2024-0091 Office Use Only
1
ACCESSORY STRUCTURE Permit#: 2024— OCYj)
PERMIT APPLICATION —
Town ofQuecnsbury Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: I%Z•
P:518-761-8256 www.queensbury.net
Flood Zone? Y N Reviewed By:
Project Location: c. i/1 '`J ( c , 6)l ea dJ
�y
Tax Map ID#: 1,0T Subdivision Name:
PROJECT INFORMATION: LE E 5 Vie I
TYPE: IA Residential El Commercial, Proposed Use: fl FEB 21 ')r�bi
STRUCTURE: TOWN OF OUEENSBURY
BU!LD G U CODES
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower Deck
❑ Detached Garage (>300 s.f.) El Dock ❑Gazebo ❑ Pavilion ❑ Pole Barn ❑Porch El Ramp
❑ Shed (<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch Li-Other: &t/' /Z-
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2nd floor:
Total square feet:
Brief description of scope of project: / he-e4- ,/fir
twit ,ojZc G/_ PECK ( f /Z / ,- /‘ ( Dve,e�*
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Accessory Structure Application Revised November 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ J f vv 0
2. , Are there any structures not shown on the plot plan? ❑ YES El NO Explain: -
3. Are there any easements on the property? El 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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:
SIGNATURE: DATE: Z/ 1/4-"1
Accessory Structure Application Revised November 2022
•
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 4-
Ma iling Address, C/S/Z: /1 Cc 67,/ee.)--1 -,/0-7 , lgr70�,
Cell Phone: (co') 2 2-f— 6 7 7 6' Land Line:
Email: z2CG11-0.--VG-6 12- --9 Co Pz-.
• Primary Owner(s):
Name(s): !�..� ' rc
Mailing Address, C/S/Z: YJie-frv6 / ZPEretif�u , /'. j� f
Cell Phone: l.i d) z z 7—'? 7 f Land Line:
Email: ?ck, .,
►.2 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 questio regarding this project:
Cell Phone: '7'o00 l/.47..nr-aic Land Line: (3o') 76.'—,777K
Email: %C/ c / /2. 3'15 e-ram t
lgr.GG (Az J G Le S1 4
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Accessory Structure Application Revised November 2022
TOWN OF QUEENSBURY
TOWN OF QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
����®f�� & CODES DEPT indicating the plans and specifications are in
Reviewedfull compliance with the Building Codes of
By: New York State.
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Date: \-a,--('
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CERTIFICATION.•
I HEREBY CERTIFY TO:
1) ZACHARY CHANDLER
1 HEREBY CERTIFY THAT THIS MAP WAS PREPARED IN ACCORDANCE
WITH THE CURRENT EXISTING CODE OF PRACTICE FOR LAND SURVEYS
ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL
LAND SURVEYORS, INC. THE CERTIFICATION IS LIMITED TO PERSONS
FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED, TO THE TITLE:
COMPANY, TO THE GOVERNMENTAL AGENCY, AND TO THE LENDING
INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP. THE
CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE.
RUSSELL E. HOWARD NYSPLS# 050540
DATE: 04/08/24
;171 LAKE
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SITE LOCATION MAP
DEED REFERENCE:
1) RAYMOND R. SORESNO AND PATRICIA A. SORESINO, FILED It,
WARREN COUNTY CLERK IN BOOK 6165 .AT PAGE 296, DATE
MAP REFERENCE:
1) "MAP OF A SURVEY MADE FOR CARL H. COONEY" LAST REVISED JANUARY
PREPARED BY DAVID J. BOLSTER, LICENSED LAND SURVEYOR.
NOTES:
1) BASE MAP PREPARED FROM AN APRIL FIELD SURVEY.
2) NORTH ORIENTATION IS BASED ON MAP REFERENCE 1.
3) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT OF TITLE AND
IS THEREFORE SUBJECT TO ANY EASEMENTS, COVENANTS OR RESTRICTIONS OF RECORD
ANY STATEMENT OF FACTS SUCH. DOCUMENT WOULD DISCLOSE.
4) SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN, COUNTY, AND STATE
REGARDING THE DEVELOPMENT OF LAND.
5) UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED L..ANI''
SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, SUB —DIVISION 2, OF THE
NEW YORK STATE EDUCATION LAW.
6) ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S ORIGINAL SEAL ARE GENUINE
TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL WORK AND OPINION.
7) CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREP.; <ED
IN ACCORDANCE WITH THE CURRENT EXISTING CODE OF PRACTICE FOR LAND SURVEYS
ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS, INC
THE CERTIFICATION IS LIMITED TO PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS
PREPARED, TO THE TITLE COMPANY, TO THE GOVERNMENTAL AGENCY, AND TO THE LENDING
INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP. THE CERTIFICATIONS HEREIN ARE
NOT TRANSFERABLE.
8) THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS
KNOWN AND OFTEN MUST BE ESTIMATED, IF ANY UNDERGROUND IMPROVEMENTS OR
ENCROACHMENTS EXIST OR ARE SHOWN, THE IMPROVEMENTS OR ENCROACHMENTS ARE
NOT COVERED BY THIS CERTIFICATE.
5 WAGON TRAIL
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only title surveys bearing the
MAP OF A SURVEY MADE FOR
LEGEND
LJHJ
1 \V/
makers original seal should be
l/J'' 1/,/�
relied upon since other than
embossed —seal copies may containo
unauthorized and undetectable
ZACHARY CHANDLEEI-L
Ir
IRON ROD FOUND
modifications, deletions, additions,
o IPF
IRON PIPE FOUND
and changes.
• IRS
IRON ROD SET
U Ai g i ,j A copy of this document without
UTILITY POLE
a proper application of the
Town Of QueerrSb2GT 2f 7L
STONE WALL
20 0 10 20 40 80 surveyor's original seal should be
— x
—
WIRE FENCE
CHAIN LINK FENCE
assumed to be anunauthorized
copy
y�
LL N. HOWAIW
IVSSE
l
WOOD FENCE
—Copyright Co ht 20La Russell i Howard
Licensed Land Surveying—
4
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POINT
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F.P.
FENCE POST
lip Reproduction or copyin of this
violation
342 Main Street, Hudson Falls, New York 12839 518-747-8747
—anw— --
OVERHEAD WIRES
document may be
1 ir
n1'
NOW OR FORMERLYP
of copyright law unless permission
n Date: 04/02/24 �1L2et 01 O 01
of the author and / or
f�
copyright holder is obtained
'P d12•.SeC2': 04 fj®8 f24 Drawing #: 24014