2024-0349 Office Use Only
ACCESSORY STRUCTURE Permit#: Ong"`-`•t�"^,�� 11 03
— tic(
4-1 )
APP Permit Fee: $ 1
pLECIEUVE
Town of fl�uccnsb ry
742 Bay Road,Queensbury,NY 12804 Invoice#: ao -`Q 570
P:518-761-8256 www.queensburv.net JUL 15 2024 Flood Zone? Y TYPE:
TOWN OF f UEENSBURY
BUILDING& CO ES Reviewed By:
Project Location: 267 'esd-
Tax Map ID#: 3o 1 . a 1 — Subdivision Name:
PROJECT INFORMATION:
TYPE: 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
W6 ad-
El Ramp C Shed (<300 s.f.) ❑ Solar Panels (w/o rafter upgrades) ❑ 3-Season Porch
❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor:
2nd floor: p�
Total square feet: I 6 51 U'A'
Brief description of scope of project: WdCa .5)-4 f91, ) 4-15
Accessory Structure Application Revised May 2024
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ '50e
2. Are there any easements on the property? ❑ NO &YES
3. Are there any structures not shown on the plot plan? NO ❑ YES Explain:
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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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: $ ?1
SIGNATURE: 14d-. DATE: 7/Y —ZV
Accessory Structure Application Revised May 2024
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): EA { $cJ
Mailing Address, C/S/Z: ^we--2J-/?2 o✓I/7,i '-
Cell Phone: (/ B GET. .- 31/0 Land Line:
Email: S'gocAl 1/1U -7,."198 0 G ,'I1j, I� co
• Primary Owner(s):
Name(s): ?n-'vleC
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):
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: hpyk1C 1Q71
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised May 2024
\ goo
e
\
70
Ul
Ul
o
�\ c Q)
rn
Z723 N O�
o
'� 3ndd rn-9,
\ap O = �
o U) Sit
O� N
rn _N
IQ Ul O � N
N O
VII = O D W
7o CP
Np tj rt � S
fl
s9, ,£b•I9I
Ul
�A r1olkj Oa
r1i � o
oao
Zn
-To I-ool
cz
Oi
I �•'
® � C
N O
rD rn rn
® o� rn
c � I
a
1 � orn
P. 1 � z
N `z,
I Iwo o � ® �� a=�
I
I004
oN