application Office Use Only
4W ADDITION/ALTERATION PERMIT Permit#: (Y— C) FJ1- 20 lg
APPLICATION Permit Fee:$ V� OO
Tvtvn of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#: 95Zo
P:518-761-8256 www.ciueensburV.net
Project Location: 1557 State Route 9
Tax Map ID#: 288.8-1-6 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): Meyer&Fuller,PLLC
Mailing Address, C/S/Z: 161 Ottawa Street,Lake George NY 12845
Cell Phone: 518 )791-9481 Land Line: 518 ) 668-2199
Email: jmeyer@meyerfuller.com
• Primary Owner(s):
Name(s): 1557 Route 9,LLC
Mailing Address, C/S/Z: 161 Ottawa Street,Lake George,NY 12845
Cell Phone: 518 ) 791-9481 Land Line: 518 ) 668-2199
Email: jmeyer@meyerfuller.com
• Contractor(s):
Business Name: Honey-Do Man
Contact Name(s): Kevin Tucker
Mailing Address, C/S/Z: 442 Corinth Road,Queensbury,NY 12804
Cell Phone: 518 ) 260-4810 Land Line:
Email:
• Arch itect(s)/Engineer(s): JUN 13 2018
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line: � )
Email:
Contact Person for Building & Code Compliance: Jeffrey Meyer
Cell Phone: 518 ) 791-9481 Land Line: 518 ) 668-2199
Email: jmeyer@meyerfuller.com
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
PROJECT INFORMATION:
TYPE: x Commercial Residential
WORK CLASS:
Single-Family Two-Family _ Multi-Family (#of units )
Townhouse x Business Office Retail
_ Industrial/Warehouse Garage (#of cars ) _Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space):
Total square feet: 0 Total square feet: 0
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $/4,�o�
2. If Commercial project, what is the proposed use: Professional offices
3. Source of Heat (circle one): Gas Oil Propane Solar Other
Fireplaces need a separate Fuel Burning Appliances & Chimney Application
4. Are there any structures not shown on the plot plan? YES NO Explain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the�arcel? 1.16 acres
b. Is this a corner lot? YES
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PUBLIC RIVATE WEL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
3. 1 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. 1 acknowledge that prior to occupying the facilities proposed 1, or my agents, will obtain a certificate
of occupancy.
5. 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: Jeffrey R.Meyer
SIGNATURE: DATE: o
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018