CC-0217-2020 Office Use Only
Atj ADDITION/ALTERATION PERMIT Permit#: CC °2-V-4 z2,r0
APPLICATION Permit Fee:$ (c?2- . l o
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#: 2e-cj1-
P:518-761-8256 www.queensbury.net
Project Location: u•S. 9, LAKE GEORGE, NY 12845 (STARBUCKS COFFEE:TENANT FIT UP)
Tax Map ID#: Ziaa�• 12—t -ZI Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): DANIEL BRENNAN -STARBUCKS PERMIT AGENT
Mailing Address, C/S/Z: 8 STONEGATE LANE, SALEM NH 03079
Cell Phone: ( 6034505-5633 Land Line: ( )
Email: DPBPERMITS@GMAIL.COM
• Primary Owner(s):
Name(s): ADIRONDACK OUTLET MALL
Mailing Address, C/S/Z: 1454 STATE ROUTE 9, LAKE GEORGE, NY 12845
Cell Phone: ( ) Land Line: (518) 793-3196
Email: dkennye.adirondackoutletmall.com
0 Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):(PENDINGT
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: TWO ONE TWO DESIGN
Contact Name(s): ALYSSA GRIFFIN-OR-R H SWEERS II
Mailing Address, C/S/Z: 11327 MACKEY STREET, OVERLAND PARK, KS 66214
Cell Phone: ( ) Land Line: ( )(646) 787-9294
Email:ALYSSA@TWOONETWODESIGN.COM
Contact Person for Building & Code Compliance: DANIEL BRENNAN -STARBUCKS PERMIT AGENT
Cell Phone: ( ) 603-505-5633 Land Line: ( )
Email: DPBPERMITS@GMAIL.COM
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: X Commercial Residential
WORK CLASS:
_Single-Family _Two-Family Multi-Family(#of units
Townhouse Business Office Retail
Industrial/Warehouse _Garage (#of cars ) X Other (describe COFFEE SHOP
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: NA 1st floor: 2,077SF
2nd floor: NA 2nd floor: NA
3rd floor: NA 3rd floor: NA
Basement(habitable space): NA Basement (habitable space): NA
Total square feet: NA Total square feet: 2,077 SF
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 275,000
2. If Commercial project,what is the proposed use: DRIVE THRU COFFEE SHOP
3. Source of Heat (circle one): QM Oil Propane Solar Other
Fireplaces need a separate Fuel Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? YES ®Explain:
5. Are there any easements on the property? YES
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel?
b. Is this a corner lot? YES
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system?
Addition/Alteration Application Revised February 2019
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If the work is not completed by the 1 year 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. I also understand that I/we 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.
I have read and agree to the above:
PRINT NAME: DANIEL BRENN - TARBUCKS PERMIT AGENT
SIGNATURE: DATE: 05-19-2020
Addition/Alteration Application
Revised February 2019
Roland J.Down Service Experts
411114k 13 Airport Road
Scotia,NY 12302
p 518.399.9126
Roland J.Down t 518.399.9183
RolandJDown.com
HEATING.AIR CONDITIONING&
PLUMBING l A Service Experts Company
Laura,
Roland J.Down has completed the air balancing for the properties at 1424 Rt..9 Lake Geor_;eg g'7
AMV
and 25 Silver Boutique.
Starbucks has been balanced;the readings at each diffuser are within a normal range based on the
drawings provided.The units have been verified to meet the minimum requirements set by NYS for
fresh air-intake. Rooftop'unit(s)operation have been verified and the system is balanced and compliant
with the air intake requirements.
25 Silver has also been balanced;the readings at each diffuser are within a normal range based on the
drawings provided.The unit has been verified to meet the minimum requirements set by NYS for fresh
air intake.Rooftop unit operation has been verified and the system is balanced and compliant with the
air intake requirements.
Thank you,.
Kristofer Rockwell
Commercial Account Manager
518-857-1164