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Use OnlyamanmacaonUVieBer piss -2020PERMITAPPLICATIONr Tan f eentey Tape Neen s1U7(APR OO| 742 Bay Road,Queensbury,NY 12804 |iiaP:518-761-8256 www.queensbury.net jgvoiceTOWNOFQUE f Project Location:5 a RA * TaxMapiD#:295,|\S-2-11 Subdivision Name: JohnCleadon Hidden Estates CONTACT INFORMATION: ©Applicant: Name(s):“Timothy P.Timbrook Mailing Address,C/S/Z:65 Joba Clendoa Queensloyung NY 12804 Cell Phone:(GOT )S81-Geo5 land Line:_()None. Email:__tp-timbrcook @ gmail.Conn +Primary Owner(s): Name(s):“Timathy P_§Bacbace “J “Timbrcook Mailing Address,C/S/Z:__Same_ Cell Phone:_()Land Line:_() Email: ®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\/Engineerls):(Toot ny Tienborook )Business Name: Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person for Building &Code Compliance:__Saxn€ Cell Phone:_(_)Land Line:_() Email:, PROJECT INFORMATION: TYPE:____Commercial 7 Residential WORK CLASS: L 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: Ast floor:240SF_2"floor: Total square feet:_240SeADDITIONALPROJECTINFORMATION:1,Estimated Cost of Construction:$_<$0007materialcas}See attached esthmele 2.If Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES (WO)Explai 4,Are there any easements on the property?&NO 30!No est buffer at southerly hne. DECLARATION: 1.1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12month period. 2.Ifthework is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval. 3.|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 obtain a certificate of occupancy. 5.lalsounderstand that Ave are required to provide an as-built survey by alicensed land surveyor ofall newly constructed facilities prior to issuance of acertificate of occupancy. Ihave read and agree to the above: PRINT NAME:Timothy hn bya. DAT!SIGNATURE: 4[3|202 recessry tute hopicaton esed Februar 2018,