AST-0157-2022 Office Use Only
ACCESSORY STRUCTURE Permit#: ��-• 1��— ?�22
Toj,,,,ofQeq„56uq PERMIT APPLICATION permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net Flood Zone? Y 6 Reviewed By:
Project Location: 1Qe_-e-6SbU4ZW ;V
Tax Map ID#: 301 e7 Subdivision Name:
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo X-1p,
avilion ❑ Pole Barn ❑ Porch ❑ Ramp
❑ Shed (<300 s.f.) ❑ Solar Panels (w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: a,-
2
"d floor: �� �APR 0� n"�
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Total square feet. _
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Brief description of scope of project: 11 S uC`1� 3.flC_K YAP16 PAV) L/otq ' r �� )4 /
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-Accessory Structure Application Revised March 2022
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 41 8 oo' O Z)
2. Are there any structures not shown on the plot plan? ❑ YES fV0 Explain:
3. Are there any easements on the property? ❑ YES &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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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:
SIGNATU DATE: Z�
Accessory Structure Application Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 'D f i ���5 A Ao-U_ • . QUE70N_5'Rik" AV
Mailing Address, C/S/Z: (Le
Cell Phone:65'1 b) �7zl - 7 SL 9 Land Line: C5100-70!Z-ZS-6 0
Email: PC.O f McAe—RA 04 (0 YQW I 6100'N
• Primary Owner(s):
Name(s): 7Av 10 `'57-a�11 �ER��1.� � G1�,>v�,�u-s l��-,-f l�'I{ ( 2?�b
Mailing Address, C/S/Z: ,� �� � �� _
Cell Phone: 5(1 -32-1 -773417 Land Line: `j�� '��'2 .-2"SC-r'
Email:L f S t3q CcG 1)0. Cow
[B/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"
• Arch itect(sVEngineer(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 March 2022
Deck and Roof, Design checklist
Is deck f g or attached
G- Footing _
Sono tubes sized for posts 4x4 �&612
Big foot or footing for roof load
t� Proper attachment to post and footing shown
Proper flashing or waterproofing to structure shown
i` )V Attachment to structure shown on plans
tti / alva,nize or stainless steel bolts shown NO ZINC COATED
Hex headed bolts NO CARRIAGE BOLTS
iagonal bracin hown for deck over 24"---(
Floor joists parallel to carrying beams
Deck post to beam attachment shown
Over 30" requires handrail
Over 30" requires guards
/1R Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021
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TOWN OF QUEENSBURY
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COD. BUILDiNG & C P 1 .
13UILDING Reviewed.Bv,.
Date: AAI�A212--
UEENSBURY
BUILDING DEPARTMENT 7n.ro 0
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
With the Building-jdes--ofL-----
`—New York Statq.
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