application �✓�� 1'r �2_-�) - 20th
Office Use Only
ACCESSORY STRUCTURE APPLICATION
Received
DATE k� /-3 Tax Map IDC/I /_
TAxMAPID 22 . 0.7 — l — I Z Permit No,. lTr��{114
ZONING V/K Permit Fee-' 7
Rec Fee P
N/STORlC SITE _Yes X No Approvals
SUBOMs/ON NAME 'L/lA Lot#
APPLICANT OWNER Lt'1r'L$�dD�fr 46e�E
ADDRESS ADDRESS ly R.";CO/L, �ri�lF
/1�leLlryck,ti•cvl-dl� fN� (zL(8
PHONE 36 PHONE 36 4/9(59
CONTRACTOR Adm. MJ-1- COST OFCONSTRUCTON(ESTIMATED): $
ADDRESS: 54J'K Sck, 44JSL M BUILDING ADDRESS: /O Z Rack
l4,yi1'C/l 1d
•
PHONE: ✓l l— �6Z l t,J
CONTACT PERSON FOR BULLRING 6 CODES COMPLIANCE Ga,:k PHONE
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
Boathouse 14 floor sq.ft. 2n°floor sq.ft. Total sq.ft. Height
Boathouse with Sundeck S) L 5 F
Deck
Detached Garage(#of cars
Dock sF
Pole Bam
Porch-open
"Porch—3 season,Covered,Enclosed
Shed
Other Accessory Structure(s)
"Considered floor area&must comply with FAR(floor area ratio)requirements if located in the WR zone
DECLARATION: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. 1 certify that the
application, plans and supporting materials are a true & complete statement description of the work proposed,that all work will
be performed in accordance with the NY State Building Codes, local building laws and ordinances; and in conformance with
local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy. 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: p /' G Date:
Signature: ( ) I Date:
B� 1
Town of Queensbury Building&Codes Accessory Structure Application July 2014