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application:Office Use Only ACCESSORY STRUCTURE Permitt:KEE =b2b4-2025 ome PERMIT APPLICATION permit Fee:§.12 742 Bay Road,Queensbury,NY 12804 518-761-8256.www.queensbury.net Invoice #: Zio __Project Location:_17 Knolls Rd North, Tax Map ID #:253.3-1-17 Subdivision Name:Ridge Knolls. CONTACT INFORMATION: *Applicant: Name(s):Eric Goodwin Mailing Address,C/S/Z:_17 Knolls Road North. Cell Phone:_(518)522-3020 Land Line:_(518_)792-8659 Email: *Primary Owner(s Name(s):Same as above Mailing Address,C/S/Z: Cell Phone:_() 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/: Cell Phone:_()Land Line:_() Email: **List all additional contractors on the back of this form ©Architect(s)/Engineer(s): Business Name:Arch HD. Contact Name(s):Jeff Doak. Mailing Address,C/S/Z: Cell Phone:_(518)321-6148 Land Line:_(518) Email:Jeff.archHD@gmail.com. Contact Person for Building &Code Compliance:_Jeff Doak Cell Phone:_(_518)_321-6148 land Line:_( Email Jeff.archhd@gmail.com Accessory Structure Application Revised February 2018 PROJECT INFORMATION: TYPE:O Commercial Residential WORK CLASS: &Deck,Open Porch CO Solar Panels (w/o rafter upgrades)O Carport O Cell Tower CO ShedCOPavilion,Pole Barn,Canopy O Dock O Gazebo C1 Detached Garage C.Boathouse (with or w/o sundeck)C 3-Season Porch Other (description:) SQUARE FOOTAGE OF STRUCTURE: astfloo:NY 21 2"floor: Total square feet:__)4 ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$$40,000. 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?C1 YES.NO. 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. If the 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 |,or my agents,will obtain a certificate of ‘occupancy. lalso understand that Ave are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy. |have read and agree to the above: PRINT NAME:Eric Goodwin, SIGNATURE:DATE:___06/08/2020, Accessory Structure Application Revised February 2019