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CC-0663-2023 DocuSign Envelope ID:E44CB3F1-2509-497B-BC71-6551D5DEF468 Office Use Only ADDITION/ALTERATION PERMIT Permit#: CC' Olo - 20 • APPLICATION Town of Queensbury Permit Fee:$ 200 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice#: 6 iQ - Flood Zone? Y Reviewed By: kNQ. 0(217+ Project Location: McDonald's - 819 Route 9 Tax Map ID#: 302.6-1 -49 Subdivision Name: PROJECT INFORMATION: TYPE: ❑ Residential ® Commercial, Proposed Use: restaurant ❑ 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: 300+/- 2nd floor: 2nd floor: 3rd floor: 3rd floor: Basement (habitable space): Basement (habitable space): Total sq ft: n/a Total sq ft: 300+/- Scope of work to be done: Renovation of customer service area. ta. c_ OCT 1 ? 20,3 T BUN ONQUE�/�r U COO`gSRY Addition/Alteration Application Revised June 2022 Docusign Envelope ID:E44CB3F1-2509-497B-BC71-6551D5DEF468 ADDITION/ALTERATION Submission Requirements: • ro n of O n-,bur (RESIDENTIAL AND COMMERCIAL) 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net 1. Completed Addition/Alteration permit application (please print neatly or type) 2. Workers Compensation insurance information for ALL contractors involved in the project—this is REQUIRED EVEN FOR SOLE PROPRIETORS THREE (3) COPIES (either 1 pdf& 2 paper (min. 11" x 17") OR 3 paper (min. 11" x 17") OF THE FOLLOWING: 3. Structural drawings, which may include: a. Signed& sealed architect or engineer stamp IF the cost of construction is over$20,000 b. Floor plan, if applicable c. Foundation plan, if applicable d. Cross sections, if applicable e. Elevations, if applicable f. Windows &door schedules, if applicable—printed on the drawings is acceptable g. Calculation sheet for natural light, ventilation& emergency egress, if applicable—printed on the drawings is acceptable 4. Plot plan, using a survey map, if possible, which includes: a. Drawn to scale(i.e. 1 inch= 30 feet) b. Indicate the proposed changes with setbacks to the property lines c. Include all structures on the property d. Include the location of water supply(well or water lines) e. Include the location& configuration of the septic system or sewer line 5. REScheck(for residential projects) or COMcheck (for commercial projects), signed and stamped, if applicable—please visit www.energycodes.gov for more information ADDITIONAL IMPORTANT INFORMATION: 1. Any changes to the approved plans prior to or during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If, for any reason,the building'perniit 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. Addition/Alteration Application Revised June 2022 DocuSign Envelope ID:E44CB3F1-2509-497B-BC71-6551D5DEF468 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 15,000 2. Source of Heat (circle one): © Gas ❑ Oil El Propane El Solar ❑ Other: Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application 3. Are there any structures not shown on the plot plan? El YES ❑ NO Explain: n/a 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 ® NO • What is the water source? © PUBLIC ❑ PRIVATE WELL • What type of wastewater system is on the parcel? ❑ SEWER ® PRIVATE SEPTIC DECLARATION: 1. I 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. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 4. I 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 6. I 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: Nancy Malone PRINT NAME: -DocuSigned by: SIGNATURE: Woutabi1vt.Ud,01/lt, DATE: 10/16/2023 •---B110c8b8D40345A... Addition/Alteration Application Revised June 2022 DocuSign Envelope ID:E44CB3F1-2509-497B-BC71-6551D5DEF468 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): McDonald's USA, LLC Mailing Address, C/S/Z: 110 N Carpenter St. Chicago IL 60607 Cell Phone: ( )630-209-1540 Land Line: _ ( ) Email:brian.sheedy@us.mcd.com • Primary Owner(s): Name(s): same as above 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): TBD Contractor Trade: Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: ( ) Email: **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(s): Business Name: Core States Contact Name(s): Nataliya Glukhoman Mailing Address, C/S/Z: 46 East Main Street Suite 201,Somerville, NJ 08876 Cell Phone: ( ) 908-462-9700 Land Line: ( ) Email:core-states.com Contact Person for Compliance in regards to this project: Shawn Gregoire(Boher Engineering) Cell Phone: ( ) Land Line: ( )518-438-9900 Email:sregoire@bohlereng.com Addition/Alteration Application Revised June 2022 CORE STATES GROUP January 19,2024 Warren County Building Department 1340 US 9 Lake George, NY 12845 Re:McDonald's Restaurant 031-0030 Queensbury, NY(819 Rt 9) To Whom it may concern: Please accept this letter as verification that the above addressed McDonald's Restaurant,to the best of my understanding was built in accordance with the approved building plans, New York State and location codes. Please feel free to contact me with any questions. Sincerely, (11) \----- C921----Th-N. Jennifer Hauser Project Architect 224.585.3955 I jhauser@core-states.com (--- * r.1-6 Ilh * is> ,/1 W OF NE -4O Page 1 `, 312.718.5415 A www.core-states.com —© 135 Water Street Suite 201 I Naperville,IL 60540 \ YO K Department C� 20 STATE of Health KATHY HOCHUL JAMES V. McDONALD, M.D., M.P.H. JOHANNE E. MORNE, M.S. Governor Commissioner Acting Executive Deputy Commissioner October 19, 2023 7E1— Renee Reardon e P.O. Box4510 °CT252023 Queensbury, NY 12804 TOWN O Re: McDonald's Proposed Modifications SD!LDING&ECESBURY Facility Code: 56-AC85 DES Queensbury(T), Warren County Dear Ms. Reardon: On October 17, 2023, this office received a Notice of Intent to Construct, Enlarge or Convert a Facility (DOH-154), Engineered plans, and equipment specifications for proposed modifications to the McDonald's located at 819 State Route 9, Queensbury (T). In reviewing the submission, we find the proposal to be in substantial compliance with the New York State Sanitary Code (NYSSC), with the following conditions: • If the drive thru will remain open during the construction process, safety measures must be implemented to prevent potential cross contamination of food from the construction process. Proper barriers must be set up to prevent construction dust from coming into contact with food and food contact surfaces. • According to our records, the dining area is currently approved for 52 seats. Please update this office if the seating/occupancy capacity for the dining area changes. • All ice wells & ice machines must be equipped with an indirect drain to waste, preferably an air gap. • All lighting in and around food preparation, cooking, and storage areas must be either shatterproof or shielded. • As a reminder, it is recommended that minimum 4" baseboard coving be installed at all floor and wall junctures in food storage and food preparation areas to facilitate easy cleaning. The coving must be smooth, easily cleanable, and non-porous. • Finally,-you-must obtain-a-Cer-tificate-ofOccupancy-(C/O)-or-a Certificate-of-Compliance - - (C/C) from your local code enforcement official. Once obtained, please forward a copy to this office for filing. As a reminder, operating after the proposed modifications are completed is prohibited until a satisfactory completed works inspection has been completed and approval is granted by a representative of this office. Please contact me at (518) 793-3893 to schedule a pre-operational and completed works inspection. • Empire State Plaza,Corning Tower,Albany,NY 122371 health.ny.gov Sincerely, Corey DiLorenzo Principal Sanitarian Glens Falls District Office 77 Mohican St. Glens Falls, NY 12801 (518) 793-3893 cc: Ms. Rebecca Bussed, GFDO Queensbury(T) Code Enforcement File