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RC-0507-2020
i Office Use Only Y.L t ADDITION/ALTERATION PERMIT Permit#: Q.C..- 950`} - ZCJ APPLICATION Permit Fee: $ Toivn of Queensbury 742 Bay Road,Queensbury,NY 12804 Invoice#: 2-12_b P:518-761-8256 www.queensburv.net Project Location: .323 iyZc;,ivr- /2-4 a/S, Tax Map ID#: 5-:73 4 2 7 .30e. /Z®Z•S' Subdivision Name: `-/r& s c, od CONTACT INFORMATION: • Applicant: Name(s): "aoxy e. Crad. ( s e, Mailing Address, C/S/Z: ?)c ?) i g2Jrnr6 1 co ytiee orj gock. j okt Cell Phone: ( 51 ) ) 260-L4l.04O 11114o La in: ( a ) �--i3?t - tn` S Email: C�C�rle,e_ he 11D is c,i&h . C�LI �,� • Primary Owner(s): �l Name(s): Q>r], 1' rde. tpi I Mailing Address, C/S/Z: Cell Phone: (ta4)- ) 2 -ql,IQcI- rumen,-e . band lLinr ) �'?��. -uC�"�S-� YYlrtia rr Email: Y`(Ncta .11 tC) On •cm -) \ ❑ Check if all work will be performed by property owner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contact Name(s): P-c -;s,o\ 00 .7 oi. � �► Sdc CC_ ieuc- o► `E'er Contractor Trade: Xio , j ;i Ge) �/ Mailing Address, C/S/Z: K7,ca,t)e&� �n;u� � �� a1�wr 5 '/�4 / .? Cell Phone: ( .578 ) 75'6 Land Line: ( 6-'/9 �� 5-/8) �s�4' 7�'o S' — ‘a, LEH **List all additional contractors on the back of this form AUG 2 2 ? ipj • Architect(s)/Engineer(s): , Business Name: I i t-IVI� 1,I t JET `�SBU Contact Name(s): ;ySc9/. ,r�W� Mailing Address, C/S/Z: 17 e!'� /ai So ' az, ' /2..A?J Cell Phone: ( 528 ) ALA-. Land Line: ( tcj(f- ) Email: Contact Person for Building & Code Compliance' cam; s axoc VJ G 7o us. AA Cell Phone: ( ) Land Line: (.5/8 ) 7 - R. 3E' -o e Z©u LT- <—j ) 'v,' 7ao7 Addition/Alteration Application Revised January 2020 1• PROJECT INFORMATION: TYPE: Commercial Residential WORK CLASS: Single-Family Two-Family _Multi-Family (#of units Townhouse . Business Office Retail Industrial/Warehouse V Garage (#of cars ) _Other (describe ) ADDITION SQUARE FOOTAGE: .2 c C Art_pc2 ALTERATION SQUARE FOOTAGE: 1 o r: G.YCI. - d1b-Z- �, aro one c/ 1st floor: nd or:�� 1e•O 2nd floor: 3rd floor: 3rd floor: Basement (habitable space): Basement (habitable space): Total square feet: l\}2- Total square feet: ADDITIONAL PROJECT INFORMATION:�j/ 1. Estimated Cost of Construction: $ C) Cad C7(90 c'O 2. If Commercial project, what is the proposed use: N - 3. Source of Heat (circle one): Gas Oil Propane Solar Other 0 eii'GT Fireplaces need a separate Fuel Burning Appliances & Chimney Application 4. Are there any structures not shown on the plot plan? YES p Explain: 5. Are there any easements on the property? • YES 6. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? ® 03 B ( r.e9 b. Is this a corner lot? YES c. Will the grade be changed as a resul of t e 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 January 2020