application BUILDING "C"
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Office Use Oniy
Permit IS: CC -ULI3.7- 2 Y1 9
`' PRINCIPLE STRUCTURE PERMIT (�
Permit Fee:$ 9 9 s-• G G
APPLICA
Tirf,tiu r,i•bur i, tY/ U* Fs sril /—l1T
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury,net Invoice if �? 70
PH JUN262019 U
Project Location: 106 EVERTS AVE
TOWN OF OUEEr.ISPU".
Tax Map ID#: 302.8-2-66.1 (LOT 2) s Subtilvotr Name:.SSCOVILLE
'TOWN SD.RESOLUTION 86-2013: S850 recreation fee for new dwelling units single family,duplexes/two-family.
multiple family, apartments, condominiums.townhouses and/or manufactured&modular homes.but not mobile
homes This Is In addition to the permit fee(s).
CONTACT INFORMATION:
• Applicant:
Name(s): STEVE SCOVILLE
Mailing Address,C/S/Z: 6 LAKE VIEW DRIVE,WILTON NY 12831
Cell Phone: ( 518 ) `19b' 1015c Land Line: ( 518 ) 5C6Ar-084,o
Email: scoville584@xmail.com/discov1978@g nail.com
• Primary Owner(s):
Name(s): SAME
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Contractor(s):
Business Name: Paul Kruger(Concrete) O'Connor Construction,{Site Work)
Contact Name(s):
Mailing Address,C/S/Z:
Cell Phone: ( .___) Land Line: )
Email:
• Architect(sl/Engineer(s):
Business Name: TRACHTE BUILDING SYSTEMS INC
Contact Name(s):
Mailing Address,C/S/Z: 314 WILBURN ROAD,SUN PRAIRIE WI
Cell Phone: ( ) Land Line: ( 800 ) 356-5824
Email:
Contact Person for Building&Code Compliance: DON SCOVILLE
Cell Phone: ( 518 ) 19co_ 2"4 Land Line: ( 518 )745-1849
Email: 'scov1978@ mail.com
owe of 1•.Ieenstury Bud S.Code tnforcemen: e r r ude ir•ucture Appi.cahon Revised ieb,.,arY 201
PROJECT INFORMATION:
TYPE Commercial id I
WORK CLASS:
___Single-Family Two-Family :lulti Family(#of
Townhouse Busries3 Office _._Retail Hotel/Motel
Industrial/Warehouse Garage(#ofcars _ X Other(describe SELF STORAGE
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
1ST floor: 6300 SF Bldg"C" 1sT floor:
2nd floor: _ 2nd floor:
3r0 floor: Total square feet:
4th floor:
Total square feet: 6300 SF
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ $75,000
2. Proposed use of the building: SELF STORAGE FACILITY rr
3. If Commercial or Industrial,indicate the name of the business: ..Yer\-S )►Ncenskie.. e-.\t� S1araJe-e.
4. Source of Heat(circle one): 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? YES xplain:
6. Are there any easements on the property? YES COO
7. SITE INFORMATION: 3 ��
a.What is the dimensions or acreage of the parcel?
b. Is this a corner lot? YES
c.Will the grade be changed as a resu t of the construction? 4110NO
d.What is the water source? PUBLIC PRIVATE WELL N/A
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Ni.\
Town ofQueewburyarch)&Code (..o,_eme.t Prrc pie StnctureAppr-a:n"Revise:Fetr..a,'7Jr
DECLARATION:
I. acknowledge that no construction shall commence prior to 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 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: STEVE SCOVILLE
SIGNATURE: Q DATE: q
Town of Queensbury Building&Code Enfoetlment Principe Structure Application Revised February 2017