application PRINCIPLE STRUCTURE Office Use Only
PERMIT APPLICATI ON �-� —�jl1 `— ' c,
Permit#: .
Town ofQucensbury Permit Fee: $ !p
50° 01)
742 Bay Road, Queensbury, NY 12804 *Rec. Fee: $
P: 518-761-8256 www.queensbury.net
Invoice#: ) 397
Project Location: 1172 State Route 9
Tax Map #: 288.20-1-20 Subdivision Name: E IEC
n in E
TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units si I �j - i y,
multiple family, apartments,condominiums, t)wnhouses,and/or manufactured adularr h� m o es, dj,{1ot
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homes. This is in addition to thepermit fee(s). by
CONTACT INFORMATION:
• TOWN OF QUEENSBURY
BUILDING&CODES
• Applicant:
Name(s): The 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
Contractor 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 ) 812-9345 Land Line: ( 518 ) 792-3500
Email: all
yatt@sftp.com
**List all additional contractors on the back of this form
• Architect(s)/Enqineer(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
Principle Structure Packet Revised February 2019
PROJECT INFORMATION:
TYPE: X Commercial Residential
WORK CLASS:
Single-Family Two-Family _Multi-Family(#of units )
Townhouse Business Office Retail Hotel/Motel
_Industrial/Warehouse Garage(#ofcars ) X Other(describe Amusement Park )
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
la trY: Shipwreck Cove: 2600+sq.ft. 1ST floor:
Rieft: Bucket Blaster: 830 sq. ft. 2nd floor:
XIIRcat: Pump House: 256 sq. ft.
Total square feet:
Basement(habitable space):
Total square feet: 3686 sq.ft.
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 300,000.00
2. Proposed use of the building: Water attraction _
3. If Commercial or Industrial, indicate the name of the business: The Great Escape Theme Park,LLC
4. Source of Heat: Gas Oil Propane Solar Other: N/A
(Fireplaces need a separate Fuel Burning Appliances& Chimney Application, one per appliance)
5. Are there any structures not shown on the plot plan? NO Explain: Located in the Great Escape
Theme Park.
6. Are there any easements on the property? YES NO
7. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 237.6 acres
b. Is this a corner lot? YES (01
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? JUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Sewer
Principle Structure Packet Revised February 2019
,
DECLARATION :
I. lacknowledge that no construction shall commence priorto issuance of a valid building
permit and work will be completed within a 12 month period.
2. If the work is not completed by the 1year 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 understand that I/we are required to provide an as-built survey by a licensed land surveyor of
all newly constructed facilities priorto issuance ofa certificate of occupancy.
I have read and agree to the above:
PRINT NAME: 6: c a /b9 A—
SIGNATURE: DATE: 3/z ( // I
•
Principle Structure Packet Revised February 2019