2024-0096 '.. • Office Use Only
ACCESSORY STRUCTURE Permit#: ac'i\
Tom of b PERMIT APPLICATION Permit Fee:$ g�
742 Bay Road,Queensbury,NY 12804 Invoice it: 2-024 \c)
P:518=761-8256 www.queensburv.net Flood Zone? Y N Reviewed By:
Project Location: 223 Cloverdale Road Cleverdale, NY 12820
Tax Map ID#: 227.13 2-5. Subdivision Name:- N/A
PROJECT INFORMATION:
TYPE: B Residential ❑ Commercial,Proposed Use:
•
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy 8 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: 12' X 20'
2nd floor: NA
Total square feet: 240
Single car carport on driveway- Picture and Instructions Attached
Brief description of-scope of project: . - - _ _
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FEB 26 2024
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Accessory Structure Application Revised June 2022
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ACCESSORY STRUCTURE
``- Submission Requirements:
7 a sours (i.e.: decks,sheds,detached garages,pole barns,solar panels,cell towers,etc.)
742 42 Bayay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net
•
1. Completed Accessory Structure permit application(please print neatly or type)
2. Workers Compensation insurance information for ALL contractors involved in the project—this is
REQUIRED EVEN FOR SOLE PROPRIETORS
THREE (3) COPIES (either 1 pdf&2 paper (min. 11" x 17") OR
3 paper (min. 11" x 17") OF THE FOLLOWING:
3. Structural drawings,which may include:
a. Signed& sealed architect or engineer stamp IF the cost of construction is over$20,000
b. Floor plan, if applicable
c. Foundation plan, if applicable
d. Cross sections, if applicable
e. Elevations, if applicable
f. Windows&door schedules, if applicable—printed on the drawings is acceptable
g. Calculation sheet for natural light,ventilation&emergency egress, if applicable—printed on the
drawings is acceptable
4. Plot plan,using a survey map, if possible,which includes:
a. Drawn to scale(i.e. 1 inch=30 feet)
b. Indicate the proposed changes with setbacks to the property lines
c. Include all structures on the property
d. Include the location of water supply(well or water lines)
e. Include the location&configuration of the septic system or sewer line
5. REScheck(for residential projects)or COMcheck(for commercial projects), signed and stamped, if
applicable—please visit www.energycodes.gov for more information
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans,additional reviews and re-approval.
2. If, for any reason,the building permit application is withdrawn. 30%of the fee is retained by y the Town of
Queensbury. After 1 year from the initial application date, 100%of the fee is retained.
Accessory Structure Application Revised June 2022
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$>5000.00
2. Are there any structures not shown on the plot plan? ❑ YES ® 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.
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5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. I also understand that 1/we are required to provide an as-built survey bya 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: Becky L. DeGasperis
BeckyDeGasperis‘L .Digitally signed by Becky L DeGasperis
SIGNATURE: Date:2024.022214:49:52-05'00' DATE: 2/22/2024
Accessory Structure Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Becky L DeGasperis
Mailing Address, C/S/Z: 20 Frizzell Terrace, Sparta, NJ 07871
Cell Phone: 973-222-9248 Land Line: N/A
Email: becky.degasperis@outlook.com
• Primary Owner(s):
Name(s): LaceyView,LLC
Mailing Address, C/S/Z: 20 Frizzell Terrace Sparta, NJ 07871
Cell Phone: 973-222-6476 Land Line: N/A
Email: becky.degasperis@outlook.com
8 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):
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:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _ Land Line:
Email:
Contact Person for any questions regarding this project: Becky -
Cell Phone: 973-222-9248 Land Line:
Email: becky.degasperis@outlook.com
Accessory Structure Application Revised June 2022