CC-0459-2021 Office Use Only
ADDITION/ALTERATION PERMIT Permit#: CL I"
APPLICATION 2s
— � Permit Fee:$
TownoFQuecns6ury
742 Bay Road,Queensbury,NY 12804
Invoice#: J��
P:518-761-8256 www.gueensburV.net
Flood Zone? .Y N Reviewed
Project Location:To D 51e64k� o JS'e
Tax Map ID #: � - ��- l � Subdivision Name:
�j JP,2pt S�jUi'�
PROJECT INFORMATION:
TYPE: Residential Commercial, Proposed Use:
Single-Family _Two-Family _Multi-Family(#of units ) _Townhouse
Business Office _Retail _Industrial/Warehouse _Garage (#of cars_)
X Other(describe
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: r 3rd floor:
Basement(habitable space): Basement-(habitable space):
Total sq ft: Total sq ft:
Scope of work to be done:
:a D Cie V
SUN 15 2021
TOwNBUIL OF
DIN6 Co
Addition/Alteration Application Revised January 2021
J
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
c�
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 _�<_'VO Explain:
4. Are there any easements on the property? YES O
SITE INFORMATION:
• Is this a corner lot? —YES X/N O
• Will the grade be changed as a res It of the construction? —YES `) 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 If,for any reason,the building permit application is withdrawn; 30%of the fee is retained by the Town of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: to C v�
SIGNATURE: DATE:
Addition/Alteration Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• A. 1i1 t•
Name(s): L_ r
Mailing Address, C/S/Z: qLF10 ot) -e Ct GVe-e05�6'Y'l2�4
Cell Phone: ( ) OW 673 r Land Line: _L_)
Email
• Prima Owners :
Name(s): G �,
Mailing Address, C/S/Z: e C1
Cell Phone: _� � ) Cfa3 2 Land Line:
Email:
M"Check if aff work will be performed b ro ert owner onl
p Y p p Y �t
• 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**
• 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:
Cell Phone: Land Line:
Email:
Addition/Alteration Application Revised January 2021
FIRE MARSHAL'S OFFICE
Town of Queensbury .
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
A1�T REVIi�
Tokyo Steakhouse & Hibachi
940State Route 9
CC-0459-2021
6/22/2021
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Inspection of Hibachi suppression system prior to dining room re-
opening.
2) Verify new seating per plan submitted.
3) Determine new max occupancy and provide same to owner.
6Depu y 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
iremarshal@queensburt/net • zvzvza.queensbury.net