AST-0328-2021 �r
Office Use Only
i ACCESSORY STRUCTURE Permit#: AST'0528 -ya%
Town ofQ bury PERMIT APPLICATION Permit Fee:$ �5
742 Bay Road,Queensbury,NY 12804 Invoice#: 41 C�3
P:518-761-8256 www.gueensbury.net Flood Zone? Y N eviewed By:
Project Location:
Tax Map ID M Subdivision Name:
PROJECT INFORMATION: M
C�TYPE: d Residential ❑ Commercial, Proposed Use: �STRUCTURE: �SRY
❑ Boathouse(with or w/o sundeck) ❑ Canopy /Carport ❑ Cell Tower ❑ Deck
❑ 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:
c�1st floor: J
211 floor:
Total square feet:
Brief description of scope of project: "b t T�— OF �y f 41 xc� C-Rnl 1� 0 r)
Cf A(-AA6 la' 00 T AAld 5�V )-aa) .
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Accessory Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of construction: $ 1'-I 1 QOO
2. Are there any structures not shown on the plot plan? OYES 2 NO Explain:
3. Are there any easements on the property? ❑ YES LEI 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 conform ance'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: KJrV/ti �' G�f► U AJ
SIGNATURE: DATE: Z/
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): G�2v1� US C,I.C,
Mailing Address, C/S/Z: } �� • &ete JIPl Id C4' 'P-\7f 1A3-3
Cell Phone: 0) 36S Land Line:
Email: - 4eVuu, OiIf-VIJU �� �'20[vyna11
• Primary Owner(s):
Name(s): FTM ()P KAU
Mailing Address, C/S/Z: W,V6 QcltEA.&A
Cell Phone: (�(��� ��d . -�� Land Line:
Email:
❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors
`o�n�the back of this form)
Contractor Name(s): G \"w RJe—xPci
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: (�5k)-iG Land Line:
Email:
**Workers' Comp documentation must be submitted with this application.*.*
• Architect(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:
Cell Phone: Land Line: 1 Y) G-�\YV t V-\
Email:
Accessory Structure Application Revised January 2021
Deck and Roof Design checklist
-QS Is deck freestanding or attached 4`C]V\ rZF6� 6Va�t-
Footin "
Sono tubes sized for posts 44 8" 6xx66112"
Big foot or footing for roof load
Proper attachment to post and footing shown
Proper flashing or waterproofing to structure shown
Attachment to structure shown on plans
Galvanized or stainless steel bolts shown NO ZINC COATED
Hex headed bolts NO CARRIAGE BOLTS
— Diagonal bracing shown for deck over 24"
►� ;� Floor joists parallel to carrying beams
L'LDeck post to beam attachment shown
Over 30" requires handrail
l�. Over 30" requires guards
A ver 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
TOWN OF QUEENSBURY
t BUILDING DEPARTME
compliance
with our comments shall not be construed as 0666-2
H indicating the plans and specifnations are in
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