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applicationOffice Use Only ACCESSORY STRUCTURE Permit a: AS] -OLAO -2020 PERMIT APPLICATION permit Fee:$12 -Town of Queene ZS742BayRoad,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice #: Project Location:31 Fairwood Drive. Tax Map ID #:202..4\o -]—|Subdivision Name: CONTACT INFORMATION: ©Applicant: Name(s):__Carrie Mauro.: Mailing Address,C/S/Z:_31 Fairwood Drive — Cell Phone:_(__518_)791-4062 Land Line: Email:cmauro528@gmail.com, +Primary Owner(s): Name(s):Carrie Mauro, Mailing Address,C/S/Z:__31 Fairwood Drive. Cell Phone:_(__518__)791-4052. Email: &Check if all work will be performed by homeowner only ¢Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phoni )Land Line: Email: **List all additional contractors on the back of this form ©Architect(s)/Engineer(s): Business Name Contact Name(s): Mailing Address,C/S/2: Cell Phone:_()Land Line! Email: Contact Person for Building &Code Compliance Cell Phone:_)Land Line! Email: ‘Accessory Structure Application Revised February 2019 PROJECT INFORMATION: TYPE:©Commercial Residential WORK CLASS: &Deck,Open Porch Ci Solar Panels (w/o rafter upgrades)O Carport O Cell Tower O Shed C Pavilion,Pole Barn,Canopy O Dock C GazeboCODetachedGarageBoathouse(with or w/o sundeck)Cl 3-Season Porch C other (description:) SQUARE FOOTAGE OF STRUCTURE: Ast floor:_260 2"floor: Total square feet: ADDITIONALPROJECTINFORMATION;1.Estimated Cost of Construction:$_3,800 2.If Commercial project,what is the proposed use: 3.Are there any structures not shown on the plot plan?YES expiain: 4.Are there any easements on the property?1 YES DECLARATION: 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.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._lalso understand that [Ave are required to provide an as-built survey bya licensed land surveyor ofall newly constructed facilities prior to issuance of acertificate of occupancy. have read and agree to the above: PRINT NAME:Carrie Mauro. SIGNATURE:Carrie T.Mauro.LAV u\wate:__4/24/20 ‘Accessory Structure Application Revised February 2019