CC-0021-2022 Office Use Only
ADDITION/ALTERATION PERMIT Permit#: C,- 00D 2G21-
APPLICATION Permit Fee:$ Zoe
7bwn of CZcensbury
742 Bay Road,Queensbury,NY 12804
Invoice#: O
P:518-761-8256 www.gueensbury.net
Flood Zone? Y N Reviewed By:
Project Location: � 3a Twk� �[ AY' Z86f
Tax Map ID#: Gi Subdivision Nam?: 0
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PROJECT INFORMATION:
JAN 2 6 2022 10
TOWN OF QUEENSBURY
TYPE: Residential Commercial, Proposed U BUILDING&CODES
_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: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement(habitable space):
Total sq ft: Total sq ft:
Scope of work to be done:
or C1CtAv_'/ 'P
Addition/Alteration Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 5bi��`
2. Source of Heat (circle one): i/ 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 v NO
SITE INFORMATION:
• Is this a corner lot? YES ✓ NO
• Will the grade be changed as a result of the construction? _YES V1 NO
• What is the water source? v 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are atrue 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 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: R6CT
SIGNATURE: ' DATE:
Addition/Alteration Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): J�d r
Mailing Address, C/S/Z: 13 J La re
Cell Phone: ( _) Land line:
Email: 1T1rr_0 F Qvb5'PL6 P 5 CO m
• Primary Owner(s): rr _
Name(s): �
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line: � )
Email:
❑ 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): Ty�,rr�4 f2.O0`�
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: �3G l.- Land Line:
Email:
"Workers' Comp documentation must be submitted with this application"
• Architect(s)/Engineer(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: -r
Cell Phone: Land Line:
Email:
Addition/Alteration Application Revised January 2021
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Stewart's Shop #0458
1433 State Route 9
CC-0021-2022
1/31/22
The following comments based on review of the submitted plans:
1) Verify Fire Extinguisher inspection & locations.
2) Locks & latches shall comply with 2020 NYSFC.
3) Verify existing CO detection. (sales-on ceiling)
4) Verify existing Exit & Emergency lights. (Breaker #47)
5) Verify storage & aisles
6) Verify front door key in Knox Box.
7) `Verify new locations of fuel emergency disconnects. Provide
documentation of test after relocation.
Deputy Fire Marshal
Gary K. Stillman
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fire Marshal 's Office . Phone: 518-761-8206 . Fax: 518-745-4437
flremarshal@queensbury.net o zuwzu.queensbury.net
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