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AST-0363-2022 Office Use Only ACCESSORY STRUCTURE Permit#: Ate\ " O 2©22 PERMIT APPLICATION Town ofQ Permit Fee: $ 6C-D' 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.gueensbury.net r Flood Zone? Y Reviewed By: r! /4 Project Location: 1 (D 0E P..'R R� V Tax Map ID#: C) ZD Subdivision Name: IP-1go&D \�D.0AF— \\\\— PROJECT INFORMATION: D EC E Q V g TYPE: Residential ❑ Commercial, Proposed Use: JUN 10 2022 'OWN OF QUEENSBURY STRUCTURE: BUILDING&CODES ❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ 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: ZZO` F 2nd floor: Total square feet: Brief description of scope of project: YL ZO AE Accessory Structure Application Revised March 2022 i ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ Q 2. Are there any structures not shown on the plot plan? M YES 540 Explain: 'T-o (3� (Z� ti ocJC 3. Are there any easements on the property? ❑ YES NO iJV_:vJ lbAIEV 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3. If the work 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 a true 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 1/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: � F r SIGNATURE: DATE: J1— Z�- Accessory Structure Application Revised March 2022 f CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): -ZE�HiJ Mailing Address, C/S/Z: \ QQ �-\F-Vw-D Cell Phone: or\Qj-`ITV ICAL� Land Line: Email: � cJif-N Primary Owner(s): Name(s): 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): -Vw m-- (Tkt-\) Contractor Trade: ���® � tj V-6 Mailing Address, C/S/Z: 7-5 Go4SDC�J Cell Phone: Land Line: Email **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(s): Business Name: Contact Name(s): Mailing Address, C%S/Z: Cell Phone: Land Line: Email Contact Person for any questions regarding this project: '�� � C?e)P1\1F-0 Cell Phone: and Line: Email _1�►o�j�l�tl��� C1t� _ C 7(� V Accessory Structure Application Revised March 2022