CC-0188-2022 �
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Office Use Only
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TOWN OF QUEENSBUR
Project Location: 11T2 State RnutaQ BUILDING&CODES 9
Tax Map UD 288.20' -2O Subdivision. Name:
PROJECT INFORMATION*
TYPE: Residential X Commercial, Proposed Use:
Sin8}e�FamUly __.Two-Family Multi-Family k#ofunhs Townhouse.
8ushnessOffice Retail . IndustrW./VVarahouse Garage (# ofcaya___)
)( Other kdescribe Amusement Park \
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ADDITION SQUARE ALTERATION.SQUARt FOOTAGE:
1st floor,. Istfloor: 175
211 floor: 2nd floor:
3rd floor: .3rd floor:
Basement(habitable space): Basement(habitable space):
Scope of work tpbedone:
Construction of two interior walls to create a new office.
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 5000.00
2. Source of Heat(circle one): ❑ Gas CQ Oil ❑ Propane ❑ Solar ❑ Other: N/A
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? ® YES ❑ NO Explain: Located in the Great
Escape Theme Park
4. Are there any easements on'the property? ❑ YES ® NO
SITE INFORMATION:
• Is this a corner lot? ❑ YES ® NO
• Will the grade be changed as a result 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:
I. 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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. IfthL-mrl< is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certifythat the application, plans and supporting materials are atrue and a complete statement and/or description
of thework 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. I 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 anus-built survey by a licensed land surveyor of all newly
constructed facilities priorto issuance of certificate of occupancy.
I have read and agree to the above:
PRINT NAME:
SIGNATURE:. DATE:
Addition/Alteration Application Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Great Escape.Theme Park, LLC (Rebecca Wood),
Mailing.Address, C/S/Z: 1.172 State Route 9, Lake George, NY 1.2845
Cell Phone: ( Land Line: 518 )792-3500
Email: rwood(cDsftp.com
• Primary Owner(s):
Name(s):. Same" as Above
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): Dean Hyatt
Contractor Trade: Work to be completed by Great Escape Theme Park
Mailing Address, C/S/Z: 1172 State Route 9. Lake George NY 12845
Cell Phone: ( 518 ) _955-0865 Land Line: ( 518 ) 792-350o
Email: dhyatt(cDsftp.com
**Workers' Comp documentation must be submitted with this application**
• Architect(s)/Eneineer(s):
Business.Name: JARRETT Engineers, PLLC
Contact Name(s):.Robert U. Holmes.11. P:E.
Mailing Address., C/.S/Z:
Cell Phone: 518. ).79.6-7381 Land Line: 518 ) 792-2907
Email: bholmeseiarrettengineers.com
Contact Person for Compliance in regards to this project: Dean Hyatt
Cell Phone: ( 5IB ) 955-0865 Land Line: ( 518)_ _792-3500
Email: dhvatt(cDsftp.com
Add!tion(Alteration Appiicatlon Revised January 20.21
PLEASE INCLUDE WITH YOUR SUBMITTAL:
1. Completed Additions/Alterations permit application
THREE (3) COPIES OF THE FOLLOWING:
2. Structural drawings, which include:
a. Signed&sealed architect or engineer stamp; IF the cost of construction is over�20,000
b: Floor plan, if applicable
c. Foundation plan, if applicable
d. Cross sections, if applicable
e. Elevations, if applicable
f. Window& Door schedules, if applicable—printed on the drawings is acceptable
.g. Ca1cufation sheet for natural light,ventilation &emergency egress, if applicable—printed on the
drawings is acceptable
3. Plot plan, using a survey map if possible; which includes:
a. Drawn to scale (i.e. 1 inch = 1-feet)
b. Indicate proposed changes, with setbacks to property lines
c. Include all structures on the property
d: Include location of water supply(well or water lines)
e. Include location &configuration of septic system or sewer line
4. REScheck(resi-dential projects)or COMcheck(commercial projects), signed and stamped, if applicable —
www.energycodes.gov
5.. Workers' Comp insurance information for all contractors involved—REQUIRED, EVEN FOR SOLE
PROPRIETORS
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans,additional reviews and re-approval.
2. .If,for any reason,the buifding 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.
Addition/Alteration Application Revised January 2021