RC-0437-2022 Office Use Only
ACCESSORY STRUCTURE. Permit#: 2Z 22—
To�Queer PERMIT APPLICATION permit Fee:$ '22tr
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net Flood Zone? Y eviewed By:
ell
Project Location: e101 t2 FroY
Tax Map ID#: ��• t 2- ' L' 3 Subdivision Name: F T— F � '
17 c
PROJECT INFORMATION: JUL' 13 2®Z29
TYPE: E\Residential ❑ Commercial, Proposed Use: T0V►/N O ► =?, r% ,
L—!� ILDlNG& GOOFS
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn R Porch ❑ Ramp
❑ Shed (<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: �Of
2nd floor: ZIIP�
Total square feet:
Brief description of scope of project: A Ve- 2 /`S� C 0 L,'&il
Accessory Structure Application Revised March 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$
2. Are there any structures not shown on the plot plan? ❑ YES RL 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 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 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:
SIGNATURE: DATE:
Accessory Structure Application Revised March 2022
i
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, /S/Z: -IY6 � [.eH ��= veei^3�✓v�`
Cell Phone: Land Line: /yam
Email: 9 C �Se
• Primary Owner(s):
MailingAddres�c/S/Z: 46 A m
Cell Phone: / --2e�j — �0�� Land Line: In
Email: CI�le%�6-1?
❑ 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): �iysy �t�.y►!c
Contractor Trade:
Mailing Address, C/S/Z: 30,2- /l IRV,
Cell Phone: (,<i 5 Land Line:
Email � �►.�,��r�� ,,.,G,f Cop-►
"Workers' Con4i documentation must be submitted with this application"
• Architects En ineer s :
Business Name: VCvef
Contact Name(s):Pq�
Mailing Address, C/S/Z:/57-DT 04, //s y�
Cell Phone: J/4 Land Line: 57/8'— 748-1/697
Email
Contact Person for any questions regarding this project: �j ( ov�esG
Cell Phone: S(g— Ara —2e;Ls - Land Line:
Email C,4cireseCZ—) L-.
Accessory Structure Application Revised March 2022
0437-
2022
VLC--
3ess
'Greg
pese, os
ClAs ov
Aro n�e�'
ltoCo
deck E C E 0 V E
JUL 13 2022
TOWN OF QUEENSBURY C.
BUILDING&CODES
0
q�x
V�filo-
POO
FORM 0OTeq
301.12-1-30 RC-0437-2022
Chanese, Greg &Jess
46 Helen Dr
Convert deck to screened porch 108 s.f. RA�rDT .r.� �
1 v v l Vl N
TO:
TOWN,01:
BUlLDIN & C tjRy
8
I�0
CN
------------
FILE COPY '
1
w
f
FOAM 418 oozes