RC-0557-2023 i
Y`
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: 12-C, , Q IE°r 2E2,3
APPLICATION 2^
Town ofQuccnsbury Permit Fee:$ 2�
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice#: (cLc3 A
Flood Zone? Y 7 N 1 Reviewed By:Y \$
Project Location: 12 c G`I
Tax Map ID#: Subdivision Name:
PROJECT INFORMATION:
ice
TYPE: Lid/Residential El Commercial, Proposed Use:
Single-Family ❑ Two-Family ❑ Multi-Family(if of units_) El Townhouse
El Business Office ❑ Retail El Industrial/Warehouse El Garage (#of cars
rcTiOther(describe K. booF ' )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: I 3rd floor:
Basement'(habitable space): Basement (habitable space):
Total sq!ft: Total sq ft:
Scope of work to be done: P- i<-av
in.? LE C
LPL// J / SEPOb2G237 /
TOWN OF ni
_BU ILDIINC.3 OCaOiS
Addition/Alteration Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ I , Z<<0
2. Source of Heat(circle one): 0 Gas 0 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? 0 YES 0 NO Explain:
4. Are there any easements on the property? ❑ YES ❑ NO
SITE INFORMATION:
• Is this a corner lot? 0 YES NO
• Will the grade be changed as a result of the construction? 0 YES NO •
• What is the water source? 0 PUBLIC 0 PRIVATE WELL
• What type of wastewater system is on the parcel? 0 SEWER 0 PRIVATE SEPTIC
DECLARATION:
I. 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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:
PRINT NAME: ,c��„� �"����� - ua,•�C Vvc-v i0tii
SIGNATURE: DATE: /3- I 2--5
Addition/Alteration Application Revised June 2022
✓,
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): fioae P21/0 Lu VT/0 1
Mailing Address, C/S/Z: ZZ Cers ;vr �c,eR_ 1.�, 5, iu y /70"
Cell Phone: ( ) Land Line: ( ;Ib ) 1' 5,5
Email: howsEvo lull o,1p V t�„mac.t l-cost/
• Primary Owner(s):
Name(s): X y a J t- 17f
Mailing Address, C/S/Z: �D Sr.N r 12o . /2 y , N y /78'0c/
Cell Phone: o-1-- ) (0�`6-50-79 Land Line: ( )
Email: /'yarnic-4-;19S4,ymg;/:4ow
❑ Check if all work will be performed by property owner only
• Cont .actor(s): (List all additional contractors on the back of this form)
Contact Namle(s): Y oµto vo c r oa•�
Contractor T ade: Z2 ( �reN i R-�_ �oNc� ,S N y /to97 „v
7
j )
Mailing Address, C/S/Z:
7
Cell Phone: ) Land Line: ( S/3 ) 6 9 - PG l0
Email: G ori.(evoiof/on�e 6uG' I- Lowe
**Workers' Comp documentation must be submitted with this application**
• Archiect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Addrss, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Compliance in regards to this project: NON e 1dv[.uTroiJ
Cell Phone: ( ) Land Line: ( `I(' ) -`Z(p 6, 3
Email: [nod--dvw t;ovtaj tA-0,,/. cc��
Addition/Alteration Application Revised lune 2022
Home Evolution Contractor LLC
22 Crescent Terrace
Cohoes, New York 12047
518..639..7663
hol-neevolution5l8@g-naii.col-n � www.horneevolution.corn
RECIPIENT:
Ryan Latif
80 Sweet Road Sent on Aug 30, 2023
Queensbury, New York 12804 Estimator Josh B. (518) 528-0166
IMMMMMMM�
I of 4 pages
Home Evolution Contractor LLC
22 Crescent Terrace
Cohoes, New York 12047
518..639..7663
hor-neevolution5l8@g-naii.cor-n � www.horneevolution.corn
2 of 4 pages
Home Evolution Contractor LLC
22 Crescent Terrace
Cohoes, New York 12047
518-639-7663
hor-neevolution5l8@g-naii.cor-n � www.horneevolution.corn
Roof Replacernent Horne Evolution submits specifications and 1 $
(Standard Systern) estirnates for the following:
1. Rernove and dispose of 2--LAYERS of roofing
rnaterial included
Charges will be added for additional layer(s) of of
roofing rnaterial:
$75 per square (I O'xl 0') shingles OR $100 per
square(I O'xl 0')
for Cedar Shake
2. Replace any rotted decking if found (20 sheets
included in price)..2 SHEETS FREE*
*Additional decking replaced: +$99 PER sheet of
plywood or+$25 PER
linear ft. of boards
3. Install new drip edge along entire perimeter of
roof white 1.5"
4. Install ice&water shield on all bottorn edges, in
valleys, side walls and roof penetrations (6 ft.)
IKO Storrn Shield
5. Install underlayrnent on rernaining roof for
rnoisture barrier (tar paper)
6. Install ice&water shield and replace darnaged
flashing around chirnney (Standard .. IKO Storrn
Shield)
7. Install new pipe boots on all pipes corning out of
roof(Standard)
8. Install prerniurn vinyl ridge vent on top peaks for
air flow, with rnatching shingle caps
9. Includes manufacturers"Urnited Lifetirne"
transferrable warranty on shingles installed. (IKO
Carnbridge) color to be dual black.
10. Horne Evolution is providing a 10..YEAR
WORKMANSHIP WARRANTY on
shingles installed *Proof of workmanship warranty
is your signed contract
keep for your records*
**FREE PRODUCT PROVISION: It is at Horne
Evolutions discretion to provide each custorner
with 2 FREE sheets of plywood.
In the event that the free products are not used,
they shall rernain the
property of Horne Evolution, and no refund or credit 3 of 4 pages
will be given to the
custorner.
Home Evolution Contractor LLC
22 Crescent Terrace
Cohoes, New York 12047
518..639..7663
hor-neevolution5l8@g-naii.cor-n www.horneevolution.corn
Total
Aug 30, 2023
........................................................................................................... .........................
IDate Chent Sgnature
*Non..taxable
Ths esfiniate us valfid$or oie next 30 days,after whch values may be subject to change.
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