AST-0251-2022 Office Use Only
' .. ACCESSORY STRUCTURE Permit#: PAST- ..OZ51 = .?sOZ2
` PERMIT APPLICATION 1_
Town 00-y bury. Permit Fee:$. •ZOI. o�.
74.2 Bay.Road,Queensbury,NY_ 12804 Invoice
P.:518461=8256 wwW.Queensbury.net Flood Zone? .Y N Reviewed By: .
Project Location: I rl 1 I 1 I �ClMilV1-P
n i1, E C E W
Tax Map ID#:. 110 a I:�-t ( :. . . Subdivision N
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PROJECT.INFORMATION:: _
OVUhf.®F.OIJ�B SBURY
PE:TY Residential 0 Commerciai,_Proposl'd �sTUILDII!!G .CODES,
J. STRUCTURE:
❑.Boathouse(with or w/o suhdeck) ❑ Canopy ❑ carport El.Cell Tower ❑ Deck
Detached Garage(>300:s:f.) ❑:Dock ❑.Gazebo ❑ Pavilion D Pole Barn ❑ Porch. ❑ Ramp
❑ Shed(<300 s.f.) 0 Solar Panels.(w/o,rafter upgrades) ❑ 3-Season Porch-. 'El.Other:
SQUARE.FOOTAGE OF STRUCTURE:
1st floor:
2nd floo
r:.
Total square feet: C �f�
-
Brief"description of scope of-project: Q LaX
Accessory Structure Application Revised March 2022
i
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ /J I Doc
2. Are there any structures not shown on the plot plan? ❑ YES NO Explain:
3. Are there any easements on the property? ❑ YES Ig 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 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 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 certificate of occupancy.
I have read and agree to the above:
PRINT NAME: ��rn�S �° Ab,-,add, Joc—
SIGNATURE. � _ DATE: J�1(:QLJQ Q-
Accessory Structure Application Revised March 2022
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b a y
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): C(Dr)S�YL�CAD9t? n
-Mailing Address, C/S/ CYvc O/ey
Cell Phone:
L�an�Line:
`�19����
Email: in� I f/*com s 7 ��o l-ICC) /Cc7)r�
• Primary Owner(s):
Name(s): 6401
Mailing Address, C/S/Z: I r7 7 T,7�3ha Mry/-iff/— �lL� 'JS�J�-1 _
Cell Phone: 6t Fqq 1,?61,flo Land Line:
Email: S�-e Id to 3b / P S Ma-t' /, conli
❑ 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): t�^`
Contractor Trade: V If�
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
**Workers' Comp documentation must be submitted with this application**
• Architect(s)/Eneineer(s):
Business Name: // 1I11
Contact Name(s): �jl i c' w. P�ajq PE n /
Mailing Address, C/S/Z: On r3U� S / � �q(p C�/���5 L(S G&L9 /
Cell Phone: Land Line: 5/� —gJ t0
Email
Contact Person for any questions regarding this project: %Ua)
Cell Phone: ������� � Land Line:
Email
Accessory Structure Application Revised March 2022
Aug, 2. 2 0 2 2r,11 ; 19A MDIA No, 9828 P. 5/6
DIDDLE DEPARTMENT INSPECTION AGENCY, INC.
%Woea that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable govemmental, utility and Agency rules in effect on the date
noted below and is issued Subject to the"following conditions.
Owner. Stuart Field Date:
07/26/2022
Occupant:
Garage Location17 Triphammer Rd.
Occupancy: Ingle Family Dwg_ Queensbury, Warren Co. NY
Applicant: �
Hilltop Construction
Cindy Albrecht
51 Crowley Rd.
L Hudson Falls, NY 1.2839. 4• '• J
Joseph A.Holmes
No. 145262171112EL
Equipment:
3-Switches;5-Receptacles; 9-Fixtures •••- op 22
rF
2022
Q N�
This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the ancy and
above-end the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership
Inspection. No warranty is expressed or Implied as to the mechanical safety,effl- of the property indicated above,this certificate shall be immediately null and void.
cienry or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon ttte above conditions,
be valid for a perlod of one year from the above noted date. Should the electrical this certificate may be revelidated upon reinspaction by Middle Department
system to which this certificate applies be altered in any way,including but not limit- Inspection Agency,Inc. An application for inspection must be submitted to Middle
ed to,the introduction of additional electrical equipment and/or The repracetnent of Department Inspection Agency, Inc.to initiate the inspection and revalidation
any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service,