application r _
Office Use Only
ACCESSORY STRUCTURE
/ Permit#: P1 O4lc 2532
PERMIT APPLICATION �
Town of Queensbury Permit Fee:$ 4J
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice#: 28
Project Location: 18 Heritage Pt
Tax Map ID #: 290.17-1-10 Subdivision Name: Hiland Park PUD
CONTACT INFORMATION:
• Applicant:
Name(s): Carolyn Curren and Stuart Leinoff
Mailing Address, C/S/Z: 18 Heritage Pt; Queensbury, NY 12804
Cell Phone: ( 518 ) 796-1787 Land Line: ( 518 ) 793-1095
Email: leinoffs@gmail.com
• Primary Owner(s):
Name(s): Carolyn Curren and Stuart Leinoff
Mailing Address, C/S/Z: 18 Heritage Pt; Queensbury, NY 12804
Cell Phone: ( 518 ) 796-1787 Land Line: ( 518 ) 793-1095
Email: leinoffs@gmail.com
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): Shed Stop Inc
Contractor Trade: Shed Sales and Installation
Mailing Address, C/S/Z: 6854 US-4, Fort Ann, NY 12827
Cell Phone: ( ) Land Line: ( 518 ) 639-3055
Email:
**List all additional contractors on the back of this form -�
ECEOVIES
• Architect(s)/Engineer(s): d '�
Business Name: AUG 1 1 Pi! ' 4�
Contact Name(s):
Mailing Address, C/S/Z: TOWN OF QUEENSBURYSUI DING&CODES
Cell Phone: ( ) Land Line: (
Email:
Contact Person for Building & Code Compliance: p1+C `r
Cell Phone: ( ) Land ine: (
Email:
Accessory Structure Application Revised February 2019
_r
PROJECT INFORMATION:
TYPE: Commercial x Residential
WORK CLASS:
Deck, Open Porch _Solar Panels(w/o rafter upgrades) _Carport _Cell Tower
x Shed _Pavilion, Pole Barn, Canopy Dock Gazebo
Detached Garage _Boathouse(with or w/o sundeck) 3-Season Porch
Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 160 sq ft
2nd floor:
Total square feet: 160 sq ft
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 5,000
2. If Commercial project,what is the proposed use:
3. Are there any structures not shown on the plot plan? YES Explain:
4. Are there any easements on the property? YETI NO
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: Stuart Leinoff
SIGNATURE: &Hag ith/Of DATE: 8/10/2020
Accessory Structure Application Revised February 2019