AST-0876-2021 Office Use Only
ACCESSORY STRUCTURE Permit#: 2—a2�1
PERMIT.APPLICATION 1
Town ofQuecnsbury Permit Fee:
742 Bay.Road,Queensbury,NY-'12804- Invoice#:
P.:518-761=8256 www.4ueensbury.net _ Flood Zone? .Y - .N iteyiewed By:
Project Location: 4e
OCk U fr5_�
Tax Map ID#: SubdivWcin.Name:
PROJECT.INFORMATION:
TYPE: : 1W Residential E .Commercial;•Proposed Use:
STRUCTURE:
[Z-BOathoUse(with or w/o sundeck): ❑ canopy ::❑ Carport ❑ Cell Tower l Deck
El Detached Garage(>GWs:f.) ❑;Dock ❑.Gazebo 1�1 Pavilion - ❑ Pole Barn: ❑.Porch. ❑.Ramp
❑ Shed(<300 s.f.) ❑ Solar Panels(w/o rafter upgrades), 3-Season•Porch -:El Other:
SQUARE.FOOTAGE OF STRUCTURE: Lg
1stfloor-
2 n,floor: DEC
T�
Total square feet: (,.,.(P-0 C)FUURY.
i�1G�OC3 Wf� OAS
. �3UIL®I
Brief.description'of scope of project:
i
K 3 .
Accessory Structure Application Revised January 20211
ADDITiO'NAL PROJECT INFORMATION: "
1. Estimated Cost of Construction:$
2. Are there any structures not shown on the plot plan? OYES Explain:
3. Are there any easements on the property? ❑ YES rs"N0
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within s 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 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: J
SIGNATURE: DATE: -d
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant.. `
Name(s): f-11/17/010
Mailing Address, C/S/Z:
Cell Phone:51 $ aS9'- q,3c271vh9JJz Land Line: 5/8. 791T105338 C� c�
Email: hdVa aK, U-(n Corn o vi Co CO M
• Primar Owners :
Name(s): Ok+r'l c l< Con ✓•1 o�—S
Mailing Address, C/S/Z: R-oc ,�2ev15
k-kLk -6r 2� t6 U-V yt Ja F0`r
Cell Phone: Land Line: cV?
Email: C(,&�e j u,66-e►z 96 0-)CL" I , Loin,
0 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:
Mailing Address, C/S/Z:
.Cell Phone: Land Line:
Email:
"Workers' Comp documentation must be submitted with this application"
• Architects En ineer s : P
Business Name: pC� i� ll ��I a
Contact Name(s):
Mailing Address, C/S/Z: 90 Qov J`"q(v C�+--Vi S Fa-I(Sr k(V
Cell Phone: Land Line: 5(g ct a - q Q-(0
Email: \4.W\A wrp e. . COV'Y'
Contact Person for any questions regarding this project:
Cell'Phone: Land Line: 5q q q g- Q 3 3
Email:
Accessory Structure Application Revised January 2021
Deck and Roof Design checklist
Is deck freestanding or attached
Footing
Sono tubes sized for posts 44 8" 6x6 12"
JABig 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
Jg Galvanized or stainless steel bolts shown NO ZINC COATED
Iv Hex headed bolts NO CARRIAGE'BOLTS A-h
Diagonal bracing shown for deck over 24"
Floor joists parallel to carrying beams
Deck post to beam attachment shown
Over 30 requires handrail
Over 30 requires guards
l�Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021