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AST-0631-2023 Office Use Only , 1 ACCESSORY STRUCTURE Permit#: —0I0,6 l 292� PERMIT APPLICATION 1 p Ob — Trnvn of Queensbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 Invoice#: (c2-C-Q- P:518-761-8256 www.aueensbury.net Flood Zone? Y viewe Project Location: 2 0 R iS t �cJ�, Qu.e.1vr Tax Map ID#: 253"1'' I Subdivision Name: PROJECT INFORMATION: TYPE: 0 Residential OD Commercial,Proposed Use: S/10041 15 ,irv:50 STRUCTURE: ❑ Boathouse(with or w/o sundeck) El Canopy ❑ Carport 0 Cell Tower 0 Deck ❑ Detached Garage(>300 s.f.) El Dock ❑ Gazebo 0 Pavilion ❑ Pole Barn ❑Porch 0 Ramp ❑Shed(<300 s.f.) ❑tSolar Panels(w/o rafter upgrades) 0 3-Season Porch 0 Other: SQUARE FOOTAGE OF STRUCTURE: 1st floor: Ag10 'C 12 A 880 Sy FT 2nd floor: Total square feet 2.ggv Si r T Brief description of scope of project: K e/i'i v e 39450 S'r Fr Ca n ,0 y -ne Cpn3.47,&&4 �. ,/iew 28-0 5.3 P? Cotiopy. Accessory Structure Application Revised November 2022 • rV ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ /8'6 000 2. Are there any structures not shown on the plot plan? ❑ YES St NO Explain: 3. Are there any easements on the property? ❑ YES I 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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: ietT/t � C F1,04Air> SIGNATURE: DATE: ?/2 9/23 Accessory Structure Application Revised November 2022 • CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): PAT) ICK Mailing Address, C/S/Z: 79 Sunsc'1' I r -'L1 Q iee#Sbw7 M Y /2$d74/ Cell Phone: 5)&- 2(o0-�2.L cii-1 Land Line: 51�-79'1-• 2-CS Email: ?belan12o4 rL Q,4L, Carp, • Primary.Owner(s): Name(s): Dow ha 'c 5Ay IA.3 4 Game aik 1' Mailing Address, C/S/Z: `)?O, J3o 4'ZG.S, aM.r ,Sbw7,./c/`/ /Levy Cell Phone: Land Line: Email: ❑ Check if all work will be performed by property owner only • Contractor(s): (List all.additional contractors on the back of this form) Contractor Name(s): T Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land.Line: • Email: • **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(s): Business Name: f uc,,,SKi• t u- Arc. h)-1-ef 4-S Contact Name(s): ETI A,✓ Mailing Address, C/S/Z: /3'1 Doc 4-irG -i+aczj Ary /zto9 Cell Phone: Land Line: ne-74// - a2rvb Email: e p ha.11Q NYC.4P, cF. C "^ Contact Person for any questions regarding this project: ('j4Tr1 G 56(... iv Cell Phone: 5'U- Land Line: S/8'7` Z.-2c3U Email: bedavit dGY- coo. Accessory Structure Application Revised November 2022 t :. FEE HAANEN ENGINEERING Job No 1610 2 Sheet No. I of I Subject: RI-lA ASSac'c3-et Du ht1 o '. f0.y. Fi3I, — Co-i-ro PY 8)11 cl By 1`H.5 6- Date 0i(l lj I2L Loa,-A. CO-CP ,bn C. 'Revs 4V- t 0 ( 02-12-3 Load CAc -or1s Id PSF 9 R.oo F De-s i-5-y, Dead Load F. ,2„) RodP 'Desiv..) L)v .. Loa 4 2opsP. 33 R0k1 F Des i9 n Snow Load .. 'CNYSBc , Ai c 7--- I o) 6o psi —$ orkirt4 5noA Lcud h 1941F 6 --s &N.) Im p v'>`''}-U?Ice. (ia c Iv r lS = I • D 4. --, �x poSu re. roc 1vv Ce g_ I .a --p TG1er-n uJaY Ce = ). 2 : . � t,S Eky •i%I0. .DeNko\A (11-S u rh rl3 /belt_ S h-N&A.rrt W`U- r 04- 1 . u 1 cd I?1 . A �1' , �;� ue. (,t.)1 y..y-��y '�',W1c e 1 "1 � W t^� l�-- W1 L 61 tf, P" . J: f ,No.61241 . ct,`'... ..`?OFSS'a0 %/7.12. F14 Doc Sy,„,,, L«.1.1 lop ; O• T• Ce• CE• ./ Psr- 50. 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