AST-0641-2022 lECEDVEni
Office Use Only
®c7Q►Q( TRUCTURE Permit#: CIS i— GG �(, ZB�`��
PERMIL APLICI TION
Town ofQueensbu i Permit Fee:$ �S/Cy,
ry TOWN OF C UEENSBURY E
BUILDING &CODES ) Invoice#: SG�
742 Bay Road,QueensburyT NY--12804—�--'- ' -,10//�wZ�
P:518-761-8256 www.queensbury.net
Flood Zone? Y 6:1
Reviewed By: M
Project Location: 21 Brookfield Run Queensbury NY 12804
Tax Map ID#: 290.-1 .66 Subdivision Name: Brookfield Run
PROJECT INFORMATION:
TYPE: 8 Residential ❑ Commercial, Proposed Use:
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: 10x20 = 200
2nd floor: N/A
Total square feet: 200
Pre-Fabricated 10x20 shed w to be placed at edge of driveway meeting all
Brief description of scope of project:
front, side and rear setbacks.
Accessory Structure Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$10,000
2. Are there any structures not shown on the plot plan? El YES El 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 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. 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: Anthony F. Metivier.
SIGNATURE: p.:7 . DATE: 1 0/18/2022
Accessory Structure Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Anthony Metivier
Mailing Address, C/S/Z: 21 Brookfield run Queensbury NY 12804
Cell Phone: 518-932-1109 Land Line:
Email: afinetivier@gmail.com
• Primary Owner(s):
Name(s): Jamie and Anthony Metivier
Mailing Address, C/S/Z: 21 Brookfield Run Queensbury NY 12804
Cell Phone: 518-932-1109 Land Line:
Email: afinetivier@gmail.com
8 Check if all work will be performed by property owner only
• Contractor(s): (List all additional ontractors on the back of this form)
Contractor Name(s):
S /vr
Contractor Trade:
Mailing Address, C/S/Z: 6��5�� ('Lc— `" 4 'vqP /1l /2 c-27
Cell Phone: Land Line: 5 —
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: Anthony Metivier
Cell Phone: 518-932-1109 Land Line:
Email: afinetivier@gamil.com
Accessory Structure Application Revised June 2022
I _
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08/24/2022 .2:44 TM FAX 5186393056 SHED STOP ct+.luuvi,vv
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TO: EKS 570-725-3309 . • PURCHASE ORDER , _ FROM: SHED STOP,`lib_ ,o--
P.O. No. SS222416 **114TER TIES EVERY WON 16'&LONGER***
ORDERED: ' 8/24/2O2U II
Name: Shed Stop,Inc. "'VALUE SHED
1 *15/8 PROSTRUCT FLOOR
Address:. 6854 STATE ROUTE 4 **4'LP SMART SIDE
Fort Ann, NY 12827 1. '"i?0S8 ROOF SHEETING
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Phone: 518-639-3055/Fax 518-639-3056 a
I
Siding: ***LP SMART 1 —
Building Size: 10X20
Gable end
Building Style 10l
VALUE NE CLASSIC A-FRAME
Building Color RED O"RAFTER TIES ON TOP
PLATE
Trim Color RED ""3!TR' NSOM DORMER
pp���
Roof Color V vita"" BLACK
Doors 1- 6X6'6" &1-3FT 20' TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Windows: - 2-24X27 Based n our limited examination,compliance
with o r comments sh III not be construed as
Frame&C BROWN indica g the plans ands iflcations are in
FLOOR TYPE '5/8 PRO STRUCK ' __ -' full'co pliance 'with the uild'ing Codes of
New state.
Gable Vents YES
RIDGE VENTS YES
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SHUTTERS
COLOR: d TO � ,OF- utENSBURY
RAMP: BUILDING & CODES.DEPT.
OPTIONS: Reviewed y:
FLUSH MOUNTED WINDOWS Date: a ,7_
P.T. JOIST & PLYWOOD NOTES:
MIRATEC CORNERS
RIDGE VENT _ +P61-- p
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290.-1-66 AST-0641-2022
Anthony Metivier ---
21 Brookfield Run
Shed 200 sq. ft.