AST-0361-2022 Office.Use Only
ACCESSORY STRUCTURE Permit#: ��
_ PERMIT APPLICATION
Town ofQueensbury. Permit Fee:S-.
742 Bay Road,Queensbury;NY_12804, Invoice
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P:SM761-8256' www.gueensbLirV.net.
Flood Zone? X N _ Reviewed By:
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Project Location: UJO( . ���� 1 Y �l 1�!LLb . ..
Tax Map ID.#:_01�1�Y + I:`i I - I Subdivision Nam
PROJECT-INFORMATION: -U
JU `3. .
TYPE: :: IV Residential Commercial;_Propose s.: 1
:TOWN Off'CCU lV��'i�URY
STRUCTURE:
E.Boathouse(withor w/o sundeckf - ❑ Canopy: . ❑ Carport ❑ Cell Tower E.
Deck
❑,Detached Garage(5300.s:f.)- Q.Dock.. ❑ Gazebo ❑.Pavilion ❑ Pole Barn ❑ Porch . ❑ Ramp.
Shed (<300 s:f.) El Solar Panels.(w/o rafter upgrades) ❑ 3-Season Porch ,Other:
v :
SQUARE FOOTAGE OF'STRUCTURE:-
1st floor:
2"d flo . .
Total square feet: `t'tJ0
Briefdescription of scope of project:
Accessory Structure Application Revised March 2022'
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$p?0;��
2. Are there any structures not shown on the plot plan? ❑ YES NO Explain:
3. Are there any easements on the property? ❑ YES [A 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 certifythat 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: ADYI*
I �_, UJ&zC*1'0L4r/7
SIGNATURE: DATE:
Accessory Structure Application Revised March 2022
CONTACT iNF0 1\fiA,TB®H: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
o Applicant.
Name(s): 1`C (�D C0/��
Mailing Address, C/S/
1�
Cell Phone• r :
�'��� � Land Line507r ����
Email:
6 Primary®wner(s):
Name(s): tyoj\(11L _� C\ CW \J V_
Mailing Address, C/S/Z: C�GZb
Cell Phone: Lind Line:
Email:
® 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): fqA,W 11"Llt (Ics
Contractor Trade: CoMA-nc*- On
Mailing Address, C/s/Z: LA o®% 5t V_+ 40 ft-rClq�_Q N\4 12-"9
Cell Phone: (Quq LQ%%q Land Line:
�`n/�
Email �
"Workers' Comp docume t o must be submitted with this application"
• Architects En ineer� s):
Business Name: VweJ t� WWif-'s
Contact Name(s): MM 9,txqtWn 'Pax)[ nl �2 d
Mailing Address, C/S/Z: LI*L v \JyW � �d • l/1` )
Cell Phone: �A Aq bq®k0 Land Line:
Email
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Contact Person for any questions regarding this project: RaL
Cell Phone:�)t %'1q I,LJLP Land Line:
Email
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Accessory Structure Application Revised March 2022
f'
03i17/2023 14 : 17 From : 15182209014 Cincinnati Sawyer Page : 2/2
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DIDDLE DEPARTMENT T INSPECTION AGENCY, INC.
i '6W46- that the electrical wiring to the electrical equipment listed below has been examined and is approved as
F , being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
( noted below and is issued subject to the following conditions.
Y Owner: Unknown Date: 03/15/2023
K- Occupant: Locatio
t Garage W2 Country Club Rd.
{
Occupancy. Queensbury,Warren Co. NY
Single Family Dwg. _
Applicant:
I Hilltop Construction
Cindy Albrecht
i
51 Crowley Rd. LAI R 17;' 2/'10129 73
I �, LHudson Falls, NY 12839 _�._�.
w; TOVIM 01- 6CFE NeSBURY
Ray Novak Jr. QUILDIING (4 CODES
No.
r 145262175602E
RK
Equipment:
10
'1'Pursuant to your request, inspection of the visible portion only of the electrical installation at the above property was
',alcompleted on March 15th,2023.
I Phis letter indicates compliance with applicable code requirements at the time of our inspection.
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`• This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and
j above and 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,effi- of the property indicated above,this certificate shaft be immediately null and void.
> deny or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions,
be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department
system to which this certificate applies be altered in any way,including but not Gmit . Inspection Agency,Inc. An application for inspection must be submitted to Middle
i �� ed to,the introduction of additional electrical equipment and/or the replacement of Oeparlment Inspection Agency, Inc.to initiate the inspection and revalidation
1 °%� any of the Components instzllad as of the above troted date,this certificate shall be process. A fee will be charged for this sBrvice.
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