AST-0221-2022 h
Office Use Only
ACCESSORY STRUCTURE Permit#:
Town of0geeml5my MIT APP 'I uATW Permit Fee:$ .00
742 Bay Road,Queensbury,NY 128n Invoice#:
� APR 2 8 2027
P:518-761-8256 www. ueensbu t Flood Zone? Y /Reviewec!By-
TOWN OF QUEENSBURY
BUILDING & CODES
Project Location: 33 Holly Lane, Lake George, NY 12845
Tax Map ID#: 239.12-2-37 Subdivision Name:
PROJECT INFORMATION:
TYPE: 2 Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage(>300 s.f.) ❑ Dock ❑ Gazebo 2 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: 361
2nd floor:
Total square feet: 361
Brief description of scope of project: 19'x 19' Prefabricated Pavillion. Replacing old camp previously removed.
O vv-
Accessory Structure Application Revised March 2022
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 30000
2. Are there any structures not shown on the plot plan? ❑ YES 2 NO Explain:
3. Are there any easements on the property? ❑ YES 2 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 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: ��--lf �� .� DATE: � p'"
Accessory Structure Application Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Brian and Meredith Hogan
Mailing Address, C/S/Z: 34 Holly Ln., Lake George, NY 12845
Cell Phone: 518-424-7872 Land Line: 518 656-3504
Email: brian.hogan34@gmail.com
• Primary Owner(s):
Name(s): Same as applicant
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): Doug McCall Construction
Contractor Trade: General Contractor
Mailing Address, C/S/Z: 1485 County Rte 29, North Creek NY 12853
Cell Phone: (518) 744-1495 Land Line: (518) 251-3619
Email mccall.k@frontiernet.net
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engineer(s): ..v--1,
Business Name: NA
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
Contact Person for any questions regarding this project:
Cell Phone: 518-424-7872 Land Line: 518 656-3504
Email Brian.H34@icloud.com
Accessory Structure Application Revised March 2022
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