AST-0339-2023 Office Use Only
ACCESSORY STRUCTURE Permit#: 0'i j—
PERMIT APPLICATION 110
Town of Queensbury Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: 621c
P:518-761-8256 www.pueensburv.net _� ,
Flood Zone?�Reviewed By: �- om//
Project Location: \ \ 1 i f AS al I 1 Q g4) ViSloo(a NH I o
Tax Map ID#: 8 1 . —1 ' Subdivision Name:
PROJECT INFORMATION:
TYPE: XP Residential ❑ Commercial, Proposed Use
llECEOV ”
JUN 14 2023
p
STRUCTURE: TOWN OF QUEENSBURY
BUILDING & CODES
❑ Boathouse(with or w/o sundeck) ❑Canopy ❑ Carport ❑ Cell Tower LI Deck
❑ Detached Garage(>300 s.f.) VDDock ❑ 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:
2nd floor:
Total square feet: 15V Sq % 'CI- (Aock:')
Y
Brief description of scope of project: Ct 01( Q!G iSl I a S/x p ' y .-L01n1'Dr
6664. w , o. Skrai o 30 k S cxk . i s
15 0 V\ C.Or rs-r, NS NOVek i v, ILI— GIJ a yvt44-c
IAIA c A6 ` S Vtaw— v \ 1 S OL 1
4‘1_ OUSWV-11, 19. 1\itt_
Accessory Structure Application Revised March 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 1$1 500
2. Are there any structures not shown on the plot plan? El YES )4 NO Explain:
3. Are there any easements on the property? ❑YES ❑ NO
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 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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. 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
and 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.
I have read and agree to the above: /'
PRINT NAME: Uh1�1ok- WtVl ' &rro
SIGNATURE: [\ dN, DATE: (0 13 Z 3
Accessory Structure Application Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 121t Avkr`•` VVu ✓1
/ / 6 Lx' i-I l.-S N 1 ( zeDI
Mailing Address, C S Z: I �2+corV 1°�cV�
Cell Phone: 515 ?-'lc 55b2_ Land Line: r1 inr
Email: f ltexre "cu'ro@v.a,
r ,,�1 - (pw�
• Primary Owner(s): U
Name(s): Man_ Ciro k Avi,o►+\r4 b `rt -C9rrb
Mailing Address, C/S/Z: % VOLI C.ON 1ra-N5 PALLS N`f 1 Zso 1
Cell Phone: CM a1S CS-0 2 Land Line: NIA
Email: fki‘'‘ hpaav� r�@�nM1 � - (icy►-`
❑ 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): 5140,wvi L- CAlal•Ia.in / &rat. CoirvVrtLcAier
Contractor Trade: $V uv►N(r/CoN t.)c.r'
Mailing Address, C/S/Z: 541 CareLrta_ . �r\-- Pcnb. Ny 126 2-7
Cell Phone: Si 8 h1 b o81 S Land Line: S1 B 145 1958
Email 51r1„,„J yv-i kers; ottG90ri9, � �-o te61
**Workers' Comp docuMentation must be submitted with this application**
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
Contact Person for any questions regarding this project:
Cell Phone: SI$ -1S SS-b2- Land Line: INJ
Email C`n;►‘Adoerv`GQrro? grv►e.o�� [,o►.x,
1,,,L�l / Gpv1SYuCJbv c1?eS1'lovJ : &Now., 'l
'[�(G�` 51�1-�8_" -Pit. Jo,8./5 ,",
Sv A.A.M l U SssAx @ "I• LOv1.1
Accessory Structure Application Revised March 2022
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): W 1L1,l NINA. a_ e-S
Contractor Trade: soil, N(71 (,,,, Sr2vci
Mailing Address, C/S/Z: 2_1 O)AY\S Sir t -LENS FA1LS Ny 12-ao
Cell Phone: cis - a22-(.1 bl Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised March 2022
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0- BASE OF OLD, BENT Lands NIF Donald E. and Colleen J. Beadleston
I IRON PIPE FOUND (5651524)
Tax Map No, 289,17-1-42
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ed at 651138 reserves a "right of way for ° i z
sage on foot" across the premises "over ¢ x 120.5 0� OLD F IRON
trip of land 8 feet wide measuring from 1 �_� PIPE FOUND IJ/
shore Of Glen Lake" for the use of Alex- E � 1 n O�>i (DE>ro: 200 FT �,.--,,
der and Susanna l-lftscir, their heirs and v i ZOa` /
S-4
V i 10.5 3 �'
signs. No evidence found of current use
such a right-of-way.ci
* mo-IoLD 1"IRON 0 �.�-�^'� 0 - CINDER BLOCK O J
a �aa % I f m PIPE FOUNo - STEPS -----� 0�N Lands N/F John and Susan Moosbrugger
e z q o M P,j,PV (10691301)
a z( h ,% Tax Ma No.: 289.17-1-50
tq � '� / / i+•l f 1183 1 P
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W ��oQ� Area to shoreline):
Gien O 4 8 WHITE 12.0-
° a 1 19i SHED r E COVER a Ft. + l
RITE PINE • Y113.1 UTILITY 1 -.,� MANHOL 12, 09Q Sq. ,
,,. 1 FIBER- m / 0 TOP; 114.4
/ ??5.2
± • TRE: 6- WHITE �F, FRAME I GLASS -, DEED REFERENCE: (0. 228 Acre +J
?0°° Helen Kobor . l
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�� ( • 2" INE � Z 29"OAK PINE �^' OQ�F' 1r 5.9 PAVER STONE LK ; •
113.
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O w q p TREE GOB 113.2 CONC. WALK 1?4.1 TO ' ��� ; •
(/� _ _ _ _ 23.5'_ O *- $ ? 13.7 EAVES: 1.0 FT Thomas Valenti and Maureen Valenti Tax Map No.. 289.17-1-41 k 4 r
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J ! LAN 25°6' E D: 1212412010 o ry
3 CONC. 0 l I 12.8 LL
q CONC. LANDING r 1 I 32.8' R: 1212912010 651138 STEP I CONIC
W STEPS
Water Elevation Jn April 30, 2010: �- �-'
1` 905.1 o F 2? x LAWN
91 t.4 I U cn
r 1993.UJ I PER DECK' ^ RIDGE LINE - _ _ __ - T K% R � ?14.7
,.( - NOTE:
Up 113.4 c _ _ _ . - 128.8 A vi OO
- " -�- - -
� aoi� 127.s AT �i4K_.-- - - - • - � Premises tyre subject to any and all
FRAME DOCK I t I ® C*p UPPER -LEVEL 2-BAY FRAME GARAGE / rights of the public to use Birdsall
I I b 4 FRAME DECK -0 1 z / Road.
1 RESIDENCE ° C /
�. C"i 81-LEVEL
FRAME t ° ? 18.4
I o yVg4D STRIPS N ?16.2
I I i IN CONC. DECK
a
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1 25.6
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113.3 113.3 (t AVE5: LOFT.)
113.8
SURFACE
ASPHAI r DRIVE byAY
NOTE:
Deed at 6511,8
eLon"e right,
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title and inter
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DEED: 175 FT)
LONE METAL
POST
SHU i = WITI i-
(T HANDLES-
BENCH ARK4-30:
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9° BALSAM
175. OOrr
FENCE _ - T _ _
ROW
_ _ _ - -
-OF- VARlABTI DIAMETER_ PINE TREES
NOTE:
Deed at 651/38 excepts and reserves a 16-foot fight -
of -way "leading from the Dunwoodie lot to a strip of
/ land two rods wide " Deed also grants and conveys
a right-of-way `for all purposes over said 16-foot right
/ 04, �-of-way and over said strip of land two rods leading
°� Q��'o / to the main highway.
O� rQ 5 o
Paint sp t atop stone sew O o ey po 18
4 n IAMETER) _ - ' �i`�
EI . yltfBYT ---T- _ - vt i MASONRY pJ��Q Q�r Q Q Pofl qo ROW_Of 14 PINE TREES_ (4; -p -
Assumed datum) STEPS - �fia _ - - - -
( Qe A a OQp �Q� ?Q _ • a �p - o� A ram, A, "� �jQ �+`+�Jf%�L t ���� "`. ��V" Q / Q�
10A 9 Qe J O,-A� �r ��0 y x j�"�i�0 "! a7 A V r®"'W ^ �V ± 57ONE PLATE ATOP/ it
STONE/MAS. PIER
a UJ
STONE RETAINING fill
2 WALL
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Lands N1F Steven T, and Lisa M. Jackoski
o;L' (1226140)
5,01
j Tax Map No. 289.17-1-40
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0 IRON PIPE FOUND `�
WITH METAL CAP
4Q
c
.4
aryek IA.
ZONING INFORMATION:
Lands of Jackoski Parcel is zoned "Waterfront Residential" (WVR)
Minimum Lot Width: 150 Ft,
Minimum Water Frontage: 150 Ft.
0 Minimum Front Setback: 30 Ft.
® �A Minimum Side Setback., 20 Ft.
NEW POLE ld Minimum Rear Setback: 30 Ft.
NG s JIJN ' Minimum Shoreline Setback: 50 Ft.
OLD290 7`o OF * Average Lot Width = 65 Ft. ±
BU/�D/NG Co
Y
DB's
Only copies made from the original of this
Unauthorized alteration or addMon ,o a sno,_y
survey map which are marked with an
map bearing a licensee lard surveyor's sa Is
original of the land surveyor's embossed
a violation of Section 7209 subdivision 2,:' to
seal and bearing the surveyor's original
New York State Education Law
signature in red ink shall be considered
valid and true copies.
MAP
OF A SURVEY OF LANDS OF
Thomia'S and Maul e In ti
Known a5 "117 Birdsall Read"
SITUATED IN
Town of QueenSbury , Warren County , New York
Scale: 1 " = 10' May 7, 2010
Map Amended. 61912010
SURVEY AND Map by CHARLES T. NACY TO Shoal markers Set.
Licensed Land Surveyor
32 John Street
Queensbury, NY 12804