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Office Use Only ADDITION/ALTERATION PERMIT|permit:AC-0094 -29 20 Teen of Queensbury APPLICATION Permit Fee:$AIO.0° 742 Bay Road,Queensbury,NY 12804 518-761-9256.woew.queensbur.net invoice _2497__Project Location:10 Briggs Ct Tax Map ID #:301.15-l46 Subdivision Name:Ward 3 CONTACT INFORMATION:1D)|MAR 06 2028 ©Applicant: Name(s):Adirondack Basement Systems Ine. Mailing Address,C/S/Z:4 Jones Rd,Halfmoon NY 12065 Cell Phone:_(_518)_3719621__Land Line:_() Email:_Msanangelo@Adirondackbasement.com «Primary Owner(s): Name(s):Kendra Mango Mailing Address,C/S/Z:_10 Briggs Ct Queensbury,NY 12804 Cell Phone:_(_518_)5864488__Land Line:_() Email: O Check if all work will be performed by homeowner only ©Contractor(s): Contact Name(s):Adirondack Basement Systems.Ine. Contractor Trade:Basement Repair Mailing Address,C/S/Z:4 Jones Rd,Halfmoon,NY 12065 Cell Phone:_(518)3719621 Land Line:_() Email:_**List all additional contractors on the back of this form e Architect(s)/Engineer(s): Business Name Contact Name(s)_Mailing Address,C/S/Z:__ Cell Phone:_( Email:|—_ )Land Line:{_) Contact Person for Building &Code Compliance: Cell Phone:_()Land Line: Email: Aadition/alteration Application Revised February 2018 PROJECT INFORMATION: TYPE:O Commercial (Residential WORK CLASS: Ci Single-Family CTwo-Family—-CiMulti-Family (#of units CTownhouse LBusiness Office retail 1 Industrial/Warehouse CO Garage (#of cars )(1 Other (describe ) ADDITION SQUARE FOOTAGE: Ast floor:Ast floor: 2"floor:2"floor: 3!floor:3 floor: Basement (habitable space):Basement (habitable space): Total square feet:Total square feet: ADDITIONAL PROJECT INFORMATION: Estimated Cost of Construction:$12,572.00 If Commercial project,what is the proposed use: ALTERATION SQUARE FOOTAGE: Source of heat:(IGas(JOil1PropaneL solar (Other Fireplaces need a separate Fuel Burning Appliances &Chimney Application Are there any structures not shown on the plot plan?CIYES KINO Explain: Are there any easements on the property?OYEes:Ono, SITE INFORMATION: a.What is the dimensions or acreage of the parcel?_.49 b.Is this a corner lot?Oyes Ono c.Will the grade be changed as a result of the construction?IVES CNno d,What is the water source?Copustic COpRIVATE WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system? Addtion/Ateration Application fevised February 2019 DEGLARATION f. rey 5, acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period Ifthe work is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval. \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. 1 acknowledge that prior to occupying the facilities praposed |,or my agents,will obtain a certificate of occupancy. J also understand that |Ave are required to provide an as-built survey by a licensed land surveyor ofall newly constructed facilities prior to issuance of acertificate of occupancy. have read and agree to the above: PRINT NAME:Me Sanfecto SIGNATURE:ML AGE. Addition/Alteraton Application pate:3/2/20 Revised February 2018