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AST-0810-2021 Office Use Only 1 ACCESSORY STRUCTURE Permit#: AtST-©t)k0 - 2s021 Town ofQucensbury PERMIT APPLICATION permit Fee: $ 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.aueensbury.net Flood Zone? Y 6 Reviewed By: Project Location: 73 J�'m 6Z-P'--jV Z40 ' 0�,EZAIJeVAY Tax Map ID#: ,5 1 3 YDO Subdivision Name: PROJECT INFORMATION: D E C E B E TYPE: Residential ❑ Commercial, Proposed Use: �:a�� Q 2021 TOWN OFOUEEIVSEURY STRUCTURE: BUILDINIG L C0Mi5 ❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck ❑ Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp VShed (<300 s.f.) ❑ Solar Panels (w/o rafter upgrades) ❑ 3-Season Porch ❑ Other: SQUARE FOOTAGE OF STRUCTURE: 1st floor: 1 q 7 �' o 2nd floor: Total square feet: Brief description of scope of project: .7 U F!z L-> i 5 89 : y R-►,iBR.VC.A r ITV 13Y AF-61YL ����Y�a�'.y��� � i5A 1�EiG-►v/:.RICE rt iJ C I cj IncACif 0 4,04 A J!aeve 5#Jr, rvyr-L'. Sri 1,->CA79Z) iN &ClC,lAA0 /,�� f /�i��i✓� �E��� /�'% Accessory Structure Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): /4iwaal, J L)a,0V1.4,V Mailing Address, C/S/Z: `` 3 � f✓ /2 � Cell Phone: S/S , ilk'/ . dy 12. Land Line: • Primary Owner(s): Name(s): -AA-4 -1 L D-WL4-4N Mailing Address, C/S/Z: -7 3 jae4m Cr.4,N0 s,u ��� � OL-"ii-rjcv y �Z-90V Cell Phone: Sid qq! CtI9 2 Land Line:,+ Email:�/ f J/v a ❑ 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): AAefi•4Z �i�IvCi1,�a'".�C.r• ";�.5�d..' ,s�T AAf4.V cJA/,&5 Contractor Trade: Jfa,E6 Swt.,D4,aj Mailing Address, C/S/Z: 41aaj J,—;A 7,< &?.. */a 4.<-(9 yt g My Cell Phone: 2.3 2 65'aj' Land Line: ;i j Email:k V L#V1;G A1<-C 55 `(1y ail. 'a,r.4 "Workers' Comp documentation must be submitted with this application" • Architect(s)/Engineer(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: Q Email: Accessory Structure Application Revised January 2021 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 7., y4 2. Are there any structures not shown on the plot plan? ❑YES RNO Explain: Pbwi. -05 N-D- P d v A1ldAC4 ^v D #V'Z.4j ��r'w%�C.if; rrS►'1/ e a' 3. Are there any easements on the property. El YES ❑ 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. If the work 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 a true 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: /�rE.zfr�k L ���� SIGNATURE: ` f DATE: /-J 2.7• 242/ Accessory Structure Application Revised January 2021 Doc S ign Envelope ID:1A5E581C-2A92-466B-BDFD-6E938E403B8E `" K ORDER ARGYLE STRUCTURES 4008 STATE ROUTE 40 TOWN OF QUEENSBURY STRVC BUILDING DEPARTMENT •�� �'G ARGYLE NY 12809 Based on our limited examination,compliance (� with our comments shall not be construed as �► (518) 232 -0505 indicating the plans and soeclficatlons are in N full compliance with the Building Codes cT New York State. EXPECTED DELIVERY: (p e,p ��4 �1TE: (b [to 1A o L ��� p� '�BDILT Ala" , Z �oVvEV o c PHONE NUMBER 1 ��i{- I`C�`�t ' CUSTOMER NAME: Ni�� 'DoY►1a1n '_�, �� z,�,, , SIZE/MODEL: ROOF STYLE:` SIDING TYPE: 12 fLV-E COPY �-V11�DYtY�2� WINDOWS: DOORS: ❑Man Door: 36", 9-Lifie � ❑ No Windows 1"` 'v'4iVV BL Barn Door ❑left inswing ❑Solid Metal Door 05, [)right, ❑ Insulated Vx3' right inswing Insulated 2'x3' �'$' ❑10' ❑Barn Door X Style ❑ 1 24 11x27 Vinyl ❑Single Man Door�arn Door Simple Style ❑36" ❑Doors Tall as Possible ❑ 2'x3' Vinyl ❑8'x7' Garage Door [)Diamond Plate Thresholds) FLOORING: ROOF: - )2<oor Joists (2x4) ❑ Galvanized SIDE WALLS: ❑or —_� ❑ 4/12 Pitch or , 4" CDX Wood Flooring ❑Standard 6 -� g ❑ Colored Metal � (NO HIP) ❑ 3/4" P.T. Flooring- Shingles - _ ❑ 16" on Center or ❑12" STARS: ❑ Insulated (-)On Doors Foam Insulated Floor olored Gable Vent IMCA ❑ � _ ❑Above Doors ❑1" ❑1.5" ❑2" ❑ Vinyl Vent ❑NONE ' \ EXTERIOR COLOR: ❑Ramp: 3+MZUl LuftadW Paint: rd ❑Electrical Package �� �� ❑ Vinyl: ❑Shelving ❑ SP Painted: ❑Loft TRIM: alnt:r ❑1 02 White PVC 1"/4" SOLD BY: S OW HOW TO LOAD: PRICE: ��� .� B &�(�b CODES DEPT. — eviewed F3 s AST-0810-2021 PAYMENT: Date: _ 295.15-2-9 TE- Donlon, Michael 4- LY DIGNATURE: 73 John Clendon Rd 192 S.f. Shed a L"'3v - Trtr``'! I` -�m'1 i ICIL f sal' , I�—B I Lot 11 Isr . \ 80.41 ' BS 58°09'30" E C76.06' L _ S 06030'20" W �r , 61 E I 00 GAL. > 9 w' a a EPTIC TANK Stone Drive - DISTRIBUTION B OX Wood Frame - _ Lot 12 - House 35214.0 S Feet o 0.8 Acres o N Off' CV3 ,g ��, p '!max •.` � ,��-. .. F.'D / `) °fi 3 - 50 LF A155ORPTION z R25.00 _ TRENC11E5 BS-54°22'22" E _ - f - C24.33' 0 - sE r r' S 83029'40" E in M. 15.00 .00' `r` Y; = N 06030'20" E