AST-0257-2023 t
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r_ {a -,Office Use Only
AC,CESSORY'STRUCTURE-7 r\ !Permit#: 4 ( ///S a3
row,ofQ���sb�ry PERMIT APPLICATION j ;Permit •Fee:$ 14°•c
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nk � f `
742 Bay Road,Queensbury,NY 12804 k _. ,�:._, ,�, Invoice#: 7�+Z 7
P:518-761-8256 www.queensbury.net yli, ; c;ce ::-
Flood Zone? Y ,NN Reviewed By
Project Location: C:• 1C- T� 1 "z-e-�-� u��•-'S���-�-�
Tax Map ID#: c 2 • d — 3 — 3`g. Subdivision Name: Oct t >p 0""
PROJECT INFORMATION: •
TYPE: K Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo El Pavilion ❑ Pole Barn APorch ❑ Ramp •
El Shed (<300 s.f.) ❑ Solar Panels (w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: Z�
2"d floor:
Total square feet:
Brief description of scope of project: ��=- �` - a v X c S v N Ca �.Z-- �F •
Na. • w/\
Accessory Structure Application Revised November 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ A (3 L oc
2. Are there any structures not shown on the plot plan? ❑ YES NO Explain:
3. Are there any easements on the property? ❑ YES i(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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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: �n ) Cpc a i. L- V-
SIGNATURE: ..-'ys. DATE: 1(L_1 1.-2— 1—:3
Accessory Structure Application Revised November 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): k c `,, CAA-P.-t—lrL.l::: C2
Mailing Address, C/S/Z: ct oP-v.._ "r'R-% C C_t(2-- tQ ,.A5cgoct-ti t-4`e 1.-2_42,04
Cell Phone: 4:g t' '"1 ko-.2, -j"T 4 Land Line: l) t4
Email: -$-ejr•q.",01V-e4- 3 0,4 o M . ‘ C uA .
• Primary Owner(s):
Name(s): -A-C4s> k t'-'l A-n..y G,A-4'-44 t-G0____
Mailing Address, C/S/Z: c't - rc ,� C_.LQ_ Q.a .1/41-cs_..-IS cs Jc `t 11-u 4'
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:Cell Phone: Land Line: 440Acei-n-/v-G ,
Email:
Accessory Structure Application Revised November 2022
ECIEEIWE-, 7-\\
Tax Id: 302.17-3-38 MAY I 7 2023
Todd&Mary Chandler TOWN OF OUEENT537RY
BUILDING 8,CODE'S
9 Oak Tree Circle
Queensbury,NY 12804
(518)763-3774
Proposed replacement of 12ft x 16ft open deck with 16ft x 16ft covered porch.
Existing 12ft x 16ft open deck.
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14-16T-74 Exl2x 17.Open Deck
12'
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25'
1351 1,
1000G Septic Tank
Electric/Cable TV
63'
--- Gas Line
• Water Line
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