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Ft: ADDITION/ALTERATION PERMIT Permit#: �c- ' O±Z- - 20 LO
APPLICATION fovvn of(Zuern,h['shin Permit Fee: $ 200 --
742 Bay Road,Queensbury, NY 12804 ^f
P: 518-761-8256 www.queensbury.net Invoice #: 2 '�u 1
Project Location: 320 Ridge Road
Tax Map ID #: Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): Vincent Moriarty
Mailing Address, C/S/Z: 320 Ridge Road, Queensbury/NY/ 12804
Cell Phone: _( 518 ) 253-7605 Land Line: _( None )
Email: vwmoriarty@gmail.com
• Primary Owner(s):
Name(s): Vincent Moriarty
Mailing Address, C/S/Z: 320 Ridge Road,Queensbury/NY/ 12804
Cell Phone: _( 518 ) 253-7605 Land Line: ( None )
Email: vwmoriarty@gmail.com
❑ Check if all work will be performed by homeowner only
• Contractor(s):
Contact Name(s): Monahan& Every Plumbing&Heating,LLC
Contractor Trade: Plumbing
Mailing Address, C/S/Z: 106 Dix Ave, Glens Falls/NY/ 12801
Cell Phone: _( ) Land Line: ( 518 ) 745-7586
Email: Raytheplumber211@yahoo.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 ) 741-0268 Land Line: _( )
Email: ephallAnycap.rr.com
Contact Person for Building & Code Compliance: Vincent Moriarty
Cell Phone: _( 518 ) 253-7605 Land Line: _( )
Email: vwmoriarty@gmail.com
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: ❑ Commercial ® Residential
WORK CLASS:
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:
1st floor: 1st floor: 252
2' floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): _ Basement (habitable space):
Total square feet: Total square feet: 252
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 19,000
2. If Commercial project, what is the proposed use: _
3. Source of heat: ®Gas❑Oil❑Propane❑Solar ❑Other Fireplaces need a separate Fuel
Burning Appliances & Chimney Application
4. Are there any structures not shown on the plot plan? OYES NO Explain:
5. Are there any easements on the property? DYES ®NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? GO x \gO
b. Is this a corner lot? DYES ®NO
c. Will the grade be changed as a result of the construction? DYES ®NO
d. What is the water source? ®PUBLIC ❑PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Sewer
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: 1 Kutltil- Nocc-c 't
SIGNATURE: DATE: f i ) )C1
Addition/Alteration Application Revised February 2019