Loading...
applicationOffice Use Only 7 ADDITION/ALTERATION PERMIT Permit #:H -0780 *208} APPLICATION Permit Fee:$_200 ~ Town of Quceasbury 742 Bay Road,Queensbury,NY 12804 hnveica ts P:518-761-8256 www.queensbury.net Project Location:_'&Heai tage P+.Queensbury Tax Map ID #:aH CONTACT INFORMATION: e Applicant: Name(s):__CERNE:Consrenctiad Mailing Address,C/s/z:_'S&9_@t.9 Cell Phone:_($I8_)__3b1 -6331 Email:Ceanonegu:(dees ine Z gens «Primary Owner(s): Name(s):Mike +Erica SHEed Mailing Address,C/s/2:_1 HEéRitna<Pt.QuéewsBuby WY 12K 04 Cell Phone:_(SIP_)_788 =7/22 land Line:_() Email:ERICALYANS HEAD Oma.com C1 Check if all work will be performed by homeowner only ¢Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):_Ce#ove Consrenctiond Contractor Trade:__Bui ldee_ Mailing Address,C/S/Z:__/S 8?P49 FH.Ebwaen NY 12a7as Cell Phone:_(SI&_)_361 -6331 land Line:_() Email:Ceeeove@us ideesine @ qma-!Cam *#List all additional contractors on the back of this form ©Architect(s)/Engineer(s): Business Name:Visteon Engines Ny Contact Name(s):__O40 _Ryad v Mailing Address,C/s/Z:_206 6led S+,Suit 30 Glens Fails,WY 12?1 Cell Phone:_(S8_)_742 -75697 land Line:(SI )_292 -7264 Email:_deyad@ dwape .om Contact Person for Building &Code Compliance:Greven Ceekove Cell Phone:_(SI.)3b{-6331 Land Line:_(), Email:_(eeponeeu:Mdeesinc @ Gmail Com ‘ddition/Ateration Apalication Revised February 2019 PROJECT INFORMATION: Commercial X_ResidentialTYPE: WORK CLASS: X Single-Family _Two-Family __Multi-Family (#of units ) __Townhouse ___Business Office __Retail __Industrial/Warehouse Garage (#f of cars )Other (describe ) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: ast floor:_kiteued 2"floor: 3°floor:3"floor: Basement (habitable space):Basement (habitable space): Total square feet:Total square feet: ADDITIONAL PROJECT INFORMATION. 1.Estimated Cost of Construction:$_30,000 If Commercial project,what is the proposed use: Source of Heat (circle one):Oil Propane Solar Other Fireplaces need a separate Fuel Burning Appliances &Chimney Application Are there any structures not shown on the plot plan?YES (Wo Explain: .Are there any easements on the property?YES SITE INFORMATION: What is the dimensions or acreage of the parcel? Isthisacornerlot?YES.o> Will the grade be changed as a resultoftheconstruction?YES What is the water source?PRIVATE WELL Is the parcel on SEWER or a PRIVATE SEPTIC system? gpoao7o ‘Addition/Ateration Application Revised February 2018 DECLARATION: 1 |acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. If the work is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval. \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. |acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy. 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. Ihave read and agree to the above: PRINT NAME:STEVEN _Clewtonle SIGNATURE: [Addition/alteration Application DATE:_/t&2-/9a Revised February 2019