AST-0250-2022 w
Office Use Only
ACCESSORY STRUCTURE Permit#:
TOTVLI ofQue sen bury PERMIT APPLICATION Permit Fee:$ N�
742 Bay Road,Queensbury,NY 12804 Invoice#: 1�T
P:518-761-8256 www.gueensburv.net Flood Zone? Y p Nl Reviewed By:
Project Location: PA014A1'-ra 11rD &1 �(� S .c:2u , ( Y 1 7,
Tax Map ID#: 5 • I O ' Z� 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 ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp
_hed (<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
a V E SQUARE FOOTAGE OF STRUCTURE:
FUE
MAY �� ���� 1st floor:
�1 GF GU ENISBURY
2nd floor:
IT-UiS ` GDCb Total square feet:
Brief description of scope of project:
Accessory Structure Application Revised March 2022
1
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$�jgod,ljC)
2. Are there any structures not shown on the plot plan? ❑ YES ❑ NO 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 122 rriorifh 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 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 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:
SIGNATURE: DATE:
Accessory Structure Application Revised March 2022
1
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: wxi--Oj ,
Name(s): ✓
Mailing Address, C/S/Z: li q MocAnT194vi Cfj , J �A/-
Cell Phone: -57/K-79/.0115' Land Line:
Email:
• Primary Owner(s):
Name(s): Sq �
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): 57�W
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engineer(s):
Business Name:
Cont t Name(s):
Mailing ress, C/S/Z:
Cell Phone: Land Line:
Email
Contact Person for any questio egar ' this project: IN
Cell Phone: Lan e:
Email
Accessory Structure Application Revised March 2022
F
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Double,,Plywood Gussets
Double Top Plates "R —2X4 16"O.C.rafters ��
1/2" -ply CDX�ar 0
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Facia&Drip Edge ctural Shingles
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p jm ! 4 5%8"Exterior Grade Plywood Hinges T1-11 Wood Siding
2X4 P ess eireat d
I -^�' Pressure 5-Plywood Or Raised Panel Or
"15'eUR egul Floor OSB on O �y QSmart`side
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Based on our limited examination,compliance
with our comments shall not be construed as yy c
indicatiiig the plans and specifications are in
i f411•,.c"m Ifan .e'with he Building Codes of ale,
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=: 34
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ff 341/4 341/4 241/2" ZO
341/4" 34114 341 4 341/4" 12'
36112 48„ 48 Z4,
36 1/2'
° 295.10-2-28 AST-0250-2022 `
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