AST-0397-2022 i
Office Use Only
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ACCESSORY STRUCTURE Permit#: f}ST-= + ' 20 22
To of wn 6 PERMIT APPLICATION permit Fee:$ 10
742 Bay Road,Queensbury,NY 12804 Invoice#: l �j
P:518-761-8256 www.clueensburv.net Flood Zone?&N Reviewed Bye o
Project Location: D � fir
Tax Map ID#: 10 1 Subdivision Name: E 2
PROJECT INFORMATION: TOWN OF QUEEINISDURY
BUILDING u CODES
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ 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:
1st floor:
2nd floor:
Total square feet:
Brief description of scope of project:
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Accessory Structure Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$
2. Are there any structures not shown on the plot plan? DYES )NNO Explain:
3. Are there any easements on the property? ❑YES kNO
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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 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:
SIGNATURE: DATE: Oo Z 3
Accessory Structure Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): ��ST Gv�/6�Z /� `' `Ka
Mailing Address, C/S/Z: 276 Ai6f P Q��c11 ! /V J V, ` 7
Cell Phone: /36�/1��'73 j Land Line:
Email: ( Sfhl/!`�G�Ce C��Cn4c4 l/,cO-n-
Primary Owners):
Name(s): bul CHIN 5
Mailing Address, C/S/Z: /71 J', Nairn tZ&e 1/CG fA ! Y.
Cell Phone: C19-- V,19,g p3 Land Line:
Email: � C/o//l n ��y�t lire (6-14-�
❑ 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): i ejlr 6Ul" �&wi
Contractor Trade:
Mailing Address, C/S/Z: /7,7 l /ti dQ c tLP
Cell Phone: 57-`f-L3 61 , C-73,rj-- Land Line:
Email: LS P' "f ,celll►^
"Workers' Comp documentation must be submitted with this application"
• Architect(s)/Enaineer(s):
Business Name:
Contact Name(s):
Mailing Address,C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project: ka A
Cell Phone: -IF /3047ff Land Line:
Email: 6"o 5#111 l/A4s Fp(A'Il C6111`
Accessory Structure Application Revised January 2021
J �A)' A
' Map References
Map of lands off
Donal &Jacqueline Klann fo�
1111 Dated: Novmeber 09, 1981 Lands NOIF o
II By: Coulter &McCormack Q�N Gary 0. Pinero
1� �( B:2995 P:161
Map of a survey made for 289.10-1-44
Carmen Marchesin Q TOW F QUEENSBURY
Dated: August 08, 2006 I1U B DING DEPARTMENT
By: Van Dusan & Staves
Land Surveyors o ur limited examination,compliance
comments shall not be construed as
Map of a survey made for se
` ting the plans and specifications are in
Paul & Corina Zemanek Dated: June 09, 2016 compliance I' p `with the Building Codes of s•o s
Last revised: October 03, 2017 r7` York State. °'3 m
By., Van Dusan & Staves
Land Surveyors
Deed Reference Lt G Lends NpIF o
O Larry S. Zemanek
Michael F. Miller, 8:648 P 289.10 I-511-51 PPF /
as Administrator of the Estate of
Marie M. Miller Lands NpIF o
Albert Story
To
o m q B:925 P:131
Paul M. Collins & {� : i '�v s+ 285.10-1-47
Mary L. Collins TOWN OF QUEE ° V 1
Dated: January 14, 202E
Recorded on: January 27, 2022 r1 C. t, _S D T. 0 '� 0
B:6552 P:136 BUILDING •(� ,C� � n �
rn
Charles E. Graves, Jr. "
TO Reviewed.d ;Q��
Charles E. Graves, Jr. & ^� d (D 0
Christina Graves ID.�'be" L/
Dated: September 11, 201E l -- Rr(B ns7 S X- Q
Recorded on: September 12, 2012 1
B:4569 P:22 ✓ 0 C
< 3 — o
PP(aea) Cr
Glen Lake _ °� "°1h% 9$ 40� a
titi
Q;A9
a� °ray a°ti9 o M.R. �
NOTES: r' [O]
1.) THIS MAP WA5 PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT OF 9�ea
TITLE OR AN UP TO DATE TITLE REPORT AND 15 THEREFORE SUBJECT TO , to
ANY STATEMENT OF FACTS SHOWN THEREON. 31 -n w
2.) THE FIELD SURVEY WAS CONDUCTED DURING WINTER WEATHER 1 N
CONDITIONS WITH SIGNIFICANT SNOW AND ICE COVER. \7�a.7a Area '
3J PARCEL 15 SUBJECT TO ANY EA5EMENT5 OF RECORD, \?0 15782.7 Sq. Feet
4.7 TH15 MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY MADE IN v t O
ACCORDANCE WITH THE EXISTING CODE OP PRACTICE ADOPTED BYTHE \A 0.36 Acres
NEW YORK STATE ASSOCIATION OP PROFE55IONAL LAND SURVEYORS. '�►�
5.) THI5 MAP 15 COPYRIGHT 0 2022 VAN DU5EN t 5TEVE5 LAND
SURVEYORS. UNAUTHORIZED ALTERATION OR ADDITION TO TH15 /
DOCUMENT 19 VIOLATION OF SECTION 7209,SUBDIVISION 2,OP NEW
YORK STATE EDUCATION LAW. Le end
G.) DIMENSIONS BETWEEN PROPERTY UNE5 AND STRUCTURES ARE TO THE / / p g
NEAREST HALF FOOT AND ARE FOR THE SOLE PURPO5E OF \ IPF = Iron Pipe Found
INTERPRETING THEIR CONFORMANCE WITH ZONING AND NOT INTENDED \ 28 gip, p
TO AID IN THE ESTABLISHMENT OR RETRACEMENT OP PROPERTY LINES, \ IRF = Iron Rod Found
7.) UNDERGROUND UTLITIE5,If ANY,ARE NOT SHOWN HEREON. `+y PPF = pinched Pipe Found
8.) THE SURVEYED PARCEL 15 SUBJECT TO WHATEVER RIGHTS,TITLE OR �zb M.R. =Magnetic Reaction Found
INTEREST THE TOWN OF QUEEN55URY AND THE PEOPLE OF THE STATE OF NEW
PORK MAY HAVE TO MAINTAIN THE ROADS,AND TO WHATEVER RIGHTS, Glen Lake
TITLE OR INTEREST THE TRAVELING PUBLIC MAY HAVE TO THE BED OF THE
ROADS.
a� Date:March 14,202E
Map of a Survey made for Scale I"=20'
& �d
S teve s Paul & Mary Collins S-1
Land Surveyors
SHEET 1 OF 1
109 Haviland Road Queensbury, New York 12804 Town of Queensbury, Warren County, New York
COLLINS C3726
(618) 702-0474 New York Lic. No. 50135 N0, DATE DESCRIP77ON DWG.NO,22.OI I
289.10-1.50
ADIRONDACK MADE LAKE GEORGE,NY Paul Collins
ENGINEERED FOR [-IF E ALUMINUM TUBE-FRAME DOCKS
s ��T ��� _►_ ARTICULATING*CANTILEVER RROLL-INS 14 Elm Road
ai - !i$K!Sj 518-361-5735 BESTBUILTDOCKS@CMAIL.COM
` 17 ASH DR. LAKE GEORGE, NV Queensbury, NY
Close-up Detail
Dock/ Deck Combo
Propane Tanks(3) 3o V•
AD
Co
31
Glen Lake
o Area
�0 15782.7 Sq. Feet
0.36 Acres
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0
JUL 14 2022
9 a� TOWN OF QUEENSBURY
_ BUILUNG& CODES
Glen Lake �-�
ADIRONDACK MADE LAKE GEORGE,Nv Paul Collins
ENGINEERED FOR LIFE ALUMINUM TUBE-FRAME DOCKS
ARTICULATING OCANTILEVEROROLL-INS 14 Elm Road
518-361-5735 BWBUII3D0CK5@9MAILC0M Q u e e n s b u ry, NY
14 WALKUP CUTOFF LAKE GEORGE,NY 12845
Overhead View:
Lakeside Deck/Dock Combo 61
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4
GLEN LAKE
20'
TOP VIEW
i
8' 87
EXISTING INEW FOOTING I NEW FOOTING
SHORELINE
ADIRONDACK MADE LAKE GEORGE, NY
ENCIT4 EERED FOR LIFE Paul Collins
ALUMINUM TUBE-FRAME DOCKS
ARTICULATING*CANTILEVER OROLL-INS
N& rj 14 Elm Road
518-361-5735 BESTSUILMOCKSOGMAIL.COM
17 ASH DR. LAKE GEORGE, NV Qu e e n s b u ry, NY
WxNlakeside Deck(removable)
FRONT VIEW
N W FOOTING �,--t_NEW FOOTING EXISTING
SHORESr=00TING
WATER
8' 4'=---mm* 1
TOP VIEW
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EXISTING NEW FOOTING NEW FOOTING
GOTING
SHORELINE
ADIRONDACK MADE LAKE GEORGE, NY Paul Collins
ENGtiN EERE� FOR LIFE ALUMINUM TUBE FRAME DOCKS
� - - N ARTICULATING•CANTILEVER•ROLL-INS 14 Elm Road
s70, ;,KS S1S-3�"i1-5735 BESTBUILfDOCKSC@CMAIL.COM
17 ASH DR. LAKE GEORGE, MY Queensbury, NY
Site Overview - Side View
Dock/ Deck Combo
SIDE VIEW
20 8'
DOCK' DECK
0" W FOOTING
WATER
ROCKS
E
G
LAKE BOTTOM
ADIRONDACK MADE LAKE GEORGE,NY
ENGINEEIZEU FOR LIFE ALUMINUM TUBE-FRAME DOCKS Best Built Docks
�'1 ARTICULATING•CANTILEVER0ROLL-INS
513-351-5735 BESTBUILTDOCKSQCMAIL.COM TypicaL
17 ASH DR. LAKE GEORGE, MY Forrn / Footing
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SIDE VIEW
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