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RC-0672-2023 DocuSign Envelope ID:B3D46950-D1CD-4FDA-A4B8-BE14A112CC3B Office Use Only ADDITION LTERATIO N ERMIT Permit#: —• ZO2 APPLICATION To` Q ryl Permit Fee:$ ' 2S 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice#: Flood Zone? Y `J eviewed Project Location: 13 Ohio Ave, Queensbury, NY 12804 Tax Map ID#: Subdivisi• `e:t l r \/1 L� 1 PROJECT INFORMATION: NOV O 1 2023 TOWN OF QUEENSBURY TYPE: ! Residential ❑ Commercial, Proposed Use: BUILDING&CODES ® 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: 514 2nd floor: 2nd floor: 378 3rd floor: 3rd floor: Basement(habitable space): Basement (habitable space): Total sq ft: Total sq ft: 892 Scope of work to be done: Living Room - install vinyl flooring, Kitchen - Replace oven/cook top, vent hood, , dishwasher, kitchen sink, faucet, cabinets and countertops, install vinyl flooring, Bathroom - Replace toilet, vanity, sink and tub, Bedrooms - Install carpet and repair drywall, Basement - Replace water heater and repair breaker, Exterior - Paint, landscaping, roofing repairs, repair wood rot on exterior trim, restore water meter and install gas meter, Back Porch - Install insulation, close up walls and install windows, Interior Throughout - Remove paneling and paint, correct non working outlets Addition/Alteration Application Revised June 2022 DocuSign Envelope ID:B3D46950-D1CD.4FDA-A4B8-BE14A112CC3B ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 17,323 2. Source of Heat (circle one): © Gas El Oil El Propane ❑ Solar El Other: Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application 3. Are there any structures not shown on the plot plan? ❑ YES © NO Explain: 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: PRINT NAME: Ricardo Lopez SIGNATURE: - Ldo.,Apt DATE: 10/12/23 Addition/Alteration Application Revised June 2022 ' e DocuSign Envelope ID:B3D46950-D1CD-4FDA-A4B8-BE14A112CC3B CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Ricardo Lopez Mailing Address, C/S/Z: 2588 Atlantic Ave, Brooklyn, NY 11207 Cell Phone: ( )646761-1884 Land Line: ( ) Email:Ricardo@crownfieldservices.net • Primary Owner(s): Name(s): Crown Field Services Mailing Address, C/S/Z: 2588 Atlantic Ave, Brooklyn, NY 11207 Cell Phone: ( )646761-1884 Land Line: ( Email:ricardo@crownfieldservices.net • 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): Crown Fied Services, LLC Contractor Trade: Mailing Address, C/S/Z: 2588 Atlantic Ave, Brooklyn NY 11207 Cell Phone: ( )646761-1884 Land Line: ( ) Email: ricardo@crownfieldservices.net **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(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: Ricardo Lopez Cell Phone: ( )646-761-1884 Land Line: ( ) Email: Addition/Alteration Application Revised June 2022 gc--© 20?{3 Scope of work to be done: Living Room - install vinyl flooring, Kitchen - Replace oven/cook top, vent hood, , dishwasher, kitchen sink, faucet, cabinets and countertops, install vinyl flooring, Bathroom - Replace toilet, vanity, sink and tub, Bedrooms - Install Carpet and repair drywall, Basement - Replace water heater and repair breaker, Exterior - Paint, landscaping, roofing repairs, repair wood rot on exterior trim, restore water meter and install gas meter, Back Porch - Install insulation, close up walls and install windows, Interior Throughout - Remove paneling and paint, correct non working outlets First Floor 14' ? 14'6' 13'2' Living Room 10'5 Kitchen 13'T Covered Porch 25'x13' 0 • Foyer 6' 6€ c oom 6' loom 8'10" 8'9" 6' Bathroom 10'9" 6' 10'10" FILE COPY • NOTICE TOWN OF O4Ir_r_i,n3I.JRY FOAM INSULATION MUST BE B d on our lirni! -' COVERED BY A 15 MINUTF with our co: - es THERMAL BARRIER full i.o ,=_ir, ''.;iiaauiri; Co.' of LFnw York T' P"vr'�Ffl "�' �?f_,� �-. �, r fit.,� 0 t'IOl�E 'FC:s71l. \O \_EP� ` . Y t�:U LE'sw'.;£ _. - ;""r''T. NCO �t'd0 c,�� �o valev�� _ Date: 1i_ II rkn o ‘06T-R CIDO-Ne6 6 KizA 4 c o S;) A (4��toe