AST-0520-2023 •
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Office Use Only
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ACCESSORY STRUCTURE Permit#: T'65 20 -20 2.
Town PERMIT APPLICATION Permit Fee:$ WO " _
742 Bay Road,Queensbury,NY"12804 Invoice#: 4 .5 Z 2—
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P:518-761-8256 www.aueensbury.net 7
Flood Zone? Y O Reviewed By:I V v'
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Project Location: 7 Willow Rd.
• Tax Map ID#: 3 0 1 , 6 - 2- 3 o Subdivision Name: Pines
PROJECT INFORMATION:
TYPE: 8 Residential ❑ Commercial,Proposed Use:
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STRUCTURE:
0 Boathouse(with or w/o sundeck) 0 Canopy 0 Carport 0 Cell Tower 8 Deck
•• Cl Detached Garage(>300 s.f.) ❑ Dock 0 Gazebo 0 Pavilion 0 Pole Barn 0 Porch ❑ Ramp
0 Shed(<300 s.f.) 0 Solar Panels(w/o rafter upgrades) 0 3-Season Porch ❑ Other:
_ -- —_ -------i
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SQUARE FOOTAGE OF STRUCTURE:
1.1
1i i AdG 2 ,f.,;., ? 1st floor
,),.-_, i - k
_..._w..._I 2nd floor:
• -�a�rti�i� c:;
;131LU;NC2, t i;N.i1!,:Sz _ _ Total square feet:
Brief description of scope of project: i c' x 1:2.' 0 re s S 1,, re r a e L--7 /%t ,, .L e r
Frq m o c! 1
c(e c k on qra q�8
Accessory Structure Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$8500
2. Are there any structures not shown on the plot plan? ❑ YES 2/NO Explain:
3. Are there any easements on the property? ❑YES [iND
DECLARATION:
1. 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 priorto/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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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_. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. I 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
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rand ordinances, and in conformance with local zoning regulations.
5. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. I 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.
have read and agree to the above:
PRINT NAME: Vincent Leonard
SIGNATURE: DATE: 6/Q/05
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Accessory Structure Application Revised June 2022
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Via c4. + L e.or,a,rf
Mailing Address,C/S/Z: ? .w : cl ay.1 led 6jkdeh,5 b 1.4.7 w ' i2�S a Y
Cell Phone: S► Y 7 v c/ 3 a O o Land Line: tv/il
Email: yy4 goruA /Z(, GwrAi i. , Corms
• Primary Owner(s):
Name(s): Vincent Leonard
Mailing Address, C/S/Z: 7w ? lioo kb. 6h.P0oicintky GvV IZSa4/
Cell Phone: S) Fs ?4,9 3 gob Land Line: ftrl/3
Email: vileonard@amail.com
❑ 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): Ah dre a/ C . S r✓e
Contractor Trade: Ge h t r RI Co„1-r 4 c for
Mailing Address, C/S/Z: 53.I Pucker St Warr ens burg , N.Y ig:trs
Cell Phone: (S18) 2 (o0 - i SIP Land Line:
Email: MA S wee+ ►0y El G e ;t . (-oh,
**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: Ahdre w C • Swe e
Cell Phone: 6-It.) Z 60 -! S Land Line:
Email: ANA Sweef ON @ G ►ti,ai / , coy.,
Accessary Structure Application Revised June 2022
Andrew C Sweet 7 U�% /)u n/ 1Ro/,
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, General Contractor, Inc. Q u c e n s d µ'-y, .
• 921 Pucker St i��o
Warrensburg.NY 1288E Al V
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-� TOWN OF QUEENSBURY
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