AST-0575-2022 ACCESSORY STRUCTURE Office Use OnlyPermit#: <1 — O -2 22-
Town of Queensbury PERMIT APPLICATION Permit Fee: $ 8`J
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.queensbury.net
Flood Zone? Y N Reviewed By:
Project Location: 59 Country Club Rd Queensbury, NY 12804
Tax Map ID#: 5 ^ 1 " Subdivision N. • -•
PROJECT INFORMATION:
SEP 14 2022 pj
TYPE: RI Residential ❑ Commercial, Proposed Use:
TOWN OF QUEENSBURY
BUILDING&CODES
STRUCTURE:
❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ 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:
1st floor: 192
2nd floor:
•
Total square feet: 192
Brief description of scope of project: Prebuilt 1 floor shed. This will be delivered on a truck
and will be replacing the existing shed.
Accessory Structure Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $16429.85
2. Are there any structures not shown on the plot plan? ❑ YES ❑I■ 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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: Josh Clendaniel
( 9/14/2022
SIGNATURE: /jle ��6 DATE:
I
Accessory Structure Application Revised June 2022
t e 1
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Josh Clendaniel
Mailing Address, C/S/Z: 59 Country Club Rd Queensbury, NY 12804
Cell Phone: 518-596-4470 Land Line: 518-596-4470
Email: joshuaclendaniel@gmail.com
• Primary Owner(s):
Name(s): Josh Clendaniel
Mailing Address, C/S/Z: 59 Country Club Rd Queensbury, NY 12804
Cell Phone: 518-596-4470 Land Line: 518-596-4470
Email: joshuaclendaniel@gmail.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): GardenTime
Contractor Trade: Prebuilt Sheds
Mailing Address, C/S/Z: 652 Quaker Rd Queensbury, NY 12804
Cell Phone: Land Line: 518-793-8555
Email:
**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: 44
1 A
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised June 2022
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0 Y4� A ). . ` 4 SEP 1 b 2022 —01
.,1} <•,.,.., , r TOWN OF QUEENS3URY
BUILDING&CODES
Patriot Canton in Duratemp with battens and meatal roof
• y • ; , y , [
296.15-1-9 AST-0575-2022
Clendaniel, Josh
59 Country Club Rd
Shed 195 s.f.
Sales Location: UBY
GARDEN iTI]vIE1 -23-22
Name-Date:
Clendan'lel '
652 Quaker Road 1467 Route 9 25 Gordon Lane Address:59 Country Club Road
Queensbury,NY Clifton Park,NY Wilton,NY City:Queensbury, Zip: 12804
p:(518)793-8555 p:(518)793-8555 p:(518)793-8555
NY
f:(518)793-8551 f:(518)982-1425 f:(518)871-1700 Home Phone:
Cell Phone:518-596-4470
Salesperson:tOmm Source:on site Work Phone:
Acct#: Invoice#: Load#: E-Mail:ioshuaclendaniel a@gmail.com
' Vendor:Classic Stock#: Location:
0 1N-STOCK I ORDER
Building Type: Shed Options:
- - - - --- - e Price:
Size: 12x16 -- = -- -- -
Series: Patriot - ---
style: Canton — _- -- ----- _ c
RA'
siding: Dura-Temp Batten stripupgrade "- -
on Duratemp =z___`.. w
Metal Roof: Black -- - -
Windows: ---- - — - -
_Size: 24x36 -- - -- - -- --- — - _.
Color: White _ - Fuel Surcharge noted in additional miles box below Shutters: - Deposit paid with check#199 $8215.00 8-25-22 TMC ,_
Color: white - �-
Style: Boxed Trim_ _ — a
Flower Boxes: — T _ __ — -- -- - Building Sub Total:
Color na 1 Building Layout: -- -- - - - --` - -
Mule:
Ramp Size: 5'x4'
Driver's Notes: -
Additional Site Prep*:
Sched.Delivery: --.— ___
Delivery Person: — *Additional Site Prep Costs, if any,to be
Time In: — Time Out: _ J , Determined after site visit.
---------------
Permits are the responsibility of the customer as required.
ill checking this box,I allow Garden Time to photograph our installed building for advertising purposes.
Garden Time will not be held liable for any property damage incurred during the delivery process(ie.Septics, ruts, plants, shrubs, driveways,
lawn,etc.)Site must be prepared and accessible at time of delivery.One half of an hour of on-site time is included,$55 per man per hour is
calculated therafter.Special orders are subject to a 25%restocking fee.Full payment is due on or before delivery.
:ustomer Signature: Received:
www.GardenTimeinc.com
S I TE P LA N
59 Country Club Rd
Queensbury, NY 12804
Parcel ID: 523400 296.15-1-9
Lot area: 0.99 Acres
Plot Size: 1111 X1 711
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