AST-0196-2023 Office Use Only
ACCESSORY STRUCTURE • 1'6 -} _ J CTURE Permit#. 0��b S® 3
PERMIT APPLICATION
Toxin ofCZecnsbury Permit Fee: $ 14tG
742 Bay Road, Queensbury, NY 12804 Invoice#:
P:518-761-8256 www.gueensburV.net Flood Zone? Y N Reviewed By:
Project Location: q6 Ea.c O.A 1��. Q uexY15 Gt, y /f/V I
Tax Map ID #: 3�b .� _ �. �� Subdivision Name:
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower 0,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:
I---FAP R 2 f I, ` 1st floor: �`��✓ St'
1
_ __®�..�� 2nd floor:
`OVJf'v� Oi- 0���'?ti~�1 i\ S . 1�7• ��� S� r T.
BUILDING t�; �UD �Fi
a_ OtJll Total square feet:
Brief descript'o of scope of project:_ F\eA)I yd�c� �'� s�•��- c0 ecK La
save, S;dQ
Accessory Structure Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 2
2. Are there any structures not shown on the plot plan? ❑ YES IM NO Explain:
3. Are there any easements on the property? ❑ YES R NO
DECLARATION:
l. I 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 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: eJ;r% Vw)AOM
SIGNATURE: i DATE: Lf �-t'
Accessory Structure Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant-
Name(s): 2Vi 6
Mailing Address, C/S/Z: E0,5-,&P, 2e4l%SUvr'y A�lY
Cell Phone: SI S-S S6-- 6763 Land Line:
Email: i<ymdorN `OS ® C ��ul
• Primary Owner(s):
Name(s): same
Mailing Address, C/S/Z:
Cell Phone: 4 Land Line:
Email:
R 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(sVEngi 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:
AccessmyStruclure Application Revised June 2022
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BUILDING DEPARTMENT �� v _-- --
i 10j',f - C;'.7 y=;;;` ,,�__�� Based on our limited examination,compfiarice �=-
_35� , with our comments shall not be construed as
-� t�.-.>> indicating the plans and specifications are in .
�� --' ful compliance with the Building Codes
York State.
6DEelT(+ V;I S Paver— �e�atr Wa��
THIS PLAN TO BE.ON PROJECT X
SITE AT ALL TIMES FOR THE
DURATION OF CONtSTRUCTION
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316.5-1-12.12 AST-0196-2023
Yanden, Kevin
45 Eagan Rd
Deck 320 s.f.
6xb SuP��` Pas-�-s
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TOWN OF QUEENSBURY /)U ck�w
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as �o
indicating the plans and specifications are in X
full compliance with the Building Codes of
New York State.
Door-
.
316.5-1-12.12 AST-0196-20
005 Yanden, Kevin 23
45 Eagan Rd
Deck
320 s.f.