CC-0454-2021 Office Use Only
ADDITION/ALTERATION PERMIT Permit#:
APPLICATION y�
Town d..Queensbury Permit Fee:$ �V
742 Bay Road,Queensbury;NY 12804
P:518-761-8256 www.gueensbury.net Invoice#:
1q-15
Project'Location: US Route 9
Tax Map ID#: 2 - . -1-1 Subdivision Name:Lake George Outlets
CONTACT INFORMATION:
• Applicant:
Na.me(s):BBL Construction Services, LLC
Mailing Address, C/S/Z:302 Washington Ave Ext Albany NY 12203
Cell Phone: 518-461-5878 Land Line: 518-452-8200
Email:jcrupi@bblinc.coni
Primary Owner(s): -
Name(s):"Lake George Northway LLC
Mailing Address; C/S/Z: 2700 Westchester Ave Suite 407 Purchase,NY 10577
Cell Phone:"914-329=5303 Land Line: 914-253-6500
Email: sshanus@shanusmanagement.com
❑ Check-if all work will be performed by homeowner o""nly
• Contractor(s):
Contact Name(s): BBL Construction Services,.LLC
Contractor Trade: General Construction
MaiIin.g AddTess, C/S/Z:"302 Washington Ave Ext Albany,NY 12203
Cell Phone: 518-461-5878 Land Line: 518--452-8200 1
Email:jciupi@bblinc.com Sn?
t7 o
"List all additional contractors on the back of this form — n i
mC=
Arch itects)/Engineer(s): 0
Business Name:PGAL-Architects 3
rn
Contact Names)-:Matthew Ellis G
Mailing Address, C/S/Z: 791 Park of Commerce Blvd Suite 400 Boca Raton FL 33487
Cell Phone:_( ) Land Line: 561-988-4002
Email: info@shremshock.com
Contact-Person for Building & Code Compliance: Jake Williams
Cell Phone: 518-225-2374 Land Line: 518-452-8200
Email:jwilliams@bblcarlton.com
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: 0 Commercial ❑ Residential
WORK CLASS:
❑ Single-Family ❑Two-Family El Multi-Family (#of units )
❑Townhouse ❑Business Office X Retail ❑ Industrial/Warehouse
❑ Garage (#of cars } ❑ Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION.SQUARE.FOOTAGE:
1st floor: 1st floor: 1,000
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement (habitable space):
Total square feet: Total square feet: 2,000
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $40,000
2. If Commercial project, what is the proposed use: Retail store
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? DYES ❑NO Explain:
5. .Are there any easements on the property? ❑YES ❑NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 6.21 acres
b. Is this a corner lot? ❑YES ❑NO
c. Will the grade be changed as a result of the construction? ❑YES ONO
d. What is the water source? OPUBLIC El 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: John Crupi
SIGNATURE: DATE: 6/4/21
Addition/Alteration Application Revised February2019