AST-0438-2023 ✓jam Office Use Only
ACCESSORY STRUCTURE Permit#: :r- 04/31-_ 2
Town of Queensbury PER 'PLICATION Permit Fee: $ / 11 GD
OLECE742 Bay Road,.Queensbury,NY 12804 1 OJ IE oice#:
P:518-761-8256 www.queensbury.net JUL q „ 'l e od Zone? Y Reviewed By.
TOWN WN---
OF C ut= Ise 7 tr.t.4CLf. R
Project Location: ��" e
Tax Map ID#: . (($ Subdivision Name:51Absil ) �C�
PROJECT INFORMATION: V
TYPE: y Residential ❑ Commercial, Proposed Use:
STRUCTURE:❑ Boathouse(with or w/o sundeck) ❑ Canopy ❑ Carport ❑ Cell Tower eck
El Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo El 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-:=..
2nd floor:
Total square feet:. 9)
Brief scope of description of , a project: VeALIOLA �� ✓�
p p P 1
G: to o al we_ t
Accessory Structure Application Revised November 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 4, VIC
2. Are there any structures not shown on the plot plan? El YES K,NO Explain:
3. Are there any easements on the property? ❑ YES
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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 area 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.
have read and agree to the above: -
PRINT NAME: 'ie. `
z)
SIGNATURE: DATE: 7J/ /
�S 1
Accessory Structure Application Revised November 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): \ Zs ' j
Mailing Address, C/S/Z: •"5
Cell Phone: Srb--1-14-1fO9 Land Line: —
Email: (` ,in_Q.A Ne-S qa-1 () 1. c v 1
• Primary Owner(s):
Name(s): =
Mailing Address, C/S/Z: � �.
Cell Phone: Land Line:
Email:
*i heck 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(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: . WC ,
1vw
Cell Phone: Land Line: t
Email:
Accessory Structure Application Revised November 2022
• 308.19-2-13 AST-0438-2023
Vanessa & Jeffrey Ives
- "" 23 Essex Ct.
il'E e; Il W`E Partial deck aro nd_.pool..«..
JUL 1 8 20°) . 1LYJ
_. ATTEPITION H®ME OW
T cwN +J� 11Di=E.r� ;c�u��r IdER
BUILDING L CODE CODES
Please assure you are familiar with the Pool
_��_.1 --�n- - ---- Enclosure requirements specific to your pool,
You are required to meet all applicable codes .
�( �Y regarding swimming pools, spas &- Yhot tubs
`� at the time of inspection,
. - •TOWN OF QUEENSSURY
'BUILDING & CODES DEPT.,
P�evlewed y: . _� TOWN OF QUEENSBURY
- ., - BUILDING DEPARTMENT
- ` ;., • Date: _ 0 —2-:—)) Based on our limited examination,compliance
with our comments shall not be construed as
indicati;g the plans and specifications are !n
full compliance with the Budding Codes of
New York State.
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308.19-2-13 AST-0438-2023
Vanessa & Jeffrey Ives
• ; 23 Essex Ct.
s ..:.
g Partial deck around pool
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