CC-0148-2022 Office Use Only
ADDITION/ALTERATION PERMIT Permit#: 292'y-
APPLICATION permit Fee:$ 200'
Town of Queensbury
742 Bay Road,Queensbury,NY 12804
Invoice#:
P:518-761-8256 www.gueensbury.net
Flood Zone? Y Reviewed
Project Location: �-��-
Tax Map ID#: S a- l p ® 9-cm-1 -8 Subdivision Name: ��
� ;'
PROJECT INFORMATION: MAR 3 O 2Q2,� -
TOWN OF OUEI-=N BURY
TYPE: Residential X Commercial, Proposed Use: �LIG CODES
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: oW l St. F4
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space):
Total sq ft: Total sq ft: apcl St ,
Scope of work to be done: Co r)Ve t--(-I r1 S )c_P_ AeLK i.(rD C a rn ler
Ili-I-cl)en r Qxe� �zcfeck
o r� Wo-1 I -f v b- c-Ccfn54T u c+e -m d i0 idl-the (z o� _ --FF w i I I a15 a a r\ access
d®oI' m -fhb 2x1s-ffr Kr-cVlen -� b� .btc_i (-f-. P10lrnb«q anal �)e�-h�icr� in
bar a.re� w� ( l � "0 VeA � wa-113 .N o ye e �`n9 W l l I �e
Q5 -4);s w i l I
Addition/Alteration Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ 1 7),5_®d
2. Source of Heat (circle one):_Gas _Oil _Propane _Solar Other NIA `en°-�- heo-4— a—':z,
e>v rnn e—r- OS--
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? YES __kNO Explain:
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 _XN0
• What is the water source? _PUBLIC XPRIVATE 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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 certificate of occupancy.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE:
0
Addition/Alteration Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z: a- ' ,� e- Tr'
Cell Phone:_(6-Nf Land Line:
Email: ,
• Primary Owner(s):
Name(s): rr cS►V, L-(�
Mailing Address, C/S/Z: -fri o(4P Dr-, a rzt-4-o Q N /16
Cell Phone: (-17 9 Land Line: (-��
Email: t5r eK@—me - CoM
❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
ContactName(s): royi)n Nn-s oc::Nan aryl r::: 1tq-+r-ie, LL 02-gurn2Y-6n er-i v)W '1
Contractor Trade:
Mailing Address, C/S/Z: o� G u-,e:er I t`C2r -e_ lr-eer>6baCt/
Cell Phone: (5-/ Land Line: SI ) Q6 09
Email: Ca-mbrno!0 E@,y a-hoo,Cyao
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engineer(s):
Business Name: R u6 &1 jja l l
Contact Name(s):
Mailing Address, C/S/Z: 13 H A'V IA V-e • G'i e-ns F a l�s la '90 1
Cell Phone: (SIB ) ' 41 —0aCdK Land Line:
Email:-n,ho I I o-nyCLe,a', corn
Contact Person for Compliance in regards to this project: IQ
Cell Phone: Land Line: �_)
9�q
Email:
Addition/Alteration Application Revised January 2021
D � r
r'L Copy
Brown' �Construction and Electric LLC
CameronBrown
(518)t-260-2879
cambrown58@yahoo.com
Work Pro o for 990 NY-149. Queensbury AT 12804
(streaking inaose bbq)
,DescriFtiorQf work: kitchen expansion out onto part of the deck.
Closing off a back,comer of the deck with new door into expanded area.
Work to be done is all the framing and sheeting of the walls and floors,
all electrical work including cooler circuits, new lighting,;etc. All rough
and finish construction tasks except plumbing and mechanical.
Materials:
To-be acquired as needed. Cannot give a close enough number now.until
measurements and a solid plan is complete.Rough estimated range of
($6500- $8000)
Labor:Estimated time of 3 weeks with,2-3 men there with an estimated
total of($12;000)
(*) symbolizes the very.-highest end4I could'forsee. I forsee this being
able to be done for right around$17,500
Thank your-for yourbusiness
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Streaking Moose
990 State Route 149
CC- 0148-2022
3/31/2022
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection
• Verify location of exit/Emergency lighting. Function test will be required
• Lock/ latches shall comply with Chapter 10 of 2020 IFC.
• Verify paths of egress
•. Verify storage
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fi r e M a r s h a 1 's Off i c e - P h o n e: 518-761-8206 - F a x: 518-745-4437
-flremarshal@queensbtiiil.net - www.queensbury net