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ADDITION/ALTERATION PERMIT Permit#: CC' 2c02�
-�Tcxtin ofQucensbury APPLICATION
�---` Permit Fee: $
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net
Invoice#: 5
Project Location: 75 Carey Rd. Suite 3
Tax Map ID #: 308.20-1-3.3 Subdivision Name: Okie Properties, LLC
CONTACT INFORMATION:
• Applicant:
Name(s): Michael A. O'Connor
Mailing Address, C/S/Z: PO Box 34, Cohoes,NY 12047
Cell Phone: (518)857-1555 Land Line: 518-238-2600
Email: zmikeoc 1 @yahoo.corn
Primary Owner(s):
Name(s): Okie Properties, LLC
Mailing Address, C/S/Z: Same as above
Cell Phone: ( ) Land Line: _( )
Email:
❑ Check if all work will be performed by homeowner only
• Contractor(s):
Contact Name(s): Alltek Energy Systems, Inc.
Contractor Trade: Plumbing and heating
Mailing Address, C/S/Z: 58 Hudson River Rd., Waterford,NY 12188 I I
DEC 16 2020
Cell Phone: (518)857-1555 Land Line: _(_518_)238-2600
Email: mikeoc@alltekenergy.com
"List all additional contractors on the back of this form - -
• Architects)/Engineer(s):
Business Name: Mark Bergeron, PE
Contact Name(s): Same
Mailing Address, C/S/Z: 62 Van Vranken Road, Clifton Park,NY 12065
Cell Phone: (518)248-0906 Land Line: _( )
Email: mpbdindustries@aol.com
Contact Person for Building & Code Compliance: Michael O'Connor
Cell Phone: (518)857-1555 Land Line: (518)238-2600
Email: zmikeocl@yahoo.com
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: N Commercial ❑ Residential
WORK CLASS:
❑ Single-Family ❑Two-Family El Multi-Family (#of units )
❑Townhouse ❑Business Office ❑Retail XX Industrial/Warehouse
❑ Garage (#of cars ) ❑ Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 3,000 1st floor:
2nd floor:'800 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space):
Total square feet: Total square feet:
1 toOO s�
ADDITIONAL PROJECT INFORMATION: ��,,
1. Estimated Cost of Construction: $ 50,000.00
2. If Commercial project, what is the proposed use:Auto refinishing
3. Source of heat: O Gas❑OiIO Propane❑Solar ❑Other Fireplaces need a separate Fuel
Burning Appliances &Chimney Application
4. Are there any structures not shown on the plot plan? ❑YES ONO Explain:
5. Are there any easements on the property? ❑YES ONO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 1.7 acres
b. Is this a corner lot? DYES ONO
c. Will the grade be changed as a result of the construction? ❑YES ONO
d. What is the water source? N PUBLIC ❑PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Sewer
Addition/Alteration Application Revised February 2019
DECLARATION
1. 1 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. 1 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. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. 1 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: Michael A. O' nnor
SIGNATURE: DATE:
Addition/Alteration Application Revised February 2019