2024-0371 r
Office.Use Only
stiq )f ADDITION/ALTERATION Permit#: 2024N -
Town ofQee b ry PPL1C�► J,Q�V,.,. w Permit Fee: $ NAIYCt,
742 Bay Road,Queensbury,NY 12804 C II V E �1
P:518-761-8256 www.queensbury.net Invoice#:_ I'ti1`'Pc
JUL 2 4 2024 Flood Zone? Y TYPE: : N
_ TOWN OF QUEENSBURY Reviewed By:
Project Location: �� t &CODES
Tax Map ID #: fig',a- 2— '/3. / Subdivision Name:
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
❑ 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:
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: Log--
u✓ 60 .4.e4 E #ISr
4-1-AA T Sa-u-rd l( 4cF %,t-J Afinuipfat r, a
Addition/Alteration Application Revised May 2024
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 1
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?,NO ❑ YES Explain:
4. Are there any easements on the property? DNO ❑ YES
SITE INFORMATION:
• Is this a corner lot? 0 ❑ YES
• Will the grade be changed as a result of the con truction? O ElYES
• What is the water source? ElPUBLIC PRIVATE WELL ❑ OTHER:
• What type of wastewater system is on the parcel? El 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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: &/41Srd o 07z1,tJ
SIGNATURE: , �=(� (/ DATE: 7 Zy
Addition/Alteration Application Revised May 2024
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): (4✓Lt5 z3/4E/ 6T1204()
Mailing Address, C/S/Z: io ) &e
Cell Phone: '-7"/9-95-y( Land Line: A1/"
Email: Ceh/LJS.�r�hr4O3�� l�#f}fvo,a'v.4
• Primary Owner(s):
Name(s): 5 .
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:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Architect(s)/Engineer(s):
Business Name: -7-6,
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email:
Addition/Alteration Application Revised May 2024
Job:13091548 f4ark: 111 Quantity: 25 Type: 4.3 Span: 280000 P1-R1: 6 Left OR: 1- 4- 0 P Right OR: 1- 4- 0 P Page 1'
Corinna iro.. S'
ALL MAIDS CQITXRID CSI BTU 2LIM=10071 Brace tense an Papaws: PAITlON RUCTIONS: Trvelea ll.m:£aeLastxl by:
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JT PLAIT SIZO. zt I DBN 0.96 2.4 1650P1.5 BC 24.0w 0- 0- 0 29- 0- 0 LOS Il7-BX 11F-BX Total a tW. Dead oads y To Analysis SARAT eo r To:
A 4.00n12.00 2.00 0.21 ISO 0.26 2s I 6Q2's-12. nC Cant, 0-0-0 28-0- 0 A 1726 6-ba a 31377 5 SC V 67 20 0.0 14.0 1lC/IsC2006
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S3 4.00o 6:001I CRGI 0.25 4C Tbe.1,16 11�L.10 Ptw1.14 951 IbQt� !C V 0 20 16.3 28.0 for 20.0 pa! LL um the B.C.
Bp . IB
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p DPLT SRO OPL2IT + 6 Bind toad Cawood in exam dare n rectangle
Z . 1.39 LDS F 2 Ih.bsl. Load Came Cal 3- 6-0 tall by
•
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+ 1 Deed food Caw will Lit between the B.C.
XL Dell -0.79-in 9 -D L/411 end any other limber.
Dell -0.55" in IS L/597 Design thanked for 20 peg nen-
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sph
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pat
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• 4t4rr /%�' \ \\ 10x� •............. 4a4. lbw coup. foram 2 40 lba
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4x191i i %` `.
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i ing'18r e.ndankmei s Rree.nes Co.kie. eopuser tbrae* emeelfaen.11. Pis* ]Cola BL'LS/Snow le diaq Deaitpnerl
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flijoidi Flooring and Restorotton, LL to plirrrhasor,
Purchaser Initials __ _ _ D4te 731— 4. 'V
Nil Name _
Rapid Roolitig PrInt
cos:ogler Ptint nanle
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SigiVtd,r‘ _ "or e
Obstemer Rapid RpoIIPS Milnagerherot
W-= iDate,
iiitiotheie foie preferred Pieptertion,tipgrdee__
.11111•111011MA .411/Wl.
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AFT PAPER INSULATION
MUST BE COVERED BY
ON-COMBUSTIBLE BARRIER
: .3
NOTICE
Date° _ - FOAM INSULATION MUST BE
COVERED 6 Y A 1 P�$INUTE
TOWN OF O.UEENSBURI'
BUILDING DEPARTMENT TI�ERIAI BRIER
Based.on our limited examination,compliance
with our comments shall riot be construed as
indicating the plans and specifications are in I
full compliance with the L�uiiding Codes of *•I
New York State, n
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