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AST-0293-2022 Office Use Only ACCESSORY STRUCTURE Permit#: 202 Z Town ofQueensbury PERMIT APPLICATION Permit Fee:$ a�D 742 Bay Road,Queensbury,NY 12804 Invoice#: A OCD�. P:518-761-8256 www.gueensbury.net Flood Zone? Y N eviewed By: Project Location: 81 eh Ant Rrdou- Tax Map ID#: Z��• �' -FJ Subdivision Name: rnZ PROJECT INFORMATION: ® � MAY 1' Zp?? TYPE: V/Residential Elr Commercial, Proposed Use: O pINGU& C.0 v�Y STRUCTURE: IFS ❑ Boathouse (with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower ❑ Deck ❑ Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp W Shed (<300 s.f.) ❑ Solar Panels (w/o rafter upgrades) ❑ 3-Season Porch ❑ Other: SQUARE FOOTAGE O�FSTRUCTURE: 1st floor: ' 7 40 S"/ 2nd floor: Total square feet: Brief description of scope of project: 4nl*'S ) a r-.r&n -h:�, ha-to-�" k4 cur � ( Accessory Structure Application Revised March 2022 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 1q, 0111), pb 2. Are there any structures not shown on the plot plan? ❑ YES WAO Explain: 3. Are there any easements on the property? ❑ YES WIN"O 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3. 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 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: SIGNATURE: lw DATE: Accessory Structure Application Revised March 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): ChiAfatiallip—, Mailing Address, C/S/Z: 3! Cktslnw-f RiAg- - �� LU►�- y I Cell Phone: 5 l&—744- ,;?0&,`�_ Land Line: Email: Primary Owner(s): Name(s): Mailing Address, C/S/Z: \��nk 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): C-;;ar� -Ti Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email **Workers' Comp documentation must be submitted with this application** • Arch itect(s)/Engineer(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 March 2022 GARDEN UTIME ESTIMATE Queensbury,NY 518.793.8555 x 327 Date:5-17-22 Wilton,NY 518.793.8555 x 306 Quote#: Clifton Park,NY 518.793.8555 x 302 Customer ID: Expiration Date:6-7-22 To: Anita Chiaravalle 31 Chestnut Ridge Road Queensbury,Ny 12804 Email: justforanita@gmail.com Phone: 518-744-2062 Salesperson/E-mail Job Payment Terms Due Date tomm@gardentimeinc.com 50%down,balance at time of delivery #2210212 12x20 NE Hamilton Qty Description Unit Price Line Total 1 #2210212 12x20 NE Hamilton in Duratemp in red/red and black shingles $ Savings ( ADDITIONAL 6'DOUBLE DOORS($850);4 TRANSOM WINDOWS($600); 1 UPGRADE TO 24X36 WINDOWS($170);DELUXE VENTS($150);LG CUPOLA $ WITH CLEAR COAT&PAINT($865) Building Subtotal Garden Time offers site prep if needed.For an 12x20 building the cost is$770.00 This 1 includes leveling site up to 6"out of level and installation of appropriate sized pad of $ crushed stone to accommodate building and drip area. If you are more than 50 Miles from our closest facility there will be additional mileage charges.Up to 12'wide is$5 per additional mile,over 12'wide is$10 per additional mile. 1 Fuel Surcharge $ 1 5x4 Ramp $ Subtotal Prices are subject to market conditions and may be increased accordingly Sales Tax Materials and/or Services not listed are not included Total �~Thank you for your business! i i w �..: _, only has been visually inspected and certified as of r / this date pursuant to applicable codes. Date Inspector J l y ' pmuuuuuuui u i N ^ y� m m4�iD D-4-io 0-:rr-;UTIm z ADto �EADz " N .";�:-•.71..i z rAm +O -�=r=Axz DD"'0 m c xxDAO Z c M O D<D OIT pzA D �A_m�z iDOc4-()G �xm-m jr �1 + )HU �Amdiii 03A� ( Oz tpyAZ Z L;�,:pl•��'4 �rmAA�a �O�00Ati itTm�D NN xA-+bm N z iT cr p � m� E O f5 b 2 a 0 -+ m o d (l -; �2' 3I D z x O c :��` b �i N- i V 00 O A E P, { d � w 6�� p m� � d tcn A M M 4, A� -, O D A° A dO D�xAD�O ZZ vZ �rcnpm O0 0 r E i U At�itcto ,A A dC. 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Cifone Construction Co, Inc. PO Box 684 Glens Falls, NY Ph. (518) 792-9242 Fx, (518) 792-3006 www,<Ifonacom 31 CHESTNUT RIDGE ROAD GUEENSBURY, NY 547Rourd SPRINGS,NY 12866 'a'RDk GAS 51e-58M17 PAX516-58&0019 WW W.PAONEARCHrT%CTURE.COM TITLE: SITEPLAN