application %-------rrr r r----r-rr-r-rrrrr--r-rr-rrr rrr r r----r r rrr rrrr-rr-rr0 -r-------------------r r�
rICE USE ONLY
TAX MAP N� PERMIT NO
0 0 �r
o FEE PAID BLDG.&CODES APPROVAL 'p
' _ 8 2n0
r-------------------r-r--____-___
ACCESSORY STRUCTURE BUILDING PERMIT �� NSEJ y
Use this application for any structure other than the Principal Structure(house)to include, bun .ES
garage, shed, greenhouse, dock,deck, etc. Refer to Informational Brochure No. 3 entitled Accessory Structure -
Sheds/Fences.
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.NO INSPECTIONS WILL BE)MADE UNTIL THE APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
OWNER: (/ ZJJ '"j Jj f I V/ INSTALLER/BUILDER: ) I�� I�i�le" 2D ,`
ADDRESS:Ik4,k&CkaL) A 0ue,,jkjs,� � ADDRESS: Cool Hi 11 /PC. /'*y,� IYk.
PHONE NOS. -� �5 ONE NOS.
LOCATION OF PROPERTY: /�Ui PS� (YL2C _17&--J SUBDIVISION NAME: A//'' Tp a, ,-
LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION: l ') - E
ESTIMATED COST OF CONSTRUCTION: $ '� �!�Cb ANY OTHER ACCESSORY STRUCTURES ON PROPERTY? r
IF YES,PLEASE LIST: ' ' ZA e.C/ '
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: tY PHONE:
sT No PROPOSED
PROPOSED CONSTRUCTION 1 FLOOR 2 FLOOR TOTAL HEIGHT
SQ.FT. SQ.FT. SQ.FT. FT.&IN.
OPEN PORCH
DECK
3 SEASON,COVERED OR ENCLOSED PORCH`
BOATHOUSE
BOATHOUSE WITH SUNDECK
DOCK
SHED
POLE BARN
DETACHED GARAGE(NO.OF CARS: )
OTHER ACCESSORY STRUCTURE:
"CONSIDERED FLOOR AREA&MUST COMPLY WITH FAR[FLOOR AREA RATIO]REQUIREMENTS IF THE STRUCTURE IS LOCATED IN
THE WATERFRONT RESIDENTIAL ZONE.
To the best of my knowledge,the statements contained in the application,together with the plans and specifications
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all
provisions of the Building Codes,the Zoning Ordinance,and all other laws pertaining to the proposed work shall be
complied with,whether specified or noted,and that such work is authorized by the owner. Further, it is understood that
/we shall submit prior to a Certificate of Occupancy or Certificate of Compliance
being issued,as requested by the Zoning Administrator or Director of Building
and Codes,an As-Built Survey by a licensed surveyor,drawn to scale, QUESTIONS? CALL 761-8256 OR EMAIL
showing actual location of all new construction. codesp_gueensbury.net
I have read and agree to the above. VISIT OUR WEBSITE FOR MORE INFORMATION
wWW.gueensbury.net
Signed A�Ca:��/� A Dated: Z
Name/Title(Printed) ,��C' !n� dt Noy
F"rw Town of Queensbttq • Community Development Office • 742 Bay Road, Queensbuiy, NY 12804