AST-0123-2023 Office Use Only
ACCESSORY STRUCTURE Permit#:
Town ofQueensbury PERMIT APPLICATION permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: 1 j
P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed B '.
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Project Location: � �'
Tax Map ID#: 4 �'—G 1 Subdivision Na
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PROJECT INFORMATION:
MAR 2 4 2023
TYPE: � Residential ❑ ,Commercial, Proposed Use:
TOWN pF QUBENSBURY
BUILDING&CODES
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:
211 floor:
Total square feet:
Brief description of scope ofproject; ® 4 NuVp' I P'J-
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Accessory Structure Application Revised November 2022
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 1
2. Are there any structures not shown on the plot plan? ❑ YES NO Explain:
3. Are there any easements on the property? ❑ YES N(N0
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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 atrue 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: �'J DATE:
Accessory Structure Application Revised November 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant.-
Name(s): AMV.
Mailing Address, C/S/Z: _ -e 111� .Z / q
Cell Phone: ! q 67( Land Line: Z
Email: k(ov auk
• Primary Owner(s):
Name(s):
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 November 2022
40
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BU!LCING DEPARTMENT
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301.14-1-27 AST-0123-2023
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75 Peggy Ann Rd r,
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160 s.f.
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' PRESCRIPTIVE RESIDENTIAL WOOD DECK CONSTRUCTION GUIDE
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March 24,2023 D 2� fly1:564
0 15 30 60 ft
MAR 2 4 023 0 5 10 20 m
TOWN O QUEENSPURY
BUILDING dQeS
NYS ITS GIS Program Office,Westchester County GIS
Map Produced by Oueensbury GIS. Map is for General Reference Purposes Only