application BUILDING "D"
Office Use ONtr
•--Aermit a: CC �!tto U( 6? � I
PRIN�• i•
C � '1 y� , u FRrmit Fee:5 7 5-0. (>v
• ski •L
(tyr•,t.bt,r, .Rec Fee:$ N/t�
742 Bay Reath,rueensbury,NY 118041 J U N 2 6 2019
P:518-761-8256 www.queenstwrk t -t)It voice#: J73/
Project Location: 106 EVER'"S AT@WN OF QUECNSBURY
BtlitDITICTIZCODES
Tax Map ID#: 302.8-2-66.1 (LOT 2) Subdivision Name: SCOVILLE
*TOWN BD.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 ) 19 eo- MSc Land Line: ( 518 ) 564-o t:3 rr,o
Email: scovi11e584@gmail.com/discov1978AgmaiLcom
• 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: f_ )
Email:
• Architect(s)/Enaineerls):
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: ( 503 ) 21° 4- Land Line: ( 518 )745-1849
Email: djscov1978@gmail.com
Town of Queenbury Building&Code Enforcemen; Principle Structure Application Revised{ebtwry 2011
PROJECT INFORMATION:
TYPE: Commercial X id I
WORK CLASS:
Single-Family Two-Family Multi-Family(#of
Townhouse Bwiness Office __Retail Hotel/Motel
IndustriaL'Warehou;z Garage(#ofcars ; X Other(describe SELF STORAGE
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
1ST floor: 5000 SF Bldg"D" 1"floor:
2"floor: 2 floor: _
3"floor: Total square feet:
4'^floor:
Total square feet: 5000 SF
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ $75,000
2. Proposed use of the building: SELF STORAGE FACILITY
3. If Commercial or Industrial,indicate the name of the business: •ve.'r "�"`'`�3t\C'SLN°r45€'
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 CO xplain:
6. Are there any easements on the property? YES CO
7. SITE INFORMATION: ,h
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 result of the construction? CPNO
d.What is the water source? PUBLIC PRIVATE WELL Ni.A
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? NiA
4
Town of Queensbury Uildry&code Ento,ceme,t Prrc.p;e Structure Appratm Revised Fete
DECLARATION:
I. 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: DATE: 6
Town of Queensbury Building&Code Enforcement Principle Structure Applocauon Revised f ebruary 2017
I