AST-0233-2023 Office Use Only
ACCESSORY STRUCTURE Permit#: �`�' 00.3.3 ',;b,-7.3
Town of Qucbury PERMIT APPLICATION Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net Flood Zone? Y &0 Reviewed ByLl-�
Project Location:
Tax Map ID#: 3 O a _ 3 \ Subdivision Name:
Mm
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use: PLAY Q 9 sn^�
10- 0
STRUCTURE: �U1LD;1v _�c rJ J',
❑ 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:
2"d floor:
Total square feet:
Brief description of scope of project: Q ` Q ti: CAL
q�Z Gb0 ova .
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ S�
2. Are there any structures not shown on the plot plan? ❑ YES -Ef NO Explain:
3. Are there any easements on the property? ❑ YES X 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 I, or my agents, will obtain a certificate of
occupancy.
6. 1 a[so understand that 1/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:
SIGNATURE: DATE:
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):-[A tit��t.►� S h:-e , J
Mailing Address, C/S/Z: \? vnOLA
Cell Phone: S\'S -41 o - S \3 7 Land Line:
Email: yr zANk\tw . S\,%;<\ R y eo.,00. G ovv\
• Primary Owner(s):
Name(s): aS 0l
Mailing Address, C/S/Z:
Cell Phone: Land 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):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Architect(sVEngineer(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:
Email:
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FILE COPY
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Questions? Issues?
CONTACT US
24 hours / 7 days a week
OWorranty Parts `b -'�✓' � '<; �"� �>W/��'
www.sunjoyonline.com
customer.care@sunjoygroup.com c'
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A10200690222
Country of Origin: China 1 Production Number: xxxxxxxxxx
301.20-1-39 AST-0233-2023
Shiel, Matthew
17 Heresford Ln
Floating deck for gazebo 168 s.f.
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