Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
application
Office Use Onh ADDITION/ALTERATION PERMIT |Permit 2C-000$-2e%0 APPLICATION.—pall) Toon etn |)|FEB 192742BayRoad,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net || | Project Location:Li Tax Map ID #:_295 -10~-|-~30 Subdivision Name: CONTACT INFORMATION: lo ©Applicant: Name(s):_‘Premier Prope Builders LLC Mailing Address,C/S/Z:_2%Hus)Ave Hudson Falls Wy 1239 Cell Phone:_(SIX _)74\-FIFO Land tine:(7 =Email:premieeph 20@ gies licom +Primary Owner(s): Name(s):Daud Pickoda Mailing Address,C/S/Z:[44 4).ldwood Pi Queensbury Ny iZ¥04 Cell Phone:_(51%_)_(033 -4)0O landtine:(!)Email:_pevival do igjur homes @ Guasil.com O Check if all work will be performed by property owner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):__No etree’ Contractor Trade:Premier Properly Builders Lic Cemeral Coadraclor Mailing Address,C/s/z:_2%Nw}Ave Hvdson Falls Ny 12%39 Cell Phone:(51%_)74I-7)70.Land line:_(2“) Email:_Pfemierph 20 @ masl-com *4List 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:_May Hea Premier Prop, Cell Phone:(51%_)F4l-7 FO.Land Line:_() Email:prevaiex-ph OSs ranslcora ‘Additon/Ateration Application Revised fanuary 2020 PROJECT INFORMATION: TYPE:Commercial J Residential WORK CLASS: A Single-Family __Two-Family __Multi-Family (#of units ) ___Townhouse __Business Office __Retail ___Industrial/Warehouse Garage (#of cars )Other (describe,) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: Basement (habitable space):Basement (habitable space Total square feet:Total square feet: ADDITIONAL PROJECT INFORMATION: 1 Estimated Cost of Construction:§_/f 000.00, If Commercial project,what is the proposed use: Source of Heat (circle one)Oil Propane —Solar._~—Other Fireplaces need a separateFuéfBurningAppliances&Chimney Application Are there any structures not shown on the plot plan?YES NO)Explain: Are there any easements on the property?YES ©) SITE INFORMATION: What is the dimensions or acreage of the parcel?_/,59 Ac. Isthisacornerlot?YES eo Will the grade be changed as a result of the construction?YES.iO) What is the water source?PUBLIC PRIVATE WELL Is the parcel on SEWER or a PRIVATE SEPTIC system?Driv eeaogse ‘Addition/Ateration Application Revised lanuary 2020 DECLARATION: 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.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.also understand that [Ave are required to provide an as-built survey by alicensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy Ihave read and agree to the above: OD SIGNATURE:£71 DATE:2bs [no Aduition/Ateration Application Revised January 2020