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AST-0170-2023
Office Use Only ACCESSORY STRUCTURE Permit#: `/`�© `aba3 I , ..__.. . Queen ry PE Town of a e.a � tMlPermit Fee:$ 742 Bay Road,Queensbury,NY 12804 APR 1 6 j' ;Invoice#: P:518-761-8256 www.queensbury.net E ( Flood Zone? Y Reviewed By: ) TOWN O;C I,iFF,Isp.1 p BUIl.QIS<C: T,,. Project Location: o (4)Qk "Veac 61.)0V�l �cJe;C,✓),C46//-V t/Z j Tax Map ID#: gUO i / 1 —/7 Subdivision Name: 7-he /V cVfii f PROJECT INFORMATION: TYPE: ni Residential ❑ Commercial, Proposed Use: STRUCTURE: • ❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck El 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: / 2c7c 2nd floor: Total square feet: /� GSA 7(27 • Brief description of scope of project: —10O! 5'/e-GY/ Accessory Structure Application Revised November 2022 f f ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 00 0 2. Are there any structures not shown on the plot plan? ❑ YES Ai NO Explain: 3. Are there any easements on the property? ❑ YES JNO • 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of } Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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: )�t�4 SIGNATURE: DATE: 4//7 Accessory Structure Application Revised November 2022 i CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: • Name(s): C>,;?/ /e/-)?, -� Mailing Address, C/S/Z: /��-oA� //- 4h✓ OUY ens4,.^y/j/V/-2,0V Cell Phone: 5 f(P-�3�-`3 / / Land Line: Email: ,:53,,�//, - ) /GIG G�'eGv� • Primary Owner(s): Name(s): ✓Yar Mailing Address, C/S/Z: Va/•4i A/Y/2?'O(-, Cell Phone: a/P-3?8" Land Line: z Email: s3 ,bnHGa/,,ruJ�� fir»./oGor» 0 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): G'q ✓/w�,-, !/m-�i 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: • Cell Phone: Land Line: Email: Accessory Structure Application Revised November 2022 . • • • _ TOWN OF QUEENSBURY TOWN OF QUEENSBURY • BUILDING & CODES DEPT . BUILDING DEPARTMENT •Based on our limited examination,compliance • . .- with our comments shall not be construe . . Reviewed By: • . _ ._ _ _ indicating-the plans and-IpeCifications are in • ___ '7,,-...- • full compliance with the Building' Codes of New York State. . ' K .. ........... ' • ,,,ToTh.-7 dt*OVT..liE,FIEFOOOle-----,„9., ' .0".........•...,..,1--emeir=Piro'm.5.-;'.*•...%.."1,. • ./ ,---•imiAl.mieffliT*I.-47 ig,,e„ - 04 COO**OW*.tlir*C.,-,----•.),, •`k.'h. f e iftWiLS MEM ' ,---',A,.agm,..*-4-O•.1....i-4.idie 1,1,4 --,---,-,_-...-_-,, .--... -„,,,,-,.,,-...---..-...-5.7....,-.,,,-,,-\-7---- - -- 1 0•ffico...IITONV. k,,-- - I ' 41,..--cr,--'7.-•-,-,i-v.-,---,a- T.,-n-,,laf"...„- .t.-----,.......,--4. __--'' ,,' 4 : 0.1 Mei.40,-.9-10.!TOT • 441•TismsaiMit--.....A-A.m.,..... ..11.._......a--,.-A,..,-1---......_4.,,O---,,....ii-.._ i --- , 1 , I 1 4 I . _..- ''... -,,,. I. I 4 • II _--.7.. . 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I , s Sales Location:WLT El 23 ( GARDEN ( TIME J (DVaaree Jed/Sprarapen 652 Quaker Road 1467 Route 9 25 Gordon Lane Address:88 Oak Valley Way Queensbury,NY Clifton Park,NY Mon,NY City:Queensbury NY zp:12804 p:(516)793-8555 p:(518)793-8555 p:(518)793.8555 f:(518)793.8551 f:(518)982-1425 f:(518)871-1700 Home Phone: Cell Phone:518 232 7821 Salesperson:CHUCK source:walk in/Dhone Work Phone: Acct#: Invoice#: -Load#: E-Mail:JidAndrew o(�,hotmaii.com Vendor:Lantz Stock#:2310140 Location:Wilton `, IN-STOCK O ORDER Building Type:-Select One- Q ;Options: Base Price__ i Size: 10 X 16 • 0� -..._- -. -_----- --_._-__ -- -- — Series:Standard - - -- i -- - Style:Brookshire 0 Siding:Dura Temp Q f Color: Buckskin DI Sale Price—__—_�__--�. ------__---- GARDEN TIRE WILTON is GORDON LN Trim:Sandstone 0 GANSEVCCBT NY 12831 —^ f Stain: 5Terminal ID18 793 D945 -- --. __.....------- ,-,,,.. �a1 - Roof: --- 4/I3/23 9:51 AM 1 Shingles:Black — -- _ Accr r: -----.. .,-. —I Metal Roof: MOTO SALE -- • j Windows: —I I Size: 24 X 36 I AMOUNT aPPrzoveDsue08. . Color. Brown D, CUSTOMER Copy 1 i Shutters: I , 50 fuel surcharge Color. ALMOND Style Louvered_ 0 Flower Boxes:0 Building Sub Total: Color. ;Building Layout: — i Mule— ' • _ Ramp Size:4'x4' ' 1 Total:i j Driver's Notes: I Additional Site Prep':• Sched.Delivery: — — I Delivery Person: I ( a Additional Site Prep Costs,if any,to be i Time In: Time Out: ] ;Determined after site visit. - • • Permits are the responsibility of the customer as required. 11 By checking this box.I allow Garden Time to photograph our Installed building for advertising purposes. Garden lime wit not be held liable for any property damage incurred during the delivery process(Ia.Septics,ruts,plants,shrubs,driveways. lawn.etc.)Site must be prepared and accessible at time of delivery.One half of an hour of on-site time is Included,$55 per man per hour is calculated therafter.Special orders are subject to a 25%restocking fee-Full payment Is due on or before delivery. > Customer Signature: 1" t1.o4= l'i -E Received: www_GardenTimelnc.com • 1 i 11\ I 1 I r r I I I r I 1 1 i TOWN Or -- r -- 1 ILL;fN......&GO<'E`' ;. - - --,-- . : j ' � 1 I v "hl I _. . .,,,, .,\ , , , . :,, Esp., : . 1 , _ . , . . , . , I . ;_ . . , , ; . , , . , ; 1 ,., , . ; 1 , / 1 , . , . . . . ,, ......N1 I ... . H 1 1 r r r r i r r r r r ' I I I I r f I ! - r, , _ , ..... I , , .. { � qi, Ir j , I � ii I , , ,. I r � I , - 1 , ,1 r i 1 J .1 I i , r .?..... r r r r 1 - .. . . 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