AST-0111-2021 SQ Office Use Only
N4GRAT Permit#: P %T-
APPLICATION Permit Fee:$ 40 `
42 Bay Road,Queensbury,NY 12804
Invoice#:
P:518-761-8256 www.Queensbury.net
Flood Zone? Y N Reviewed By:
Project Location: 56
Tax Map ID#: 2,e, Subdivision-Name:
PROJECT INFORMATION:
TYPE: Residential Commercial, Proposed Use:
�C Single-Family Two-Family multi-'Family(#of units ). Townhouse
Business.Office _Retail —Industrial/Warehouse _Garage(#of cars_)
_Other(describe ).
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 21d floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement(habitable space):
Total sq ft: Total sq ft:
Scope of workto be done:
C'ONST►-t,IC T't lzli n
Addition/Alteration Application, Revised January 2021
- 1
C =
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:
2. Source of Heat (circle one):_Gas _Oil _Propane _Solar Other
Fireplaces/inserts need a separate Fuel Burning Appliances &Chimney Application
3. Are there any structures not shown on the plot plan? YES �. NO Explain:
4. Are there any easements on the property? YES NO
SITE'INFORMATION: `^
• Is this a corner lot? _YES �c NO
• Will the grade be changed as result of the construction? —YES NO
• What is the water source? X PUBLIC _PRIVATE WELL
• What type of wastewater system Is on the parcel? SEWER k' PRIVATE SEPTIC
DECLARA'nON:
1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will require
the submittal of amended plans,additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of
Queensbury.After 1 year from the initial application date,100%of the fee is retained.
3. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certifythat the application, plans and supporting materials are a true and a 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.
5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. 1 also understand that 1/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: .JANiU N1AClc I Iy i bS A
? I 2' D ZOOV ICG SIGNATURE: j
Addition/Alteration Appllcation Revised January 2021
0..
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
a Applicant.
Name(s): . ANF- N1ACi<I NTn�}�
Mailing Address, C/S/Z: .I &(,J12NEy' LAaNt, L-)�J - s3Z
Cell Phone: ./c;6 -7qO�) Land Line:
Email: I I I Gk G
• Primary Owners :
Name(s): 4%N M C lls0S` �LILLIAN 15IF5v11C A``', LI E �Ni-\ `*
Mailing Address, C/S/Z: 54t--W
Cell Phone: Land Line: � )
Email:
-)( HZ3. V,>Gk5 j^iG�-, IS rGt At -D N LU I....IVe A i T"F'
❑ Check if all work will be performed by property owner only -1P,1()P-EDIT
• Contractor(s): (List all additional contractors on the back of this form)
Contact Name(s):^ f`,I C i�1(�E L A\KI
Contractor Trade: C-f\- TzpE N 1 t� i
Mailing Address, C/S/Z:
Cell Phone: ( _) TD co KE7 Land Line:
Email: -b ebWkt-:!
"Workers' Comp documentation must be submitted with this application"
• Architect(sVEneineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project: , ITV��(ke K I N i-o3m
Cell Phone: 1.5IUb )7Ci 6 -�iMS'y Land Line: Imo)
Email: 1 611 U., 11GE "0 I 1-,thC. A^
Addition/Alteration Application Revised January 2021
Deck and Roof Design checklist
` C� Is deck freestanding or attached\
Footing
rJ4ASono tubes sized for posts_4X4 8" 6X612"
LP Big foot or footing for roof load
''es Proper attachment to post and footing shown
Proper flashing or waterproofing to structure shown
u` S Attachment to structure shown on plans
1�S Galvanized or Stainless Steel Bolts shown NO ZINC COATED
Hex headed bolts NO CARRIDGE BOLTS
—Diagonal bracing shown for deck over 24"
Floor joist parallel to carrying beams
TK&Deck post to beam attachment shown
Over 30" requires handrail
n/ Over 30" requires guards
Over 30" required guards @ 34"to 38" in height and handrails @ 34"—38"
296.18-1-45 AST 0111-2021
Mackintosh, Jane
=FILECOPY 36 Montray Rd
Open porch 176 s.f.
TOWN
' 1 N OF QUEENSBURY '-
'� BUILDING & CODES DEPT. '
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TOWdbF QUEENS$_URY
BUILDING DEPARTMENT
8_ged on our limited examination;compliance
tt� ��r comments shall hot be construed as
:..sating the plans and specifications are in
r li compliance`Wth the build Codes of
"aw York State.
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