application k' Office Use Only
ACCESSORY STRUCTURE Permit#: AST—\ }k - 20 2_0
PERMIT APPLICATION _ 1
Town of Queensbury Permit Fee:$ i 12_5.
742 Bay Road,Queensbury,NY 12804 n p,
P:518-761-8256 www.queensbury.net Invoice#: Lr(J94
Project Location: 51 John Clendon Road, Queensbury
Tax Map ID#: 295.15-2-14 Subdivision Name:
CONTACT INFORMATION: re
• Applicant:
Name(s): TIMOTHY P O'LEARY 6I IAUG 19 20,2
Mailing Address, C/S/Z: 51 John Clendon Road
Cell Phone: ( 5d ) 7`I 7- 7yq/a Land Line: ( �_�
Email: ~!�
• Primary Owner(s):
Name(s): 53,Y1,I0 c.S OpOkc6r —
Mailing Address, C/S/Z: -
Cell Phone: ( ) Land Line: ( )
Email:
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): Build Right, LLC.
Contractor Trade: General
Mailing Address, C/S/Z: 135 Main Street, South Glens Falls/New York/12804
Cell Phone: ( )(518)229-2225 Land Line: ( )
Email:buildright518@gmail.com
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: creation studios 9
Contact Name(s): David Hutchinson
Mailing Address, C/S/Z: 98 Green Barn Road, Hudson Falls/New York/12839
Cell Phone: ( )518 683 4608 Land Line: ( )
Email:creationstudios9@yahoo.com
Contact Person for Building & Code Compliance: COvI*Y(tecQv —Pvr ‘1C_ct
Cell Phone: ( ) Land Line: ( )
Email:
Accessory Structure Application Revised February 2019
•
PROJECT INFORMATION:
TYPE: Commercial X Residential
WORK CLASS:
Deck,Open Porch _Solar Panels(w/o rafter upgrades) _Carport Cell Tower
Shed _Pavilion, Pole Barn, Canopy _Dock Gazebo
Detached Garage _Boathouse (with or w/o sundeck) _3-Season Porch
Other(description: Existing Deck Roof
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 1 92
2nd floor: 0
Total square feet: 1 92
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 1 2,000
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? 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: David Hutchinson
SIGNATURE: DATE: 08 11 20
Accessory Structure Application Revised February 2019