AST-0264-2023 Office Use Only
J ACCESSORY STRUCTURE Permit#: � — bZh4- 202�
Town ofQ b ry PERMIT APPLICATION permit Fee:
742 Bay Road,Queensbury,NY 12804 Invoice#: (0
P:518-761-8256 www.gueensbury.net Flood Zone? Y �N` Reviewed By:
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Project Location: 3 I J7 0 n 01c C i fC (G
Tax Map ID#: 1•�2-- �� 't Subdivision Name:
PROJECT INFORMATION:
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: L3 D D S 9
2nd floor:
Total square feet:
s
Brief description of scope of project: y 1 4 c c(C. P o d 1p . Sc fee ti .3 ei e� 7/-C
Accessory Structure Application Revised June 2022
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 15j dQU
2. Are there any structures not shown on the plot plan? ❑ YES 'NO Explain:
3. Are there any easements on the property? ❑ YES 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 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: e�G V�✓� ���7� f i `7,
SIGNATURE: DATE: CI
Accessory Structure Application Revised June 2022
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 1. �e
Mailing Address, C/S/Z- 1 7, rC�c r,w u ? d c SG G
Cell Phone: Land Line:
Email: Ya �o-a, e-o^-
• Primary Owner(s):
Name(s): L srts sg, An.( jcs.tC' 6 g d<—,
Mailing Address, C/S/Z: nr'cG. C,rc (c--- ac.Cry Ur,.._
Cell Phone: Land Line:
Email: Miss,/arIss f. ro�^
❑ 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): Tak r 03v'r
Contractor Trade:
Mailing Address, C/S/Z: 17 66 reei, ")u,a /? ' SG
Cell Phone: / -)Y y- /ram Land Line:
Email: I r bcFt, kav►J a d ad .ram
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engi nee r(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:
Accessory Structure Application Revised June 2022
301.12-2-47 AST7,0264-2023
HogueFlesse & Larissa
31 Heinrick Cir
3-season porch 300 s.f.
Y
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance A
with our comments shall not be construed as
indicating the plans and svelfications are in
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full compliance with the ulIdIng Codes of
New York State.
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TOWNbF QUE�NSBU
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BUILbING & G',,0DES T. VILE r'()PY
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Reviewed B0
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Dat— MAY is
'Ay 1=9 2021"
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31 Heinrick Circle Back Yard View r
Fence• PROPERTY LINE(APPROX 163 FEET)
27 feet (BACK PROPERTY LINE TO POOL)
> 90 fe t (PLAY AREA TO POOL)
Play
area
Pool 32`X 12 ` BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed*as
Indicating the plans and sppecifications arc) in f p (v J
full'compliance with the Huilding Codes of 1
<-+25 feet (LEFT PROPERTY LINE TO POOL) New Yolk State.
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-----$-5�fe&"POOL TO HOUSE T 8�"Q
TO l ��F�Ns
TOWN OF QUEENS r v Y
BU(LDiNG � CODES DEP
Reviewed By:
Date: s 7 z,
Deck V feet X20 feet• FILE COPY
l f V YU
House
301. 7 DEMO-03_, =2021.
Moses, Da 1i
32 Heinrick Cix
Fill in nd pool