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Office Use Only ADDITION/ALTERATION PERMIT|permit:Q-07274-2020 APPLICATIONeae Permit Fee:$\Y¥D — 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice #: Project Location:597 Bay Road Tax Map ID #:296.7-1-8 Subdivision Name:NA CONTACT INFORMATION: .licant: Name(s):David Jung —Jung Revocable Trust ~Canterbury Woods Apartments,LLC Mailing Address,C/S/Z:37 Canterbury Woods St.,Queensbury NY 12804 Cell Phone:347-66-3436 Land Line:_(___), Email:davesjung@gmail.com ECEIVE «Primary Owner(s):8 2020 Name(s):Same as Applicant MAY 2 Mailing Address,C/S/Z:TOWN OF QUEENSBURY Cell Phone:_(___).land Line:(___)BUILDING &CODES Email: O Check if all work will be performed by homeowner only *Contractor(s): Contact Name(s):Christopher Corlew Contractor Trade:General Contractor Mailing Address,C/S/Z:31 Poplar St,Hudson Falls NY 12839 Cell Phone:518-812-3393 Land Line:_() Email:ccorlew934@icloud.com **List all additional contractors on the back of this form ©Architect(s)/Engineer(s): Business Name:Rucinski Hall Architecture Contact Name(s):Ethan P.Hall Mailing Address,C/S/Z:134 Dix Ave,Glens Falls,NY 12801 Cell Phone:518-260-2888 Land Line:518-741-0268 Email:ephall@nycap.rr.com Contact Person for Building &Code Compliance:Ethan P.Hall Cell Phone:518-260-2888 Land Line:518-741-0268 Email:ephall@nycap.rr.com ‘Adition/Alteration Application Revised February 2019, PROJECT INFORMATIO! ‘TYPE:@ Commercial CO Residential WORK CLASS: Ci Single-Family OTwo-Family C1 Multi-Family (#of units DTownhouse XBusiness Office CRetail C.Industrial/Warehouse O Garage (#of cars C Other (describe.) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: Ast floor:124 SF2floor:145 SF 3°floor: Basement (habitable space):Basement (habitable space):80 SF Total square feet:Total square feet:349 SF ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$$10,000 2.If Commercial project,what is the proposed use:Business Office 3,Source of heat:[Gas(JOil1PropaneC]Solar ClOther Fireplaces need a separate Fuel Burning Appliances &Chimney Application 4,Are there any structures not shown on the plot plan?CIYES KINO Explain: 5.Are there any easements on the property?LIES NO 6.SITE INFORMATION: a.What is the dimensions or acreage of the parcel?1.69 acres Is this a corner lot?Cves NO Will the grade be changed as a result of the construction?CUES What is the water source?BAPUBLIC CIPRIVATE WELL Is the parcel on SEWER or a PRIVATE SEPTIC system?Private peaos _Adéition/ateration Applicaton Revised February 2018 DECLARATION: 1.lacknowledge 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 byalicensedlandsurveyorofall newly constructed facilities prior to issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME:Ethan P.Hall —Architect\Agent for the applicant SIGNATUR DATE:4 May 2020 ‘Addtion/Aiteraton Application Revised February 2019