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AST-0345-2023 /lam` Office Use Only �J ACCESSORY STRUCTURE Permit#: �GT- 025-ic�,- 20 Z-:�) PERMIT APPLICATION Town ofQue� Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 Invoice#: 6 ZZ,j P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By:�� Project Location: /� U Tax Map ID#: � 1 • �� i� . Subdivision Name: PROJECT INFORMATION: TYPE: 9<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: P U P—ak 2nd floor: Total square feet: Brief description of scope of project: TOWN FLOWGID.- BUILDING & CODES Accessory Structure Application Revised June 2022 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.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 prior to issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: SIGNATURE: DATE: 4/1 Accessory Structure Application Revised June 2022 1 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: 1 Name(s): 0,J 3's Lt�1 Mailing Address, C/S/Z: D O o V-eA f 0[1 tQ N Cell Phone: t Land Line: Email: ' , / 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** • 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: \-AC'O"VT\ Cell Phone: Land Line: Email: Accessory Structure Application Revised June 2022 Q 16 2023__ QVt CpS0 pRY Ntet�`i post K Ppo So �6 0,( 13420 Older $Z®1 �e job �} 1G a n A2 �NS������ _ .�"`.�+� •ter.�_' f.� �,zt s� � posh 4s1 t lb 19 1400 . U©° 21 Q a 0 v� ` 7 23 b 25' 7 2E+ 8 Z? 9 2$ iQ 29 11 3d i2 14 (4)2x8*FL LASH* N C) r) X zap rt; ! Soo M ra r � 1 0 r• c I c > r' A z 0, m a - (4; 2x8*FLUSH' O W 4 m Uri N 00 W _ 0 x M CD LO co CD- cat > 0 m (-4 2x8*FLUSHQD s Z ;a;u x cc 3>�> >Lo(n ' t 00 _ C -_ , p � N c cnQ> M-p� � -U 0 > X C) C cn � c rV)Nj 0� m M ml cLt) ram' Z .p (4)2x8*FLUSH`d` t,i > m 0 t > INJ 11 < X -�u)K0--n m Xr� % C7 -i � c C 0 1 M � Q e 7 0) (A co ���.pry•.�� rri c 777� > tiC7 z ` (4) x8*FLUSH* c lM •- 0uM > m c��' X VI+�l 0 f 3 SEASON RESIDENCE DATE FEB 3 21 9 NUTLY LANE;LAKE GEORGE NY SHEET OF GONE aY: DECK DESIGN OWNER GRINER RK DeRaven DesNn. &. Drafting (� DAVID �..+D J, HOPPER ARCHITECT CON RACTOR d SCALE: 333 Kingsley Rd,Burrit bills NY FILE ## FEB4GR1 /q,, �, 518*478*0630 GRINER C 0 CD 0 Z (D Z a C. 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