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application '• 1 Office Use Only ADDITION/ALTERATION PERMIT Permit#: — 04C1L-2.53 l) �Q APPLICATION Permit Fee:$ 200 ,(5 Town of Quccnsbury 742 Bay Road,Queensbury,NY 12804 Invoice#: I S �Z P:518-761-8256 www.queensburv.net Project Location: _74 State Route 149 Tax Map ID #: 289.9-1.7.1 Subdivision Name: CONTACT INFORMATION: • Applicant: Name(s): David King Mailing Address, C/S/Z: Lake George RV Park, Inc. 74 State Route 149 Lake George, NY 12845 Cell Phone: I ) Land Line: _( 518 ) 792-3775 Email: dave@lakegeorgervpark.com • Primary Owner(s): Name(s): Jessica king Qualified Residence Trust, David King Mailing Address, C/S/Z: Lake George RV Park, Inc. 74 State Route 149 Lake George, NY 12845 Cell Phone: ( ) Land Line: ( 518 ) 792-3775 Email: dave@lakegeorgervpark.com ❑ Check if all work will be performed by homeowner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contact Name(s): Hilltop Constrruction-Tom Albrecht Jr. Contractor Trade: General Contractor Mailing Address, C/S/Z: 51 Crowley Rd Hudson Falls, NY 12839 Cell Phone: ( ) Land Line: ( 518 ) 79800338 Email: tomjr@hilltopconstructionco.com **List all additional contractors on the back of this form • Architect(s)/Engineer(s): Business Name: Phinney Design Group Contact Name(s): Michael Phinney Mailing Address, C/S/Z: 142 Grand Ave Saratoga Springs, NY 12866 Cell Phone: ( ) Land Line: ( 518 ) 587-7120 Email: mphinney@phinneydesign.com Contact Person for Building & Code Compliance: Tara Borodin-Galarza Cell Phone: ( ) Land Line: ( 518 ) 587-7120 x21 Email: tborodin@phinneydesign.com Addition/Alteration Application Revised February 2019 PROJECT INFORMATION: TYPE: Commercial X Residential WORK CLASS: X Single-Family _Two-Family Multi-Family (#of units Townhouse Business Office Retail Industrial/Warehouse Garage (#of cars ) Other(describe ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: NA 1st floor: 40 sf 2nd floor: NA 2nd floor 136 sf 3rd floor: NA 3rdfloor: 136 sf Basement (habitable space): Basement (habitable space): Total square feet: Total square feet: 312 sf ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 250, ©°° 2. If Commercial project, what is the proposed use: 3. Source of Heat (circle one): Gas Oilopan Solar Other Fireplaces need a separate Fuel Burning Appliances &Chimney Application 4. Are there any structures not shown on the plot plan? YES Ka Explain: 5. Are there any easements on the property? YES 6. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? 3.06 acres b. Is this a corner lot? YES PGA c. Will the grade be changed as a result of the construction? YES d. What is the water source? I5L(OC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Private Septic Addition/Alteration Application Revised February 2019 DECLARATION: 1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 3. I certify that the application, plans and supporting materials are a true and 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. 4. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. 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: t> 14,a(, r, SIGNATURE: ,�,44 DATE: 1 )1,3111 Addition/Alteration Application Revised February 2019