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Office Use Only ACCESSORY STRUCTURE —it;ASX -ONO)-2020PERMITAPPLICATIONPermeSTomofCocoa, 1A ay Road,Queensbury,NY 12808 Permit Fee:weP:518-761-8256 www.queensbury.net Invoice #:2-9 2- Project Location:(Qu feng A NY .Poreh 3 ROVE POA Tax Map ID #:3 OS +2 ©—|—"S4__subdivision Name:Tye A \heightspecs1ViTHIflmay012020.|[U! CONTACT INFORMATION: *Applicant: Name(s}:Ck \s 0 Kk.Bae che larMailingAddress,C/S/Z:_\\_(A,Ay SAnwe Wy 12.YoY Cell Phone:_((6)UG ot -2(b landline:_(_) Email:_®&baXc heiar 4 |©yvanoo.cam +PrimaryOwner(s): Name(s}:ALi Son K.Bo co netarMailingAddress,C/S/Z:_\\_Lwin Vents QucenSoary MWY (QV0y Cell Phone:_(_S16)UsG ~2(ol land Line:_() Email:_Q wat Cheio-~Ul @ Yarra.¢ O Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with thisapplicationContractorName(s):|Oma 'S Due — Contractor Trade:_L_|¢cnsed &ener Con +yac-+ov™ Mailing Address,C/S/2:sia?Beantown Rood Fort Ann,Ay [Aka7CellPhone:_(52)2(oo —SS ~7=Land Line:_() Email:OM sofoyr4owYanoo.rn**List all additional contractors on the back of this form Ss*Architect(s)/Engineer(s): Business Name: Contact Name(s):Ah AK .Sack\ey,CPE Mailing Address,C/S/z:_@.O.©WMO willSbora,WY IQAGqQG Cell Phone:(5 \6)963 —YY G7]Landline:() Email:uc peynn Go ws uC OM, Contact Person for Building &Code Compliance:—\oun ce Giaee oS our buiidns, Cell Phone:(SLX)TO\—SAS (stand tine: Email eceszry Sucre Alton evses february 2019 PROJECT INFORMATION: TYPE:Commercial ZL Residential 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 J.other (description:POren/fourndarion Fe GAN,SeepaseSQUAREFOOTAGEOFSTRUCTURE: Ast floor: 2"floor: Total square feet:SSI SF,Porch Toundakon we ear, ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:§“3,(,6D.OO Lortoor §Morr O\S 2.If Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES (00)Explain: 4.Are there any easements on the property?Yes (> ECLARATION: 1.|acknowledge that no construction shall be commenced prior to issuance of a v: completed within a 12 month period permit and will be 2.Ifthe work 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 I,or my agents,will obtain a certificate of ‘occupancy, |also understand that IAve are required to provide an as-built survey by a licensed land surveyor ofall newly constructed facilities prior to issuance of acertificate of occupancy. Ihave read and agree to the above: PRINTNAME:AVIWKS OW K.BatChelar SIGNATURE:/J0denr 22af0 qd Gort pate:_Y (2.4/AORO