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AST-0106-2022 Office Use Only ACCESSORY STRUCTURE Permit#: Pc�-C —©l Olp-2022 Town ofQ n b y PERMIT APPLICATION Permit Fee:$ 2 D — 742 Bay Road,Queensbury,NY 12804 Invoice#: 4 b P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By: Project Location: E)r Tax Map ID#: 307, 1 z. - 3 - Subdivision Name: PROJECT INFORMATION: NT TYPE: Residential ❑ Commercial, Proposed Use: 2022 NSBURy ODES 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: 7 Z O 2"d floor: Total square feet: Brief description of scope of project: ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ l J,ffJj.CG 2. Are there any structures not shown on the plot plan? ❑YES Q NO Explain: 3. Are there any easements on the property? ❑ YES "INO 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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: DAV/V SIGNATURE: DATE: CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant:. Name(s): TC ,,cJ Mailing Address, C/S/Z: /? 2 enc�`�� 4�J2e.�s�ur7 Al Y i2�u y Cell Phone: Sl-k 222 - 5-0 VY Land Line: Email: �/,Ypis4744relAI"g H ifteul-cal" Primary Owneds): Name(s): z- 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): ?�rtc4 �Gncdo Cwh tr y Contractor Trade: fcvs+r�(a�ia, Mailing Address, C%S/Z: /������ �✓l /414/4 A-/b 12020 Cell Phone: Land Line: Email: "Workers' Comp documentation must be submitted with this application" • Architect(s)/Engineer(s): Business Name: Contact Name(s): Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Contact Person for any questions regarding this project: rD.4V 1rj Y#7-11y Cell Phone: 222 -57J J Land Line: Email: I ��r op.P TPOPOSEt Flo• � -j; i , i t CtATI o.1J 1 jl�` CGc THAV¢tJ y- a • � OC _ W V n 3 — + 1 w MAR ? 2022 1 AMUSE o 17-7 1� r ° TOWN OF Q NBBURY ;y�,,,� � K..,• h UB� . BUILDING& ODBS �� ' N $Z' Z `DAV t'D A(ATW; /7 2 rNA•s • io..N .. queEEl N>6�at w A[¢eu cou.,rtY � N..`C—� 1.11uo $yiLdcYo2�5GLCH3 F.Fdu.L,d.Y. �'' f.l'•F.r rc.� �if;y 57'ArE+Y J4c. :�.Ai'•-I,3sbn P.fe �Y�' , /-KJ.e 2n� SET