CC-0138-2020Office Use Only
ADDITION/ALTERATION PERMIT Permit#: CC—D \ - 20 20
APPLICATION 2,1,
Town ofQuecnsbury;
Permit Fee.
742 Bay Road,Queensbury,NY 12804
qtP:518-761-8256 www.queensbury.net
Invoice#: 2
Project Location: 989 State Route 9
Tax Map ID#: 296.13-1-22.1 &22.2 Subdivision Name:
CONTACT INFORMATION:
Applicant:
ECEOWE
Name(s): Larry Kelley SEP 2 2 2020
Mailing Address, C/S/Z: 1003 US 9, Queensbury,NY 12804
Cell Phone: (518) 409-8319 Land Line: _(802) 558-0756 TOWN OF QUEENSB URY
Email: larry@fivestargolfcars.com
BUILDING CODES
Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( Land Line: _(
Email:
Check if all work will be performed by homeowner only
Contractor(s):
Contact Name(s): Keith Hunter
Contractor Trade: Carpenter
Mailing Address, C/S/Z: 355 Ushers Road,Ballston Lake,NY 12302
Cell Phone:_(518) 833-8645 Land Line: _(
Email: keithhunter2466@gmail.com
List all additional contractors on the back of this form
Architect(s)/Engineer(s):
Business Name: JARRETT Engineers, PLLC
Contact Name(s): Robert U. Holmes II,P.E.
Mailing Address, C/S/Z: 12 East Washington St., Glens Falls,NY 12801
Cell Phone: (518) 796-7381 Land Line: (518) 792-2907
Email: bholmes@jarrettengineers.com
Contact Person for Building & Code Compliance: Larry Kelley
Cell Phone: (518) 409-8319 Land Line: (802) 558-0756
Email: larry@fivestargolfcars.com
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: X Commercial Residential
WORK CLASS:
Single-Family Two-Family Multi-Family (#of units
Townhouse X Business Office X Retail Industrial/Warehouse
Garage (#of cars X Other(describe) Golf cart repair
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:_847
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement(habitable space):
Total square feet: Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 60,000.00
2. If Commercial project, what is the proposed use: Golf cart sales &service
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 IZINO Explain:
5. Are there any easements on the property? OYES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 3.57 Acres
b. Is this a corner lot? OYES ZINO
c. Will the grade be changed as a result of the construction? LIVES NO
d. What is the water source? i]PUBLIC PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Private at this time. Connection to Municipal
sewer to be made.
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.
S. 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/--- -1( Ce
SIGNATURE: 7 < DATE: 9- 1C—Z_
Addition/Alteration Application Revised February 2019
JARRETT Engineers, PLLC CCivil & Environmental Engineering
12 East Washington Street 518-792-2907
Glens Falls, NY 12801
February 9, 2021
Town of Queensbury – Building & Codes
Attn: Dave Hatin, Director
742 Bay Road
Queensbury, NY 12804
daveh@queensbury.net
Re: LLC Five Star Golf Management
989 State Route 9
Qby Permit # CC-0138-2020
JE# 19-063
Dear Dave:
This letter is to certify that representatives from this office have visited the Five Star Golf
Management site to observe the completed building modifications. Based on our observations, we
believe that the modifications have been constructed substantially in conformance with the
approved design plans entitled ‘Proposed Change of Use Five Star Golf Cars and Utility
Vehicles’, revision B dated 9/29/2020.
If you have any questions, please do not hesitate to contact us at (518)792-2907 or
bholmes@jarrettengineers.com.
Sincerely,
JARRETT Engineers, PLLC
Robert U. Holmes II, P.E.
Project Manager
Ecopy(ies) w/encl: John O’Brien
LarryKelley
F:\DataFile\2019 Proj\Comm\19-063 5 Star SP\Work Docs\19063 21xxxx Cert Ltr\Srce Files\19063 210209 Cert Ltr.doc
Digitally signed by Gail
Morehouse
Date: 2021.02.09 14:23:43
05'00'