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applicationOffice Use Only ACCESSORY STRUCTURE ,A=00519 -207PERMITAPPLICATIONPermitae Seiat Caen - 742 Bay Road,Queensbury,NY 12804 Permit Fee:$_\2>~__ P:518-761-8256 www.queensbury.net Invoice #:__242 bo Project Location:|7]FEW woos RB Ge Jer Tax Map 1D #:2 84.Jo-l-9 Subdivision Name: CONTACT INFORMATION: ©Applicant: Name(s):anes Kee Mailing Address,C/s/2:17 feetajoos Pa,Lave Sox Cell Phone:(SU)4,4 OFS |Land Lin&?_() Email: «Primary Owner(s): Name(s):Ag wove Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Ye{check if all work will be performed by homeowner only *Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):Av Ave Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: **List all additional contractors on the back of this form ©Architect(s)/Engineer(s): business Name:Powys [ere Avert tecree Contact Name(s):__(‘yllew fol lL~ Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person fo)Building &Code Compliance:_s MeN Vein Cell Phone:(SY)72+085 |Land Line:_() Email:_COW}si2eVeT(0)Yoho — Accessor Stractre Application evsedFebruny 2018, PROJECT INFORMATION: TYPE:____.Commercial resident WORK CLASS: Deck,Open Porch ___Solar Panels (w/o rafter upgrades)__Carport __Cell Tower __Shed ___Pavilion,Pole Barn,Canopy __Dock __Gazebo ___Detached Garage __Boathouse (with or w/o sundeck)__3-Season Porch __Other (description:) SQUARE FOOTAGE OF STRUCTURE:-rwetoor YX14!=S60 ce Fr 2"floor:SLO ca GrTotalsquarefeet: ADDITIONAL PROJECT INFORMATI 1.Estimated Cost of Construction:$. 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?YES Cio) DECLARATION: 1,L acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2.Ifthework is not completed by the 1 year expiration date the permit may be renewed,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.|acknowledge that prior to occupying the facilities proposed |,or my agents,will obtainacertificateof ‘occupancy. 5.lalso understand that [Ave are required to provide anas-built survey by alicensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy. Ihave read and agree to the above: PRINT NAME:[ites Lie SIGNATURE:WA _ DATE:sh 2 ccesory Structure Applition evens Fabrary 2019,