AST-0781-2019Office Use Only
ACCESSORY STRUCTURE
AS 1S (-20PERMITAPPLICATIONao1sTownofQueensburypermitFee:$_1 25.00742BayRoad,Queensbury,NY 12804 2a?P:518-761-8256 www.queensbury.net
BEC 0 ye2019
Tax Map ID #:Bol.Q-O-\\‘subdivision Ware:
CONTACT INFORMATION:
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iling Address,C ne Coon Wurt Queensburu TUTARDYetprerowane[9%
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Email:GONE IG Se hve.com
PiulcellPrimaryOwner(s):SAVIO
Name(s):
Mailing Address,C/S/Z:
Cell Phone:_()Land Line:_()
Email:
0 Check if all work will be performed .by homeowner only
Contractor(s):Workers’Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address,C/S/Z:
Cell Phone:_(),Land Line:_().
Email:
List all additional contractors on the back of this form
Architect(s)/Engineer(
Business Name:
Contact Name(s):;
Mailing Address,C/S/Z:v
Cell Phone:_()Land Line:_()
Email:Hee for Building &Code Compliance:
Cell Phone:_()Land Line:_()
Email:2RevisedFebruary2019
PROJECT INFORMATION:
TYPE:_____Commercial Residential
WORK CLASS:
2 eck,Open Porch __Solar Panels (w/o rafter upgrades)__Carport __Cell Tower
Shed __Pavilion,Pole Barn,Canopy __Dock __Gazebo
Detached Garage __Boathouse (with or w/o sundeck)_3-Season Porch
Other (description:)
SQUARE FOOTAGE OF STRUCTURE:
wai.5 (4 uf -)
2"floor:
Total square tee,FOED1
ADDITIONAL PROJECT INFORMATION:
1.Estimated Cost of Construction:$,BQ Xx
2.if Commercial project,what is the proposed use:
3.Are there any structures not shown on the plot plan?YES (NO )Explain:
4,Are there any easements on the property?ves 6)
DECLARATIOI
1,|acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2.Iftheworkisnotcompletedbythe1yearexpirationdatethepermitmayberenewed,subject to fees
and department approval.
3.I certify that the application,plans and supporting materials are a true and 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.
4.1 acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of
occupancy.
5.lalso understand that [Ave are required to provide anas-built survey bya licensed land surveyor of allnewly
constructed facilities prior to issuance of acertificate of occupancy.
Ihave read and agree to the above:
PRINT NAME
DATE:SIGNATURE:
aecessbey Structore Aasticadion Revised February 2019
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2..,‘ . 301.1.2-2-11. AST-0781-2019A..-0. ; cr.44-- V ..." :
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TOWN Guarino, Greta & Philip1 •
I : • OF QUEENSBURY' ! .
onia CtBUILDINGDEPARTMENT'. 18 Col l,
Based on our limited examination,compliance 1 , ' -1— Deck 327 s.f. - ---------------.With.Dur_comments shall-not.be-construed-as ' ---',------------------ --": '- --
1 indicating the plans and specifications are in 1 •• ' i , ' ' ! I ' • - ', ' '' ,
full'compliance with the Building Codes of ',
New York State. ' '
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Guarino,Greta Philip
18 Colonial ct
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327 sf.