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CC-0518-2021 Office Use Only ADDITION/ALTERATION PERMIT Permit#: cc_. - 05 i - • Z© 2k APPLICATION Permit Fee: $ Town of Queensoury 742 Bay Road;Queensbury,NY 12804 Invoice#: l P:'518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By: Project Location: 3 0��' . �u-li-JL�� 7za� u-1, _-- - . ( ,Ga -Tax Map ID#: Subdivision Na' t rdale JUL 07 2 2�TOWN OF QUEENSBURY PROJECT INFORMATION: BUILDING�CODES 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: 2nd floor: 2nd floor: 3rd floor: 3rd floor: Basement (habitable space): Basement (habitable space): Total sq ft: Total sq ft: $cope,of.work to be done: hew Pa. %� C�i�lr�►�� � rOGjnS bwi0'1 SP{jr\Kir-e- Gc.��p�G �>✓ .�. . .�Ar�-tAJ rci\muA-r p 14-d�0jnlrly Addition/Alteration Application Revised January 2021 r I ; ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $11AD, 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? YES O • Will the grade be changed as a res�It of the construction? YES _il�o • 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3. If the work 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: D�rA,U ns ,1I, /l SIGNATURE: C ,,,,,^ DATE: Addition/Alteration Application Revised January 2021 f } CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL e Applicant: Name(s): f: fj ,J h. f:w l 1 — 77-/- i J �Mailing Address, C/S/Z: 9 r3 rrjuc-- d►, c.,,rur-- S r4r,5 L— I IS . NY. lei UL? Cell Phone: ) N,6 / - 3 -/ ,9 :2 Land Line: 5 W It-0 - /61 12- Email: �t, A ,- &- Ine-AV-71A a��� • Primary Owner(s): G,bO y L Name(s): Mailing Address, C/S/Z: Cell Phone:) Land Line: 6 Email: ❑ Check if all work will be performed by property owner only e Contractor(s): (List all additional contractors on the back of this form) Contact Name(s): Al prjA hcjj.. CiJ:t��S r� 6 e--�_1�t,,),4 Contractor Trade: In Mailing Address, C/S/Z: 3 L !I / Cell Phone: Q ) aZ Land Line: Email:- e- c,m x L V Gz,,.,,, "Workers' Comp documentation must be submitted with this application" e Arch itect(s)/Engineer(s): Business me: Contact Nam Mailing Address, Z: Cell Phone: Land Line: �) Email: Contact Person for Compliance in regards to this p 'ect: � >J,, Cell Phone: ( �1`/ ) y0 / 3LI12 Land e: / - ) Email: e- `/A m Addition/Alteration Application Revised January 2021 • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): l�la/ �h�rn L�-lt��v fps Contractor Trade: b r.-)ld In Gar,tr`��7'z✓ Mailing Address, C/S/Z: _?,Cr �Sr,�-foSw five- S 61v-, S �wl1S / ;t4fG� Cell Phone: I e" lg?f Land Line: 5-1 Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Addition/Alteration Application Revised January 2021 r FIRE MARSHAL'S OFFICE Tozvn of Queensbunj 742 Bay Road, Queensbury, NY 12804 "Home of Natural Beauty ... A Good Place to Live " PLAN REVIEW Tushita Heaven 324 Quaker Road, #7 CC-0518-2021 Copy 7-26/21 The following comments based on review of the submitted plans: 1) Verify Fire Extinguisher inspection & locations. 2) Lochs & latches shall comply with 2020 NYSFC. 3) CO detection required. 4) Verify new & existing Exit & Emergency lights. 5) Verify storage & aisles 6) Provide a Knox Box. 7) Pr ide NFPA13 letter for sprinkler system modifications. 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 Fat. 518-745-4437 fimmarshal@queensbu!2L.net zvzvzv.queensbur<t net