application Office Use Only
ADDITION/ALTERATION PERMIT Permit#: CC 512: —2n(7
APPL 15 l!fl E Q V E tzm t Fee:$_ 75', 00
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Inv-ioe#: 12q 3
P:518-761-8256 www.queensbury.net MAR 13 2019 1 -
Project Location: 1172 State Route 9 TOWN OF QUEENSBURY
BUILDING&CODES
Tax Map ID #: 288.20-1-20 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): Great Escape Theme Park,LLC(Eric Gilbert)
Mailing Address, C/S/Z: PO Box 511,Lake George,NY 12845
Cell Phone: ( ) Land Line: ( 518 ) 792-3500
Email:
• Primary Owner(s):
Name(s): Same as Above
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Dean Hyatt
Contractor Trade: Work to be completed by Great Escape Theme Park
Mailing Address, C/S/Z: PO Box 511,Lake George,NY 12845
Cell Phone: ( 518 ) 955-0865 Land Line: ( 518 ) 792-3500
Email: dhyatt@sftp.com
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: JARRETT Engineers,PLLC
Contact Name(s): Robert U.Holmes II,P.E.
Mailing Address, C/S/Z: 12 East Washington St.,Glens Falls,NY 12801
Cell Phone: ( 518 ) 796-7381 Land Line: ( 518 ) 792-2907
Email: bholmes@jarrettengineers.com
Contact Person for Building& Code Compliance: Dean Hyatt
Cell Phone: ( 518 ) 955-0865 Land Line: ( 518 ) 792-3500
Email: dhyatt@sftp.com
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: X Commercial Residential
WORK CLASS:
Single-Family Two-Family Multi-Family (#of units
Townhouse Business Office Retail
Industrial/Warehouse Garage (# of cars ) X Other (describe Amusement Park
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 478 1st floor: 544(limited to our project area)
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space):
Total square feet: 478 Total square feet: 544
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 50,000.00
2. If Commercial project, what is the proposed use: Food Service(Tidal Wave Cafe)
3. Source of Heat (circle one): Gas Oil Propane Solar Other N/A
Fireplaces need a separate Fuel Burning Appliances &Chimney Application
4. Are there any structures not shown on the plot plan? ®E NO Explain: Located in the Great Escape
Theme Park
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 237.6
b. Is this a corner lot? YES
c. Will the grade be changed as a result of the construction? YES
d. What is the water source? 1JBLIa PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Sewer
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: Fit/ L.a kI-
SIGNATURE: _ DATE: (Video/0
Addition/Alteration Application Revised February 2019