application Office Use Only
ACCESSORY STRUCTURE
1 Permit#: .k51� 01�1�� "2020
PERMIT APPLICATION Permit Fee:$ 3 '
Town of Queensbury
742 Bay Road,Queensbury, NY 12804 �D
P:518-761-8256 ww .queensbury.net Invoice#:
wi
Project Location: _14 Rush Hollow Court
Tax Map ID #: 295.20-1-31 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): Greg Ball
Mailing Address, C/S/Z: _14 Rush Hollow Court
Cell Phone:_(_518 )469-1121 Land Line: _(
Email:_gregnball@gmail.com
• Primary Owneresl:
Name(s): Julie Austin (Ball) _
Mailing Address, C/S/Z:_14 Rush Hollow Court
Cell Phone:_(_518_)_796-5968 Land Line: _(
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/Z:
Cell Phone:_( ) Land Line: _( )
Email:
**List all additional contractors on the back of this form E c E
• Architect(s)/Engineer(s): OCT 07 2020
Business Name:
Contact Name(s): TOWN OF QUEENS!3URY
Mailing Address, C/S/Z:
BUILDING&CODES
Cell Phone:_( ) Land Line: _(
Email:
Contact Person for Building & Code Compliance: o,c.ant-
Cell Phone:_( ) Land Line: _(
Email:
Accessory Structure Application Revised February 2019
PROJECT INFORMATION:
TYPE: ❑ Commercial N Residential
WORK CLASS:
❑ Deck, Open Porch El Solar Panels (w/o rafter upgrades) El Carport El Cell Tower
N Shed ❑ Pavilion, Pole Barn, Canopy El Dock El Gazebo
El Detached Garage El Boathouse (with or w/o sundeck) El 3-Season Porch
El Other(description:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: 720 -
2nd floor: 360
Total square feet: 1080
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $_10K
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? N YES ❑ 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:_Greg Ball '
SIGNATURE: . DATE:_9/30/20
Accessory Structure Application Revised February 2019