RC-0696-2021 Office Use Only
ADDITION/ALTERATION PERMIT permit#:
APPLICATION
TOM ofQecrostiiuy Permit Fee:$ Z2�
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensbury.net Invoice#:
Project Location:�62 Country Club Rd
Tax Map ID#: 296.14-1-51 Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s):Hilltop Construction Company
Mailing Address, C/S/Z:51 Crowley Rd. Hudson Falls, NY 12839
Cell Phone:_(518)_258-9327_Land Line: _(518)_798-0338
Email: tomjr@hMtopconstructionco.com
Primary Owners :
Name(s): Frank and Cindy Steciuk
Mailing Address,C/S/Z:_62 Country Club Rd. Queensbury,NY 12804
Cell Phone: 518 527-4323 Land Line: _(�
Email: cindy.steciuk@gmail.com
❑ Check if all work will be performed by homeowner only
• Contractor(s):
Contact Name(s):_Tom Albrect Jr.,Hilltop Construction
Contractor Trade:General
Mailing Address, C/S/Z:_51 Crowley Rd.Hudson Falls,NY 12839
Cell Phone:_(518)_258-9327 Land Line: _L518)`798-0338_
Email: tomjr@bMtopconstructionco.com
"List all additional contractors on the back of this form
• Architect(s)/Eneineer(s):
Business Name: Oldenquist Design Architecture and Planning
Contact Name(s):Nina.Oldenquist,AIA
Mailing Address, C/S/Z: 15 Dixon Ct.Queensbury,NY 12804
Cell Phone:_(518)726-6557_Land Line: _('}�n/a
Email: Nina@OldenquistDesign.com
Contact Person for Building&Code Compliance: Nina.Oldenquist,AIA
Cell Phone:_L518)_726-6557 Land Line: _(_)
Email:Nina@OldenquistDesigmcom
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: ❑ Commercial X Residential
WORK CLASS:
X 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: 90
2nd floor: 211 floor:
3rd floor: 3"d floor:
Basement(habitable space): Basement(habitable space):
Total square feet: Total square feet: _90
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$"50,000
2. if Commercial project,what is the proposed use:
3. Source of heat: ❑Gas❑Oil❑Propane❑Solar El Other—n/a Fireplaces need a separate Fuel
Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? DYES ONO Explain:
S. Are there any easements on the property? DYES Shared driveway access ONO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? —
2.02 acres
b. Is this a corner lot? DYES ONO
c. Will the grade be changed as a result of the construction? DYES ONO
d. What is the water source? ®PUBLIC ❑PRIVATE WELL
e. is the parcel on SEWER or a PRIVATE SEPTIC system? _Septic
Addition/Alteration Application Revised February 2019
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If thework is not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
3. 1 certify that the application, plans and supporting materials are a true and 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.
4. 1 acknowledge that prior to occupying the facilities proposed 1, or my agents, will obtain a certificate
of occupancy.
5. 1 also understand that 1/We are required to provide an as-built survey by a licensed land surveyor of all
newly constructed facilities priorto issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: Tom Albrecht Jr., Hilltop Construction Co.
SIGNATURE: DATE: 9/14/2021
Addition/Alteration Application Revised February 2019
Deck and Roof Design checklist
,derIsfreestanding or ttac e
Footing
Sono tubes sized for posts 44 8" 6x6 2" -
Big foot or footing for roof load
Proper attachment to post and footing shown
Proper flashing or waterproofing to structure shown
Attachment to structure shown on plans
Galvanized or stainless steel bolts shown NO ZINC COATED 4%0
Y Hex headed bolts NO CARRIAGE BOLTS ' "
NA-A--Diagonal bracing shown for deck over 24"
9V Floor joists parallel to carrying beams
j'=�AWpost to beam attachment shown
�,)Ik Over 30" requires handrail
MAOver 30" requires guards
YJ1A Over 30" requires guards @ 34" to 38" in height and handrails @ 34"-38"
Revised 4/15/2021