AST-0206-2023 ` Office Use Only
f�S I-0 Zo b ZOZ3
ACCESSORY STRUCTURE Permit#:. '
TownofcZ�b ry PERMIT APPLICATION permit Fee:$ g5
742 Bay Road,Queensbury,NY 12804 Invoice#: �p0
P:518-761-8256 www.gueensbury.net
Flood Zone? Y'-� Reviewed By.
Project Location: /S /e ec/en ne-
Tax Map ID#:
�12-1 -'2=� Subdivision Name: RM
PROJECT INFORMATION: �, Dnn
TYPE: L� Residential ElCommercial, Proposed Use: Y:�
MAY 0 2 2023UU
STRUCTURE: TOWty OF UEENSBURY
BUILDING & CODES
❑ Boathouse (with or'w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage (>300 s.f.) ❑ Dock [R 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: 9 9 2
211 floor:
Total square feet: I "
Brief description of scope of project: 5f-e c--fi iq Stitt- 6now k- CCAIW 6,17,e b.
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Accessory Structure Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ _-3Do O.O L7
2. Are there any structures not shown on the plot plan? ❑ YES VNO Explain:
3. Are there any easements on the property? ❑ YES L/ 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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: QS
SIGNATURE: DATE: 40-3
Accessory Structure Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: ,
Name(s): ,d yd- C,,sli
Mailing Address, C/S/Z: 115 LOoeaem I—ov%k , �L Y 12&0
Cell Phone: 23Z•Z'7 I \ Land Line: h(A
Email: I @ 1Vgca► l .C611f\
Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
C�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)/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: Wt 4ay d RS0,40
Cell Phone: Land Line:
Email: 1(-(r65A--Ei
Accessory Structure Application Revised June 2022
F E r�
'S MANUAL -ANCHORING_-LAYOUT
OWNER ., �- 65ll- li r 6RY
TOv��tftl� fic:�.� f,s,v
t U.._DttNG_�:i
14'-10 1116"
[4.5m]
14'-41/16"
[4.4m]
13'-10 1116"
[4.2m]
TOWN OF QUEENSBURY FILE COPY '
1300ING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of ,
New York State.
CDrEl TOWN OF QUEENSBURY
BUILDING & CODES PT4,.,N �� 0.�4
Revtewgd B _. �- ���
Date Z'
FOOD `���
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(4)ANCHORS
PLATES
PER POST 3 318,
[86mm]
308.12-1-27 AST-0206-2023
Rosati, Richard
15 Wooden Ln
Gazebo 192 s.f.
3
OWNER'S MANUAL - BASIC SETUP DIMENSIONS & ASSEMBLY NOTES
It is critically important that you start with square and level footings, concrete pad or deck to
attach your structure
• Pay close attention to the items needed for each step. Make sure you are using the correct hardware for each step.
Using incorrect hardware may result in improper assembly
• Remember to double check for underground utilities and overhead electrical lines
Post mounts are provided with your structure which allows you to permanently install your structure to a
pre-existing or new wood or concrete surface. See Anchor Instructions for further details and recommendations.
• The hardware to attach the post mounts to the structure is included.
• The hardware to mount the structure permanently to a concrete surface is included.
• The hardware to mount the structure permanently to a wood deck is NOT included and will need to be purchased
separately. You must ensure there is ample structural support under the deck before permanently attaching.
16'- 3/4"
[4.9m]
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12'- 3/4"
[3.7m]
V NN
Co E Co
14'-10" 9`-10"
[4.5m] [3.0m]
16'- 1/2"
[3.3m]
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E:RIICHARD ROSATI
15 WOODEN LN.UEENSBURY,NY 12804
232- 2-714