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application Office Use Only ( 9 ADDITION/ALTERAT *N PERMIT Permit#: J APPLICATION C Town of Queensbury Permit Fee: $ "�4 742 Bay Road,Queensbury, NY 12804 1 �3 P:518-761-8256 www.queensbury.net Invoice#: Project Location: 36B Smoke Ridge, Queensbury Tax Map ID #: 308.08-1-27 Subdivision Name: ORIGINAL PERMIT#91-687 e :11:411,1.1) CONTACT INFORMATION:• Applicant:Name(s): JMC PROPERTIESMailing Address, C/S/Z: PO BOX 684, GLENS FALLS,NY 12801 Cell Phone: ( ) Land Line: (518) 792-9242 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): Contact Name(s): CIFONE CONSTRUCTION CO. Contractor Trade: GENERAL CONTRACTOR Mailing Address, C/S/Z: PO BOX 684, GLENS FALLS, NY 12801 Cell Phone: ( ) Land Line: (518) 792-9242 Email: **List all additional contractors on the back of this form • Architect(s)/Engineer(s): Business Name: Contact Name(s): Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: _( Email: Contact Person for Building & Code Compliance: JOHN CIOFNE Cell Phone: ( ) Land Line: (518) 792-9242 Email: OFFICEl@CIFONE.COM Addition/Alteration Application Revised February 2019 PROJECT INFORMATION: TYPE: ❑ Commercial X Residential WORK CLASS: ❑ Single-Family X Two-Family ❑Multi-Family (#of units ) ❑Townhouse El Business Office ❑Retail ❑ Industrial/Warehouse ❑ Garage (#of cars ) ❑ Other (describe ) ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: 1st floor: 532 2nd floor: 2nd floor: 717 3rd floor: 3rd floor: Basement (habitable space): Basement (habitable space): NONE Total square feet: Total square feet: 1249 = $374.70 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 50,000.00 2. If Commercial project, what is the proposed use: 3. Source of heat: IGas❑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 parcel? 123 X 250 b. Is this a corner lot? ❑YES ONO c. Will the grade be changed as a result of the construction? ❑YES ONO d. What is the water source? ❑X PUBLIC ❑PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? SEPTIC Addition/Alteration Application Revised February 2019 4 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: V O h Cco h-r SIGNATURE: d . _ DATE: ,5 ley 19 F Addition/Alteration Application Revised February 2019