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applicationOffice Use Only ACCESSORY STRUCTURE permit #:_ ASV 024-2020 _——PERMIT APPLICATION permit Foe:$|2742BayRoad,Queensbury,NY 12804 - Project Location:_3 Woodshire Court,Queensbury Tax Map ID #:___308.7-1-11 Subdivision Name: CONTACT INFORMATION: ©Applicant: Name(s):_Wayne M Majuri Jr Mailing Address,C/S/Z:3 Woodshire Court,Queensbury NY 12804 Cell Phone:_(518)407-9450 _Land Line:) Email:_wmmajuri@gmail.com, +Primary Owner(s): Name(s):Wayne M Maiuri Jr_and Kelly L Majuri Mailing Address,C/S/Z:_3 Woodshire Court,Queensbury,NY 12804 Cell Phone:_(518)407-9450 _Land Line:_() Email:_wmmajuri@gmail.com, &Check if all work will be performed by homeowner only *Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_() Email: **List all additional contractors on the back of this form ¢Architect(s)/Engineer(s): Business Name: Contact Name(s): Mailing Address,C/S/ Cell Phone:) Email: Contact Person for Building &Code Complianc Cell Phone:_()Land Line: Email: Accessory Structure Application Revised February 2018 PROJECT INFORMATION: TYPE:Commercial &Residential WORK CLASS: &Deck,Open Porch CO Solar Panels (w/o rafter upgrades)O Carport O Cell Tower Oished C1 Pavilion,Pole Barn,Canopy CO Dock.O Gazebo Detached Garage ©Boathouse (with or w/o sundeck)O 3-Season Porch ClOther (description: SQUARE FOOTAGE OF STRUCTURE: 1st floor:_405 2"floor: Total square fe 405 ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$_2,600.00 2.If Commercial project,what is the proposed use: 3,Are there any structures not shown on the plot plan?YES NONE 4,Are there any easements onthe property?(1 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. 2.Ifthe work is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval. |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 I/we are required to provide an as-built survey bya licensed land surveyor ofall newly constructed facilities prior to issuance ofa certificate of occupancy. have read and agree to the above: PRINT NAME:__Wayne M Majuri Jr SIGNATURE:DATE:_6/2/2020 ‘Accessory Structure Application eulsed February 2019