CC-0429-2020 r Office Use Only
;t ADDITION/ALTERATION PERMIT Permit#: C-- '04-2-9 - W 22
_., APPLICATION Permit Fee:$ 11-17D
Town of Queeusbury
742 Bay Road,QueensburV,NY 12804 Invoice#:
P:518-761-8256 www.gueensburV.net
Project Location: U'�'Gu�ls 61J2}� jG('JC�C ° P�-Z-7-L5
Tax Map ID#: Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): A,5A-b Pryot' m /^/<f
Mailing Address, C/S/Z: �q45 g 7,,t-fe- g-t&I
Cell Phone: Land ne: � )
Email:
• Primary Owner(s):
Name(s): 7AA A Sso" c- I X-H
Mailing Address, C/S/Z: qea- '+� G ��-;.Lr i9'�:G�I�E��✓Su3J /V-/ /L �
Cell Phone: ( .Q9 ) 1% 61 -- ?>>,-ZA Land Line:
Email: r 0/5 YJ ,�Q_o 13 e�S'/� tA4A-rL C_v M
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: 1 S�l19 ) `l 'i � / Land Line:
Email:
"List all additional contractors on the back of this form
• Arch itect(s)/Engineer(s): E C E a W E
Business Name:
Contact Name(s): JUL ZO MO
Mailing Address, C/S/Z: - a
Cell Phone: _L ) Land Line: BUILDING&CODES
Email:
Contact Person for Building & Code Compliance: 7 -63A-SSUM
Cell Phone: ( S1"S ) 3 6 1 - 3 4 Land Line: ( Elf
Email: io,6YS IQ13 - i� � ��it A- L C�oM
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
_Single-Family _Two-Family _Multi-Family(#of units )
Townhouse Business Office V/Retail
Industrial/Warehouse —Garage (#of cars ) —Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement (habitable space):
Total square feet: t/(O"r Total square feet: WDc'11
ADDITIONAL PROJECT INFORMATION: Q
1. Estimated Cost of Construction: $ /6� cJ• ®�''
2. If Commercial project, what is the proposed use: JZ6-A L-�
3. Source of Heat (circle one): Gas Oil Propane Solar Other
Fireplaces need a separate � Urning Appliances &Chimney Application
4. Are there any structures not shown on the plot plan? YES 6:0'explain:
S. Are there any easements on the property? YES LN
6. SITE INFORMATION:
a. What is the dimensions oy-acr—eage of the parcel? ,Y��
b. Is this a corner lot? YES NO
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PUBLIC PRIVATE W
e. Is the parcel on SEWER or a PRIVATE SEPTIC system?
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 1, 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: ' A''' V
SIGNATURE: n , DATE: 07'- - z. v
Addition/Alteration Application Revised February 2019
1 ,�r� rim ••,�"!r'.
4
aA
TOWN OF QUEENSBURY i
BUILDING DEPARTMENT
Based n our limited-examination,compliance }
r - --— ---�---sprit comments shall not be construed as s
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State. a
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266.3-178 CC-0429-2020
�4 Queensbury Truck& Pizza Stop
985 State Rte
New hood and duct
wow
OIL
Reviewed B
.:n•....._.. _ ...,....vim �a,� -Y
Daie:
- I
FIRE MARSHAL'S OFFICE
Tozvn of Queensbunj
742 Bay Road, Queensbunj, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW.
-ASAD Petroleum.
985 Route 149
CC-0512-2019
8/1/20.19
New Hood and.duct
The following items shall be provided:
• Need the following information—
Suppression specifications Authorized installer -�
Provide Mounting clearance details for hood
Include fan override �'7• . ` '��
Grease light test required for duct St,', - ' s �
- Hinge kit on hood for future cleaning
- Detail duct and fan installation and clearances
- Suppression activation must be tied to fire alarm system
- FM to witness function test and fuel shutdown
-^Need-hood-specifications - �-
NFPA 96 requires a horizontal termination to be through a non
combustible wall???.
Michael J Palmer
Fire Marshal
742 Bay Road -
Queensbury NY 128.04
Fire Marshal 's Office - P h o iz e: 518-761-8206 F a s: 518-745-4437
fiiemarshal@queensbitill.net - WMV.queensbun azet
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