AST-0419-2021Office Use Only
ACCESSORY STRUCTURE Permit#: SST
PERMIT APPLICATION Permit Fee: $
742 Bay Road,Queensbury,NY 12804 Invoice#: 56—k-
P:518-761-8256 www.gueensbury.net
Flood Zone? Y N Reviewed By:
Project Location: br—N
Tax Map ID#: g, I d _ I _ d Subdivision Name: Wit' j'ik V'
PROJECT INFORMATION:
TYPE: 9 Residential Commercial, Proposed Use: D
JUN 0 2 2021
STRUCTURE:
TOWN OF C)UEENSBURY
Boathouse (with or w/o sundeck) [] Canopy Carport Cell Tower
ILDING&CODES
Detached Garage (>300 s.f.) Dock Gazebo Pavilion Pole Barn Porch Ramp
1 Shed (<300 s.f.) Solar Panels (w/o rafter upgrades) 3-Season Porch Other:
Iv xJ-o
SQUARE FOOTAGE OF STRUCTURE:
1st floor: d v 0 51 cr
2nd floor:
Total square feet: C)00 r
Brief description of scope of project:
J +I0 ,ra.C) SSA aap d
Accessory Structure Application Revised January 2021
I ,
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
2. Are there any structures not shown on the plot plan? OYES ONO Explain:
3. Are there any easements on the property? YES $2 NO
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period. Any changes to the approved plans prior to/during construction will require
the submittal of amended plans, additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of
Queensbury. After 1 year from the initial application date, 100%of the fee is retained.
3. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are atrue and a 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.
5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. 1 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:
SIGNATURE: DATE: J0
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
Applicant:
Name(s):JoSQplk rk <<
Mailing Address, C/S/Z: 1 Gerry R-kkpc GJzc"5 b"
7
Cell Phone: S I ( yyl - J36c Land Line:
Email: - i l ,5 2 Q G, M 43-L . corn
Primary Owner(s):
Name(s): (YNcry ,e4, Iti-A J oSe l -
Mailing Address, C/S/Z: I Berry
Cell Phone: SI e-qq 1-a-3 6 5 Land Line:
Email: L-M A L:Td 2 Q GmAsi- .
Check if all work will be performed by property owner only
Contractor(s): (List all additional contractors on the back of this form)
Contractor Name(s): 25vq-6 Cam,
Contractor Trade: UV(A
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Workers' Comp documentation must be submitted with this application"
Architect(s)/Engi nee r(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project:
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised January 2021
SALES INVOICE;
C UTOWN4F E'BI.R
BUILDING & GODES EPT, E: SHI
Reviewed By'.
3 SOLD
Date:Deliver to: Office use:
MALI , JOE Sale: M;
7 BERRY PATCH DRIVE Delivered: O,
QUEENSBURY NY 12804 Paid:
Phone: 518-441-2369 Sold By: M
Email STOCK#
4 3 N DESCRIPTION:
CCD W d
OD
aCDr• 1OX20 NEW ENGLAND QUAKER
COLOR -GP TAN
N TRIM - NAVAJO D C E 0 V
p E
3 SHINGLES - DUAL BLACK
3 3 FOOT DOOR JUN 0 2 2021 10d
a
INSIDE WALL TOWN OF QUEENSBURY
TRAN WINDOWS OVER WINDOWS 2
I DING& CODAS
6 FOOT DOUBLE DOOR GABEL END
N
DELIVERY!
FULL WALL E FT
FROM END
10 RAMP
S PREP PRICE IS BASED ON NO MORE THAN
6 INCHES OUT OF LEVEL.
FILE COPY Full List Price
EAVE SIDE DISC
Make all checks payable to Shed Stop,Inc.
Delivery of shed may take 4 to 8 weeks,custom orders may take longer. Subtotal
Building Permits and placement are the responsibility of the Customer as required.
Shed Stop Inc.,or its subcontractors,will not be held liable for any property damage Tax Rate
that includes,but is not limited to,ruts,damages to septic tanks or leach fields,plants, Sales Tax
shrubs,lawns,walkways or driveways incurred during the delivery and set up process or
damage caused by your property. Total
Site must be prepared and accessible at time of delivery.
Shed Stop will not be responsible for tie downs. Payment(wl)
THANK YOU FOR YOUR BUSINESS!
Balance Due
Deposit Ostacles
Customer Signature
Delivery
Customer Signature
Shed Stop,Inc. 6854 State Rt.4 Fort Ann,NY 12827 Phone:518-639.3056 Fax:518.639-3056 fort:
A-Frame
Standard shown with vinyl siding.
Standard vinyl si tional doors with
transom windows.
match Barn
Standard shown with vinyl siding.
UTILITIES
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41,102 sq.ft.
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