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AST-0216-2023 I _ • Office Use Only ACCESSORY STRUCTURE Permit#: AST.- 02-1 dm„ ) • Town PERMIT APPLICATION of Qyeensbury Permit Fee: $ 8'5 742 Bay Road,Queensbury,NY 12804 Invoice#: 1201-1- P:518-761-8256 www.queensbury.net • FloOd Zone? Y Reviewed By:kc Project Location: 3 13 eAir) I /0 1-1 Tax Map ID#: /E.- - /(.5 • Subdivision Name) )1 U ul MAY 04 PROJECT INFORMATION: 20; " TYPE: Residential Commercial, Proposed Use: , • • STRUCTURE: Boathouse(with or w/o sundeck) LII Canopy El Carport El Cell Tower El Deck • El Detached Garage(>300 s.f.) 1E1 Dock LI Gazebo CI Pavilion El Pole Barn El Porch El Ramp ErS-ried (<300 s.f.) CI Solar Panels(w/o rafter upgrades) 111 3-Season Porch LI Other: SQUARE FOOTAGE OF STRUCTURE: z 1st floor:_/(0 0 • •• rd floor: / Total square feet: /0-6 Brief description of scope of project: ZBarkfifS--'1,49 13 u a- 5 ko d -60 5-60 doo 5 r (^, ct.5 rractor lat,Jr1 otJor, /-7-(9/-4,1)/ce_...)e1. tOGe/Cf elk eAr / (Alg -60 16-ecye. (ic cOve,ce..,i. 0re,e1 ay),d otlSo be- rix) ey e_c70 re- 69 nei-i,t)orss • • Accessory Structure Application Revised November 2022 I. ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 2. Are there any structures not shown on the plot plan? ❑ YES L'J NO Explain: 3. Are there any easements on the property? ❑ YES 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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: �j e,v%n �( 1 ooe.y SIGNATURE: DATE: S/A3 Accessory Structure Application Revised November 2022 f f CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): //ooeY Mailing Address, C/S/Z: 23 (3emz%e7 roo-d a511c.)- ivy, Z gtiL1 Cell Phone: 93 a - -4//J Land Line: /1yy,4 Email: Khoo yy-3 @, mrtr 1- G 0"?-1 • Primary Owner(s): Name(s): geArtrti itOoey nay Id /400 eY Mailing Address, C/S/Z: t,�6- no d r C U et? bury, Al /d q Cell Phone: ,<a `g'432--14/.:- Land Line: AT/s Email: / h0de/( 93 3fVIa'( . con-7 !Z heck 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): gm?t` pR If e_d S /n ctnu Pc( un'r� 66_ Contractor Trade: C©i- 5 tru G e-i`o0 Mailing Address, C/S/Z:, e4-0-e- //, .4gio,r D/",`ve Gable5'//,(%1 Syr /20113 Cell Phone: ,6/8- a3/— =7Land Line: Email: /4- **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: ,G'/ elrii� //oo,y Cell Phone: s '/g-9,32- Lf / Land Line: A'yA— Email: g1 ovely3 5n-r..i/-CO,v2 Accessory Structure Application Revised November 2022 01 w m ae ad Alt ON Wd �tA'Npp< fir A \\ y �� t � o �. M�+j � � _ l y per aq� ��►' -. 0 w r o UM x.cz th {n if 4�ax 11 t a,(Aw $ n �'(A m i IV r�r W . o L1 152.73, . �US7L6EA/T $60•25 yp.E .4 p N C co m n i13 j o- w 1� i y � y � rtx w.0 m SHED •' � P-3 M _� _151.A9' w e —STD wtivE S63.40'61'E N >& ` N V� a v 1Wn m CD 2Z'OR Cb co �+ rd10 1= WOQm Wvm mom tij 9 � ccnmm tv "a0 ~ LL„JJ ' •4 . N Xl P ax .. >'oc 0>-4m Q>mm aZm Zrn C+7mm ;a m z J G''N WCo Corn m�W mW� m T Cf � rnt� W Z Z N w i m O 2 o N 8Q _ s•w N zo' T52.94' P PLO 7 r ^ASPHALT DRIVE '� a `• id I ; a 00 c 35 OM zm x i 0 m N