AST-0247-2022 Office Use Only
ACCESSORY STRUCTURE Permit#: S1 ' y Z022'
N M— L
Town ofQuee sn b ry PERMIT APPLICATION Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: ��"
P:518-761-8256 www.gueensbury.net Flood Zone? Y W-11 Reviewed By:)MZ
Project Location: 7006
Tax Map ID M Subdivision Name:
PROJECT INFORMATION: D E C 9 E
TYPE: D Residential El Commercial, Pr p WAY 0 5 2022
TOWN OF QUEENSBURY
STRUCTURE: BUILDING & CODES
❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower aDeck
❑ Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp
❑ Shed (<300 s.f.) ❑ Solar Panels-(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
T
1st floor:
2nd floor:
Total square feet:
Brief description of scope of project: S -�
4 < ;
Accessory Structure Application Revised March 2022
A
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$
2. Are there any structures not shown on the plot plan? ❑ YES 3/NO Explain:
3. Are there any easements on the property? ❑ YES a-N-O
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-moritfi 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 1, 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:
Accessory Structure Application Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: / 1
Name(s):
Mailing Address, C/S/Z:
Cell Phone: g'G� Jr3' '6 1 P Land Line:
Email:
• Primary Owners):
Name(s): x 0
Mailing Address, C/S/Z:
Cell Phone: &7- Land Line:
--Em-a-il: - - -- - — — ------ -- - -- — — --
❑ 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):
Contractor Trade: e
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
"Workers' Comp documentation must be submitted with this application"
• Arch itect(s)/Eneineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
Contact Person for any questions regarding this project: x(.fAY�'�
Cell Phone: Land Line:
Email
Accessory Structure Application Revised March 2022
Deck and Roof Design checkl ist
Is deck freestanding o attache
Footing
Sono tubes sized for posts T' x6 12"
N�Big foot or footing for roof load
�l Proper attachment to post and footing shown
__±:L/Proper flashing or waterproofing to structure shown
MAttachment to structure shown on plans
4l
Galvanized or stainless steel bolts shown NO ZINC COATED
NlPr-Hex headed bolts NO CARRIAGE BOLTS
WDiagona bracing shown for deck over 24"
tFloor joists parallel to carrying beams
PIA-Deck post to beam attachment shown
) (: -Over 30" requires handrail
�f-\'Over 30" requires guards
Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021
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