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RC-0471-2021
Y Office Use Only ADDITION/ALTERATION PERMIT Permit#: P APPLICATION Permit Fee:$ Z© Town ofQneens My 742 Bay Road,Queensbury,NY 12804 Invoice#: b P:518-761-8256 www.aueensbury.net Flood Zone? Y N Reviewed By: Project Location: Tax Map ID#: -30 d,, Subdivision Name: �� O A-p— DCvdo maa+ PROJECT INFORMATION: TYPE: Residential Commercial, Proposed Use: /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: 2"d floor: 2"d floor: V floor: V floor: Basement(habitable space): Basement(habitable space): Total sq ft: Total sq ft: Scope of work to be done: T V'd.tilLL- L'KAmJ 6 Pic n -(z) S i 3 2 1/LSD (t 11aj cd✓i s'�vuc--(16 1 w k"J'00i InS(da-+e- wjed 1 re-IL4s-6(( sid' T-r- rvt4eric)r 3AA-�/4 aS� ° JUN 1 -: 0 E v5y 0tav«e-- (k Fac,+o e 0,30 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 0 D 3 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: ES A. Are there any easements on the property? _YES V NO SITE INFORMATION: '/ • Is this a corner lot? _YES y NO / e Will the grade be changed as a r ult of the construction? _YES v NO • What is the water source? PUBLIC _PRIVATE WELL • What type of wastewater system is on the parcel? _SEWER PRIVATE SEPTIC DECLARATION: 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date,100%of the fee is retained. 3.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 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. 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: IIi,e,,j a C�`l��-1 � �IQ SIGNATURE: DATE: l�' [2:c2 2—j s CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: . Name(s): Ma ffk&,) rl e-vi Mailing Address, C/S/Z: 30 rzvs dc+ b ✓' au e�l�sbcty Cell Phone: ) -? q6C h o g Land Line: R a Fri a-7 Email: b Ctic✓lcQ®c� G yDrruwvte�^� C�r'►i1 • Primary Owner(s): Name(s): :S"c6tr QrLd- Jeri ht rev - CucQvi e Mailing Address, C/S/Z: 6- 1 3t4Aas b 4- QCt eecgs ba, Cell Phone: ( 61 T ) 2 2 3 � ;K 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): flu fF�e� D ` �rie�l Contractor Trade: -t- re- 1cac eXk-eA-� t s'f-a l(a ern Mailing Address, C/S/Z: 3b u ee-o,s 6u v-�f Cell Phone: ( S to ) 7 9 to 0( 0 e Land Line: ( S! Fr 2-:Z Email: a fowiv &or.�6_D naAmkivter,(-b►vg **Workers' Comp documentation must be submitted with this application** • Architect(s)/Eneineeds): Business Name: Contact Name(s): Mailing Address, C/S/Z: Cell Phone:�_) Land Line: Email: Contact Person for Compliance in regards to this project: Ma OAeLJ A- O'gri ej-7 Cell Phone: ( 519' ) 2 llo d (o0,'K Land Line: (St r) -2 R.4, 8-(( ;,---7 Email: CUbw1AA0e,0G� yDadlfuv[Ker" C,6M �• Manufacturing ACKNOWLEDGEMENT BUILDING PRODUCTS TOWN OF QUEENSBURY Customer Quote Summary j BUILDING& CODES BILL,TO: SW TO: LANSING BLDG PRODUCTS/ALBANY NY LANSING BLDG PRODUCTS/ALBANY NY III I II III IIII III III IIIII 1 III III PO BOX 6649 4253 ALBANY STREET Barcode ALBANY -NY 12205-4609 Phone: 804-266-8893 Fax: 8042616743 Phone: 518-862-1490 Fax: ;;:(DiJOT]E•1VBR CUST:NBgt. CdTSTOIiR'PO DATE CREATED DAT1E'ORIDrRED:`: ®Rills I' 'I' ' 5032017 1 1141328 4/15/2021 1 Quote Not Ordered Charge PALI ju ORDiERE Y•<:::::- MATT None Whse Delivery LONDONDERRY MANUFACTURING ... ...... .... ERK - kjg -Keith Griswold CUDNEY lT DESCRIP ON' PRICE- L�%TIJINDEID; 10000-1 Welded Vinyl RW 2-Lite,Unit Size 35.75 x 25,RO 36.25 x 25.5 1 Unit 1:U-Factor=0.30,SHGC=0.28,VT=0.49,HH-M-47-00906- 00002,Size Options=Custom Size,Transactional Order Type=Charge Order,New Construction,Simulated Meeting Rail=No,Reverse Sash Pattern=NoUnit 1 Left Glass, 1 Right Glass:HII-M-47-00906-00002 Frame Width(Inches)=35.75,Frame Height(Inches)=25 Double Glazed,Low E Argon Filled Base Color=White I ( ! Single,Pin Exterior Sash=No,Adjust Sash Lock Height=No ��3s.i5° Full Screen,Fiberglass Mesh,Screen Shipping Separate RO-36.25" Contour In-Glass,Colonial,Match Frame,2W2H Integral J Fin,Inside Extension Jamb Receiver Pocket=Yes Complete Interior Trim Kit--Yes,ITK Finish=Primed Pine,ITK Casing Profile=2 1/2"Colonial,ITK Setup=Picture Frame,ITK Extension Jamb Depth=Custom,Interior Trim Kit Extension Jamb Custom Depth= 7.25 Overall Frame Width(Inches)=35.75,Overall Frame Height(Inches)_ 25,Overall Rough Opening Width(Inches)=36.25,Overall Rough Opening Height(Inches)=25.5 Clear Opening Width=12.6875,Clear Opening Height=20.375,Clear TOWN OF Q U E E N S B U RY OpeE.Star one:N rth-Cege=1.8 BUILDING & CODES DEPT. E.Star Zone:North-Central=Yes Room Location: None Assigned Reviewed B Date: -Z--( TOViN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited examination,compliance 302.9-1-19 RC-0471-2021 with our comments shall not be construed as indicating.the plans and specifications are in Cudney, Scott &Jennifer full compliance with the Building Codes of 53 Zenas Dr New York State. Install New Window Last Update:4/28/2021 9:39 AM Page 1 Of 2 Printed:4/28/2021 9:41 AM Scan with Smartphone to access installation ,� instructions in HBP's Document Center