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Office Use Only j_C
„ ADDITION/ALTERATION PERMIT Permit#:
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APPLIC v' c E ll w ISe 1l2j.. 00
Town of Quccnsbuly
742 Bay Road,Queensbury,NY 12804 #: g 776
P:518-761-8256 www:queensbury.net
JUL 2 0 2020
Project Location: 13
TOWN OF QUEENSBURY
BUlt[aiflli(nsfoC Tax Map ID#: —1 —
CONTACT INFORMATION:
•. Applicant:
Name(s): Demarse Electric Inc./Apex Solar Power
Mailing Address, C/S/Z:64 Maln Street.Queensbury,NY:12804
Cell Phone: . ( 518 )415-5511 Land Line: /( )
Email: Lstewart@apexsolarpower.corri
• Primary Owner(s):
Name(s): Dennis Fitzgerald
Mailing Address, C/S/Z: Queensbury,NY,12804
Cell Phone: ( 518 ) 798-3248. Land Line: .( )
Email: dennismfitzgeraid@gmaii.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): Please see applicant
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:
Contact Name(s):
Mailing Address,C/S/Z:.
Cell Phone: ( ). Land Line: .( )
Email: .
Contact Person for Building &Code Compliance: Lynn Stewart
Cell Phone`. ( 518. . ) 415-.5511 Land Line: ( )
Email: Lstewart@apexsolarpower.com,.
Addition/Alteration Application Revised February 2019
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PROJECT INFORMATION:
TYPE: Commercial x Residential.
WORK CLASS:
x 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:
2nd floor: 2"d floor:.
3rd floor: 3'd floor:
Basement(habitable space): Basement(habitable space):
Total square feet: Total square feet:
~� % 33. E
ADDITIONAL PROJECT.INFORMATION: AS � ��' , F� ~5ci /'
el r
pp .`7. 2U
1. Estimated Cost of Construction:$ �"l� ,20q,1 "! I 202.6
2. If Commercial project,what is the proposed use:
3. Source of Heat(circle one):. . 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? YES NO Explain:
5. Are there any easements on the property? YES 01
6. SITE INFORMATION:
a: What is the dimensions or .creage of the parcel? : t / G 11 •
b. Is this a corner lot? V�
c. Will the grade be changed result of e construction? . YES .
d. What is the water source? PUBLIC PRIVATE WELL
e. Is the parcel sillaW or a PRIVATE SEPTIC system?
Addition/Alteration Application Revised February 2019
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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. Ifthework 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: OL ?&i
•
SIGNATURE: DATE::
Addition/Alteration Application Revised February 2019
https://www.pdfescape.com/open/?5FDD3D76656DBAF0028771A6B374C3A650CA91 B18E8A963C 4/5