AST-0225-2022 +Ccq_--a �rR� Office Use Only
1 A ON PERMIT Permit#: �T— pZ25 - Zo2'L
APPLICATION Permit Fee,:$ 11Q5'
Town of Queens
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.gueensbury.net
Flood Zoni? Y N eviewed By:
Project Location: 89 Everts Road
rEi1
Tax Map ID#: 302.8-2-4 Subdivi I ame:.�_ 1
PROJECT INFORMATION: -
26 2029
TO W�'
SUIT yIlF[$,�S��IRY
CODES
TYPE: ❑ Residential ❑ Commercial, Proposed Use: "�---
❑ Single-Family ❑ Two-Family ❑ Multi-Family(#of units—) ❑ Townhouse
❑ Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars )
X Other(describe Telecommunication Equipment Modification )
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: Removing 12 antennas,replacing with 12 new antennas,Removing 6 Remote
Radio Heads and replacing with 6 Remote Radio Heads, swapping a 6 circuit OVP for 12 circuit OVP,
removing 12 coax cables, adding 1 hybiflex 6x12 cable, adding one combiner. See attached drawings
for details.
Addition/Alteration Application Revised March 2022
i
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$15.000.00
Source of Heat (circle one): ❑ Gas ❑ Oil ❑ Propane ❑ Solar ❑ Other: _N/A
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? ❑ YES XNO Explain:
4. Are there any easements on the property? ❑ YES X NO
SITE INFORMATION: Cell Tower- The below does not apply
• 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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. 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 certificate of occupancy.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE. 4/21/2022
Addition/Alteration Application Revised March 2022
nu- YRAM 1 D
Net •rk Services, LLC
Telecommunications Construction Services And Consu/ling
April 21,2022
Town of Queensbury
Building Department
742 Bay Road
Queensbury,New York 12804
Attn: Kate Deck, Office Specialis, Building& Codes Enforcement
RE: Building Permit Application
Site Location: 89 Everts Road
Dear Kate:
As you know, Pyramid Network Services on behalf of Verizon Wireless, is submitting the attached
building permit application for modification of equipment on the Telecommunications Tower located at 89 Everts
Road. Per our conversations, I am submitting this application with three (3) copies of constructions drawings
detailing the proposed project.
Upon your review of the enclosed application materials, please call 518-653-2598 or email me at
asquires@pyrainidns.com with the required fee for this application. I will then submit a check for that fee,
together with the required certificates of insurance. If there is anything else needed, please let me know.
Thank you in advance for your assistance.
Sincerely,
Allison J. Squires APR 26
Site Acquisition Specialist
TOWN OF OUF.7 BURY
BUILDING -)DES
6615 Towpath Road,East Syracuse,NY 13057
Phone: 315-701-1300,Fax: 315-445-0653
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):Verizon Wireless c/o Pyramid Network Services
Mailing Address, C/S/Z:6615 Towpath Road, E. Syracuse, NY 13057
Cell Phone: (518 ) 653-2598 Land Line: � )
Email:
Primary Owner(s):
Name(s): Pamal Broadcasting Ltd
Mailing Address, C/S/Z: 6 Johnson Road, Latham, NY
Cell Phone: ( Land Line: ( 518 ) 615-1000
Email:tjacobsenOadirondackbroadcasting.com
❑ 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):Verizon Wireless
Contractor Trade: Telecommunications
Mailing Address, C/S/Z:6615 Towpath Road, East Syracuse, NY 13057
Cell Phone: Land Line:
Email
"Workers' Comp documentation must be submitted with this application"
• Arc hitect(s)/Eneineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
Contact Person for Compliance in regards to this project: Allison J. Squires
Cell Phone:_ ( 518 ) 65 - 5A8 Land Line: _L _)
Email:asguiresO_pyramidns.com
Addition/Alteration Application Revised March 2022
������ T��������'��i
Town of0ueensbury
/ttm�John D^Bhen,Director ufBuilding 8cCode Enforcement
742Bay Road
Oueenohury,New York 12804
CONSTRUCTION CERTIFICATION LETTER
BUILDING PERMIT: AST-0225-2022
VERIZON WIRELESS SITE NAME: GLENS FALLS NORTH
SITE ADDRESS: 89 EVERTS AVE, QUEENSBURY. NY 12804
Tectonic Engineering Consultants, Geologists & Land Surveyors, [LpI,(Tectonic)has reviewed post -
construction photos(datedAugust12,2022)provdedbythegenens|oontmctoc The purpose nf
Tectonic's review was to ensure the work completed under this permit was performed in general
conformance with the Construction Drawings (dated April 12, 2022) prepared by Tectonic. The conclusion
of our review is that, to the best of my knowledge, the site has been completed in accordance with the
approved drawimgs-
|fyouhaveanyquesdoms, please donot hesitate tocontact the undersigned.
Sincerely,
Tectonic Engineering Consultants, Geologists & Land Surveyors, D.P.C.
Adrian H.Massie, PE
Sr. Project Manager M W
Project Contact Info
3GBritish American Boulevard, Guh 101 1 Latkmn NY1211O
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