AST-0592-2022 KNOWN
Office Use Only
ACCESSORY STRUCTURE Permit#: 1�\-8`�12 - 202-2—
Town ofQuee b ry PERMIT APPLICATION Permit Fee: $
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net Flood Zone? Y DN Reviewed 134kfl
Project Location: '135 �J� �'�`�" `` N ��acQ c3kee-t1SbK"r
Tax Map ID#: �q J a l�j_ - o�Lf Subdivision Name:
PROJECT INFORMATION:
TYPE: A 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 ❑ Other:
DE C E 0 W SQUARE FOOTAGE OF STRUCTURE:
SEP 2 2 2022 1st floor: OLA C
TOWN OF QUEENSBURY 2"floor: /A
BUILDING&CODES Total square feet: -'241) 0),T;off
Brief description of scope of project: S�-e— klo<Goa
Accessory Structure Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ I j �.•�� iMW emu°k
2. Are there any structures not shown on the plot plan? ❑ YES ❑x NO Explain:
3. Are there any easements on the property? ❑ YES 5rNO
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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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. 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: 3O Sc!U�/Q
SIGNATURE: "'ADATE: C 122 111
Accessory Structure Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 0 C(LiVD
Mailing Address, C/S/Z: 1WI Assemy Lav a$LfS
Cell Phone: '1M— Land Line:
Email:
Primary Owner(s):
Name(s): Sane Cw Wy1�ap&4-
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):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
"Workers' Comp documentation must be submitted with this application"
• Arch itect(s)/Engi nee r(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 June 2022
This is for a shed purchased at Garden Time that would be delivered
wholly constructed. There would be no construction of this shed on
the property. Garden Time would deliver the shed and do the site
work needed with delivery. The shed is 12 feet wide by 20 feet in
length (240 square feet). It will be located 25 feet from the side
property line (location of shed shown on the survey map. It exceeds
well beyond 30 feet from the front or rear of the property.
Sales Location:WLT 111
TIME ) Name:Joe Scr vo
652 Quaker Road 1467 Route 9 25 Gordon Lane Address:935 West Mountain Road
Queensbury,NY Clifton hark,NY Wilton,NY City:Queensbury zip: 12804
p:(518)793-8555 p:(518)793-8555 p:(518)793.8555
f:(518)7934551 f:(518)9824425 f:(518)8714700 Home Phone:
Cell Phone:518-222-4786
Salesperson:Tim/Rob Source:Phone Work Phone:
Acct#: Invoice#: Load#: E-Mail-
Vendor:Classic Stock#:2210035 Location:CP ■ IN-STOCK 0 ORDER
Buildin e 1 .
i g Typ . Shed �I i Options: Base Price:
i Size: 12x20 I
i Series: Classic —Ell Additional 3' Door with Transom Winndow [
Color: Alabaster
Tnm• White
Stain:
Total Price
�
_ _ i�
E_ 9-
Shingles:Black
Metal-Roof: SEP 2 2- 2022 ; -
Windows: t
. Size: 24x36 4 TOWN OF-OUEENSBURY--
- _BUILDING la CODES -
-s----------
Color: .White
Shutters: - -
Color: (Sale Price - j
Style: -Select One- Fuel Surcharge _ _ _ j _ _
Flower Boxes: Building Sub Total:
Color: Building Layout: Mule:i na i
— -- ;
i Ramp Size.• 5'x4'
Notes: Additional Delive 5/mile:i na i
(Select One) Site Prep: _
l Driver's Notes: -- j Additional Site Prep .
Sched.Delivery: __—
Delivery Person: - j Additional Site Prep Costs,if any,to be
Time In: Time Out: — ( Determined after site visit. 1
Permits are the responsibility of the customer as required.
By checking this box,I allow Garden Time to photograph our installed building for advertising purposes.
Garden Time will not be held liable for any property damage incurred during the delivery process(le.Septics,ruts,plants,shrubs,driveways,
lawn,etc.)Site must be prepared and accessible at time of delivery.One half of an hour of on-site time is included,$55 per man per hour is
calculated therafter.Special orders are subject to a 25%restocking fee.Full payment is due on or before delivery.
Customer Signature: Received:
www.GardenT!meinc.com
a
uap P9IereMrs:
8
Pr9pasaJ SVMtvision uatl9 I9r ----- ���'""
flq�ytl P.a: A,.-Parrrtap D L C
PnvlseJ:Ja ry�s
fuel o,L,a�nn iwrren ccanry clerx�s Brncr
./ulY 16,,99J
By:�van Cvsen 8 Stovns
uap of a BpuMrY survey
aPy, rq SEP 12 2022
JosnpM1 a F.lena scr.lvo
uatntl:feEruary o I5 )01q i
By:6�rraM1 LaM Surv9ylnq•PLLC
CenNa� p!
arant.ro
TOWN
OI`
y9.5,311)
�- QUEENSBURY
BUILDINQ,%coDgo Y
erM1e�,;°;;A
I � 5 55-oB�B � � Ij"i'1161I.iiE€'•
�^`�, v il.o.-«a z9s.,J.,.J. — _- ae..o�ga•i b /" N N jl e;'IeS°�i��'�
�'. Prt'f• (,�,"�.�`- I ———— ——— zzBy. m rl,�tl rla.nl.
01
Praoea, i O
,shed, -25-F� -from_
p� ime=
9.{s pxr p 7 61r.•
' .a.Pn6r.,�,Jrre,naPp"„P,�atW ,n rnr / P q — -T
„ear Y<�rtM1 8 a.� H a z
+r wncnrssaaECJ,oaxrrasuaEPrscrxscpxp �.638 P:J62
4-J A
�
apJa aY 1 rl n O ro
rovMs�rtu�;rmx�� Fr,mar ry Anrro uarriMsln
arorrs6raxnt urvoawvs.wes a g8:1f55 P:B , S '
17 9 1
9Px...P.Pr �
I n u Ln a)
' NVfOMiV�j
a.,rL,�P�,q_.P.•a�pP�a<op.p�xe,pa s—i
DBB6,