Loading...
AST-0504-2021 ,T I y Office Use Only ACCESSORY STRUCTURE Permit#: A S ?.oZ PERMIT APPLICATION Town ofQuccnsbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 E 2-11 rr'� f �/] p v ice#: l P:518-761-8256 www.gueensburv.net D lvi L� V F d Zone? Y Reviewed By Aa JUL 01 2021 \ TOWN OF QUEENSBURY Project Location: �►� 0 Woo) � BUILDING&CODES Tax Map ID#: Subdivision Name: PROJECT INFORMATION: TYPE: N� 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 .Shed(<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch F-1 Other: SQUARE FOOTAGE OF STRUCTURE: 1st floor: 2nd floor: Total square feet: Brief description of scope of project: S�,�d i �, b cc ck y p Y� [ �►�n. ,�( r9 mil. } Accessary Structure Application Revised January2021 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 6 000 2. Are there any structures not shown on the plot plan? ❑YES NO Explain: 3. Are there any easements on the property? ❑ YES VN0 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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 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: kev�h O'Le-QL SIGNATURE:�i �I` DATE: to Accessory Structure Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): KCVI'h 0 � gjQ eVV000( Mailing Address, C/S/Z: ��' • Q (,�eei�s h u-c�t d�('� [a `� Cell Phone: Land Line: Email: p Uct vi j k 3a`j @ 9 Met(( .(-dvvx- PrimaryOwner(s): Name(s): cl, J LjAitii k-Y 0 rLLOL a Mailing Address, C/S/Z: I U V— W G( Prjkrar, Q U'u-mh u Cell Phone: 5 1 9-— 3— $ 18 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** • Arch itect(s)/Eneineer(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 January 2021 � I I � I � I � I ( I ® I A1APIVO7jFS I Lands Now or Formerly of I I I I 1. Boundarvinlormationshonn hereon perA•fapRef.1. Christopher J. Patten i I V 2 NortKonentationandbcazmgbaseperhlapRef L `�'� Book 5416 Page 233 I 3. Marren Countytaxparce/266.3-1-735. mvoo' Ch= 266.3-1-73.4 I 4. Thelocationofunderground improvements orencroachments,if 6 62g 6'1'E proposed I any exist,orasshown hereon,are not certified There nlay be B® `� I other underground uN/ities,the existence ofnh;chareunknonn. We ~ !o 1 I Size and location ofall underground utilities must be verified by N I the appropriateauthorides. The UndergroundFacilitlesFrotective n I ( Organization must be notified prior to conducting test boring Proposed �;�ell.�l � excalationandconstruction. WOOD 30 RIDGE ' .k e 46.6 N,N,Ste\ \ Setbac�q"1\ $30\` I 5. This sun ev lvas prepared without the beneCtofan up to date r � N m g Sslo i abstract of title. COURT � S y0' Ogg I 6. Reproduction or copying,ofthis document may be a violation of 3..6 Proposed N, I I copyright laly unless permission of the authorand/or copj eht ( Concrete N I holder is obtained. Foundation 3.6 ( �a 3.6' JS� I 7A copy olth;s document without a properapp/icatian of the 10' 3 0' ( 1, g. .,SPA sumeyar's embossed seal should be assumed to bean unaulhnlized ( 2.5' 6,� copyLands Now or Formerly of ( 1}o, tl o' N,\\ Charles Tilley y `� c ( Proposed AREA=1.02t acres DEED REFERENCE:Book 5292 Page 261 �� M Septic Area CIr ( Lands Now or Formerly of 1. Convejanceto Patten Property Development LLCbvdeedfiled 266.3-1-73.6 p ( O Af in the Warren County Clerks Office on June 26,2015in Book awes & Elizabeth Carter 5207nfDeedsatpageM7. °l ( N Book 623 Page 947 © o ( o N 266.4-1-1 AMPREFERENCE.• N p L hlapentitled"RIDGEWOODKOMa RIDGE ROAD \� ) SUBO1WS10AF preparedbvVanDusenandStevesLand (+j I Surveyors,dated May 5,2005,last re+dsed July 11,2005,filed in the Warren County Clerks Office on Apr#5,2007as neap number C-5. ZC-j �' L- ----------IS'Setback--------- J ® �. cvs— +l11A1�� N840 48'00"W ® 0 q Lands Now or Formerly of 237.27 M'`n" D DATE RE\nsau RECORD/ofscnlPTM DPJFMR , „A Map ofa Proposed Flo tP1. O--� John & Rosann Curran v"a•n%......ro�e ,f .� 7— o m» Patten Property Development O m ,tlY'Rn1I:vK.1tn 7a1V,VOFQUEEA5BW7!• 11'ANHd�\'Lt I+L—IL—.11. Book 1315 Page 134 nc Irre'ee ecv N Barra h Land surveying,PLLC 266.3-1-74 aacxur KIM ® oral.va Ma3i6rA'orlh5hFhI nomGts),7R17692 r l ilrk 7253. YME SVNE7 IUPS COPES OP 1"[MRVElOn SC:tf�':I•�/! OPfbr D.17F.:4%n/dlli