CC-0342-2022 Office Use Only
ADDITION/ALTERATION PERMIT Permit#: GC.— 0 3F•Z•?,OZ�
_ z APPLICATION
Permit Fee:$ _ZJDC,�'>��
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.aueensbury.net
Flood Zone? Y /N..oPXeviewed B
Project Location: Lu2e�-vv I ,PaJ u��,risl`Nr`� t p� D�
Tax Map ID#• Subdivision Name:
PROJECT INFORMATION:
TYPE: ❑ Residential __5d Commercial, Proposed Use: �hq �J e
❑ Single-Family ❑ Two-Family ❑ Multi-Family(#of units_j ❑ 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:
31d floor: 31d floor:
Basement(habitable space):, Basement(habitable space):
Total sq ft: Total sq ft;
Scope of work to be done:„ r�i �T q<K- R-A
TO
BUILDING&
_..CO®ES Y
Addition/Alteration Application Revised March 2022
ADDITIONAL PROJECT INFORMATION:
as
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? 1AYES ❑ NO
® Will the grade be changed as a result of the construction? ❑ YES -tfi NO
• What is the water source? -% PUBLIC ❑ PRIVATE WELL
• What type of wastewater system is on the parcel? SEWER ❑ PRIVATE SEPTIC
DEGLARAMN:
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 If, for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 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 1, 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: f-1,,j-�Aj P,dJCG\O
SIGNATURE: DATE:
Addition/Alteration Application Revised March 2022
CONTACT INFORMATION:- PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Hc,,rv1W � �Gc�
Mailing Address, C/S/Z: i3a S40�, P- ml, . (-zg3
Cell Phone: ( SIT Land Line:
Email: W, R 44P�bu;1
• Primary Owner(s):
Name(s): �J& I )f
Mailing Address, C/S/Z: M. 4,Jil w Qom$u �rvr 2
Cell Phone: S( 1 ) 361 -Wag c 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): -�O r, Ckir_5
Contractor Trade: �kjy4ln4i 01W f �
MailingAddress, S/Z: '-7 � $ t-a� r �• ]2._966
Cell Phone: ( 1 V ) 694 133 9 Land Line:
Email: J2,mles . Cowv ,
"Workers' Comp documentation must be submitted with this application"
• Arch itect(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: H (.ICJ �t
Cell Phone: Land Line: � )
Email: (� Li-a U) yy., k Carte
Addition/Alteration Application Revised March 2022
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Building Kidz of Queensbury
7 Luzerne Road
9� Copy CC-0342-2022
6/2/2022
New Bathroom
The following comments are based on review of drawings:
• FM has no comments
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office ■ Phone: 518-761-8206 - Fax: 518-745-4437
firemarshal@queensburt,.net - zuz Mqueensbunl.net
J2 Plumbing&Heating PROPOSAL
70 Lake Ave
Saratoga Springs, NY 12866 Accepted
Presented to: job # 2009
Harvey Roadcap job Name 5/17122 Plumbing&
7 Luzerne Rd HVAC Work
Queensbury, NY 12804 Proposal# P-2009-1
Technician Jonathan Ching
Issue Date May 20 2022
Customer Contact: Location Address;
M:(518)573-6633 7 Luzerne Rd
E:hiroadcap@buildingkidz.com Queerisbury.NY 12804
601
supplylrtstaA and Liberty Toitetwith pump
Pipe to 3"vent in ceiling.Tie in vent
Supply water line with shut off.
(2?vanities rough in drain&supplies to pump.Tnrn out both vanities. ......1
*Vanities and faucets supplied by client
Your Price
Sign up for a Maintenance Plan and save$486.80
Full Name: Harvey Roadcap
Signature: &,-U&�
Signature Date/Time: 05125/2022 10:37PM, EDT
�2
I agree to the work as specified above.
Contact Us: (518)871-1647 services@j2plumber.com www.j2plumber.com