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CC-0078-2020PRINCIPLE STRUCTURE Office Use Only PERMIT APPLICATION Permit #:GC -00%8 -20 20 To of Cue permit Fee:$[t= 742 Bay Road Queensbury,NY 12804 nec.Fee:§_Nf P:518-761-8256 www queensburynel Invoice #:__2404 Project Location:578 Aviation Rd Tax Map 92.12 Subdivision Name: TOWN BD RESOLUTION 86-2013:$850 recreation fee for new dwelling units:single family,duplexesitwo-family, multiplefamily,apartments,condominiums,townhouses,andior manufactured &modular homes,but not mobile homes.This is in addition to the permit fee(s) CONTACT INFORMATION. ©Applicant: Name(s):AES Mechanical Services Group,Ine__-Missy Harrison ‘Contract Admin Mailing Address,C/S/Z:2171 AL Hwy 229 Tallassee,AL 36078 Cell Phone:_()Land Line:_(334___)252-1003 Email:_missy@aesmech.com +Primary Owner(s): Name(s):Target Corporation Mailing Address,C/S/Z:1000 Nicollet Mall TPN 9 Minneapolis MN Cell Phone:_()Land Line:_(612-304.4073 IZ HYN-550\ Email:_trent.nelsen@target.com Oi Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):AES Mechanical Services Group,Inc Contractor Trade:HVAC Mailing Address,C/S/Z:2171 AL Hwwy 229 Tallassee,AL 36078 Cell Phone:_(_)Land Line:(334 _)252-0380 Email:missy@aesmech com **List 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:_() Email: Contact Person for Building &Code Compliance: Cell Phone:_()Land Line: Email: Principle Structure Packet Revised February 2019, PROJECT INFORMATION: TYPE:_X_Commercial __Residential WORK CLASS: __Single-Family Two-Family Multi-Family (of units __) Townhouse __Business OfficeXRetail_Hotel/Motel __Industria/Warehouse __Garage(#ofcars__)__Other(describe _) STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAG! 1°floor:1"floor: 24 floor:_2™floor: 3"floor:Total square feet: Basement (habitable space): Total square feet: ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$55,000.00 2.Proposed use of the building: 3.If Commercial or industrial,indicate the name of the business:Target 1830 4,Source of Heat:Gas Oil Propane —Solar_Other: (Fireplaces need a separate Fuel Burning Appliances &Chimney Application,one per appliance) 5.Are there any structures not shown on the plot plan?YES NO Explain: 6.Are there any easements on the property?YES NO 7.SITE INFORMATION: ‘a.What is the dimensions or acreage of the parcel? b.Is this a corner lot?Yes NO c.Will the grade be changed as a result of the construction?YES_-—s NO d.What is the water source?PUBLIC.PRIVATE WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system? Principle Structure Packet Revised February 2039) DECLARATION: |.lacknowledge that no construction shall commence priorto issuance of a valid building permit and work will be completed within a 12 month period. 2.Ifthe work is not completed by the tyear 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.|acknowledge that prior to occupying the facilities proposed |or my agents,will obtain a certificate of occupancy 5,lunderstand that lve are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance ofa certificate of occupancy. |have read and agree to the above: PRINT NAME: SIGNATURE:DATE: Principle Structure Packet Revised February 2019