AST-0006-2022 Office Use Only
ACCESSORY STRUCTURE Permit#: DO -- 202 -
� , PERMIT APPLICATION
Permit Fee:$ 1
742 Bay Road,Queensbury,NY 12804 Invoice#: litSe3tj
P:518-761-8256 alt {�/�
Flood Zone? Y 6 Reviewed By: u V''S
Project Location: a y 1 1!'fEm 3L7 rz. 117
Tax Map ID#: A x 61 /c -.2 ""2
Subdivision Name:
PROJECT INFORMATION:
JAN 0 5 2022
TYPE: [Residential ❑ Commercial, Proposed Use:
TOWN OF.OUEENSSURY
f ?(ttt_�}!vir & CODES
STRUCTURE:
11" oathouse(with or w/o sundeck) ❑ Canopy 0 Carport 0 Cell Tower ❑ Deck
❑ Detached Garage(>300 s.f.) ❑ Dock 0 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: 16 y
2"d floor:
Total square feet:
Brief description of scope of project: RGMovt' t, p c lv /c ;,A,D leiga0C4, 19 S Play
Accessory Structure Application
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 0.000 "'
2. Are there any structures not shown on the plot plan? DYES L'IN0 Explain:
3. Are there any easements on the property? ❑ YES i3 NO
DECLARATION;
1. I 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 If,for any reason,the.building permit application is withdrawn,30%of the fee is retained by the Town of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. 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 newt
constructed facilities prior to issuance of a certificate of occupancy. Y
I have read and agree to the above:
PRINT NAME: rim*. oftwo
SIGNATURE: 0/-lat,,e.
DATE:12''0'2/
Accessory Structure Application
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicants
Name(s): F2 }IJIC 96 N9,leD' 12 g .0
Mailing Address, C/S/Z: po Qox �91 a LE, LO NY
Cell Phone: c/, 7/6 iy eel Land Line: sre* 656 365.
Email: arro 2,c c o e lYI,p+t. • cc sw
• Primary Owner(s):
Name(s): ;IAN krt[y
Mailing Address, C/S/Z: y / /ff" '4y " �1t) 2�y
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): 6/444K . QEN44?o(De VatTF Dock CO- 'P-9"V
Contractor Trade: Ai�c
Mailing Address, C/S/Z: 90 pme 291 GL,F.vLl�»e N y 12 "ao
Cell Phone: so 746 ."/ Land Line: P� 1‘2
Email: EC,T1 i <LCo a b/' 1/L r £ 6602
**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: Fi't4iufC £""'
Cell Phone: f/t 796 /ygy Land Line: 6"70# CS'6 3G15"
Email: a /re Aae co efity; t. , Coo
Accessary Structure Application
Revised January 7n71
Deck and Roof Design checklist
gun o►-ee, 0,2,P Ieoirkw - on divak.
C fr$ Is deck freestanding or attached
Footing
/L Sono tubes sized for posts 4x4 8" 6x6 12"
tv/ A-Big foot or footing for roof load
6 Proper attachment to post and footing shown
N Ip Proper flashing or waterproofing to structure shown
1i5 Attachment to structure shown on plans
VIPS Galvanized or stainless steel bolts shown NO ZINC COATED
Hex headed bolts NO CARRIAGE BOLTS
(--CJDiagonal bracing shown for deck over 24"
(' Floor joists parallel to carrying beams
V-'Deck post to beam attachment shown
C.--PS Over 30" requires handrail
vl-C Over 30" requires guards
(1(G� Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021
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BUILDING & CODES DEPT. .______J
• Kelly Irrevocab.le Family
241 Assembly Point Compound
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