2024-0327 ,
Office Use Only
" 2� ACCESSORY STRUCTURE Permit#: '-0v22-
) APPLICATION Permit Fee:$ -.1).%.
T wn of Qucrnsb �
Ti42 Bay ICl,16ueensbury,NY 12804 Invoice#: Or/4k
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P:518-761-8256 www.queensbury.net ��
Flood Zone? Y Tif
Y r- N
Reviewed By: -A
t
Project Location: L7 Pi4G ' -sT D,�
Tax Map ID#: zi7C, r d 3—1—210.„ Z __ Subdivision Name: \Zd Y--c&ASO S sVb eL,'$tbA
PROJECT INFORMATION:
TYPE: X Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse (with or w/o sundeck) El Canopy ❑ Carport El Cell Tower ❑ Deck
❑ Detached Garage (>300 s.f.) ❑ Dock El Gazebo El Pavilion El Pole Barn El Porch
El Ramp 4-SIza (4''QO s4) El Solar Panels (w/o rafter upgrades) ❑ 3- eason Porch
lOther: P.0 (,l
SQUARE FOOTAGE OF STRUCTURE: °®O[ ,44
1st floor: 3- U y Ta4/ ®p ®3<50
$6,/Y .
Total square feet: 33 o S
y -14-
Brief description of scope of project: c - vt AA ,,,A,sk S\,e,A
Accessory Structure Application Revised May 2024
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ I D 0
2. Are there any easements on the property? 4 NO ❑ YES
3. Are there any structures not shown on the plot plan? Tpt 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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: M tLa-t \I-6 1at/1 1
SIGNATURE: IJ(IL4- �Vki DATE: IA/ 3 2$2.1
Accessory Structure Application Revised May 2024
•
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: /j
Name(s): � /! la/divs
Mailing Address, C/S/Z: p/2-
Cell Phone: .Sri 9;7_ 170 Land Line:
Email: • r,s rr air,( Tot,J Yes,crri, rrr?ri
• Primary Owner(s):
Name(s): - ->0\
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
tip, 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: Or ,Y1\C AA—
Cell Phone: Sic- 932 /Ire Land Line: i C
Email:
Accessory Structure Application Revised May 2024
•
•
John O'Brien
From: John O'Brien
Sent: Monday, September 30, 2024 3:12 PM
To: John O'Brien
Subject: Kokoletsos 16 Pinecrest Drive
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