RC-0474-2022 r
Office Use Onlv
ADDITION/ALTERATION PERMIT Permit#: 2c.— • 24'?1z_.
Town ofQueensbury APPLICATION Permit Fee: $ 2.2p
742 Bay Road,Queensbury;IVY 12804 C�
P:518461-8256 www.gueensbury.net Invoice#:
Flood Zone? Y Reviewed By:6`A
Project Location: Q "t-vi t/
�K
Tax Map ID #: Subdivision Name:
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed-Use:
mangle-Family ❑ Two-Family ❑ Multi-Family (#of units_) ❑ Townhouse
❑ Business Office ❑ Retail ❑Ind ustrial/Warehouse ❑ Garage (#of cars )
❑ Other(describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
311 floor: 311loor:
Basement (habitable space): Basement (habitable space):
Total sq ft: Total sq ft:
Scope of work to be done:
OD �l
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JUL 2 8 2022
TOWN OF QUEENSBUF y
BUILDING&Con;=.
Addition/Alteration Application Revised June 2022
1
. a
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• A licant:
Name(s): &Lt s
Mailing Add-ress, C/S/Z: La IM
Cell Phone: - (.4� Land Line: ( )
Email:
Primary Owner(s):
Name(s): ((/Vl
Mailing Address,'C/S/Z: to —Eda16 �&d L
Cell-Phone: Land Line:
Email:. . .ob
❑ 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):
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: Land1ine:
Email:.
Contact Person for Compliance in regards to this project: 011W Lid
Cell._Phone: ._(9r ). . - and Line: ( _)
Email:: .
ion/Alteration Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:-$
2. Source of Heat (circle one): ❑ Gas ❑ Oil It .P opane ❑ Solar ❑ Other:
Fireplaces/inserts need a separate-Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? ❑ YES. E9116 Explain:
4. Are there any easements on the property? ❑ YES L-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:
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: rt tL� itooa---i
SIGNATURE: DATE:
dition/Alteration Application Revised June 2022
.. TOWN - -
.�..____.-....__._.___._....._.___. ..._._......_.._____..._.._.__._...__._ .__. GFQUEENSBURY
BUILDING DEPARTMENT ;<
d.Based,on our limited examination,compliance
with our comments shall not be construed as
ind_icaf ,
-.—..-------------....J- g the plans and sppecifications are in
s full co� Hance with the B
p wilding Codes of
l
- ....... .._.._.............._hlew.Yok State_.
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BUILDING & COPES E PT.
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Front View Side View
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-- -- {DIMENSIONSAP.E PI tJdUW1E7ER3 yEDGESSNARP OO NOISCALE ORAWR+G REVEION {
80LffiANCES. { C EDGES ` ,........
-__....
- - 474-2022 �ANAME__..-..:� �E r su DATE_.;.._.__....._ ! Tim
Rockwell.LLC
290.-1 67 RC 0 I _:.__." ! Premier window Well
i (�xD .'.� Pr x i x i i
i Roman Steven �� ._._.._...__;._.. ._.�
, _._.-_,$
t.___.w_..__.__..__._. .____ ___---
19 Brookfield Run lam. ___.._,_._._-_$...._.__.__sATERIAU �WGNG PT 96
I Egress window 1 -4_ W —663 0 ._a
--__�.8GHT; I SCALMIO SHEET 1011 �I
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EGRESS WORKSHEET
• IDENTIFY WHERE ALL UTILITIES ENTER THE HOME AND WHERE
THEY RUN UNDERGROUND /
• MEASURE AND MARK THE DISTANCE FROM THE EGRESS TO THE
PROPERTY LINE
•-DOES THE GRADE FALL AWAY FROM THE HOUSE WHERE THE
EGRESS IS GOING?
• IS THERE PROPER CLEARANCE FOR THE EQUIPMENT NEEDED? '�
•WHAT LS THE TYPE OF SOIL? s"
�A �-i-
• RE.THERE FOOTER DRAINS?
• IS THE CUSTOMER_ KEEPING THE REMAINING SOIL?
• IS THE:BASEMENT CURRENTLY FINISHED?
IS-THERE WATER AND ELECTRICITY AVAILABLE?
• IS:THERE LANDSCAPING_ OR EQUIPMENT IN THE WAY? �t
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Front of house
csr name address date
i S
EGRESS MEASUREMENT -SHEET
WINDOW SIZE:
A SLIDER STANDARD
48"x48"
INSWING STOCK SIZ
.5"x36" .
WINDOW SIZE
li
-. D Wx H
•'`,�� tlfd�l Ifdl®Hlditl®EtLL®!®I�UIDCRHDtJ�IfdL",IDOLILLtH7tFt1IL77t7➢
Standard 7"
Header B:
B -®:
"
Standard 57" - 12 "
SEE CHART FOR EGRESS SIZING
E IS HEIGHT WINDOW TOP
NEEDS TO BE LOWERED FOR
i
CEILING OR HEADER ETC
SCAPEWEL: 42" or 54" wide
C 4 4048-XX-40" max window width-
s 4862-XX- 54" 36" &48"
<44"n fi
I + ELITE ROCKWELL: 66" wide
" max window width- 60"
# Medium size 2-6 "
Large size 3-72"
CUSTOM WINDOWS NEED SEPARATE PRICING
Tie Into Tie Into
Interior Exterior
Drainage Drainage
csr name address date
, � Prepared by: Prepared for:
A :; Joe Toomey Steven Roman
Avirondock 13ase7c jtoomey@adirondackbasement.com sterom@gmail.com
na.,maN W°k"r" R:2. = & P j *� P (631)335-6421
v av 0 Adirondack Basement Systems,Inc
Basement&foundation Speclalists
www.AdirondackBasement.com. Job location:
TF 800-752-5807 19 Brookfield Run
O 518-371-9621 Queensbury,NY 12804-9796
F 518-371-5888
Prepared on:
7-21-22
Product List
Egress Window Well,Premier Medium ...... 1 Egress Cutting,Poured ..................... 1 Egress Excavation,Equipment Excavation ... 1
Egress Window,Large ...................... 1 Landscaping Removal ...................... 2
Project Summary -- —_-.o .- ----- t
Add Means of Egress ............................................ $
Total Investment ................................................. $
Total Contract Price $
hi
Deposit Required-25% .... $
Amount Due Upon Installation .................... $
Customer Consent
Any alteration from the above specifications and corresponding price adjustment(if necessary)will.be made only at the Customer's request or approval.
Completing the work in this PropA at the time scheduled is contingent upon accidents or delays beyond our control.This Proposal is based primarily on
e p the Customer's description o blem.T Proposal may be withdrawn.if not accepted by the Customer within 30 days. I
Authorized Signature Date- 2.`
Acceptance of Contract—I am/we are aware of and agree t he contents of this Proposal,the attached Job Detail sheet(s),and the attached Limited
Warranty,(together,the"Contract").You'are authorized o do the work as specified in the Contract.I/we will make the payment set forth in this Contract
at the time the project is completed.I/we will pay your service charge of 1-1/3%per month(16%per annum)if my/our account is 30 days or more past due,
plus your attorney's.fees and costs to collect and enforce this Contract.
Any requirements imposed by a local municip 'ty not specifi efi d in this proposal_may incur a separate charge. Electrical work is not included
unless specifically defined in this os I.
Customer Signature Date —7 �I
Customer has received a copy of the"Repair Science"book. Initial
A TripleSafe and FuII Perimeter system has been recommended. Initial
Adirondack Basement Systems,Inc Job Location Page US
4Jones Rd Half moon NY 12065 19 Brookfield Run Queensbury.NY 12804-9796 7-21-22(1)
Job Details (Continued)
Specifications
1)66"Wide x 44"proj.x 60"Deep Elite Series Rockwell with Elite Cover and 48"x 48"Slider Window 2) 3) -4) 5)
Contractor Will
1.)Remove and replace concrete as necessary in the workplace.
Customer Will
1.)Move items at least 10 feet away from the work area.
Additional Notes
.Customer has read and understands warranty._
Customer aware ABS not responsible for condition of landscaping.
Customer aware no waterproofing warranty is included with this quote.Egress window is not waterproof,additional work at additional
cost may be necessary if water seepage becomes an issue.
Customer initial:
Customer agrees topay sales tax on all items required.b_y state law. Customer agrees to submit a complete ST-124 for any items
considered a capital improvement as defined by law. If this form is not submitted,customer agrees to pay any taxes levied by the state.
Customer initial: <00-a
Customer has been made.aware that flooding of the basement in the event of a power outage or mechanical
failure of the single:pump tern(SuperSump Plus),is not under warranty and ABS is not responsible for any resulting damages.
Customer initial:
Adirondack Basement Systems,Inc Job Location Page 3/5.
4 Jones Rd Halfmoon NY 12065 19 Brookfield Run Queensbury NY 12804-9796 7-21-22(1)
r y
Limited Warranty
Standard Exclusions Permitted By State Law
This Foundation Limited Warranty("Warranty")is made in lieu of and excludes all other warranties,express or implied,and all other obligations on.the part of Adirondack
Basement Systems("Contractor")to the customer("Customer").There are no other verbal or written.warranties and no warranties that extend beyond the description on the
face hereof,including NO WARRANTIES OF EXPRESS OR IMPLIED MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
General Terms
For the applicable time periods indicated below,this Warranty is transferable at no charge to future owners of the structure on which the work specified in this Contract is
completed.This Warranty is in effect if the job specified in this Contract is completed and paid in full and,alternatively,is null and void if full payment is not received.Contractor
does not warrant.products not mentioned below,but some of such products may be covered by a manufacturer's warranty:All material used is warranted to be as specified in
this Contract.All work will be completed in a workmanlike manner according to the standard practices of the industry.
Exclusions
THIS WARRANTY DOES NOT COVER,CONTRACTOR SPECIFICALLY DISCLAIMS LIABILITY FOR,AND CUSTOMER HOLDS CONTRACTOR HARMLESS-FROM:1)exterior
waterproofing;2)plumbing damage;3)Customer-caused damage;4)dust from installation;5)damage"to real or personal property such aswalls,countertop,or floor coverings,
framing,sheetrock,exterior materials,cabinets,appliances,and so on,including any damage alleged to have been done by the Contractor's use of heavy equipment necessary to
complete thejob;6)any-injury or damage caused by mold to property or person;7)failure or delay_in performance or damage caused by acts of God(flood,fire,storm,methane .
gas,etc.),acts of civil or military authority,or any cause outside Contractors control;8)damage from a lifting operation;9)basement water seepage;and 10)damage from heave,
lateral movements/forces of hillside creep,land sliding,or slumping of fill soils.While Contractor assumes responsibility for utility damage that occurs as a result of Contractor's
installation,such protection is limited to replacing/repair the area Contractor damaged and does not include any upgrades to utilities for code compliance or other reasons,
Items For Which Customer Is Responsible
Customer shall:1)make full payment to the crew leader upon completion of work;2)prepare the work area for installation;3)be responsible for any finish carpentry,painting,
paneling,landscaping,etc.that maybe necessary after Contractor's work is finished;4)mark private lines(satellite,,propane,sprinkler,etc.)5)maintain positive drainage away ..
from the repaired wall(s);6)keep gutters clean and in good working order;7)direct downspouts a sufficient distance away from the repaired wall(s);8)maintain proper
expansion joints in concrete slabs that are.adjacent to the repaired wall(s);and 9)any items mentioned in this Contract under"Customer Will"or"Additional Notes."
Warranty Activation
Warranty is in effect when job is completed and paid in full.
Exclusions
THIS WARRANTY DOES NOT COVER,AND THE CONTRACTOR SPECIFICALLY DISCLAIMS LIABILITY FOR WATER DAMAGE TO FLOOR COVERINGS,FURNITURE,
STORED ITEMS,FINISHED WALLS AND OTHER OBJECTS INSIDE THE FOUNDATION.Contractor will not be responsible for any damages caused by mold,to include but not
be limited to property damage,personal injury,loss of income,emotional distress,death,loss of use,loss of value,and adverse health effects,or any other effects.Homeowner
agrees to keep area dry and report all other obligations on contractor's part.There are no other warranties verbal or written.
Adirondack Basement Systems,Inc Job Location Page 4/5
4Jones Rd Halfmoon NY 12065 19 Brookfield Run Queensbury NY 12804-9796 7-21-22(1)-
Notice of Right to Cancel
You are entering into a contract.If that contract is a result of,or in connection with a salesman's direct contact with,or call to you at your
residence without your soliciting the contract or call,then you have a legal right to void the contract or sale by notifying us within 14
business days from whichever of the following events occurs last:
1.The date of the transaction,which is: or
2.The date you received this notice of cancellation..
How to Cancel
If you decide to cancel this transaction,you may do so by notifying us in writing at:
Adirondack Basement Systems
4JonesRd
Halfmoon,NY 12065
Adirondack Basement Systems,Inc
TF 800-752-5807
O 518-371-9621
F 518-371-5888
www.AdirondackBasement.com
4 Jones Rd
Halfmoon,NY 12065
You may use any written statement that is signed and dated by you and states your intentions to cancel,or you may use this notice by
dating and signing below.:Keep one copy of the,notice because it contains important information about your rights.
1 wish to cancel.
Owner's Signature Date
Owner's Signature Date
The,undersigned acknowledges ipt of the two copies of the Notice of Right to Cancel.
- 7
Owner's Signature Date
Owner's Signature Date
Adirondack Basement Systems,Inc Job Location Page US
4 Jones Rd Halfmoon NY 12065 19 Brookfield Run Queensbury NY 12804-9796 7-21-22(1)
Job 'Detaiis
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........................................................ . ....... ........ ............—..............
Typeof Wall ................................................................................................................................. Poured Concrete
ExistingWall Finish ....................................................................................................................................... Plain
ExistingFloor Finish ................................................................................................................................. Concrete
Adirondack Basement Systems,Inc Job Location Page 2/S
4 Jones Rd Halfmoon NY 12065 19 Brookfield Run Queensbury NY 12804-9796 7-21-22(1)