CC-0186-2023 Office Use Only
ADDITION/ALTERATION PERMIT Permit#: CC--O 7-"?S
Town ofQueen b ry APPLICATION Permit Fee:$ Zms
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Invoice#: (o0 Z-(o
Flood Zone? Y N Reviewed By:
Project Location: ^/ 3 S�4 rjZA
Tax Map ID#: Subdivision Name: -rircor,1„
PROJECT INFORMATION:
TYPE: ❑ Residential Commercial, Proposed Use: 1aaa;
❑ 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:
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: Uri 1tX� ON �„�. ��� bac.� tVovtA--
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Addition/Alteration Application `r� Revised June 2022
1
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ O;t, yU 0
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 '6-"*'IVO. Explain:
4. Are there any easements on the property? ❑ YES Ea'NO
SITE INFORMATION:
• Is this a corner lot? ❑ YES [YNO
• Will the grade be changed as a result of the construction? ❑ YES QN-N0
• What is the water source?- 5-PUBLIC ❑ PRIVATE WELL
• What type of wastewater system is on the parcel? L�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2: If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 certifythat 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:
PRINT NAME:
SIGNATURE: / DATE: L> Z.I Z�
Addition/Alteration Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): e- -Sk5 C..
Mailing Address, C/S/Z: ?&C< = 'Dr. 12 1
Cell.Phone: 5 S 1 y Land Line:
Email: IZ ,\!7k e S?5*XP N a-rA.. L OVI.,L
• Primary Owner(s):
Name(s): ��\7t� l�+�r►�y��"cRd
Mailing Address, C/S/Z: �Dr . �Ve.rs�a,.a aT.l�l 1LY��
Cell Phone: SS ) 9 Land Line: � )
Email:
A?r 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): Art he IvC0
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( 5 r ) 711- o`/Y`1 Land Line: � )
Email:
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engineer(s):
Business Name: C re---V-;(ti Sk,)a;as
Contact Name(s): ,\je- %A -V CAA tw5aVl.
Mailing Address, C/S/Z: 9C�_ C'Et', )-lud-Soh
Cell Phone: ) (0 b - (7 D Land Line: �)
Email: C reo,*io i 5-'udi-35 °I -e \Ak6ou , uv,-.-L
Contact Person for Compliance in regards to this project: ckd� �✓y
Cell Phone: ( 5e ) 7 j1 ► — 6 yy`1 Land Line: �)
Email:
Addition/Alteration Application Revised June 2022
FIRE MARSHAL'S OFFICE .
Tozun of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Beef Jerky
1439X Route 9
CC-0186-2023
5/1//2023
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection X2
• Verify paths of egress
• CO detection is required
• Locks /Latches to comply with Chapter 10 of IFC
• Install Combo Pak front exit and whse
• NFPA 72 letter of compliance for fire alarm repairs
Michael J Palmer .
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office Phone: 518-761-8206 Fax: 518-745-4437
firemarshal fteembunj net 7MMqueensbury net