Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
application
Office Use Only|ADDITION/ALTERATION PERMIT|permit x,KC Qoab-o20 Town of Qucensbury APETICATION Permit Fee:$000.09 742 Bay Road,Queensbury,NY 12804 518-761-8256 www.queensbury.net Invoice 23%P_ Project Location:_4 Old Forge Rd. Tax Map ID #:302.13-1-19 Subdivision Name:_ 1H) CONTACT INFORMATION:JAN 21 2020 ©Applicant: Name(s):Adirondack Basement Inc. Mailing Address,C/S/2:4 Jones Rd Halfmoon,NY 12065__ Cell Phone:_(_518__)_6030786___Land Line:_(_518_)_376 9621 Email:CBleau@Adirondackbasement.com. «Primary Owner(s): Name(s):Larry Brown_ Mailing Address,C/S/Z:_4 Old Forge Rd Cell Phone:_518)_307 9983 Land Line:__Email:_LarryBrown7285@gmail.com_ O Check if all work will be performed by homeowner only ©Contractor(s): Contact Name(s):Michael San angelo Contractor Trade:Basement rehab Mailing Address,C/S/Z:_4 Jones Rd Halfmoon,NY 12065 _518__)_6030786_____LandLine:_(_518_)3769621__ **List all additional contractors on the back of this form ¢Architect(s)/Engineer(s): Business Nam Contact Name(s):=Mailing Address,C/S/Z: Cell Phone:_()Land Line:_(____) Email: Contact Person for Building &Code Compliance: Cell Phone:_()Land Lin Email: ‘dditon/Alteration Application Revised February 2019 PROJECT INFORMATION: TYPE:O Commercial Cl Residential WORK CLASS: D Single-Family Oitwo-Family COMulti-Family (#of units ) CiTownhouse CiBusiness Office Crretail CO Industrial/Warehouse D Garage (#of cars )O Other (describe. ADDITION SQUARE FOOTAGE: Ast floor:Ast floor: 2"4 floo'2°floor: 3"flo!3°floor: Basement (habitable space): Total square feet: ADDITIONAL PROJECT INFORMATION: 1, 2. Estimated Cost of Construction:$7067.00. If Commercial project,what is the proposed use: Source of heat:C]GasCJOil1PropaneLsolar iother Burning Appliances &Chimney Application Basement (habitable space): Total square feet: ALTERATION SQUARE FOOTAGE: Fireplaces need a separate Fuel Are there any structures not shown on the plot plan?CIYES CINO Explain: Are there any easements on the property?Oyes Ono, SITE INFORMATION: a.Is this a corner lot?Dyes Onob. cs d. e What is the dimensions or acreage of the parcel? Will the grade be changed as a result of the construction?Oyes What is the water source?Opustic COPRIVATE WELL Is the parcel on SEWER or a PRIVATE SEPTIC system? ‘Adcition/Alteration Application Ono Revised February 2019 aDECLARATION: 1.|acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period 2.Ifthework 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. |have read and agree to the above: PRINT NAME:___Michael San Angelo. SIGNATURE:DATE:__12/27/19. ‘Addition/Alteration Application Revised February 2019