CC-0475-2022 S
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Office Use Only
ADDITION/ALTERATION PERMIT Permit#: CC
APPLICATION Permit Fee:$ ZD O
To.mm of C uccnsbun
742 Bay Road,Queensbury,NY 12804 invoice M WAO
P:518 761-8256 www.aueensbury.net
Flood Zone? Y Reviewed By�
Project Location: 3 41 6/3 Y .. /l• C����,2 G c= �� r-2� �
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Tax Map ID#: 7S', �. Subdivision Name:
JUL 212022
PROJECT INFORMATION: TO�, •z, -
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8U-1_D_ING a: CODES
TYPE: ❑ Residential Commercial, Proposed Use:
❑ Single-Family ❑ Two-Family ❑ Multi-Family(#of units—) ❑Townhouse
❑ Business Office JK Retail ❑ Industrial/Warehouse ❑ Garage (#of cars )
❑ Other(describe )
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ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 5
1st floor: 1st floor: 1_.:2
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement(habitable space):
Total sq ft: Total sq ft: _
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Scope of work to be done: /=a U/ z .
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Revised March 2022
Addition/Alteration Application t`
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ `L)e co' °`t
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 .KI NO Explain:
4. Are there any easements on the property? ❑ YES IN NO
SITE INFORMATION:
• Is this a corner lot? 19 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 lK PRIVATE SEPTIC
DECLARATION: j
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
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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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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. If the work 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 area 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 1, or my agents, will obtain a certificate of,
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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 acertificate of occupancy.
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I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE: - -Z2
Addition/Alteration Application Revised March 2022 {
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address,C/S/Z: /r,Z 6 9' .63 7V` /eO. !�4i'CL G� �•NGG= iV_Y
Cell Phone: (-j7R ) .378 0.2 f9 Land Line: �)
Email: -P17 �'cl L?2 r v. cn m
• Primary Orwneds):
Name(s): :�L
Mailing Address, C/S/Z: -
Cell Phone:�_) Land Line:
Email:
❑ 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):
Contractor Trade:
Mailing Address,C/S/Z: .s S YLL= r'f28pP
Cell Phone: (.5 t6 l 7-15'- 2 6 7 Land Line: � )
Email: !%!/»GGI /, corY7
"Workers' Comp documentation must be submitted with this application"
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. Architect(s)/Eneineeds): '
Business Name:
Contact Name(s): H
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Mailing Address,C/S/Z:
Cell Phone: Land Line: � ) {
Email:
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Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email:
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Addition/Alteration Application . Revised March 2022
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Map References:
Map of a Proposed Subdivision
Known As
Farm To Market Commons
Dated:.July 23, 1990
Last Revised February 1, 1995
By: Van Dusen & Steves
New York State
Department of Transportation
Acquistion Map
Map No. 100
Parcel No. 123
Deed Reference:
Christine D. Meins
To
Geoffrey A. Hoffman
And
Cheryl A. Hoffman
Dated: October 31, 2008
Book:3671 Page:25
NOTE5:
1.) TH15 MAP WA5 PREPARED WITHOUT THE BENEFIT OF AN A155TRACT OF
TTU OR AN UP TO DATE TITLE REPORT AND 15 THEREFORE 5UBJECT TO
ANY 5TATEMENT OF FACT5 5HOWN THEREON.
2•) NO PROPERTY CORNERS WERE 51!rr A5 PART OF TH15 5URVEY.
3.) PARCEL 15 5UBJECT TO ANY EA5EMENT5 OF RECORD.
4.) THIS MAP WAS PREPARED FROM AN ACTUAL FIELD 5URVEY MADE IN
ACCORDANCE WITH THE EXISTING CODE OF PRACTICE ADOPTED BY THE
NEW YORK STATE A550CIATION OF PROFM51ONAL LAND 5URVEYOR5.
5.) TH15 MAP 15 COPYRIGHT 0 2022 VAN DU5EN t 5TEVE5 LAND
5URVEYOR5. UNAUTHORIZED ALTERATION OR, ADDITION TO TH15
DOCUMENT 15 VIOLATION OF 5ECTION 7209, 5UBDIV151ON 2, OF NEW
YORK 5TATE EDUCATION LAW.
G.) DIMEN51ON5 BETWEEN PROPERTY UNE5 AND 5TRUCTURE5 ARE TO THE
NEARE5T HALF FOOT AND ARE FOR THE 501E FURP05E OF
INTERPRETING THEIR CONFORMANCE WITH ZONING AND NOT INTENDED
TO AID IN THE E5TA5L15HMENT OK RETRACEMENT OF PROPERTY UNE5.
7.) UNDERGROUND UTILITIE5, IF ANY, ARE NOT SHOWN HEREON.
8.) THE 5URVEYED PARCEL 15 SUBJECT TO WHATEVER RIGHT5, TITLE OR
INTERE5T THE TOWN OF QUEEN55UKY AND THE PEOPLE OF THE 5TATE OF NEW
YORK MAY HAVE TO MAINTAIN THE ROAD5, AND TO WHATEVER RIGHTS,
TITLE OR INTERE5T THE TRAVELING PUBLIC MAY HAVE TO THE BED OF THE
ROAD5.
Conc. Mon.A
/ & CMP.
Lands of
Geoffrey & Cheryl Hoffman
Book:5787 Page:191
e4 278. -2-8
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9' Op,
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W� Area
o ` 536.5 Sq. Feet p
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24, Mapleco
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Porch
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GRAPHIC SCALE
10 20 40
( IN FEET )
1 inch = 20 ft.
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p�CE9VE
LJUN 0 9 2023
TOWN OF OUEENSSURY
BUILDING & CODES
F�
LE C®PY
A-/ l0 - 9-0 0�
F 1.3 13 2"23
Zoned NC
Neighborhood Commercial*
Setbacks:
Front = 40'
Sides = 20'
Rear = 15'
* In Travel Corridor Overlay District
Route 149 - 75' Front Setback
Legend:
CONC. MON. = CONCRETE MONUMENT
L-0-'l = UTILITY POLE
® = WELL
�- = 51GN
278.-2-9 AST-0321-2023
Geoffrey Hoffman
1234 Bay Rd.
Porch with handicap ramp
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Date: September 22, 2022
Scale 1"=2V
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SHEET 1 OF 1
IHOFFMAN D-3051'
DWG. NO. 22-195
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