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applicationOffice Use Only ACCESSORY STRUCTURE permit:*ST-B206-107.0 PERMIT APPLICATION qs -Town of Quceasbury Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 invoices ‘Lie 22P:518-761-8256 www.queensbury.net Project Location: Tax Map ID #:_308.7-1-69 Subdivision Name:__Berringer Hights. CONTACT INFORMATION: e Applicant: Name(s):__Christian Raeth. Mailing Address,C/S/Z:_58 Richmond Hill Drive. Cell Phone:_(_518 )_222-0288,Land Line: Email:chrisr1231969@gmail.com ¢Primary Owner(s): Name(s):same. Mailing Address,C/S/Z: Cell Phone:Land Lins Email: C Check if all work will be performed by homeowner only *Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Garden Time Contractor Trade:Garden store Mailing Address,C/S/Z:_652 Quaker Road Cell Phone:_()land Line:_(__518 5 Email: Business Name: Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_() Email: Contact Person for Building &Code Compliance: Cell Phone:_()Land Lins Email: Accessory Structure Application Revised February 2018 eee PROJECT INFORMATION: TYPE:©Commercial ®Residential WORK CLASS: 1 Deck,Open Porch C1 Solar Panels (w/o rafter upgrades)Ci carport cell Tower &shea Pavilion,Pole Barn,Canopy i Dock Ci Gazebo CO.Detached Garage Boathouse (with or w/o sundeck)1 3-Season Porch 0 Other (description:) SQUARE FOOTAGE OF STRUCTURE: Ast floor:1602"floor: Total square feet:_160_ ADDITIONAL PROJECT INFORMATIOI 1.Estimated Cost of Construction:$__6961.42 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?O yes &NO DECLARATION: 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.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 obtain a certificate of occupancy. also understand that IAve are required to provide an as-built survey by alicensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy. \have read and agree to the above: PRINT NAME:n Raeth, SIGNATURI DATE Accassory Structure Application Revised February 2019