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2024-0155 V �/ Office Use Only ' ACCESSORY STRUCTURE Permit#: 2E 24-' D 15 � , ---....___% PERMIT APPLICATION Town of Queensbury Permit Fee: ;15 — 742 Bay Road,Queensbury,NY 12804 Invoice#: .► / P:518-761-8256 www.queensbury.net Flood Zone? Y C ,fteviewed By: iUj Project Location: o'C.6 SI/6.Al2-gf/S 14 aIy Moil*IA/ vD5 RN< Tax Map ID#: ' En -5 — 1,--'l- 1 Subdivision Name: PROJECT INFORMATION: TYPE: Residential ❑ Commercial, Proposed Use: STRUCTURE: ❑ Boathouse(with or w/o sundeck) Canopy ❑ Carport Cl Cell Tower ❑ Deck ❑ Detached Garage (>300 s.f.) ❑ Dock El Gazebo El Pavilion •❑ Pole Barn ❑ Porch El Ramp • El Shed (<300 s.f.) El Solar Panels(w/o rafter upgrades) El 3-Season Porch ❑ Other: ---- 1{F_,,_...�R_._ _ _ SQUARE FOOTAGE OF STRUCTURE: ��II `I PI it .,�.f``.4. _. [v . l`' `-+ ' LE +-�I i ' 1st floor: .11 MAR ,�� IL/i nd9a�� r r 2 floor: TOWN OF I i`_:- ":'-, ,""'' Total square feet: /�(� S�_ LUILG!fJG c a Brief description of scope of project: Roo F 0 V1:72_ beck Accessory Structure Application Revised November 2022 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 3 f 700 2. Are there any structures not shown on the plot plan? El YES II NO Explain: 3. Are there any easements on the property? El YES ITh‘ 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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: kC b-r a SIGNATURE: 'if DATE:___4a l Accessory Structure Application Revised November 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: //11 Name(s): Y3-e✓ Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Primary Owner(s): Name(s): Shl)r E11,5ArNe � Mailing Address, C/S/Z: Cell Phone: Land Line: Email: ❑ 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): groT 1 onii/ Contractor Trade: Ron1'=71/6 Mailing Address, C/S/Z: 3 1 f 2 (2- M) S% (F 111 Y Cell Phone: SV 36/—a4 598 Land Line: 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: Cell Phone: Land Line: Email: Accessory Structure Application Revised November 2022 : • " :)-)/c'tiy, r„,,,,,,,2,f zz.- ,‘'.:1 ,,,,,f A , g( iiiti.iii 1.4,--. if,,k,,.., , tint--pkyricits .bnolt; 'Let 14'1-4,sat r ..„. 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' 74:BC1W757674"UiLDr'iNG DEPA;N•1181: RY .- NY i r:P. 70 = Reviewed -- ' _ 0, : n.our-linwere-xam"i 7:ti , p lance ents shall no b C5j \`' S63 i.lillgosmtruid e plans and sk. . , li LI ,-;-- ." L Pans are in , CD • ,,, itil --' X . 'r...___Lt I—I. r4 L...___ EXT5-rixic, DEcts, h9 FQ - ''aaed 0 New yorkPs • i our CO:: in 4 1 kli frill COM i. with the i9 . tate. isingt Codes of Ul 1.11 7 V IV 7111 _.------------__:— 3 .E---419-34,‘50.410 VGL-:5 ) _____ iLvilrr . / .coo -41. 0 p.:4--_eiTAN, Dar. pt OW ritc MAR 21 202i - . t - • • • , , ___-1:0Li!.1:.:1 7..-.7,:._::71,-71;1').'i , r_... 40,1•.4, Town Of Queensbury Interactive Mapper __ ,_,.,,-. , '•A' .0.A"., ,--,1‘leili4ift 1 _ . , . , ., . ,. 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