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CC-0890-2021 ,-� Office Use Only Y" ADDITION/ALTERATION PERMIT Permit#: c c10' 2021 APPLICATION ' 6-3 Permit Fee:$ Town of Queensbury 742 Bay Road,Queensbury,NY 12804 AA • 4, Invoice#:_ �� _ P:518-761-8256 www.queensbury.net Flood Zone? Y '-viewe• f Project Location:— ',Z;\.,6., 1\J\k--N Tax Map ID #: •��� ._ 1 _ Subdivision Name: 83000 JNicr 1(18 A?:1118SN33110 3O NMOl PROJECT INFORMATION: IZOZ ` Z 33a TYPE: Residential k Commercial, Propo e ill of333 Single-Family Two-Family Multi-Family (#of units ) ou +use Business Office 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 sq ft: Total sq ft: ze� � 1 Scope of work to be done: 11 \5 V S t",0.1I P0���1 /C I ec )Q0- \5 c„1 ,1 Addition/Alteration Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): z r-c 1( h cr)Tir e. Mailing Address, C/S/Z: ( t-( T`'l Q (2-09‘.)r( °\L , C€dr5 `€ nk 1? 6 Cell Phone: (•1T4 ) (A-5 ©7 Z O ,_ Land Line: ( 5` 12S ) °• ��� 1 c-It Email: 2 r to L. ( f-c) , �DrIC • Primary Owner(s): Name(s): ®-r �i Mailing Address, X 1,,, �- �-C� P1c.\C. e Qv e-e ,�1-a a.�,^- 1 fl g0di Cell Phone: (T1" ) 7R6 33 �"`7 Land Line: ( ) 7't Z. of Email: t° a M 0 - 1 O e yo, k,et f. Coxes Check if all work will be performed by property owner only • Contractor(s): (List all additional contractors on the back of this form) Contact Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: { ) __ Land Line: ( ) Email: **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(s): Business Name: hc-e��� XC.,\( rcIr1 \ eC�� r\s\r\e-e r5 Contact Name(s): I tM Cs-0,r'r kCEO{ 1 Mailing Address, C/S/Z: 7 7.7 S" C..10.14c-te\ Pay-lcc, . S ��-. ZSQ nec,- M6sy01-1 Cell Phone: ( ) Land Line: (, [ '-( ) co X 1 .52 Email: ;1 S©n S1n r CAC,. C dM Contact Person for Compliance in regards to this project: .7 JC (ric\C Z,C91 C_ Cell Phone: (5 ) G c CT? Z O Land Line: (S ) 7 c\- l ' Sc Email: Z r\r‘Q ® Q-Z, C-- :O L e C CfiA Addition/Alteration Application Revised January 2021 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ l O o®0 .00 2. Source of Heat (circle one):DO 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 A NO Explain: 4. Are there any easements on the property? YES NO SITE INFORMATION: • Is this a corner lot? YES K NO • Will the grade be changed as a result of the construction? YES X, NO • What is the water source? K PUBLIC PRIVATE WELL • What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC DECLARATION: 1. I 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. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 4. I certify that 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 6. 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: 2-R-C k. M\rc-- SIGNATURE: DATE: I L Z- 77- Addition/Alteration Application Revised January 2021 FIRE MARSHAL'S OFFICE Town ofQueensbury Q burt i J 742 Bay Road, Queensbury, NY 12804 "Home of Natural Beauty ... A Good Place to Live " PLAN REVIEW Ed & Ed Enterprises Sperry Shoes 1439 State Rt 9, Space 62 CC-0890-2021 4/15/22 I have reviewed the submitted drawings for the above project; and offer the following comments: 1) Verify Fire extinguisher locations & inspection. 2) Locks / latches shall comply with 2020 NYSFC. 3) Verify operation of existing exit/ emergency lights. 4) Verify Knox Box key. 5) Verify aisles & storage. 6) Verify CO Detection 7) NFP'A 72 Letter of Compliance for fire Alarm system Deputy Fire Marshal Tyson Converse 742 Bay Road Queensbury NY 12804 518 761 8205 garys@queensbury.net Fire Marshal 's Office • Phone: 518-761-8206 • F a x: 518-745-4437 firenzarshal@queensburj.net • www.queensbury.net