AST-0035-2023 W
Office Use Only
ADDITION/ALTERATION PERMIT Permit 00Zf> - 2023
APPLICATION
Town ofQucensbu all
Permit Fee:$ Z-G.,
742 Bay Road,Queensbury,NY 12804
Invoice#:
P:518-761-8256 www.gueensbury.net
Flood Zone? YCi/IV viewed B _W_
Project Location: A4JT �(�\
Tax Map ID Subdivision Name:
PROJECT INFORMATION: JAN 3 0 20
23
TOWN O r3=O E URY
TYPE: ZResidential El Commercial, Proposed Use: -�
❑ Single-Family ❑ Two-.Family ❑ Multi-Family (#of units_) ❑ Townhouse
❑ Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars )
CI Other(describe c1rTI�C i�� -�BP.�C-,� C ��` f�t�lt� 6 % 6\f
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: ; stefilars--O& '507
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement (habitable space):
Total sq ft: Total sq ft:
Scope of work to be done: klilcke✓L ih IVI.151 S/�CcCt _ Stove a"J /`eCeafeL --- M;c,-0 Wave. and
P.-If ee✓J��t e 4tA s4 k e /,emoV C'et' -1 -0 M &1 e C'fr; iCc l '0 0wi 'it box . Oate-- S c+i/J��J�r+e_5
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ul, pel k Jget CIAM ✓fs .M st be �`e�royerj l=l4o,r ���� ;s atf6c,
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Addition/Alteration Application Revised March 2022
i
ADDITIONAL PROJECT INFORMATION:
41p'Estimated Cost of Construction: $ 1 .5) 3 7%2
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 Z NO Explain:
4. Are there any easements on the property? 0 YES ❑ NO
SITE INFORMATION: _/
• Is this a corner lot? El YES Ll NO
• Will the grade be changed as VPL
lt of the construction? El YES [1/NO
• What is the water source? BLIC El PRIVATE WELL
• What type of wastewater system is on the parcel? ❑ SEWER LJ 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 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 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:
R1NT-`7 : AAIM�- �
an :-R_L03a L2oz�
Addition/Alteration Application Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): ANDREA I AYJ_o►Q
Mailing Address, C/S/Z: 13 EAST QRI V . O UI;F AIS ?3 GtRY . NEW VOR k l 2 S'0 µ
Cell Phone: 1 i; ) 2�>Z- 6 531 Land Line: �)
Email: ���Qrev� fi3�a�,�o+- ( 1�►o-I ►vt�►� . Co+�-t
• Primary Owner(s):
Name(s): AN DR E A TA y/L o k
Mailing Address; C/S/Z: 13 1:A 5 i De.TI/F_ . G yeer/5 r uky _ Alew VoRk 1 zgoy-
Cell Phone: _( 5 l fS ) 252-- & 533 Land Line: J
Email: otAd rea Comet
P'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): 5a^itr ,w,er er icE f ac_
Contractor Trade: f;c %✓i
Mailing Address, C/S/Z: 690 1 �x 22 41`, 061t-l. Fe his . IVY 12 & 01
Cell Phone: ( 511' ) 796 - 37ko Land Line: ( 5I $ ) 7922- 7,257
Email: SANITARY 2-WERSERVIC &IvlA.I LZOM
"Workers" Comp documentation must be submitted with this application"
• Architects En ineer s : rr^^
Business Name: HtAf J,il.,% s /Vq i ti e-e_rm C
Contact Name(s): e/t
Mailing Address, C/S/Z: 1 6 V") J L eeAS ins N y US D#_
Cell Phone: (51 S- ) 7'/& - 2 5/S Land Line: ( 51 ) 7lf S- D 3 0 7
Email: Te[NTf_je366), )/A1400 •L_"DM
Contact Person for Compliance in regards to this project: e-r 0q e Or-e_ 0 S
Cell Phone: ( 51$" ) 7'16 •- 3 7690 Land Line: �)
Email:
Addition/Alteration Application Revised March 2022
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01/2 From : 15182209014 Cincinnati Sawyer Fage : 2/2
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
�6rtyfs that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrica{ Code, appli ble governmental, utility and Agency rules in effect on the date
r t noted below and is issued subject to the following conditions.
Owner. Taylor Date:• � t 01/17/2023
! Occupant: 1st FI. Renovations Locatio
"t3 East Dr.
I' Occupancy&ngle Family Dwg: Queensbury,Warren Co. NY
—1 I
co ' Applicant: Andrea E.Taylor
13 East Dr.
Queensbury, NY 12804
,
L J
Joseph A.Holmes
No. 318014174631EL
Equipment:
,025
1 -Switch; 1 -GFCI Receptacle; 2-Fixtures; 1 -30A Water Heater
u
uFE�SBURY
TOWW D1�G&CODES
This certificate applies to the electrical wiring to the electrical equipment listed immediately n II and 8 4s certificate applies only to the use,occupancy and
above and the installation inspected as of the above noted date based on a visual ownership as i tCated herein. Upon a change in the use,occupancy or ownership
inspection, two warranty is expressed or impiied as to the mechanical safety,efft- of the property Indicated above,this certificate shall be Immediately null and void.
Clancy or fitness of the equipment for any particular purpose. This certificate shall in the event that this certificate becomes invalid based upon the above conditions,
be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department
c system to which this certificate applies be altered in any way,Including but not limit- lnspection Agency,Inc. An application for inspection must be submitted to Middle
ad to,the introduction of additional electrical equipment and/or the replacement of Department L•rspection Agency, Inc, to initiate the inspection and revalidation
any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service.