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AST-0528-2023 10111111116. Office Use Only ACCESSORY STRUCTURE Permit#: �' L --- rum,of'Qipc;,Si,i,n PERMIT APPLICATION Permit Fee:$ ) v 0 742 Bay Road,Queensbury,NY 12804 Invoice#: IOC " P:518-761-8256 www.nueensbury.net 7 r Flood Zone? Y I Reviewed By l Project Location: 366 Zoze2Nie (coreD dVee OW?y ip /z8°9 Tax Map ID #: -�®8, ! I - 1 — qv. Subdivision Name: PROJECT INFORMATION: TYPE: esidential El Commercial,Proposed Use: STRUCTURE: • El Boathouse(with or w/o sundeck) ❑ Canopy 0 Carport ❑ Cell Tower 21 Deck El Detached Garage(>300 s.f.) El Dock ❑ Gazebo 0 Pavilion 0 Pole Barn El Porch El Ramp El Shed (<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other: SQUARE FOOTAGE OF STRUCTURE:_._ -+-_ ..._ 1st floor: N i !� 2 ^ I 11 _. () ��; i , 7; J ig fL Fy 2'dfloor: GM!" 4/ 0 49 _ `� �' AUG 2 5 2a 23 /'J i Total square feet: 3Y Brief description of scope of project: E/! a.--Alon dea f 011 /3 Aid D�..r /I t,,,,deri iv • ii, goit-‘ ; 7 . , /1-i-, P _lji_..L.n11• 04/6 ivi iw SA6etV Y` 1e I ,„.7•E'!v Ate- ..,r.,Z..1 4,1 �i rr > a' i f f r r Li rr.•rrwxv'B,w UnY Appts 41 N,n Revised lone 2i CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • licant° Name(s): )1vi,'t� 64Z19a+2 5 Mailing Address, C/S/Z: 3�� Lv7;,<, 4✓6 °hi-A Cell Phone: 22,-z- o21 n Land Line: Email: biarzA2.v5 . yam• .� �1 _C©r+� • Primary Owner(s): Name(s): 4z)4/Ane 4 ` mpr. LiftzA rws- Mailing Address, C/S/Z: zera"6 ra(4 Cell Phone: 61q--22z-0./o Land Line: Email: L7lw-�"A-rzos ❑ Check if all work will be performed by property owner gpliy. • Contractor(s): (List all additional contractors on the back of this form) Contractor Na me(s): '217,044,1 ,/vr ' iZ 4 TNT/2e c"` I,'"c�`r`o Contractor Trade: ,� C©z cc— Je• Mailing Address, C/S/Z: �� ✓utack 5/ cb.i Plit2 c, N i 12 Re 2 Cell Phone: S'/ f �y ` Land Line: S�, — �Email: `�I /T c.r��s ��.� ��1 P cL,t **Workers' Comp documentation must be submitted with this application** • Architect(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: / a',._i f Cell Phone:. 1 S f2 0?99( Land Line: $ . Email: G0-11 . (_'f.--1 1 .n ',niHtu, Jy,Gnr.dunr aed Amex) ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ y / 06 2. Are there any structures not shown on the plot plan? Fir YES ❑ NO Explain: 3. Are there any easements on the property? ❑ YES LrNo DECLARATION: 1. I acknowledge that no construction shall be commenced prior to the issu port a valid permit permitconstr and will brequire e completed within a 12 month period.Any changes to the approvedplansP 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. I 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 6. I 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: cA9u)b L14\f)1-�+ZUS SIGNATURE: CO DATE: V 2 SoZ ACttYOrt,INct7i4A i,ctiu>n Nemec!June 2! ` ,TT i fIai € 'i l' � 41 i i W f , " L x; - fi aa, i i }t W{h i {k1 I J_ "./ M a. ``:i � V,. . t` i al l.1' .'-, :. efe. ' i'' - 'Si: - P b` \ ] {. -1 IM.<'t k--'q"�1,, h 1. ' 1` I 3i t �h h i1` 4 Q3 .'.. .f ,a•. v., v, 1 , . . t • r . i . t ._i ,0 , , •� ' tt . , . . -.- { ,;:i $i _ fir.x xyv,' jF�, „.', 308.11-1-40.1 AST-0528-2023 • ;, g F u Lazarus, Ronda & DavidI. `�' ., �� af, 366 Luzerne ` ,ter I : k '.* u erne Rd , ,� r , �{"`4 ` ,. Front porch s.f deck 252 s.f. 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I _.. ♦ I 'III t t t • `` 7 1 1 f 1 r T f �} �, - { i I - . j _ .a.... -.i 1 ..7 47 * i •�tK'' _} �' i(;.r •L s ..1..,-.;.,A:.- w. - .. .„. ,., -, ,..�_a - yk a i '' s " ac r _ - - 1 , 366 luzerne rd lEEN&1b,..13y LAND CONSERVANCY,IN,•`1 308 11.1-d1 SMITH,FRED ' 11 308.11.1-40 1 RYERSON,RANDY B • j1,� ll{ i1 // - - -Pi.r3-6-6- L - .'" . . ., ,rA11 .• fo 1 354 41,,aune PYd ` 1 :53 PM1:5Gd Undafles 0 0.01 0.0 i tk 02 m 6 Dints ! ✓ i� kit eJ�v J Y'���1 LI 14, I— .0 00, 0 01 0 03 keII 1 Ear Gt ;eMaaj MG Crntw.oR A•�, � GA ,F✓. +1S7 GtM dwCt . j UG , - r,....7.......•..,., iYC'r:wr.l. 4lMVt4 d y,pr - .. 1l/Si ^ + i, d(io dok- (t a t((-5 ...k_ -32-- . , �j(/ gyp}, '• I . N .;,-. r(ov\P 6,./v --- . *, et 1 1 "r �• . 1 it mil\;, y1 r: 1 u: 'VIELD REPORT CUSTaJ�mp Joe SITE : m , 66 (Aze ae to, A .. ar OF Mk` Slma+L for ew x+awd 4%art radwtl warttWcompteamlcwt� Q dy load a*,Not mporwok baw ft towmcdm at ttw TWMO . McRalk�ceYa wa tlwa sad+mo. `:6ad--U ed::.. 6d: :~L 7iAI C�4PAC T SINK. -ti_,,PST :. ' CAPACITY �..:.. zz 55" .. a ► 4,646 - ,