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ACCESSORY STRUCTURE Permit#: HST G���
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PERMIT APPLICATION
Town ofQueensbury Permit Fee:$_ O
742 Bay Road,Queensbury,NY 12804 D E Y� � nvoice#: ``� 7
P:518-761-8256 www. ueensbur .n11
Flood Zone? Y N Reviewed By: �V\�
PAW 10 2021
TOWN OF QIEENSBURY
BUILD i.IG& C:ODES �g
Project Location:
Tax Map ID#: Subdivision Name:
PROJECT INFORMATION:
TYPE: N Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp
Shed(<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2nd floor:
Total square feet: I Ct
Brief description of scope of project:
Accessory Structure Application Revised January 2021
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ / 3—�
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 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 priorto issuance of acertificate of occupancy.
I have read and agree to the above:
PRINT NAME: C/1 �
SIGNATUR DATE:
Accessory Structure Application Revised January 2021
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Mailing Address, C/S/Z:
3 ���a e) L 0, W u��e�s��y rv� 1 -4 S'O`�
Cell Phone: Cp)-�f-77a-b8E9 Land Line:
Email: r-1c3i" CQw-
Primary Owner(s):
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Mailing Address, C/S/Z: P3 ZcaU`e.' �.�. + � 1`S ,P,31CS'4
Cell Phone: f0);%-•77,,p- Land Line:
Email: 6M1r &ntsmjeA7a A0y'AQ,0 •
❑ 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): -f:a4e)S A))';' • 5)1 -
Contractor Trade:
Mailing Address, C/S/Z: ) a q M,n ;e 3�.nyi-e A A-A.
Cell Phone: S),S• L?(B 9 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: G)5 775? --G9,R cj Land Line:
Email: i�&gSSmA?-o7a Agri^G�,I C,®rti
Accessory Structure Application Revised January 2021
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Datchee p i
60 Standard Featured: /)
4�a_
6'6"rose Walls(6 3"inside wall heights)
s - Double German Doors '���f
4, 2-18"x27"or 24"x27"Window
.,•;.:;.�. =J.�s:-� q° 0.Louvered Shutters A '
-I� Metal Corners
1 0'x 1 6' DUTCH 0'x 1 2' MINI-BARN — Mini'-Barad:
Shown with optional end vents ' WALLS __-
Clay• Green Trim A cado • Almond Trim.-,rS ke
=.i< 1 -18"x27"or 24"x27"
� �- � Window with no Shutters
Weatherwood Roof
-1= 4`Side Walls(3'9"inside wall heights)
4, 5'Side Walls(4'9"inside wall heights)
i= 6'Side Walls(5'9"Inside wall heights
10' 14' MINI-BARN — 6' WALLS
Sho nwithoptionalpicturewirulo oaUEENSBURY
ffee• Beige Trim• Shakewoo Ro CODES DEPT,
Reviewed By.
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14'x24' DUTCH GARAGE 12'x24' DUTCH GARAGE — VINYL -
Shown with optional end vents,and 1x3 window trim instead of shutters Shown with optional diamond doorplate,larger windows, German - �-
Lite Gray• White Trim • Fox Hollow Roof shutters,Miratec flower boxes, &double doors instead of single door
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