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applicationOffice Use Only ADDITION/ALTERATION PERMIT|Permit#:CC-0056"2020 APPLICATION Permit Fee:$§(>~Toa of Quceasbury tron742BayRoad,Queensbury,NY 12804 Invoice #:_2.2>4\25 P:518-761-8256 www.queensbury.net Projet Loan:352 BayRnd,Suites 3 TaxMapiD#:2-94.|]-|-29 subdivision Name: CONTACT INFORMATION: ©Applicant: Name(s):Ola Scheolhovie,LEC Mailing Address,C/S/2:_2546 Rebe 9L)Quarshue Cell Phone:_(¢/3_)_664 -259 Land Line:_() Email: + PrimaryOwner(s}:Name(s):=Sams 95 above — Mailing Address,C/S/Z: Cell Phone:_()Land Line:_{) Email: CO Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Castaway Wra Contractor Trade: Mailing Address,C/S/Z:__2546 Ryze.IL,Queensbury CellPhone:_(5/3 )__£64 -¢259 Land Line:’_(), Email: **List all additional contractors on the back of this form ©Architect(s)/Engineer(s): Business Name:Chosen Eng neering PLES Contact Name(s):bonny Chase Mailing Address,C/S/Z:3214 State Rede 16,Gvernsbue CellPhone:(SI?)669 -5259 land Line:_( Email:, Contact Person for Building &Code Compliance:__Lonay Chase CellPhone:_(S7f_)664 -S25")Land Line:_() Email:chafe @ gmail,Gm ‘Addion/lteration Application Revised February 2019, *Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Tranbhy Electric|mike Trambley Contractor Trade:lect Mailing Address,C/S/Z:QO Filswodh Lane [ake Cement Cell Phone:_(7/f_)246-2 Land Line:_(). Email: ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Keil,Bacon Contractor Trade:Plumber Mailing Address,C/S/Z:U8 Sunnyside.Ae QuasveSbvog Cell Phone:_(51°_)44 -022 land Line:_() Email:, ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_(),Land Line:_() Email: .intractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_(). Email: .intractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()land Line:_(), Email: ‘Addtion/Aeration Application Rewsed February 2019 PROJECT INFORMATION: TPE:Jf Commercial Residential ‘WORK CLASS: __Single-Family __Two-Family _Multi-Family (#of units ) ___Townhouse ausiness Office __Retail __Industrial/Warehouse ___Garage (#of cars ____Other (describe ) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: Ast floor:Soo fy24floor= 3"floor: Basement (habitable space):Basement (habitable space):_~ Total square feet:Total square feet:_57?£4 ADDITIONAL PROJECT INFORMATION:¢ 1.Estimated Cost of Construction:$450? 2.If Commercial project,what is the proposed use:office.Space 3.Source of Heat (circle one):Gas Oil Propane Solar Othe)Chet base (ecxac) Fireplaces need a separate Fuel Burning Appliances &Chimney Application 4.Are there any structures not shown on the plot plan?We)(NOD Explain: 5.Are there any easements on the property?YES (G& 6.SITE INFORMATION: What is the dimensions or acreage of the parcel?feves Isthisa corner lot?(YE No Will the grade be changed as a result of the construction?YES What is the water source?PUBLIC:PRIVATE WELL Is the parcel on SEWER)pr a PRIVATE SEPTIC system? peaose |Addtion/Ateration Application Revised February 2019, DECLARATION: 1 |acknowledge that no construction shall be commenced prior to issuance of a valid permit and will oe completed within a 12 month period. 2.Ifthe work is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval 3.|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.|acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy. 5.lalso understand that |Ave 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:_D:ane.M1 dlel Schwathwe,Lee SIGNATURE:bw weLelg/DATE: ‘Addon Aeration Application Revised February 2019