application Office Use Only
ACCESSORY STRUCTURE Permit#: AST 054( -2 2-
-- ; PERMIT APPLICATION
Permit Fee:$
Town of Queensbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice#:
Project Location: lb {DvAy
Tax Map ID#: 1s")- 1-‘i Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s):Tim McNeil
Mailing Address, C/S/Z: 16 Quincy Lane, Queensbury, NY 12804 3 PE a !
Cell Phone: 585-278-6252 Land Line: _( )
[ P122B
TOWN OF QUEENS`Ur.
• Primary Owner(s): BUILDING&CODES
Name(s):Tim and Jeannine McNeil
Mailing Address, C/S/Z: 16 Quincy Lane, Queensbury, NY 12804
Cell Phone: 585-278-6252 Land Line: _(
Email tmcneil@osrmanage.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): Garden Time
Contractor Trade:
Mailing Address, C/S/Z: 652 Quaker Road
Cell Phone: Land Line: 518-793-8555
Email:
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( ,)
Email: -
Contact Person for Building& Code Compliance: pk'COYA
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Cell Phone:_( ) Land Line: _( )
Email:
Accessory Structure Application Revised February 2019
PROJECT INFORMATION:
TYPE: ❑ Commercial Residential
WORK CLASS:
❑ Deck,Open Porch ❑ Solar Panels(w/o rafter upgrades) ❑ Carport 0 Cell Tower
® Shed ❑ Pavilion, Pole Barn,Canopy Cl Dock ❑ Gazebo
0 Detached Garage ❑ Boathouse(with or w/o sundeck) ❑ 3-Season Porch
❑ Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor:240
2"d floor:
Total square feet:240
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$$6900
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? ❑ YES ll 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:Tim Mc eil SIGNATURE: DATE:9-11-2020
Accessory Structure Application Revised February 2019