use: STRUCTURE: ❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower Zeck ❑ 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: zsb 2nd floor: Total square feet: /� 1 Brief description of scope of project: �� ��� �\n N W'SC'.-r Co Accessory Structure Application Revised March 2022 i ADDITIONAL PROJECT INFORMATION: 1. EstiMPW tes •M 6 2. Are there any structures not shown on the plot plan? ❑ YES IJ NO Explain: easements on theproperty? ❑ YES LJ NO 3. Are there any eas 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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 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 Aabov �R �D DATE: Accessory Structure Application Revised March 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): ucsD ot�Csl?\ Mailing Address, C/S/Z: `-L- �� C_c_J P .�r,�p'� Land Line: Email: ' - Primary Owner(s): Name(s): v/ f�tA Mailing Address, C/S/Z: Cell Phone: 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): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email "Workers' Comp documentation must be submitted with this application" • Architect(s)/Engineer(s): Business Name: t\.3� Contact Name(s): Mailing Address, C/S/Z: Cell Phone: Land Line: Email Contact Person for any questions regarding this project: CeG1> sta�e '�� ,• 'c�` Land Li e• Email_ T _ Accessory Structure Application Revised March 2022 AMERICAN PROJECT NAME WOOD COUNCIL www.awc.org DATE PAGE# info@awc.org —----------- _7 i- J- 3 LJ-- j F,QUEENSBU ---8UlLblNGiDL ------ S.-�ecj-611-6u�liftfed�e,,,,,a�nifj@tior!;-qoMpliahce hot-be-conslru6d5. cl ica ions-are-m-, -indfa:i --fhe-plahs---,,:d fl 17, IN des—of "tale • 0 F-Qu - �-rjllj ILDIN g Ri§Vi6Aled- /iv -j- 1-7 • 7- ---------- J- J-- F • - 7-1 7—Z V;T ---- --- C2-n4� j -j- IV- 7. T -14-1 J-2- X, ;S. 1 t*9 7 r--_ • J