CC-0157-2019TOWN OF QUEENSBURY
742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: CC-0157-2019
Tax Map No: 303.15-1-32
Permission is hereby granted to: Just Goods, Inc.
For property located at:276 DIX AVE
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: Silver Dix LLC Business Office-Alteration 501000.00
Owner Address: 3109 Stirling RD,200 Total Value 501000.00
Ft.Lauderdale,FL 3 3 312
Contractor or Builder's Name/Address Electrical Inspection Agency
Rozell Industries Inc.
129 Park RD
Queensbury,NY 12804
Plans& Specifications
Commercial Alterations 300 s.f.
new separation wall)
175.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,April 6, 2020
If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Friday,April 5, 2019
SIGNED BY.for the Town of Queensbury.
Director of Building&Code Enforcement
t Office Use Oniy
ADDITlOfilAL`['EY1CfN PERltilll'1"
APPLICATION Permit Fee:
Ton of EZueensbury
742 Bay Road,Queensbury,NY 12804 invoice m
P:516-761-8256 Aj vev.a+ueensburv.ne-r
Project Location: 1460*116 V11 bq6 t-
Tax Map ID#o 3U5.I y-' j2 Subdivision Name:
CONTACT INFORMATION:
Applicant:
Name(s): Jt,s`( C
Mailing Address, C/S/Z: s'I y2E+ Sri-L,Ms fh- AN 1, &VI
Cell Phone: ql y ) 7 Y Cis?,f i Land Line: c/-
Email:. J iM JU"T
G Primary Owner(s):
Name(s): I Wofk- bi x LAG Sr yC- W Y qP4
Mailing Address, C/S/Z: 33 rw 'iris f A L i--' ,L",
Cell Phone: 3 6/ - z-,Land Line: "t )3 -76 40
Email: a /i- 0e'f
Contractor(s)a
Business Name: r -/kk- -10-5
Contact Name(s): u 0-'el
Mailing Address, C/S/Z: I?--r y ?j i f` fL 'y
Cell Phone: _{ i:) 36/ Z y 7 Land Line: ( S/,fr ) 7qJ
Email:
Architect(s)/Engineer(s):
Business Name: JANk
Contact Name(s): p>a LApU-
Mailing Address, C/S/Z: JV-,e b1.x AA 6gl,Jj3 15 h& ift
Cell Phone: ( "ME )7.,j& Land Line:
Email: eyhall&,L {corr?
Contact Person for Building & Code Compliance: t-V44
Cell Phone: 61 e ) Land Line: (10119
Email: YEA (@Cr- CD
Town of Queensbury Building&[ode Enforcement Addition/Alteration Application Revised February 2017
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PROJECT INFORMATION.
TYPE: V Commercial Residential
WORK CLASS:
Single-Family Two-Family Multi-Family(#of units
Townhouse Business Office Retail
V//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:
4tb floor: 4th floor:
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
2. If Commercial project,what is the proposed use: IrlI461 wA1 aw!5e
WALC.
3. Source of Heat(circle one): ( 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 Explain:_ tSU e WT004 w_ W81144-
5. Are there any easements on the property? YES I(
6. SITE INFORMATION:
a. .What is the dimensions or acreage of the parcel? eb6 46091.
b. Is this a corner lot? YES K9 0)
c. Will the grade be changed as a result o`lhethe construction? YES
d. What is the water source? < L! PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? !!tabe--
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
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DECLARA
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. If the work 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: AIL%
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017
4.
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